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1.
ESC Heart Fail ; 8(6): 4370-4393, 2021 12.
Article in English | MEDLINE | ID: covidwho-1589128

ABSTRACT

Major changes have occurred in these last years in heart failure (HF) management. Landmark trials and the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of HF have established four classes of drugs for treatment of HF with reduced ejection fraction: angiotensin-converting enzyme inhibitors or an angiotensin receptor-neprilysin inhibitor, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, namely, dapagliflozin or empagliflozin. These drugs consistently showed benefits on mortality, HF hospitalizations, and quality of life. Correction of iron deficiency is indicated to improve symptoms and reduce HF hospitalizations. AFFIRM-AHF showed 26% reduction in total HF hospitalizations with ferric carboxymaltose vs. placebo in patients hospitalized for acute HF (P = 0.013). The guanylate cyclase activator vericiguat and the myosin activator omecamtiv mecarbil improved outcomes in randomized placebo-controlled trials, and vericiguat is now approved for clinical practice. Treatment of HF with preserved ejection fraction (HFpEF) was a major unmet clinical need until this year when the results of EMPEROR-Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic HFpEF) were issued. Compared with placebo, empagliflozin reduced by 21% (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P < 0.001), the primary outcome of cardiovascular death or HF hospitalization. Advances in the treatment of specific phenotypes of HF, including atrial fibrillation, valvular heart disease, cardiomyopathies, cardiac amyloidosis, and cancer-related HF, also occurred. Coronavirus disease 2019 (COVID-19) pandemic still plays a major role in HF epidemiology and management. All these aspects are highlighted in this review.


Subject(s)
COVID-19 , Heart Failure , Heart Failure/drug therapy , Heart Failure/epidemiology , Humans , Quality of Life , SARS-CoV-2 , Stroke Volume
2.
JMIR Mhealth Uhealth ; 9(11): e30674, 2021 11 02.
Article in English | MEDLINE | ID: covidwho-1496839

ABSTRACT

BACKGROUND: Managing the care of older adults with heart failure (HF) largely centers on medication management. Because of frequent medication or dosing changes, an app that supports these older adults in keeping an up-to-date list of medications could be advantageous. During the COVID-19 pandemic, HF outpatient consultations are taking place virtually or by telephone. An app with the capability to share a patient's medication list with health care professionals before consultation could support clinical efficiency, for example, by reducing consultation time. However, the influence of apps on maintaining an up-to-date medication history for older adults with HF in Ireland remains largely unexplored. OBJECTIVE: The aims of this review are twofold: to review apps with a medication list functionality and to assess the quality of the apps included in the review using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale. METHODS: A systematic search of apps was conducted in June 2019 using the Google Play Store and iTunes App Store. The MARS was used independently by 4 researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score. RESULTS: Google Play and iTunes App store searches identified 483 potential apps (292 from Google Play and 191 from iTunes App stores). A total of 6 apps (3 across both stores) met the inclusion criteria. Of the 6 apps, 4 achieved an acceptable MARS score (3/5). The Medisafe app had the highest overall MARS score (4/5), and the Medication List & Medical Records app had the lowest overall score (2.5/5). On average, the apps had 8 functions based on the IMS functionality criteria (range 5-11). A total of 2 apps achieved the maximum score for number of features (11 features) according to the IMS Institute for Healthcare Informatics functionality score, and 2 scored the lowest (5 features). Peer-reviewed publications were identified for 3 of the apps. CONCLUSIONS: The quality of current apps with medication list functionality varies according to their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality (ie, the overall quality of an app). However, subjective quality (ie, satisfaction with the apps) was poor. Only 3 apps are based on scientific evidence and have been tested previously. A total of 2 apps featured all the IMS Institute for Healthcare Informatics functionalities, and half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication.


