Heart Failure Connect
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Conclusions and Relevance: In this study, among patients with HFpEF and pacemakers, treatment with a moderately accelerated, personalized pacing rate was safe and improved quality of life, NT-proBNP levels, physical activity, and atrial fibrillation compared with the usual 60 bpm setting.

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Postop Complication With Euglycemic Diabetic Ketoacidosis in a Patient Receiving Empagliflozin

Postop Complication With Euglycemic Diabetic Ketoacidosis in a Patient Receiving Empagliflozin

Source : https://www.cureus.com/articles/128017-postop-complication-with-euglycemic-diabetic-ketoacidosis-in-a-patient-receiving-empagliflozin

Euglycemic diabetic ketoacidosis (EDKA) is an uncommon diabetic complication with increasing prevalence and is associated with the use of sodium-glucose co-transporter 2 inhibitors (SGLT2i). We report the case of a...

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Conclusions: Patients treated with SGLT2i presenting with prostration and elevated anion gap metabolic acidosis should be tested for the presence of ketones. The early recognition of risk factors in patients under SGLT2i allows the prevention and treatment initiation of EDKA. Standard guidelines should be developed to help physicians in...

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Sodium-Glucose Co-transporter 2 Inhibitors in Patients with Heart Failure with Preserved Ejection Fraction: Proposed Mechanisms, Recent Evidence, and Clinical Implications - PubMed

Sodium-Glucose Co-transporter 2 Inhibitors in Patients with Heart Failure with Preserved Ejection Fraction: Proposed Mechanisms, Recent Evidence, and Clinical Implications - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/36728757/

Heart failure (HF) affects approximately 6 million Americans and is projected to increase in prevalence as the population ages. While progress has been made in the treatment of heart failure...



Conclusions/Relevance: While trials of empagliflozin for HFpEF did not show a mortality benefit, sodium-glucose co-transporter 2 inhibitors are promising additions to the management of HFpEF for their effects on the disease's risk factors through weight loss, natriuresis, blood pressure lowering, and glycemic control.

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Assessment of the Safety, Efficacy, and Benefit of Empagliflozin in Patients With Type 2 Diabetes Mellitus (T2DM) and Heart Failure With Reduced Ejection Fraction (HFrEF) at High Risk for Cardiovascular Events - PubMed

Assessment of the Safety, Efficacy, and Benefit of Empagliflozin in Patients With Type 2 Diabetes Mellitus (T2DM) and Heart Failure With Reduced Ejection Fraction (HFrEF) at High Risk for Cardiovascular Events - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/36721538/

Background Since the increasing prevalence of type 2 diabetes mellitus (T2DM), heart failure coexisting with it has had a significant impact on clinical management and prognosis. Patients with T2DM and...



Conclusion: In this study, there was no significant difference observed in hospital admission of the patients between the empagliflozin and non-empagliflozin groups. No cardiovascular mortality was reported in the study population. Further matched group comparative studies or placebo-controlled studies are required to compare the existing...

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Consider the safety profile of this heart failure treatment

In February 2022, the FDA approved empagliflozin to decrease the risk of cardiovascular death and hospitalization in adults with heart failure. With regard to cardiovascular indications, this agent has also been approved to decrease the risk of cardiovascular death in adults with type 2 diabetes and pre-existing cardiovascular disease, as well as to decrease the risk of death/hospitalization in individuals with heart failure and low ejection fraction.

The safety and effectiveness of empagliflozin were compared with standard of care in a randomized, double-blind trial. Overall, the adverse effects of this agent were similar to those of patients with diabetes. In patients with heart failure with preserved ejection fraction (HFpEF), acute renal failure, hypotension, and urinary tract infections were the most common adverse effects of interest, whereas in patients with heart failure with reduced ejection fraction (HFrEF), volume depletion, symptomatic hypotension, and urinary tract infections were most common. Empagliflozin should not be prescribed to patients who are allergic or to those on dialysis. Before prescribing empagliflozin, it is important to carefully consider risk factors for diabetic ketoacidosis (DKA), as this agent increases the risk of DKA.

