State of the art: using natriuretic peptide levels in clinical practice.

Natriuretic peptide (NP) levels (B-type natriuretic peptide (BNP) and N-terminal proBNP) are now widely used in clinical practice and cardiovascular research throughout the world and have been incorporated into most national and international cardiovascular guidelines for heart failure. The role of NP levels in state-of-the-art clinical practice is evolving rapidly. This paper reviews and highlights ten key messages to clinicians: 1) NP levels are quantitative plasma biomarkers of heart failure (HF).

Management of heart failure with renal artery ischemia.

With improved treatment, patients are surviving longer with impaired ventricular function. Hypertension results in ventricular remodeling in many patients. More than 5 million people have heart failure and are likely to have one or more co-existent diseases associated with aging, one of which is chronic kidney disease (CKD).

Use of cardiac resynchronization therapy in patients hospitalized with heart failure.

Background: The frequency and characterization of patients receiving cardiac resynchronization therapy (CRT) are largely unknown since the publication of pivotal clinical trials and subsequent incorporation of CRT into the American College of Cardiology/American Heart Association guidelines for heart failure.

Methods And Results: We analyzed 33,898 patients admitted from January 2005 through September 2007 to 228 hospitals participating in the American Heart Association's Get With the Guidelines-Heart Failure program. There were 4201 patients (12.

Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF).

Objectives: The aim of this study was to develop a clinical model predictive of in-hospital mortality in a broad hospitalized heart failure (HF) patient population.

Background: Heart failure patients experience high rates of hospital stays and poor outcomes. Although predictors of mortality have been identified in HF clinical trials, hospitalized patients might differ greatly from trial populations, and such predictors might underestimate mortality in a real-world population.

Race-based therapeutics.

The issue of race in medicine is problematic. Race is not a physiologic grouping, and all persons of a given race do not necessarily share the same clinical phenotype or genetic substrate. Despite clear signals that certain risk factors and diseases vary as a function of race, translating those differences into race-based therapeutics has been awkward and has done little to change the natural history of cardiovascular disease as it affects special populations.

Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program.

Objectives: This study ascertains the relationship between continuation or withdrawal of beta-blocker therapy and clinical outcomes in patients hospitalized with systolic heart failure (HF).

Background: Whether beta-blocker therapy should be continued or withdrawn during hospitalization for decompensated HF has not been well studied in a broad cohort of patients.

Methods: The OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) program enrolled 5,791 patients admitted with HF in a registry with pre-specified 60- to 90-day follow-up at 91 academic and community hospitals throughout the U.

Heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF.

Background: Few data exist regarding contemporary care patterns for heart failure (HF) in the outpatient setting. IMPROVE HF is a prospective cohort study designed to characterize current management of patients with chronic HF and ejection fraction < or =35% in a national registry of 167 US outpatient cardiology practices.

Methods And Results: Baseline patient characteristics and data on care of 15381 patients with diagnosed HF or prior myocardial infarction and left ventricular dysfunction were collected by chart abstraction.

Characteristics and outcomes in African American patients with decompensated heart failure.

Background: Outcomes in patients with chronic heart failure vary by race. Racial differences in the characteristics and outcomes of patients with acute decompensated heart failure (ADHF) have not been well characterized. Therefore, we assessed race-related differences in presentation, treatment, in-patient experiences, and short-term mortality due to ADHF before and after accounting for known covariates.

Race and the natural history of chronic heart failure: a propensity-matched study.

Background: Racial differences in the epidemiology and outcomes of heart failure are well known. However, the association of race with the natural history of heart failure has not been previously studied in a propensity-matched population of chronic heart failure in which all measured baseline patient characteristics are well-balanced between the races.

Methods And Results: Of the 7788 patients with chronic systolic and diastolic heart failure in the Digitalis Investigation Group trial, 1128 were nonwhites.

A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF.

Aims: Cigarette smoking is a well-established risk factor for cardiovascular disease yet several studies have shown lower mortality after acute coronary syndromes in smokers compared with non-smokers, the so called 'smoker's paradox'. This study aimed to ascertain the relationship between smoking and clinical outcomes in patients hospitalized with heart failure (HF).

Methods And Results: OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) collected data on 48 612 patients from 259 hospitals.

Day of admission and clinical outcomes for patients hospitalized for heart failure: findings from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF).

Background: Differences in hospital staffing may influence outcomes for patients with acute conditions, including heart failure (HF), depending on which day of the week the patients are admitted. This study examined the relationship between the day of the week patients are hospitalized for HF and death rate, length of stay (LOS), and rehospitalization rate.

Methods And Results: A total of 259 US hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) submitted data on 48 612 patients with HF.

Safety and efficacy of outpatient nesiritide in patients with advanced heart failure: results of the Second Follow-Up Serial Infusions of Nesiritide (FUSION II) trial.

Background: Patients with American College of Cardiology/American Heart Association stage C/D heart failure experience substantial morbidity and mortality, but available interventions beyond standard medical and device therapies are limited. Nesiritide relieves dyspnea and reduces pulmonary congestion, but its risk profile is uncertain. Pilot data suggested a potential benefit of nesiritide given as serial outpatient infusions.

Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF.

Background: Few studies have examined factors identified as contributing to heart failure (HF) hospitalization, and, to our knowledge, none has explored their relationship to length of stay and mortality. This study evaluated the association between precipitating factors identified at the time of HF hospital admission and subsequent clinical outcomes.

Methods: During 2003 to 2004, 259 US hospitals in OPTIMIZE-HF submitted data on 48 612 patients, with a prespecified subgroup of at least 10% providing 60- to 90-day follow-up data.

Blacks and whites have a similar prevalence of reduced left ventricular ejection fraction in the general population: the Dallas Heart Study (DHS).

Background: The objective of the study was to evaluate racial differences in the prevalence of left ventricular (LV) dysfunction. Few data compare the relative frequency of reduced LV ejection fraction (EF) (LVEF) in blacks and whites. Because of the higher prevalence of risk factors for heart failure in blacks, including hypertension, obesity, and LV hypertrophy, we hypothesized that LV dysfunction would also be more common in this ethnic group.

Quality of care of and outcomes for African Americans hospitalized with heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry.

Objectives: We sought to examine the characteristics, quality of care, and clinical outcomes for a large cohort of African-American patients hospitalized with heart failure (HF) in centers participating in a quality improvement initiative.

Background: Heart failure in African Americans is characterized by variations in natural history, lesser response to evidence-based therapies, and disparate health care. We hypothesized that a performance improvement program will achieve similar adherence to quality measures in African Americans admitted with HF compared with non-African Americans.

Comparison of clinical features and outcomes of patients hospitalized with heart failure and normal ejection fraction (> or =55%) versus those with mildly reduced (40% to 55%) and moderately to severely reduced (<40%) fractions.

Heart failure (HF) with normal ejection fraction (EF) is an increasingly common presentation of acute decompensated HF. Differences between patients with HF and truly normal EF and those with mildly impaired EF have not been described. The Acute Decompensated Heart Failure Registry (ADHERE) contains information on >100,000 HF hospitalizations and may provide insight into this distinction.