Improving outpatient care in chronic heart failure

Despite advances in pharma and high-technology medicine, the rate of burdensome hospital admissions and mortality in patients with chronic heart failure (CHF) remains high. Over half of all admission-entailing decompensations have been repeatedly shown to emerge from non-compliance with outpatient prescriptions. Poor adherence to medication and non-medication treatment can only be broken by improving the patient’s awareness of the disease and his closer monitoring by healthcare professionals. The power of clinical and laboratory illness monitoring in line with the recommended quality criteria of medical aid in heart failure (HF) is strongly limited today by time resources available in outpatient and midwifery clinics. Meanwhile, an international and certain domestic experience has been built up to run CHF outpatient centres with involvement of specially-trained nursing and senior medical staff. Analytic evidence on such centres suggests a reduction in mortality and hospitalisation rate among the visiting patients. To combat existing drawbacks of CHF outpatient care, the National Medical Research Center of Cardiology in alliance with the Specialist Society of Heart Failure have developed the nurses’ guidelines for CHF rooms and are launching a medical staff training programme to manage CHF rooms, registry and data analysis. Furthermore, a procedure has been developed for patient routing to regional CHF outpatient cabinets that is being actively deployed in the Tyumen Region

Comparative estimation of prognostic value of the models GRACE, TIMI, PURSUIT in risk stratification of coronary complications in patients with non-ST-elevation acute coronary syndrome

The aim of investigation was to held comparative analysis of prognostic value of different models of short-term and long-term cardiovascular risk estimation in patients with non-ST-elevation acute coronary syndrome (ACS). Material and methods. This prospective investigation included 150 patients with non-ST-elevation ACS. During observation estimation of risk complications development level was held with the help of prognostic models GRACE, TIMI, PURSUIT, comparative analysis of predictive possibilities of this models, was held. Results. According to the results of investigation model GRACE demonstrated the most high sensitivity (100%) in prediction of all cause mortality during in-hospital observation. The most high specificity (90%) was marked in prediction of unfavourable outcomes during 6-months observation. TIMI risk stratification model revealed the most high sensitivity (64%), specificity (77%) and predictive accuracy (67%) in prediction of death/myocardial infarction/ischemia during 1-year observation, showed maximal value of positive predictive accuracy during in-hospital period and 12 months of observation in compare with other models. PURSUIT model of cardiovascular risk estimation showed the highest specificity (91%), which was marked in prediction of death/myocardial infarction during next 12 months. High predictive accuracy of this model (91 %) related to death/myocardial infarction revealed during 6 months and was maintained during 1-year observation. Conclusion. All systems of risk stratification had high prognostic value, negative predictive accuracy, that is all of them were effective in prognosis of favourable events in patients with non-ST-elevation ACS. GRACE model of risk stratification had maximal sensitivity in prediction of death and death or myocardial infarction during hospitalization and 6-month or 1 -year dynamic observation. System of risk stratification TIMI showed maximal value of positive predictive accuracy during in-hospital period and dynamic observation. System of risk stratification PURSUIT demonstrated maximal specificity in prediction of in-hospital, 6-month and 1-year outcomes. Also this model had maximal predictive accuracy related to the prognosis of death and death/myocardial infarction during in-hospital period and 1-year observation.Цель исследования: провести сравнительный анализ прогностической ценности различных моделей оценки краткосрочного и долгосрочного коронарного риска у больных острым коронарным синдромом без стойких подъемов сегмента ST. Материалы и методы. В проспективное наблюдение включено 150 больных острым коронарным синдромом без стойких подъемов сегмента ST (ОКСБПБТ). В ходе наблюдения проводилась оценка уровня риска развития осложнений с применением прогностических моделей GRACE, TIMI, PURSUIT; проводился сравнительный анализ предиктивных возможностей используемых моделей. Результаты. Согласно полученным результатам наиболее высокая чувствительность модели GRACE (100%) отмечалась в предсказании смерти от всех причин в госпитальный период. Наиболее высокая специфичность (90%) отмечалась в прогнозировании летальных исходов в течение 6-месячного наблюдения. Система риск-стратификации TIMI продемонстрировала наиболее высокие показатели чувствительности (64%), специфичности (77%) и предиктивной точности (67%) в отношении предсказания смерти/ИМ/ишемии на период годового наблюдения; показала наибольшее значение (по сравнению с другими шкалами) положительной предсказующей точности и в период госпитализации, и в период 12-месячного наблюдения. Система оценки риска PURSUIT показала наиболее высокую специфичность (91 %), которая наблюдалась в отношении прогнозирования смерти/ИМ в течение последующих 12 месяцев. Высокая предиктивная точность данной модели (91%) в отношении смерти/ИМ отмечалась в период 6 месяцев и сохранялась на протяжении годового наблюдения.Заключение. Все системы риск-стратификации обладают высокой прогностической значимостью; отрицательной предиктивной точностью, т.е. хорошо прогнозируют благоприятные исходы больных OKCBnST. Модель риска GRACE обладает максимальной чувствительностью при прогнозировании смерти и смерти или ИМ в период госпитализации и на период 6-месячного и годового динамического наблюдения. Шкала TIMI показала наибольшее значение положительной предсказующей точности и в период госпитализации, и в период динамического наблюдения. Система оценки риска PURSUIT обладает наибольшей специфичностью в прогнозировании госпитальных, 6-месячных и годовых исходов. Вышеуказанная система обладает наибольшей предсказывающей точностью в отношении прогноза смерти и смерти/инфаркта миокарда на период госпитального и годового наблюдения

