Journal of Cardiac Failure最新文献

Background: The benefit of efforts to identify heart failure (HF) risk in cancer survivors is unclear. Individuals with diabetes mellitus (DM) are at elevated risk of both cancer and HF and may warrant further consideration regarding HF prevention.

Objectives: To examine the incidence of HF in individuals with DM and cancer compared with DM alone.

Methods: A national cohort was established by linking the Australian National Diabetes Services Scheme (NDSS; n=792,742, aged ≥50 years) with hospital admissions, the National Death Index, and the Pharmaceutical Benefits Scheme. Cancer was defined by hospital admission or chemotherapy prescriptions. Incident HF was defined as first HF hospitalization or HF-related death. Poisson models were adjusted for age, sex, socio-economic status, remoteness, coronary artery disease and hypertension.

Results: Between 2010 and 2022, 31,082 HF events occurred during 6.3 million person-years. Among 143,111 individuals with DM and cancer, HF incidence per 1,000 person-years was 10.8 (95% CI 10.47-11.04) versus 4.4 (95% CI 4.37-4.47) with DM alone (IRR 1.52, 95% CI 1.48-1.57). Risk was highest in those ≥70 years with DM and cancer (10/1,000 person-years) and those with haematologic malignancies (19/1,000 person years). Compared to DM alone, cancer admission without chemotherapy carried greater HF risk (IRR 1.76, 95% CI 1.69-1.84) than did chemotherapy exposure (IRR 1.36 95% CI 1.31-1.42), suggesting cancer itself is associated with HF. Risk was strongest when cancer was coded as a secondary diagnosis, suggesting synergy with multimorbidity.

Conclusions: People with DM and cancer (especially aged ≥70 years), represent a high-risk group for HF.

Background and aims: Tricuspid regurgitation (TR) is a common comorbidity in elderly patients with heart failure (HF), but its impact on functional and cognitive decline remains poorly understood. This study aimed to assess the relationship between TR severity and longitudinal changes in activities of daily living (ADL) and cognitive function.

Methods and results: We analyzed 1,269 HF patients (HF with preserved ejection fraction: 67.5%) with available data on ADL and cognitive function at both baseline and 1-year follow-up from a cohort of 1,646 consecutive HF patients enrolled in the KUNIUMI (Kobe UNIversity Heart FailUre Registry in Awaji MedIcal Center) Registry Chronic Cohort. TR severity was assessed by vena contracta width on echocardiography and classified as less than mild, moderate, or severe; 125 patients were classified as having severe TR. ADL and cognitive function were evaluated using the Barthel Index and the ABC Dementia Scale (ABC-DS), respectively. A ≥10-point decrease was defined as a significant decline. At baseline, patients with less than mild TR had significantly higher Barthel Index and ABC-DS scores compared to those with moderate or severe TR. After 1 year, only patients with severe TR showed significant declines in both Barthel Index (88.5 ± 21.4 to 82.0 ± 28.6, P<0.001) and ABC-DS (108.8 ± 16.5 to 103.6 ± 22.5, P<0.001). Severe TR was independently associated with ADL decline (OR 2.04, 95% CI 1.14-3.66) and cognitive deterioration (OR 2.99, 95% CI 1.59-5.62) in multivariable logistic regression analysis.

Conclusion: Severe TR is independently associated with both functional and cognitive decline in HF patients, highlighting its role as a systemic marker of vulnerability. Geriatric assessment may aid risk stratification and inform TR-targeted therapeutic strategies.

Heart failure (HF) represents a growing clinical and socioeconomic burden worldwide, placing increasing pressure on health care systems in both high- and low-resource settings. Remote patient care (RPC), encompassing telemonitoring and other digitally enabled strategies, has emerged as a promising adjunct to conventional follow-up by enabling continuous physiological assessment and early detection of clinical deterioration. Such proactive surveillance facilitates timely therapeutic adjustments and may improve patients' outcomes. A broad range of monitoring approaches is currently available or under development, including patient-directed home measurements, wearable technologies, and sensor-based solutions integrated into therapeutic cardiac implantable electronic devices (CIEDs). Among these, the HeartLogic multisensory algorithm offers a pragmatic and scalable solution, leveraging data from existing CIEDs without the need for additional procedures. It is a multiparametric, implant-based algorithm that detects early signs of HF decompensation by integrating sensor data, including heart sounds, intrathoracic impedance, respiratory rate, heart rate, and patient activity. Growing evidence supports its clinical use. DANLOGIC-HF (Danish Pragmatic Randomized Trial to Evaluate the Effect of HeartLogic-Guided Management on Heart Failure Outcomes) is the first randomized controlled trial designed to provide robust outcome data about whether HeartLogic-guided management reduces HF-related events. In this article, we discuss the current evidence for HeartLogic, as well as ongoing and planned clinical trials, with particular emphasis on the pragmatic randomized controlled trial DANLOGIC-HF (Danish Pragmatic Randomized Trial to Evaluate the Effect of HeartLogic-Guided Management on Heart Failure).

Background: Three cardiogenic shock (CS) phenotypes have been proposed and validated in various datasets: non-congested (I), cardiorenal (II), and cardiometabolic CS (III). The DanGer Shock trial demonstrated a mortality benefit of microaxial flow pump (mAFP) use in myocardial infarction-related CS. In this post-hoc analysis, we aimed to assess trajectories and outcomes of these phenotypes in the DanGer Shock population.

Methods: Patients randomized in the DanGer Shock trial were retrospectively assigned to one of three CS phenotypes at admission. Missing values for phenotyping were imputed using multiple random forest imputation. Outcomes were 180-day mortality, and trajectories of key clinical, laboratory and hemodynamic parameters first 72 hours within phenotypes, stratified by allocation to mAFP or standard of care.

Results: Out of 355 adult patients in the trial, 145 (41%), 38 (11%), and 172 (48%) patients were in the non-congested, cardiorenal, and cardiometabolic phenotypes, respectively. 180-day mortality was higher in cardiometabolic (69%) compared to non-congested (33%) and cardiorenal CS (47%). Clinical metabolic and hemodynamic trajectories and their treatment response differed between phenotypes. mAFP use was associated with lower mortality in non-congested CS (odds ratio: 0.51 [0.28-0.91], p=0.02). The odds of mortality were 0.81 [0.57-1.16] (p=0.25) in cardiometabolic and 0.91 [0.35-2.34] (p=0.84) in cardiorenal CS (p for interaction: 0.43).

Conclusion: In this post-hoc analysis of the DanGer Shock trial, predefined CS phenotypes showed distinct outcomes, with the non-congested phenotype faring best and the cardiometabolic worst. The greatest apparent benefit of mAFP was observed in non-congested CS. These findings are hypothesis-generating and warrant confirmation in prospective studies.

Clinical trial registration: ClinicalTrials.gov unique identifier: NCT01633502. Condensed Abstract In this DanGer Shock post-hoc analysis, study participants were retrospectively assigned to one of three cardiogenic shock (CS) phenotypes: non-congested, cardiorenal, or cardiometabolic CS. 41%, 11%, and 48% of all 355 patients were in these phenotypes, respectively. 180-day mortality was higher in cardiometabolic (69%) compared to non-congested (33%) and cardiorenal CS (47%). mAFP use was associated with lower mortality in non-congested and numerically in cardiometabolic, but not in cardiorenal CS. In summary, CS phenotypes showed distinct outcomes, with the non-congested phenotype faring best and the cardiometabolic worst. The greatest apparent benefit of mAFP was observed in non-congested CS.