Publications by authors named "Coats A"
Article Synopsis
- Physicians often don't follow heart failure treatment guidelines well, particularly when it comes to prescribed dosage levels.
- Non-cardiologists usually show even lower compliance with these guidelines, which can negatively affect patient outcomes like survival rates and quality of life.
- This document seeks to identify reasons for these issues and offers updated guidance for starting and increasing heart failure medication dosages, aimed at both cardiologists and general practitioners.
Aims: Clinical practice guidelines are commonly written by professional societies in high-income countries (HIC) with limited anticipation of implementation obstacles in other environments. We used heart failure (HF) guidelines as a paradigm to examine this concern, by conducting a survey to understand clinicians' ability to implement HF guidelines and their perceptions of the current HF guideline applicability in low- and middle-income countries (LMIC).
Methods And Results: An online survey of physicians in the database of the Translational Medicine Academy who treat HF patients was offered by email from 5 October to 27 November 2023, inquiring of participants' demographic information, experience, and views of HF guidelines as related to their practice.
Article Synopsis
- SGLT2 inhibitors, like empagliflozin, are shown to improve outcomes for heart failure patients and reduce uric acid levels, with a focus on those having heart failure with preserved ejection fraction (HFpEF).
- In a study of patients receiving empagliflozin, about 49% had elevated uric acid levels, which were linked to worse heart failure severity and higher risk of severe outcomes like hospitalization.
- Empagliflozin significantly lowered uric acid levels early on and reduced related clinical events by 38%, with its effectiveness in improving heart failure outcomes not impacted by initial uric acid levels.
Article Synopsis
- Study investigates the use of patiromer, a potassium binder, to improve the effectiveness of RAAS inhibitors in patients with heart failure and hyperkalemia.
- In a trial with over 1,000 patients, those with hyperkalemia were able to optimize their medication while on patiromer, showing a slight reduction in serum potassium levels compared to placebo.
- Results suggest patiromer helps patients with current hyperkalemia maintain optimal doses of medication more effectively than those with a history of hyperkalemia, enhancing treatment outcomes for heart failure management.
Article Synopsis
- Hyperkalemia (HK) impacts the effectiveness of renin-angiotensin system (RAS) inhibitors and mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with reduced ejection fraction (HFrEF).
- The study analyzed patients with HFrEF and either HK or a history of HK during a run-in phase designed to optimize their RAS inhibitor and MRA doses using patiromer.
- Results showed significant increases in the use of RAS inhibitors and MRAs among patients meeting the optimization criteria, indicating that patiromer helped enhance treatment for those with HK or a history of HK.
Article Synopsis
- Many heart failure (HF) patients do not receive optimal doses of RAAS inhibitors due to worries about hyperkalemia (HK).
- The CARE-HK registry enrolled 2558 adults with chronic HF, primarily those with reduced ejection fraction, to evaluate RAASi treatment patterns and HK management across clinical practices in Europe and the USA.
- The study aims to better understand how RAAS inhibitors are used in patients at high risk for HK and to analyze their treatment outcomes in routine medical settings.
Article Synopsis
- Left ventricular hypertrophy (LVH) is linked to higher risks of cardiovascular disease and mortality, particularly in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) who commonly experience hypertension and LVH.
- This pooled analysis from the FIDELITY studies aimed to investigate the effects of the drug finerenone, a nonsteroidal mineralocorticoid receptor antagonist, on cardiovascular and kidney health in CKD and T2D patients, those with and without baseline LVH.
- Results indicated that while finerenone significantly reduced the risk of heart failure hospitalization in patients with LVH compared to those without, its overall impact on cardiovascular and kidney outcomes was not significantly different based on baseline LV
Survey on the knowledge and practices in anorexia of aging diagnosis and management in Japan.
J Cachexia Sarcopenia Muscle
October 2024
Article Synopsis
- Anorexia of aging (AA) affects older adults, leading to loss of appetite and decreased food intake, and the study explores how continuing education for healthcare professionals may impact the management of this condition in Japan.
- An online survey conducted by Japanese geriatric organizations gathered responses from 870 healthcare professionals regarding their knowledge and practices related to AA detection, treatment, and the use of educational resources.
- Results showed that healthcare providers engaged in continuing education were more likely to use validated screening tools and evidence-based practices for AA management compared to those who did not participate in educational initiatives.
Article Synopsis
- - The study evaluated the effectiveness of patiromer, a drug used to manage high potassium levels (hyperkalemia), in patients with heart failure and chronic kidney disease, especially focusing on its benefits when used alongside RAAS inhibitors.
- - Results showed that patiromer was particularly effective in controlling serum potassium levels in patients with more advanced chronic kidney disease (CKD), without increasing the risk of adverse effects.
- - The research concluded that patiromer allows for safer use of RAAS inhibitors in patients with heart failure, especially those with lower estimated glomerular filtration rates (eGFR), while minimizing hyperkalemia risk.
Article Synopsis
- Immunological therapies, including immune checkpoint inhibitors (ICIs) and cell-based therapies like CAR-T, have transformed cancer treatment by enabling the immune system to target cancer cells.
- While these therapies are generally effective, they can cause immune-related adverse events (irAEs) that vary in severity and timing, from mild skin rashes to serious complications such as myocarditis or cytokine release syndrome.
