Publications by authors named "Koji Takagi"
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.
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
- 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.
Unraveling the activity and stability of cationic tellurium activators in Ritter-type reactions.
Chem Commun (Camb)
October 2024
We carried out Ritter-type reactions using two kinds of cationic tellurium activators. Compared with the trivalent dianisylmethyltelluronium cation, the divalent telluroviologen derivatives showed higher activity and better stability. Telluroviologen activator could cleave the C-OH bond of benzhydrol and the reaction was accelerated under LED light irradiation.
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- - 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
Article 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
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.
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.
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- - 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.
Article Synopsis
- The study investigates the safety, tolerability, and efficacy of high-intensity care (HIC) for heart failure using the MAGGIC risk score, which is a risk assessment tool for patients with chronic heart failure.
- Patients in the STRONG-HF trial were divided into two groups, one receiving HIC with rapid medication uptitration and the other receiving usual care, with the main goal of comparing outcomes such as death and hospitalization rates at 180 days.
- Results showed that while HIC led to higher medication use, the overall death or readmission rates varied according to the MAGGIC risk score, suggesting that the severity of heart failure risk impacts treatment outcomes.
Aims: The effects of initiating sacubitril/valsartan in patients with stable heart failure with reduced ejection fraction (HFrEF) on response to fluid and sodium expansion are unknown.
Methods And Results: We have explored changes in natriuresis, diuresis, and congestion in response to the administration of intravenous fluid/sodium load in patients with HFrEF before as compared to after the initiation of sacubitril/valsartan. At baseline (before sacubitril/valsartan initiation) and 2 and 3 months after the initiation, patients underwent an evaluation that consisted of three phases of 3 h: the rest phase (0-3 h), the load phase (3-6 h) in which 1 L of intravenous Ringer solution was administered, and the diuretic phase (6-9 h) at the beginning of which furosemide was administered.
Background: This analysis provides details on baseline and changes in quality of life (QoL) and its components as measured by EQ-5D-5L questionnaire, as well as association with objective outcomes, applying high-intensity heart failure (HF) care in patients with acute HF.
Methods: In STRONG-HF trial (Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies) patients with acute HF were randomized just before discharge to either usual care or a high-intensity care strategy of guideline-directed medical therapy up-titration. Patients ranked their state of health on the EQ-5D visual analog scale score ranging from 0 (the worst imaginable health) to 100 (the best imaginable health) at baseline and at 90 days follow-up.
Article Synopsis
- - The study investigates the effectiveness of a high-intensity care (HIC) strategy with rapid guideline-directed medical therapy (GDMT) compared to usual care (UC) for patients hospitalized due to acute heart failure (AHF) and examines the influence of baseline systolic blood pressure (SBP).
- - Researchers analyzed the outcomes of 1,075 patients categorized by their baseline SBP and changes in SBP after discharge, finding that the benefits of HIC were not influenced by baseline SBP levels or early changes in SBP.
- - Results showed that patients in the HIC group achieved similar target doses of GDMT regardless of whether they had increased, stable, or decreased SBP within the first week after discharge,
Importance: The Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by N-Terminal Pro-Brain Natriuretic Peptide Testing of Heart Failure Therapies (STRONG-HF) trial strived for rapid uptitration aiming to reach 100% optimal doses of guideline-directed medical therapy (GDMT) within 2 weeks after discharge from an acute heart failure (AHF) admission.
Objective: To assess the association between degree of GDMT doses achieved in high-intensity care and outcomes.
Design, Setting, And Participants: This was a post hoc secondary analysis of the STRONG-HF randomized clinical trial, conducted from May 2018 to September 2022.
Aim: In this subgroup analysis of STRONG-HF, we explored the association between changes in renal function and efficacy of rapid up-titration of guideline-directed medical therapy (GDMT) according to a high-intensity care (HIC) strategy.
Methods And Results: In patients randomized to the HIC arm (n = 542), renal function was assessed at baseline and during follow-up visits. We studied the association with clinical characteristics and outcomes of a decrease in estimated glomerular filtration rate (eGFR) at week 1, defined as ≥15% decrease from baseline.
Background: Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies (STRONG-HF) demonstrated the safety and efficacy of rapid up-titration of guideline-directed medical therapy (GDMT) with high-intensity care (HIC) compared with usual care in patients hospitalized for acute heart failure (HF). In the HIC group, the following safety indicators were used to guide up-titration: estimated glomerular filtration rate of <30 mL/min/1.73 m, serum potassium of >5.
View Article and Find Full Text PDFAims: To assess the potential interaction between non-cardiac comorbidities (NCCs) and the efficacy and safety of high-intensity care (HIC) versus usual care (UC) in the STRONG-HF trial, including stable patients with improved but still elevated natriuretic peptides.
Methods And Results: In the trial, eight NCCs were reported: anaemia, diabetes, renal dysfunction, severe liver disease, chronic obstructive pulmonary disease/asthma, stroke/transient ischaemic attack, psychiatric/neurological disorders, and malignancies. Patients were classified by NCC number (0, 1, 2 and ≥3).
Background: Acute heart failure (AHF) is associated with a poor prognosis regardless of left ventricular ejection fraction (LVEF). STRONG-HF showed the efficacy and safety of a strategy of rapid uptitration of oral treatment for heart failure (HF) and close follow-up (high-intensity care), compared with usual care, in patients recently hospitalized for AHF and enrolled independently from their LVEF.
Objectives: In this study, we sought to assess the impact of baseline LVEF on the effects of high-intensity care vs usual care in STRONG-HF.
Aims: STRONG-HF examined a high-intensity care (HIC) strategy of rapid up-titration of guideline-directed medical therapy (GDMT) and close follow-up after acute heart failure (AHF) admission. We assess the role of age on efficacy and safety of HIC.
Methods And Results: Hospitalized AHF patients, not treated with optimal GDMT were randomized to HIC or usual care.
Aims: STRONG-HF showed that rapid up-titration of guideline-recommended medical therapy (GRMT), in a high intensity care (HIC) strategy, was associated with better outcomes compared with usual care. The aim of this study was to assess the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) at baseline and its changes early during up-titration.
Methods And Results: A total of 1077 patients hospitalized for acute heart failure (HF) and with a >10% NT-proBNP decrease from screening (i.
Aims: The aim of this study was to evaluate efficacy and safety of rapid up-titration of guideline-directed medical therapies (GDMT) in men and women hospitalized for acute heart failure (AHF).
Methods And Results: In STRONG-HF, AHF patients were randomized just prior to discharge to either usual care (UC) or a high-intensity care (HIC) strategy of GDMT up-titration. In these analyses, we compared the implementation, efficacy, and safety of the HIC strategy between men and women.
Background: This study aimed to assess the value of blood and urine biomarkers in addition to routine clinical variables in risk stratification of patients admitted to ICU.
Methods: Multivariable prognostic models were developed in this post hoc analysis of the French and EuRopean Outcome ReGistry in Intensive Care Units study, a prospective observational study of patients admitted to ICUs. The study included 2087 patients consecutively admitted to the ICU who required invasive mechanical ventilation or a vasoactive agent for more than 24 h.