Subject(s)
COVID-19 , Heart Failure , Mobile Applications , Aged , Delivery of Health Care , Heart Failure/drug therapy , Humans , Informatics , Pandemics , SARS-CoV-2
3.
J Cardiothorac Surg ; 16(1): 226, 2021 Aug 09.
Article in English | MEDLINE | ID: covidwho-1463257

ABSTRACT

BACKGROUND: Inferior vena cava thrombosis is cited to be a complication of inferior vena cava filter placement and post coronary artery bypass surgery. Often only mild symptoms arise from these thrombi; however, due to the chronic nature of some thrombi and the recanalization process, more serious complications can arise. Although anticoagulation remains the gold standard of treatment, some patients are unable to be anticoagulated. In this case, we present a 65-year-old male who underwent IVC filter placement and open-heart surgery who later developed extensive femoral and iliocaval thrombosis leading to right heart failure, which required thrombus extraction with an AngioVac suction device. CASE PRESENTATION: We present a 65-year-old male who presented with bilateral pulmonary emboli with extensive right lower extremity deep vein thrombosis. Upon investigation he had ischemic heart disease and underwent a five-vessel coronary artery bypass for which he had an IVC filter placed preoperatively. On post operative day 3 to 4, he was decompensated and was diagnosed with an IVC thrombus. He progressed to right heart failure and worsening cardiogenic shock despite therapeutic anticoagulation and was taken for a suction thrombectomy using the AngioVac (AngioDynamics, Latham, NY) aspiration thrombectomy device. The thrombectomy was successful and he was able to recover and was discharged from the hospital. CONCLUSION: Despite being a rare complication, IVC thrombosis can have detrimental effects. This case is an example of how IVC thrombus in the post-operative setting can lead to mortality. The gold standard is therapeutic anticoagulation but despite that, this patient continued to have worsening cardiogenic shock. Other therapies have been described but because of its rarity, they are only described in case reports. This case shows that the AngioVac device is a successful treatment option for IVC thrombus and can have the possibility of future use.


Subject(s)
Coronary Artery Bypass/adverse effects , Shock, Cardiogenic/surgery , Thrombectomy , Vena Cava Filters/adverse effects , Vena Cava, Inferior , Venous Thrombosis/surgery , Aged , Anticoagulants/therapeutic use , COVID-19/diagnosis , Coronary Artery Bypass/methods , Heart Failure/drug therapy , Heart Failure/etiology , Heart Failure/surgery , Humans , Male , Pandemics , Prosthesis Implantation/adverse effects , Pulmonary Embolism/drug therapy , Pulmonary Embolism/etiology , Pulmonary Embolism/surgery , SARS-CoV-2 , Shock, Cardiogenic/drug therapy , Shock, Cardiogenic/etiology , Thrombectomy/instrumentation , Treatment Outcome , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgery , Venous Thrombosis/drug therapy , Venous Thrombosis/etiology
5.
Clin Drug Investig ; 41(10): 907-915, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1450031

ABSTRACT

BACKGROUND: Sacubitril-valsartan is effective in reducing the N-terminal pro-B-type natriuretic peptide level of hospitalized patients with acute decompensated heart failure, with a high acquisition cost compared with enalapril treatment. OBJECTIVE: This study aimed to determine the cost utility of sacubitril-valsartan compared with enalapril for acute decompensated heart failure treatment. METHODS: A Markov model was constructed to project the total costs, life-years, quality-adjusted life-years (QALYs) of early initiation, and a 2-month delay of sacubitril-valsartan treatment and enalapril treatment in hospitalized patients with acute decompensated heart failure over a lifetime horizon from a Thai healthcare system perspective. Clinical inputs were mainly derived from the PIONEER-HF and PARADIGM-HF trials, together with Thai epidemiological data. Cost data were based on the Thai population. All costs and outcomes were discounted at 3% annually. A series of sensitivity analyses were performed. RESULTS: Compared with enalapril, sacubitril-valsartan incurred a higher total cost per year (THB 42,994 [US$1367.48] vs THB 19,787 [US$629.37]), and it gained more QALYs (4.969 vs 4.755). The incremental cost-effectiveness ratio was THB 108,508/QALY (US$3451.26/QALY). Early initiation of sacubitril-valsartan treatment was more cost effective than delayed treatment. Sensitivity analyses revealed that at a level of willingness to pay of THB 160,000/QALY (US$5089/QALY), sacubitril-valsartan was a cost-effective strategy of about 60%. CONCLUSIONS: Sacubitril-valsartan is cost effective in patients with acute decompensated heart failure. However, the results are highly dependent on the long-term cardiovascular mortality, and they are applicable only to Thailand or countries with a similarly structured healthcare system. Long-term registries should be pursued to decrease the uncertainty around long-term mortality.


