Journal of Cardiac Failure最新文献

{"title":"In case you missed it: Chicago Hemodynamic Forum 2025.","authors":"Rebecca S Steinberg, Chelsea Amo-Tweneboah, Cory Sejo, Mark Belkin, Alexander G Hajduczok","doi":"10.1016/j.cardfail.2025.11.497","DOIUrl":"https://doi.org/10.1016/j.cardfail.2025.11.497","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952285","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}

{"title":"Real-world Genetic Testing Practices in Cardiomyopathy: National Insights From 1.7 Million Patients.","authors":"Quan M Bui, Ana Morales, Eric D Adler, Marcus A Urey, Anshul Sinha, Jessica Wang, Kimberly N Hong, Mattheus Ramsis","doi":"10.1016/j.cardfail.2025.11.496","DOIUrl":"10.1016/j.cardfail.2025.11.496","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933422","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}

{"title":"Donation After Circulatory Death Donors for Heart Transplantation: Does Center Volume Matter?","authors":"Doug A Gouchoe, Shane S Scott, Divyaam Satija, Ervin Y Cui, Martin G Walsh, Matthew C Henn, Ajay Vallakati, Brent C Lampert, Sakima Smith, Nahush A Mokadam, Bryan A Whitson, Asvin M Ganapathi, Kukbin Choi","doi":"10.1016/j.cardfail.2025.11.498","DOIUrl":"10.1016/j.cardfail.2025.11.498","url":null,"abstract":"<p><strong>Purpose: </strong>Donation after circulatory death (DCD) as a donor for heart transplantation is a new practice. We sought to determine if center volume (high vs low) influenced perioperative outcomes and short-term survival.</p><p><strong>Methods: </strong>The United Network for Organ Sharing registry was used to identify DCD heart recipients from 2019 to 2025. Recipients were stratified based on center volume: high-volume (>15 transplants over the observational period from 2019 to 2020) or low volume (≤15 transplants). Comparative statistics and Kaplan-Meier methods with the log-rank test were used to compare groups and determine survival. A Cox regression analysis using select donor and recipient criteria was created to determine the association of center volume and mortality.</p><p><strong>Results: </strong>Low-volume group recipients had significantly longer waitlist times, temporary mechanical circulatory support use, and were more likely to be status 1 or 2 compared to the high-volume group. However, high-volume centers had significantly higher exceptions granted per center compared to low-volume centers. There were no significant differences in perioperative outcomes or short-term survival. Following adjustment, center volume was not independently associated with increased mortality, while increasing ischemic time was.</p><p><strong>Conclusions: </strong>Transplant center volume had no significant effect on perioperative outcomes or survival after DCD heart transplantation. The discrepancy in presumed medical urgency and increased waitlist time in the low-volume cohort is highlighted by significantly more exceptions granted to high-volume recipients. This should be a noted area for improvement in the new allocation system to make heart transplantation more equitable for all recipients.</p>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917605","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}

{"title":"Mean Arterial Pressure and Mortality in Infarction-Related Cardiogenic Shock With and Without Cardiac Arrest: A Meta-Analysis.","authors":"Sanne Ten Berg, Margriet Bogerd, Elma Peters, Koen Ameloot, Johannes Grand, Juan Russo, Jacob Jentzer, Pietro DI Santo, Rebecca Mathew, Benjamin Hibbert, Jesper Kjaergaard, Martin Meyer, Markus Skrifvars, Brian Roberts, Bruno Levy, Hamid Merdji, Arjan Malekzadeh, Wim Lagrand, Annemarie Engström, Alexander Vlaar, Luuk Otterspoor, José P S Henriques","doi":"10.1016/j.cardfail.2025.12.004","DOIUrl":"10.1016/j.cardfail.2025.12.004","url":null,"abstract":"<p><strong>Background: </strong>This comprehensive systematic review and meta-analysis aimed to evaluate the effect of different mean arterial pressure (MAP) levels on short-term mortality in patients with acute myocardial infarction complicated by cardiogenic shock with cardiac arrest (AMICS-CA) and without (AMICS without CA).