Source : https://pubmed.ncbi.nlm.nih.gov/39340828/
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04435626.
Finerenone reduced cardiovascular risk in heart failure patients regardless of SGLT2 inhibitor use, suggesting potential additive benefit from combining these therapies in preserved or mildly reduced ejection fraction.
Source : https://pubmed.ncbi.nlm.nih.gov/39665884/
The structural development of the heart depends heavily on mechanical forces, and rhythmic contractions generate essential physical stimuli during morphogenesis. Cardiac cells play a critical role in coordinating this process...
Mechanical forces during heart development regulate cell identity and morphogenesis, with zebrafish studies revealing how dynamic stresses influence endocardial and myocardial behavior, including valve formation and trabeculation.
Source : https://pubmed.ncbi.nlm.nih.gov/39034866/
Systemic aging influences various physiological processes and contributes to structural and functional decline in cardiac tissue. These alterations include an increased incidence of left ventricular hypertrophy, a decline in left...
Systemic aging drives cardiac and vascular decline via inflammation, senescence, and metabolic dysfunction, increasing heart failure risk. Interventions include exercise, diet, senotherapeutics, and metabolic or anti-inflammatory therapies.
Source : https://pubmed.ncbi.nlm.nih.gov/39281002/
Optimal use of guideline-directed medical therapy (GDMT) can prevent hospitalization and mortality among patients with heart failure (HF). We aimed to assess the prevalence of GDMT use for HF across...
GDMT use for HFrEF has increased globally, especially in high-income countries, but remains suboptimal in low- and middle-income regions, highlighting a need for multi-level interventions to improve access.
Source : https://pubmed.ncbi.nlm.nih.gov/40351187/
The Get With the Guidelines-Heart Failure program was developed in 2005 with the goal of bringing evidence-based guidelines in heart failure management into widespread clinical practice. The program includes workshops,...
The Get With the Guidelines-Heart Failure program has enhanced heart failure care across 600+ U.S. hospitals, improving outcomes through evidence-based practices, data integration, and ongoing quality improvement efforts.
Source : https://pubmed.ncbi.nlm.nih.gov/40360219/
Obesity is a major risk factor for heart failure with preserved ejection fraction (HFpEF) and contributes through multiple pathophysiological pathways, including systemic inflammation, neurohormonal activation, and mechanical inhibition. The treatment...
Obesity significantly impacts HFpEF through inflammation and mechanical stress; GLP-1 RAs and SGLT2 inhibitors show promise in improving symptoms, weight loss, and outcomes in obesity-related HFpEF.
Source : https://pubmed.ncbi.nlm.nih.gov/39342254/
Prevalence of heart failure (HF) and diabetes are markedly increasing globally. In a population of HF patients, approximately 40% have diabetes which is associated with a more severe HF, poorer...
Heart failure (HF) patients frequently have undetected dysglycemia, with diabetes and prediabetes increasing HF severity and risk; routine screening and prevention strategies are essential to improve outcomes.
Source : https://pubmed.ncbi.nlm.nih.gov/38845019/
Even when adjusted for confounders, mortality for cardiogenic shock in women is approximately 10% higher than men. This effect is seen in both acute myocardial infarction and heart failure cardiogenic...
Women with cardiogenic shock face higher 30-day mortality than men and are less likely to receive mechanical circulatory support, even after adjusting for clinical confounders, warranting urgent treatment improvements.
Source : https://pubmed.ncbi.nlm.nih.gov/38866621/
With the predefined cut-offs, HeartDiet's suitability as a screening tool to assess needs for dietary interventions was limited, since no respondents were categorised as having a heart-healthy diet. An abridged...
The study assessed the HeartDiet tool in cardiac rehab, finding limited screening utility as no patients met heart-healthy criteria; an abridged version is feasible but reduces educational value.
Source : https://pubmed.ncbi.nlm.nih.gov/38897818/
Prenatal echocardiography is the primary tool for fetal diagnosis of CCH. Continuous scanning helps avoid missing data and misdiagnosis.
The study analyzed 14 criss-cross heart cases diagnosed via fetal echocardiography, highlighting structural abnormalities and confirming that continuous prenatal scanning is key to accurate diagnosis and management strategy development.
Source : https://pubmed.ncbi.nlm.nih.gov/39773401/
There exist large survival differences after ICD implantation between implanting centres in Belgium that cannot only be explained by a volume-outcome effect. Centres size and characteristics are inhomogeneous and vary...
