Category: Volume 1

Epidemiological Study of Heart Failure in China

Epidemiological Study of Heart Failure in China

Authors: Guo, Yang; Zhao, Dong; Liu, Jing

Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. HF is one of the most important and severe end stages of many cardiovascular diseases. Epidemiological studies of HF have focused mainly on the prevalence, incidence, mortality, fatality, and distribution and temporal trends of these indicators among different populations. This review highlights important epidemiological studies of HF in China.

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Cardiac Sarcoidosis

Cardiac Sarcoidosis: Sorting Fact from Fiction in This Rare Cardiomyopathy

Authors: Rajapreyar, Indranee; Langlois, Elizabeth

Sarcoidosis is a rare condition of granulomatous infiltration of many tissues of the body, including the heart. Cardiac sarcoidosis has been challenging to study, as it is often asymptomatic, although the initial presentation can be sudden cardiac death. The incidence and prevalence rates have been difficult to establish and no expert agreed upon guidelines for diagnosis and management of cardiac sarcoidosis exist, and clinical manifestations are varied. The pathophysiology of granuloma formation in the myocardium as well as other tissues is governed by immune response to some environmental antigen. Genetics is also thought to play a role, although gene alterations have not been extensively studied, and no specific set of genetic mutations has been identified to aid in identification of individuals at risk of developing disease. Epigenetic factors likely play a significant role in modulation of gene expression with respect to immune response. There is no standardized screening tool for the identification of cardiac sarcoidosis. The presence of systemic sarcoidosis and new-onset third-degree heart block or ventricular arrhythmias warrants further investigation for cardiac sarcoidosis. MRI and PET are useful in helping to identify cardiac sarcoidosis but are not stand-alone tests. Endomyocardial biopsy is the gold standard but has a low yield owing to the patchy nature of granuloma formation in the myocardium. Therapy should be instituted early and involves immunosuppressive therapy with predominant use of corticosteroids. Arrhythmias, either ventricular or high-grade heart blocks, are managed with device therapy. Clinical presentation may warrant use of antiarrhythmic agents and/or catheter ablation. Survival and disease prognosis are dependent on early diagnosis and treatment. This review details the current understanding of cardiac sarcoidosis and highlights diagnostic strategies and treatment with the aim of guiding the clinician to early identification of patients and implementation of appropriate management in this rare disease entity.

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Unusual Cardiomyopathies

Unusual Cardiomyopathies: Some May Be More Usual Than Previously Thought and Simply Underdiagnosed

Author: Smart, Frank W.

Heart failure is the most common cause of hospitalization in the United States. Just as the prevalence of heart failure has increased, the number of diseases identified that result in the heart failure syndrome has escalated. Certain cardiomyopathies that have previously been regarded as very rare are being recognized with increasing frequency, because of improved imaging techniques and an increased understanding of the pathophysiologic mechanisms that result in these diseases. Improved echocardiographic techniques and methods such as spectral Doppler and 3D image rendering, along with the use of advanced diagnostic tools such as cardiac CT angiography and cardiac magnetic resonance imaging are now common. These advanced imaging methods have led to an increased appreciation of the frequency of diseases such as isolated left ventricular noncompaction and cardiac amyloidosis. Left ventricular noncompaction, once thought to occur in roughly one in one million patients, may actually be seen in fewer than one in 1000 patients. Cardiac amyloidosis, in the senile form, may exist in 80% of 80-year-old patients, although the incidence of clinical symptoms is less. As the genetic alterations that contribute to these diseases are further elucidated, improved diagnosis and a better understanding of the prognosis of these uncommon cardiomyopathies will follow.

Document Type: Research Article

DOI: http://dx.doi.org/10.15212/CVIA.2015.0006

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Heart Failure Issues and Management: A European Perspective

Authors: Dominguez-Rodriguez, Alberto; Gonzalez-Gonzalez, Julia; Belleyo-Belkasem, Carima; Abreu-Gonzalez, Pedro

Heart failure poses an increasing problem for global health care systems. The epidemiological data which have been accrued over the last 30 years have predominantly been accumulated from experience within North America and Europe. The European experience in heart failure, although similar to that in North America, has recently demonstrated differences in hospitalization which may underlie the differences between health care system configurations. Despite the predicted increase in the number of patients affected by heart failure, over the last 30 years a clear management algorithm has evolved for the use of pharmacotherapies, device-based therapies, and mechanical therapies, including left ventricular assist devices and cardiac transplantation. Although the treatment of such patients has been clearly delineated in national and international guidelines, the underuse of all available and appropriate therapies remains a significant problem. The purpose of this review is to provide a European perspective on management of heart failure.

