Morbidity and mortality in cats previously heart screened normal regarding feline cardiomyopathy

Felin kardiomyopati är den vanligaste förekommande hjärtpatologin hos katt och är även den främsta orsaken till kardiovaskulär mortalitet. Flera former av kardiomyopati förekommer, men hypertrofisk kardiomyopati (HCM) och restriktiv kardiomyopati (RCM) har visats vara de mest frekvent förekommande. Då ärftlighet för HCM påvisades hos maine coon-katter, initierade en svensk rasklubb tillsammans med PawPeds ett screeningprogram mot HCM hos katt år 2004. Vid screeningen hjärtauskulteras och hjärtultraljudas katten, varefter katten klassificeras som ”frisk”, ”gränsfall (equivocal)” avseende kardiomyopati eller som affekterad med HCM (graderad mild-måttlig-kraftig), RCM, eller med ”annan diagnos”. Djurägaren rekommenderas sedan uppföljande hjärtscreeningar oavsett resultat. Ingen uppföljande studie avseende morbiditet och mortalitet finns publicerad i dagsläget rörande de screenade katterna. Studiens syfte var att studera morbiditet och mortalitet hos nordiska katter som klassificerats som ”friska”, ”gränsfall” avseende felin kardiomyopati eller med ”annan diagnos” i PawPeds hälsoprogram. Studien var retrospektiv och inkluderade katter som screenats under perioden 1 januari 2004 till 31 december 2015 i Norden. Enkäter skickades ut till djurägare för totalt 11 123 katter, och 1342 svar erhölls. Svarsfrekvensen för enkäten var cirka 10 % för den totala populationen screenade katter i PawPeds hälsoprogram under studieperioden och 11 % för utskickade enkäter. I den aktuella studien inkluderades totalt 1071 katter, varav 1011 var klassificerade som ”friska”, 48 katter som ”gränsfall” och tolv katter med ”annan diagnos”. Studiens resultat visar att även katter klassificerade ”friska”, ”gränsfall” eller med ”annan diagnos” vid avelsscreening riskerar att utveckla och avlida till följd av kardiomyopati. Andelen katter som utvecklade kardiomyopati efter screening i den studerade populationen var 3,6 % för katter klassificerade som ”friska”, 18,8 % för katter klassificerade som ”gränsfall”, och 8,3 % för katter klassificerade med ”annan diagnos”. Av katterna klassificerade som ”friska” som senare utvecklade hjärtsjukdom var 65,9 % endast screenade vid ett tillfälle, motsvarande siffra för katter klassificerade som ”gränsfall” var 44,4 %. För både friscreenade och gränsfallskatter visades värdet av att screena katterna vid upprepade tillfällen, då medianåldern vid utveckling av kardiomyopati var 4,5 respektive 3,0 år. Hankatter fanns vara predisponerade för utveckling av kardiomyopati. Beträffande morbiditet var tand- och ledsjukdomar de två främsta rapporterade sjukdomskategorierna hos katter klassificerade ”friska” eller ”gränsfall”. Majoriteten (87 %) av de friscreenade katterna som utvecklade hjärtsjukdom rapporterades avlida till följd av sin hjärtsjukdom. De fem vanligaste dödsorsakerna för katter klassificerade som ”friska” var njursjukdom (17 %), tumörsjukdom (16 %), infektionssjukdom (12 %), hjärtsjukdom (10 %) och trauma/olycka (5 %). För katter klassificerade ”gränsfall” var njursjukdom (15 %) och ledsjukdom (15 %) de vanligaste dödsorsakerna. Inga tydliga samband mellan klassificeringen ”annan diagnos” och morbiditet eller mortalitet kunde ses i studien. Studiens huvudfynd var att katter ur samtliga screeninggrupper utvecklade kardiomyopati med en medianålder ≥3 år. Resultatet stärker dagens rekommendation om uppföljande screeningtillfällen för att identifiera de katter med en sen utveckling av kardiomyopati.Feline cardiomyopathy is the most common heart pathology in cats and also the largest contributor to cardiovascular mortality. Several different forms of cardiomyopathies are recognised in cats, with hypertrophic cardiomyopathy (HCM) and restrictive cardiomyopathy (RCM) being the most common ones. As a result of HCM being reported as hereditary in Maine Coon cats, a Swedish breed club initiated a screening program against HCM together with PawPeds in 2004. The screening consists of a heart auscultation and a heart echocardiographic examination of the cat, after which the cat is classified as “normal”, “equivocal”, “HCM (graded mild-moderate-severe)”, “RCM” or “other”. The cat is recommended follow up heart screenings, regardless of the screen result. There is no currently published follow-up study regarding morbidity and mortality in screened cats. The purpose of the study was to examine the morbidity and the mortality in Nordic cats previously classified as “normal”, “equivocal” regarding feline cardiomyopathy or “other” in the PawPeds health programme. The study was retrospective and included cats screened under the period of 1st of January 2004 to 31th of December 2015 in any Nordic country. A questionnaire was sent to a total of 11 123 cat owners, with 1342 responses obtained. This results in an answer frequency of 10% for all of the screened cats in PawPeds health programme during the study period, and an answer frequency of 11% for the questionnaires. A total of 1071 cats were included in the present study, 1011 were classified as “normal”, 48 cats as “equivocal” and 12 cats as “other”. The study showed that even cats classified as “normal”, “equivocal” or “other” in the screening programme are at risk of developing and die due to cardiomyopathy. In cats classified as “normal”, the proportions of cats that developed cardiomyopathy after screening were 3,6%, in the “equivocal” cats 18,8%, and 8,3% in cats classified as “other”. The study showed the importance of follow up screening of cats both for those classified as “normal” and “equivocal”, as the median age for developing cardiomyopathy were 4,5 and 3,0 years respectively. A total of 65,9% of the cats screened “normal” were only screened once, for the “equivocal” cats the same number was 44,4%. A predisposition for cardiomyopathy in males was observed. Regarding morbidity, dental and joint diseases were the most frequent disease categories in the “normal” and “equivocal” group. The majority (87%) of cats with heart disease in the “normal” screening group were reported to die due to their heart disease. The five most common causes of death in cats classified as “normal” were kidney disease (17%), neoplastic disease (16%), infectious disease (12%), heart disease (10%) and trauma/accident (5%). The most common causes of death in cats classified as “equivocal” were kidney disease (15%) and joint disease (15%). No pattern regarding morbidity or mortality between the classification could be identified in cats classified as “other”. The main finding of the study was that a proportion cats in all screening groups developed cardiomyopathy at a median age of ≥3,0 years. This result is in agreement with the current recommendation of follow up screening in cats to identify cats with a late onset of cardiomyopathy

