Publications by authors named "Cotter G"
Aims: We sought to characterize the clinical course of patients following worsening heart failure (WHF) treated in an outpatient setting and to identify factors associated with a poor response to standard of care with loop diuretics.
Methods And Results: Between September 2022 and March 2023, 44 eligible patients (mean age 66.3 years, 84% male) with ejection fraction <50% and with WHF symptoms in the preceding week treated in an outpatient setting were enrolled.
Owing to their rapid cooling rate and hence loss-limited propagation distance, cosmic-ray electrons and positrons (CRe) at very high energies probe local cosmic-ray accelerators and provide constraints on exotic production mechanisms such as annihilation of dark matter particles. We present a high-statistics measurement of the spectrum of CRe candidate events from 0.3 to 40 TeV with the High Energy Stereoscopic System, covering 2 orders of magnitude in energy and reaching a proton rejection power of better than 10^{4}.
View Article and Find Full Text PDFAims: Serelaxin is recombinant human relaxin-2, a hormone responsible for haemodynamic adaptations and organ protection in pregnancy. In the RELAX-AHF trial, serelaxin demonstrated reductions in cardiac, renal and hepatic damage. In RELAX-AHF-2, organ damage-related biomarkers were assessed in a biomarker substudy.
View Article and Find Full Text PDFUnlabelled: Since the advent of smartphones, peer interactions over digital platforms have become a primary mode of socializing among adolescents. Despite the rapid rise in digital social activity, it remains unclear how this dramatic shift has impacted adolescent social and emotional experiences. In an intensive, longitudinal design ( = 26, = 206 monthly observations for up to 12 months, 12-17 years), we used digital phenotyping methods to objectively measure within-person fluctuations in smartphone use (screen time, pickups, notifications) across different categories (social media, communication, entertainment, games) and examined their prospective, bidirectional associations with positive and negative mood.
View Article and Find Full Text PDFBackground: The prognostic importance of residual congestion after acute heart failure (AHF) hospitalization is still debated.
Objectives: The authors aimed to assess the impact of residual congestion in a large cohort of patients with AHF enrolled in the RELAX-AHF-2 (Relaxin in Acute Heart Failure 2) trial.
Methods: Residual congestion was assessed at day 5 after admission among hospitalized patients using an established composite congestion score (CCS) based on the presence of orthopnea, peripheral edema, and increased jugular venous pressure, ranging from 0 to 8 points.
Article Synopsis
- Excessive fluctuations in blood pressure are linked to higher risks of serious health issues like cardiovascular mortality and stroke, possibly due to patients not consistently following medical advice.
- A new trial uses an algorithm to track blood pressure variability in patients' electronic health records (EHR) and offers remote interventions to improve adherence to treatment.
- The study aims to identify patients with high variability and evaluate the impact of the intervention on their blood pressure, while also ensuring a fair allocation of healthcare resources.
Article Synopsis
- Cardiogenic shock (CS) poses significant health risks, necessitating effective interventions to maintain blood pressure and tissue perfusion, while current treatments, like inotropes, can lead to serious side effects.
- The SEISMiC study aims to evaluate the safety and effectiveness of istaroxime, a new drug that may improve blood flow without overstimulating adrenergic receptors, in patients at risk for CS.
- This multinational, double-blind study involves patients with severe heart failure and aims to measure the drug's impact on blood pressure and other cardiac metrics over a 60-hour period, aiming to clarify istaroxime's potential benefits in managing pre-CS conditions.
Article Synopsis
- A study looked at how steroids, like prednisone, help reduce congestion in patients with acute heart failure (AHF).
- Patients taking prednisone showed more improvement in their congestion levels compared to those receiving regular care.
- The results suggest that steroids can help with symptoms related to congestion, but more research is needed to confirm these findings.
Article Synopsis
- - Anemia is a common issue among heart failure patients, affecting their treatment outcomes, and this study aimed to examine how anemia prevalence changes and its relationship with clinical results in heart failure patients from the STRONG-HF study.
- - In the study of 1077 patients, anemia rates rose from 27.2% at enrollment to 32.1% at 90 days, with a slightly higher primary composite outcome observed in anemic patients, but the difference wasn't statistically significant.
- - Patients with baseline anemia showed less improvement in health-related quality of life, while the incidence of anemia was higher in those receiving high-intensity care compared to usual care; factors like male sex and non-European regions were linked to a higher
Aims: Acute heart failure (AHF) is a major cause of hospitalizations and death in the elderly. However, elderly patients are often underrepresented in randomized clinical trials. We analysed the impact of age on clinical outcomes and response to treatment in patients enrolled in Relaxin in Acute Heart Failure (RELAX-AHF-2), a study that included older patients than in previous AHF trials.