Document Type: Research Article

DOI: http://dx.doi.org/10.15212/CVIA.2015.0014

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Congestive Heart Failure Clinics: How to Make Them Work in a Community-Based Hospital System

Authors: Larned, Joshua; Kabach, Mohamad; Tamariz, Leonardo; Raimondo, Kristine

Introduction: Congestive heart failure (CHF) accounts for over $32 billion in health care costs per year and is at the epicenter of health care reform. CHF remains a major cause of hospitalizations. It is known and has been reported that missed diagnosis of and missed opportunities to treat heart failure are associated with higher mortality and morbidity. CHF disease management programs have emerged as a potential solution to the CHF epidemic. The paradox remains that CHF disease management programs still cluster in tertiary hospital systems. The impact of heart failure specialists and specialty teams in community health systems is less well understood. Currently there are not enough CHF-trained teams in the community setting to address this unmet health need.

Methods: We explored the impact of CHF clinics in a community-based hospital system on readmission rates, mortality, and symptomatic relief. A total of 384 patients were enrolled in the clinic between 2012 and 2015. Data collected included age, sex, type of heart failure, New York Heart Association class, ejection fraction, serum creatinine and brain natriuretic peptide values, and readmission and mortality rates within 30 days, 3 months, 6 months, and 1 year. We also compared readmission rates between patients who were followed up in the CHF clinic versus those who were not seen in the CHF clinic.

Results: A statistically significant difference was demonstrated in readmission rates between patients who were followed up in the CHF clinic versus those who did not visit the CHF clinic for up to 1 year of follow-up.

Conclusion: CHF community hospital clinics that use a rapid and frequent follow-up format with CHF-trained teams effectively reduce rehospitalization rates up to 1 year.

Document Type: Research Article

DOI: http://dx.doi.org/10.15212/CVIA.2015.0005

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Editorial by the Founding Editor

Editorial by the Founding Editor

Author: Hu, Dayi

 When China opened its doors to the world 26 years ago, there were very few cardiology meetings organized in China with an international outlook. Shortly thereafter, in 1990, the Great Wall International Congress of Cardiology (GW-ICC) held its inaugural meeting. In its first few years, the main focus of the GW-ICC was promoting research and education within the Chinese cardiology community, and on promulgating techniques such as catheter ablation of tachyarrhythmias and balloon angioplasty. Even from this early stage, the GW-ICC became a great social and scientific success. The reason for this success was that the GW-ICC offered opportunities for Chinese cardiologists to make direct contact with their US and European colleagues who in turn loved to come to China and learn about the issues facing cardiologists here.

Since that time, the GW-ICC has been at the forefront of the growth in Chinese cardiology research, reflecting China’s growing importance in world research rankings. For example, in 2014, the ISI database shows China to be the third largest source of cardiology-related papers, surpassed only by the United States in first place and the United Kingdom in second place. In the year 2015 up through July, China has moved to second place ahead of the United Kingdom. This trend will certainly continue.

It is evident that China now needs its own English-language, multi-national journal where top-rated articles from around the world can be published.Cardiovascular Innovations and Applications (CVIA), the new, official journal of the GW-ICC will fill this void. Unique to this journal will be the continuation of a scientific exchange of ideas between leading Chinese clinicians/researchers and clinicians/researchers around the globe.

CVIA will initially publish focused articles of original clinical research that explore current and novel developments in cardiovascular disease, as well as its prevention and rehabilitation. In keeping up with its title, CVIA will promote innovations and applications for the global betterment of cardiovascular public health. As CVIA develops and matures, it is aimed to become a respected and trusted reference for the cardiology academic community around the world.

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Heart Failure Treatment in the Future

A Clinician’s Commentary on Heart Failure Treatment in the Future

Author: Conti, C. Richard

Standard Therapy for Heart Failure

Until now the principal focus of heart failure therapy has been on the sympathetic nervous system and the renin-angiotensin system. Beta blockade counters the unwanted effects of catecholamines on the myocardium as well as moderately reducing afterload. Since angiotensin is a vasoconstrictor and has some toxic effect on the myocardium, both contributing to heart failure, inhibition of the renin–angiotensin system has been logical therapy for heart failure. However, use of angiotensin-converting enzyme (ACE) inhibitors may increase bradykinin levels, which are responsible for the cough that may be associated with their use as well as angioedema that may result from the same medications.