Torasemide in heart failure treatment

Hjärtsvikt är ett tillstånd då hjärtfunktionen försämrats och cirkulationen inte förser kroppens alla organ med tillräckligt stort blodflöde. Vid hjärtsviktsbehandling är loopdiuretika viktigt för att behandla ödem då det verkar vätskedrivande. Torasemid är ett loopdiuretika som har visats vara effektivt och bra tolererat. I flera studier har effekterna jämförts mellan torasemid och furosemid varvid många betydelsefulla och förmånliga effekter har observerats för torasemid. Syftet med litteraturstudien var att ta reda på om torasemid kan vara ett bättre alternativ till furosemid vid hjärtsviktsbehandling, om torasemid bör kombineras med spironolakton, om furosemid borde sluta användas och varför torasemid inte används i större utsträckning vid hjärtsviktsbehandling. Slutsatsen av litteraturstudien är att torasemid borde användas istället för furosemid vid behandling av hjärtsvikt, vilket grundas på de fördelar som har redovisats i genomförda studier. Fördelar som har setts för torasemid är förbättring av New York Heart Association-klass, tillbakabildning av fibros i myokardiet, lägre totalmortalitet, lägre hjärtrelaterad mortalitet och en effekt även då patienten har utvecklat diuretikaresistens mot furosemid. Detta är betydande fördelar som talar för att torasemid ska vara förstahandsvalet vid val av loopdiuretika vid hjärtsviktsbehandling. Några biverkningar eller nackdelar har dessutom inte dokumenterats för torasemid som gör att läkemedlet skiljer sig från furosemid. Att sluta använda furosemid vore dock inte lämpligt, eftersom det har snabb effekt vid akut hjärtsviktsbehandling, men det borde inte längre tillhöra förstahandsvalet av loopdiuretika vid långtidsbehandling. Det är dock ett bra alternativ till torasemid vid överkänslighet eller andra kontraindikationer. Varför torasemid inte används mer vid hjärtsviktsbehandling är troligen beroende av att dess gynnsamma effekter inte är kända bland förskrivare av läkemedel, och för att furosemid väljs slentrianmässigt utan vidare eftertanke på alternativ. Spironolakton är en aldosteronantagonist som är viktig vid hjärtsviktsbehandling eftersom aldosteron spelar stor roll för hjärtats patofysiologi. En kombination av torasemid med spironolakton är att rekommendera, eftersom studier tydligt visar att torasemid och spironolakton inte har samma effekter. Effekten av spironolakton är viktig eftersom den ger minskad mortalitet och ingår därför i dagens standardbehandling vid hjärtsvikt. Utifrån alla dessa aspekter borde valet av loopdiuretika beaktas vid hjärtsviktsbehandling, och kunskapen om torasemids förmånliga effekter spridas.Congestive heart failure is a condition where the heart function is impaired and the circulation does not provide enough blood flow to the organs. Loop diuretics are important in the treatment of heart failure, due to its ability to treat the edema with the diuretic effects. Torasemide is a loop diuretic that has been proven to be effective and well tolerated. Many studies have compared the effects between torasemide and furosemide, in which important and beneficial effects have been observed for torasemide. The study’s intention was to find out if torasemide was a better alternative to furosemide in heart failure treatment, if torasemide should be combined with spironolactone, if furosemide shouldn’t be used anymore, and why torasemide is not used in a larger extent in the treatment of heart failure. The study’s conclusion is that torasemide should be used instead of furosemide in heart failure treatment. This is based on the benefits that have been seen in performed studies. The beneficial effects for torasemide that have been seen are an improvement in New York Heart Association-class, lower degree of fibrosis in the cardiac muscle cell, lower overall mortality, lower cardiac mortality and an effect on patients who have developed diuretic resistance to furosemide. These are advantages that are significant, and suggests that torasemide should be the first choice of loop diuretics in the treatment of heart failure. Disadvantages or side effects seen for torasemide are not distinguished from those seen for furosemide. The usage of furosemide should not be stopped, because of its rapid onset of action in acute heart failure treatment, but furosemide should not be the first choice of loop diuretics in long term treatment. It is a good alternative to torasemide and can be used in the case of hypersensitivity for torasemide or other contraindications. The reason why the usage of torasemide is not more widespread is likely due to lack of knowledge of torasemid’s beneficial effects for prescribing doctors. It is also likely due to routine-like selection of furosemide without further thought of available alternatives. Spironolactone is an aldosterone antagonist and is important in the heart failure treatment, since aldosterone is involved in the pathophysiology of the heart. A combination of torasemide and spironolactone is recommended, as studies clearly shows that the effects are not the same for torasemide and spironolactone. The effect of spironolactone is important as it has been proven to reduce mortality and therefore belongs to the current heart failure standard therapy. Based on all of these aspects, the choice of loop diuretics should be considered in the treatment of heart failure, and the knowledge of torasemide’s beneficial effects compared to furosemid, should be addressed