Subject(s)
Enalapril , Heart Failure , Aminobutyrates/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Biphenyl Compounds , Cost-Benefit Analysis , Drug Combinations , Enalapril/therapeutic use , Heart Failure/diagnosis , Heart Failure/drug therapy , Hospitalization , Humans , Stroke Volume , Tetrazoles/therapeutic use , Thailand , Valsartan
6.
G Ital Cardiol (Rome) ; 22(10): 854-860, 2021 Oct.
Article in Italian | MEDLINE | ID: covidwho-1441022

ABSTRACT

Sacubitril/valsartan (S/V) has been shown to reduce the risk of cardiovascular death or heart failure hospitalization and improve symptoms in chronic heart failure with reduced ejection fraction compared to enalapril. After 7 years since the publication of the results of PARADIGM-HF, further insight has been gained with potential new indications. Two prospective randomized multicenter studies (PIONEER-HF and TRANSITION) in patients hospitalized for acute heart failure (AHF) have shown an improved clinical outcome and biomarker profile as compared to enalapril, and good tolerability, safety and feasibility of initiating in-hospital administration of S/V. Furthermore, some studies have highlighted the favorable effects of S/V in attenuating adverse myocardial remodeling, supporting an early benefit after treatment. Observational data from non-randomized studies in AHF report that in-hospital and pre-discharge prescription of evidence-based drugs associated with better survival still remains suboptimal. Additionally, the COVID-19 pandemic has also negatively impacted on outpatient activities. Therefore, hospitalization, a real crossroads in the history of heart failure, must become a management and therapeutic opportunity for our patients. The objective of this ANMCO position paper is to encourage and facilitate early S/V administration in stabilized patients during hospitalization after an AHF episode, with the aim of improving care efficiency and clinical outcome.


Subject(s)
COVID-19 , Heart Failure , Aminobutyrates , Angiotensin Receptor Antagonists , Biphenyl Compounds , Drug Combinations , Heart Failure/drug therapy , Humans , Pandemics , Prospective Studies , SARS-CoV-2 , Stroke Volume , Tetrazoles , Treatment Outcome , Valsartan
7.
Molecules ; 26(18)2021 Sep 16.
Article in English | MEDLINE | ID: covidwho-1410350

ABSTRACT

Drug repositioning is a successful approach in medicinal research. It significantly simplifies the long-term process of clinical drug evaluation, since the drug being tested has already been approved for another condition. One example of drug repositioning involves cardiac glycosides (CGs), which have, for a long time, been used in heart medicine. Moreover, it has been known for decades that CGs also have great potential in cancer treatment and, thus, many clinical trials now evaluate their anticancer potential. Interestingly, heart failure and cancer are not the only conditions for which CGs could be effectively used. In recent years, the antiviral potential of CGs has been extensively studied, and with the ongoing SARS-CoV-2 pandemic, this interest in CGs has increased even more. Therefore, here, we present CGs as potent and promising antiviral compounds, which can interfere with almost any steps of the viral life cycle, except for the viral attachment to a host cell. In this review article, we summarize the reported data on this hot topic and discuss the mechanisms of antiviral action of CGs, with reference to the particular viral life cycle phase they interfere with.


