Efficacy and safety of torsemide versus furosemide in heart failure patients: A systematic review of randomized controlled trials

Applied Clinical Informatics

Background Heart failure is a complex clinical syndrome noted on approximately 1 in 8 death certificates in the United States. Vital to reducing complications of heart failure and preventing hospital readmissions is adherence to heart failure self-care routines. Mobile health offers promising opportunities for enhancing self-care behaviors by facilitating tracking and timely reminders. Objective We sought to investigate three characteristics of heart failure patients with respect to their heart failure self-care behaviors: (1) internet use to search for heart failure information; (2) familiarity with mobile health apps and devices; and (3) perceptions of using activity trackers or smartwatches to aid in their heart failure self-care. Methods Forty-nine heart failure patients were asked about their internet and mobile health usage. The structured interview included questions adapted from the Health Information National Trends Survey …

Heart Rhythm O2

BackgroundLimited real-world evidence exists for outcomes with contemporary guideline-directed medical therapy (GDMT) or GDMT with implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT-D) therapy for patients with heart failure with reduced ejection fraction (HFrEF) and left ventricular ejection fraction (LVEF) ≤35%.ObjectiveThe present study aimed to assess survival associated with GDMT or GDMT with ICD/CRT-D therapy.MethodsThis retrospective observational study included real-world de-identified data from January 1, 2016, to December 19, 2023, from 24 U.S. institutions per participating institutional agreements (egnite Database; egnite, Inc.). Patients with a diagnosis of HFrEF and an echocardiographic study documenting LVEF ≤35% were included for analysis.ResultsOf 43,591 patients with eligible index event of LVEF ≤35%, prescription history through ≥1 …

Chinese medical journal

Background Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China. Methods Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed. Results A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset …

Heliyon

BackgroundLow-dose colchicine has been shown to lower major adverse cardiovascular events (MACE) among those with cardiovascular disease (CVD). It remains unclear how long a CVD patient needs to live to potentially benefit from colchicine. Our study aimed to determine the time to benefit (TTB) of colchicine in individuals with CVD.MethodsLiterature searches were performed in PubMed for the cardiovascular outcome trial of colchicine in patients with CVD until October 12, 2023. The primary outcome measured was MACE. Reconstructed individual participant data (IPD) and the stratified Cox proportional hazards model were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) to estimate the efficacy of colchicine, and Weibull survival curves were fitted to estimate TTB for specific absolute risk reduction (ARR) thresholds (0.002, 0.005, and 0.01).ResultsFour trials randomizing 11,594 …

Existing risk prediction models for hospitalized heart failure patients are limited. We identified patients hospitalized with a diagnosis of heart failure between 7 May 2013 and 26 April 2022 from a large academic, quaternary care medical centre (training cohort). Demographics, medical comorbidities, vitals, and labs were collected and were used to construct random forest machine learning models to predict in‐hospital mortality. Models were compared with logistic regression, and to commonly used heart failure risk scores. The models were subsequently validated in patients hospitalized with a diagnosis of heart failure from a second academic, community medical centre (validation cohort). The entire cohort comprised 21 802 patients, of which 14 539 were in the training cohort and 7263 were in the validation cohort. The median age (25th–75th percentile) was 70 (58–82) for the entire cohort, 43.2% were female …

Perhaps nowhere else is the tradeoff between access and quality of care as apparent as in the emergency invasive management of patients with acute coronary syndromes (ACS) and cardiogenic shock (CS). These patients require rapid hemodynamic stabilization and emergency percutaneous coronary intervention (PCI), demanding a highly skilled cardiac catheterization laboratory team. Though PCI has grown safer over the years, there remains a small inverse association between hospital and operator volume and outcomes, 1 and all else being equal, higher-volume operators and hospitals should have better outcomes, perhaps especially in these very sick patients. 2 However, all else is not equal in the setting of CS complicating ACS, in which in-hospital mortality is twice as high among those with first-medical-contactto-device time> 90 minutes compared with# 90 minutes. 3 The importance of timely access to …

Journal of the American College of Cardiology

BackgroundPoor adherence to GDMT leaves patients with HFrEF at persistent risk of clinical decline. We assessed adherence to GDMT, including quadruple therapy (QT) ie, ARNI, β-blocker, MRA, SGLT2i, and identified characteristics associated with adherence among US patients with HFrEF.MethodsPatients with HFrEF who had≥ 2 fills of GDMT from 4/2022-12/2022 were identified and described using Optum's de-identified Clinformatics® Data Mart Database. A multivariable logistic regression evaluated associations between patient characteristics and adherence ie, proportion of days covered≥ 0.8.ResultsThe analytic cohort included 47,421 patients (mean age 71 years [SD: 11], 60% male, 68% White, 12% Black). GDMT prevalence was lowest for SGLT2is (8%) and highest for β-blockers (77%); adherence was lowest for ARNI (73%) and SGLT2is (78%)(Table). Less than 1% of patients received QT and 62 …

