Journal of Cardiac Failure最新文献

英文中文

Lower Rates Of Hyperkalemia-related Hospitalization With Long-term Outpatient Sodium Zirconium Cyclosilicate Therapy In Patients With Kidney Disease Or Heart Failure

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure

Pub Date : 2025-01-01 DOI: 10.1016/j.cardfail.2024.10.032

Abiy Agiro , Connie Rhee , Erin Cook , Alexandra Greatsinger , Fan Mu , Jess Smith , Emily Reichert , Ellen Colman , Arun Malhotra

Introduction

While prior studies indicate that patients with long-term sodium zirconium cyclosilicate (SZC) treatment experience lower rates of hyperkalemia (HK)-related hospitalizations compared to patients with short-term SZC treatment, this has not been evaluated among patients with cardiorenal conditions, including chronic kidney disease (CKD), end-stage kidney disease (ESKD) or heart failure. The GALVANIZE Outcomes study compared healthcare resource use (HRU) between long-term and short-term SZC-users exactly- and propensity score-matched on key characteristics using real-world data among patients with cardiorenal conditions.

Methods

Adults with a diagnosis code for any stage CKD, ESKD, or heart failure initiating SZC in the outpatient setting from 7/2018-12/2022 were identified from a large US insurance claims database and were stratified based on duration of SZC use. Long-term SZC users (>90 days) and short-term SZC users (≤30 days) were exactly and propensity score matched on key demographic characteristics, comorbidities, treatments, and baseline HRU. Rates per person-year of HK-related hospitalizations or emergency department (ED) visits and of HK-related hospitalizations were compared during follow-up from SZC initiation (index) to the earliest of 6 months post-index, end of data availability, other potassium binder use, or re-initiation of SZC following discontinuation.

Results

Of the 2,892 included matched pairs with cardiorenal conditions, 59% were male and the mean age was 64 years. Most patients had CKD (64%) and about one-third had ESKD (35%) and heart failure (33%). Diabetes was present in almost three-quarters of patients (71%) and hypertension was common (89%). Patients with long-term SZC use had a 40% lower rate of HK-related hospitalizations or ED visits than patients with short-term SZC use during follow-up (p<0.001). Long-term SZC users also had a 37% lower rate of HK-related hospitalizations than short-term SZC users (p<0.001).

Conclusions

Among patients with cardiorenal conditions, long-term SZC use was associated with significantly lower rates of HK-related hospitalizations or ED visits than matched patients with short-term SZC use.

Funding

AstraZeneca

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引用次数: 0

Response to Letter to the Editor: Regarding: the Power in Our Patients’ Hands: Exploring LVAD and Suicide 回复致编辑的信：关于"病人手中的权力：探讨 LVAD 与自杀"。

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure

Pub Date : 2025-01-01 DOI: 10.1016/j.cardfail.2024.10.436

QUENTIN R. YOUMANS MD, MSc , CHRISTINE YU MOUTIER MD , KATHY NEELY MD , ALYSSA M. VELA PhD , EREN YOUMANS WATKINS PhD , ANJAN TIBREWALA MD, MS

引用次数: 0

Higher ECMO Flow Index And Hyperoxia Are Associated With Increased Mortality In Adults With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation: An ELSO Registry Analysis

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure

Pub Date : 2025-01-01 DOI: 10.1016/j.cardfail.2024.10.012

Alvaro A Delgado , Laura Aguilar Franco , Kevin Kennedy , Arthur Reshad Garan , Edward Wilson Grandin

Introduction

Among adults with cardiogenic shock (CS) undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO), recent observational studies suggest increased mortality for patients with early exposure to higher ECMO flows and hyperoxia. The interaction between ECMO flows and arterial hyperoxia with outcomes in this population is unknown.

Hypothesis

Compared to patients with early exposure to full ECMO flow and hyperoxia, those receiving partial flow and normoxia will have lower in-hospital mortality.

