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Heart Failure and Its Complications: Advances in Clinical Diagnosis and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 September 2024) | Viewed by 10516

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Dr. Michael J. Bonios

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Guest Editor

Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
Interests: heart failure; complications; arrhythmias; pharmacological therapy; devices; mechanical circulatory support
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Special Issue Information

Dear Colleagues,

Heart failure is a complex syndrome that progresses through various stages, each presenting its own unique challenges. As the disease advances, the risk of complications such as pump failure, arrhythmias, thromboembolic events, and infections increases. Fortunately, advancements in the therapeutic armamentarium against heart failure have provided more effective medical therapies and novel diagnostic and treatment devices that cater to both early and advanced stages of the condition. However, it is important to acknowledge that both medical and device therapies are accompanied by side effects and complications that can significantly impact patient outcomes.

In light of these considerations, we invite you to contribute original articles to this Special Issue entitled, "Heart Failure and Its Complications: Advances in Clinical Diagnosis and Management". The research areas for exploration may include, but are not limited to:

Evaluation of medical therapy and its associated side effects;
Investigation of arrhythmias, infections, and thromboembolic events in heart failure patients;
Assessment of complications related to implantable cardioverter defibrillators and cardiac resynchronization device therapy;
Complications in patients with cardiogenic shock and temporary mechanical circulatory devices;
Durable mechanical circulatory support devices and their complications;
Study of heart failure and its correlation with cachexia, cognitive impairment, anxiety, and depression.

We look forward to receiving your contributions.

Dr. Michael J. Bonios
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

heart failure
complications
arrhythmias
pharmacological therapy
devices
mechanical circulatory support

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Published Papers (7 papers)

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Research

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12 pages, 999 KiB

Open AccessArticle

Smartphone App-Based Remote Monitoring Challenges in Patients with Cardiac Resynchronization Therapy Defibrillators—A Multicenter Study

by Dagmar Kowal, Marek Prech, Agnieszka Katarzyńska-Szymańska, Artur Baszko, Grzegorz Skonieczny, Elżbieta Wabich, Maciej Kempa, Błażej Rubiś and Przemysław Mitkowski

J. Clin. Med. 2024, 13(21), 6323; https://doi.org/10.3390/jcm13216323 - 23 Oct 2024

Viewed by 558

Abstract

Background/Objectives: Remote monitoring (RM) cardiac implantable electronic devices for adults delivers improved patient outcomes. However, previously used bedside transmitters are not optimal due to deficient patient adherence. The goal of this study was to evaluate the efficacy of RM regarding the connectivity of smartphone app-based solutions, adherence to scheduled automatic follow-ups, and prevalence of alert-based events. Methods: We evaluated the adult heart failure (HF) population with an implanted cardiac resynchronization therapy defibrillator (CRT-D) divided into two arms: with app-based RM (abRM) and without app-based RM (control). Results: A total of 81 patients (median age of 69.0) were included in our study. Sixty-five patients received a CRT-D with abRM functionality, and sixteen did not. Twelve patients had no smartphone, and two provided no consent, resulting in their transfer to the control group. Finally, the abRM arm consisted of 51 patients, while 30 patients were in the control group. The median period of follow-up lasted 12 months. Among abRM patients, 98.0% successfully transmitted their first scheduled follow-up, and 80.4% were continuously monitored. Alert-based events were mainly related to arrhythmic events and device functionality with significantly shorter median times to notification (1 day vs. 101 days; p < 0.0001) in the abRM group. Conclusions: Our study showed a high level of compliance with timely initial transmission and adherence to scheduled remote follow-ups. Patient enrollment eligibility was a major challenge due to the limited accessibility of smartphones in the population. App-based RM demonstrated an accurate notification of events and patient-initiated transmissions in emergencies, regardless of location. Full article

(This article belongs to the Special Issue Heart Failure and Its Complications: Advances in Clinical Diagnosis and Management)

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11 pages, 1007 KiB

Open AccessArticle

The Impact of the Withdrawal of SGLT2 Inhibitors on Clinical Outcomes in Patients with Heart Failure

by Masaki Nakagaito, Teruhiko Imamura, Ryuichi Ushijima, Makiko Nakamura and Koichiro Kinugawa

