Clinical profile and management of outpatients with non-ischemic and non-hypertensive systolic heart failure: Analysis of the Polish DATA-HELP registry

Background: Although coronary artery disease and arterial hypertension are the most common etiologies underlying heart failure (HF), there are still many patients present with non-ischemic and non-hypertensive HF whose management remains very challenging. In this research study the clinical profile and applied treatment of patients with HF without coronary artery disease or hypertension versus patients with known etiology of HF (ischemic/hypertensive) were compared. Methods: Clinical data about 5563 patients with stable systolic HF were obtained from prospective multicenter DATA-HELP registry performed between October and December 2009 in ambulatory clinics in Poland, in which 500 cardiologists and 290 general practitioners participated. Results: Heart failure of non-ischemic and non-hypertensive etiology which affected 10% of all patients and was particularly frequent in younger patients, both in women: < 50 years old 42%; 50–65 years old 12%; > 65 years old 7%; and men: < 50 years old 47%; 50–65 years old 10%; > 65 years old 5%; p < 0.0001. Patients with non-ischemic and non-hypertensive HF were characterized by younger age, fewer co-morbidities, shorter duration of HF and, surprisingly, more advanced HF. Patients in this group were less likely to have received life-prolonging treatment in HF recommended by European Society of Cardiology (ESC) and more often required symptomatic management. Similarly, they were more likely to have implanted CRT-D and ICD. Conclusions: Heart failure of non-ischemic and non-hypertensive origin affects particularly young patients. These patients, despite suffering from more advanced HF are not optimally managed according to ESC guidelines

Relations between combined oral contraceptive therapy and indices of autonomic balance (baroreflex sensitivity and heart rate variability) in young healthy women

Introduction: There are structural and functional links between autonomic nervous and endocrine systems. Derivatives of estrogens and gestagens applied in combined oral contraceptives (COC) reduce the production of endogenous sex steroids, but their effect on autonomic nervous system remains unknown. Aim: To compare indices of heart rate variability (HRV) and baroreflex sensitivity (BRS) among young healthy women taking vs. non-taking COC. Material and methods: We performed a cross-sectional study in a group of 53 healthy women (age: 23±3 years, BMI: 22.3±2.8 kg/m2) taking COC for ≥ 3 months (COC-group) and in a group of 113 healthy women (age: 24±4 years, BMI: 22.0±3.1 kg/m2) not taking COC for ≥3 months (n-COC-group). All examined women were between the 4th and the 8th day of menstrual (or pill-driven) cycle lasting from 21 to 35 days. Indices of autonomic balance was assessed based on the time- and frequency- domains of heart rate variability (HRV, very low (VLF), low (LF), high (HF) frequencies and total HRV spectrum). BRS was evaluated using the sequence (BRS-Seq) and the controlled breathing (BRS-CtBr) methods. Results: There were no differences in: age, weight, height, measures of adiposity and fat distribution, the menstrual (or pill-driven) cycle day on the day of examination, heart rate and HRV parameters between the two studied groups (all p>0.1). BRS-CtBr was higher among n-COC-group as compared to COC-group (20.00±6.28 vs. 18.07±6.57 ms/mmHg,

Self-Reported Medication Adherence Measured With Morisky Medication Adherence Scales and Its Determinants in Hypertensive Patients Aged ≥60 Years: A Systematic Review and Meta-Analysis

Background: The aim of this systematic review and meta-analysis was to estimate medication adherence in hypertensive patients aged ≥60 years and to explore potential determinants of adherence with antihypertensive treatment in this age group.Methods: A systematic search of the PubMed, Scopus, and Google Scholar using the Cochrane guidelines was performed. The analysis included articles published between 1 January 2000 and 30 June 2018. The patients were considered adherent if they scored ≥6 pts. on the Morisky Medication Adherence Scale (MMAS-8) or ≥3 pts. on the Morisky Green Levine Medication Adherence Scale (MGL). If available, also odds ratios (OR) with 95% confidence intervals (95% CI) for determinants of medication adherence were recorded.Results: Thirteen studies including a total of 5,247 patients were available for the meta-analysis. The pooled percentage of adherence was 68.86% (95% CI: 57.80–79.92%). Subgroup analysis did not demonstrate a significant difference in the adherence measured with the MMAS-8 and the MGL (68.31 vs. 70.39%, P = 0.773). The adherence of patients from Western countries (Europe, United States) turned out to be significantly higher than in other patients (83.87 vs. 54.30%, P = 0.004). The significant determinants of better adherence identified in more than one study were older age, retirement/unemployment, duration of hypertension >10 years, and a lower number of prescribed drugs.Conclusion: Medication adherence in the oldest old hypertensive patients seems to be higher than in younger persons. Adherence in older persons was associated with age, socioeconomic status, and therapy-related factors