Subject(s)
Antiviral Agents/therapeutic use , Cardiac Glycosides/therapeutic use , Antiviral Agents/pharmacology , COVID-19 , Cardiac Glycosides/metabolism , Digitoxin , Digoxin , Drug Repositioning/methods , Heart Failure/drug therapy , Heart Failure/virology , Humans , Neoplasms/drug therapy , Ouabain , Pandemics , SARS-CoV-2 , Sodium-Potassium-Exchanging ATPase , Virus Internalization/drug effects , Virus Replication/drug effects
8.
Clin Cardiol ; 44(9): 1263-1271, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1400778

ABSTRACT

BACKGROUND: This study aimed to investigate the effect of melatonin supplementation on endothelial function in patients with heart failure with reduced ejection fraction (HFrEF). METHODS: This is an analysis of the MeHR trial, a randomized double-blinded placebo-controlled clinical trial with two parallel arms of 1:1. Oral 10 mg melatonin tablets or placebo was administered for 24 weeks. Deference in the percentage of flow-mediated dilatation (FMD) after the intervention was the primary outcome. RESULTS: Ninety-two patients were included in the study (age: 62.7±10.3 years, 87.0% male, ejection fraction (EF): 28.6±8.1). After adjustment for baseline FMD and age, a statistically significant difference in post-treatment FMD in favor of the melatonin group was seen (estimated marginal means [95%CI], melatonin: 7.84% [6.69-8.98], placebo: 5.98% [4.84-7.12], p = .027). There was no significant difference in the mean of post-treatment systolic/diastolic blood pressure, serum total antioxidant capacity, and serum malondialdehyde (MDA) between groups. Subgroup analysis showed significant improvement in FMD and MDA in the melatonin group in nondiabetic patients, while no difference was seen between study groups in diabetic patients. CONCLUSIONS: Melatonin supplementation in HFrEF might improve endothelial function; however, this beneficial effect might not be seen in diabetic patients.


Subject(s)
Heart Failure , Melatonin , Dietary Supplements , Double-Blind Method , Female , Heart Failure/diagnosis , Heart Failure/drug therapy , Humans , Male , Middle Aged , Stroke Volume
9.
Naunyn Schmiedebergs Arch Pharmacol ; 394(10): 2013-2021, 2021 10.
Article in English | MEDLINE | ID: covidwho-1391844

ABSTRACT

Coronavirus disease 2019 (Covid-19) is a novel worldwide pandemic caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During Covid-19 pandemic, socioeconomic deprivation, social isolation, and reduced physical activities may induce heart failure (HF), destabilization, and cause more complications. HF appears as a potential hazard due to SARS-CoV-2 infection, chiefly in elderly patients with underlying comorbidities. In reality, the expression of cardiac ACE2 is implicated as a target point for SARS-CoV-2-induced acute cardiac injury. In SARS-CoV-2 infection, like other febrile illnesses, high blood viscosity, exaggerated pro-inflammatory response, multisystem inflammatory syndrome, and endothelial dysfunction-induced coagulation disorders may increase risk of HF development. Hypoxic respiratory failure, as in pulmonary edema, severe acute lung injury (ALI), and acute respiratory distress syndrome (ARDS) may affect heart hemodynamic stability due to the development of pulmonary hypertension. Indeed, Covid-19-induced HF could be through the development of cytokine storm, characterized by high proliferation pro-inflammatory cytokines. In cytokine storm-mediated cardiac dysfunction, there is a positive correlation between levels of pro-inflammatory cytokine and myocarditis-induced acute cardiac injury biomarkers. Therefore, Covid-19-induced HF is more complex and related from a molecular background in releasing pro-inflammatory cytokines to the neuro-metabolic derangements that together affect cardiomyocyte functions and development of HF. Anti-heart failure medications, mainly digoxin and carvedilol, have potent anti-SARS-CoV-2 and anti-inflammatory properties that may mitigate Covid-19 severity and development of HF. In conclusion, SARS-CoV-2 infection may lead to the development of HF due to direct acute cardiac injury or through the development of cytokine storms, which depress cardiomyocyte function and cardiac contractility. Anti-heart failure drugs, mainly digoxin and carvedilol, may attenuate severity of HF by reducing the infectivity of SARS-CoV-2 and prevent the development of cytokine storms in severely affected Covid-19 patients.