J. Clin. Med. 2024, 13(11), 3196; https://doi.org/10.3390/jcm13113196 - 29 May 2024

Cited by 1 | Viewed by 1197

Abstract

Background: The clinical impact of the withdrawal of sodium–glucose cotransporter 2 inhibitors (SGLT2i) on all-cause readmission in patients with heart failure remains unknown. Methods: We enrolled a total of 212 consecutive patients who were hospitalized for heart failure and received SGLT2i during their index hospitalization between February 2016 and July 2022. Of these patients, 51 terminated SGLT2i during or after their index hospitalization. We evaluated the prognostic impact of the withdrawal of SGLT2i on the primary outcome, which was defined as the all-cause readmission rate/times. Results: Over a median of 23.2 months, all-cause readmission occurred in 38 out of 51 patients (74.5%) withdrawn from SGLT2i and 93 out of 161 patients (57.8%) with continuation of SGLT2i (p = 0.099). The incidence of all-cause readmissions per year was 0.97 [0–1.50] in patients withdrawn from SGLT2i and 0.50 [0–1.03] in patients with continuation of SGLT2i (p = 0.030). There was no significant difference in total medical costs (62,906 [502–187,246] versus 29,236 [7920–180,305] JPY per month, p = 0.866) between both patient groups. Conclusions: Termination of SGLT2i may be associated with incremental all-cause readmission and no benefit in reducing total medical costs. Full article

(This article belongs to the Special Issue Heart Failure and Its Complications: Advances in Clinical Diagnosis and Management)

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13 pages, 258 KiB

Open AccessArticle

The Role of Prognostic Scores in Assessing the Prognosis of Patients Admitted in the Cardiac Intensive Care Unit: Emphasis on Heart Failure Patients

by Aidonis Rammos, Aris Bechlioulis, Stefania Chatzipanteliadou, Spyros Athanasios Sioros, Christos D. Floros, Ilektra Stamou, Lampros Lakkas, Petros Kalogeras, Vasileios Bouratzis, Christos S. Katsouras, Lampros K. Michalis and Katerina K. Naka

J. Clin. Med. 2024, 13(10), 2982; https://doi.org/10.3390/jcm13102982 - 19 May 2024

Cited by 1 | Viewed by 962

Abstract

Background/Objectives: Patient care in Cardiac Intensive Care Units (CICU) has evolved but data on patient characteristics and outcomes are sparse. This retrospective observational study aimed to define clinical characteristics and risk factors of CICU patients, their in-hospital and 30-day mortality, and compare it with established risk scores. Methods: Consecutive patients (n = 294, mean age 70 years, 74% males) hospitalized within 15 months were studied; APACHE II, EHMRG, GWTG-HF, and GRACE II were calculated on admission. Results: Most patients were admitted for ACS (48.3%) and acute decompensated heart failure (ADHF) (31.3%). Median duration of hospitalization was 2 days (IQR = 1, 4). In-hospital infection occurred in 20%, 18% needed mechanical ventilation, 10% renal replacement therapy and 4% percutaneous ventricular assist devices (33%, 29%, 20% and 4%, respectively, for ADHF). In-hospital and 30-day mortality was 18% and 11% for all patients (29% and 23%, respectively, for ADHF). Established scores (especially APACHE II) had a good diagnostic accuracy (area under the curve-AUC). In univariate and multivariate analyses in-hospital intubation and infection, history of coronary artery disease, hypotension, uremia and hypoxemia on admission were the most important risk factors. Based on these, a proposed new score showed a diagnostic accuracy of 0.954 (AUC) for in-hospital mortality, outperforming previous scores. Conclusions: Patients are admitted mainly with ACS or ADHF, the latter with worse prognosis. Several patients need advanced support; intubation and infections adversely affect prognosis. Established scores predict mortality satisfactorily, but larger studies are needed to develop CICU-directed scores to identify risk factors, improve prediction, guide treatment and staff training. Full article

(This article belongs to the Special Issue Heart Failure and Its Complications: Advances in Clinical Diagnosis and Management)