Methods

We queried the ELSO Registry from 2018-2023 for adults with CS receiving VA-ECMO, excluding patients with ECPR or a concomitant mechanical left ventricular unloading device. Patients were stratified at 24 hours of support into four groups based on ECMO flow index (circuit flow/body surface area), with partial flow defined as <2.0 L/min/m², and the partial pressure of arterial oxygen (PaO₂), with normoxia defined as PaO₂ ≤150 mmHg. We compared the primary outcome of 90-day in-hospital mortality using Kaplan-Meier time-to-event analysis and multivariable Cox proportional hazards modeling.

Results

Among 5274 adults with CS undergoing VA-ECMO, at 24 hours of support there were 2974 (56.4%) patients receiving partial flow and 2805 (53.2%) patients exposed to normoxia. The median duration of VA-ECMO support was 117 hours. Patients exposed to partial flow and normoxia were more often male, had a higher BSA, were less likely to have post-cardiotomy shock and central cannulation, were more likely to receive a smaller arterial cannula (≤15 Fr), had a lower incidence of pre-ECMO renal failure, and a higher rate of pre-ECMO cardiac arrest. (Figure, Panel A). Compared to patients exposed to partial flow and normoxia, those receiving full flow and hyperoxia had significantly higher 90-day in-hospital mortality, 56% versus 39%, log-rank p<0.001 (Figure, Panel B). This relationship persisted in multivariable Cox modeling, where compared to the referent group of patients with partial flow and normoxia: full flow & normoxia, adjusted hazard ratio (adj-HR) 1.15 (95% CI: 1.03-1.29), p=0.016; partial flow & hyperoxia, adj-HR 1.38 (95% CI: 1.24-1.54), p<0.001; full flow & hyperoxia, adj-HR 1.49 (95% CI: 1.33-1.67), p<0.001.

Conclusions

In adults with CS supported with VA-ECMO, patients with early exposure to partial ECMO flow (<2.0 L/min/m²) and normoxia (PaO₂ ≤150 mmHg) had significantly lower 90-day in-hospital mortality compared to those receiving full flow and hyperoxia.

{"title":"Higher ECMO Flow Index And Hyperoxia Are Associated With Increased Mortality In Adults With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation: An ELSO Registry Analysis","authors":"Alvaro A Delgado , Laura Aguilar Franco , Kevin Kennedy , Arthur Reshad Garan , Edward Wilson Grandin","doi":"10.1016/j.cardfail.2024.10.012","DOIUrl":"10.1016/j.cardfail.2024.10.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Among adults with cardiogenic shock (CS) undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO), recent observational studies suggest increased mortality for patients with early exposure to higher ECMO flows and hyperoxia. The interaction between ECMO flows and arterial hyperoxia with outcomes in this population is unknown.</div></div><div><h3>Hypothesis</h3><div>Compared to patients with early exposure to full ECMO flow and hyperoxia, those receiving partial flow and normoxia will have lower in-hospital mortality.</div></div><div><h3>Methods</h3><div>We queried the ELSO Registry from 2018-2023 for adults with CS receiving VA-ECMO, excluding patients with ECPR or a concomitant mechanical left ventricular unloading device. Patients were stratified at 24 hours of support into four groups based on ECMO flow index (circuit flow/body surface area), with partial flow defined as <2.0 L/min/m<sup>2</sup>, and the partial pressure of arterial oxygen (PaO<sub>2</sub>), with normoxia defined as PaO<sub>2</sub> ≤150 mmHg. We compared the primary outcome of 90-day in-hospital mortality using Kaplan-Meier time-to-event analysis and multivariable Cox proportional hazards modeling.</div></div><div><h3>Results</h3><div>Among 5274 adults with CS undergoing VA-ECMO, at 24 hours of support there were 2974 (56.4%) patients receiving partial flow and 2805 (53.2%) patients exposed to normoxia. The median duration of VA-ECMO support was 117 hours. Patients exposed to partial flow and normoxia were more often male, had a higher BSA, were less likely to have post-cardiotomy shock and central cannulation, were more likely to receive a smaller arterial cannula (≤15 Fr), had a lower incidence of pre-ECMO renal failure, and a higher rate of pre-ECMO cardiac arrest. (Figure, Panel A). Compared to patients exposed to partial flow and normoxia, those receiving full flow and hyperoxia had significantly higher 90-day in-hospital mortality, 56% versus 39%, log-rank p<0.001 (Figure, Panel B). This relationship persisted in multivariable Cox modeling, where compared to the referent group of patients with partial flow and normoxia: full flow & normoxia, adjusted hazard ratio (adj-HR) 1.15 (95% CI: 1.03-1.29), p=0.016; partial flow & hyperoxia, adj-HR 1.38 (95% CI: 1.24-1.54), p<0.001; full flow & hyperoxia, adj-HR 1.49 (95% CI: 1.33-1.67), p<0.001.</div></div><div><h3>Conclusions</h3><div>In adults with CS supported with VA-ECMO, patients with early exposure to partial ECMO flow (<2.0 L/min/m<sup>2</sup>) and normoxia (PaO<sub>2</sub> ≤150 mmHg) had significantly lower 90-day in-hospital mortality compared to those receiving full flow and hyperoxia.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 181-182"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Experience With Long-term Inotrope Therapy In Advanced Cardiac Amyloidosis Management