Subject(s)
COVID-19/complications , Heart Failure/etiology , SARS-CoV-2 , Adrenergic alpha-1 Receptor Antagonists/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , COVID-19/drug therapy , Cardiotonic Agents/therapeutic use , Carvedilol/therapeutic use , Cytokine Release Syndrome/prevention & control , Digoxin/therapeutic use , Heart Failure/drug therapy , Humans
11.
ESC Heart Fail ; 8(5): 3906-3916, 2021 10.
Article in English | MEDLINE | ID: covidwho-1353443

ABSTRACT

AIMS: This study aims to establish the feasibility, safety, and efficacy of outpatient intravenous (IV) diuretic treatment for the management of decompensated heart failure (HF) for patients enrolled in the HeartFailure@Home service. METHODS AND RESULTS: We retrospectively analysed the clinical episodes of decompensated HF for patients enrolled in the HeartFailure@Home service, managed by ambulatory IV diuretic treatment either at home or on a day-case unit. A control group consisting of HF patients admitted to hospital for IV diuretics (standard-of-care) was also evaluated. In total, 203 episodes of decompensated HF (n = 154 patients) were evaluated. One hundred and fourteen episodes in 79 patients were managed exclusively by the ambulatory IV diuretic service-78 (68.4%) on a day-case unit and 36 (31.6%) domiciliary; 84.1% of patient episodes under the HF@Home service were successfully managed entirely in an out-patient setting without hospitalization. Eleven patients required admission in order to administer higher doses of IV diuretics than could be provided in the ambulatory setting. During follow-up, there were 20 (17.5%) 30 day re-admissions with HF or death in the ambulatory IV group and 29 (32.6%) in the standard-of-care arm (P = 0.02). There was no difference in 30 day HF readmissions between the two groups (14.9% ambulatory vs. 13.5% inpatients, P = 0.8), but 30 day mortality was significantly lower in the ambulatory group (3.5% vs. 21.3% inpatients, P < 0.001). CONCLUSIONS: Outpatient ambulatory management of decompensated HF with IV diuretics given either on a day case unit or in a domiciliary setting is feasible, safe, and effective in selected patients with decompensated HF. This should be explored further as a model in delivering HF services in the outpatient setting during COVID-19.


Subject(s)
COVID-19 , Heart Failure , Furosemide , Heart Failure/drug therapy , Humans , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
12.
J Card Fail ; 27(11): 1280-1284, 2021 11.
Article in English | MEDLINE | ID: covidwho-1340570

ABSTRACT

BACKGROUND: Maintaining a steady medication supply during a public health crisis is a major health priority. We leveraged a large U.S. pharmacy-claims database to understand the use of evidence-based therapies in heart failure (HF) care during the coronavirus disease-2019 (COVID-19) pandemic. METHODS: We analyzed 27,027,650 individual claims from an all-payer pharmacy-claims database across 56,155 chain, independent and mail-order pharmacies in 14,164 zip codes in 50 states. Prescriptions dispensed (in 2-week intervals) of evidence-based HF therapies in 2020 were indexed to comparable timeframes in 2019. We normalized these year-to-year changes in HF medical therapies relative to those observed with a stable basket of drugs. RESULTS: Fills of losartan, lisinopril, carvedilol, and metoprolol all peaked in the weeks of March 2020 and demonstrated trajectories thereafter that were relatively consistent with the reference set of drugs. Fills of spironolactone (+4%) and eplerenone (+18%) showed modest trends toward increased relative use during 2020. Fills of empagliflozin (+75%), dapagliflozin (+65%) and sacubitril/valsartan (+61%) showed striking longitudinal increases throughout 2020 that deviated substantially from year-to-year trends of the overall basket of drugs. For all 3 therapies, fills of all quantity sizes increased relatively throughout 2020. For both generic and brand-name therapies, prescription fill patterns from mail-order pharmacies increased substantially over expected trends beginning in March 2020 CONCLUSION: Prescription fills of most established generic therapies used in HF care were maintained, whereas those of sacubitril/valsartan and the sodium-glucose cotransporter-2 inhibitors steeply increased during the COVID-19 pandemic. These nationwide pharmacy claims data provide reassurance about therapeutic access, during a public health crisis, to evidence-based medications used in HF care.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Heart Failure , Sodium-Glucose Transporter 2 Inhibitors , Heart Failure/drug therapy , Heart Failure/epidemiology , Humans , Pandemics , Prescriptions , SARS-CoV-2 , United States/epidemiology
14.
Rev Cardiovasc Med ; 22(2): 271-276, 2021 06 30.
Article in English | MEDLINE | ID: covidwho-1310347

