Journal of Cardiac Failure最新文献

{"title":"Safety And Efficacy Of Direct Oral Anticoagulants In Adults With Durable Left Ventricular Assist Devices","authors":"Ashwin Pillai ,&nbsp;Aryan Mehta ,&nbsp;Balaphanidhar Mogga ,&nbsp;Cesar Rubio-Ramos ,&nbsp;Katrina Etts ,&nbsp;Kelly McNamara-Diorio ,&nbsp;Amanda Maxfield ,&nbsp;Dawn Surprenant ,&nbsp;Jason Gluck ,&nbsp;Abhishek Jaiswal","doi":"10.1016/j.cardfail.2025.11.018","DOIUrl":"10.1016/j.cardfail.2025.11.018","url":null,"abstract":"<div><h3>Background</h3><div>Therapeutic anticoagulation is essential for patients with durable left ventricular assist devices (LVADs). While warfarin remains the default anticoagulant of choice, its narrow therapeutic range, multiple pharmacologic interactions, the need for continuous dose adjustments, the limited time in therapeutic range (often &lt;40%) resulting in both thrombotic and hemorrhagic complications, all contribute to patient and provider dissatisfaction. There is limited data exploring alternate anticoagulation strategies in this cohort. We report the safety and efficacy of the direct acting oral anticoagulant (DOAC) apixaban for anticoagulation in patients with the HeartMate (HM) 3 LVAD.</div></div><div><h3>Hypothesis</h3><div>DOACs offer a safe and effective anticoagulant in patients with durable HM3 LVADs</div></div><div><h3>Methods</h3><div>We compared thromboembolic and hemorrhagic events between patients with HeartMate 3 LVADs receiving warfarin to those who transitioned from warfarin to a DOAC due to adverse events or labile therapeutic responses on warfarin in our center.</div></div><div><h3>Results</h3><div>From 2018-2024, we included 47 patients, 16 on warfarin and 31 on apixaban. Cohorts were identical for baseline demographics and estimated risk of bleeding (Table 1). The absolute rate of all-cause bleeding per 100 patient-years was similar (warfarin (33) vs apixaban (29), p=0.24). The relative risk (RR) of major bleeding within the first 3 months of initiating anticoagulation was lower with DOAC - RR 0.08 (95% CI, 0.01 - 0.65, p=0.01) with an incidence of rate of 6.4% on apixaban vs 43.8% on warfarin. All-cause bleeding was less frequent with DOAC at 32% vs 68.8% - RR 0.14 (95% CI 0.03 - 0.62, p=0.009). Thrombotic events were identical. Table 2 summarizes clinical outcomes.</div></div><div><h3>Conclusion</h3><div>In patients with HM3 LVADs, DOAC might provide a safe and clinically useful alternative to default warfarin.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 176-177"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950167","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":"Exploring The Characteristics And Outcomes Of Heart Transplant Recipients Receiving Inpatient Palliative Care","authors":"Shriya Khurana ,&nbsp;Kelley Anderson ,&nbsp;William Weintraub ,&nbsp;Richa Gupta ,&nbsp;Hunter Groninger","doi":"10.1016/j.cardfail.2025.11.023","DOIUrl":"10.1016/j.cardfail.2025.11.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart transplantation remains the gold standard treatment for stage D heart failure, conferring a median survival of over 12 years, but recipients often face complex clinical and emotional challenges. Palliative care can play a vital role in mitigating these challenges, including symptom management, psychosocial-spiritual counselling, and assisting with complex medical decision-making. Despite its importance, characteristics of heart transplant recipients who receive palliative care consultations and their outcomes remain inadequately studied. Objective: To characterize a population of heart transplant recipients receiving palliative care in-hospital and assess their outcomes.</div></div><div><h3>Methods</h3><div>At a transplant center in Washington DC, we conducted a retrospective chart review of adult heart transplant recipients who received a palliative care consultation for any indication between 2019 and 2024. We collected data on patient demographics, reason for palliative consult, hospital utilisation, and outcomes.