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure

Pub Date : 2025-01-01 DOI: 10.1016/j.cardfail.2024.10.020

Ashwin Pillai , Kerry Singh , Seth Fakess , Ina Lico , Abhishek Jaiswal

Background

Patients with symptomatic cardiac amyloidosis (CA) have limited therapeutic options with many being ineligible for left ventricular assist devices or heart transplants. Tafamidis has limited efficacy in reversing advanced refractory CA. While long term continuous intravenous inotrope infusion therapy (LTInoT) might improve quality of life in individuals with advanced heart failure, its utility in symptomatic, refractory heart failure due to cardiac amyloidosis remains unknown. We describe our experience with LTInoT in patients with cardiac amyloidosis and refractory heart failure.

Methods

We conducted a retrospective review of consecutively enrolled patients with cardiac amyloidosis on LTInoT from 2019-2023, cumulatively for 9031 person-days of follow-up (∼301 person-months).

Results

17 patients (12 male) were included. Participants were predominantly White (n=11) with a mean age of 79±8 years. 10 participants had HFrEF and 13 had ATTR. Chronic kidney disease, hyperlipidemia, and atrial fibrillation were comorbid in 13(76%), 12(71%), and 12(71%) patients, respectively. The mean left ventricular EF was 32±14%. LTInoT comprised milrinone (n=10) and dobutamine (n=7). Concurrent medications included a mineralocorticoid receptor antagonist (n=11, 65%), Tafamidis (n=9, 53%), and sodium-glucose co-transporter inhibitor (n=7, 41%). Cardiovascular hospitalizations (Median [quartile 1-3]) decreased while receiving LTInoT relative to a year prior (2[1-3] vs 3[2-4], p=0.03). All-cause hospitalizations were similar (3[2-4]). 6 (35%) patients died within a year of LInoT (Table). The median duration after which mortality occurred was 6 months (Q1-Q3: 3-16 months).

Conclusion

LTInoT has potential to reduce cardiovascular hospitalizations in advanced heart failure due to cardiac amyloidosis. Further investigation is needed to identify suitable candidates for LInoT.

