Background Frailty is common and significantly impacts prognosis in heart failure(HF). The Vulnerable Elders Survey-13(VES-13), widely used in oncogeriatrics and public health, remains unexplored as a frailty screenin...Background Frailty is common and significantly impacts prognosis in heart failure(HF). The Vulnerable Elders Survey-13(VES-13), widely used in oncogeriatrics and public health, remains unexplored as a frailty screening tool in HF outpatients. In this study, we prospectively evaluated VES-13 against a multimodal screening assessment in detecting frailty and predicting individual risk of adverse prognosis.Methods Frailty was assessed at the initial visit using both a multimodal approach, incorporating Barthel Index, Older American Resources and Services scale, Pfeiffer Test, abbreviated Geriatric Depression Scale, age > 85 years, lacking support systems,and VES-13. Patients scoring ≥ 3 on VES-13 or meeting at least one multimodal criterion were classified as frail. Endpoints included all-cause mortality, a composite of death or HF hospitalization, and recurrent HF hospitalizations.Results A total of 301 patients were evaluated. VES-13 identified 40.2% as frail and the multimodal assessment 33.2%. In Cox regression analyses, frailty identified by VES-13 showed greater prognostic significance than the multimodal assessment for allcause mortality(HR = 3.70 [2.15–6.33], P < 0.001 vs. 2.40 [1.46–4.0], P = 0.001) and the composite endpoint(HR = 3.13 [2.02–4.84], P< 0.001 vs. 1.96 [1.28–2.99], P = 0.002). Recurrent HF hospitalizations were four times more frequent in VES-13 frail patients while two times in those identified as frail by the multimodal assessment. Additionally, stratifying patients by VES-13 tertiles provided robust risk differentiation.Conclusions VES-13, a simple frailty tool, outperformed a comprehensive multimodal assessment and could be easily integrated into routine HF care, highlighting its clinical utility in identifying patients at risk for poor outcomes.展开更多
BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis ...BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.展开更多
Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Metho...Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Methods This was an ambispective cohort study. A total of 85 older adults participating in the Chronic Heart Failure Program at Guillermo Almenara National Hospital were included. Each had an initial frailty assessment, forming two cohorts: frail and non-frail older adults. Medical records were reviewed, and patients were followed for one year to track events of interest(hospitalization and mortality). Overall survival and risk factors for hospitalization and death were determined.Results During follow-up, 15.3% of the older adults died, and frailty was identified in 58.8% of the patients. Overall survival using the Kaplan-Meier method was 96.5% at 3 months after entering the Chronic Heart Failure Program;92.9% at 6 months;and85.9% at one year. Multivariate analysis using Poisson regression found that frailty was not a risk factor for hospitalization(a RR =0.92;95% CI: 0.42–2.03). Survival analysis using the Cox proportional hazards model showed that frailty was also not a risk factor for mortality after one year of follow-up(a HR = 1.32;95% CI: 0.27–6.53).Conclusions Our research does not confirm frailty as a risk factor for hospitalization or mortality in older adults enrolled in the“Chronic Heart Failure Program” after one year of follow-up.展开更多
Chronic heart failure(CHF)impairs cognitive function.Xijiaqi Formula(XJQ),a traditional Chinese medicine(TCM)used clinically to treat CHF,demonstrates potential for improving cognition in CHF patients.However,its prec...Chronic heart failure(CHF)impairs cognitive function.Xijiaqi Formula(XJQ),a traditional Chinese medicine(TCM)used clinically to treat CHF,demonstrates potential for improving cognition in CHF patients.However,its precise mechanism in treating post-CHF cognitive dysfunction remains unclear.This study systematically investigates XJQ’s effects on post-CHF cognitive dysfunction and the underlying mechanisms.The components of XJQ were identified through liquid chromatography-mass spectrometry.CHF was induced in rats via ligation of the left anterior descending coronary artery,followed by six weeks of XJQ treatment.Cardiac function was evaluated through echocardiography and hemodynamic parameters,while cognitive function was assessed using Morris water maze(MWM)and open field tests(OFT).XJQ treatment enhanced both cardiac and cognitive functions in CHF rats.Network pharmacology identified 12 core active components of XJQ and indicated its effect on cognitive dysfunction involved regulating synapses,inflammation,and phosphodiesterase 4(PDE4)-dependent cyclic adenosine monophosphate(cAMP)signaling.XJQ inhibited microglial and astrocyte activation,decreased proinflammatory cytokines,and mitigated neuronal damage.Notably,XJQ promoted synaptic repair and dendritic growth by downregulating PDE4 and upregulating cAMP,protein kinase A(PKA),cAMP-response element binding protein(CREB),brain-derived neurotrophic factor(BDNF),PSD95,and synapsin I levels.Molecular docking and Bio-layer interferometry assays confirmed direct binding of quercetin,kaempferol,isorhamnetin,and darutoside to PDE4.In conclusion,XJQ alleviates neuroinflammation and enhances synaptic plasticity to improve cognitive dysfunction in CHF rats via the PDE4/cAMP/PKA/CREB signaling pathway.These findings provide valuable insight into the heart-brain axis.展开更多