</div></div><div><h3>Results</h3><div>A total of 230 palliative care consults took place for 129 patients over the study period. The cohort had a median age of 63 years and was predominantly male (65.2%). Most patients self-identified as African American (61.7%) or White (36.5%) and 90.4% as non-Hispanic. The reasons for palliative care consultation included symptom management (19.6%), patient/family counselling (12.2%), and goals of care (9.1%); most patients had multiple reasons for consultation (59.1%). Their average length of hospital stay was 26.1 days. ICU admissions occurred in 11.3% of patients, with an average ICU length of stay of 13.8 days. While 93.4% patients had full code status on admission, 15.6% had changed code status to do-not-resuscitate by hospital discharge. Of the entire cohort, only eight patients died in the hospital. Most patients (62.2%) had a life expectancy of greater than one year at hospital discharge.</div></div><div><h3>Conclusion</h3><div>Heart transplant recipients receiving inpatient palliative care form a unique cohort. Understanding characteristics of palliative consultation in this population may improve palliative care, resource availability, and supportive care outcomes for these patients in need.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 179"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950172","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":"Care Burden For Heart Transplantation And Durable Left Ventricular Assist Device In The United States: A Propensity-matched Analysis In The Contemporary Era.","authors":"Balaphanidhar Mogga ,&nbsp;Karanrajsinh Raol ,&nbsp;Ashwin Pillai ,&nbsp;Prathyusha Mudduluru ,&nbsp;Zeina Jedeon ,&nbsp;Dheeraj Pinninty ,&nbsp;Katrina Etts ,&nbsp;William Baker ,&nbsp;Abhishek Jaiswal","doi":"10.1016/j.cardfail.2025.11.026","DOIUrl":"10.1016/j.cardfail.2025.11.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart transplantation (HT) remains the gold standard for end-stage heart failure, while durable left ventricular assist devices (LVAD), particularly the HeartMate 3 (HM3), have improved survival and reduced complications. Using a nationwide database, this study compares index hospitalization costs, length of stay (LOS), and readmission costs between HT and LVAD recipients.</div></div><div><h3>Methods</h3><div>We analyzed adult patients undergoing HT or LVAD implantation from the Nationwide Readmissions Database (2018-2021) using ICD-10-CM procedure codes. Before matching, 7,129 HT and 7,240 LVAD recipients were identified (a total of 14,369 patients and 27,308 weighted hospitalizations). After propensity score matching (1:1), 5,330 HT and 5,330 LVAD recipients were included. The primary outcomes were index hospitalization costs, LOS, and 30-day and 90-day readmission costs.</div></div><div><h3>Results</h3><div>Among 10,660 propensity-matched patients, LVAD therapy incurred higher median index hospitalization costs ($246,087) compared to HT ($228,869, p &lt; 0.001). Post-procedural LOS was significantly longer for LVAD recipients (21 vs. 17 days, p &lt; 0.001), contributing to increased hospitalization costs. LOS was also longer in LVAD recipients (34 vs. 32 days, p &lt; 0.001) (Table 1). Regarding readmission costs, HT recipients had higher median 30-day ($16,606 vs. $11,736, p &lt; 0.001) and 90-day ($15,233 vs. $11,680, p &lt; 0.001) readmission costs compared to LVAD. This difference was partly attributable to more procedures during readmissions among HT recipients (2 vs. 1, p &lt; 0.001). However, despite higher readmission costs, LVAD recipients had a significantly greater overall 90-day readmission rate (45.6% vs. 40.7%, p &lt; 0.001) (Table 2).</div></div><div><h3>Conclusion</h3><div>In a propensity-matched cohort of 10,660 patients, LVAD therapy was associated with higher index hospitalization costs, longer LOS, and greater overall resource utilization. While HT incurred higher readmission costs per episode, LVAD patients had a higher overall readmission burden. These findings provide key insights into cost considerations in advanced heart failure management and highlight the need for strategies to optimize cost-effectiveness while improving patient outcomes.