Heart Failure

The literature is replete with studies of treatments for chronic heart failure that have shown morbidity and mortality benefits.

Studies have shown that elderly patients with heart failure are undertreated with evidence-based therapy, such as angiotensin-converting enzyme inhibitors and beta-blockers, although these therapeutic options appear to be effective in this age group. The risk of some side effects may be increased in elderly patients, and physicians should be aware of those when prescribing therapy. Cardiac resynchronization therapy is predicted to play a major role in future heart failure treatment, including in the elderly population.

Heart failure is the leading cause of hospitalization among Medicare beneficiaries, and it is the most costly diagnosis-related group by a factor of 2.

We prospectively studied the relationship between C-reactive protein, obtained within 12 to 24 hours of symptom onset, and long-term risk of death and heart failure in survivors of acute myocardial infarction. The risk of death and heart failure increased progressively with increasing quartiles of C-reactive protein. We found a graded positive relationship between C-reactive protein levels and post-discharge mortality and heart failure.

Over a period of 14 years, we followed 282 patients aged 70 years or older who were hospitalized with heart failure. Median survival was 2.5 years, but 25% of patients died within 1 year, and 25% survived for at least 5 years following hospital discharge. A simple 7-item risk score based on data readily available at the time of hospitalization effectively stratified patients into low-, intermediate-, and high-risk categories for subsequent mortality.

Congestive heart failure does not necessarily "go away" in the elderly.

We conducted a multi-hospital population-based study of 2445 residents of a large New England metropolitan area hospitalized with acute heart failure and found that the long-term prognosis for these patients remains poor. More than one third of patients died in the first year after hospital discharge,and nearly 4 of 5 patients died over the 5-year follow-up period. Several demographic and clinical factors were associated with an adverse prognosis. It is important to know the factors that negatively affect long-term survival after hospital discharge for decompensated heart failure so that treatment can be directed toward specific high-risk groups.

The effects of recurrent tachycardia after resolution of cardiomyopathy have not been thoroughly assessed. We evaluated and followed 24 patients with tachycardia-induced cardiomyopathy for more than 12 years. Our observations showed that patients with tachycardia-induced cardiomyopathy may be at long-term risk for sudden death. Surreptitious cardiomyopathy due to occult ultrastructural changes may persist. It has yet to be determined whether rapid and aggressive rate control would prevent structural damage to risk of sudden cardiac death.

Diuretic use has long been a mainstay in the management of symptomatic heart failure with pulmonary or systemic congestion, or both.

We assessed preoperative cardiac physiology using echocardiography in patients undergoing cardiac surgery to identify predictors of postoperative atrial fibrillation. Subjects with enlarged left atrial volume had a 5-fold greater risk of postoperative atrial fibrillation, independent of age and other risk factors, than those without enlarged left atrial volume. Left atrial volume appears to be a powerful tool to stratify patients according to risk before surgery and to effectively target preventive therapy.

The epidemiologic finding that women with heart failure have better overall survival than men may be because of the higher prevalence of diastolic heart failure or heart failure with preserved ejection fraction (HF-PEF) among women.

Heart failure in the United States affects 4.9 million people, of whom 2.5 million are women.

Heart failure affects approximately 5 million Americans, and more than 500 000 new cases are diagnosed each year.

We conducted a substudy of the Rate Control Versus Electrical Cardioversion (RACE) study to evaluate cardiovascular morbidity, mortality, and the outcome of rate and rhythm control treatment in subjects with and without hypertension with persistent atrial fibrillation.

Assessing prognosis in heart failure poses a challenge in clinical practice.

We analyzed a subgroup of 2445 subjects with diabetes, macrovascular disease, and previous myocardial infarction (MI) from the Prospective Pioglitazone Clinical Trial in Macrovascular Events to determine the effects of pioglitazone on mortality and macrovascular morbidity. Pioglitazone was shown to decrease the occurrence of adverse cardiac outcomes, including recurrent MI, in these high-risk subjects. This additional benefit of pioglitazone in patients with diabetes and a previous MI suggests that it may be appropriate to include this medication in the management strategy of patients with MI.

Prior studies have shown an association between heart failure and the presence of hypertension and left ventricular hypertrophy (LVH). We investigated the relationship between regression of electrocardiographic (ECG) LVH by Cornell product with antihypertensive regimens and new-onset heart failure in subjects with hypertension and baseline LVH.

As clinical cardiologists, we face an ever-changing landscape with regard to the management and care of hypertensive patients.

The current guidelines for the management of heart failure in women are based upon data collected from studies predominantly enrolling men. However, because important differences exist in the sex-based pathogenesis of and prognosis for heart failure, the current risk-benefit analyses that guide the evidence-based management of heart failure in women demands prospective assessment.

Our increasing ability to intervene in high-risk patients—with lower risks and greater chances for successful outcomes—is felt across the broad spectrum of cardiovascular disease. This is particularly evident in patients with dilated cardiomyopathy (DCM).

As outlined by the authors, use of metformin is an appealing option because it is safe, produces few side effects, and is a cost-effective way to target some of the defects known to contribute to the metabolic defects associated with diabetes.

In the cohort study conducted by Ahmed and colleagues, the investigators assessed whether diabetes was associated with worse outcomes in heart failure regardless of the associated risk factors and comorbidities.

Atrial fibrillation affects over 2.2 million Americans and is estimated to affect up to 10 million by 2050.

We have seen a dramatic increase in use of ICDs along with expanded indications for these devices.

The benefits of implantable cardioverter-defibrillators (ICDs) have been shown in randomized clinical trials. The factors that affect the risk–benefit ratio in a community setting, however, have not been evaluated.

This propensity-matched study, in which patients with and without diabetes were well balanced in all measured baseline characteristics, including traditional risk factors and comorbidities, found that diabetes was associated with increased mortality and hospitalization in ambulatory patients who had chronic, mild-to-moderate heart failure and were receiving angiotensin-converting enzyme inhibitors. These findings also highlight the sex- and age-related variations in the effect of diabetes in these patients.