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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article continues a series of reports on recent research developments in the field of heart failure. Key presentations made at the American College of Cardiology meeting, held in New Orleans, Louisiana, USA in March 2004 are reported. These new data have been added to existing data in cumulative meta-analyses. The WATCH study randomised 1587 patients with heart failure and left ventricular systolic dysfunction to warfarin, aspirin or clopidogrel. The study showed no difference between the effects of these agents on mortality or myocardial infarction, but hospitalisations for heart failure were higher on aspirin (22.2%) compared to warfarin (16.1%). The SCD-HeFT study showed that ICD therapy reduced all-cause mortality at 5 years by 23% in patients with predominantly NYHA class II heart failure and left ventricular systolic dysfunction, but amiodarone was ineffective. The DINAMIT study showed that ICD therapy was not beneficial in patients with left ventricular dysfunction after a recent MI, even in those with risk factors for arrhythmic death. In CASINO, levosimendan improved survival compared with dobutamine or placebo in patients with decompensated heart failure. INSPIRE showed that SPECT imaging can be used to assess risk early after acute MI safely and accurately. Rimonabant was shown to be safe and effective in treating the combined cardiovascular risk factors of smoking and obesity. An overview of new developments in cardiac resynchronisation therapy (CRT) in heart failure is also reported.
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PMID:Clinical trials update and cumulative meta-analyses from the American College of Cardiology: WATCH, SCD-HeFT, DINAMIT, CASINO, INSPIRE, STRATUS-US, RIO-Lipids and cardiac resynchronisation therapy in heart failure. 1518 77

Ventricular resynchronisation by pacing, introduced at the end of the 1990s, has revolutionised the management of advanced chronic cardiac failure. Its value in the reduction of haemodynamic mortality has been demonstrated in the latest studies. However, despite these decisive advances, patients with cardiac failure continue to have a high incidence of sudden death which, classically, according to its stage of progression, represents 28 to 68% of deaths in this condition. The implantable automatic defibrillator (IAD) has been shown to be effective in preventing sudden death, mainly in patients with severe left ventricular dysfunction. Based on these data, and in a context of rapid technological progress, devices capable of both defibrillating and resylchronising the heart have been introduced. The problems experienced at the beginning of their utilisation, mainly related to "double-counting" of left and right ventricular electrical activation have been resolved and the method is now technically feasible. A complication rate >10%, mainly due to the implantation of the left heart catheter, continues to bear witness to the difficulties of this technique and to the severity of the condition of patients referred for the treatment. The COMPANION trial has shown a greater reduction in mortality of patients treated by resynchronisation associated with IAD compared with resynchronisation alone or medical therapy in > or = Stage III cardiac failure. The SCD-HeFT trial has recently demonstrated that the primary prevention of global mortality by the IAD is effective in cardiac failure irrespective of the underlying cardiac pathology, especially in functional Stage II. These results should lead to significant increase in the indications for implantation of devices capable of both resynchronisation and defibrillation. However, the obvious problems of cost associated with the difficulty of the technique mean that a systematic attitude cannot be recommended. A case-by-case discussion has its place but the causal cardiac disease, ischaemic or not, does not seem to be a determining factor.
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PMID:[Implantable defibrillator and ventricular resynchronisation]. 1560 15

This article provides information and a commentary on landmark trials presented at the American Heart Association meeting held in November 2004, relevant to the pathophysiology, prevention, and treatment of heart failure. An open trial of the ACORN Cardiac Support Device (CSD) showed encouraging preliminary results in patients with severe heart failure. The PEACE (Prevention of Events with Angiotensin-Converting Enzyme inhibition) study supports data from previous studies showing that ACE inhibitors reduce vascular events in patients at increased risk. The CREATE (clinical trial of metabolic modulation in acute MI treatment evaluation) study of patients with acute myocardial infarction (MI) showed no mortality benefit of a glucose/insulin/potassium regimen, but treatment with reviparin reduced the incidence of death, MI, or stroke. Azimilide was not associated with a significant reduction in shocks, but reduced the shocks or episodes of markedly symptomatic ventricular tachycardia terminated by pacing in the SHIELD (Shock Inhibition Evaluation with Azimilide) study. The addition of isosorbide dinitrate plus hydralazine to standard therapy improved survival in black heart failure patients in the A-HeFT (African-American Heart Failure Trial) study. In an investigation of hypertensive patients with diabetes, carvedilol had fewer adverse effects on diabetic control than metoprolol. A meta-analysis of high-dose vitamin E supplementation suggested an association with increased mortality. The ESCAPE (Evaluation Study of CHF and Pulmonary Artery Catheterisation Effectiveness) study showed no benefit of pulmonary artery catheterisation over clinical management in patients with severe heart failure. Routine prophylactic coronary revascularisation for stable coronary disease prior to major vascular surgery showed no benefit in the CARP (Coronary Artery Revascularization Prophylaxis) study. Analysis of data from SCD-HeFT supports the cost-effectiveness of ICDs in heart failure, although overall cost implications may be prohibitive.
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PMID:Clinical trials update from the American Heart Association meeting: ACORN-CSD, primary care trial of chronic disease management, PEACE, CREATE, SHIELD, A-HeFT, GEMINI, vitamin E meta-analysis, ESCAPE, CARP, and SCD-HeFT cost-effectiveness study. 1564 44