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge. Meeting this has resulted in changes to working practices and the impact on the management of patients with heart failure with reduced ejection fraction (HFrEF) is largely unknown. We performed a retrospective, observational study contrasting patients diagnosed with HFrEF attending specialist heart failure clinics at a UK hospital, whose subsequent period of optimisation of medical therapy was during the COVID-19 pandemic, with patients diagnosed the previous year. The primary outcome was the change in equivalent dosing of ramipril and bisoprolol at 6-months. Secondary outcomes were the number and type of follow-up consultations, hospitalisation for heart failure and all-cause mortality. In total, 60 patients were diagnosed with HFrEF between 1 December 2019 and 30 April 2020, compared to 54 during the same period of the previous year. The absolute number of consultations was higher (390 vs 270; p = 0.69), driven by increases in telephone consultations, with a reduction in appointments with hospital nurse specialists. After 6-months, we observed lower equivalent dosing of ramipril (3.1 ± 3.0 mg vs 4.4 ± 0.5 mg; p = 0.035) and similar dosing of bisoprolol (4.1 ± 0.5 mg vs 4.9 ± 0.5 mg; p = 0.27), which persisted for ramipril (mean difference 1.0 mg, 95% CI 0.018-2.09; p = 0.046) and bisoprolol (mean difference 0.52 mg, 95% CI -0.23-1.28; p = 0.17) after adjustment for baseline dosing. We observed no differences in the proportion of patients who died (5.0% vs 7.4%; p = 0.59) or were hospitalised with heart failure (13.3% vs 9.3%; p = 0.49). Our study suggests the transition to telephone appointments and re-deployment of heart failure nurse specialists was associated with less successful optimisation of medical therapy, especially renin-angiotensin inhibitors, compared with usual care.


Subject(s)
Adrenergic beta-1 Receptor Antagonists/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Bisoprolol/administration & dosage , COVID-19 , Heart Failure/drug therapy , Ramipril/administration & dosage , Adrenergic beta-1 Receptor Antagonists/adverse effects , Aged , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Bisoprolol/adverse effects , Chronic Disease , Female , Heart Failure/diagnosis , Heart Failure/mortality , Heart Failure/physiopathology , Humans , Male , Ramipril/adverse effects , Retrospective Studies , Time Factors , Treatment Outcome
15.
ESC Heart Fail ; 8(2): 799-801, 2021 04.
Article in English | MEDLINE | ID: covidwho-1291604