Objective:This integrative review aims to synthesize observational evidence on the prevalence,predictors,and psychosocial correlates of death anxiety in patients with hear t failure(HF).Methods:A comprehensive literat...Objective:This integrative review aims to synthesize observational evidence on the prevalence,predictors,and psychosocial correlates of death anxiety in patients with hear t failure(HF).Methods:A comprehensive literature search was conducted using 5 major databases:Scopus,Pub Med,Science Direct,Embase,and Pro Quest.Inclusion criteria were primary research studies published in English between January 2014 and March 2025 that quantitatively assessed death anxiety among patients with HF and explored its associations with demographic,clinical,or psychosocial variables.Results:A total of 12 eligible studies were identified and systematically reviewed,revealing that death anxiety is moderate to high among most samples.Key predictors of this anxiety included older age,feelings of loneliness,low socioeconomic status,and longer duration of HF.Additionally,several studies highlighted protective factors such as spiritual orientation,religious coping,and resilience.Interventions,including cognitive-behavioral therapy(CBT)and illness perception training,showed significant reductions in death anxiety.Conclusions:Death anxiety is a prevalent and impactful concern among Patients with HF,influenced by both individual and contextual factors.Routine assessment and integration of psychosocial and spiritual care—alongside evidence-based psychological interventions—are essential to address this critical aspect of HF management.展开更多
Objective:Heart failure(HF)is a complex clinical syndrome that affects nearly 64 million individuals globally.Frequent hospital readmissions lead to poor health outcomes,impact quality of life(QoL),and are associated ...Objective:Heart failure(HF)is a complex clinical syndrome that affects nearly 64 million individuals globally.Frequent hospital readmissions lead to poor health outcomes,impact quality of life(QoL),and are associated with high mortality rates.This study assessed readmissions,mortality,and QoL outcomes in patients with HF in a tertiary care hospital setting.Methods:Patients aged≥18 years with HF,who visited the tertiary care hospital in Karad,India were included in the study(November2019 to October 2021).Demographics,disease characteristics,and condition at discharge were recorded using the medical records of patients.The quantitative data included readmission rates and mortality rates.The qualitative aspects describing patients'QoL were assessed using a patient-reported 21-question QoL questionnaire.Results:A total of 98 patients,predominantly male(63.3%),with a mean age of 62.9 years were included.The majority of the patients(80.6%)required<15 days of hospitalization.The 2-year readmission rate was 24.4%,while the mortality rate was 43.9%.Self-care pattern showed that patients seemed to be taking mild to average care while taking good care was rare.The QoL data showed that 22.4% were living a good quality life,44.9% average,while 32.7% were living a low-quality life.Better education and better self-care were associated with a low rate of readmission.Conclusions:We were able to assess the incidence of readmission,mortality,and QoL in patients with HF in a tertiary care hospital setting.The study showed that HF impacts patients'physical,emotional,and psychological wellbeing.展开更多
When patients initially present with atrial fibrillation along with an enlarged heart and heart failure, followed by atrioventricular block, it's essential to consider genetic factors.^([1])Genetic testing can off...When patients initially present with atrial fibrillation along with an enlarged heart and heart failure, followed by atrioventricular block, it's essential to consider genetic factors.^([1])Genetic testing can offer crucial diagnostic evidence, aiding in prognosis assessment and the adoption of appropriate treatment strategies.展开更多
Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend ...Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.展开更多
Chronic heart failure(CHF) remains a global health challenge with limited therapeutic options. Mitochondrial dysfunction is a key pathological feature, and traditional Chinese medicine(TCM) shows unique potential in t...Chronic heart failure(CHF) remains a global health challenge with limited therapeutic options. Mitochondrial dysfunction is a key pathological feature, and traditional Chinese medicine(TCM) shows unique potential in targeting this mechanism. Evidence from human and animal models of heart failure indicates that TCM can restore mitochondrial function by regulating mitochondrial Ca^(2+) homeostasis, oxidative stress, energy metabolism, mitochondrial dynamics, and mitophagy. TCM-based treatment of CHF offers notable clinical advantages, including improved therapeutic efficacy, enhanced cardiac function, and reduced incidence of major cardiovascular events. Experimental studies demonstrate that TCM decoctions and monomers modulate signaling pathways such as PPAR–RXRα, NF-κB, and PI3K/AKT to alleviate oxidative stress. TCM also increases AMPK activity via phosphorylation of PGC-1α, indirectly promoting mitochondrial biogenesis;attenuates calcium influx and enhances Ca^(2+) reuptake, thereby ameliorating myocardial mitochondrial dysfunction in CHF;and improves CHF by rebalancing mitochondrial dynamics and autophagy.展开更多
BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hos...BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hospitalists.This study compared the impact of optimal medical therapy in HF(OMT-HF)certification on GDMT implementation and patient outcomes between an intervention group(IG)of hospitalists and a standard-of-care comparison group(SOC-CG).METHODS This study was implemented from November 2022 to May 2023.Hospitalized car-diology patients with HF and left ventricular ejection fraction≤40%were rando-mized to IG or SOC-CG.Exclusion criteria included patients in cardiogenic shock,unable to consent,or at high risk.Follow-up was at 30 days post-discharge.Diffe-rences between groups were analyzed using Fisher’s exact test for categorical va-riables and Wilcoxon rank-sum or unpaired t-test for continuous variables.Chan-ges in Minnesota Living with Heart Failure Questionnaire(MLWHFQ)scores were evaluated using a paired t-test.RESULTS IG patients had lower readmission rates[9(42.85%)vs 11(17.46%),P=0.03]and a decreased trend in mortality 30-day post discharge.IG patients also showed greater mean improvements in total(-27.03±24.59 vs-5.85±23.52,P<0.001),physical(-13.8±12.3 vs-2.71±11.16,P<0.001)and emotional(-4.76±8.10 vs-1.42±5.98)dimensions on the MLWHFQ compared to SOC-CG,however,change in emotional dimension did not reach statistical significance.CONCLUSION Hospitalist OMT-HF certification may lead to better 30-day outcomes in hospitalized HF patients including quality of life,mortality and readmission rates.Larger prospective studies are warranted to validate these findings.展开更多
Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory proces...Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.展开更多
In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complicati...In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.展开更多
BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extraco...BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.展开更多
According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(C...According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.展开更多
Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and si...Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs.HF is classified according to left ventricular ejection fraction(LVEF)and falls into three groups:LVEF≥50%-HF with preserved ejection fraction(HFpEF),LVEF<40%-HF with reduced ejection fraction(HFrEF),LVEF 40%-49%-HF with mid-range ejection fraction.Diagnosing HF is primarily a clinical approach and it is based on anamnesis,physical examination,echocardiogram,radiological findings of the heart and lungs and laboratory tests,including a specific markers of HF-brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies.Updated diagnostic algorithms for HFpEF have been recommended(H2FPEF,HFA-PEFF).New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF(e.g.,sodium-glucose cotransporter-2-SGLT2 inhibitors)and such progress in treatment of HFrEF patients resulted in new working definition of the term“HF with recovered left ventricular ejection fraction”.In line with rapid development of HF treatment,cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms,improve exercise capacity and quality of life as well as reduce disability and hospitalization rates.We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.展开更多
Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when disc...Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when discussing falls as multiple factors associated with heart failure(HF)aetiology and treatment are assumedly implicated in falls occurrence.A retrospective study reported a 14%increased risk of falls among OPLHF,and prospective data has shown that up to 40%of HF patients may experience a fall within a year from diagnosis.展开更多
Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of ve...Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of very elderly patients admitted for acute HF.Methods This study is a retrospective analysis of the EPICTER registry,that included patients admitted for acute HF in 74 Spanish hospitals.For this analysis,a total of 1887 patients were included and divided into 2 groups:85 years or older(very elderly,680 patients)and those under 85 years.Results Compared to patients<85 years,very elderly patients were more frequently women,had more hypertension and disease cerebrovascular disease,and less presence of chronic obstructive pulmonary disease(COPD),diabetes,and acute myocardial infarction.There were no differences in symptoms,except for delirium,significantly more common in very elderly patients.Management of these patients was more conservative and died more than the younger ones(41%vs.25%,P<0.001).The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease,delirium,and estimated survival of less than 6 months assessed by the physician in charge of the patient care.Conclusion Very elderly patients admitted for HF differ from younger ones in comorbidities,management,and symptoms,and have higher mortality.The presence of delirium,peripheral arterial disease,and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.展开更多