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 180-181"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950214","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":"Clinician Persuasion in Shared Decision-Making: A Qualitative Analysis of Patient-Physician Discussions About the Benefits and Tradeoffs of Heart Failure Medications","authors":"Henry Biermann ,&nbsp;Candace D. Speight ,&nbsp;Sarah C. Montembeau ,&nbsp;Andrea R. Mitchell ,&nbsp;Emily F. Lowe ,&nbsp;Advaita Krishnan ,&nbsp;Laura D. Scherer ,&nbsp;Daniel D. Matlock ,&nbsp;Peter A. Ubel ,&nbsp;Larry A. Allen ,&nbsp;Neal Dickert","doi":"10.1016/j.cardfail.2025.11.056","DOIUrl":"10.1016/j.cardfail.2025.11.056","url":null,"abstract":"<div><h3>Introduction</h3><div>How physicians frame medication benefits and tradeoffs while engaging in shared decision making with patients is not well described in the management of heart failure with reduced ejection fraction (HFrEF).</div></div><div><h3>Methods</h3><div>This qualitative, secondary analysis of recorded encounters between clinicians and patients with HFrEF sought to identify major themes regarding communication of medication benefits and tradeoffs. Encounters occurred in six clinics within two academic health systems. English-speaking adult patients with a diagnosis of HFrEF (ejection fraction &lt;40%) were enrolled. Major themes regarding communication of benefits and tradeoffs were identified through analysis of transcripts.</div></div><div><h3>Results</h3><div>A total of 247 patient encounters were analyzed. Patients’ mean (SD) age was 62.9 (13.9); 70.5% were male; 64.0% were White, 26.3% Black, and 3.2% Hispanic/Latinx. Overall, 70% of encounters contained a discussion involving medication benefits. Substantial variability was observed, and four main themes emerged. 1) Primary benefits (increased survival, reduced hospitalizations, better quality of life) were commonly discussed in clinic visits, but clinicians described the magnitude of such benefits in only two cases; 2) Adjunctive drug benefits (improved physiology, tolerability, affordability) were described nonspecifically; 3) Persuasive forms of communication were common, including direct appeals to authority/guidelines, references to pharmaceutical advertisements, and emotive language; 4) Significant heterogeneity was present in the content and character of benefit tradeoff discussions.</div></div><div><h3>Conclusions</h3><div>Rare inclusion of medication benefit magnitude, variability in the presentation of benefits, and use of persuasive and emotive communication all challenge traditional notions of shared decision-making but are commonly encountered in clinical interactions for heart failure. Further work is needed to identify which of these characteristics are modifiable and which may promote or interfere with patient-centered care.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 195"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950343","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":"Acute Heart Failure: Transitioning From Symptom-Based Care to Remission","authors":"GAD COTTER MD ,&nbsp;BETH A. DAVISON PhD ,&nbsp;DOUGLAS L. MANN MD ,&nbsp;JAN BIEGUS MD, PhD ,&nbsp;JOZINE M. TERMAATEN MD, PhD ,&nbsp;MATTEO PAGNESI MD, PhD ,&nbsp;YONATHAN FREUND MD, PhD ,&nbsp;ADRIAAN A. VOORS MD, PhD ,&nbsp;PIOTR PONIKOWSKI MD, PhD ,&nbsp;MARCO METRA MD ,&nbsp;ALEXANDRE MEBAZAA MD, PhD","doi":"10.1016/j.cardfail.2024.12.016","DOIUrl":"10.1016/j.cardfail.2024.12.016","url":null,"abstract":"<div><div>During the past century, the characteristics of patients with heart failure (HF) and acute HF (AHF) have shifted from patients with severe pump failure due to rheumatic, hypertensive and ischemic heart disease to older and more obese patients with multiple severe comorbidities. The pathophysiology of AHF has shifted, in parallel, from that of advanced, end-stage pump failure caused by severe left ventricular dysfunction to age, obesity and comorbidity-related cardiovascular dysfunction combined with neurohormonal and inflammatory dysregulation or “inflammaging.” With the advent of neurohormonal blockers leading to improved outcomes of patients with chronic HF, the focus of AHF therapy has also changed from care directed at early symptom improvement to therapies directed toward longer-term improvements in quality of life and outcomes. Studies conducted in the past 5 years suggest that the beneficial effects seen with the 4 pillars of guideline-directed medical therapy for HF, mostly comprising neurohormonal blockade, can