New ways to visualize and combat congestion in heart failure = Nuevos modos de visualizar y combatir la congestión en la insuficiencia cardiaca

No abstract available

The year in cardiology: heart failure. The year in cardiology 2019.

No abstract available

A META-ANALYSIS REPORTING EFFECTS OF ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS IN PATIENTSWITHOUT HEART FAILURE

Translation articles: G. Savarese, P. Costanzo, J.G.F. Cleland, E. Vassallo, D. Ruggiero, G. Rosano, P. Perrone-Filardi «A Meta-Analysis Reporting Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Without Heart Failure» J Am Coll Cardiol 2013;61(2):131-42; http://dx.doi.org/10.1016/j.jacc.2012.10.01

Are metabolic equivalents (METS) an accurate method for estimating change in peak oxygen consumption after cardiac rehabilitation?

Background: Maximal cardiopulmonary exercise testing (CPET) is the “gold standard” method of determining Vo2peak. When CPET is unavailable, VO2peak and metabolic equivalents (METs) are estimated from treadmill or cycle ergometer workloads. UK cardiac rehabilitation programmes (CR) use estimated METs to report changes in cardiorespiratory fitness (CRF). However, the accuracy of determining changes in VO2peak based on changes in estimated METs is not known. Methods: 27 patients with coronary heart disease (88.9% male; age 59.5 ± 10.0 years, body mass index 29.6 ± 3.8 kg.m-2) performed maximal CPET before and after an exercise based CR intervention. VO2peak was directly determined using ventilatory gas exchange data and was also estimated using the American College of Sports Medicine (ACSM) leg cycling equation for METs. Agreement between changes in directly determined VO2peak and VO2peak estimated from METs was tested using Bland-Altman limits of agreement (LoA), and intraclass correlation coefficients. Results: Directly determined VO2peak did not increase significantly following CR (0.5 ml.kg-1.min-1 (2.7%); p=0.332). In contrast, estimated VO2peak increased significantly (0.4 METs; 1.4 ml.kg-1.min-1; 6.7%; p=0.006). The mean bias for estimated VO2peak versus directly-determined VO2peak was 0.7 ml.kg-1.min-1 (LoA -4.7 to 5.9 ml.kg-1.min-1). Aerobic efficiency, (ΔVO2/ΔWR slope) was significantly associated with estimated VO2peak measurement error. Conclusion: Changes in estimated VO2peak determined using the ACSM equation for leg cycling are not accurate surrogates for directly determined changes in VO2peak. Reporting mean CRF changes using estimated METs may over-estimate the efficacy of CR and lead to a different interpretation of study findings compared to directly determined VO2peak

Valuing health-related quality of life in heart failure: a systematic review of methods to derive quality-adjusted life years (QALYs) in trial-based cost-utility analyses

The accurate measurement of health-related quality of life (HRQoL) and the value of improving it for patients are essential for deriving quality-adjusted life years (QALYs) to inform treatment choice and resource allocation. The objective of this review was to identify and describe the approaches used to measure and value change in HRQoL in trial-based economic evaluations of heart failure interventions which derive QALYs as an outcome. Three databases (PubMed, CINAHL, Cochrane) were systematically searched. Twenty studies reporting economic evaluations based on 18 individual trials were identified. Most studies (n = 17) utilised generic preference-based measures to describe HRQoL and derive QALYs, commonly the EQ-5D-3L. Of these, three studies (from the same trial) also used mapping from a condition-specific to a generic measure. The remaining three studies used patients’ direct valuation of their own health or physician-reported outcomes to derive QALYs. Only 7 of the 20 studies reported significant incremental QALY gains. Most interventions were reported as being likely to be cost-effective at specified willingness to pay thresholds. The substantial variation in the approach applied to derive QALYs in the measurement of and value attributed to HRQoL in heart failure requires further investigation

Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from The First Euro Heart Failure Survey

Background: Heart failure is heterogeneous in aetiology, pathophysiology, and presentation. Despite this diversity, clinical trials of patients hospitalized for HF deal with this problem as a single entity, which may be one reason for repeated failures. Methods: The first EuroHeart Failure Survey screened consecutive deaths and discharges of patients with suspected heart failure during 2000–2001. Patients were sorted into seven mutually exclusive hierarchical presentations: (1) with cardiac arrest/ventricular arrhythmia; (2) with acute coronary syndrome; (3) with rapid atrial fibrillation; (4) with acute breathlessness; (5) with other symptoms/signs such as peripheral oedema; (6) with stable symptoms; and (7) others in whom the contribution of HF to admission was not clear. Results: The 10,701 patients enrolled were classified into the above seven presentations as follows: 260 (2%), 560 (5%), 799 (8%), 2479 (24%), 1040 (10%), 703 (7%), and 4691 (45%) for which index-admission mortality was 26%, 20%, 10%, 8%, 6%, 6%, and 4%, respectively. Compared to those in group 7, the hazard ratios for death during the index admission were 4.9 (p ≤ 0.001), 4.0 (p < 0.001), 2.2 (p < 0.001), 2.1 (p < 0.001), 1.4 (p < 0.04) and 1.4 (p = 0.04), respectively. These differences were no longer statistically significant by 12 weeks. Conclusion: There is great diversity in the presentation of heart failure that is associated with very different short-term outcomes. Only a minority of hospitalizations associated with suspected heart failure are associated with acute breathlessness. This should be taken into account in the design of future clinical trials

Classification of the level of evidence in international guidelines for acute and chronic heart failure

Over the centuries, medicine has evolved as a system of care dependent on magic and superstition, fashion, a large placebo effect, self-confident physicians, the fears of patients, and some astute observations. More recently, attempts have begun to put medical care on a more scientific basis by making observations on large numbers of patients to evolve rational constructs for why treatments are effective or fail and ultimately by putting theory and observation to the test in randomized controlled trials. It will be a long time before the science of medicine has eliminated, replaced, or endorsed the current practices and dogma of medical treatment, but a start must be made if future generations of patients are to avoid potentially unnecessary or harmful traditional treatments. Chronic aspirin therapy (1, 2, 3, 4), cosmetic angioplasty (5), and intravenous inotropic therapy (6,7) are just three examples of unproven and potentially wasteful or harmful interventions that are widely practiced due to the failure of doctors to understand the evidence presented to the

Should we resurrect acetazolamide as a diuretic for congestion due to heart failure?

No abstract available