- The statement discusses the growing understanding of cardiovascular toxicities associated with these therapies, outlines their diagnosis and management, and identifies gaps in current research that need further exploration.
Article Synopsis
- Heart transplantation (HTx) has been around for over 50 years, yet there's a lack of guidelines for post-transplant prevention and rehabilitation practices.
- The statement emphasizes the need for tailored prevention and rehabilitation programs that consider both modifiable and non-modifiable factors to enhance the physical capacity and quality of life for HTx recipients.
- It advocates for a multidisciplinary approach involving all members of the HTx team to support patients throughout their recovery journey, highlighting the importance of starting these programs early after transplantation.
Aims: To update the European Society of Cardiology (ESC) quality indicators (QIs) for the evaluation of the care and outcomes of adults with heart failure.
Methods And Results: The Working Group comprised experts in heart failure including members of the ESC Clinical Practice Guidelines Task Force for heart failure, members of the Heart Failure Association, and a patient representative. We followed the ESC methodology for QI development.
The association between type 2 diabetes mellitus (T2DM) and heart failure (HF) has been firmly established; however, the entity of diabetic myocardial disorder (previously called diabetic cardiomyopathy) remains a matter of debate. Diabetic myocardial disorder was originally described as the occurrence of myocardial structural/functional abnormalities associated with T2DM in the absence of coronary heart disease, hypertension and/or obesity. However, supporting evidence has been derived from experimental and small clinical studies.
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- The text highlights a lack of knowledge and guidelines on physical activity and lifestyle measures for heart transplantation (HTx) recipients, despite the procedure's long history.
- It emphasizes the need for tailored prevention and rehabilitation strategies to enhance physical capacity, quality of life, and survival for these patients.
- The statement calls for a multidisciplinary approach to care, starting early post-transplant and continuing throughout the patients' journey, as HTx recipients have unique rehabilitation needs compared to other heart-related patients.
Article Synopsis
- Limited information exists on the physical activity and lifestyle measures for heart transplantation (HTx) recipients, despite the history of HTx spanning over 50 years without established guidelines for prevention and rehabilitation.
- The scientific statement aims to highlight the significance of prevention and rehabilitation post-HTx and identify both modifiable and non-modifiable factors that can enhance physical capacity, quality of life, and survival for these patients.
- A multidisciplinary approach is essential for developing tailored prevention and rehabilitation programs that begin early after HTx and continue throughout the patient's recovery journey.
Right heart failure (RHF) following implantation of a left ventricular assist device (LVAD) is a common and potentially serious condition with a wide spectrum of clinical presentations with an unfavourable effect on patient outcomes. Clinical scores that predict the occurrence of right ventricular (RV) failure have included multiple clinical, biochemical, imaging and haemodynamic parameters. However, unless the right ventricle is overtly dysfunctional with end-organ involvement, prediction of RHF post-LVAD implantation is, in most cases, difficult and inaccurate.
View Article and Find Full Text PDFDespite the progress in the care of individuals with heart failure (HF), important sex disparities in knowledge and management remain, covering all the aspects of the syndrome, from aetiology and pathophysiology to treatment. Important distinctions in phenotypic presentation are widely known, but the mechanisms behind these differences are only partially defined. The impact of sex-specific conditions in the predisposition to HF has gained progressive interest in the HF community.
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- Guideline-directed medical therapy (GDMT) is crucial for reducing illness and death in patients with heart failure and reduced ejection fraction (HFrEF), but it's not being used effectively in practice.
- Barriers like clinical inertia and organizational issues often lead to delays in starting or optimizing recommended treatments.
- The Heart Failure Association of the ESC highlights various strategies, such as improving heart failure care pathways, using digital tools, and increasing education for both patients and healthcare providers, to enhance the implementation of GDMT for better patient outcomes.
Article Synopsis
- Pulmonary hypertension (PH) linked to left heart failure (PH-LHF) is a common condition that worsens symptoms, reduces physical ability, and harms right heart function, leading to a poor outlook for patients.
- Despite various drugs being tested, there are currently no specific treatments for PH-LHF, highlighting significant gaps in understanding its pathophysiology and clinical management.
- The document calls for improved research on pulmonary venous changes, patient categorization for tailored therapies, and rigorous pre-clinical studies to enhance clinical trials and expand treatment options beyond current methods used for pulmonary arterial hypertension.
Background: Growth hormone (GH) resistance is characterized by high GH levels but low levels of insulin-like growth factor-I (IGF-I) and growth hormone binding protein (GHBP) and, for patients with chronic disease, is associated with the development of cachexia.
Objectives: We investigated whether GH resistance is associated with changes in left ventricular (LV) mass (cardiac wasting) in patients with cancer.
Methods: We measured plasma IGF-I, GH, and GHBP in 159 women and 148 men with cancer (83% stage III/IV).
Article Synopsis
- * A total of 7,435 studies were analyzed, with 50 papers meeting specific eligibility criteria, revealing a diversity in trial designs and intervention types, including multimodal approaches and various QOL measurement tools.
- * Among the findings, 18 trials reported statistically significant improvements in QOL for intervention groups, highlighting the effectiveness of specific methods like the EORTC QLQ-C30 and FACIT questionnaires in evaluating patient outcomes.