BACKGROUND Acute decompensated heart failure(ADHF)is one of the leading causes of mortality,highlighting the importance of early identification of high-risk patients.The fibrosis-5(FIB-5)index,traditionally used to ev...BACKGROUND Acute decompensated heart failure(ADHF)is one of the leading causes of mortality,highlighting the importance of early identification of high-risk patients.The fibrosis-5(FIB-5)index,traditionally used to evaluate hepatic fibrosis,may hold prognostic value in ADHF patients by reflecting systemic congestion,inflammation,and organ dysfunction.The hypothesis of this study is that the FIB-5 index is an independent predictor of 1-month mortality in patients with ADHF.METHODS This retrospective study included 155 patients diagnosed with ADHF between 2020 and 2024.Patients were divided into two groups based on their left ventricular ejection fraction(LVEF≤40%or LVEF>50%).Survival was monitored for one month,and clinical,biochemical,and echocardiographic parameters were compared between survivors and death.Logistic regression and receiver operating characteristic curve analyses were performed to assess the prognostic value of the FIB-5 index.RESULTS During the 1-month follow-up,66 patients(42.6%)died.The mean FIB-5 index was significantly lower in non-survivors(−10.46±6.93)compared to survivors(−8.10±6.67)(P=0.03).Multivariate regression analysis identified the FIB-5 index as an independent predictor of 1-month mortality(OR=1.089,95%CI:1.022–1.160,P=0.009).The receiver operating characteristic curve analysis demonstrated an area under the curve of 0.609(95%CI:0.51–0.699)with sensitivity of 59.6%and specificity of 63.4%.Kaplan-Meier survival analysis revealed significantly higher mortality rates among patients with lower FIB-5 values(log-rank:7.887,P=0.005).CONCLUSIONS The FIB-5 index is an independent predictor of 1-month mortality in ADHF patients.Its low cost,non-invasive nature,and ability to reflect systemic inflammation and congestion make it a promising tool for risk stratification.Prospective studies are needed to validate its utility in clinical practice and evaluate its role in guiding therapeutic decisions.展开更多
Objectives To compare respiratory parameters of peripheral blood mononuclear cell mitochondria and iron metabolism indicators in patients with different NYHA functional classes of ischemic heart failure(HF).Methods Th...Objectives To compare respiratory parameters of peripheral blood mononuclear cell mitochondria and iron metabolism indicators in patients with different NYHA functional classes of ischemic heart failure(HF).Methods This single center, prospective, non-blinded study enrolled 20 patients with diagnosed chronic HF of ischemic genesis with reduced and mildly reduced left ventricle ejection fraction. The maximum oxygen consumption at the peak of the exercise test(VO2peak), iron metabolism parameters and respiratory activity of peripheral blood mononuclear cell mitochondria were assessed.Results Among the patients, a half of individuals were diagnosed with iron deficiency. Subgroups of patients with different HF severity did not significant differ in VO2peak(P=0.209), serum iron(P=0.468) and ferritin(P=0.235) levels. But there was a trend in increasing in these parameters with increasing NYHA HF functional class. Respiratory control coefficient(RC) in NADdependent and FAD-dependent mitochondrial oxidation were lower in patients with NYHA HF Ⅲ functional class compared to individuals with NYHA HF I functional class(P=0.028 and P=0.040, respectively). Serum iron(P=0.026), ferritin(P=0.045)levels, transferrin saturation(P=0.006) were negatively correlated with RC in NAD-dependent mitochondrial oxidation.Conclusions In aggravation of ischemic HF NYHA FC, there is a decrease in RC of PBMC mitochondria during the oxidation of NAD-dependent and FAD-dependent substrates. In the whole sample, patients with laboratory-confirmed iron deficiency accounted a half of the total number. Iron metabolism parameters had a paradoxical inverse relationship with the level of RC in PBMC mitochondria of patients with HF.展开更多
BACKGROUND The use of sodium-glucose cotransporter 2(SGLT2)inhibitor in heart failure(HF)patients is increasing significantly,regardless of whether they have a history of diabetes.The effects of SGLT2 inhibitor on HF ...BACKGROUND The use of sodium-glucose cotransporter 2(SGLT2)inhibitor in heart failure(HF)patients is increasing significantly,regardless of whether they have a history of diabetes.The effects of SGLT2 inhibitor on HF are likely mediated through multiple mechanisms,including suppression of the renin-angiotensin-aldosterone system(RAAS),reduction in oxidative stress leading to enhanced myocardial efficiency,and attenuation of adverse cardiac remodeling by preventing fibrosis.These pathways are fundamental to reducing mortality,improving patients'quality of life,and alleviating the burden on the United States healthcare system by decreasing HF-related hospitalizations.AIM To evaluate SGLT2 inhibitor effects on HF,focusing on hospitalization for HF(HHF),cardiovascular(CV)deaths,and all-cause mortality.METHODS A comprehensive search was conducted in PubMed for randomized controlled trials(RCTs)evaluating the effects of SGLT2 inhibitor in HF patients compared to placebo,covering the period from January 1,2014,to January 1,2025.The primary outcomes assessed were HHF,CV deaths,and all-cause mortality.RevMan Web 5.4.1 was used to assess the risk of bias heterogeneity and to perform the statistical analyses.A random-effects model was employed for all statistical evaluations.RESULTS A total of nine RCTs were included in this analysis:DELIVER,DECLARE-TIMI 58,DAPA-HF,EMPA-REG OUTCOME,EMPEROR-Reduced,EMPEROR-Preserved,SOLOIST-WHF,EMPULSE,and VERTIS-CV.For HHF,eight trials(excluding the SOLOIST-WHF;n=25906)were pooled,while CV deaths were assessed using data from eight trials(excluding the EMPULSE;n=26598).Compared to placebo,SGLT2 inhibitor significantly reduced the risk of HHF(relative risk:0.74;95%CI:0.71-0.77;P<0.00001)and CV death(odds ratio:0.88;95%CI:0.83-0.92;P=0.0006).All nine trials(n=27128)were included in the analysis of all-cause mortality.SGLT2 inhibitor were associated with a statistically significant reduction in all-cause mortality compared to placebo(OR:0.91;95%CI:0.84-0.98;P=0.02).CONCLUSION These results suggest that SGLT2 inhibitor significantly reduce the risk of hospitalization for HF,CV deaths,and all-cause mortality.展开更多