{"title":"Experience With Long-term Inotrope Therapy In Advanced Cardiac Amyloidosis Management","authors":"Ashwin Pillai , Kerry Singh , Seth Fakess , Ina Lico , Abhishek Jaiswal","doi":"10.1016/j.cardfail.2024.10.020","DOIUrl":"10.1016/j.cardfail.2024.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Patients with symptomatic cardiac amyloidosis (CA) have limited therapeutic options with many being ineligible for left ventricular assist devices or heart transplants. Tafamidis has limited efficacy in reversing advanced refractory CA. While long term continuous intravenous inotrope infusion therapy (LTInoT) might improve quality of life in individuals with advanced heart failure, its utility in symptomatic, refractory heart failure due to cardiac amyloidosis remains unknown. We describe our experience with LTInoT in patients with cardiac amyloidosis and refractory heart failure.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of consecutively enrolled patients with cardiac amyloidosis on LTInoT from 2019-2023, cumulatively for 9031 person-days of follow-up (∼301 person-months).</div></div><div><h3>Results</h3><div>17 patients (12 male) were included. Participants were predominantly White (n=11) with a mean age of 79±8 years. 10 participants had HFrEF and 13 had ATTR. Chronic kidney disease, hyperlipidemia, and atrial fibrillation were comorbid in 13(76%), 12(71%), and 12(71%) patients, respectively. The mean left ventricular EF was 32±14%. LTInoT comprised milrinone (n=10) and dobutamine (n=7). Concurrent medications included a mineralocorticoid receptor antagonist (n=11, 65%), Tafamidis (n=9, 53%), and sodium-glucose co-transporter inhibitor (n=7, 41%). Cardiovascular hospitalizations (Median [quartile 1-3]) decreased while receiving LTInoT relative to a year prior (2[1-3] vs 3[2-4], p=0.03). All-cause hospitalizations were similar (3[2-4]). 6 (35%) patients died within a year of LInoT (Table). The median duration after which mortality occurred was 6 months (Q1-Q3: 3-16 months).</div></div><div><h3>Conclusion</h3><div>LTInoT has potential to reduce cardiovascular hospitalizations in advanced heart failure due to cardiac amyloidosis. Further investigation is needed to identify suitable candidates for LInoT.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 185"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Afterload Reduction After Non-invasive Low-level Tragus Stimulation In Acute Heart Failure

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure

Pub Date : 2025-01-01 DOI: 10.1016/j.cardfail.2024.10.068

Michiaki Nagai , Keigo Dote , Masaya Kato , Shota Sasaki , Sunny Po , Tarun Dasari

Introduction

While pulse pressure (PP) arises mainly from the combined influences of stroke volume and large arterial compliance, central blood pressure (BP) has been recognized as a major indicator of left ventricular (LV) afterload. Non-invasive transcutaneous vagus nerve stimulation has been reported to improve cardiac function in HF patients. In this study, we investigated the relationship between active low-level transcutaneous electrical stimulation (LLTS) and change of PP and central BP in patients with acute HF (AHF).

Methods

The 22 patients hospitalized for AHF after initial stabilization (median 80 yrs, males 60%) were randomly assigned to active or sham group, and LLTS (20Hz, 1mA) was delivered using an ear clip attached to the tragus (active group) or the earlobe (sham control group) for 1hour daily over 5 days. Brachial PP and central aortic systolic pressure (CASP) and heart rate (HR) were noninvasively measured before and after stimulation.

Results

Baseline characteristics were not significantly different between active (n=8) and sham (n=8) groups. In the active group, PP (73.7 vs 60.8mmHg), CASP (133 vs 119mmHg) and HR (79 vs 77bpm) were significantly decreased after stimulation (all p<0.05). Not PP, but the changes in CASP (-11.5 vs 8.37mmHg) and HR (-4.63 vs 2.73bpm) before and after stimulation were significantly different between active and sham groups (all p<0.001). No device-related side effects were observed.

Conclusion

In this study, the active LLTS resulted in an acute afterload reduction in the elderly AHF patients. Non-invasive LLTS may be useful and safe for reducing afterload rather than stroke volume or large aortic stiffness in AHF.