View Article and Find Full Text PDFArticle Synopsis
- * Patients receiving prednisone showed a significant reduction in inflammation as indicated by decreased levels of high-sensitivity C-reactive protein (hsCRP) and a notably lower risk of heart failure worsening, readmissions, or death over 90 days compared to the usual care group.
- * While burst steroid therapy improved outcomes like quality of life and reduced heart failure risks, it was associated with more adverse events like hyperglycemia, indicating a need for larger studies to confirm these findings and further assess safety
Decongestion in acute heart failure: Is it time to change diuretic-centred paradigm?
Eur J Heart Fail
October 2024
Congestion is a common cause of clinical deterioration and the most common clinical presentation at admission in acute heart failure (HF). Therefore, finding effective and sustainable ways to alleviate congestion has become a crucial goal for treating HF patients. Congestion is a result of complex underlying pathophysiology; therefore, it is not a direct cause of the disease but its consequence.
View Article and Find Full Text PDFAims: The optimal dose of diuretics and nitrates for acute heart failure treatment remains uncertain. This study aimed to assess the association between intravenous nitrates and loop diuretics doses within the initial 4 h of emergency department presentation and the number of days alive and out of hospital (NDAOH) through 30 days.
Methods: This was an ancillary study of the ELISABETH stepped-wedge cluster randomized trial that included 502 acute heart failure patients 75 years or older in 15 French emergency departments.
Article Synopsis
- Heart failure (HF) is a serious systemic disease that leads to high levels of illness and hospital visits, significantly lowering patients' quality of life.
- The text stresses the need for high-intensity care to ensure that patients receive the optimal doses of guideline-directed medical therapy (GDMT) to improve their health outcomes.
- It also addresses challenges to achieving these optimal treatments, like patient adherence and comorbid conditions, while exploring future possibilities for enhancing care in HF patients.
Article Synopsis
- The STRONG-HF trial tested the effectiveness of rapidly increasing neurohormonal blockade in patients with acute heart failure (AHF) compared to usual care.
- Patients receiving high-intensity care (HIC) showed significantly higher rates of successful decongestion at day 90 (75%) compared to usual care (68%), alongside improvements in various decongestion markers.
- Successful decongestion was linked to a lower risk of hospital readmission or all-cause death, indicating that the HIC approach offers better long-term outcomes for AHF patients.
Background: Multimorbidity frequently occurs in patients with acute heart failure (AHF). The co-occurrence of comorbidities often follows specific patterns.
Objectives: This study investigated multimorbidity subtypes and their associations with clinical outcomes.
Aims: Inflammation has emerged as a potential key pathophysiological mechanism in heart failure (HF) in general and acute HF (AHF) specifically, with inflammatory biomarkers shown to be highly predictive of adverse outcomes in these patients. The CORTAHF study builds on both these data and the fact that steroid burst therapy has been shown to be effective in the treatment of respiratory diseases and COVID-19. Our hypothesis is that in patients with AHF and elevated C-reactive protein (CRP) levels without symptoms or signs of infection, a 7-day course of steroid therapy will lead to reduced inflammation and short-term improvement in quality of life and a reduced risk of worsening HF (WHF) events.
View Article and Find Full Text PDFArticle Synopsis
- - Biologically active adrenomedullin (bio-ADM) has potential as a marker for residual congestion in heart failure (HF) patients, as shown in the STRONG-HF trial, which indicated that high-intensity care of guideline-directed medical therapy can improve patient outcomes.
- - A study measuring bio-ADM levels in 1,005 heart failure patients found that higher baseline bio-ADM concentrations were linked to increased risks of mortality and rehospitalization, while bio-ADM changes correlated with congestion status after 90 days.
- - Although bio-ADM showed modest predictive ability for patient outcomes, the study found that high-intensity care improved outcomes regardless of initial bio-ADM levels, and its change over 90
Background: The STRONG-HF trial showed that high-intensity care (HIC) consisting of rapid up-titration of guideline-directed medical therapy (GDMT) and close follow-up reduced all-cause death or heart failure (HF) readmission at 180 days compared to usual care (UC). We hypothesized that significant differences in patient characteristics, management, and outcomes over the enrolment period may exist.
Methods: Two groups of the 1,078 patients enrolled in STRONG-HF were created according to the order of enrolment within center.