文摘Background Frailty is common and significantly impacts prognosis in heart failure(HF). The Vulnerable Elders Survey-13(VES-13), widely used in oncogeriatrics and public health, remains unexplored as a frailty screening tool in HF outpatients. In this study, we prospectively evaluated VES-13 against a multimodal screening assessment in detecting frailty and predicting individual risk of adverse prognosis.Methods Frailty was assessed at the initial visit using both a multimodal approach, incorporating Barthel Index, Older American Resources and Services scale, Pfeiffer Test, abbreviated Geriatric Depression Scale, age > 85 years, lacking support systems,and VES-13. Patients scoring ≥ 3 on VES-13 or meeting at least one multimodal criterion were classified as frail. Endpoints included all-cause mortality, a composite of death or HF hospitalization, and recurrent HF hospitalizations.Results A total of 301 patients were evaluated. VES-13 identified 40.2% as frail and the multimodal assessment 33.2%. In Cox regression analyses, frailty identified by VES-13 showed greater prognostic significance than the multimodal assessment for allcause mortality(HR = 3.70 [2.15–6.33], P < 0.001 vs. 2.40 [1.46–4.0], P = 0.001) and the composite endpoint(HR = 3.13 [2.02–4.84], P< 0.001 vs. 1.96 [1.28–2.99], P = 0.002). Recurrent HF hospitalizations were four times more frequent in VES-13 frail patients while two times in those identified as frail by the multimodal assessment. Additionally, stratifying patients by VES-13 tertiles provided robust risk differentiation.Conclusions VES-13, a simple frailty tool, outperformed a comprehensive multimodal assessment and could be easily integrated into routine HF care, highlighting its clinical utility in identifying patients at risk for poor outcomes.
文摘BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.
文摘Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Methods This was an ambispective cohort study. A total of 85 older adults participating in the Chronic Heart Failure Program at Guillermo Almenara National Hospital were included. Each had an initial frailty assessment, forming two cohorts: frail and non-frail older adults. Medical records were reviewed, and patients were followed for one year to track events of interest(hospitalization and mortality). Overall survival and risk factors for hospitalization and death were determined.Results During follow-up, 15.3% of the older adults died, and frailty was identified in 58.8% of the patients. Overall survival using the Kaplan-Meier method was 96.5% at 3 months after entering the Chronic Heart Failure Program;92.9% at 6 months;and85.9% at one year. Multivariate analysis using Poisson regression found that frailty was not a risk factor for hospitalization(a RR =0.92;95% CI: 0.42–2.03). Survival analysis using the Cox proportional hazards model showed that frailty was also not a risk factor for mortality after one year of follow-up(a HR = 1.32;95% CI: 0.27–6.53).Conclusions Our research does not confirm frailty as a risk factor for hospitalization or mortality in older adults enrolled in the“Chronic Heart Failure Program” after one year of follow-up.
基金supported by the National Natural Science Foundation of China(Nos.82430116 and 82574622)the Special Fund of Central Committee High Level Chinese Medicine Hospital(Nos.DZMG-LJRC-0014,DZMG-ZJXY-23013)+1 种基金Chinese Medicine Inheritance and Innovation“Thousand Million”Talents Project(Qihuang Project 2021)Qihuang Scholarsthe Medical and Health Industry Development Project of Tongzhou District(2023).
文摘Chronic heart failure(CHF)impairs cognitive function.Xijiaqi Formula(XJQ),a traditional Chinese medicine(TCM)used clinically to treat CHF,demonstrates potential for improving cognition in CHF patients.However,its precise mechanism in treating post-CHF cognitive dysfunction remains unclear.This study systematically investigates XJQ’s effects on post-CHF cognitive dysfunction and the underlying mechanisms.The components of XJQ were identified through liquid chromatography-mass spectrometry.CHF was induced in rats via ligation of the left anterior descending coronary artery,followed by six weeks of XJQ treatment.Cardiac function was evaluated through echocardiography and hemodynamic parameters,while cognitive function was assessed using Morris water maze(MWM)and open field tests(OFT).XJQ treatment enhanced both cardiac and cognitive functions in CHF rats.Network pharmacology identified 12 core active components of XJQ and indicated its effect on cognitive dysfunction involved regulating synapses,inflammation,and phosphodiesterase 4(PDE4)-dependent cyclic adenosine monophosphate(cAMP)signaling.XJQ inhibited microglial and astrocyte activation,decreased proinflammatory cytokines,and mitigated neuronal damage.Notably,XJQ promoted synaptic repair and dendritic growth by downregulating PDE4 and upregulating cAMP,protein kinase A(PKA),cAMP-response element binding protein(CREB),brain-derived neurotrophic factor(BDNF),PSD95,and synapsin I levels.Molecular docking and Bio-layer interferometry assays confirmed direct binding of quercetin,kaempferol,isorhamnetin,and darutoside to PDE4.In conclusion,XJQ alleviates neuroinflammation and enhances synaptic plasticity to improve cognitive dysfunction in CHF rats via the PDE4/cAMP/PKA/CREB signaling pathway.These findings provide valuable insight into the heart-brain axis.
