Geographic variations in the PARADIGM-HF heart failure trial

Aims: The globalization of clinical trials has highlighted geographic variations in patient characteristics, event rates, and treatment effects. We investigated these further in PARADIGM-HF, the largest and most globally representative trial in heart failure (HF) to date. Methods and results: We looked at five regions: North America (NA) 622 (8%), Western Europe (WE) 1680 (20%), Central/Eastern Europe/Russia (CEER) 2762 (33%), Latin America (LA) 1413 (17%), and Asia-Pacific (AP) 1487 (18%). Notable differences included: WE patients (mean age 68 years) and NA (65 years) were older than AP (58 years) and LA (63 years) and had more coronary disease; NA and CEER patients had the worst signs, symptoms, and functional status. North American patients were the most likely to have a defibrillating-device (53 vs. 2% AP) and least likely prescribed a mineralocorticoid receptor antagonist (36 vs. 61% LA). Other evidence-based therapies were used most frequently in NA and WE. Rates of the primary composite outcome of cardiovascular (CV) death or HF hospitalization (per 100 patient-years) varied among regions: NA 13.5 (95% CI 11.7–15.6), WE 9.6 (8.6–10.6), CEER 12.3 (11.4–13.2), LA 11.2 (10.0–12.5), and AP 12.5 (11.3–13.8). After adjustment for prognostic variables, relative to NA, the risk of CV death was higher in LA and AP and the risk of HF hospitalization lower in WE. The benefit of sacubitril/valsartan was consistent across regions. Conclusion: There were many regional differences in PARADIGM-HF, including in age, symptoms, comorbidity, background therapy, and event-rates, although these did not modify the benefit of sacubitril/valsartan

Transitional Care to Reduce Heart Failure Readmission Rates in South East Asia.

10.15420/cfr.2016:9:2Card Fail Rev2285-8

Transthyretin amyloid cardiomyopathy: The emerging role of cardiac amyloid imaging COMMENT

10.47102/annals-acadmedsg.202164ANNALS ACADEMY OF MEDICINE SINGAPORE507566-57

Utility and pitfalls of the electrocardiogram in the evaluation of cardiac amyloidosis

10.1111/anec.12967ANNALS OF NONINVASIVE ELECTROCARDIOLOG

Ventricular tachycardia from myocarditis following COVID-19 vaccination with tozinameran (BNT162b2, Pfizer-BioNTech)

10.1111/pace.14486PACE-PACING AND CLINICAL ELECTROPHYSIOLOG

Single-dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo-controlled study (PRACTICE-ASIA-HF)

10.1002/ehf2.12250ESC HEART FAILURE52344-35

Predictors of Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock despite Intra-Aortic Balloon Pump: Opportunities for Advanced Mechanical Circulatory Support in Asia

Introduction: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) mortality remains high despite revascularization and the use of the intra-aortic balloon pump (IABP). Advanced mechanical circulatory support (MCS) devices, such as catheter-based ventricular assist devices (cVAD), may impact mortality. We aim to identify predictors of mortality in AMI-CS implanted with IABP and the proportion eligible for advanced MCS in an Asian population. Methods: We retrospectively analyzed a cohort of Society for Cardiovascular Angiography and Intervention (SCAI) stage C and above AMI-CS patients with IABP implanted from 2017–2019. We excluded patients who had IABP implanted for indications other than AMI-CS. Primary outcome was 30-day mortality. Binary logistic regression was used to calculate adjusted odds ratios (aOR) for patient characteristics. Results: Over the 3-year period, 242 patients (mean age 64.1 ± 12.4 years, 88% males) with AMI-CS had IABP implanted. 30-day mortality was 55%. On univariate analysis, cardiac arrest (p p = 0.004) was more common in non-survivors. Non-survivors were less likely to be smokers (p = 0.001), had lower ejection fraction, higher creatinine/ lactate and lower pH (all p Conclusions: Early mortality in AMI-CS remains high despite IABP. Many patients would have qualified for higher degrees of MCS

Genomics in practice - a review of inherited cardiac conditions

Interest in inherited cardiovascular conditions (ICCs) is fueled by resources devoted to its diagnosis, management, and research. The rapid advancement of DNA genomic sequencing deepens our understanding of ICCs. The ICC genomic landscape empowers the development of diagnostic guidelines and the discovery of potential therapeutic targets and promises novel therapeutics, especially in precision cardiology. Therefore, it is essential for healthcare institutes and systems to develop contextual frameworks based on current guidelines to provide holistic care for patients with ICCs. The clinical frameworks and considerations described in this review provide an overview of the operations of an ICC clinic, including wet and dry lab conditions, work performed by a healthcare professional, and the variety of cases, ranging from cardiomyopathies to arrythmias to aortopathies. Insights from our experience in an ICC clinic in Singapore add to the discussion of the challenges and benefits for patients and clinicians who serve them

The Singapore heart failure outcomes and phenotypes (SHOP) study and prospective evaluation of outcome in patients with heart failure with preserved left ventricular ejection fraction (PEOPLE) study: Rationale and design

10.1016/j.cardfail.2013.01.007Journal of Cardiac Failure193156-16