Men With a Terminal Illness Relax Their Criteria for Facial Attractiveness

According to the life history paradigm, in life-threatening conditions, sexual selection criteria are relaxed in order to increase the probability of a last resort reproduction, ultimately contributing to reproductive success. This should be reflected in loosened mating preferences — a process observed in nonhuman animals. Studies investigating this aspect in humans, however, are scarce. This study explored the aesthetic preferences towards facial and nonfacial stimuli in terminally ill patients with heart failure (HF) and their healthy, same-sex peers. The aim was to examine if these two groups of men demonstrate different patterns of aesthetic judgments. Using a 7-point scale, 65 male patients with HF and 143 healthy men evaluated the perceived attractiveness of 15 photographs (five adult male faces, five adult female faces, and five nonfacial pictures). A mixed-design analysis of variance was run to assess group differences in aesthetic preferences. Compared to healthy controls, stimuli. HF patients rated the pictures using significantly higher scores, but this applied only to male and female, but not nonfacial, stimuli. We propose that lower criteria for facial attractiveness in HF patients are linked to relaxation of mate preferences as a result of a life-threatening conditions, and that this process can be an adaptive mating strategy from an ultimate, evolutionary perspective. However, other mechanisms (e.g., seeking social support) may be also responsible for the observed patterns

„W trosce o słabe serce” — model edukacji chorych hospitalizowanych z powodu dekompensacji niewydolności serca ze zmniejszoną frakcją wyrzutową

Introduction. Kompleksowa opieka nad chorymi z niewydolnością serca (KONS) is the name of a Polish programme for the coordinated care for patients with heart failure that has been proposed as a complex heart failure management solution based on European Society of Cardiology (ESC) Heart Failure recommendations. The challenge is that there are currently no available systemic solutions for educating these patients. Our project aimed to evaluate the effectiveness of a pilot model of education and telemonitoring known as ‘The Weak Heart’ for patients hospitalised due to decompensation of heart failure with reduced ejection fraction (HFrEF). Materials and methods. ‘The Weak Heart’ educational model consists of three phases: phase I — training and certification of nurses to perform the role of heart failure nurse specialists; phase II — checking the effectiveness of the model in a clinical setting; and phase III — implementation of patient education standards in cardiac centres. Data collected will be used to evaluate the impact of the programme on patients’ understanding regarding heart failure, their compliance with recommendations, and their pro-health behaviours in terms of self-care and self-control. Conclusion. ‘The Weak Heart’ programme will allow conclusions to be drawn concerning the usefulness and effectiveness of the first targeted heart failure-based patient educational model in Poland. Positive results in this pilot project could become the basis for implementing systemic changes, and introducing the model into everyday clinical practice.Introduction. Kompleksowa opieka nad chorymi z niewydolnością serca (KONS) is the name of a Polish programme for the coordinated care for patients with heart failure that has been proposed as a complex heart failure management solution based on European Society of Cardiology (ESC) Heart Failure recommendations. The challenge is that there are currently no available systemic solutions for educating these patients. Our project aimed to evaluate the effectiveness of a pilot model of education and telemonitoring known as ‘The Weak Heart’ for patients hospitalised due to decompensation of heart failure with reduced ejection fraction (HFrEF). Materials and methods. ‘The Weak Heart’ educational model consists of three phases: phase I — training and certification of nurses to perform the role of heart failure nurse specialists; phase II — checking the effectiveness of the model in a clinical setting; and phase III — implementation of patient education standards in cardiac centres. Data collected will be used to evaluate the impact of the programme on patients’ understanding regarding heart failure, their compliance with recommendations, and their pro-health behaviours in terms of self-care and self-control. Conclusion. ‘The Weak Heart’ programme will allow conclusions to be drawn concerning the usefulness and effectiveness of the first targeted heart failure-based patient educational model in Poland. Positive results in this pilot project could become the basis for implementing systemic changes, and introducing the model into everyday clinical practice

clinical profile and management of outpatients with non ischemic and non hypertensive systolic heart failure analysis of the polish data help registry