A Questionnaire Survey on Long-Term Outcomes in Cats Breed-Screened for Feline Cardiomyopathy

Simple Summary Feline cardiomyopathy (FCM) is a serious, potentially fatal disease in cats. There is an international screening program that aims to identify pedigree cats affected with FCM, as the disease is believed to be inherited in some cat families. Using a self-reporting questionnaire, this study explored the long-term outcomes of cats breed-screened for FCM. We found that approximately 9.3% of the cats developed FCM at some time-point of which approximately 50% were diagnosed within the screening program and 50% of these cats at the first breed-screen occasion. For cats that did develop FCM, there was a significantly higher risk for a cardiac related death and also a shorter time to all-cause mortality, compared to cats that did not develop FCM. Frequency and types of non-cardiac disease were similar in all screen classification groups. The large proportion of cats that did develop FCM later in life, despite normal previous screen results, underscores the value of repeated breed-screenings later in life to identify cats that develop FCM. Feline cardiomyopathy (FCM) is an important contributor to feline morbidity and mortality. This explorative follow-up questionnaire study was aimed at investigating the long-term outcome in cats breed-screened for FCM (BS-FCM) in three Nordic countries. Records of cats with >= 1 BS-FCM between 2004-2015 were included. Of the 1113 included cats, 104/1113 (9.3%) had developed FCM at some time-point. Fifty-nine of the 104 (56.7%) FCM cats were diagnosed within the screening program (Screen(FCM)), and 33/59 (55.9%) of these were diagnosed at the first BS-FCM. Screen(FCM) cats or with an owner-reported FCM diagnosis at a later time-point had a higher risk of cardiac-related death compared to cats that never developed FCM. A shorter lifespan was found in Screen(FCM) cats compared to those with normal screen results (p < 0.001). Times to all-cause mortality were shorter (p < 0.001) in cats that developed FCM at any time-point compared to those that did not. Non-cardiac morbidities were similar in all screen classification groups. The large proportion of cats that developed FCM at a later time-point underscores the need for repeated screenings later in life. Cats that developed FCM at any time-point had a shorter lifespan, with a similar proportion and in line with the nature of non-cardiac morbidities, compared to those without FCM

A Questionnaire Survey on Long-Term Outcomes in Cats Breed-Screened for Feline Cardiomyopathy

Feline cardiomyopathy (FCM) is an important contributor to feline morbidity and mortality. This explorative follow-up questionnaire study was aimed at investigating the long-term outcome in cats breed-screened for FCM (BS-FCM) in three Nordic countries. Records of cats with &ge;1 BS-FCM between 2004&ndash;2015 were included. Of the 1113 included cats, 104/1113 (9.3%) had developed FCM at some time-point. Fifty-nine of the 104 (56.7%) FCM cats were diagnosed within the screening program (ScreenFCM), and 33/59 (55.9%) of these were diagnosed at the first BS-FCM. ScreenFCM cats or with an owner-reported FCM diagnosis at a later time-point had a higher risk of cardiac-related death compared to cats that never developed FCM. A shorter lifespan was found in ScreenFCM cats compared to those with normal screen results (p &lt; 0.001). Times to all-cause mortality were shorter (p &lt; 0.001) in cats that developed FCM at any time-point compared to those that did not. Non-cardiac morbidities were similar in all screen classification groups. The large proportion of cats that developed FCM at a later time-point underscores the need for repeated screenings later in life. Cats that developed FCM at any time-point had a shorter lifespan, with a similar proportion and in line with the nature of non-cardiac morbidities, compared to those without FCM