A New Drug for Heart Failure

At long last a new drug for heart failure with a different mechanism of action has come on the scene to treat the heart failure patient. This new drug blocks the enzyme neprilysin, which is expressed in a variety of tissues and degrades several endogenous vasoactive (vasodilator) peptides. The inhibition of neprilysin increases the levels of these vasodilator peptides. When vasodilation occurs as a result of this new compound, bradykinin levels are not increased and thus cough and angioedema may not occur.

DOI: http://dx.doi.org/10.15212/CVIA.2015.0001

 

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Strategies to Reduce Heart Failure Hospitalizations and Readmissions

Strategies to Reduce Heart Failure Hospitalizations and Readmissions: How Low Can We Go?

Author: Aranda, Juan M.

It is estimated that more than one million heart failure hospitalizations occur each year. Systolic heart failure and heart failure with preserved ejection fraction contribute equally to heart failure hospitalizations. Heart failure readmission rates continue to be about 25%. Strategies to reduce heart failure readmission are key to reducing hospitalization rates. The strategies to reduce heart failure hospitalization are as follows: (1) During hospitalization, diuresis to the euvolemic state is essential. Fifty percent of discharged heart failure patients have minimal weight loss during the hospitalization, representing minimal diuresis, but still fluid overload. (2) During hospitalization, interrogate the defibrillator or biventricular pacemaker (if applicable) to ensure that there is no right ventricular pacing and there is appropriate biventricular pacing. Interrogation of devices can identify arrhythmia or suboptimal biventricular pacing, which can contribute to decompensation. (3) Before discharge, identify the reason for decompensation, such as atrial fibrillation, infection, pulmonary embolism, or noncompliance. (4) Before discharge a multidisciplinary team is needed to educate the patient on diet, medications, fluid weight surveillance, and exercise. (5) A postdischarge visit should occur within 10 days and with emphasis on uptitration of neurohormonal blockers and continued congestion management. Such interventions conducted by a multidisciplinary team have the potential to reduce heart failure hospitalization rates.

Keywords: heart failure; readmissions; strategies

Document Type: Research Article

DOI: http://dx.doi.org/10.15212/CVIA.2015.0004

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Table of Contents Volume 1 Number 1

Inaugural Issue of Cardiovascular Innovations and Applications Journal Launches with Special Issue on Heart Failure.

Beijing, October 21, 2015: The new journal Cardiovascular Innovations and Applications (CVIA) has been launched with a Special Issue on Heart Failure. CVIA was founded on the occasion of the 25th anniversary of the Great Wall-International Congress of Cardiology (GW-ICC) in 2014 by Professor Dayi Hu, president of the GW-ICC and past president of the Chinese Society of Cardiology, who will serve as Founding Editor.

Richard Conti, MD, a past president of the American College of Cardiology and former Editor of Clinical Cardiology, servers as Editor-in-Chief of the new journal, which has published its first issue to coincide with the GW-ICC meeting in October 2015 in Beijing, China.

The GW-ICC is one of the largest congresses in the Asian-Pacific region and is the most comprehensive and influential academic conference on cardiology. Held as a regular annual conference since 1990, GW-ICC has provided a platform for continuing education in cardiovascular disease diagnosis, treatment, and technology training, through events that leverage the expertise of internationally renowned cardiologists and scholars from the United States, Europe and Asia.

The CVIA Special Issue on Heart Failure has been Guest Edited by Juan M. Aranda, Jr. of the University of Florida and brings together contributions from leading cardiologists from the United States, China and Europe.

Featured papers in this issue are:

A Clinician’s Commentary on Heart Failure Treatment in the Future  by C. Richard Conti.  This paper considers the results of the latest heart failure trial entitled ‘Efficacy and Safety of LCZ696 Compared to Enalapril on Morbidity and Mortality of Patients with Chronic Heart Failure.’ The drug LCZ696 has now been approved by the FDA and will be manufactured by Novartis as Entresto.