Optimization of intravascular volume determination in patients with acute decompensated heart failure

Acute decompensated heart failure (ADHF) is based on multilevel pathological pathways, which include hemodynamic overload and venous stasis. Determination of the volemic status is one of the most important tasks in managing such patients. Despite the availability of modern diagnostic markers (physical examination, chest x-ray, and brain natriuretic peptide (BNP) assessment), they do not accurately assess the degree of fluid overload, and therefore there remains a need to find a new, accurate and simple technology for assessing pulmonary congestion. The urgency of this problem has led to the development of a novel non-invasive remote dielectric sensing (ReDS) technology, which is a quantitative method for measuring the total volume of lung fluid by determining the tissue dielectric properties. The use of this technology makes it possible to quickly, non-invasively and quantitatively measure the fluid content in the lungs, makes it possible to optimize the treatment regimen and reduces the number of readmissions. This article presents the results of studies on the efficacy, safety and prospects for using a ReDS technology for the quantitative measurement of total lung fluid in patients with ADHF

FRI0337 REAL WORLD SECUKINUMAB DRUG-SURVIVAL IN PSORIATIC ARTHRITIS

Background:Secukinumab (Cosentyx) is a human IgG1 monoclonal antibody that selectively binds to and neutralizes IL-17A. Several prospective randomized control trials have demonstrated the efficacy and safety of secukinumab in PsA, but there is a paucity of real life data in the PsA population.Objectives:To prospectively study secukinumab’s safety, efficacy, and tolerability in the cohort of PsA patients from the Israeli registry of inflammatory diseases.Methods:PsA patients fulfilling the CASPAR criteria from the Israeli registry of inflammatory diseases were included in the analysis, from 2010 to November 2019. The primary end point was secukinumab drug survival compared to other available TNFi drug. Bivariate and multivariate analysis of the factors that affect the drug event free survival was done by cox regression analysis. Drug survival according to treatment line (all treatment lines, or 2ndand above treatment lines) was examined using Kaplan-Meier curves.Results:Four hundred and four PsA patients were included, which had 709 treatment episodes (initiations) during the study period. Ninety patients had been treated with secukinumab (22%). Secukinumab treated patients were significantly older at time of initiation of treatment, and disease duration was longer. Secukinumab was more likely to be a second, third or forth line of treatment than the TNFi. . Time to an inefficacy event was longer for secukinumab than any other anti-TNF treatment. As a first line treatment secukinumab had drug survival similar to other TNFi. As a second or third line treatment, secukinumab had a better drug survival than other TNFi. Methotrexate did not have a significant effect on inefficacy event rate in combination treatment with secukinumab. Secukinumab, as infliximab and golimumab, was as effective in the higher BMI group as it was in the normal weight to obese groups. Smokers (current or past) did better on secukinumab than on TNFi. Secukinumab had a similar rate of adverse events compared to TNFi.Conclusion:In this multicenter real world study, secukinumab had a comparable drug survival to TNFi. As a second and beyond line of treatment secukinumab had a better drug survival and lower HR for an inefficacy event. IL-17 inhibition is an effective mechanism of action to treat PsA in real life, and should be used more frequently as a first and second line treatment.Tables and a graph:Table 1.Inefficacy events according to treatment and drug survival in 1, 2, and 3 years.DrugTotal episodesInefficacy events (%)HR95% CIP value1styear survival %2ndyear survival %3rdyear survival %SEC9030 (33.3)10.095865841ETA20286 (42.6)1.160.77-1.760.479755850IFX8734 (39.1)1.010.62-1.650.966826452ADA227103 (45.4)1.360.9-2.040.143715346GOL103103 (50)1.641.05-2.590.031635042Table 2.inefficacy events and drug survival according to line of treatment.DrugTotal episodesInefficacy events (%)HR95% CIP value1styear survival %2ndyear survival %3rdyear survival %1stlineSEC132 (15.4)10.216929276ETA13055 (42.3)3.250.79-13.340.101765951IFX2811 (39.3)2.880.64-13.010.168816352ADA10337 (35.9)2.630.63-10.910.183796359GOL2514 (56)4.551.03-200.0456050402ndand 3rdlinesSEC347 (20.6)10.039906666ETA6829 (42.6)1.680.74-3.850.218735751IFX5120 (39.2)1.420.6-3.360.431856454ADA11962 (52.1)2.51.15-5.480.022654635GOL5223 (44.2)2.260.97-5.270.066550464thlineSEC4321 (48.8)10.082824424ETA42 (50)1.10.25-4.730.9026733–IFX83 (37.5)0.830.25-2.790.7626969–ADA54 (80)4.871.6-14.810.00530––GOL2613 (50)1.290.64-2.580.473625231Figure 1.Cumulative survival without an inefficacy event of secukinumab compared to TNFα inhibitors regardless of treatment line.Disclosure of Interests:Tali Eviatar: None declared, Devy Zisman Consultant of: Novartis, Merav Lidar Consultant of: Novartis, Tatyana Reitblat Consultant of: Novartis, Alexandra Balbir-Gurman Consultant of: Novartis, Ori Elkayam Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Novartis, Jansen</jats:sec