ABSTRACT

The past decade has witnessed the publication of many trials in the field of heart failure, several of which have demonstrated that new drugs could potentially reduce major cardiac events and sometimes even decrease total mortality. Most medical practitioners have experimented with withdrawal of the drug under investigation, having no knowledge of what the patient had received, consistent with a blinded design. In some such cases, the patient's clinical status may be rapidly compromised after withdrawal, suggesting (i) that the patient had been receiving the active drug and (ii) that the drug under investigation might exert beneficial effects. The patients should receive early benefit from the drug, but they are left most often without this beneficial treatment not only until the trial results are complete but also until after the guidelines are updated and after the reimbursement (months to years after the results). Here, we propose that the study sponsor should plan from study conception that all participating patients (regardless of whether they are in the placebo or active drug group) will have access to the drug upon trial completion-once safety is verified and until the results are known. Nowadays, it is not conceivable to submit the results of a large trial for publication without approval from a suitable ethical committee. Similarly, the access to the effective drug should be considered as a requirement for clinical research, not only for ethics committee approval, and for the registration of the trial in an international database until publication.


Subject(s)
COVID-19 , Heart Failure , Pharmaceutical Preparations , Heart Failure/drug therapy , Humans , SARS-CoV-2 , Treatment Outcome
16.
Open Heart ; 8(1)2021 06.
Article in English | MEDLINE | ID: covidwho-1269804

ABSTRACT

BACKGROUND: Prior diagnosis of heart failure (HF) is associated with increased length of hospital stay (LOS) and mortality from COVID-19. Associations between substance use, venous thromboembolism (VTE) or peripheral arterial disease (PAD) and its effects on LOS or mortality in patients with HF hospitalised with COVID-19 remain unknown. OBJECTIVE: This study identified risk factors associated with poor in-hospital outcomes among patients with HF hospitalised with COVID-19. METHODS: Case-control study was conducted of patients with prior diagnosis of HF hospitalised with COVID-19 at an academic tertiary care centre from 1 January 2020 to 28 February 2021. Patients with HF hospitalised with COVID-19 with risk factors were compared with those without risk factors for clinical characteristics, LOS and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF hospitalised with COVID-19. RESULTS: Total of 211 patients with HF were hospitalised with COVID-19. Women had longer LOS than men (9 days vs 7 days; p<0.001). Compared with patients without PAD or ischaemic stroke, patients with PAD or ischaemic stroke had longer LOS (7 days vs 9 days; p=0.012 and 7 days vs 11 days, p<0.001, respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared with younger patients (adjusted OR: 1.04; 95% CI 1.00 to 1.07; p=0.036). Prior diagnosis of VTE increased mortality more than threefold in patients with HF hospitalised with COVID-19 (adjusted OR: 3.33; 95% CI 1.29 to 8.43; p=0.011). CONCLUSION: Vascular diseases increase LOS and mortality in patients with HF hospitalised with COVID-19.


Subject(s)
COVID-19/mortality , Comorbidity/trends , Heart Failure/mortality , Vascular Diseases/complications , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , COVID-19/complications , COVID-19/diagnosis , COVID-19/virology , Case-Control Studies , Female , Heart Failure/diagnosis , Heart Failure/drug therapy , Heart Failure/virology , Hospitalization/statistics & numerical data , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Ischemic Stroke/complications , Ischemic Stroke/epidemiology , Length of Stay/statistics & numerical data , Male , Middle Aged , Peripheral Arterial Disease/complications , Prognosis , Retrospective Studies , Risk Factors , SARS-CoV-2/genetics , Substance-Related Disorders/complications , Venous Thromboembolism/complications
18.
Am J Health Syst Pharm ; 78(13): 1195-1199, 2021 06 23.
Article in English | MEDLINE | ID: covidwho-1153110

ABSTRACT

PURPOSE: A case of uncontrolled hypertension nonresponsive to traditional pharmacologic management in a pediatric patient with a ventricular assist device awaiting a heart transplant is reported. SUMMARY: A 4-month-old male in heart failure was experiencing uncontrolled hypertension. Because of a lack of hemodynamic stability, he was unable to be listed as a heart transplant candidate. He received multiple antihypertensive agents (calcium channel blockers, ß-blockers, and direct-acting vasodilators) as both intermittent and continuous infusions over the course of several days without achieving normotension. The decision was then made to administer intravenous phentolamine as a continuous infusion to pursue a different mechanism than with traditional antihypertensive agents to achieve hemodynamic stability. Within 8 hours of initiation of the continuous phentolamine infusion, the patient became normotensive and was listed for a heart transplant. The continuous phentolamine infusion was administered over the next 4 days to maintain normotension, and on day 4 the patient underwent successful orthotopic heart transplantation. CONCLUSION: A 4-month-old male in heart failure with a ventricular assist device, experiencing uncontrolled hypertension nonresponsive to traditional pharmacologic management, was successfully treated with a continuous intravenous infusion of phentolamine.


