Implantable Hemodynamic Monitors Improve Survival in Patients With Heart Failure and Reduced Ejection Fraction.

Background: Trials evaluating implantable hemodynamic monitors to manage patients with heart failure (HF) have shown reductions in HF hospitalizations but not mortality. Prior meta-analyses assessing mortality have been limited in construct because of an absence of patient-level data, short-term follow-up duration, and evaluation across the combined spectrum of ejection fractions.

Objectives: The purpose of this meta-analysis was to determine whether management with implantable hemodynamic monitors reduces mortality in patients with heart failure and reduced ejection fraction (HFrEF) and to confirm the effect of hemodynamic-monitoring guided management on HF hospitalization reduction reported in previous studies.

Hemodynamic-Guided Heart Failure Management in Patients With Either Prior HF Hospitalization or Elevated Natriuretic Peptides.

Background: In patients with symptomatic heart failure (HF) and previous heart failure hospitalization (HFH), hemodynamic-guided HF management using a wireless pulmonary artery pressure (PAP) sensor reduces HFH, but it is unclear whether these benefits extend to patients who have not been recently hospitalized but remain at risk because of elevated natriuretic peptides (NPs).

Objectives: This study assessed the efficacy and safety of hemodynamic-guided HF management in patients with elevated NPs but no recent HFH.

Methods: In the GUIDE-HF (Hemodynamic-Guided Management of Heart Failure) trial, 1,000 patients with New York Heart Association (NYHA) functional class II to IV HF and either previous HFH or elevated NP levels were randomly assigned to hemodynamic-guided HF management or usual care.

Hemodynamically-Guided Management of Heart Failure Across the Ejection Fraction Spectrum: The GUIDE-HF Trial.

Background: Hemodynamically-guided management using an implanted pulmonary artery pressure sensor is indicated to reduce heart failure (HF) hospitalizations in patients with New York Heart Association (NYHA) functional class II-III with a prior HF hospitalization or those with elevated natriuretic peptides.

Objectives: The authors sought to evaluate the effect of left ventricular ejection fraction (EF) on treatment outcomes in the GUIDE-HF (Hemodynamic-GUIDEd management of Heart Failure) randomized trial.

Methods: The GUIDE-HF randomized arm included 1,000 NYHA functional class II-IV patients (with HF hospitalization within the prior 12 months or elevated natriuretic peptides adjusted for EF and body mass index) implanted with a pulmonary artery pressure sensor, randomized 1:1 to a hemodynamically-guided management group (treatment) or a control group (control).

The GUIDE-HF trial of pulmonary artery pressure monitoring in heart failure: impact of the COVID-19 pandemic.

Aims: During the coronavirus disease 2019 (COVID-19) pandemic, important changes in heart failure (HF) event rates have been widely reported, but few data address potential causes for these changes; several possibilities were examined in the GUIDE-HF study.

Methods And Results: From 15 March 2018 to 20 December 2019, patients were randomized to haemodynamic-guided management (treatment) vs. control for 12 months, with a primary endpoint of all-cause mortality plus HF events.

Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial.

Background: Previous studies have suggested that haemodynamic-guided management using an implantable pulmonary artery pressure monitor reduces heart failure hospitalisations in patients with moderately symptomatic (New York Heart Association [NYHA] functional class III) chronic heart failure and a hospitalisation in the past year, irrespective of ejection fraction. It is unclear if these benefits extend to patients with mild (NYHA functional class II) or severe (NYHA functional class IV) symptoms of heart failure or to patients with elevated natriuretic peptides without a recent heart failure hospitalisation. This trial was designed to evaluate whether haemodynamic-guided management using remote pulmonary artery pressure monitoring could reduce heart failure events and mortality in patients with heart failure across the spectrum of symptom severity (NYHA funational class II-IV), including those with elevated natriuretic peptides but without a recent heart failure hospitalisation.

Evolving Use of Biomarkers in the Management of Heart Failure.

Objective, noninvasive, clinical assessment of patients with heart failure can be made using biomarker measurements, including natriuretic peptides, cardiac troponins, soluble suppression of tumorigenicity 2, and galectin-3. The aim of this review is to provide clinicians with guidance on the use of heart failure biomarkers in clinical practice. The authors provide a didactic narrative based on current literature, an exemplary case study, and their clinical experience.

Functional connectivity as a means to delineate differences between treatment-resistant and treatment-responsive schizophrenia.

It has been estimated that one-third of schizophrenia patients are treatment resistant (TRS). Recent studies have shown that functional connectivity (FC) can be used for measuring connections between brain regions in diseased states. White, Wigton, Joyce, Collier, Fornito, and Shergill (Neuropsychopharmacology First published September 9, 2015; doi:10.

Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model: A Web-based program designed to evaluate the cost-effectiveness of disease management programs in heart failure.

Background: Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable.

Methods: We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics; use of evidence-based medications; and costs to generate predicted outcomes.

Foundations of Pharmacotherapy for Heart Failure With Reduced Ejection Fraction: Evidence Meets Practice, Part I.

