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
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 There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental...BACKGROUND There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental suicidal ideation among children with CHD and the associated factors.METHODS This was a cross-sectional study among 50 parents of children with CHD who attended the Cardiac Clinic of University of Nigeria Teaching Hospital Ituku-Ozalla.Information was obtained using the Columbia Suicide Severity Rating Scale and the Hospital Anxiety and Depression Scale.RESULTS A greater percentage of parents whose child had a heart defect had anxiety symptoms(50.0%)than did those whose child had no heart defect(24.0%),and the difference in proportions was statistically significant(χ^(2)=7.250,P=0.007).A greater percentage of parents whose child had a heart defect had suicidal ideation(28.0%)than did those whose child had no heart defect(8.0%),and the difference in proportions was statistically significant(χ^(2)=6.775 P=0.009).A positive correlation was elicited between anxiety and suicide ideation,and this correlation was statistically significant(r=0.748,P<0.001).A positive correlation was elicited between depression and suicidal ideation scores,and this was statistically significant(r=0.617,P<0.001).CONCLUSION There is strong interconnectivity between anxiety and depression with suicidal ideation.There is an urgent need to start screening for the mental health of parents of children with CHD to avert the high propensity of complete suicide.In addition,policy makers may introduce a national clinical practice guideline on the importance of psychotherapy and mental health screening and targeted interventions for parents of children with CHD.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
Background:The traditional method of heterotopic abdominal heart transplantation(HTx)involves crossclamping the inferior vena cava,which inevitably leads to bilateral lower limb ischemia(LI).This study first aimed to ...Background:The traditional method of heterotopic abdominal heart transplantation(HTx)involves crossclamping the inferior vena cava,which inevitably leads to bilateral lower limb ischemia(LI).This study first aimed to investigate the impact of LI on renal function in rats subjected to unilateral nephrectomy(UNx).Second,a modified method utilizing renal vessel-assisted anastomosis in rats with left UNx was compared with the traditional method for abdominal HTx.Methods:Male Sprague-Dawley rats were utilized as subjects for both experimental phases.In experiment 1,the animals were divided into four groups:sham operation group;LI group-rats undergoing occlusion of the abdominal aorta and vena cava below the renal vessels;UNx group-rats with left UNx;and LI+UNx group.All operated animals were monitored for up to 7 days for biochemical markers,renal histopathology,and survival rates.In experiment 2,we introduced the renal vessel-assisted method as the experimental group and compared it against the traditional method as the control within rat heterotopic HTx models.We assessed operative characteristics,echocardiography results,histological findings,and graft survival.Results:First,LI resulted in acute kidney dysfunction characterized by a decrease in 7day survival rates and creatinine clearance rates in both the LI and LI+UNx groups compared to the sham operation and UNx groups.Particularly,histopathological damage in the kidney and liver did not exhibit significant effects during this period.Second,the implementation of the renal vessel-assisted method significantly reduced bleeding volume at suture sites and enhanced the 7day survival rate compared to the traditional method.Conclusion:Acute kidney injury was induced by LI postoperation in treated rats.The renal vessel-assisted method demonstrated its effectiveness as a superior alternative that mitigates complications associated with the traditional method.展开更多
Background:Studies have shown that heart rate variability(HRV)is a predictor of the prognosis of cardiovascular diseases.Contact heartbeat monitoring equipment is widely used,especially in hospitals,and benefits from ...Background:Studies have shown that heart rate variability(HRV)is a predictor of the prognosis of cardiovascular diseases.Contact heartbeat monitoring equipment is widely used,especially in hospitals,and benefits from the rapidity and accuracy of the detection of physiological health indicators.However,long-term contact with equipment has many adverse effects.The purpose of this study was to improve the accuracy of HRV detection via noncontact equipment,thus enabling HRV to be assessed in various scenarios.Methods:A novel deep learning approach was proposed for measuring heartbeats through camera videos.First,we performed facial segmentation and divided the face into 16 grid cells with different light balance scores.After the trend is filtered by the Hamming window,a transformer-based neural network is used to further filter the signal.Finally,heart rate(HR)and HRV are