Journal of cardiology最新文献

Background: The readmission rate in patients with heart failure (HF) has risen worldwide. One reason for the lack of reduction in readmission rates may be the absence of standardized evaluation methods tailored to the readmission period. Therefore, this study aimed to examine the influence of nutritional status and physical functions on readmission after discharge in patients with HF according to the readmission period.

Methods: This study was a scoping review. We conducted a comprehensive search for observational studies using the electronic databases PubMed, MEDLINE, CINAHL, and NPO Japan Medical Abstracts Society.

Results: The search resulted in a total of 452 selected articles, we finally selected 12 articles. The results of this scoping review showed that patients with HF who were readmitted from 3 months to 1 year after discharge exhibited significantly worse nutritional status and muscle strength compared with patients who were not readmitted. Patients with HF readmitted from 6 months to 1 year after discharge showed significantly worse postural balance function compared with patients who were not readmitted. Exercise tolerance was significantly worse in patients with HF readmitted from 6 months to 1 year and more than 1 year after discharge as compared with patients who were not readmitted. Malnutrition influenced readmissions from 3 to 6 months, 6 months to 1 year, and more than 1 year after discharge. Muscle weakness influenced readmissions from 3 months to 1 year after discharge. Low exercise tolerance influenced readmissions from 6 months to more than 1 year after discharge.

Conclusion: Malnutrition may influence readmissions over a wide range of periods, from 3 months to more than 1 year after discharge. Muscle weakness may influence short- to mid-term readmissions within 1 year after discharge, whereas low exercise tolerance may influence mid- to long-term readmissions occurring after 6 months.

Heart failure with preserved ejection fraction (HFpEF) is one of the most common forms of heart failure, and its prevalence is rising. As disease-modifying therapies become available, the accurate identification of early-stage HFpEF has become a major clinical priority. However, many patients with HFpEF are often managed for comorbidities such as hypertension, obesity, or diabetes, without recognizing the presence of HFpEF and targeted heart failure evaluation. In primary care, clinicians should keep HFpEF on the differential diagnosis for patients with unexplained exertional dyspnea, especially in older adults and in those with comorbidities such as obesity and atrial fibrillation. Simple clinical scores have been developed for this setting, including the HFpEF-ABA and BREATH₂ scores. These scoring systems can help clinicians estimate pre-test probabilities, enabling them to identify patients who should be referred to secondary or tertiary specialist centers. Close collaboration between primary care and secondary or tertiary centers is essential for timely diagnosis, treatment, and follow-up. In secondary and tertiary care settings, more detailed multimodality scores, such as H₂FPEF and HFA-PEFF which utilize natriuretic peptide levels and comprehensive echocardiography, are useful to rule in HFpEF. However, these scores have limited sensitivity to rule out HFpEF, particularly in obese patients, in whom natriuretic peptides and diastolic indices may underestimate the severity of left ventricular filling pressure. Patients with an intermediate probability should be evaluated by exercise stress echocardiography, but a substantial proportion of patients with negative or indeterminate test results still meets invasive hemodynamic criteria for HFpEF. This review summarizes current diagnostic strategies for suspected HFpEF and proposes a practical framework that combines validated noninvasive tools with selective use of invasive hemodynamic exercise testing and careful longitudinal follow-up.