{"title":"Afterload Reduction After Non-invasive Low-level Tragus Stimulation In Acute Heart Failure","authors":"Michiaki Nagai , Keigo Dote , Masaya Kato , Shota Sasaki , Sunny Po , Tarun Dasari","doi":"10.1016/j.cardfail.2024.10.068","DOIUrl":"10.1016/j.cardfail.2024.10.068","url":null,"abstract":"<div><h3>Introduction</h3><div>While pulse pressure (PP) arises mainly from the combined influences of stroke volume and large arterial compliance, central blood pressure (BP) has been recognized as a major indicator of left ventricular (LV) afterload. Non-invasive transcutaneous vagus nerve stimulation has been reported to improve cardiac function in HF patients. In this study, we investigated the relationship between active low-level transcutaneous electrical stimulation (LLTS) and change of PP and central BP in patients with acute HF (AHF).</div></div><div><h3>Methods</h3><div>The 22 patients hospitalized for AHF after initial stabilization (median 80 yrs, males 60%) were randomly assigned to active or sham group, and LLTS (20Hz, 1mA) was delivered using an ear clip attached to the tragus (active group) or the earlobe (sham control group) for 1hour daily over 5 days. Brachial PP and central aortic systolic pressure (CASP) and heart rate (HR) were noninvasively measured before and after stimulation.</div></div><div><h3>Results</h3><div>Baseline characteristics were not significantly different between active (n=8) and sham (n=8) groups. In the active group, PP (73.7 vs 60.8mmHg), CASP (133 vs 119mmHg) and HR (79 vs 77bpm) were significantly decreased after stimulation (all p<0.05). Not PP, but the changes in CASP (-11.5 vs 8.37mmHg) and HR (-4.63 vs 2.73bpm) before and after stimulation were significantly different between active and sham groups (all p<0.001). No device-related side effects were observed.</div></div><div><h3>Conclusion</h3><div>In this study, the active LLTS resulted in an acute afterload reduction in the elderly AHF patients. Non-invasive LLTS may be useful and safe for reducing afterload rather than stroke volume or large aortic stiffness in AHF.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 206-207"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association of Psychosocial Risk Factors With Quality of Life and Readmissions 1 Year After LVAD Implantation 社会心理风险因素与 LVAD 植入术后一年的生活质量和再住院率的关系。

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure

Pub Date : 2025-01-01 DOI: 10.1016/j.cardfail.2024.03.011

JEFFREY WANG MD , ALEXIS K. OKOH MD , YUXUAN CHEN BS , REBECCA S. STEINBERG MD, MSc , APOORVA GANGAVELLI BS, MSc , KRISHAN J. PATEL MD , YI-AN KO PhD , JEFFREY D. ALEXIS MD , SHIVANI A. PATEL MPH, PhD , DAVID J. VEGA MD , MANI DANESHMAND MD , ERSILIA M. DEFILIPPIS MD , KHADIJAH BREATHETT MD, MS , ALANNA A. MORRIS MD, MSc

Background

Among patients with advanced heart failure (HF), treatment with a left ventricular assist device (LVAD) improves health-related quality of life (HRQOL). We investigated the association between psychosocial risk factors, HRQOL and outcomes after LVAD implantation.

Methods

A retrospective cohort (n = 9832) of adults aged ≥ 19 years who received durable LVADs between 2008 and 2017 was identified by using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Patients were considered to have psychosocial risk factors if ≥ 1 of the following were present: (1) substance abuse; (2) limited social support; (3) limited cognitive understanding; (4) repeated nonadherence; and (5) major psychiatric disease. Multivariable logistic and linear regression models were used to evaluate the association between psychosocial risk factors and change in Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 scores from baseline to 1 year, persistently poor HRQOL (KCCQ-12 score < 45 at baseline and 1 year), and 1-year rehospitalization.