Improving outpatient care in chronic heart failure

Despite advances in pharma and high-technology medicine, the rate of burdensome hospital admissions and mortality in patients with chronic heart failure (CHF) remains high. Over half of all admission-entailing decompensations have been repeatedly shown to emerge from non-compliance with outpatient prescriptions. Poor adherence to medication and non-medication treatment can only be broken by improving the patient’s awareness of the disease and his closer monitoring by healthcare professionals. The power of clinical and laboratory illness monitoring in line with the recommended quality criteria of medical aid in heart failure (HF) is strongly limited today by time resources available in outpatient and midwifery clinics. Meanwhile, an international and certain domestic experience has been built up to run CHF outpatient centres with involvement of specially-trained nursing and senior medical staff. Analytic evidence on such centres suggests a reduction in mortality and hospitalisation rate among the visiting patients. To combat existing drawbacks of CHF outpatient care, the National Medical Research Center of Cardiology in alliance with the Specialist Society of Heart Failure have developed the nurses’ guidelines for CHF rooms and are launching a medical staff training programme to manage CHF rooms, registry and data analysis. Furthermore, a procedure has been developed for patient routing to regional CHF outpatient cabinets that is being actively deployed in the Tyumen Region.</jats:p

Alcohol septal ablation and outcomes in patients with obstructive hypertrophic cardiomyopathy depending on outflow gradient and basal hypertrophy; [Исходы алкогольной септальной абляции у пациентов с обструктивной гипертрофической кардиомиопатией в зависимости от выраженности градиента и толщины межжелудочковой перегородки]

The aim of this study was to investigate the short and long-term efficiency of alcohol septal ablation (ASA) in different groups of obstructive hypertrophic cardiomyopathy (oHCM) patients with severe and non-severe gradients in the left ventricle outflow tract (LVOT) and those with severe and non-severe basal septal hypertrophy. Material and methods. In this study, 212 oHCM patients were included. The mean age was 52±15. Female patients were 50.7% (107 patients). Patients were divided into 4 groups, according to the septal hypertrophy pattern and the severity of LVOT gradient at rest: group 0 – patients without severe LVOT gradient (<50 mmHg at rest) or severe basal hypertrophy (<20 mm); group 1 – patients with severe LVOT gradient (≥50 mmHg at rest), but without severe basal hypertrophy (<20 mm); group 2 – patients without severe LVOT gradient (<50 mmHg at rest), but with severe basal hypertrophy (≥20 mm); group 3 – patients with severe LVOT gradient (≥50 mmHg at rest) and with severe basal hypertrophy (≥20 mm). Results. The median follow-up was 74 (38–127) months. The long-term survival rates in entire cohort were as follows 98.1 (95% CI 96.2–100.0)%, 92.3 (95% CI 88.5–96.3)%, 77.2 (95% CI 70.1–85.0)%, at 1-, 5-, 10-years of follow-up. The cumulative incidence of mortality cases in the long-term was 41 patients (19.3%). The difference in survival rates between groups in this study did not reach the statistical significance (p=0.16), but comparing a group 3 (PG≥50 mmHg and IVS≥20 mm) with the rest of patients (PG <50 mmHg and/or IVS <20 mm) the statistically significant difference between survival rates was identified (p=0.029) with a hazard ratio (HR) = 1.98 (95% CI 1.06–3.72). The mean functional class of chronic heart failure improved from 2.5±0.6 to 1.5±0.6. In the follow-up, the LVOT gradient decreased from 60 (40–89) mmHg to 15 (9–124) mmHg at rest and from 108 (80–135) mmHg to 26 (16–49) mmHg after provocation. The mean IVS reduction was 5±3 mm in the follow-up. Residual obstruction was observed in 42 cases (20%) in the whole cohort. Comparing patients with PG≥50 mmHg with those with PG <50 mmHg the higher reoperation rates were observed in patients with the severe LVOT gradient at baseline [p=0.046, HR = 2.12 (95% CI 1.00–4.49)]. Conclusion. Alcohol septal ablation showed higher reintervention rates in cases with severe resting left ventricle outflow gradient at baseline. Patients with severe resting gradient and severe basal hypertrophy at baseline had higher long-term mortality rates despite the septal reduction. © 2024 Geotar Media Publishing Group. All rights reserved