International Journal of Heart Failure最新文献

Patients with diabetes mellitus (DM) have a higher prevalence of heart failure (HF) than those without it. Approximately 40% of HF patients have DM, having poorer outcomes than those without DM. Myocardial ischemia caused by endothelial dysfunction, renal dysfunction, obesity, and impaired myocardial energetics is pathophysiology of DM-induced HF (DM-HF). Also, patients with HF show an increased risk for the onset of DM due to several mechanisms including insulin resistance. This review is focused on the epidemiology, pathogenic mechanism and treatment strategy of DM-HF.

Background and objectives: Differences in drug prescriptions exist between clinical trials and real-world practice. We evaluated the real-world treatment patterns of sacubitril/valsartan in Korean patients with heart failure (HF).

Methods: In this retrospective, multicenter cohort study, 600 patients with HF with reduced left-ventricular ejection fraction (LVEF <40%) with ≥1 sacubitril/valsartan prescription were identified by reviewing patient-level medical records at six academic tertiary hospitals in Korea between February 2017 and April 2019.

Results: At baseline, 59.2%, 28.3%, 4.8%, and 7.7% of the patients received low (50 mg bid), moderate (100 mg bid), target (200 mg bid), and unconventional dose of sacubitril/valsartan, respectively. Patients with low and moderate doses experienced either 'no-titration' (39.8%) or 'stable up-titration' (41.5%). At 12 months, 31.7%, 28.5%, 24.8%, and 15% received low, moderate, target doses, and unconventional dose, respectively. On follow-up, 31 (5.2%) patients discontinued sacubitril/valsartan. The time-averaged N-terminal pro-B-type natriuretic peptide (NT-proBNP) level decreased from 879.6 to 406 pg/mL (ratio, 0.5; 95% confidence interval, 0.4-0.5). The mean LVEF increased by 10.4±12.2% from 27.2±5.8 to 36.3±11.1%, whereas LV end-diastolic volume index decreased by 18.7±26.1 mL/m² from 114.5±37.7 mL/m² to 98.9±42.3 mL/m² at baseline and follow-up, respectively.

Conclusions: In real-world practice, 95% patients started with low and moderate doses of sacubitril/valsartan. Many patients experienced dose up-titration during follow-up; 30% reached the target dose. Cardiac reverse remodelling was reflected by a profound NT-proBNP level and LV size reduction, and LVEF increment. This study confirms the gap in treatment patterns between clinical trials and real-world practice.

Background and objectives: Heart failure (HF) and atrial fibrillation (AF) are considered new cardiovascular epidemics of the last decade. Recent national trends show an uptrend in HF hospitalizations. We aimed to identify the 30-day readmission rate, causes, and impact on healthcare utilization in HF exacerbation with a history of AF.

Methods: We utilized 2018 Nationwide readmission data and included patients aged ≥18 years with International Classification of Diseases, Tenth Revision, Clinical Modification code indicating HF exacerbation and AF were included in the study. Primary outcome is 30-day readmission rates. Secondary outcomes were mortality rates, common causes of readmission, and healthcare utilization. Independent predictors for readmission were identified using cox regression analysis.

Results: The total number of admissions in our study was 48,250. The mean age was 77.8 years (standard deviation, 12.1), and 47.74% were females. The 30-day readmission rate was 16.72%. The mortality rate at index admission and readmission was 7.28% and 8.12%, respectively. The most common cause of readmission was the hypertensive heart and kidney disease with HF. The independent predictors of readmission were low socio-economic class, Medicaid, Charlson comorbidities score. The financial burden on healthcare for all the readmission was $461 million for the year 2018.

Conclusions: The 30-day readmission rate was 16.72%. The mortality rate increased from 7.28% to 8.12% with readmission. The financial burden for readmission during that year was $461 million. Future studies directed with interventions to prevents readmissions are warranted.

Background and objectives: Inhibitors of sodium-glucose cotransporter 2 (SGLT2i) reduce the risk of hospitalization for heart failure (HF). We aimed to examine the effect of empagliflozin on change of diuretics dose in outpatient HF patients.

Methods: We retrospectively reviewed the medical records of 612 patients who were treated using both empagliflozin and diuretics. We excluded patients who did not meet the criteria for HF. Dose and duration of empagliflozin and diuretics were measured.

Results: Of 612 patients, a total of 251 was analyzed and followed for a mean 430.0±175.4 days. The mean age was 69.3, 51.8% were female, and 93.2% had type 2 diabetes. The distribution of initial diuretics type when starting empagliflozin showed that furosemide comprised 24.7%, spironolactone 20.7%, thiazide 36.9%, and others. Total 23.1% of patients reduced diuretic dose, 13.1% increased diuretic dose, 41.4% continued at the same diuretic dose, and 22.3% switched to different diuretics. Among patients who were using furosemide, 36.0% reduced diuretics dose. There was a diuretic reduction in 22.6% of HF preserved ejection fraction (HFpEF, left ventricular ejection fraction [LVEF] ≥50%) and in 26.5% of HF reduced EF (HFrEF, LVEF <50%). The average doses furosemide at the start of empagliflozin decreased from 16.3mg/day to 8.5mg/day at the time of follow-up.

Conclusions: Among outpatient clinic HF patients treated with both diuretics and empagliflozin, 23.1% of patients had their diuretics reduced, and the mean dose of furosemide was reduced by about half. This suggests that empagliflozin has clinical advantages in managing outpatient HF patients.