What has been your clinical experience with adverse events secondary to the administration of empagliflozin? How do you manage these adverse events? When do you decide to discontinue this agent?

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Consider the safety profile of this heart failure treatment

In February 2022, the FDA approved empagliflozin to decrease the risk of cardiovascular death and hospitalization in adults with heart failure. With regard to cardiovascular indications, this agent has also been approved to decrease the risk of cardiovascular death in adults with type 2 diabetes and pre-existing cardiovascular disease, as well as to decrease the risk of death/hospitalization in individuals with heart failure and low ejection fraction.



The safety and effectiveness of empagliflozin were compared with standard of care in a randomized, double-blind trial. Overall, the adverse effects of this agent were similar to those of patients with diabetes. In patients with heart failure with preserved ejection fraction (HFpEF), acute renal failure, hypotension, and urinary tract infections were the most common adverse effects of interest, whereas in patients with heart failure with reduced ejection fraction (HFrEF), volume depletion, symptomatic hypotension, and urinary tract infections were most common. Empagliflozin should not be prescribed to patients who are allergic or to those on dialysis. Before prescribing empagliflozin, it is important to carefully consider risk factors for diabetic ketoacidosis (DKA), as this agent increases the risk of DKA.



What has been your clinical experience with adverse events secondary to the administration of empagliflozin? How do you manage these adverse events? When do you decide to discontinue this agent?


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Consider the safety profile of this heart failure treatment

In February 2022, the FDA approved empagliflozin to decrease the risk of cardiovascular death and hospitalization in adults with heart failure. With regard to cardiovascular indications, this agent has also been approved to decrease the risk of cardiovascular death in adults with type 2 diabetes and pre-existing cardiovascular disease, as well as to decrease the risk of death/hospitalization in individuals with heart failure and low ejection fraction.



The safety and effectiveness of empagliflozin were compared with standard of care in a randomized, double-blind trial. Overall, the adverse effects of this agent were similar to those of patients with diabetes. In patients with heart failure with preserved ejection fraction (HFpEF), acute renal failure, hypotension, and urinary tract infections were the most common adverse effects of interest, whereas in patients with heart failure with reduced ejection fraction (HFrEF), volume depletion, symptomatic hypotension, and urinary tract infections were most common. Empagliflozin should not be prescribed to patients who are allergic or to those on dialysis. Before prescribing empagliflozin, it is important to carefully consider risk factors for diabetic ketoacidosis (DKA), as this agent increases the risk of DKA.



What has been your clinical experience with adverse events secondary to the administration of empagliflozin? How do you manage these adverse events? When do you decide to discontinue this agent?


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made a Post

Consider the safety profile of this heart failure treatment

In February 2022, the FDA approved empagliflozin to decrease the risk of cardiovascular death and hospitalization in adults with heart failure. With regard to cardiovascular indications, this agent has also been approved to decrease the risk of cardiovascular death in adults with type 2 diabetes and pre-existing cardiovascular disease, as well as to decrease the risk of death/hospitalization in individuals with heart failure and low ejection fraction.



The safety and effectiveness of empagliflozin were compared with standard of care in a randomized, double-blind trial. Overall, the adverse effects of this agent were similar to those of patients with diabetes. In patients with heart failure with preserved ejection fraction (HFpEF), acute renal failure, hypotension, and urinary tract infections were the most common adverse effects of interest, whereas in patients with heart failure with reduced ejection fraction (HFrEF), volume depletion, symptomatic hypotension, and urinary tract infections were most common. Empagliflozin should not be prescribed to patients who are allergic or to those on dialysis. Before prescribing empagliflozin, it is important to carefully consider risk factors for diabetic ketoacidosis (DKA), as this agent increases the risk of DKA.



What has been your clinical experience with adverse events secondary to the administration of empagliflozin? How do you manage these adverse events? When do you decide to discontinue this agent?