</p><p><strong>Methods: </strong>We conducted a systematic search of MEDLINE (OVID), EMBASE (OVID), CINAHL (Ebsco), and Cochrane CENTRAL databases. Studies that reported outcomes for patients with AMICS with and without CA in at least 2 groups of different MAP levels were eligible, including targeted MAPs in randomized clinical trials (RCTs) and achieved average MAPs in observational studies. Authors of the included studies were proactively contacted for additional AMI data. Data were pooled using random-effects models. The primary endpoint was short-term mortality.</p><p><strong>Results: </strong>Of 11,269 screened studies, 12 were included in the final analysis (4 RCTs and 8 observational studies), encompassing 1281 patients with AMICS-CA and 111 patients with AMICS without CA. Short-term mortality was similar between low- and high-MAP groups in AMICS-CA in both RCTs (34.9% vs 39.4%, Risk Ratio 0.88, 95% confidence interval, 0.70-1.10) and observational data, as well as in patients with AMICS without CA, although based on just 2 observational studies.</p><p><strong>Conclusions: </strong>Our meta-analysis showed no significant difference in short-term mortality between low- and high-MAP levels in patients with AMICS with CA. Similarly, although based on pooled observational data from only 2 studies, no significant difference in mortality was observed in patients with AMICS without CA. Overall, both limited evidence and heterogeneity in low- and high-MAP definitions across studies preclude firm conclusions.</p>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145900399","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}

{"title":"A Retrospective Cohort Study Exploring Exploring The Impact Of Aortic Stenosis On Outcomes In Cardiac Amyloidosis","authors":"Devika Adusumilli ,&nbsp;Ibrahim Kamel ,&nbsp;Machaiah Madhrira ,&nbsp;Aditya Sharma ,&nbsp;Amir Malik","doi":"10.1016/j.cardfail.2025.11.033","DOIUrl":"10.1016/j.cardfail.2025.11.033","url":null,"abstract":"<div><h3>Introduction</h3><div>Wild-type transthyretin-cardiac amyloidosis (ATTR) and aortic stenosis (AS) are age-related conditions with potential overlapping pathophysiology. This study evaluates the impact of coexisting AS and ATTR amyloidosis on mortality by comparing outcomes in patients with ATTR alone versus those with both AS and ATTR.</div></div><div><h3>Hypothesis</h3><div>Patients with coexisting ATTR and AS have higher mortality compared to those with ATTR alone.</div></div><div><h3>Methods</h3><div>This study utilized the TriNetX platform to perform a Compare Outcomes Analysis on two cohorts: AS + ATTR (Cohort 1, n=480 before matching, n=363 after matching) and ATTR (Cohort 2, n=4,516 before matching, n=363 after matching). Patients aged ≥65 years with wild-type transthyretin amyloidosis (ATTR) were included. Cohort 1 additionally had a diagnosis of nonrheumatic aortic stenosis (AS). The index event was defined as the first occurrence of these conditions.A 5-year (1825-day) follow-up period was used for outcome assessment. Propensity score matching (PSM) was performed to balance baseline characteristics between cohorts.The primary outcome was all-cause mortality, assessed through Kaplan-Meier survival analysis, log-rank test, and hazard ratios (HR). Additional measures included risk ratio (RR), odds ratio (OR), and risk difference (RD).</div></div><div><h3>Results</h3><div>After PSM, both cohorts had 363 patients. The median follow-up time was 386 days (IQR: 618) for AS + ATTR and 455 days (IQR: 805) for ATTR. Mortality was observed in 103 patients (28.5%) in AS + ATTR vs. 86 patients (23.8%) in ATTR. The Kaplan-Meier survival analysis demonstrated a significantly lower survival probability in AS + ATTR (40.07% vs. 56.32%, p=0.015).The hazard ratio (HR) for mortality was 1.424 (95% CI: 1.068-1.899, p=0.021), indicating an increased risk in AS + ATTR. Risk analysis showed an RR of 1.201 (95% CI: 0.939-1.537) and an OR of 1.281 (95% CI: 0.919-1.787), with a risk difference of 4.8% (p=0.144).