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Muscle Wasting and Sarcopenia in Heart Failure-The Current State of Science.
Lena, A, Anker, MS, Springer, J
International journal of molecular sciences. 2020;(18)
Abstract
Sarcopenia is primarily characterized by skeletal muscle disturbances such as loss of muscle mass, quality, strength, and physical performance. It is commonly seen in elderly patients with chronic diseases. The prevalence of sarcopenia in chronic heart failure (HF) patients amounts to up to 20% and may progress into cardiac cachexia. Muscle wasting is a strong predictor of frailty and reduced survival in HF patients. Despite many different techniques and clinical tests, there is still no broadly available gold standard for the diagnosis of sarcopenia. Resistance exercise and nutritional supplementation represent the currently most used strategies against wasting disorders. Ongoing research is investigating skeletal muscle mitochondrial dysfunction as a new possible target for pharmacological compounds. Novel agents such as synthetic ghrelin and selective androgen receptor modulators (SARMs) seem promising in counteracting muscle abnormalities but their effectiveness in HF patients has not been assessed yet. In the last decades, many advances have been accomplished but sarcopenia remains an underdiagnosed pathology and more efforts are needed to find an efficacious therapeutic plan. The purpose of this review is to illustrate the current knowledge in terms of pathogenesis, diagnosis, and treatment of sarcopenia in order to provide a better understanding of wasting disorders occurring in chronic heart failure.
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[The PARAGON-HF trial: missed opportunity or first personalized therapy?].
Senni, M, Di Tano, G
Giornale italiano di cardiologia (2006). 2020;(2):93-95
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Sodium-Glucose Cotransporter 2 Inhibitors for Prevention of Heart Failure Events in Patients with Type 2 Diabetes Mellitus: A Cost Per Outcome Analysis.
Arbel, R, Aboalhasan, E, Hammerman, A, Azuri, J
Clinical drug investigation. 2020;(7):665-669
Abstract
BACKGROUND AND OBJECTIVE Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have significant efficacy in reducing the risk of hospitalization for heart failure (hHF) or cardiovascular (CV) mortality in patients with type 2 diabetes mellitus (T2DM). However, there are differences in HF outcomes between the SGLT2i. Therefore, we compared the cost needed to achieve these outcomes between empagliflozin, canagliflozin, and dapagliflozin. METHODS We calculated the cost needed to treat (CNT) in order to prevent one event of hHF or CV mortality, by multiplying the annualized number needed to treat (NNT) to prevent one event, by the annual cost of each therapy. Efficacy estimates were extracted from published randomized controlled trial (RCT) data. A sensitivity analysis was performed to mitigate differences between the RCT populations. Drug costs were extracted from the 2020 US National Average Drug Acquisition Cost listing. RESULTS We figured empagliflozin's CNT to be $664,464 (95% CI $499,872-$1,097,280), $1,535,387 (95% CI $886,074-$3,210,501) for canagliflozin, and $2,693,145 (95% CI $1,639,563-$11,092,206) for dapagliflozin. The sensitivity analysis confirmed the cost advantage of empagliflozin. CONCLUSIONS Our findings suggest that empagliflozin prescribed for preventing CV death or hHF in T2DM patients seems to be cost saving compared to treatment with canagliflozin, and dapagliflozin.
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Cardiac Cachexia: A Well-Known but Challenging Complication of Heart Failure.
Krysztofiak, H, Wleklik, M, Migaj, J, Dudek, M, Uchmanowicz, I, Lisiak, M, Kubielas, G, Straburzyńska-Migaj, E, Lesiak, M, Kałużna-Oleksy, M
Clinical interventions in aging. 2020;:2041-2051
Abstract
Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient's prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF ("cardiac cachexia").
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Incidence of Hospitalization for Heart Failure Relative to Major Atherosclerotic Events in Type 2 Diabetes: A Meta-analysis of Cardiovascular Outcomes Trials.