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Indirect comparison of SGLT2 inhibitors in patients with established heart failure: evidence based on Bayesian methods - PubMed

Indirect comparison of SGLT2 inhibitors in patients with established heart failure: evidence based on Bayesian methods - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/36702979/

In patients with established heart failure, there was no significant difference of the major efficacy outcomes among SGLT2 inhibitor treatments; however, sotagliflozin may be associated with the lowest risk of...



Conclusions: In patients with established heart failure, there was no significant difference of the major efficacy outcomes among SGLT2 inhibitor treatments; however, sotagliflozin may be associated with the lowest risk of the composite of cardiovascular death or hospitalization for heart failure, and dapagliflozin may be associated with the...

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Conclusions: Although empagliflozin had higher pharmacy costs, the total cost of care for patients with T2DM and with established cardiovascular disease were comparable to the group of patients with all other T2DM, driven mainly by lower medical costs.

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SGLT2 inhibitor ameliorates endothelial dysfunction associated with the common ALDH2 alcohol flushing variant - PubMed

SGLT2 inhibitor ameliorates endothelial dysfunction associated with the common ALDH2 alcohol flushing variant - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/36696485/

The common aldehyde dehydrogenase 2 ( ALDH2 ) alcohol flushing variant known as ALDH2*2 affects ∼8% of the world's population. Even in heterozygous carriers, this missense variant leads to a...



Conclusions/Relevance: Together, our results suggest that ALDH2*2 induces EC dysfunction and that SGLT2i may potentially be used as a preventative measure against CAD for ALDH2*2 carriers.

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The effect of SGLT-2 inhibitors on cardiorespiratory fitness capacity: A systematic review and meta-analysis

The effect of SGLT-2 inhibitors on cardiorespiratory fitness capacity: A systematic review and meta-analysis

Source : https://www.frontiersin.org/articles/10.3389/fphys.2022.1081920/full

Objective: The study aimed to evaluate the effect of sodium-glucose transporter 2 (SGLT-2) inhibitors on various parameters of exercise capacity and provide an evidence-based basis for type 2 diabetes mellitus...



Conclusion: Despite the limited number of studies and samples involved, the meta-analysis preliminarily demonstrated that SGLT-2 inhibitors could improve some parameters of exercise capacity (VO2peak, VAT) in chronic HF patients with or without T2DM and obese individuals, which had a positive effect on promoting cardiopulmonary fitness to help...

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Emerging concepts in heart failure treatment and management: focus on SGLT2 inhibitors in heart failure with preserved ejection fraction - Drugs in Context

Source : https://www.drugsincontext.com/emerging-concepts-in-heart-failure-treatment-and-management-focus-on-sglt2-inhibitors-in-heart-failure-with-preserved-ejection-fraction/

This article provides an overview of the main pathophysiological characteristics of heart failure with preserved ejection fraction (HFpEF), the considered diverse biological effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in...



Conclusions/Relevance: SGLT2i can reduce myocardial passive stiffness (diastolic function) by enforcing the phosphorylation of myofilament modulatory proteins. This article provided an overview of the main pathophysiological characteristics of HFpEF and of the diverse mechanisms of action of SGLT2i in this setting. The supporting clinical...

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Relevance: This manuscript reviews the current therapeutic algorithm with a special focus on the therapeutic value of adding an MRA (still underused in both clinical trials and real world), changing an ACEi/ARB for an ARNi and incorporating an SGLT2i in patients with HFrEF.

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Cost-Effectiveness of Empagliflozin on Top of Standard of Care for Heart Failure With Reduced Ejection Fraction in Singapore

Cost-Effectiveness of Empagliflozin on Top of Standard of Care for Heart Failure With Reduced Ejection Fraction in Singapore

Source : https://www.valuehealthregionalissues.com/article/S2212-1099(22)00207-2/fulltext

The prevalence of heart failure (HF) and its risk factors are high in Singapore. The EMPEROR-Reduced trial demonstrated that add-on empagliflozin resulted in a reduction in the risk of cardiovascular...



