Clinical and financial impact of sleep disordered breathing on heart failure admissions.

Background: The impact of sleep disordered breathing (SDB) on heart failure (HF) is increasingly recognized. However, limited data exist in support of quantification of the clinical and financial impact of SDB on HF hospitalizations.

Methods: A sleep-heart registry included all patients who underwent inpatient sleep testing during hospitalization for HF at a single cardiac center.

Transvenous phrenic nerve stimulation for central sleep apnea is safe and effective in patients with concomitant cardiac devices.

Background: Central sleep apnea is common in heart failure patients. Transvenous phrenic nerve stimulation (TPNS) requires placing a lead to stimulate the phrenic nerve and activate the diaphragm. Data are lacking concerning the safety and efficacy of TPNS in patients with concomitant cardiovascular implantable electronic devices (CIEDs).

Novel phrenic nerve stimulator treats Cheyne-Stokes respiration: polysomnographic insights.

A symptomatic patient with atrial fibrillation and Cheyne-Stokes respiration (CSR) was implanted with a transvenous phrenic nerve stimulation (TPNS) device-the remedē System-that is indicated for adult patients with moderate to severe central sleep apnea. Sleep recordings demonstrated that TPNS eliminated periodic breathing by activating the diaphragm and stabilizing respiratory patterns. These recordings of preprogrammed periods on versus off TPNS illustrate prompt (1) stabilization of tidal airflow, respiratory effort, and oxygenation as stimulation amplitude increased stepwise and (2) recurrence of CSR immediately after TPNS deactivated.

In patients with heart failure the burden of central sleep apnea increases in the late sleep hours.

Study Objectives: Periodic breathing with central sleep apnea (CSA) is common in patients with left ventricular systolic dysfunction. Based on the pathophysiological mechanisms underlying CSA, we hypothesized that the frequency of CSA episodes would increase in the late hours of non-rapid eye movement (NREM) of sleep.

Methods: Forty-one patients with left ventricular ejection fraction <40% underwent full-night-attended polysomnography scored by a central core lab.

Uncovering interim clinical events at the time of clinical encounter by reviewing intrathoracic impedance threshold crossings.

Background: Acute decreases in intrathoracic impedance monitored by implanted devices have been shown to precede heart failure exacerbations, although there is still debate regarding its clinical utility in predicting and preventing future events. However, the usefulness of such information to direct patient encounter and enhance patient recall of relevant preceding clinical events at the point of care has not been carefully examined.

Methods And Results: In this multicenter study, we interviewed 326 patients with heart failure who received an implanted device with intrathoracic impedance-monitoring capabilities both before and after device information was reviewed.

Controversies in cardiac resynchronization therapy: do sex differences in response exist?

Cardiac resynchronization therapy (CRT) is well established in the treatment of patients with heart failure, but lacks data addressing sex differences in response. Women with heart failure outnumber men, but have additional comorbidities and typically are older. Women continue to be underrepresented in clinical trials, but examining their response to a therapy across multiple studies could provide significant insight into the treatment effect.

Effect of heart failure exacerbations on anticoagulation: a prospective, observational, pilot cohort study.

Background: Some studies have suggested that heart failure (HF) is associated with excessive anticoagulation, but definitive data or data showing causation do not exist. Knowledge of risk factors for excessive anticoagulation is critical to manage warfarin therapy safely.

Objective: This study characterized the relation between HF-associated hypervolemia and excessive anticoagulation in patients with HF taking chronic warfarin therapy.

The evaluation and monitoring of volume status in congestive heart failure.

The increasing prevalence of heart failure dictates that physicians effectively assess and treat congestion. The evaluation of volume status in the complex group of patients with heart failure is very challenging. Physical examination is at best challenging and not always helpful, confounded by body habitus and comorbidities.

Candesartan in heart failure.

Candesartan cilexetil is a nonpeptide selective blocker of the angiotensin II receptor sub-type 1. It is a prodrug that is converted to its active metabolite during its variable absorption. It is highly protein bound with a small volume of distribution and a nine-hour half-life.