Sleep disordered breathing in patients with heart failure

Sleep disordered breathing (SDB) is a common co-morbidity in patients with heart failure(HF). Both its forms — central and obstructive sleep apnea — are highly prevalent in thispopulation. SDB fragments sleep, impairs life quality, worsens exercise tolerance, worsens HFand is an independent predictor of poor prognosis. Still, SDB remains largely undiagnosed.Therefore, early detection of SDB seems to be of primary importance, especially in the presenceof new diagnostic and therapeutic methods. Treatment with continuous positive airwaypressure (CPAP) increases left ventricular ejection fraction and stroke volume in virtually allHF patients with obstructive and in 50% with central sleep apnea. For those in whom centralsleep apnea is not suppressed by CPAP, a trial of adaptive servoventilation is recommended.Although no randomized, controlled trials have shown improvement in mortality, several observationalstudies have shown that effective treatment of both forms of sleep apnea with variouspositive airway pressure devices improves survival of HF patients. Currently, 2 large trials withnewer masked based therapies with adaptive servoventilation are in progress. This article isa brief overview of present knowledge, the pathophysiology, diagnostic approach and therapy ofSDB

The patient with heart failure in the face of the coronavirus disease 2019 pandemic : an expert opinion of the Heart Failure Working Group of the Polish Cardiac Society

ABSTRACT Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), a new coronavirus that induces acute respiratory failure among other conditions, is the cause of the rapidly spreading coronavirus disease 2019 (COVID‑19), affecting thousands of people around the world. The present expert opinion is a synthetic summary of the current knowledge on the various aspects of heart failure in patients with COVID‑19. The aim of the paper was to provide clinicians with necessary information useful in daily clinical practice

Zastosowanie lewosimendanu u chorych z ostrą niewydolnością serca z objawami małego rzutu minutowego serca: opis serii przypadków

The report presents single centre experience in application of levosimendan in patients with acute heart failure with low cardiacoutput. All patients underwent haemodynamic measurement before and after administration of the drug. Levosimendanimproved haemodynamics and was useful in this subpopulation of patients

Digital health and modern technologies applied in patients with heart failure: Can we support patients' psychosocial well-being?

Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients' health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care

Skrzepliny wewnątrzsercowe w zatorowości płucnej a priori niewysokiego ryzyka: dylematy terapeutyczne

Pulmonary embolism (PE) of a priori non high risk according to ESC guidelines, but coexisting with intracardiac thrombi ispotentially a life threatening disease. The recommendations regarding therapy in such situations are not clear. We report twocases of PE with coexisting intracardiac thrombi. The 74 year-old woman was admitted after previous cardiac arrest in thecourse of PE with the presence of intracardiac thrombi in right ventricle. Due to lack of clinical improvement during heparinadministration she was treated with thrombolysis. The 72 year-old obese woman with hypertension, diabetes and previousstroke with right-sided paresis was admitted after 2 episodes of loss of consciousness, with intracardiac thrombus in bothright and left heart. Due to contraindications to both surgery and thrombolysis, she was treated with heparin. Both womenrecovered successfully. These cases illustrate the importance of individual treatment strategy

The spectrum of malignancies among adult HIV cohort in Poland between 1995 and 2012 : a retrospective analysis of 288 cases

THE AIM OF THE STUDY: The aim of the study was to evaluate the spectrum of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs) in HIV-infected patients in Poland. MATERIAL AND METHODS: A retrospective observational study was conducted among HIV-infected adult patients who developed a malignancy between 1995 and 2012 in a Polish cohort. Malignancies were divided into ADMs and NADMs. Non-AIDS-defining malignancies were further categorised as virus-related (NADMs-VR) and unrelated (NADMs-VUR). Epidemiological data was analysed according to demographic data, medical history, and HIV-related information. Results were analysed by OR, EPITools package parameters and Fisher's exact test. RESULTS: In this study 288 malignancies were discovered. The mean age at diagnosis was 41.25 years (IQR20-81); for ADMs 38.05 years, and for NADMs-VURs 46.42 years; 72.22% were male, 40.28% were co-infected with HCV. The risk behaviours were: 37.85% IDU, 33.33% MSM, and 24.31% heterosexual. Mean CD4+ at the diagnosis was 282 cells/mm(3) (for ADMs 232 and for NADMs-VUR 395). Average duration of HIV infection at diagnosis was 5.69 years. There were 159 (55.2%) ADMs and 129 (44.8%) NADMs, among whom 58 (44.96%) NADMs-VR and 71 (55.04%) NADMs-VUR. The most frequent malignancies were: NHL (n = 76; 26.39%), KS (n = 49; 17.01%), ICC (n = 34; 11.81%), HD (n = 23; 7.99%), lung cancer (n = 18; 6.25%) and HCC (n = 14; 4.86%). The amount of NADMs, NADMs-VURs in particular, is increasing at present. Male gender (OR = 1.889; 95% CI: 1.104–3.233; p = 0.024), advanced age: 50–60 years (OR = 3.022; 95% CI: 1.359–6.720; p = 0.01) and ≥ 60 years (OR = 15.111; 95% CI: 3.122–73.151; p < 0.001), longer duration of HIV-infection and successful HAART (OR = 2.769; 95% CI: 1.675–4.577; p = 0) were independent predictors of NADMs overall, respectively. CONCLUSIONS: In a Polish cohort NHL was the most frequent malignancy among ADMs, whereas HD was the most frequent among NADMs. Increased incidence of NADMs appearing in elderly men with longer duration of HIV-infection and with better virological and immunological control was confirmed. As HIV-infected individuals live longer, better screening strategies, especially for NADMs-VUR, are needed. The spectrum of cancer diagnoses in Poland currently does not appear dissimilar to that observed in other European populations

Expert opinion of the Heart Failure Working Group of the Polish Cardiac Society on the use of dapagliflozin in the treatment of heart failure with reduced ejection fraction

ABSTRACT Heart failure (HF) is a global health problem inherent in an aging population with coexisting cardiovascular diseases. Based on data from the Polish National Health Fund (Polish, Narodowy Fundusz Zdrowia), approximately 1.2 million people in Poland currently suffer from HF, and 140 000 of them die annually. Recently, Poland was ranked fifth among the European Union countries regarding the number of patients with diagnosed HF and first in terms of the number of HF hospitalizations (547 per 100 000 population) among 34 countries associated in the Organization for Economic Cooperation and Development. In recent years, a significant progress has been made in the diagnosis and treatment of HF with reduced left ventricular ejection fraction (HFrEF), which has resulted in a reduction in cardiovascular and total mortality. Despite these advantages, 5-year survival in the course of HF is still worse than that observed in some types of cancer, both in the populations of men and women. Hence, the search for drugs improving the prognosis in this group of patients is still ongoing. Sodium-glucose cotransporter 2 inhibitors represent a new group of drugs that will undoubtedly be a milestone in the treatment of patients with HFrEF. This expert opinion covers the history of dapagliflozin, which, from a drug dedicated to the treatment of type 2 diabetes, has become one of the most effective drugs improving prognosis and quality of life as well as reducing the number of hospitalizations in patients with HF. This document presents the opinion from the experts of the Heart Failure Working Group of the Polish Cardiac Society on the most relevant studies on dapagliflozin and indications for its use