estimated.Results:We used 1 million synthetic data points for pretraining and a public dataset in combination with a dataset that we constructed for task training.The final results were obtained on a test dataset that we constructed.The accuracy for HR with a low light balance score(0.867-0.983)was greater than that with a high score(0.667-0.750).Our method had higher accuracy in estimating HR than traditional filtering methods(0.167-0.417)and state-of-the-art neural network filtering methods(0.783-0.917)did.The root mean square error of the HRV from the time domain was the lowest,and the correlation index score was the highest for the HRV from the frequency domain estimated by our method compared with those estimated by two neural networks.Conclusions:Light balance,large sample training,and two-stage training can improve the accuracy of HRV estimation.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
As one of the main chronic diseases in modern society,coronary heart disease,as a major disease that affects people’s lives and health,has the characteristics of hidden onset and sudden onset.Coronary heart disease h...As one of the main chronic diseases in modern society,coronary heart disease,as a major disease that affects people’s lives and health,has the characteristics of hidden onset and sudden onset.Coronary heart disease has relatively clear risk factors.Among them,blood lipid levels and blood sugar levels,as two main risk factors,play an important role in promoting the onset of coronary heart disease.The two complement each other in a vicious cycle,synergize and promote each other,promote the process of coronary atherosclerosis,thereby causing coronary heart disease.Multiple components in blood lipids and poor management of long-term blood sugar levels play a major role in specific clinical problems.This article reviews the different components of blood lipids and the effects of hyperglycemia on coronary heart disease,and initially expounds the mechanism by which blood lipids and blood sugar levels synergize each other to aggravate the risk of coronary heart disease,and combines them with relevant clinical issues,in order to help clinicians guide the prevention of coronary heart disease in terms of blood lipids and blood sugar levels.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: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
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
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) 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
Heart disease remains a leading cause of mortality worldwide,emphasizing the urgent need for reliable and interpretable predictive models to support early diagnosis and timely intervention.However,existing Deep Learni...Heart disease remains a leading cause of mortality worldwide,emphasizing the urgent need for reliable and interpretable predictive models to support early diagnosis and timely intervention.However,existing Deep Learning(DL)approaches often face several limitations,including inefficient feature extraction,class imbalance,suboptimal classification performance,and limited interpretability,which collectively hinder their deployment in clinical settings.To address these challenges,we propose a novel DL framework for heart disease prediction that integrates a comprehensive preprocessing pipeline with an advanced classification architecture.The preprocessing stage involves label encoding and feature scaling.To address the issue of class imbalance inherent in the personal key indicators of the heart disease dataset,the localized random affine shadowsampling technique is employed,which enhances minority class representation while minimizing overfitting.At the core of the framework lies the Deep Residual Network(DeepResNet),which employs hierarchical residual transformations to facilitate efficient feature extraction and capture complex,non-linear relationships in the data.Experimental results demonstrate that the proposed model significantly outperforms existing techniques,achieving improvements of 3.26%in accuracy,3.16%in area under the receiver operating characteristics,1.09%in recall,and 1.07%in F1-score.Furthermore,robustness is validated using 10-fold crossvalidation,confirming the model’s generalizability across diverse data distributions.Moreover,model interpretability is ensured through the integration of Shapley additive explanations and local interpretable model-agnostic explanations,offering valuable insights into the contribution of individual features to model predictions.Overall,the proposed DL framework presents a robust,interpretable,and clinically applicable solution for heart disease prediction.展开更多