Pharmacologic treatment for systolic heart failure, otherwise known as heart failure with reduced ejection fraction, has been established through clinical trials and is formulated into guidelines to standardize the diagnosis and treatment. The premise of pharmacologic therapy in heart failure with reduced ejection fraction is aimed primarily at interrupting the neurohormonal cascade that is responsible for altering left ventricular shape and function. This is the first in a series of articles to describe the pharmacologic agents in the guidelines that impact the morbidity and mortality associated with heart failure.

Transitions of care in heart failure: a scientific statement from the American Heart Association.

In patients with heart failure (HF), use of 30-day rehospitalization as a healthcare metric and increased pressure to provide value-based care compel healthcare providers to improve efficiency and to use an integrated care approach. Transition programs are being used to achieve goals. Transition of care in the context of HF management refers to individual interventions and programs with multiple activities that are designed to improve shifts or transitions from one setting to the next, most often from hospital to home.

Role of the acute care nurse in managing patients with heart failure using evidence-based care.

Acute heart failure is a major US public health problem, accounting for more than 1 million hospitalizations each year. As part of the health care team, nurses play an important role in the evaluation and management of patients presenting to the emergency department with acute decompensated heart failure. Once acute decompensation is controlled, nurses also play a critical role in preparing patients for hospital discharge and educating patients and caregivers about strategies to improve long-term outcomes and prevent future decompensation and rehospitalization.

Implementing shared medical appointments for heart failure patients in a community cardiology practice: a pilot study.

Objective: To examine patient and staff satisfaction, billing charges, and programmatic feasibility of shared medical appointments (SMA) in a nurse practitioner-managed heart failure (HF) clinic in a community cardiology practice.

Methods: Twenty patients were scheduled among four SMAs for this pilot study. All aspects of a usual clinic appointment were utilized during the SMA, but an additional 20-minute teaching session was presented.

Complexities of care for patients and families living with advanced cardiovascular diseases: overview.

The complexities of care in patients with advanced heart failure, ischemic coronary artery disease, and dysrhythmias span a wide spectrum of physiologic, psychologic, emotional, functional, social, and financial factors. In addition, families may be troubled by care needs associated with the cardiovascular disease itself or its complexities. The purpose of this overview was to gain a better understanding of the complexities associated with advanced heart failure, ischemic heart disease, and dysrhythmias and to highlight a few themes that have received recent attention from healthcare providers.

Introduction of the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Costing Tool: a user-friendly spreadsheet program to estimate costs of providing patient-centered interventions.

Background: Patient-centered health care interventions, such as heart failure disease management programs, are under increasing pressure to demonstrate good value. Variability in costing methods and assumptions in economic evaluations of such interventions limit the comparability of cost estimates across studies. Valid cost estimation is critical to conducting economic evaluations and for program budgeting and reimbursement negotiations.

The metabolic syndrome in women: a growing problem for cardiac risk.

The risk of developing cardiovascular disease has recently been associated with a set of metabolic and physiological risk factors that include abdominal obesity, atherogenic dyslipidemia, hypertension, and elevated plasma glucose. The term most commonly used to describe this conglomeration of risk factors is the metabolic syndrome. Coronary heart disease risk is tripled in those individuals with this syndrome.

Anemia in heart failure: implications, management, and outcomes.

Despite advances in the treatment of heart failure (HF) over the past decade, the prognosis remains poor. Anemia is a well-recognized comorbidity in many chronic conditions, but its role in HF has only recently been recognized. Anemia is significantly related to symptoms, exercise capacity, and prognosis in HF; it has been identified as an independent risk factor for mortality in those with left ventricular dysfunction.

Strategies for behavior change in patients with heart failure.

Appropriate management of chronic heart failure and its signs and symptoms requires a considerable amount of participation by patients. Behavioral changes that prevent or minimize signs and symptoms and disease progression are just as important as the medications prescribed to treat the heart failure. The most difficult lifestyle changes include smoking cessation, weight loss, and restriction of dietary sodium.

Case studies in heart failure.

This article presents four case studies of patients with heart failure and the rationale for optimal treatment in each case.

Diastolic dysfunction.

Although the annual mortality rate for diastolic heart failure is better than that for systolic heart failure, it is still greater than that for age-matched controls. Five-year mortality rates are about 50% for patients with systolic heart failure and are about 25% for patients with diastolic heart failure. In elderly patients (over 65 years of age), the outcome with systolic and diastolic dysfunction may be more comparable.

The use of beta-blockers in the treatment of chronic heart failure.

The use of beta-blockers in addition to digoxin, diuretics, and ACE inhibitors was shown to be beneficial for patients with chronic heart failure. Benefits include decreased hospitalizations, decreased need for heart transplant, and decreased mortality. The fact that beta-blockers may improve a sense of well-being, as well as quality of life, for patients with chronic heart failure, is perhaps the greatest advantage to including these drugs in HF therapy.

Ventricular remodeling.

Ventricular remodeling is an extremely complicated process that is not well understood. There seem to be multiple feedback loops that respond to mechanical events as well as to neurohormonal stimulation, cytokine release, and other, yet unidentified, agents. The progression of ventricular remodeling after the index event includes: Myocyte slippage and thinning of infarct area, chamber dilatation.