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Aims: Despite lacking supporting randomized trials, cardiac glycosides (CGs) are widely used in heart failure and/or atrial fibrillation. Moreover, several pro- and retrospective studies and registry-data have recently raised serious concerns in terms of efficacy and safety of CGs in this field. We have therefore examined the association between CGs and clinical outcome of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization (CRT-ICD) patients of the large German DEVICE registry., Methods and Results: Between 2007 and 2014, 3782 ICD and 1529 CRT-ICD patients were enrolled in the German DEVICE registry. Those two groups were analyzed independently according to medication with or without CGs. After adjustment for patient characteristics, CGs were not significantly associated with increased one-year mortality (HR 1.27, 95%-CI 0.91-1.76, p = 0.162), major adverse cardiac and cerebrovascular events (OR 1.36, 95%-CI 0.98-1.89, p = 0.063), ICD-shocks (OR 1.29, 95%-CI 0.95-1.74, p = 0.104) or the need for rehospitalization in ICD patients at one-year-follow-up. Similar findings were obtained in CRT-ICD patients. Regarding possible determinants for glycoside treatment, atrial fibrillation at enrollment was found to be most strongly associated with the prescription of glycosides in ICD (adjusted OR 3.25, 95%-CI 2.63-4.02) and CRT-ICD patients (adjusted OR 3.17, 95%-CI 2.39-4.19)., Conclusion: Overall harmful effects of CGs in ICD- and CRT-ICD patients could not be confirmed in DEVICE. Further large and randomized-controlled trials that investigate dose-dependent effects of CGs in addition to contemporary therapy of heart failure and atrial fibrillation are needed., (Copyright © 2021. Published by Elsevier B.V.)

Exercise training has become one of the most fundamental components of cardiac rehabilitation. This systematic review with meta-analyses has the objective to determine the effectiveness of exercise on selected cardiac rehabilitation outcomes, i.e. peak oxygen consumption (VO 2 peak), hospitalization and quality of life (QOL) of patients with heart failure. PubMed, EMBASE, and Cochrane Library were searched up to May 2019 to identify randomized controlled trials comparing exercise training to usual care. Overall, 131 trials were included with a total of 9,761 patients, the majority of whom were males (74%), predominantly with reduced ejection fraction and NYHA class ranging from II to III. There was a significant improvement in VO 2 peak in the exercise group compared to non-exercise control group (mean difference: 2.98 mL/kg/ min, 95% CI: 2.52-3.43, p  < 0.001; 84 RCTs, n = 3,690 patients). Exercise training was also beneficial for the patients' QOL. The QOL meta-analysis included 5,786 patients and showed a clinically significant improvement of QOL following exercise (-0.82, 95% CI: -1.02 to -0.62; p  = 0.00001; I 2  = 91%). Hospitalization incidence of heart failure patients was also lower in the exercise compared to control group (fixed-effect Odds Ratio: 0.56, 95% CI: 0.42-0.75, p  < 0.0001; 26 trials, 4,664 participants). Exercise-based rehabilitation improves V0 2 peak and QOL and reduces the incidence of hospitalization of heart failure patients.

Purpose: Cardiologists are known to consider patients' race when treating heart failure, but their views on the benefits and harms of this practice are largely undocumented. We set out to explore cardiologists' perspectives on the benefits and harms of race-based drug labels and guidelines. Specifically, we focused on isosorbide dinitrate and hydralazine hydrochloride (sold in a patented form as BiDil), a combination of drugs recommended for the treatment of black patients receiving optimal medical therapy for symptomatic heart failure and reduced ejection fraction. Methods: We conducted 81 semistructured interviews at an American College of Cardiology Annual meeting to assess cardiologists' and cardiology fellows' attitudes toward the use of race in drug prescribing. Investigators reviewed and coded the interviews using inductive qualitative analysis techniques. Results: Many participants believed that race-based drug labels might help doctors prescribe effective medications to patients sooner. More than half of the participants expressed concerns, however, that considering race within the context of treating heart failure could potentially harm patients as well. Harms identified included the likelihood that patients who could benefit from a drug may not receive it because of their race; insufficient understanding about gene-drug-environment interactions; and simplistic applications of race in the clinic. Conclusions: Few participants expressed approval of using race in drug prescribing without recognizing the potential harms, yet most participants stated that they continue to consider race when prescribing isosorbide dinitrate and hydralazine hydrochloride. Within the context of treating heart failure, more open discussions about the benefits and harms of race-based drug labels and prescribing are needed to address cardiologists' concerns., Competing Interests: No competing financial interests exist.

Aims: Anthracycline-induced cardiotoxicity (ACT) occurs in 57% of treated patients and remains an important limitation of anthracycline-based chemotherapy. In various genetic association studies, potential genetic risk markers for ACT have been identified. Therefore, we developed evidence-based clinical practice recommendations for pharmacogenomic testing to further individualize therapy based on ACT risk., Methods: We followed a standard guideline development process, including a systematic literature search, evidence synthesis and critical appraisal, and the development of clinical practice recommendations with an international expert group., Results: RARG rs2229774, SLC28A3 rs7853758 and UGT1A6 rs17863783 variants currently have the strongest and the most consistent evidence for association with ACT. Genetic variants in ABCC1, ABCC2, ABCC5, ABCB1, ABCB4, CBR3, RAC2, NCF4, CYBA, GSTP1, CAT, SULT2B1, POR, HAS3, SLC22A7, SCL22A17, HFE and NOS3 have also been associated with ACT, but require additional validation. We recommend pharmacogenomic testing for the RARG rs2229774 (S427L), SLC28A3 rs7853758 (L461L) and UGT1A6*4 rs17863783 (V209V) variants in childhood cancer patients with an indication for doxorubicin or daunorubicin therapy (Level B - moderate). Based on an overall risk stratification, taking into account genetic and clinical risk factors, we recommend a number of management options including increased frequency of echocardiogram monitoring, follow-up, as well as therapeutic options within the current standard of clinical practice., Conclusions: Existing evidence demonstrates that genetic factors have the potential to improve the discrimination between individuals at higher and lower risk of ACT. Genetic testing may therefore support both patient care decisions and evidence development for an improved prevention of ACT., (© 2016 The British Pharmacological Society.)

Today's health care systems are faced with challenges to transform health care delivery and provide quality and valued services for the heart failure population. These challenges require collaboration and the development of strategic processes that will redefine best practices. Implementing a multidimensional nurse navigator transition program is one approach to facilitating cross-continuum of care. Such a program has been proven to significantly reduce 30-day all-cause hospital readmissions, enhanced self-management skills, and improved follow-up compliance. This transitional care model can be used to address the needs of all patients with chronic conditions., (Copyright © 2015 Elsevier Inc. All rights reserved.)