Background: Although coronary artery disease and arterial hypertension are the most common etiologies underlying heart failure (HF), there are still many patients present with non-ischemic and non-hypertensive HF whose management remains very challenging. In this research study the clinical profile and applied treatment of patients with HF without coronary artery disease or hypertension versus patients with known etiology of HF (ischemic/hypertensive) were compared. Methods: Clinical data about 5563 patients with stable systolic HF were obtained from prospective multicenter DATA-HELP registry performed between October and December 2009 in ambulatory clinics in Poland, in which 500 cardiologists and 290 general practitioners participated. Results: Heart failure of non-ischemic and non-hypertensive etiology which affected 10% of all patients and was particularly frequent in younger patients, both in women: 65 years old 7%; and men: 65 years old 5%; p < 0.0001. Patients with non-ischemic and non-hypertensive HF were characterized by younger age, fewer co-morbidities, shorter duration of HF and, surprisingly, more advanced HF. Patients in this group were less likely to have received life-prolonging treatment in HF recommended by European Society of Cardiology (ESC) and more often required symptomatic management. Similarly, they were more likely to have implanted CRT-D and ICD. Conclusions: Heart failure of non-ischemic and non-hypertensive origin affects particularly young patients. These patients, despite suffering from more advanced HF are not optimally managed according to ESC guidelines

Elevated lactate in acute heart failure patients with intracellular iron deficiency as identifier of poor outcome

Background: We believe that there is a physiological link between intracellular iron status (assessed by soluble transferrin receptor [sTfR]) and efficiency of energy production/consumption (assessed by lactate, a product of anaerobic cell metabolism), which may further impact the outcome of patients with acute heart failure (AHF).  Aims: To examine if elevated levels of lactate ( &gt; 2 mmol/L) accompanied by unmet cellular iron requirements (defined as sTfR &gt; 1.59 mg/L) identify AHF patients with an unfavourable outcome.  Methods: The study is a single-centre, retrospective analysis of AHF patients in whom lactate and iron status were assessed on admission. The endpoint of the study was one-year mortality.  Results: The study population consisted of 89 patients at a mean age of 65 ± 13 years. Mean systolic blood pressure and creatinine level were 135 ± 36 mmHg and 1.3 ± 0.6 mg/dL, respectively, and median [25th–75th quartiles] lactate level on admission was 2.0 [1.6–2.6] mmol/L. In 17 (19%) patients, both lactate and sTfR were below the cut-off values (group 1). In 38 (43%) individuals one of the markers was elevated (group 2) and in the remaining 34 (38%) patients both markers were above the predefined cut-off values (group 3). There was no difference in clinical and laboratory characteristics between the groups. During one-year follow-up 23 (26%) patients died. Mortality risk in group 3 was higher compared to the rest of the population (hazard ratio 5.6, 95% confidence interval 2.2–14, p = 0.0003), even after adjustments for well-defined prognostic factors.  Conclusions: Patients with unmet iron cell requirements and hyperlactataemia on admission have significantly higher mortality risk compared to individuals without those pathologies.

A patient with heart failure, who is frail: How does this affect therapeutic decisions?

Patients with heart failure (HF) are heterogeneous, not only related to comorbidities but also in the presentation of frailty syndrome. Frailty syndrome also affects patients with HF across the lifespan. Frailty in patients with HF has a significant impact on clinical features, diagnosis, management, adverse medical outcomes and costs. In everyday clinical practice, frail patients with HF require an individualized approach, often imposing the need to modify therapeutic decisions. The aim of this review is to illustrate how frailty and multimorbidity in HF can affect therapeutic decisions. The scientific evidence underlying this publication was obtained from an analysis of papers indexed in the PubMed database. The search was limited to articles published between 1990 and July 2022. The search was limited to full-text papers published in English. The database was searched for relevant MeSH phrases and their combinations and keywords including: “elderly, frail”; “frailty, elderly”; “frail older adults”; “frailty, older adults”; “adult, frail older”; “frailty, heart failure”; “frailty, multimorbidity”; “multimorbidity, heart failure”; “multimorbidity, elderly”; “older adults, cardiovascular diseases”. In therapeutic decisions regarding patients with HF, additionally burdened with multimorbidity and frailty, it becomes necessary to individualize the approach in relation to optimization and treatment of coexisting diseases, frailty assessment, pharmacological and non-pharmacological treatment and in the implementation of invasive procedures in the form of implantable devices or cardiac surgery