Natriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure.

Background: Most acute decompensated heart failure admissions are driven by congestion. However, residual congestion is common and often driven by the lack of reliable tools to titrate diuretic therapy. The authors previously developed a natriuretic response prediction equation (NRPE), which predicts sodium output using a spot urine sample collected 2 h after loop diuretic administration.

Psychological stress in heart failure: a potentially actionable disease modifier.

Psychological stress is common in patients with heart failure, due in part to the complexities of effective disease self-management and progressively worsening functional limitations, including frequent symptom exacerbations and hospitalizations. Emerging evidence suggests that heart failure patients who experience higher levels of stress may have a more burdensome disease course, with diminished quality of life and increased risk for adverse events, and that multiple behavioral and pathophysiological pathways are involved. Furthermore, the reduced quality of life associated with heart failure can serve as a life stressor for many patients.

Dying to know: prognosis communication in heart failure.

Prognosis communication in heart failure is often narrowly defined as a discussion of life expectancy, but as clinical guidelines and research suggest, these discussions should provide a broader understanding of the disease, including information about disease trajectory, the experiences of living with heart failure, potential burden on patients and families, and mortality. Furthermore, despite clinical guidelines recommending early discussions, evidence suggests that these discussions occur infrequently or late in the disease trajectory. We review the literature concerning patient, caregiver, and clinician perspectives on discussions of this type, including the frequency, timing, desire for, effects of, and barriers to their occurrence.

Access and Outcomes Among Hypertrophic Cardiomyopathy Patients in a Large Integrated Health System.

Background Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy. Current guidelines endorse management in expert centers, but patient socioeconomic status can affect access to specialty care. The effect of socioeconomic status and specialty care access on HCM outcomes has not been examined.

Evaluation of a guideline directed medical therapy titration program in patients with heart failure with reduced ejection fraction.

Introduction: Heart failure is associated with recurrent hospitalizations and high mortality. Guideline directed medical treatment (GDMT), including beta blockers (BBs), angiotensin converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs) and aldosterone antagonists (AAs) has shown to improve outcomes. Current guidelines recommend the use of these medication classes at maximally tolerated dosages.

Essential Elements of Early Post Discharge Care of Patients with Heart Failure.

Purpose Of Review: Heart failure is associated with an enormous burden on both patients and health care systems in the USA. Several national policy initiatives have focused on improving the quality of heart failure care, including reducing readmissions following hospitalization, which are common, costly, and, at least in part, preventable. The transition from inpatient to ambulatory care setting and the immediate post-hospitalization period present an opportunity to further optimize guideline concordant medical therapy, identify reversible issues related to worsening heart failure, and evaluate prognosis.

Measured Physical Activity and 30-Day Rehospitalization in Heart Failure Patients.

Background: Patients hospitalized with decompensated heart failure are at high risk for readmission within 30 days of discharge. Since physical inactivity is associated with increased health care utilization in other diseases, it may predict rehospitalization in heart failure.

Methods: In a single-center, prospective study, physical activity was measured following hospital discharge using an accelerometer on the wrist.

A Survey of Knowledge and Perspectives of Ventricular Assist Device Therapy: Evaluating the Timing of Advanced Heart Failure Referral.

Background: While advancements in ventricular assist device (VAD) therapy have improved survival and quality of life for select patients with advanced heart failure (HF), variations in provider knowledge and opinions may ultimately serve as barriers to therapy.

Methods And Results: A 12-item survey assessing experience, knowledge, and perspectives of VAD therapy was sent to 106 practicing cardiologists at three neighboring institutions. We received 34 responses for a total response rate of 32.

Bicuspid aortic valve masquerading as unicuspid aortic valve: A case of markedly compensated congestive heart failure in a young patient.

Bicuspid aortic valve is a relatively common cause of congestive heart failure in young patients. In a young population, symptoms mnay not correlate with the severity of disease. We report a case of bicuspid aortic valve presenting with clinical features of unicuspid aortic valve, and mild symptoms despite severe hemodynamic compromise.

Effect of spironolactone on endothelial function in patients with congestive heart failure on conventional medical therapy.

We prospectively studied the effect of spironolactone, an aldosterone antagonist, on endothelial function in patients with advanced congestive heart failure (CHF) using the brachial artery reactivity method. Twenty patients optimized on conventional CHF therapy were treated with spironolactone, and brachial artery flow- mediated dilation was measured at baseline and at 4 and 8 weeks. Spironolactone improved endothelial function at 4 weeks, and sustained the improvement at 8 weeks, in patients with CHF on conventional medical therapy, presumably due to reversal of aldosterone impairment of endothelial nitric oxide activity.

Propafenone versus ibutilide for post operative atrial fibrillation following cardiac surgery: neither strategy improves outcomes compared to rate control alone (the PIPAF study).

Background: It is unclear whether acute conversion of atrial fibrillation (AF) with anti-arrhythmic drugs following cardiac surgery restores and/or maintains sinus rhythm or reduces hospital length of stay (LOS).

Material/methods: A randomized prospective pilot study was conducted in 2 teaching hospitals from 3/28/98 to 8/2/99 to study the effect of the early use of ibutilide or propafenone on the duration of AF, rhythm at discharge, and LOS. A total of 42 stable patients with new AF after surgery were randomized to oral propafenone (600mg, single dose; n=20), ibutilide (1 mg up to 2 doses if necessary; n=10), or rate control only (n=12).