A Case-based Implementation of Heart Failure Therapies, a Consensus Pathway by the Saudi Heart Failure Working Group.

The implementation of guideline-directed medical therapy (GDMT) in heart failure (HF) has many challenges in real-world clinical practice. The consensus document is written considering the variability of the clinical presentation of HF patients. HF medical therapies need frequent dose adjustment during hospital admission or when patients develop electrolyte imbalance, acute kidney injury, and other acute illnesses. The paper describes clinical scenarios and graphs that will aid the managing physicians in decision-making for HF therapy optimization.

Reliability and Validity of Kansas City Cardiomyopathy Questionnaire in Arabic Patients with Chronic Heart Failure.

Background: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is the most specific and widely used questionnaire for assessing health-related quality of life (HRQoL) in chronic heart failure (CHF). This study aimed to examine reliability and validity of the KCCQ in Arabic patients with CHF. Material and Methods: Patients with CHF filled out the Arabic versions of the Minnesota Living with Heart Failure (MLHF) and KCCQ questionnaire, and performed a six-minute walk test (6MWT) on their first visit. On the return, the patients filled out the KCCQ along with the global rating of change (GRC) scale. Internal consistency, test-retest reliability, and construct validity were examined. Results: A total of 101 Arabic patients with CHF, with a mean (SD) age of 55 (11) years old, completed the study. The Cronbach's alpha was 0.97, and the ICC2,1 = 0.95 (95%CI: 0.92 to 0.97, p < 0.001). The Arabic version of KCCQ was correlated with the MLHF (r = -0.57, p = 0.01) and with the 6MWT (r = 0.70, p < 0.001). Conclusions: The Arabic version of KCCQ is a reliable and valid measure of HRQoL, which could be utilized in routine clinical practice for Arabic-speaking patients with CHF.

2023 National Heart Center/Saudi Heart Association Focused Update of the 2019 Saudi Heart Association Guidelines for the Management of Heart Failure.

Background: The burden of cardiovascular diseases is undeniable in local populations, who have high mortality rates and a young age of disease onset. A systematic review of emerging evidence and update of the Saudi Heart Association (SHA) 2019 heart failure (HF) guidelines was therefore undertaken. Methodology: A panel of expert cardiologists reviewed recommendations of the 2019 guidelines following the Saudi Heart Association methodology for guideline recommendations. When needed, the panel provided updated and new recommendations endorsed by the national heart council that are appropriate for clinical practice and local resources in Saudi Arabia. Recommendations and conclusion: The focused update describes the appropriate use of clinical assessment as well as invasive and non-invasive modalities for the classification and diagnosis of HF. The prevention of HF was emphasized by expanding on both primary and secondary prevention approaches. Pharmacological treatment of HF was supplemented with recommendations on newer therapies, such as SGLT-2 inhibitors. Recommendations were also provided on the management of patients with cardiovascular and non-cardiovascular co-morbidities, with a focus on cardio-oncology and pregnancy. Updated clinical algorithms were included in support of HF management in both the acute and chronic settings. The implementation of this focused update on HF management in clinical practice is expected to lead to improved patient outcomes by providing evidence-based comprehensive guidance for practitioners in Saudi Arabia.

Prevalence and management of hyperkalemia in chronic kidney disease and heart failure patients in the Gulf Cooperation Council (GCC).

Hyperkalemia is a frequent complication in patients with chronic kidney disease (CKD) or heart failure (HF) and associated with neuromuscular manifestations, changes in the electrocardiogram, and increased risk of mortality. While data on the prevalence and management of hyperkalemia in the gulf region are scarce, risk factors such as preference for potassium-rich foods (e.g., dates and dried fruits/vegetables), periods of intense fasting (e.g., Ramadan), and diabetes (an ancestor of CKD and HF) are common. Therefore, a panel of nephrologists and cardiologists from countries of the Gulf Cooperation Council (GCC) convened to collate and review available data on the prevalence, regional drivers, and current practice in the management of hyperkalemia in the region. Eventually, this review provides consensus recommendations on a balanced utilization of dietary and pharmacological options including new potassium binders for achieving and sustainably maintaining desirable serum potassium levels in countries of the GCC region. Alignment with regional habits and practice was a key aspect to facilitate the uptake of the recommendations into physicians' practice and patients' lives.

Ischemic cardiomyopathy versus non-ischemic cardiomyopathy in diabetic patients: clinical characteristics, management, and long-term outcomes.

BACKGROUND: Diabetes mellitus causes ischemic heart disease (IHD) through macrovascular or microvascular involvement. Diabetes-associated hypertension, dyslipidemia, and obesity further increase coronary artery disease risk and can cause left ventricular hypertrophy leading to heart failure with preserved ejection fraction independent of IHD. This study was undertaken to evaluate the differences in demographics, clinical characteristics, Echocardiographic parameters, management, and outcomes between non-ischemic cardiomyopathy (NICM) and ischemic cardiomyopathy (ICM) patients in cohort of diabetes patients. METHODS: This retrospective study included diabetes patients with reduced ejection fraction (≤40) who were hospitalized with heart failure between January 2014 and February 2020. Patients were divided into two groups: group 1; ICM and group 2; NICM. Data obtained on above mentioned features including mortality and heart failure readmissions were compared between the two groups. RESULTS: A total of 612 diabetes patients admitted with acute heart failure were screened of which 442 were included. Group 1 (ICM) had 361 patients (81.7%) and group 2 (NICM) had 81 patients (18.3%). Patients in group 1 were older, predominantly males and with higher prevalence of hypertension, smoking and insulin dependent Diabetes while group 2 patients had higher BMI and higher prevalence of cardiac rhythm problems. No significant difference was detected in 5-year-mortality between the two groups (P=0.165). However, heart failure associated hospitalizations were higher in group 2 though it was not statistically significant (P=0.062). CONCLUSION: There was no difference in 5-years mortality between ICM and NICM in diabetes patients. However, NICM patients had higher prevalence of obesity and rhythm problems.