ICD implantation outcomes in Belgium vary significantly across centres, with higher 3-year mortality in low-volume centres, influenced by patient characteristics and socio-economic factors beyond procedural volume alone.
Source : https://pubmed.ncbi.nlm.nih.gov/39023372/
Purpose To investigate the association between the anomalous aortic origin of the right coronary artery (R-AAOCA) from the left coronary sinus with interarterial course (IAC) found at coronary CT angiography...
A study of 224 patients with R-AAOCA from the left sinus found no link to sudden cardiac death. Coronary artery disease, not radiologic features, predicted major adverse cardiovascular events.
Data from 5,818 European patients show ≥50 % response rates hit 56 % at 6 months, but fall sharply with higher baseline MMD and disability. Early use = higher odds of good or excellent response.
Are we waiting too long to pull the CGRP trigger?
Source : https://pubmed.ncbi.nlm.nih.gov/37550835/
Improvements in disease-related symptoms acted as strong enablers to engage in an LCD. Barriers such as access to resources and time constraints were identified. These challenges may be overcome with...
https://pubmed.ncbi.nlm.nih.gov/37550835/
Patients with diabetic cardiomyopathy found low-carb diets beneficial but faced barriers like limited resources and time; improved symptoms encouraged adherence, highlighting the need for better support and education.
Source : https://pubmed.ncbi.nlm.nih.gov/40137105/
In response to the heart failure (HF) pandemic, it is important to introduce appropriate pharmacological and non-pharmacological treatments for HF patients. In addition, self-management of HF, including the continuation of...
https://pubmed.ncbi.nlm.nih.gov/40137105/
Joint HF education in Tokyo's JHFeC ensures consistent self-management post-discharge, addressing inconsistencies in patient education through multidisciplinary programs for all heart failure stages, improving treatment continuity and prognosis.
Source : https://pubmed.ncbi.nlm.nih.gov/39229911/
This survey reveals NP awareness, access, and adoption across several countries. Highlighting the importance of community-based early heart failure diagnosis and optimizing HF diagnostic pathways remains a crucial, unmet opportunity...
A global survey of 751 healthcare professionals highlights disparities in NP testing access, especially in community settings, underscoring the need for improved diagnostic pathways and greater integration in heart failure care.
Source : https://pubmed.ncbi.nlm.nih.gov/40027217/
Our meta-analysis demonstrates that LUS is a highly practical imaging for diagnosing acute heart failure, with excellent sensitivity, specificity, and accuracy. It is particularly valuable for excluding the heart failure...
Lung ultrasonography shows high accuracy in diagnosing acute heart failure, with pooled sensitivity of 92% and specificity of 90%. Despite heterogeneity, it's especially useful in ruling out heart failure.
Q&A – Heart Failure and SGLT2 Inhibitors
Tune in to hear Andrew Freeman, MD discuss the impact of SGLT2 inhibitors for the treatment of heart failure.
Transcript
Victoria Bradley: Hi everyone, and welcome to today's Q&A session on heart failure and SGLT2 inhibitors. My name is Victoria, and I will be your moderator for today's discussion. I am pleased to introduce our guest, Dr. Andrew Freeman. Dr. Freeman is a board-certified cardiologist who has been practicing in the field for over 20 years. Dr. Freeman, thank you so much for being here with us today.
Dr. Andrew Freeman: Oh, it's my pleasure.
Victoria Bradley: My first question for you is, what is the mechanism of action of SGLT2 inhibitors in the treatment of heart failure?
Dr. Andrew Freeman: Sure. For those who may not be familiar, SGLT2 inhibitors were originally released for diabetic management. It turns out they also address the entire spectrum of cardiometabolic kidney diseases, including heart failure. SGLT2 inhibitors have now become a pillar in the treatment of heart failure. They block SGLT2 proteins in the kidneys, causing the excretion of sugar and salt. This results in reduced plasma volume, decreased blood pressure, and alleviates the workload on the heart. However, there's a risk of infection due to the excretion of sugar, so it's important to ensure excellent pelvic hygiene, especially for older patients. The mechanism induces osmotic diuresis and natriuresis, reducing plasma volume and blood pressure, which lowers the pressure the heart pumps against. These changes improve heart efficiency. Additionally, these drugs have been associated with reductions in serum uric acid levels, which have various cardiovascular benefits. Overall, it's an amazing class of drugs that works through the excretion of urinary glucose and sodium.