文摘Objective:This integrative review aims to synthesize observational evidence on the prevalence,predictors,and psychosocial correlates of death anxiety in patients with hear t failure(HF).Methods:A comprehensive literature search was conducted using 5 major databases:Scopus,Pub Med,Science Direct,Embase,and Pro Quest.Inclusion criteria were primary research studies published in English between January 2014 and March 2025 that quantitatively assessed death anxiety among patients with HF and explored its associations with demographic,clinical,or psychosocial variables.Results:A total of 12 eligible studies were identified and systematically reviewed,revealing that death anxiety is moderate to high among most samples.Key predictors of this anxiety included older age,feelings of loneliness,low socioeconomic status,and longer duration of HF.Additionally,several studies highlighted protective factors such as spiritual orientation,religious coping,and resilience.Interventions,including cognitive-behavioral therapy(CBT)and illness perception training,showed significant reductions in death anxiety.Conclusions:Death anxiety is a prevalent and impactful concern among Patients with HF,influenced by both individual and contextual factors.Routine assessment and integration of psychosocial and spiritual care—alongside evidence-based psychological interventions—are essential to address this critical aspect of HF management.
文摘Objective:Heart failure(HF)is a complex clinical syndrome that affects nearly 64 million individuals globally.Frequent hospital readmissions lead to poor health outcomes,impact quality of life(QoL),and are associated with high mortality rates.This study assessed readmissions,mortality,and QoL outcomes in patients with HF in a tertiary care hospital setting.Methods:Patients aged≥18 years with HF,who visited the tertiary care hospital in Karad,India were included in the study(November2019 to October 2021).Demographics,disease characteristics,and condition at discharge were recorded using the medical records of patients.The quantitative data included readmission rates and mortality rates.The qualitative aspects describing patients'QoL were assessed using a patient-reported 21-question QoL questionnaire.Results:A total of 98 patients,predominantly male(63.3%),with a mean age of 62.9 years were included.The majority of the patients(80.6%)required<15 days of hospitalization.The 2-year readmission rate was 24.4%,while the mortality rate was 43.9%.Self-care pattern showed that patients seemed to be taking mild to average care while taking good care was rare.The QoL data showed that 22.4% were living a good quality life,44.9% average,while 32.7% were living a low-quality life.Better education and better self-care were associated with a low rate of readmission.Conclusions:We were able to assess the incidence of readmission,mortality,and QoL in patients with HF in a tertiary care hospital setting.The study showed that HF impacts patients'physical,emotional,and psychological wellbeing.
基金Military Healthcare Special Scientific Research Project(25BJZ31, awarded to SHI XM)。
文摘When patients initially present with atrial fibrillation along with an enlarged heart and heart failure, followed by atrioventricular block, it's essential to consider genetic factors.^([1])Genetic testing can offer crucial diagnostic evidence, aiding in prognosis assessment and the adoption of appropriate treatment strategies.
基金supported by the Sanming Project of Medicine in Shenzhen[SZZYSM202206001]National Natural Science Foundation of China[82004320 and 82374383]+3 种基金Natural Science Foundation of Guangdong Province of China[2022A1515011710 and 2022A1515010679]Shenzhen Science and Technology Innovation Committee[JCYJ20220530141407017 and JCYJ20240813153619026]2024 High-quality Development Research Project of Shenzhen Bao’an Public Hospital[YNXM2024078]and Shenzhen Bao’an Chinese Medicine Hospital Research Program[BAZYY20220702].
文摘Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.
基金supported by the National Natural Science Foundation of China (No. 82374195)。
文摘Chronic heart failure(CHF) remains a global health challenge with limited therapeutic options. Mitochondrial dysfunction is a key pathological feature, and traditional Chinese medicine(TCM) shows unique potential in targeting this mechanism. Evidence from human and animal models of heart failure indicates that TCM can restore mitochondrial function by regulating mitochondrial Ca^(2+) homeostasis, oxidative stress, energy metabolism, mitochondrial dynamics, and mitophagy. TCM-based treatment of CHF offers notable clinical advantages, including improved therapeutic efficacy, enhanced cardiac function, and reduced incidence of major cardiovascular events. Experimental studies demonstrate that TCM decoctions and monomers modulate signaling pathways such as PPAR–RXRα, NF-κB, and PI3K/AKT to alleviate oxidative stress. TCM also increases AMPK activity via phosphorylation of PGC-1α, indirectly promoting mitochondrial biogenesis;attenuates calcium influx and enhances Ca^(2+) reuptake, thereby ameliorating myocardial mitochondrial dysfunction in CHF;and improves CHF by rebalancing mitochondrial dynamics and autophagy.
基金Supported by Houston Methodist DeBakey Heart and Vascular Center Grant.