Sacre, JW, Magliano, DJ, Shaw, JE
Diabetes care. 2020;(10):2614-2623
Abstract
BACKGROUND Emerging evidence points to heart failure as being a common first presentation of cardiovascular (CV) disease in type 2 diabetes. PURPOSE The purpose of this study was to determine whether hospitalization for heart failure (HHF) occurs more or less frequently than major adverse CV events (MACE) in people with type 2 diabetes. DATA SOURCES Placebo arms of CV outcomes trials in type 2 diabetes were included. STUDY SELECTION Sixteen CV outcomes trials were selected, including five dipeptidyl peptidase 4 inhibitor trials, seven glucagon-like peptide 1 receptor agonist trials, and four sodium-glucose cotransporter 2 inhibitor trials. DATA EXTRACTION We extracted incidence rates of HHF, myocardial infarction (MI), stroke, and the composite outcomes of CV death or HHF and MACE (CV death, nonfatal MI, or nonfatal stroke). DATA SYNTHESIS In two trials enriched with people with chronic kidney disease, HHF was more common than both MI and stroke. Among the remaining 14 trials, HHF was less frequent than MI in 13 (93%), with this difference being significant in 8 (57%); however, HHF surpassed stroke in all but 1 study (93%; significant in 7 studies [50%]). Heterogeneity among trials was moderate/high (I 2 >50%) and partly explained by HHF/MI correlating with age and previous MI history (P < 0.05). In seven trials that reported events stratified by presence/absence of preexisting CV disease, ratios of HHF/MI and HHF/stroke were similar between groups. LIMITATIONS Enrichment of trial populations with those at high risk of CV events limits generalizability. CONCLUSIONS Although less frequent than MI, HHF is a common event in type 2 diabetes, both in those with and those without prior CV disease.
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Deleterious cardiovascular effect of exosome in digitalis-treated decompensated congestive heart failure.
Fu, JL, Yu, Q, Li, MD, Hu, CM, Shi, G
Journal of biochemical and molecular toxicology. 2020;(5):e22462
Abstract
Heart failure (HF) is a medical condition inability of the heart to pump sufficient blood to meet the metabolic demand of the body to take place. The number of hospitalized patients with cardiovascular diseases is estimated to be more than 1 million each year, of which 80% to 90% of patients ultimately progress to decompensated HF. Digitalis glycosides exert modest inotropic actions when administered to patients with decompensated HF. Although its efficacy in patients with HF and atrial fibrillation is clear, its value in patients with HF and sinus rhythm has often been questioned. A series of recent studies have cast serious doubt on the benefit of digoxin when added to contemporary HF treatment. We are hypothesizing the role and mechanism of exosome and its biological constituents responsible for worsening the disease state and mortality in decompensated HF patients on digitalis.
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Dietary Sodium Restriction for Heart Failure: A Systematic Review of Intervention Outcomes and Behavioral Determinants.
Burgermaster, M, Rudel, R, Seres, D
The American journal of medicine. 2020;(12):1391-1402
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Abstract
The 1500 mg/d dietary sodium restriction commonly recommended for patients with heart failure has recently been questioned. Poor adherence to sodium-restricted diets makes assessing the efficacy of sodium restriction challenging. Therefore, successful behavioral interventions are needed. We reviewed sodium restriction trials and descriptive studies of sodium restriction to: 1) determine if sodium restriction was achieved in interventions among heart failure patients; and 2) characterize predictors of successful dietary sodium restriction. Among 638 identified studies, 10 intervention trials, and 25 descriptive studies met inclusion criteria. We used content analysis to extract information about sodium restriction and behavioral determinants of sodium restriction. Dietary sodium was reduced in 7 trials; none achieved 1500 mg/d (range 1938-4564 mg/d). The interventions implemented in the interventional trials emphasized knowledge, skills, and self-regulation strategies, but few addressed the determinants correlated with successful sodium restriction in the descriptive studies (eg, social/cultural norms, social support, taste preferences, food access, self-efficacy). Findings suggest that incorporating determinants predictive of successful dietary sodium restriction may improve the success of interventional trials. Without effective interventions to deploy in trials, the safety and efficacy of sodium restriction remains unknown.
