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Journal of Cardiac Failure最新文献

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Lipoprotein(a) Levels and Adverse Outcomes in Heart Failure. 心力衰竭患者脂蛋白(a)水平和不良结局。
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-04 DOI: 10.1016/j.cardfail.2025.03.016
Adithya K Yadalam, Apoorva Gangavelli, Alexander C Razavi, Yi-An Ko, Ayman Alkhoder, Nisreen Haroun, Rafia Lodhi, Ahmed Eldaidamouni, Mahmoud Al Kasem, Arshed A Quyyumi

Background: Although lipoprotein(a) [Lp(a)] level elevation is associated with new-onset heart failure (HF), it is unclear if elevated Lp(a) levels predict cardiovascular events in patients with chronic HF. Thus, we examined the association between Lp(a) levels and adverse cardiovascular outcomes in patients with HF.

Methods & results: A total of 1,088 patients with HF undergoing cardiac catheterization at Emory-affiliated hospitals from 2004 to 2022 were divided into low (<30 mg/dL), intermediate (30-49 mg/dL), and high (≥50 mg/dL) Lp(a) groups. The primary outcome was the composite of cardiovascular death and HF hospitalization. Outcomes were assessed by Lp(a) group with competing-risk modeling accounting for non-cardiovascular death after adjustment for demographics, traditional cardiovascular risk factors, ejection fraction (EF), ischemic HF etiology, and NT-proBNP. Sensitivity analyses were performed to explore for heterogeneity of effect. The median age was 67, 34% were women, 18% were Black, 74% with ischemic HF, and 60% with EF ≤40%. During a median follow-up time of 4.3 years, 474 (44%) composite events occurred. When compared to participants with Lp(a) <30 mg/dL after multivariable adjustment, those with Lp(a) 30-49 mg/dL (sHR 1.35, 95% CI 1.04-1.76, P=0.025) and Lp(a) ≥50 mg/dL (sHR 1.38, 95% CI 1.11-1.72, P=0.004) had a significantly higher risk of cardiovascular death or HF hospitalization. This relationship appeared to diminish over time and was nominally stronger in those with ischemic versus nonischemic HF (P-interaction=0.06) but did not meet significance after adjustment for multiple hypothesis testing.

Conclusion: In patients with HF, Lp(a) ≥30 mg/dL independently predicts the risk of cardiovascular death or HF hospitalization.

背景:虽然脂蛋白(a) [Lp(a)]水平升高与新发心力衰竭(HF)相关,但目前尚不清楚Lp(a)水平升高是否能预测慢性心力衰竭患者的心血管事件。因此,我们研究了心衰患者Lp(a)水平与不良心血管结局之间的关系。方法与结果:将2004 - 2022年在emory附属医院行心导管术的1088例HF患者分为低组(结论:在HF患者中,Lp(A)≥30 mg/dL独立预测心血管死亡或HF住院的风险。
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引用次数: 0
Clinician Insights into Effective Components, Delivery Characteristics and Implementation Strategies of Ambulatory Palliative Care for People with Heart Failure: A Qualitative Analysis 临床医生对心力衰竭患者非住院姑息治疗的有效成分、服务特点和实施策略的见解:定性分析。
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-01 DOI: 10.1016/j.cardfail.2024.07.009
SHELLI FEDER PhD, APRN, FNP-C, ACHPN, FPCN, FAHA , LYNNE IANNONE MA , DORA LENDVAI PhD, RN , YAN ZHAN MBA, RN , KATHLEEN AKGÜN MD, MS , MARY ERSEK PhD, RN, FPCN , CAROL LUHRS MD , LARRY A. ALLEN MD, MHS , DAVID B. BEKELMAN MD, MPH , NATHAN GOLDSTEIN MD , DIO KAVALIERATOS PhD, FAAHPM

Objectives

To elicit perspectives from specialist palliative care (SPC) and cardiology clinicians concerning the necessary components, delivery characteristics and implementation strategies of successful ambulatory SPC for people with heart failure (HF).

Background

Palliative care is a recommended component of guideline-directed care for people with HF. However, optimal strategies to implement SPC within ambulatory settings are unknown.