Valvular Heart Disease(VHD),including stenosis and regurgitation,is a significant contributor to global cardiovascular morbidity.Current prosthetic solutions mechanical and bioprosthetic heart valves each present majo...Valvular Heart Disease(VHD),including stenosis and regurgitation,is a significant contributor to global cardiovascular morbidity.Current prosthetic solutions mechanical and bioprosthetic heart valves each present major limitation.Mechanical valves require lifelong anticoagulation due to thrombogenicity,while bioprosthetic valves suffer from structural degeneration and limited durability.Polymeric Heart Valves(PHVs)have emerged as promising alternatives,aiming to integrate the mechanical resilience of synthetic materials with the biocompatibility and hemodynamic performance of natural valves.Recent studies have explored advanced polymers such as Polyhedral Oligomeric Silsesquioxane–Polycarbonate–Urea–Urethane(POSS-PCU),Silicone–Polyurethane Urea(SiPUU),and nanocomposites like Polyvinyl Alcohol(PVA)and SIBS for their enhanced thromboresistance,calcification resistance,and long-term mechanical durability.Complementary to material innovation,fabrication methods such as 3D printing,Melt Electrospinning Writing(MEW),and Focused Rotary Jet Spinning(FRJS)offer patient-specific designs and microstructural control.This review systematically compares traditional and next-generation prostheses,examines mechanical and biological performance,and discusses critical design challenges including porosity,thrombogenicity,and leaflet calcification.Finite Element Analysis(FEA)and Computational Fluid Dynamics(CFD)are highlighted for optimizing design and simulating physiological conditions.By presenting recent preclinical progress and manufacturing strategies,this review outlines a translational roadmap toward clinically viable,biomimetic polymeric heart valves capable of addressing the needs of both adult and pediatric patients.Compared to traditional bioprosthetic tissues,advanced polymers offer better resistance to calcification,reduced thrombogenicity,and tunable mechanical properties.展开更多
BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-...BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-transplant and determine if there was any correlation with recipient and donor characteristics.METHODS Data from 279 consecutive heart transplant recipients from 2007 through 2020 were analyzed.Clinical variables regarding both recipients and donors as well as hemodynamic variables obtained via right heart catheterization during 1-year and 3-year annual testing were recorded.Simple and multiple linear regression tests were used to determine how recipient and donor variables influenced hemodynamic parameters at 1-year and 3-year.RESULTS Data were available for 260 patients and 224 patients at 1-year and 3-year posttransplant respectively.At 1-year,abnormal hemodynamic parameters were common with 24%patients having right atrial pressure(RAP)>10 mmHg,52%with mean pulmonary artery pressure>20 mmHg,and 12%with pulmonary capillary wedge pressure(PCWP)>18 mmHg.Similar abnormalities were noted at 3-year post-transplant.Recipient body mass index(BMI)demonstrated the strongest correlation with all 3 variables at both 1-year and 3-year by multivariate linear regression analysis(P<0.001 for both).Both donor age and predicted heart mass difference between recipient and donor were significantly linked to RAP and PCWP at 1-year but did not predict any variables at 3-year post-transplant.CONCLUSION Abnormal hemodynamics are common at 1-year and 3-year post-transplant and are associated with recipients with high BMI.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
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.
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.
文摘BACKGROUND There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental suicidal ideation among children with CHD and the associated factors.METHODS This was a cross-sectional study among 50 parents of children with CHD who attended the Cardiac Clinic of University of Nigeria Teaching Hospital Ituku-Ozalla.Information was obtained using the Columbia Suicide Severity Rating Scale and the Hospital Anxiety and Depression Scale.RESULTS A greater percentage of parents whose child had a heart defect had anxiety symptoms(50.0%)than did those whose child had no heart defect(24.0%),and the difference in proportions was statistically significant(χ^(2)=7.250,P=0.007).A greater percentage of parents whose child had a heart defect had suicidal ideation(28.0%)than did those whose child had no heart defect(8.0%),and the difference in proportions was statistically significant(χ^(2)=6.775 P=0.009).A positive correlation was elicited between anxiety and suicide ideation,and this correlation was statistically significant(r=0.748,P<0.001).A positive correlation was elicited between depression and suicidal ideation scores,and this was statistically significant(r=0.617,P<0.001).CONCLUSION There is strong interconnectivity between anxiety and depression with suicidal ideation.There is an urgent need to start screening for the mental health of parents of children with CHD to avert the high propensity of complete suicide.In addition,policy makers may introduce a national clinical practice guideline on the importance of psychotherapy and mental health screening and targeted interventions for parents of children with CHD.
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.