Circulation

Background Existing data and clinical trials could not determine whether faster intravenous thrombolytic therapy (IVT) translates into better long-term functional outcomes after acute ischemic stroke among those treated with endovascular thrombectomy (EVT). Patient-level national data can provide the required large population to study the associations between earlier IVT, versus later, with longitudinal functional outcomes and mortality in patients receiving IVT+EVT combined treatment. Methods This cohort study included older US patients (age ≥65 years) who received IVT within 4.5 hours or EVT within 7 hours after acute ischemic stroke using the linked 2015 to 2018 Get With The Guidelines–Stroke and Medicare database (38 913 treated with IVT only and 3946 with IVT+EVT). Primary outcome was home time, a patient-prioritized functional outcome. Secondary outcomes included all-cause mortality in 1 year …

Aims Multivariable prediction models can be used to estimate risk of incident heart failure (HF) in the general population. A systematic review and meta‐analysis was performed to determine the performance of models. Methods and results From inception to 3 November 2022 MEDLINE and EMBASE databases were searched for studies of multivariable models derived, validated and/or augmented for HF prediction in community‐based cohorts. Discrimination measures for models with c‐statistic data from ≥3 cohorts were pooled by Bayesian meta‐analysis, with heterogeneity assessed through a 95% prediction interval (PI). Risk of bias was assessed using PROBAST. We included 36 studies with 59 prediction models. In meta‐analysis, the Atherosclerosis Risk in Communities (ARIC) risk score (summary c‐statistic 0.802, 95% confidence interval [CI] 0.707–0.883), GRaph‐based Attention Model (GRAM; 0.791, 95 …

European Heart Journal

Background After acute myocardial infarction (AMI), patients have similar mortality regardless of whether AMI is silent or not. Less is known about whether outcomes after left ventricular systolic dysfunction (LVSD) varies by absence or presence of heart failure (HF) symptoms (Stage B and C HF, respectively). Methods In Studies of Left Ventricular Dysfunction (SOLVD), patients with EF ≤35% were randomized to enalapril or placebo. We compared 4-year mortality in 2569 patients with HF symptoms (Stage C HF) enrolled in SOLVD-Treatment trial with that in 4228 patients without symptoms (Stage B) in SOLVD-Prevention trial, adjusting for 24 baseline characteristics including age, sex, race, EF, symptoms (as indexed by NYHA class). Results Patients in SOVLD-Treatment had a higher risk of death (HR, 2.63; 95% CI, 2.37–2.90; p<0.001), which remained …

JAMA cardiology

In this issue of JAMA Cardiology, Perera and coauthors1 report that myocardial viability status has no influence on the outcomes associated with either percutaneous revascularization or optimal medical therapy in patients with heart failure and reduced ejection fraction (HFrEF). An accompanying Invited Commentary by Panza2 suggests that viability assessment should be more selectively applied to inform a risk/benefit discussion in complex cases being considered for revascularization.There is another lesson that emanates from the results of the STICH3 and REVIVED-BCIS2 trials4 involving the sequence of evaluation and management decisions that often occur in patients hospitalized with HFrEF. After initial diuresis and stabilization, there is often a clinical imperative to perform catheterization to identify coronary artery disease (CAD). This may be amplified by findings of elevated highsensitivity troponin levels …

Journal of Cardiac Failure

IntroductionHeart Failure (HF) is projected to impact over 8 million people by 2030. The complexity of HF is compounded by adverse effects of social determinants of health (SDOH), defined as "conditions in which people are born, grow, work, live, age, and the wider set of forces and systems shaping the conditions of daily life". A 2020 study of Medicare beneficiaries hospitalized with HF found that patients burdened by a SDOH factor were associated with almost 3 times the risk of 90‐day mortality, compared to those without these factors. The American Heart Association recognizes the adverse impact of SDOH on HF patients and is driving efforts to improve assessing and addressing these factors.HypothesisBy leading IMPLEMENT-HF (I-HF), a national quality improvement initiative with a component focused on improving organizations' assessment of health-related social needs (HRSN), we aim to increase the …

medRxiv

Mobile health (mHealth) methods have grown in popularity in preventative medicine due to their convenience, cost, and ability to acquire actionable data. At the same time, the burden of many diseases has grown due to their prevalence and high rates of morbidity and mortality. To combat this burden, mHealth can be customized to improve adherence to recommended regimens and decrease doctor or hospital visits for patients and their families. Heart failure (HF) is a disease with an especially high burden for which mHealth can be used to promote adherence to advised care plans with the goal of decreasing exacerbations and their associated urgent and emergency care visits. Our study compared adherence to different mHealth monitoring regimens that used activity trackers, scales, and a mobile app with gamification features and a financial incentive. In a prospective analysis of 111 HF patients monitored for 180 days, we found that a regimen including a mobile app with a gamified financial incentive led to significantly higher adherence to activity tracker (95% vs. 72.2%, p=0.0101) and weight (87.5% vs. 69.4%, p=0.0016) monitoring compared to a regimen that included the monitoring devices alone. Our findings indicate that mobile apps with added engagement features can be useful tools to reduce temporal adherence decline and may thus increase the impact of mHealth driven interventions.