Conclusion: The use of empagliflozin on top of SoC represents a highly cost-effective solution for the treatment of patients with HF with reduced ejection fraction in Singapore when considering its efficacy, relative affordability, and the growing economic burden of HF in Singapore.

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Usefulness of High-Sensitivity Troponin I in Risk Stratification and Final Disposition of Patients with Acute Heart Failure in the Emergency Department: Comparison between HFpEF vs. HFrEF - PubMed

Usefulness of High-Sensitivity Troponin I in Risk Stratification and Final Disposition of Patients with Acute Heart Failure in the Emergency Department: Comparison between HFpEF vs. HFrEF - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/36676630/

Background and Objectives: In patients with acute heart failure (AHF), there is no definite evidence on the relationship between high-sensitivity cardiac troponin (hs-cTnI) and the left ventricular ejection fraction (LVEF)...



Conclusions: In patients admitted to the ED for AHF without ACS, there is a negative relationship between hs-cTnI and a reduced LVEF, although a significant percentage of patients with a preserved LVEF also resulted to have high levels of hs-cTnI. In the absence of ACS, hs-cTnI seems to be a reliable biomarker of myocardial injury in AHF in the...

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Cost-Effectiveness of Empagliflozin in Combination with Standard Care versus Standard Care Only in the Treatment of Heart Failure Patients in Finland - PubMed

Cost-Effectiveness of Empagliflozin in Combination with Standard Care versus Standard Care Only in the Treatment of Heart Failure Patients in Finland - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/36636485/

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Conclusion: Empagliflozin is a cost-effective treatment for patients with HF in the Finnish health care setting.

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Surgical Treatment of Tricuspid Valve Regurgitation in Patients Undergoing Left Ventricular Assist Device Implantation: Interim analysis of the TVVAD trial

Surgical Treatment of Tricuspid Valve Regurgitation in Patients Undergoing Left Ventricular Assist Device Implantation: Interim analysis of the TVVAD trial

Source : https://www.jtcvs.org/article/S0022-5223(22)01243-0/fulltext

Right heart failure remains a serious complication of left ventricular assist device therapy. Many patients presenting for left ventricular assist device implantation have significant tricuspid regurgitation. It remains unknown whether...



Conclusions: The presence of significant tricuspid regurgitation before left ventricular assist device is associated with a high incidence of right heart failure within the first 6 months after surgery. Tricuspid valve surgery was successful in reducing postimplant tricuspid regurgitation compared with no tricuspid valve surgery but was not...

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Multiple Prior Live Births are Associated with Cardiac Remodeling and Heart Failure Risk in Women

Multiple Prior Live Births are Associated with Cardiac Remodeling and Heart Failure Risk in Women

Source : https://www.onlinejcf.com/article/S1071-9164(23)00004-0/fulltext

Pregnancy presents a window of opportunity to identify those who may be at greater long-term cardiovascular risk, both because this is a unique time-period when they are highly engaged in...



Conclusions: Greater number of live births are associated with worse cardiac structure and function. While there was no association with overall HF, a higher number of live births was associated with greater risk for incident HFrEF.

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A fast computational model for circulatory dynamics: effects of left ventricle-aorta coupling - Biomechanics and Modeling in Mechanobiology

A fast computational model for circulatory dynamics: effects of left ventricle-aorta coupling - Biomechanics and Modeling in Mechanobiology

Source : https://link.springer.com/article/10.1007/s10237-023-01690-w

The course of diseases such as hypertension, systolic heart failure and heart failure with a preserved ejection fraction is affected by interactions between the left ventricle (LV) and the vasculature....



Conclusion: A novel circulatory system model is presented, using a combination of spatially resolved and lumped-parameter component representations, which allows simulations of multiple cardiac cycles with computations that run faster than real time. The model is applied to examine the consequences of the aortic stiffening that occurs with...

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