基金The Youth Project of Tianjin Natural Science Foundation,Grant/Award Number:23JCQNJC01380。
文摘Background:The traditional method of heterotopic abdominal heart transplantation(HTx)involves crossclamping the inferior vena cava,which inevitably leads to bilateral lower limb ischemia(LI).This study first aimed to investigate the impact of LI on renal function in rats subjected to unilateral nephrectomy(UNx).Second,a modified method utilizing renal vessel-assisted anastomosis in rats with left UNx was compared with the traditional method for abdominal HTx.Methods:Male Sprague-Dawley rats were utilized as subjects for both experimental phases.In experiment 1,the animals were divided into four groups:sham operation group;LI group-rats undergoing occlusion of the abdominal aorta and vena cava below the renal vessels;UNx group-rats with left UNx;and LI+UNx group.All operated animals were monitored for up to 7 days for biochemical markers,renal histopathology,and survival rates.In experiment 2,we introduced the renal vessel-assisted method as the experimental group and compared it against the traditional method as the control within rat heterotopic HTx models.We assessed operative characteristics,echocardiography results,histological findings,and graft survival.Results:First,LI resulted in acute kidney dysfunction characterized by a decrease in 7day survival rates and creatinine clearance rates in both the LI and LI+UNx groups compared to the sham operation and UNx groups.Particularly,histopathological damage in the kidney and liver did not exhibit significant effects during this period.Second,the implementation of the renal vessel-assisted method significantly reduced bleeding volume at suture sites and enhanced the 7day survival rate compared to the traditional method.Conclusion:Acute kidney injury was induced by LI postoperation in treated rats.The renal vessel-assisted method demonstrated its effectiveness as a superior alternative that mitigates complications associated with the traditional method.
基金National Natural Science Foundation of China,Grant/Award Number:72204169Department of Science and Technology of Sichuan Province,Grant/Award Number:2021YFS0393。
文摘Background:Studies have shown that heart rate variability(HRV)is a predictor of the prognosis of cardiovascular diseases.Contact heartbeat monitoring equipment is widely used,especially in hospitals,and benefits from the rapidity and accuracy of the detection of physiological health indicators.However,long-term contact with equipment has many adverse effects.The purpose of this study was to improve the accuracy of HRV detection via noncontact equipment,thus enabling HRV to be assessed in various scenarios.Methods:A novel deep learning approach was proposed for measuring heartbeats through camera videos.First,we performed facial segmentation and divided the face into 16 grid cells with different light balance scores.After the trend is filtered by the Hamming window,a transformer-based neural network is used to further filter the signal.Finally,heart rate(HR)and HRV are estimated.Results:We used 1 million synthetic data points for pretraining and a public dataset in combination with a dataset that we constructed for task training.The final results were obtained on a test dataset that we constructed.The accuracy for HR with a low light balance score(0.867-0.983)was greater than that with a high score(0.667-0.750).Our method had higher accuracy in estimating HR than traditional filtering methods(0.167-0.417)and state-of-the-art neural network filtering methods(0.783-0.917)did.The root mean square error of the HRV from the time domain was the lowest,and the correlation index score was the highest for the HRV from the frequency domain estimated by our method compared with those estimated by two neural networks.Conclusions:Light balance,large sample training,and two-stage training can improve the accuracy of HRV estimation.
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As one of the main chronic diseases in modern society,coronary heart disease,as a major disease that affects people’s lives and health,has the characteristics of hidden onset and sudden onset.Coronary heart disease has relatively clear risk factors.Among them,blood lipid levels and blood sugar levels,as two main risk factors,play an important role in promoting the onset of coronary heart disease.The two complement each other in a vicious cycle,synergize and promote each other,promote the process of coronary atherosclerosis,thereby causing coronary heart disease.Multiple components in blood lipids and poor management of long-term blood sugar levels play a major role in specific clinical problems.This article reviews the different components of blood lipids and the effects of hyperglycemia on coronary heart disease,and initially expounds the mechanism by which blood lipids and blood sugar levels synergize each other to aggravate the risk of coronary heart disease,and combines them with relevant clinical issues,in order to help clinicians guide the prevention of coronary heart disease in terms of blood lipids and blood sugar levels.
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: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.
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 (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funded by Ongoing Research Funding Program for Project number(ORF-2025-648),King Saud University,Riyadh,Saudi Arabia.