</div></div><div><h3>Conclusion</h3><div>Patients with AS and ATTR amyloidosis exhibit a higher mortality risk compared to those with ATTR alone. The coexistence of these conditions may accelerate cardiac deterioration due to increased hemodynamic burden, impaired myocardial compliance, and exacerbation of heart failure symptoms. Studies have demonstrated that ATTR amyloidosis, particularly wild-type transthyretin amyloidosis, is frequently underdiagnosed in patients with AS, leading to delayed or suboptimal management. Early recognition using advanced imaging techniques, such as technetium-labeled scintigraphy and strain echocardiography, may improve diagnostic accuracy and inform individualized therapeutic strategies. Further research is necessary to better understand pathophysiology and identify optimal therapeutic strategies.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 184"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950259","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}

{"title":"Revisiting Transthyretin Cardiac Amyloidosis Staging Systems In A Diverse Cohort","authors":"Matthew Dean,&nbsp;Aditi Patel,&nbsp;Qihua Fan,&nbsp;Sarah Paciulli,&nbsp;Stephanie Cowardin,&nbsp;Jessica Davidson,&nbsp;Keyur Shah","doi":"10.1016/j.cardfail.2025.11.037","DOIUrl":"10.1016/j.cardfail.2025.11.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Risk stratification in transthyretin amyloidosis (ATTR-CM) is guided by two staging systems, the Mayo Staging System, using N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-cTnT), and the National Amyloidosis Centre ATTR Stage (NAC-ATTR) incorporating NT-proBNP and creatinine-based eGFR. These risk scores are derived from a Caucasian population prior to approved use of tafamidis. We validate these scoring systems in a diverse population, inclusive of those with hereditary ATTR-CM with V142I mutation.</div></div><div><h3>Hypothesis</h3><div>The Mayo staging system accurately predicts transplant-free survival compared to NAC-ATTR in a diverse population.</div></div><div><h3>Methods</h3><div>We analyzed data from a retrospective cohort of patients aged 18 and older with ATTR-CM followed at VCU Health from January 2009-December 2024 with complete staging biomarkers. Each patient was assigned a Mayo and NAC-ATTR stage. Troponin I (cTnI) substituted for hs-cTnT when unavailable (Table 1). Baseline characteristics were compared across stages. Unadjusted event-to-transplant-free survival Kaplan-Meier curves was plotted. Sub-analyses compared unadjusted mortality in V142I patients and among NAC-ATTR Stage 1 patients with and without detectable troponin.</div></div><div><h3>Results</h3><div>146 patients with ATTR-CM were identified. Median age was 77.9 (72.5-81.4), 64.3% were Black, 68.5% received tafamidis, 45.8% carried the V142I mutation. Most patients were classified as Stage 3 by Mayo (39.0%) and Stage 1 by NAC-ATTR (42.4%). Median BMI differed among Mayo and NAC-ATTR stages, and was lowest among Mayo Stage 3 (25.9, 23.1-29.7). Diastolic function decreased with higher stage. Among the total population and those with V142I mutation, transplant-free survival differed across both staging systems, with the lowest survival in Stage 3. Three-year (11.3% vs. 2.6%) and five-year mortality (12.9% vs. 5.1%) were higher in the NAC-ATTR Stage 1 group compared to Mayo Stage 1. Within NAC-ATTR Stage 1, patients with detectable troponin (48.3%) had lower transplant-free survival.</div></div><div><h3>Conclusions</h3><div>Among a diverse cohort of ATTR-CM patients in the tafamidis era, both the NAC-ATTR and Mayo Staging Systems stratified transplant-free survival. The NAC-ATTR was less reliable in identifying low-risk patients, suggesting current creatinine-based eGFR may underestimate mortality risk for a Black population subgroup.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 186"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950262","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}