Methods

We conducted a qualitative descriptive study composed of semistructured interviews with SPC and cardiology clinicians at Veterans Affairs Medical Centers (VAMCs) with the highest number of ambulatory SPC consultations within the VA system among people with HF between 2021 and 2022. Clinicians were asked how they provided ambulatory SPC and what they felt were the necessary components, delivery characteristics and implementation strategies of care delivery. Interviews were analyzed using directed content analysis.

Results

We interviewed 14 SPC clinicians and 9 cardiology clinicians at 7 national VAMCs; 43% were physicians, and 48% were advanced-practice registered nurses/physician associates. Essential components of ambulatory SPC encompassed discussion of goals of care (eg, prognosis, advance directives) and connecting patients/caregivers to resources (eg, home care). Preferred delivery characteristics included integrated (ie, embedded) approaches to SPC delivery, standardized patient selection and referral procedures, and formalized procedures for handoffs to and from SPC. Strategies that addressed SPC implementation included deploying palliative champions, educating non-SPC clinicians on the value of ambulatory SPC for people with HF and developing ambulatory models through leadership support.

Conclusions/Implications

Facilitating the broader adoption of ambulatory SPC among people with HF may be achieved by prioritizing these mutually valued and necessary features of SPC delivery.
目的从专科姑息关怀(SPC)和心脏病学临床医生的角度,了解为心力衰竭(HF)患者提供成功的非住院姑息关怀的必要组成部分、实施特点和实施策略:背景:姑息治疗是心力衰竭患者指导性治疗的推荐组成部分。背景:姑息治疗是指南推荐的心力衰竭患者指导性治疗的组成部分,但在非住院环境中实施姑息治疗的最佳策略尚不清楚:我们对退伍军人事务医疗中心(VAMC)的姑息治疗和心脏病学临床医生进行了半结构化访谈,这些中心是退伍军人事务医疗中心(VAMC),从 2021 年到 2022 年,退伍军人事务医疗中心系统内为高血压患者提供的非住院姑息治疗咨询数量最多。临床医生被问及他们是如何提供门诊 SPC 的,以及他们认为提供护理服务的必要组成部分、服务特点和实施策略是什么。访谈采用定向内容分析法进行分析:我们采访了全国七家退伍军人医疗中心的 14 名 SPC 临床医生和 9 名心脏病临床医生;其中 43% 是医生,48% 是高级执业注册护士/医生助理。门诊 SPC 的基本内容包括讨论护理目标(如预后、预嘱)以及将患者/护理人员与资源(如家庭护理)联系起来。首选的服务特征包括提供 SPC 的综合(即嵌入式)方法、标准化的患者选择和转诊程序,以及 SPC 的正式交接程序。实施SPC的策略包括部署姑息治疗倡导者、向非SPC临床医生宣传门诊SPC对HF患者的价值,以及通过领导支持发展门诊模式:通过优先考虑SPC服务中这些相互重视且必要的特征,可促进在心房颤动患者中更广泛地采用门诊SPC。
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引用次数: 0
Assessment of Revascularization Preferences With Best-Worst Scaling Among Patients With Ischemic Heart Disease 用最佳-最差比例评估缺血性心脏病患者的血管重建偏好。
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-01 DOI: 10.1016/j.cardfail.2024.10.006
AMRITA MUKHOPADHYAY MD , VICTORIA VAUGHAN DICKSON PhD, RN, FAAN , AISHA LANGFORD PhD, MPH , JOHN A. SPERTUS MD, MPH , SRIPAL BANGALORE MD, MHA , YAN ZHANG MPH , THADDEUS TARPEY PhD , JUDITH HOCHMAN MD, MA , STUART D. KATZ MD, MS
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引用次数: 0
Weighing the Benefits of Wearable Devices in Heart Failure Trials
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-01 DOI: 10.1016/j.cardfail.2025.03.001
JESSICA R. GOLBUS MD, MS , TREJEEVE MARTYN MD, MSc
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引用次数: 0
The Impact of Kinlessness on Older Adults with Advanced Heart Failure 无助感对晚期心力衰竭老年人的影响
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-01 DOI: 10.1016/j.cardfail.2024.06.012
SARAH GODFREY MD, MPH , JENNIFER NIXON MSW , MARK H. DRAZNER MD, MSc , MARYJANE FARR MD, MSc