文摘BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hospitalists.This study compared the impact of optimal medical therapy in HF(OMT-HF)certification on GDMT implementation and patient outcomes between an intervention group(IG)of hospitalists and a standard-of-care comparison group(SOC-CG).METHODS This study was implemented from November 2022 to May 2023.Hospitalized car-diology patients with HF and left ventricular ejection fraction≤40%were rando-mized to IG or SOC-CG.Exclusion criteria included patients in cardiogenic shock,unable to consent,or at high risk.Follow-up was at 30 days post-discharge.Diffe-rences between groups were analyzed using Fisher’s exact test for categorical va-riables and Wilcoxon rank-sum or unpaired t-test for continuous variables.Chan-ges in Minnesota Living with Heart Failure Questionnaire(MLWHFQ)scores were evaluated using a paired t-test.RESULTS IG patients had lower readmission rates[9(42.85%)vs 11(17.46%),P=0.03]and a decreased trend in mortality 30-day post discharge.IG patients also showed greater mean improvements in total(-27.03±24.59 vs-5.85±23.52,P<0.001),physical(-13.8±12.3 vs-2.71±11.16,P<0.001)and emotional(-4.76±8.10 vs-1.42±5.98)dimensions on the MLWHFQ compared to SOC-CG,however,change in emotional dimension did not reach statistical significance.CONCLUSION Hospitalist OMT-HF certification may lead to better 30-day outcomes in hospitalized HF patients including quality of life,mortality and readmission rates.Larger prospective studies are warranted to validate these findings.
基金Supported by Wenzhou Science Technology Bureau Foundation,No.2022Y0726.
文摘Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.
基金National High Level Hospital Clinical Research Funding(2022-PUMCH-B-098)CAMS Innovation Fund for Medical Sciences (2021-I2M-1-003)。
文摘In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.
文摘BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.
文摘According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.
文摘Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs.HF is classified according to left ventricular ejection fraction(LVEF)and falls into three groups:LVEF≥50%-HF with preserved ejection fraction(HFpEF),LVEF<40%-HF with reduced ejection fraction(HFrEF),LVEF 40%-49%-HF with mid-range ejection fraction.Diagnosing HF is primarily a clinical approach and it is based on anamnesis,physical examination,echocardiogram,radiological findings of the heart and lungs and laboratory tests,including a specific markers of HF-brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies.Updated diagnostic algorithms for HFpEF have been recommended(H2FPEF,HFA-PEFF).New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF(e.g.,sodium-glucose cotransporter-2-SGLT2 inhibitors)and such progress in treatment of HFrEF patients resulted in new working definition of the term“HF with recovered left ventricular ejection fraction”.In line with rapid development of HF treatment,cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms,improve exercise capacity and quality of life as well as reduce disability and hospitalization rates.We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.
文摘Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when discussing falls as multiple factors associated with heart failure(HF)aetiology and treatment are assumedly implicated in falls occurrence.A retrospective study reported a 14%increased risk of falls among OPLHF,and prospective data has shown that up to 40%of HF patients may experience a fall within a year from diagnosis.
文摘Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of very elderly patients admitted for acute HF.Methods This study is a retrospective analysis of the EPICTER registry,that included patients admitted for acute HF in 74 Spanish hospitals.For this analysis,a total of 1887 patients were included and divided into 2 groups:85 years or older(very elderly,680 patients)and those under 85 years.Results Compared to patients<85 years,very elderly patients were more frequently women,had more hypertension and disease cerebrovascular disease,and less presence of chronic obstructive pulmonary disease(COPD),diabetes,and acute myocardial infarction.There were no differences in symptoms,except for delirium,significantly more common in very elderly patients.Management of these patients was more conservative and died more than the younger ones(41%vs.25%,P<0.001).The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease,delirium,and estimated survival of less than 6 months assessed by the physician in charge of the patient care.Conclusion Very elderly patients admitted for HF differ from younger ones in comorbidities,management,and symptoms,and have higher mortality.The presence of delirium,peripheral arterial disease,and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.
文摘BACKGROUND Acute decompensated heart failure(ADHF)is one of the leading causes of mortality,highlighting the importance of early identification of high-risk patients.The fibrosis-5(FIB-5)index,traditionally used to evaluate hepatic fibrosis,may hold prognostic value in ADHF patients by reflecting systemic congestion,inflammation,and organ dysfunction.The hypothesis of this study is that the FIB-5 index is an independent predictor of 1-month mortality in patients with ADHF.METHODS This retrospective study included 155 patients diagnosed with ADHF between 2020 and 2024.Patients were divided into two groups based on their left ventricular ejection fraction(LVEF≤40%or LVEF>50%).Survival was monitored for one month,and clinical,biochemical,and echocardiographic parameters were compared between survivors and death.Logistic regression and receiver operating characteristic curve analyses were performed to assess the prognostic value of the FIB-5 index.RESULTS During the 1-month follow-up,66 patients(42.6%)died.The mean FIB-5 index was significantly lower in non-survivors(−10.46±6.93)compared to survivors(−8.10±6.67)(P=0.03).Multivariate regression analysis identified the FIB-5 index as an independent predictor of 1-month mortality(OR=1.089,95%CI:1.022–1.160,P=0.009).The receiver operating characteristic curve analysis demonstrated an area under the curve of 0.609(95%CI:0.51–0.699)with sensitivity of 59.6%and specificity of 63.4%.Kaplan-Meier survival analysis revealed significantly higher mortality rates among patients with lower FIB-5 values(log-rank:7.887,P=0.005).CONCLUSIONS The FIB-5 index is an independent predictor of 1-month mortality in ADHF patients.Its low cost,non-invasive nature,and ability to reflect systemic inflammation and congestion make it a promising tool for risk stratification.Prospective studies are needed to validate its utility in clinical practice and evaluate its role in guiding therapeutic decisions.