{"title":"Vutrisiran Reduces Days Lost To Death And/or Hospitalization Versus Placebo In Patients With Transthyretin Amyloidosis With Cardiomyopathy In The HELIOS-B Trial","authors":"Ali Yilmaz ,&nbsp;Ainara Lozano-Bahamonde ,&nbsp;Nicolas Lamblin ,&nbsp;Hiroaki Kitaoka ,&nbsp;Emre Aldinc ,&nbsp;David Danese ,&nbsp;Shaun Bender ,&nbsp;Mazen Hanna","doi":"10.1016/j.cardfail.2025.11.038","DOIUrl":"10.1016/j.cardfail.2025.11.038","url":null,"abstract":"<div><h3>Background</h3><div>In HELIOS-B (NCT04153149), vutrisiran reduced the risk of the primary composite endpoint of all-cause mortality (ACM) and CV events (CV hospitalizations and urgent HF visits) vs placebo in patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM) and also met all secondary endpoints. While the primary composite endpoint in HELIOS-B provides the central evidence for the efficacy of vutrisiran in reducing ACM and CV event risk, additional analyses that capture the distinctions between death and hospitalizations of differing lengths may provide additional insight into the efficacy of vutrisiran.</div></div><div><h3>Hypothesis</h3><div>The benefit of vutrisiran in patients with ATTR-CM can be further characterized by assessing its effect on days lost to death and/or hospitalization (DLDH) in HELIOS-B.</div></div><div><h3>Methods</h3><div>The number of DLDH, and days lost to death and/or CV hospitalization (DLDCVH), were calculated for each patient. Additionally, the remaining days (i.e., days not lost to death or hospitalization) were weighted based on functional and quality of life (QoL) assessments (Kansas City Cardiomyopathy Questionnaire-Overall Summary Score [KCCQ-OS], or KCCQ-Total Symptom Score [KCCQ-TSS] and NYHA functional class); the result of this weighting was then used to calculate the number of days without full health due to impaired function or QoL. DLDH and DLDCVH (with and without the addition of days not in full health due to functional/QoL impairment) for vutrisiran vs placebo were analyzed using a beta or zero-inflated beta model.</div></div><div><h3>Results</h3><div>The analysis included 654 patients (326 vutrisiran, 328 placebo). Over 3 years, vutrisiran treatment resulted in a mean of 32.2 (95% CI 5.3, 59.3) fewer DLDH and a mean of 32.0 (95% CI 4.6, 59.5) fewer DLDCVH vs placebo (<strong>Table</strong>). Patients treated with vutrisiran had 64% greater odds of no DLDH and of no DLDCVH vs placebo. When additionally accounting for impaired function/QoL on days alive and not hospitalized, vutrisiran treatment led to a mean of 62.8 (95% CI 25.6, 99.8) and 64.4 (95% CI 27.4, 101.5) fewer days lost (weighted DLDH and DLDCVH, respectively) vs placebo when weighted by KCCQ-OS, and a mean of 49.5 (95% CI 22.5, 76.6) and 52.6 (95% CI 26.1, 79.0) fewer days lost (weighted DLDH and DLDCVH, respectively) vs placebo when weighted by KCCQ-TSS and NYHA class collectively (<strong>Table</strong>).</div></div><div><h3>Conclusion</h3><div>In patients with ATTR-CM, vutrisiran reduced the mean days lost to death and/or hospitalization by more than 1 month vs placebo over 3 years. The vutrisiran effect was greater when the impact of impaired function and QoL was accounted for. This abstract will be presented at ESC 2025, August 29−September 1, 2025, Madrid, Spain.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 186"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950263","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}

{"title":"Design And Rationale Of A Phase 3 Study To Evaluate The Efficacy And Safety Of Nucresiran (aln-ttrsc04) In Patients With Transthyretin Amyloidosis With Cardiomyopathy","authors":"Mariana Fontana ,&nbsp;Ahmad Masri ,&nbsp;Mathew S. Maurer ,&nbsp;John McMurray ,&nbsp;Scott D. Solomon ,&nbsp;Minzhao Liu ,&nbsp;Patrick Y. Jay ,&nbsp;Ronald Witteles","doi":"10.1016/j.cardfail.2025.11.044","DOIUrl":"10.1016/j.cardfail.2025.11.044","url":null,"abstract":"<div><h3>Introduction</h3><div>Transthyretin amyloidosis (ATTR) is a progressive and fatal condition caused by deposition of misfolded transthyretin (TTR) as amyloid fibrils in multiple tissues. ATTR is classified as either hereditary (hATTR) or wild-type (wtATTR), depending on the presence or absence of amyloidogenic <em>TTR</em> gene variants, and manifests as either primarily cardiomyopathy (ATTR-CM), polyneuropathy, or a mixed phenotype. RNA interference (RNAi) therapeutics suppress the hepatic production of TTR by targeting wild-type and variant <em>TTR</em> mRNA for degradation. Previous studies showed that rapid TTR knockdown with RNAi therapeutics improves outcomes for ATTR patients regardless of etiology or manifestation. Most recently, vutrisiran was shown to improve outcomes for patients with ATTR-CM across multiple domains in the HELIOS-B study, including reducing cardiovascular events and all-cause mortality, and improving functional capacity and quality of life. Larger reductions in TTR levels correlated with greater clinical benefit in patients with hATTR and polyneuropathy, suggesting that greater TTR knockdown may offer similar benefits in ATTR-CM. Nucresiran (ALN-TTRsc04) is a next-generation RNAi therapeutic designed for the treatment of ATTR. In a Phase 1, ascending-single-dose study in healthy adults (NCT05661916), nucresiran led to rapid and sustained knockdown of TTR. Up to 95% knockdown by Day 15 and &gt;90% mean reductions through Month 6 were achieved with subcutaneously administered doses ≥300 mg that were well tolerated.</div></div><div><h3>Hypothesis</h3><div>The efficacy, safety, and pharmacokinetics/pharmacodynamics (PK/PD) of nucresiran in patients with ATTR-CM will be evaluated in a global, Phase 3, randomized, placebo-controlled study, the rationale and design of which will be described.</div></div><div><h3>Methods</h3><div>The study design, including inclusion and exclusion criteria, will be finalized in Q1 2025. Enrollment of adult patients with ATTR-CM is expected to begin in 2025. Key endpoints will assess mortality and cardiovascular events.</div></div><div><h3>Results</h3><div>The nucresiran Phase 3 ATTR-CM study design and rationale will be presented.</div></div><div><h3>Conclusions</h3><div>The Phase 3 study will investigate the efficacy, safety, and PK/PD of nucresiran in patients with ATTR-CM. Nucresiran has the potential to provide greater and more sustained TTR knockdown with lower inter-patient variability and less frequent dosing than current TTR-lowering therapies. This abstract will be presented at HFA 2025, May 17-20, 2025, Belgrade, Serbia.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 189"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950319","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}

{"title":"Potential For Missed Heart Failure Diagnosis Among Those High B-type Natriuretic Peptide Values","authors":"Paul Heidenreich ,&nbsp;Neil Kalwani ,&nbsp;Karim Sallam ,&nbsp;Stephanie Hsiao ,&nbsp;Rebecca Tisdale ,&nbsp;Colette Dejong ,&nbsp;Alexander Sandhu","doi":"10.1016/j.cardfail.2025.11.049","DOIUrl":"10.1016/j.cardfail.2025.11.049","url":null,"abstract":"<div><h3>Background</h3><div>B-type natriuretic peptide (BNP) is increasingly used to evaluate symptoms that may indicate heart failure (HF). Those with high BNP should have further evaluation per guidelines (e.g., echocardiography). However, the patient’s clinician may not be aware of or act on BNP results. We sought to determine how often a high BNP value was not followed by an echocardiogram or diagnosis of HF.</div></div><div><h3>Methods</h3><div>We identified all individuals in the US VA Health Care System with a high BNP (&gt;200 mcg/dL) or NT-proBNP (&gt;1000 mcg/dL) from 2020-2024. We excluded patients with a HF diagnosis (inpatient or outpatient) in the prior 5 years, those with a left ventricular ejection fraction (LVEF) <em>≤</em>40% in the prior 1 year, those that died in the next 90 days, and those with no medications provided by the VA in the next 90 days (to exclude those receiving care elsewhere). The primary outcome was either an echocardiogram or a HF diagnosis in the 90 days following a high BNP. We determined if there was any prescription for one of the four HF pillar medications per published guidelines (beta-blockers, renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists and sodium glucose transporter 2 inhibitors).