Markers of social health, including kinlessness, social isolation and loneliness, have important implications for quality of life and health for older adults. As the population ages, there is a growing cohort of kinless older adults without living partners or children, particularly among disadvantaged groups. Kinlessness has been associated with worse mental and physical health, significant unmet care needs, increased risk of dementia, higher rates of long-term placement, and higher mortality rates than those for patients with kin. Although other markers of social health have been studied in patients with heart failure, little is known about kinlessness in this population of patients. This review outlines the data on kinlessness and its impact on patients’ outcomes, and it proposes novel interventions to mitigate its effects.
社会健康的标志,包括无亲属关系、社会隔离和孤独,对老年人的生活质量和健康有着重要影响。随着人口老龄化,没有生活伴侣或子女的无亲属老年人群体不断扩大,尤其是在弱势群体中。与有亲属的病人相比,无亲属与身心健康状况恶化、大量护理需求得不到满足、痴呆症风险增加、长期安置率升高以及死亡率升高有关。虽然已对心衰患者的其他社会健康指标进行了研究,但对这一患者群体中的无亲属关系却知之甚少。本综述概述了有关无亲属关系的数据及其对患者预后的影响,并提出了减轻其影响的新型干预措施。
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引用次数: 0
Increasing Evidence Supports the Benefits of Rapid Uptitration of the Neurohormonal Blockade in HFmrEF/HFpEF Patients With AHF
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-01 DOI: 10.1016/j.cardfail.2024.12.015
GAD COTTER MD , BETH DAVISON PhD , JAN BIEGUS MD, PhD , MATTEO PAGNESI MD, PhD , MARCO METRA MD , JAVED BUTLER MD , OVIDIU CHIONCEL MD, PhD , PIOTR PONIKOWSKI MD, PhD , ALEXANDRE MEBAZAA MD, PhD
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引用次数: 0
Weighing the Future: A Novel Tool to Manage Patients With Heart Failure
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-01 DOI: 10.1016/j.cardfail.2025.02.009
ANJAN TIBREWALA MD, MS, JANE E. WILCOX MD, MSCI
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引用次数: 0
Lessons Learned From 2 Research Studies Enrolling Underrepresented Patients With Ventricular Assist Devices and Their Family Caregivers
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-01 DOI: 10.1016/j.cardfail.2025.01.026
AVERY C. BECHTHOLD PhD, BSN, RN , MARTHA ABSHIRESAYLOR PhD, RN , RACHEL D. WELLS PhD, RN
Given the continued challenges of and barriers to recruiting and retaining underrepresented groups in cardiovascular studies, this study aimed to describe successful recruitment strategies used by 2 related ventricular assist device (VAD) studies. The 2 exemplar studies focused on understanding how adults with a VAD and their family caregivers discuss, reflect upon and act on their personal values. To recruit a more representative and diverse sample reflective of the substantial Black population receiving care at the local academic hospital outpatient clinic, we developed multipronged recruitment strategies for a convergent mixed-methods study (Study 1) and a sequential explanatory mixed-methods study (Study 2). Two underlying principles guided recruitment strategies: (1) clinician-scientist collaboration, and (2) personalized participant interactions. This article reflects on lessons learned by an early career investigator and her mentors from 2 studies, which will support ongoing inclusive recruitment in future projects.
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引用次数: 0
In Search of Truth: Why You Think You're Right Even When You're Wrong 追寻真理:为什么你认为自己是对的,即使你错了
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-01 DOI: 10.1016/j.cardfail.2025.03.003
Shashank S. Sinha MD , Robert J. Mentz MD , Anuradha Lala MD
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引用次数: 0
Extending the Reach: Ambulatory Specialty Palliative Care for People With Heart Failure
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-01 DOI: 10.1016/j.cardfail.2025.02.010
ARDEN O'DONNELL PhD, MPH, LICSW, APHSW-C , LAURA P. GELFMAN MD, MPH,
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引用次数: 0
期刊
Journal of Cardiac Failure
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