Strategies to Reduce Heart Failure Hospitalizations and Readmission: How Low Can We Go?  by Juan M. Aranda, Jr. This paper examines the strategies available to reduce heart failure readmission levels. It is estimated that more than one million heart failure hospitalizations occur each year and heart failure readmission rates continue to be about 25%. Strategies to reduce heart failure readmission are key to reducing hospitalization rates. This paper considers strategies available at three different stages of the treatment process: during hospitalization, before discharge and post-discharge. The interventions conducted by a multidisciplinary team adopting these strategies have great potential to reduce heart failure hospitalization rates.

Other papers in this issue are:

Editorial by the Founding Editor by Dayi Hu. This editorial notes the considerable rise in China-based cardiology papers in recent years, with China now the second largest source of cardiology papers in world research rankings. As such, it is now an opportune time to launch a new China-based cardiology journal to publish the best cardiology papers, with a wide range of contributors across China, the United States and Europe.

Congestive Heart Failure Clinics: How to Make Them Work in a Community-Based Hospital System  by Joshua Larned, Mohamad Kabach, Leonardo Tamariz, and Kristine Raimondo. This paper concludes that Congestive Heart Failure (CHF) Clinics in community hospitals that use a rapid and frequent follow-up with CHF-trained teams effectively reduce hospitalization rates up to 1 year.

Heart Failure Issues and Management: A European Perspective by Alberto Dominguez-Rodriguez, Julia Gonzalez-Gonzalez, Carima Belleyo-Belkasem and Pedro Abreu-Gonzalez. This review provides a European perspective on management of heart failure.

Unusual Cardiomyopathies: Some May Be More Usual Than Previously Thought and Simply Underdiagnosed by  Frank W Smart. This paper studies certain cardiomyopathies that have previously been regarded as very rare. These are being recognized with increasing frequency, because of improved imaging techniques and an increased understanding of the pathophysiologic mechanisms that result in these diseases.

Cardiac Sarcoidosis: Sorting Fact from Fiction in This Rare Cardiomyopathy by Indranee Rajapreyar and Elizabeth Langlois. This review details the current understanding of cardiac sarcoidosis and highlights diagnostic strategies and treatment with the aim of guiding the clinician to early identification of patients and implementation of appropriate management in this rare disease entity.

Epidemiological Study of Heart Failure in China by Yang Guo, Dong Zhao and Jing Liu:  This review highlights important epidemiological studies of heart failure in China.

Noninvasive Hemodynamic Monitoring for Heart Failure: A New Era of Heart Failure Management by Gabriel A. Hernandez, Viviana Navas and Sandra Chaparro.  This paper describes advances in implantable wireless technology that now allow frequent and direct measurement of intracardiac filling pressures, which can be monitored by health care providers to help tailor therapy to reduce filling pressures and hospital readmission rates.

The Evaluation of the Heart Failure Patient by Echocardiography: Time to go beyond the Ejection Fraction by Jacqueline Dawson Dowe, Juan Vilaro, Karen Hamilton, Anita Szady and Juan M. Aranda, Jr. This article reviews the role of the echocardiogram in the evaluation of the heart failure patient, without focusing on the left ventricle.

Pulmonary Arterial Hypertension and the Failing Ventricle: Getting It Right by Stacy A Mandras, Sylvia Oleck and Hector O. Ventura.  This paper concludes that the discovery of new prognostic indicators, use of hybrid imaging for early detection of Right Ventricular Failure (RVF), and strategies to prevent the development of RVF will be important if outcomes in this patient population are to improve.

Cardiac Resynchronization Therapy in 2015: Lessons Learned by Siva Ketha and Fred M. Kusumoto. This paper reviews the pathobiology of cardiac dyssynchrony, the rationale for the use of CRT, the history and the state of the art of CRT, and guidelines and recommendations for CRT, while also focusing on the areas of controversy and potential future applications.

Continuous Flow Left Ventricular Assist Device Therapy: A Focused Review on Optimal Patient Selection and Long-Term Follow-up Using Echocardiography by Juan R. Vilaro, Anita Szady, Mustafa M. Ahmed, Jacqueline Dawson  and Juan M. Aranda Jr.  This paper provides a focused clinical review on the use of echocardiography in two main aspects of the evaluation of patients who are being considered for or are mechanically supported by Continuous Flow Left Ventricular Assist Devices (CF-LVADs): (a) optimal patient selection for CF-LVAD support and (b) follow-up assessment of optimal pump function.

Mechanical Circulatory Support for the Failing Heart: Which Device to Choose by Mustafa Ahmed and Rene Alvarez, Jr. This article reviews the literature and provides an algorithm for the treatment of cardiogenic shock.

 

 

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