Cardiac resynchronization therapy is indicated in advanced heart failure refractory to optimal drug treatment patients with left ventricular systolic dysfunction and QRS >120 milliseconds. The choice of the device has to consider several parameters: Do we have to implant a CRT pacemaker or a intracardiac cardioverter defibrillator (ICD)? The prevalence of sudden cardiac death is high in heart failure patients. In patients with an ischemic cardiomyopathy, primary prevention of sudden cardiac death trials suggests to implant a biventricular ICD. In patients with a non ischemic cardiomyopathy, the question is more controversial althought the resullts of the SCD-HeFT and COMPANION trials yielded interesting results for iCD implantation. However, the final decision has to consider the patient's baseline characteristics such as age, presence of comorbidities and cost of the device. Today, devices with totally independent ports of the right and left ventricles have technical advantages and thus are more relevant. Cardiac resynchronization therapy is a heart failure treatment and the new devices provide new tools to assess heart failure parameters such as patient's activity, respiratory parameters or heart rate variability. Left ventricular pacing alone is currently under evaluation such as atrial fibrillation prevention algorithms, atrial fibrillation being frequent in herta failure patients with hemodynamic deleterious consequences.
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PMID:[Cardiac resynchronisation therapy: what kind of equipment to use?]. 1570 5

Regarding cardiac failure, the year 2004 was notable for the dissemination of indications for the use of medical devices in heart failure: indications for cardioversion with the long awaited publication of the COMPANION study, advancement of the concept of intra-ventricular asynchronism, and studies of defibrillators in non-ischaemic cardiac failure (COMPANION, DEFINITE, SCD-HeFT, TOVA). Furthermore, pragmatic clinical studies allowed refinement of the uses of BNP (diagnostic and prognostic), underlining the importance of renal function and its progression during hospitalisation, and the risks of using strong, modern therapy in populations without "ad hoc" surveillance which do not correspond with study populations (aldactone in Canada). Just as in coronary patients, it appears to be important to commence full medical treatment prior to hospital discharge, because treatment is rarely changed thereafter. The management of seriously ill patients is evolving with several therapeutic advances: the methods of selecting patients for heart transplants have changed, with the advancement of opportunities for circulatory assistance. Attention has also been turned to the significant group, still poorly understood, of patients with diastolic heart failure, for whom diagnostic methods have been defined, as well as their clinical characteristics. Lastly the medication studies: new drugs in acute cardiac failure (preliminary results for vasopressin antagonists), wider indications for betablockers in elderly subjects (SENIORS), and advances in cellular cardiomyoplasty (using haemopoietic stem cells especially this year). It has been a fruitful year, difficult to summarise in a few lines, or even several pages....
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PMID:[The best of cardiac failure in 2004]. 1571 60

The Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) have established that patients with a reduced ejection fraction gain an overall mortality benefit from prophylactic implantable cardioverter-defibrillator therapy. Only a small proportion of the patients in these studies, however, have received life-saving therapy from the defibrillator. Because defibrillator therapy is invasive and expensive, patients with a low ejection fraction would benefit from effective risk stratification so that defibrillator therapy was used only in those at significant risk. In this review, we analyze prospective clinical trials that have evaluated microvolt T-wave alternans (MTWA) testing as a predictor of ventricular tachyarrhythmic events in populations of patients similar to those studied in MADIT II or SCD-HeFT; that is, patients with a reduced ejection fraction who were not selected on the basis of a history of ventricular tachyarrhythmias. In these studies, the average annual rate of fatal and nonfatal ventricular tachyarrhythmic events among the patients who tested negative for MTWA was around 1%. This rate is so low that it is unlikely that such patients would benefit from implantable cardioverter-defibrillator therapy. The mortality, moreover, was lower among MTWA-negative patients who did not receive implantable defibrillators than that observed in the MADIT II and SCD-HeFT patients who received implantable cardioverter-defibrillators. In response, patients with a low ejection fraction who are being considered for implantable cardioverter-defibrillator therapy should undergo MTWA testing as part of their evaluation.
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PMID:Can microvolt T-wave alternans testing reduce unnecessary defibrillator implantation? 1618 50

Primary and secondary prevention of sudden cardiac death is not sufficiently assured by medication. The (automatic) implantable cardioverter/defibrillator ((A)ICD) is able to terminate life-threatening arrhythmias (ventricular fibrillation/flutter, ventricular tachycardia) reliably. The identification and care of risk patients is of crucial importance. Initially, only survived resuscitation for ventricular fibrillation or ventricular tachycardia was regarded as a confirmed indication. Several studies (CABG patch, MADIT, MADIT II, MUSTT, DINAMIT, CAT AMIOVIRT, DEFINITE, COMPANION, SCD-HeFT) have examined the prophylactic indication for ICD therapy in risk groups. Patients with chronic state after myocardial infarction with markedly impaired left ventricular function and/or spontaneous, non-sustained ventricular tachycardia have been documented to benefit. Patients with moderately severe or severe heart failure also profit from ICD implantation, where appropriate in combination with cardiac resynchronization therapy in conduction disorders. There is divergent data on dilated cardiomyopathy. ICD is not indicated in patients with acute infarctions or undergoing elective bypass surgery.
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PMID:AICD treatment in 2004--state of the art. 1710 77

The guidelines for the implantation of cardioverter defibrillators recommend the primary prevention of sudden cardiac death based on the results of MADIT II, Companion and SCD-HeFT. The main risk factors for ventricular arrhythmias are previous myocardial infarction, depressed left ventricular function, and chronic heart failure. The presented case reports demonstrate the indication for a defibrillator or biventricular defibrillator as a basis of clinical pathways.
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PMID:[Sudden cardiac death, ICD and resynchronization therapy]. 1718 Jun 48

Heart failure (HF) is a common and lethal syndrome. Those with moderate left ventricular dysfunction have a substantial risk of premature and sudden death, approximately 25% over 2.5 years. Fifty percent of these deaths are thought to be sudden due to dysrhythmias, which may be preventable. As a consequence, patients with HF represent the largest, single identifiable population of patients that can be targeted for primary prevention of sudden cardiac death. A trial known as SCD-HeFT (The Sudden Cardiac Death in Heart Failure Trial), sponsored by the National Heart Lung and Blood Institute of the National Institutes of Health, was designed to evaluate the value of the prophylactic amiodarone or implantable cardioverter defibrillator therapy in patients with HF. This article reviews 4 key clinical insights highlighted by the SCD-HeFT results: (1) ramifications of implantable cardioverter defibrillator use in patients with New York Heart Association (NYHA) class II HF; (2) the value or lack thereof of implantable cardioverter defibrillator therapy in patients with NYHA class III HF; (3) the danger of amiodarone drug therapy in patients with NYHA class III HF; and (4) the significant value of basic medical management, when well implemented, in prolonging life in this population. In addition, future directions in the evaluation and management of patients with moderate to severe HF are addressed.
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PMID:Key clinical insights from the sudden cardiac death in heart failure trial. 1729 36

This article is going to be somewhat different than the typical article you might read on the treatment of heart failure. My goal is to get you to think in a different way about the use of primary prevention implantable cardioverter defibrillators and beta-blockers in patients with left ventricular dysfunction. Specifically, using the results from 3 landmark clinical trials--MADIT II, SCD-HeFT, and COMET--I am going to discuss the economic, ethical, and legal principles that underpin the use of these 2 therapies in patients with heart failure.
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PMID:Implantable defibrillators and beta-blockers in patients with left ventricular dysfunction: economic, ethical, and legal considerations. 1821 79


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