</div></div><div><h3>Results</h3><div>Among 84,682 patients with a high BNP and no known HF or low LVEF, 51,424 (61%) had either an echocardiogram (58%) or received a diagnosis of HF at 90 days (19%). The remaining 33,258 (39%) patients were considered to have inadequate follow-up (no-FU). The patients with no-FU were slightly older (76±10 years, vs. 75±10 years, p&lt;0.0001). There was substantial variation in the frequency of no-FU across 126 VA health systems (Figure, p&lt;0.0001) and regions of the United States with no-FU occurring in 41% of those in the West, 40% in the South, 38% in the Midwest and 36% in the Northeast (p&lt;0.0001). The fraction of patients with no-FU decreased over time (43% in 2020 to 37% in 2024, p&lt;0.0001). There were small but significant differences by race/ethnicity (greatest FU among Asian patients, lowest FU for American Indian patients). By 90 days following a high BNP, 41% of those with follow-up were prescribed at least one HF pillar medication compared to 25% of those with no-FU (p&lt;0.0001).</div></div><div><h3>Conclusion</h3><div>Many patients with high BNP values and no prior diagnosis of heart failure are not evaluated with echocardiography or given an HF diagnosis in the subsequent 90 days. This lack of imaging is associated with less evidence-based treatment of HF. The high facility variation suggests there may be best practices that can be identified and adopted to improve diagnosis and treatment for these patients.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 192"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950367","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}

{"title":"Rapid Workflow Redesign Of Heart Failure Of Remote Monitoring Enhances Device-measured Physiological Metrics","authors":"Craig Stolen,&nbsp;Molly Kupfer,&nbsp;Karen Tomes,&nbsp;Sean Horan,&nbsp;Ananta Pandey,&nbsp;Julie Snodie,&nbsp;Kate Frost,&nbsp;Shawn Merhaut","doi":"10.1016/j.cardfail.2025.11.063","DOIUrl":"10.1016/j.cardfail.2025.11.063","url":null,"abstract":"<div><h3>Background</h3><div>To realize the benefits of remote heart failure monitoring technology, it must be integrated into clinical workflow in a way that supports timely reactions to alerts. Cardiology practices are varied and there is a need to optimize remote monitoring clinical workflow across a spectrum of organizational structures.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the impact of remote monitoring workflow redesign on the use of an implantable device-based multi-sensor diagnostic and on the associated heart failure alert metrics.</div></div><div><h3>Methods</h3><div>A rapid workflow redesign program was conducted at 27 cardiology sites. The program consisted of care team interviews, process mapping, multidisciplinary workshops, best practice suggestions, and leadership discussions to align on redesign goals and implementation plans. All sites agreed to the retrospective retrieval of HeartLogic-capable ICD and CRT device data from the LATITUDE remote patient management system. HeartLogic utilization and alert metrics were compared over 12-month periods before, during, and after re-design.</div></div><div><h3>Results</h3><div>The time from device implant to HeartLogic enablement decreased from an average of 28±110 days to 10±31 days at 24 months (p&lt;0.0001), and remote data accessibility increased with delayed data transmissions decreasing from 10% to 6%. The number of HeartLogic alert onsets per year was unchanged; however, the length of individual alerts was shorter (47.6±38.4 days pre-redesign and 44.1±36.5 days post-redesign, p=0.001) and the total percent time each patient spent in alert was less (15.5±19.9% pre-redesign and 14.3±19.0% post redesign, p=0.04). The HeartLogic index values during each alert were also lower in the post-redesign period (maximum index value 28.9±12.8 vs 27.8±12.1, p=0.001).</div></div><div><h3>Conclusion</h3><div>Workflow redesign increased remote heart failure feature usage and improved alert metrics, suggesting more efficient uptake of remote monitoring and improvements in patients’ heart failure status. Focused attention on workflow with multi-disciplinary stakeholder involvement may improve clinic efficiencies that may translate into improved patient care.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 198"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950406","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}