Results

Among the final analytic cohort, 2024 (20.6%) patients had ≥ 1 psychosocial risk factors. Psychosocial risk factors were associated with a smaller improvement in KCCQ-12 scores from baseline to 1 year (mean ± SD, 29.1 ± 25.9 vs 32.6 ± 26.1; P = 0.015) for a difference of -3.51 (95% confidence interval [CI]: -5.88 to -1.13). Psychosocial risk factors were associated with persistently poor HRQOL (adjusted odds ratio [aOR] 1.35, 95% confidence interval [CI] 1.04–1.74), and 1-year all-cause readmission (adjusted hazard ratio [aHR] 1.11, 95% CI 1.05–1.18). Limited social support, major psychiatric disorder and repeated nonadherence were associated with persistently poor HRQOL, while major psychiatric disorder was associated with 1-year rehospitalization.

Conclusion

The presence of psychosocial risk factors is associated with lower KCCQ-12 scores and higher risk for readmission at 1 year after LVAD implantation. These associations are statistically significant, but further research is needed to determine whether these differences are clinically meaningful.

{"title":"Association of Psychosocial Risk Factors With Quality of Life and Readmissions 1 Year After LVAD Implantation","authors":"JEFFREY WANG MD , ALEXIS K. OKOH MD , YUXUAN CHEN BS , REBECCA S. STEINBERG MD, MSc , APOORVA GANGAVELLI BS, MSc , KRISHAN J. PATEL MD , YI-AN KO PhD , JEFFREY D. ALEXIS MD , SHIVANI A. PATEL MPH, PhD , DAVID J. VEGA MD , MANI DANESHMAND MD , ERSILIA M. DEFILIPPIS MD , KHADIJAH BREATHETT MD, MS , ALANNA A. MORRIS MD, MSc","doi":"10.1016/j.cardfail.2024.03.011","DOIUrl":"10.1016/j.cardfail.2024.03.011","url":null,"abstract":"<div><h3>Background</h3><div>Among patients with advanced heart failure (HF), treatment with a left ventricular assist device<span> (LVAD) improves health-related quality of life (HRQOL). We investigated the association between psychosocial risk factors, HRQOL and outcomes after LVAD implantation.</span></div></div><div><h3>Methods</h3><div><span>A retrospective cohort (n = 9832) of adults aged ≥ 19 years who received durable LVADs between 2008 and 2017 was identified by using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Patients were considered to have psychosocial risk factors if ≥ 1 of the following were present: (1) substance abuse; (2) limited social support; (3) limited cognitive understanding; (4) repeated nonadherence; and (5) major psychiatric disease. Multivariable logistic and </span>linear regression<span> models were used to evaluate the association between psychosocial risk factors and change in Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 scores from baseline to 1 year, persistently poor HRQOL (KCCQ-12 score < 45 at baseline and 1 year), and 1-year rehospitalization.</span></div></div><div><h3>Results</h3><div>Among the final analytic cohort, 2024 (20.6%) patients had ≥ 1 psychosocial risk factors. Psychosocial risk factors were associated with a smaller improvement in KCCQ-12 scores from baseline to 1 year (mean ± SD, 29.1 ± 25.9 vs 32.6 ± 26.1; <em>P</em> = 0.015) for a difference of -3.51 (95% confidence interval [CI]: -5.88 to -1.13). Psychosocial risk factors were associated with persistently poor HRQOL (adjusted odds ratio [aOR] 1.35, 95% confidence interval [CI] 1.04–1.74), and 1-year all-cause readmission (adjusted hazard ratio [aHR] 1.11, 95% CI 1.05–1.18). Limited social support, major psychiatric disorder and repeated nonadherence were associated with persistently poor HRQOL, while major psychiatric disorder was associated with 1-year rehospitalization.</div></div><div><h3>Conclusion</h3><div>The presence of psychosocial risk factors is associated with lower KCCQ-12 scores and higher risk for readmission at 1 year after LVAD implantation. These associations are statistically significant, but further research is needed to determine whether these differences are clinically meaningful.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 40-48"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Aortic Pulsatility Index as a Marker of Weaning to Native Recovery in Patients Supported With an Impella CP for Cardiogenic Shock 主动脉搏动指数作为使用 Impella CP 支持治疗心源性休克的患者断流至自然恢复的标志。