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Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction in Patients With Nonalcoholic Fatty Liver Disease.
Packer, M
The American journal of medicine. 2020;(2):170-177
Abstract
The most common causes of chronic liver disease in the developed world-nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)-are the hepatic manifestations of an insulin-resistant state that is linked to visceral adiposity and systemic inflammation. NAFLD and NASH lead to an expansion of epicardial adipose tissue and the release of proinflammatory adipocytokines that cause microcirculatory dysfunction and fibrosis of the adjoining myocardium, resulting in atrial fibrillation as well as heart failure with a preserved ejection fraction (HFpEF). Inflammatory changes in the left atrium lead to electroanatomical remodeling; thus, NAFLD and NASH markedly increase the risk of atrial fibrillation. Simultaneously, patients with NAFLD or NASH commonly show diastolic dysfunction or latent HFpEF. Interventions include 1) weight loss by caloric restriction, bariatric surgery, or intensive exercise, and 2) drugs that ameliorate fat-mediated inflammation in both the liver and heart (eg, statins, metformin, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and pioglitazone). Patients with NAFLD or NASH commonly have an inflammation-related atrial and ventricular myopathy, which may contribute to symptoms and long-term outcomes.
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Strategies of Unloading the Failing Heart from Metabolic Stress.
Koutroumpakis, E, Jozwik, B, Aguilar, D, Taegtmeyer, H
The American journal of medicine. 2020;(3):290-296
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Abstract
We propose a unifying perspective of heart failure in patients with type 2 diabetes mellitus. The reasoning is as follows: cellular responses to fuel overload include dysregulated insulin signaling, impaired mitochondrial respiration, reactive oxygen species formation, and the accumulation of certain metabolites, collectively termed glucolipotoxicity. As a consequence, cardiac function is impaired, with intracellular calcium cycling and diastolic dysfunction as an early manifestation. In this setting, increasing glucose uptake by insulin or insulin sensitizing agents only worsens the disrupted fuel homeostasis of the heart. Conversely, restricting fuel supply by means of caloric restriction, surgical intervention, or certain pharmacologic agents will improve cardiac function by restoring metabolic homeostasis. The concept is borne out by clinical interventions, all of which unload the heart from metabolic stress.
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Nursing taxonomies in hospital discharge planning: a quasi-experimental study.
Lemos, DMP, Saldanha, PF, Vieira, LF, Azzolin, KO
Revista brasileira de enfermagem. 2020;(5):e20180896
Abstract
OBJECTIVE to evaluate the effect of implementation of hospital discharge planning based on the taxonomies of NANDA-International, nursing interventions classification (NIC) and nursing outcomes classification (NOC) for patients with heart failure (HF) or diabetes mellitus (DM). METHODS quasi-experimental quantitative study conducted in a public university hospital located in the state of Rio Grande do Sul, Brazil. Convenience sampling included 28 adult patients hospitalized for HF or DM with the nursing diagnosis Ineffective Health Management (00078), who received the following nursing interventions: Teaching: Disease Process, Teaching: Prescribed Medication and Teaching: Prescribed Diet. Before and after the intervention, the following nursing outcomes were evaluated : Knowledge: Diabetes Management and Knowledge: Heart Failure Management. RESULTS the score of the nursing outcome Knowledge: Heart Failure Management went from 2.05±0.28 to 2.54±0.30 (P=0.002), and of the nursing outcome Knowledge: Diabetes Management went from 2.61±0.55 to 3.21±0.57 (P=0.000). CONCLUSION discharge planning based on the NIC improves the NOC score and may interfere in the health outcomes.