11 pages, 968 KiB

Open AccessArticle

Prognostic Impact of the UMIPIC Program in the Follow Up in Patients with Heart Failure and Cardiorenal Syndrome

by Manuel Méndez-Bailón, Noel Lorenzo-Villalba, Álvaro González-Franco, Luis Manzano, Jesús Casado-Cerrada, José M. Cerqueiro, José Pérez-Silvestre, José Carlos Arévalo-Lorido, Alicia Conde-Martel, Melitón Francisco Dávila-Ramos, Margarita Carrera-Izquierdo, Emmanuel Andrès and Manuel Montero-Pérez-Barquero

J. Clin. Med. 2023, 12(23), 7261; https://doi.org/10.3390/jcm12237261 - 23 Nov 2023

Cited by 3 | Viewed by 993

Abstract

Background: Individuals suffering from heart failure (HF) and cardiorenal syndrome (CRS) represent a special group of patients considering their age, multiple health issues, and treatment challenges. These factors make them more susceptible to frequent hospital stays and a higher mortality rate. UMIPIC is a multidisciplinary care model program for patients with heart failure follow up provided by internists and nurses who are experts in this entity. Our study delved into the effectiveness of this specialized care program (UMIPIC) in mitigating these risks for HF and CRS patients. Methods: We analyzed the medical records of 3255 patients diagnosed with HF and CRS types 2 and 4, sourced from the RICA registry. These patients were divided into two distinct groups: those enrolled in the UMIPIC program (1205 patients) and those under standard care (2050 patients). Using propensity score matching, we ensured that both groups were comparable. The study focused on tracking hospital admissions and mortality rates for one year after an HF-related hospital stay. Results: Patients in the UMIPIC group experienced fewer hospital readmissions due to HF compared to their counterparts (20% vs. 32%; Hazard Ratio [HR] = 0.48; 95% Confidence Interval [95% CI]: 0.40–0.57; p < 0.001). They also showed a lower mortality rate (24% vs. 36%; HR = 0.64; 95% CI: 0.54–0.75; p < 0.001). Furthermore, the UMIPIC group had fewer total hospital admissions (36% vs. 47%; HR = 0.58; 95% CI: 0.51–0.66; p < 0.001). Conclusions: The UMIPIC program, centered on holistic and ongoing care, effectively reduces both hospital admissions and mortality rates for HF and CRS patients after a one-year follow-up period. Full article

(This article belongs to the Special Issue Heart Failure and Its Complications: Advances in Clinical Diagnosis and Management)

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Review

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23 pages, 363 KiB

Open AccessReview

Renal Denervation in Heart Failure Treatment: Data for a Self-Fulfilling Prophecy

by Kyriakos Dimitriadis, Panagiotis Iliakis, Nikolaos Pyrpyris, Fotis Tatakis, Christos Fragkoulis, Vasileios Mantziaris, Aristides Plaitis, Eirini Beneki, Panagiotis Tsioufis, Dagmara Hering, Anastasios Kollias, Dimitrios Konstantinidis and Konstantinos Tsioufis

J. Clin. Med. 2024, 13(22), 6656; https://doi.org/10.3390/jcm13226656 - 6 Nov 2024

Viewed by 447

Abstract

Renal denervation (RDN), a transcatheter renal sympathetic nerve ablation procedure, is a relatively novel established procedure for the treatment of hypertension, with it being recognized as a third option for hypertension management in the most recent European guidelines, together with pharmacotherapy, for achieving blood pressure targets. Given the relationship between both hypertension and sympathetic overdrive and the development of heart failure (HF), even studies at the dawn of research on RDN explored it as a treatment to overcome diuretic resistance in those patients. As it is now recognized that RDN does not only have organ-specific but also systemic effects, several investigators have aimed to delineate whether renal sympathetic denervation could alter the prognosis, symptoms, and adverse events of HF patients. Data are available in both HF patients with reduced and preserved ejection fraction. As the significance of neuromodulation is gaining grounds in the HF therapeutic arsenal, in this review, we aim to provide a rationale for using RDN in HF and an up-to-date overview of available data in both HF phenotypes, as well as discuss the future of neuromodulatory therapy in HF management. Full article

(This article belongs to the Special Issue Heart Failure and Its Complications: Advances in Clinical Diagnosis and Management)