Subject(s)
Heart Failure , Heart Transplantation , Heart-Assist Devices , Hypertension , Child , Heart Failure/drug therapy , Humans , Hypertension/drug therapy , Infant , Male , Phentolamine , Treatment Outcome
19.
Korean J Intern Med ; 36(Suppl 1): S114-S122, 2021 03.
Article in English | MEDLINE | ID: covidwho-1143662

ABSTRACT

BACKGROUND/AIMS: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, there have been concerns about the association between exposure to renin-angiotensin-aldosterone system (RAAS) inhibitors and the risk and severity of COVID-19. METHODS: We performed a case-control study that utilized up-to-date data on the South Korean population provided by the Korean National Health Insurance System. Of the 62,909 patients with hypertension or heart failure tested for COVID-19, there were 1,644 (2.6%) confirmed cases. After case-control matching, multivariable-adjusted conditional logistic regression analysis was performed. RESULTS: Comparison between patients exposed to RAAS inhibitors and those not exposed to RAAS inhibitors revealed that the adjusted odds ratio (OR) and 95% confidence interval (CI) for COVID-19 infection and death were 0.981 (95% CI, 0.849 to 1.135) and 0.875 (95% CI, 0.548 to 1.396), respectively. Subgroup analysis for the major confounders, age and region of diagnosis, resulted in OR of 0.912 (95% CI, 0.751 to 1.108) and 0.942 (95% CI, 0.791 to 1.121), respectively. CONCLUSION: The present study demonstrated no evidence of association between RAAS inhibitor exposure and risk and severity of COVID-19.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , COVID-19/epidemiology , Heart Failure/drug therapy , Hypertension/drug therapy , Renin-Angiotensin System/drug effects , Aged , Angiotensin Receptor Antagonists/adverse effects , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Antihypertensive Agents/adverse effects , COVID-19/diagnosis , Case-Control Studies , Databases, Factual , Female , Heart Failure/diagnosis , Heart Failure/epidemiology , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Male , Middle Aged , Republic of Korea/epidemiology , Risk Assessment , Risk Factors , Severity of Illness Index
20.
J Med Case Rep ; 15(1): 143, 2021 Mar 19.
Article in English | MEDLINE | ID: covidwho-1143254

ABSTRACT

BACKGROUND: There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis. CASE PRESENTATION: In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection. CONCLUSIONS: The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.


Subject(s)
COVID-19/diagnosis , Cardiomyopathies/diagnosis , Heart Failure/diagnosis , Puerperal Disorders/diagnosis , Pulmonary Edema/diagnosis , Adult , Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19/physiopathology , COVID-19/therapy , Cardiomyopathies/drug therapy , Cardiomyopathies/physiopathology , Cesarean Section , Cough/physiopathology , Diagnosis, Differential , Diuretics/therapeutic use , Dyspnea/physiopathology , Echocardiography , Electrocardiography , Female , Furosemide/therapeutic use , Heart Failure/drug therapy , Heart Failure/physiopathology , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Interferon-beta/therapeutic use , Lung/diagnostic imaging , Pre-Eclampsia , Pregnancy , Puerperal Disorders/drug therapy , Puerperal Disorders/physiopathology , Pulmonary Edema/drug therapy , Pulmonary Edema/physiopathology , SARS-CoV-2 , Stroke Volume , Tomography, X-Ray Computed
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