Victoria Bradley: Great. Thank you. Can you tell us more about some major clinical trials that have demonstrated the efficacy of SGLT2 inhibitors in heart failure?
Dr. Andrew Freeman: Sure. I'll summarize a few key trials:
Overall, these trials demonstrate significant reductions in heart failure symptoms, biomarkers, and better outcomes, making SGLT2 inhibitors guideline-directed.
Victoria Bradley: Absolutely. Thank you for taking us through those. Can you talk about which patient populations should be considered for SGLT2 inhibitors in heart failure management?
Dr. Andrew Freeman: In general, most heart failure patients should be on an SGLT2 inhibitor unless there's a contraindication like recurrent urinary tract infections. They are effective for both HFrEF and HFpEF. It's lovely to keep people out of the hospital, feeling better, and more functional. The data supports that SGLT2 inhibitors work great for all forms of heart failure.
Victoria Bradley: How do SGLT2 inhibitors compare to other guideline-directed therapies for heart failure?
Dr. Andrew Freeman: They are complementary, not replacing anything. People should be on renin-angiotensin system inhibitors like ACEs, ARBs, or ideally ARNIs (sacubitril/valsartan). These agents reduce mortality and morbidity by interfering in neurohormonal pathways. Beta-blockers decrease sympathetic nervous system activity, improve survival, and reduce hospitalization. Mineralocorticoid antagonists (MRAs) are very effective in improving outcomes, despite requiring additional monitoring. SGLT2 inhibitors offer unique benefits like diuretic effects without significant electrolyte disturbances and positive effects on kidney function. Many heart failure patients have cardiometabolic kidney disease, diabetes, coronary disease, and sleep apnea. Treating these patients with SGLT2 inhibitors has overall benefits. These drugs initially came out for diabetes but affect everything, including heart failure.
Victoria Bradley: How do SGLT2 inhibitors provide cardiovascular benefits in heart failure beyond glycemic control, and what are the key differences in their effects between diabetic and non-diabetic patients?
Dr. Andrew Freeman: They provide glycemic control for diabetic patients but also have other cardiovascular benefits. They induce osmotic diuresis and natriuresis, lowering blood pressure, reducing plasma volume, and decreasing cardiac workload. They promote a shift towards ketone body utilization, enhancing myocardial energy efficiency. There appear to be anti-inflammatory and anti-fibrotic effects, reducing cardiac inflammation and fibrosis, improving cardiac structure and muscle function. These benefits are observed in both diabetic and non-diabetic patients, making SGLT2 inhibitors crucial in heart failure management regardless of glycemic status. Cardiologists need to embrace that these are not just diabetic drugs. Lipids and cholesterol were once the domain of endocrinology but are now squarely in cardiology. This experience can translate into better heart failure outcomes.
Victoria Bradley: Absolutely. Thank you so much for sharing your insights today. I certainly learned a lot, and I hope our audience had a good refresher on these topics. Thank you for your time today, and we hope to see you again soon.
Dr. Andrew Freeman: My pleasure. Thanks for having me.
Transcript Edited for Clarity
Source : https://pubmed.ncbi.nlm.nih.gov/38565073/
Healthcare professionals should initiate lifestyle advice already during hospitalization and continue during follow-up appointments and cardiac rehabilitation. Advice should be feasible and empathy-based, as well as tailored to the patient's...
https://pubmed.ncbi.nlm.nih.gov/38565073/
Cardiac patients are open to lifestyle advice throughout care; impactful when given by cardiologists and aligned with personal beliefs. Timely, tailored, empathetic delivery enhances motivation for lifestyle changes.
Source : https://pubmed.ncbi.nlm.nih.gov/39063087/
Navigating through antithrombotic therapy in patients with both hemophilia and cardiovascular pathology presents a complex scenario with inherent challenges and opportunities. The presence of hemophilia, characterized by impaired blood clotting,...
https://pubmed.ncbi.nlm.nih.gov/39063087/
Managing antithrombotic therapy in hemophilia patients with cardiovascular disease requires balancing bleeding risks with cardiovascular protection through tailored strategies, multidisciplinary care, and emerging therapies like DOACs.