12 pages, 1481 KiB

Open AccessEditor’s ChoiceReview

Unlocking the Potential of Acetazolamide: A Literature Review of an Adjunctive Approach in Heart Failure Management

by Michael Sabina, Zein Barakat, Adrian Feliciano, Andrew Lamb and M Mrhaf Alsamman

J. Clin. Med. 2024, 13(1), 288; https://doi.org/10.3390/jcm13010288 - 4 Jan 2024

Cited by 2 | Viewed by 3188

Abstract

Background: Heart failure (HF) patients often experience persistent fluid overload despite standard diuretic therapy. The adjunctive use of acetazolamide, a carbonic anhydrase inhibitor, in combination with loop diuretics has shown promise in improving decongestion and diuretic efficacy. This literature review aims to analyze six studies evaluating the effectiveness of acetazolamide as an additive treatment for acute decompensated heart failure (ADHF) and its impact on various outcomes. Methods: We searched the PubMed database using the terms “acetazolamide heart failure”. We refined our search with specific filters (as shown our PRISMA flow diagram) and exclusion criteria, narrowing down our results to five studies. We included an extra study via expert recommendation, ultimately including six studies for comprehensive analysis. Results: The review highlights the positive effects of acetazolamide on decongestion, natriuresis, and diuresis in HF patients. However, it also showcases the limitations of these trials. Discussion: While the reviewed studies demonstrate the potential benefits of acetazolamide in enhancing decongestion and diuretic efficiency, there are limitations to consider, including small sample sizes, lack of blinding, and limited external validity. Further research is needed to confirm these findings, compare acetazolamide with other diuretic combinations, and explore its effects in a broader population of heart failure patients, including those in the United States. The use of acetazolamide in HF management warrants continued investigation to optimize its role in improving decongestion and patient outcomes. Full article

(This article belongs to the Special Issue Heart Failure and Its Complications: Advances in Clinical Diagnosis and Management)

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Other

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14 pages, 5016 KiB

Open AccessSystematic Review

The Efficacy and Safety of Sacubitril/Valsartan Compared to Valsartan in Patients with Heart Failure and Mildly Reduced and Preserved Ejection Fractions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Sharath Kommu and Richard L. Berg

J. Clin. Med. 2024, 13(6), 1572; https://doi.org/10.3390/jcm13061572 - 9 Mar 2024

Cited by 1 | Viewed by 2486

Abstract

Background: Sacubitril/valsartan improves heart failure (HF) outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, randomized controlled trials (RCTs) in patients with heart failure and mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) have shown inconsistent results. We conducted this meta-analysis to comprehensively evaluate the efficacy and safety of sacubitril/valsartan compared to valsartan within this specific patient population. Methods: We searched the MEDLINE database and ClinicalTrials.gov and identified four RCTs that could be included in our analysis, with 3375 patients in the sacubitril/valsartan group and 3362 in the valsartan group. Results: Our study shows that, in patients with HFmrEF and HFpEF, sacubitril/valsartan was superior to valsartan in some of the key HF outcomes, such as the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ CSS), with a small but significant mean difference of 1.13 (95% confidence interval or CI of 0.15 to 2.11, p-value 0.024), an improvement in the New York Heart Association (NYHA) class (odds ratio or OR of 1.32, 95% CI 1.11 to 1.58, p-value 0.002), and the composite outcome of hospitalizations for HF and cardiovascular death, with a relative risk (RR) of 0.86 (95% CI 0.75 to 0.99, p-value 0.04). However, there was no additional benefit with sacubitril/valsartan compared to valsartan for the outcomes of cardiovascular death and all-cause mortality. In terms of side effects, sacubitril/valsartan was associated with a higher risk of hypotension when compared to valsartan (OR 1.67, 95% CI 1.27 to 2.19, p-value < 0.0001), but did not show an increased risk of hyperkalemia or worsening renal function. Conclusions: In individuals with HFmrEF or HFpEF, sacubitril/valsartan can result in improvements in the HF outcomes of the KCCQ CSS, the NYHA class, and the composite outcome of hospitalization for HF and cardiovascular death when compared to valsartan. While there was a higher risk of hypotension with sacubitril/valsartan compared to valsartan, there was no corresponding increase in the risk of hyperkalemia or worsening renal function. Full article

(This article belongs to the Special Issue Heart Failure and Its Complications: Advances in Clinical Diagnosis and Management)

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