be extended to AHF when these therapies are initiated and rapidly uptitrated during admission and after discharge. A recent pilot study, CORTAHF (Effect of Short-Term Prednisone Therapy on CRP Change in Emergency Department Patients With Acute Heart Failure and Elevated Inflammatory Markers), has suggested that these benefits can be extended by treating patients with AHF and markers of inflammatory activation with anti-inflammatory therapies. Future studies should further examine whether combined anti-inflammatory therapy and neurohormonal blockade can lead to the reversal of disrupted underlying pathophysiology and remission in patients with AHF.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 106-114"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425494","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":"Changes in Seated Pulmonary Artery Pressure in Response to Titration of Heart Failure Medications During Ambulatory Monitoring","authors":"SANDIP K. ZALAWADIYA MBBS ,&nbsp;MICHAEL KIERNAN MD, MCS ,&nbsp;BARRY A. BORLAUG MD ,&nbsp;LYNNE WARNER STEVENSON MD ,&nbsp;AKSHAY S. DESAI MD ,&nbsp;MOSI BENNETT MD ,&nbsp;WILFRIED MULLENS MD ,&nbsp;NICHOLAS J. HIIVALA BME ,&nbsp;MAX M. OWENS ,&nbsp;LIVIU KLEIN MD, MS","doi":"10.1016/j.cardfail.2025.02.001","DOIUrl":"10.1016/j.cardfail.2025.02.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Ambulatory hemodynamic monitoring (AHM) of heart failure (HF) using pulmonary artery pressure (PAP) is marked by frequent changes in HF medications. We are beginning to learn how medication titrations during AHM affect mean PAP (mPAP) measured in the seated position, which reflects most waking hours.</div></div><div><h3>Method</h3><div>We analyzed the 12-month data from the PROACTIVE-HF trial of the Cordella Cordella, Endotronix Inc, Naperville, Illinois, United States) PAP sensor system. Seated mPAP was examined in the 14-days before and after isolated changes in medications; only those medications with ≥10 titrations were analyzed. Dependent sample Wilcoxon-signed rank test was used to compare changes in mPAP with titrations.</div></div><div><h3>Results</h3><div>We analyzed 456 subjects (age: 64 years, females: 40%, Black: 18%, HF with reduced ejection fraction: 46%). Loop diuretics (LD) were up-titrated 176 times in 133 patients and down-titrated 113 times in 96 patients. Before LD up-titration, mPAP increased by 1.6 ± 1.0 mm Hg; afterwards, it decreased by 2.3 ± 1.0 mm Hg (<em>P</em> &lt; 0.001), with most reduction occurring within 1 week. Down-titration of LD was followed by an increase of 1.8 ± 1.3 mm Hg (<em>P</em> = 0.004) over the next several days. Similar trends were observed across categories of ejection fraction (≤40% and &gt;40%). Angiotensin receptor neprilysin inhibitor (ARNI) up-titration decreased mPAP by 1.8 ± 1.9 mm Hg (<em>P</em> = 0.042), whereas down-titration increased mPAP by 1.5 ± 1.4 (<em>P</em> = 0.094). Mineralocorticoid receptor antagonist (MRA) up-titration tended to decrease mPAP (1.6 ± 2.5 mm Hg, <em>P</em> = 0.286,) whereas down-titration was followed by a significant increase in mPAP of 3.2 ± 1.6 mm Hg (<em>P</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>The AHM platform using seated mPAP data provided valuable insights into its short-term responses to isolated changes in HF medications. The seated mPAP changed expectedly in response to the titration of LD, whereas the degree of response varied for ARNI and MRA. Ongoing investigation will further characterize the timing and variability of responses to inform algorithms for ambulatory management of PAP.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 32-42"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414410","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 140-144"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146478429","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 160-162"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146478433","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 171"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146478439","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 173"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146478442","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}