基金supported by Russian Science Foundation,RSF 23-75-00009(part of the study corresponding to finding 1)Part of the study corresponding to finding 2 was carried out within the state assignment,FSR No.:122020300045-5(03.02.2022).
文摘Objectives To compare respiratory parameters of peripheral blood mononuclear cell mitochondria and iron metabolism indicators in patients with different NYHA functional classes of ischemic heart failure(HF).Methods This single center, prospective, non-blinded study enrolled 20 patients with diagnosed chronic HF of ischemic genesis with reduced and mildly reduced left ventricle ejection fraction. The maximum oxygen consumption at the peak of the exercise test(VO2peak), iron metabolism parameters and respiratory activity of peripheral blood mononuclear cell mitochondria were assessed.Results Among the patients, a half of individuals were diagnosed with iron deficiency. Subgroups of patients with different HF severity did not significant differ in VO2peak(P=0.209), serum iron(P=0.468) and ferritin(P=0.235) levels. But there was a trend in increasing in these parameters with increasing NYHA HF functional class. Respiratory control coefficient(RC) in NADdependent and FAD-dependent mitochondrial oxidation were lower in patients with NYHA HF Ⅲ functional class compared to individuals with NYHA HF I functional class(P=0.028 and P=0.040, respectively). Serum iron(P=0.026), ferritin(P=0.045)levels, transferrin saturation(P=0.006) were negatively correlated with RC in NAD-dependent mitochondrial oxidation.Conclusions In aggravation of ischemic HF NYHA FC, there is a decrease in RC of PBMC mitochondria during the oxidation of NAD-dependent and FAD-dependent substrates. In the whole sample, patients with laboratory-confirmed iron deficiency accounted a half of the total number. Iron metabolism parameters had a paradoxical inverse relationship with the level of RC in PBMC mitochondria of patients with HF.
文摘BACKGROUND The use of sodium-glucose cotransporter 2(SGLT2)inhibitor in heart failure(HF)patients is increasing significantly,regardless of whether they have a history of diabetes.The effects of SGLT2 inhibitor on HF are likely mediated through multiple mechanisms,including suppression of the renin-angiotensin-aldosterone system(RAAS),reduction in oxidative stress leading to enhanced myocardial efficiency,and attenuation of adverse cardiac remodeling by preventing fibrosis.These pathways are fundamental to reducing mortality,improving patients'quality of life,and alleviating the burden on the United States healthcare system by decreasing HF-related hospitalizations.AIM To evaluate SGLT2 inhibitor effects on HF,focusing on hospitalization for HF(HHF),cardiovascular(CV)deaths,and all-cause mortality.METHODS A comprehensive search was conducted in PubMed for randomized controlled trials(RCTs)evaluating the effects of SGLT2 inhibitor in HF patients compared to placebo,covering the period from January 1,2014,to January 1,2025.The primary outcomes assessed were HHF,CV deaths,and all-cause mortality.RevMan Web 5.4.1 was used to assess the risk of bias heterogeneity and to perform the statistical analyses.A random-effects model was employed for all statistical evaluations.RESULTS A total of nine RCTs were included in this analysis:DELIVER,DECLARE-TIMI 58,DAPA-HF,EMPA-REG OUTCOME,EMPEROR-Reduced,EMPEROR-Preserved,SOLOIST-WHF,EMPULSE,and VERTIS-CV.For HHF,eight trials(excluding the SOLOIST-WHF;n=25906)were pooled,while CV deaths were assessed using data from eight trials(excluding the EMPULSE;n=26598).Compared to placebo,SGLT2 inhibitor significantly reduced the risk of HHF(relative risk:0.74;95%CI:0.71-0.77;P<0.00001)and CV death(odds ratio:0.88;95%CI:0.83-0.92;P=0.0006).All nine trials(n=27128)were included in the analysis of all-cause mortality.SGLT2 inhibitor were associated with a statistically significant reduction in all-cause mortality compared to placebo(OR:0.91;95%CI:0.84-0.98;P=0.02).CONCLUSION These results suggest that SGLT2 inhibitor significantly reduce the risk of hospitalization for HF,CV deaths,and all-cause mortality.