文摘Heart disease remains a leading cause of mortality worldwide,emphasizing the urgent need for reliable and interpretable predictive models to support early diagnosis and timely intervention.However,existing Deep Learning(DL)approaches often face several limitations,including inefficient feature extraction,class imbalance,suboptimal classification performance,and limited interpretability,which collectively hinder their deployment in clinical settings.To address these challenges,we propose a novel DL framework for heart disease prediction that integrates a comprehensive preprocessing pipeline with an advanced classification architecture.The preprocessing stage involves label encoding and feature scaling.To address the issue of class imbalance inherent in the personal key indicators of the heart disease dataset,the localized random affine shadowsampling technique is employed,which enhances minority class representation while minimizing overfitting.At the core of the framework lies the Deep Residual Network(DeepResNet),which employs hierarchical residual transformations to facilitate efficient feature extraction and capture complex,non-linear relationships in the data.Experimental results demonstrate that the proposed model significantly outperforms existing techniques,achieving improvements of 3.26%in accuracy,3.16%in area under the receiver operating characteristics,1.09%in recall,and 1.07%in F1-score.Furthermore,robustness is validated using 10-fold crossvalidation,confirming the model’s generalizability across diverse data distributions.Moreover,model interpretability is ensured through the integration of Shapley additive explanations and local interpretable model-agnostic explanations,offering valuable insights into the contribution of individual features to model predictions.Overall,the proposed DL framework presents a robust,interpretable,and clinically applicable solution for heart disease prediction.
文摘Valvular Heart Disease(VHD),including stenosis and regurgitation,is a significant contributor to global cardiovascular morbidity.Current prosthetic solutions mechanical and bioprosthetic heart valves each present major limitation.Mechanical valves require lifelong anticoagulation due to thrombogenicity,while bioprosthetic valves suffer from structural degeneration and limited durability.Polymeric Heart Valves(PHVs)have emerged as promising alternatives,aiming to integrate the mechanical resilience of synthetic materials with the biocompatibility and hemodynamic performance of natural valves.Recent studies have explored advanced polymers such as Polyhedral Oligomeric Silsesquioxane–Polycarbonate–Urea–Urethane(POSS-PCU),Silicone–Polyurethane Urea(SiPUU),and nanocomposites like Polyvinyl Alcohol(PVA)and SIBS for their enhanced thromboresistance,calcification resistance,and long-term mechanical durability.Complementary to material innovation,fabrication methods such as 3D printing,Melt Electrospinning Writing(MEW),and Focused Rotary Jet Spinning(FRJS)offer patient-specific designs and microstructural control.This review systematically compares traditional and next-generation prostheses,examines mechanical and biological performance,and discusses critical design challenges including porosity,thrombogenicity,and leaflet calcification.Finite Element Analysis(FEA)and Computational Fluid Dynamics(CFD)are highlighted for optimizing design and simulating physiological conditions.By presenting recent preclinical progress and manufacturing strategies,this review outlines a translational roadmap toward clinically viable,biomimetic polymeric heart valves capable of addressing the needs of both adult and pediatric patients.Compared to traditional bioprosthetic tissues,advanced polymers offer better resistance to calcification,reduced thrombogenicity,and tunable mechanical properties.
文摘BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-transplant and determine if there was any correlation with recipient and donor characteristics.METHODS Data from 279 consecutive heart transplant recipients from 2007 through 2020 were analyzed.Clinical variables regarding both recipients and donors as well as hemodynamic variables obtained via right heart catheterization during 1-year and 3-year annual testing were recorded.Simple and multiple linear regression tests were used to determine how recipient and donor variables influenced hemodynamic parameters at 1-year and 3-year.RESULTS Data were available for 260 patients and 224 patients at 1-year and 3-year posttransplant respectively.At 1-year,abnormal hemodynamic parameters were common with 24%patients having right atrial pressure(RAP)>10 mmHg,52%with mean pulmonary artery pressure>20 mmHg,and 12%with pulmonary capillary wedge pressure(PCWP)>18 mmHg.Similar abnormalities were noted at 3-year post-transplant.Recipient body mass index(BMI)demonstrated the strongest correlation with all 3 variables at both 1-year and 3-year by multivariate linear regression analysis(P<0.001 for both).Both donor age and predicted heart mass difference between recipient and donor were significantly linked to RAP and PCWP at 1-year but did not predict any variables at 3-year post-transplant.CONCLUSION Abnormal hemodynamics are common at 1-year and 3-year post-transplant and are associated with recipients with high BMI.
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.
