Gregg C. Fonarow

Background Heart failure is a complex clinical syndrome noted on approximately 1 in 8 death certificates in the United States. Vital to reducing complications of heart failure and preventing hospital readmissions is adherence to heart failure self-care routines. Mobile health offers promising opportunities for enhancing self-care behaviors by facilitating tracking and timely reminders. Objective We sought to investigate three characteristics of heart failure patients with respect to their heart failure self-care behaviors: (1) internet use to search for heart failure information; (2) familiarity with mobile health apps and devices; and (3) perceptions of using activity trackers or smartwatches to aid in their heart failure self-care. Methods Forty-nine heart failure patients were asked about their internet and mobile health usage. The structured interview included questions adapted from the Health Information National Trends Survey …

BackgroundLimited real-world evidence exists for outcomes with contemporary guideline-directed medical therapy (GDMT) or GDMT with implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT-D) therapy for patients with heart failure with reduced ejection fraction (HFrEF) and left ventricular ejection fraction (LVEF) ≤35%.ObjectiveThe present study aimed to assess survival associated with GDMT or GDMT with ICD/CRT-D therapy.MethodsThis retrospective observational study included real-world de-identified data from January 1, 2016, to December 19, 2023, from 24 U.S. institutions per participating institutional agreements (egnite Database; egnite, Inc.). Patients with a diagnosis of HFrEF and an echocardiographic study documenting LVEF ≤35% were included for analysis.ResultsOf 43,591 patients with eligible index event of LVEF ≤35%, prescription history through ≥1 …

Background Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China. Methods Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed. Results A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset …

BackgroundLow-dose colchicine has been shown to lower major adverse cardiovascular events (MACE) among those with cardiovascular disease (CVD). It remains unclear how long a CVD patient needs to live to potentially benefit from colchicine. Our study aimed to determine the time to benefit (TTB) of colchicine in individuals with CVD.MethodsLiterature searches were performed in PubMed for the cardiovascular outcome trial of colchicine in patients with CVD until October 12, 2023. The primary outcome measured was MACE. Reconstructed individual participant data (IPD) and the stratified Cox proportional hazards model were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) to estimate the efficacy of colchicine, and Weibull survival curves were fitted to estimate TTB for specific absolute risk reduction (ARR) thresholds (0.002, 0.005, and 0.01).ResultsFour trials randomizing 11,594 …

Existing risk prediction models for hospitalized heart failure patients are limited. We identified patients hospitalized with a diagnosis of heart failure between 7 May 2013 and 26 April 2022 from a large academic, quaternary care medical centre (training cohort). Demographics, medical comorbidities, vitals, and labs were collected and were used to construct random forest machine learning models to predict in‐hospital mortality. Models were compared with logistic regression, and to commonly used heart failure risk scores. The models were subsequently validated in patients hospitalized with a diagnosis of heart failure from a second academic, community medical centre (validation cohort). The entire cohort comprised 21 802 patients, of which 14 539 were in the training cohort and 7263 were in the validation cohort. The median age (25th–75th percentile) was 70 (58–82) for the entire cohort, 43.2% were female …

Perhaps nowhere else is the tradeoff between access and quality of care as apparent as in the emergency invasive management of patients with acute coronary syndromes (ACS) and cardiogenic shock (CS). These patients require rapid hemodynamic stabilization and emergency percutaneous coronary intervention (PCI), demanding a highly skilled cardiac catheterization laboratory team. Though PCI has grown safer over the years, there remains a small inverse association between hospital and operator volume and outcomes, 1 and all else being equal, higher-volume operators and hospitals should have better outcomes, perhaps especially in these very sick patients. 2 However, all else is not equal in the setting of CS complicating ACS, in which in-hospital mortality is twice as high among those with first-medical-contactto-device time> 90 minutes compared with# 90 minutes. 3 The importance of timely access to …

To the Editor, Heart failure (HF) is a leading cause of morbidity and mortality globally. 1 Loop diuretics, such as torsemide and furosemide, are routinely used for managing fluid overload in patients with HF. 2 Although furosemide is the most widely used loop diuretic, some studies and prior meta‐analyses suggested that torsemide may be superior to furosemide with fewer adverse effects while achieving similar or better outcomes including potential survival benefit. 3, 4 However, current evidence remains inconsistent and previous reviews may have been biased due to the inclusion of observational studies. 3 In addition, the results of the TRANSFORM‐HF trial by Mentz et al., the largest randomized controlled trial (RCT) on this topic to date involving 2859 patients, have recently been published. 5 Hence, we conducted an updated systematic review of RCTs to provide more conclusive evidence regarding the efficacy …

BackgroundPoor adherence to GDMT leaves patients with HFrEF at persistent risk of clinical decline. We assessed adherence to GDMT, including quadruple therapy (QT) ie, ARNI, β-blocker, MRA, SGLT2i, and identified characteristics associated with adherence among US patients with HFrEF.MethodsPatients with HFrEF who had≥ 2 fills of GDMT from 4/2022-12/2022 were identified and described using Optum's de-identified Clinformatics® Data Mart Database. A multivariable logistic regression evaluated associations between patient characteristics and adherence ie, proportion of days covered≥ 0.8.ResultsThe analytic cohort included 47,421 patients (mean age 71 years [SD: 11], 60% male, 68% White, 12% Black). GDMT prevalence was lowest for SGLT2is (8%) and highest for β-blockers (77%); adherence was lowest for ARNI (73%) and SGLT2is (78%)(Table). Less than 1% of patients received QT and 62 …