Journal of Cardiopulmonary Rehabilitation and Prevention

METHODSWe accessed Medicare FFS claims through the Virtual Research Data Center of the Centers for Medicare and Medicaid Services. Claims for CR services between January 1, 2019, and September 31, 2022, were identified in outpatient files using Current Procedural Terminology codes 93797 and 93798. Virtual or hybrid CR sessions were identified by claims with “CR” or “DR” modifiers (indicating disaster or emergency-related claims). To assess the impact of the pandemic on CR availability and use, we compared the rate of participation and initiation of CR in the Medicare FFS population in two 6-mo study periods: September 2019 to February 2020 (pre-pandemic, period 1) and April 2022 to September 2022 (most recent data available, period 2). As in prior work, 4 we used a 12-mo lookback period to identify patients eligible for CR within each of the study periods: patients with claims for acute …

Stroke and Vascular Neurology

Background Given the swift advancements in artificial intelligence (AI), the utilisation of AI-based clinical decision support systems (AI-CDSSs) has become increasingly prevalent in the medical domain, particularly in the management of cerebrovascular disease.Aims To describe the design, rationale and methods of a cluster-randomised multifaceted intervention trial aimed at investigating the effect of cerebrovascular disease AI-CDSS on the clinical outcomes of patients who had a stroke and on stroke care quality.Design The GOLDEN BRIDGE II trial is a multicentre, open-label, cluster-randomised multifaceted intervention study. A total of 80 hospitals in China were randomly assigned to the AI-CDSS intervention group or the control group. For eligible participants with acute ischaemic stroke in the AI-CDSS intervention group, cerebrovascular disease AI-CDSS will provide AI-assisted imaging analysis, auxiliary …

European Heart Journal

Background Heart Failure (HF) is projected to impact over 8 million people in the US by 2030. The 2022 AHA/ACC/HFSA Guideline for the Management of HF recommend four foundational medication classes for treating HFrEF patients: RAAS inhibitors, preferably angiotensin receptor/neprilysin inhibitor (ARNi), evidence-based beta-blockers (EBBB), sodium-glucose cotransporter-2 inhibitor (SGLT2i) and mineralocorticoid receptor antagonist (MRA) referred to as Quadruple Guideline-Directed Medical Therapy (Q-GDMT). Q-GDMT has shown an estimated 73% relative and 26% absolute reduction in all-cause mortality over 2 years. Yet, despite remarkable clinical potential, these therapies are patently underutilized in clinical practice. It is unknown whether an implementation science strategy may enhance adherence to Q-GDMT for HF. Methods IMPLEMENT-HF (IHF) is a …

American heart journal

Taking the next step in cardiovascular risk reduction: Integrating heart failure and peripheral arterial disease prevention — Johns Hopkins University Skip to main navigation Skip to search Skip to main content Johns Hopkins University Home Johns Hopkins University Logo Home Profiles Research units Research output Search by expertise, name or affiliation Taking the next step in cardiovascular risk reduction: Integrating heart failure and peripheral arterial disease prevention Daniel S. Matasic, Roger S. Blumenthal, Gregg C. Fonarow, Martha Gulati School of Medicine Research output: Contribution to journal › Editorial › peer-review Overview Original language English (US) Pages (from-to) 176-178 Number of pages 3 Journal American heart journal Volume 266 DOIs https://doi.org/10.1016/j.ahj.2023.07.004 State Published - Dec 2023 ASJC Scopus subject areas Cardiology and Cardiovascular Medicine Access …

Journal of the American College of Cardiology

BackgroundThe prevalence of apparent treatment resistant hypertension (aTRH) has increased from 8.8% in 1988-1994 up to 20.7% in 2005-2008. The risk of adverse cardiovascular outcomes is twice as high in those with compared to those without aTRH.MethodsThe study was conducted using data from NHANES collected between 2004-2018, spanning eight survey cycles. The analysis was restricted to nonpregnant participants≥ 20 years of age who self-reported taking antihypertensive medication. Categorical variables are reported as proportions (95% CI) while continuous variables are reported as mean (95% CI). Determinants of resistant hypertension were assessed using multivariable logistic regression. A Kaplan-Meier curve was used to display the pattern for survival over time in those with and without resistant hypertension. Analysis was performed using STATA version 16. A p-value< 0.05 considered …

Heart Failure

(A) Adjusted all-cause and heart failure (HF)-specific 30-day readmission rates between 2010 and 2019 by household income.(B) Mean 30-day readmission rates pre-and post-hospital readmission reduction program (HRRP). In 2019, quartile 1 reflected household income:# $47,999; quartile 2: $48,000–$60,999; quartile 3: $61,000–$81,999; quartile 4: $ $82,000.