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure

Pub Date : 2025-01-01 DOI: 10.1016/j.cardfail.2024.07.008

ALEC BISCOPINK MD, RYAN MOORE BS, MOLLY SILKOWSKI MD, ANTHONY P. CARNICELLI MD, RYAN J. TEDFORD MD, BRIAN A. HOUSTON MD, JEFFREY YOURSHAW MD, MICHELE L. ESPOSITO MD

引用次数: 0

Letter to the Editor: Regarding “The Power in Our Patients’ Hands: Exploring LVAD and Suicide” 致编辑的信关于"病人手中的权力：探讨 LVAD 与自杀"。

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure

Pub Date : 2025-01-01 DOI: 10.1016/j.cardfail.2024.09.020

CHRISTOPHER E. KNOEPKE PhD, MSW , ABIGAIL L. LATIMER PhD, MSW , IAN H. STANLEY PhD , GRANT YODER M.Ed. , PRATEETI KHAZANIE MD, MHS

引用次数: 0

cDPP3 in Cardiogenic Shock: More than Just a Prognostic Marker? 心源性休克中的 cDPP3：不仅仅是预后标志物？

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure

Pub Date : 2025-01-01 DOI: 10.1016/j.cardfail.2024.11.003

Avinainder Singh , Mark Godding , Ajar Kochar , Rachna Kataria

引用次数: 0

“Medication Adherence And Pharmacotherapy Clinic Utilization In An Aprn (advanced Practice Registered Nurse) Led Heart Failure Clinic: A Comparative Analysis Of Entresto, Jardiance, And Farxiga”

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure

Pub Date : 2025-01-01 DOI: 10.1016/j.cardfail.2024.10.018

Tochi N Okwueze , Ashish Haryani

Objective

To assess and compare medication adherence patterns while utilizing the pharmacotherapy clinic that leverages the federal 340B drug program among heart failure patients under the care of APRN. Entresto, Jardiance, and Farxiga are the focus of this analysis due their relatively increased cost.

Methods

Data were collected over a 24-month period for the Heart Failure Clinic and over 64 months for the Pharmacotherapy clinic, focusing on patients prescribed Entresto, Jardiance, or Farxiga. The study included heart failure patients aged 18 years and older, and were categorized based on medication regimens: Entresto, Jardiance, Farxiga, or combination therapy. The data collected included pharmacotherapy clinic utilization as well as prescription tracking of patients that have stayed on the aforementioned medications. The primary outcome was sustained medication adherence rates in spite of patient ability to pay for each medication and the secondary outcome is reduction in hospitalization and improvement in overall patient well being.

Results

Entresto: Patient count increased from 353 to 564 between March 2022 and March 2024, resulting in a 59.8% rise. Jardiance: Patient count grew from 225 to 456 during the same period, representing a substantial 102.7% increase. Farxiga: The number of patients went up from 83 to 168, indicating a 102.4% surge.

Conclusions

In this comparative analysis, medication adherence patterns and pharmacotherapy clinic utilization among heart failure patients under the care of APRN were explored with a focus on three key medications: Entresto, Jardiance, and Farxiga. The findings shed light on critical aspects of patient management and treatment optimization, despite variations in patients’ ability to pay and insurance type. Sustained and increase in medication adherence rates were recorded due to the APRN`s pivotal role in ensuring patients commitment treatment plans by overcoming a principle barrier of medications cost by utilizing the Pharmacotherapy clinic by leveraging on the federal 340B drug program with reduced medication costs as provided by the Through this analysis, we sought to contribute valuable evidence that empowers APNPs, healthcare providers, and policymakers in their efforts to enhance HF management. Reduction in hospitalization rates and overall improvement in patient well-being were secondary outcomes of interest. While further research is needed, our study provides a foundation for future investigations.

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引用次数: 0

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