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Chronic kidney disease (CKD) is one of the main limiting factors in the application of guideline-directed medical therapy (GDMT) in heart failure (HF). Paradoxically, the patients – suffering from these two diseases with high mortality rates – are the least likely to receive optimal, prognosis-modifying drug therapy. Based on the results of the randomised controlled trials published in recent years, the angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapa- and empagliflozin became the fourth pillar of the foundational, first-line therapy of HF with reduced ejection fraction (HFrEF) in the international HF guidelines and consensus documents; which have been shown to have a beneficial effect not only on the prognosis of HF but also on the course of CKD. In addition, we already have strategic morbidity- and mortality-reducing agents as dapa- and empagliflozin in both HF with mildly reduced ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF), which can favourably modify both the prognosis of HF and CKD. The present manuscript summarizes the relationship between CKD and HF and their impact on GDMT optimisation, focusing on the implementation of SGLT2is in daily clinical practice.

Introduction: The 2023 European Society of Cardiology Guidelines for the management of Cardiomyopathies recommends a phenotype-based, multimodal, multidisciplinary, and multiparametric approach to the diagnosis of cardiomyopathies. Case report: We present the case of a 70-year-old man, who underwent a routine preoperative examination before dermatological surgery. Initially, on the electrocardiogram (ECG), non-sustained ventricular tachycardia (nsVT) was seen, whereas a dilated right ventricle was observed on transthoracic echocardiography (TTE). After further cardiological examination, ECG criteria for right ventricular arrhythmogenic cardiomyopathy (ARVC) were fulfilled (negative T waves in V1-V3, presence of an epsilon wave), in addition to significant bradycardia with sinus node dysfunction, and recurrent nsVTs were detected during monitoring. Cardiac magnetic resonance (CMR) scan was performed to assess right ventricular function and morphology, which confirmed a dilated right ventricle (end-diastolic volume normalized to body surface area 155 mL/m2), however, no wall motion abnormality was detected. Transesophageal echocardiography ruled out atrial septal defects as a potential cause for right ventricular dilatation. Overall, a diagnosis of ARVC was established based on the 3 major criteria fulfilled by the 2010 ARVC Task Force Criteria. Subsequently, in view of the sinus node dysfunction and ARVC diagnosis with high risk features, we opted for primary preventive DDD-ICD implantation, followed by long-term drug therapy with beta-blocker therapy. Conclusion: ARVC is a rare structural myocardial disease, which is often challenging to diagnose, and the search for clinical clues and "red flags" (functional and morphological abnormalities, electrophysiological features) is of strategic importance.

Abstract Aims The aim of the study was to assess the incidence and predictive factors of the development of heart failure with improved ejection fraction (HFimpEF) category during a 1 year follow‐up period in a heart failure with reduced ejection fraction (HFrEF) patient population managed in a heart failure outpatient clinic. Methods and results The study evaluated data from patients enrolled in the Hungarian Heart Failure Registry (HHFR). The incidence and predictive factors of the development of the HFimpEF category after 1 year follow‐up were assessed in the group of patients who had HFrEF at baseline. We evaluated the incidence and predictors of the development of HFimpEF after a 1 year follow‐up in relation to time since diagnosis of HFrEF in patients diagnosed within 3 months, between 3 months and 1 year, and beyond 1 year. The predictive factors of the development of HFimpEF were analysed using univariate and multivariate logistic regression analysis. Of the 833 HFrEF patients enrolled in the HHFR, the development of HFimpEF was observed in 162 patients (19.5%) during 1 year follow‐up. In the whole patient population, independent predictors of the development of HFimpEF were female gender [odds ratio (OR): 1.73; 95% confidence interval (CI): 1.01–2.96; P

Background/Objectives: In heart failure (HF) with reduced ejection fraction (HFrEF), the early diagnosis and proper treatment of comorbidities (CMs) are of fundamental relevance. Our aim was to assess the prevalence of CMs among real-world patients requiring hospitalisation for HFrEF and to investigate the effect of CMs on the implementation of guideline-directed medical therapy (GDMT) and on all-cause mortality (ACM). Methods: The data of a consecutive HFrEF patient cohort hospitalised for HF between 2021 and 2024 were analysed retrospectively. Sixteen CMs (6 CV and 10 non-CV) were considered. Patients were divided into three categories: 0–3 vs. 4–6 vs. ≥7 CMs. GDMT at discharge and ACM were compared among CM categories. The predictors of 1-year ACM were also evaluated. Results: From the 388 patients (male: 76%, age: 61 [50–70] years; NT-proBNP: 5286 [2570–9923] pg/mL; ≥2 cardiovascular–kidney–metabolic disease overlap: 46%), a large proportion received GDMT (RASi: 91%; βB: 85%; MRA: 95%; SGLT2i: 59%; triple therapy [TT: RASi+βB+MRA]: 82%; quadruple therapy [QT: TT + SGLT2i]: 54%) at discharge. Multimorbidity was accompanied with a (p < 0.05) lower application ratio of RASi (96% vs. 92% vs. 85%; 0–3 vs. 4–6 vs. ≥7 CMs) and βB therapy (94% vs. 85% vs. 78%), while MRA (99% vs. 94% vs. 94%) and SGTL2i use (61% vs. 59% vs. 57%) did not differ (p > 0.05). Patients with multimorbidity were less likely to be treated with TT (93% vs. 82% vs. 73%, p = 0.001), while no difference was detected in the implementation of QT (56% vs. 54% vs. 50%, p = 0.685). The 1-year ACM of patients with an increased burden of CMs was higher (9% vs. 13% vs. 25%, p = 0.003). The risk of 1-year ACM was favourably affected by the use of TT/QT and less severe left ventricular systolic dysfunction, while having ≥5 CMs had an unfavourable impact on prognosis. Conclusions: According to our real-world analysis, HFrEF patients with an increased burden of CMs can expect a less favourable outcome. However, modern GDMT can even be applied in this patient population, resulting in a significantly improved prognosis. Thus, clinicians should insist on the early, conscious implementation of a prognosis-modifying drug regime in multimorbid HF patients as well. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The 2023 Focused Update of the 2021 ESC Heart Failure (HF) Guidelines recommends the rapid up-titration (RT) of guideline-directed medical therapy (GDMT) for all patients hospitalised for HF to improve prognosis in light of the STRONG-HF trial. However, the real-world feasibility of RT and the optimal selection of suitable patients may cause difficulties as the STRONG-HF trial applied strict randomisation criteria. We aimed to assess the proportion of hospitalised HF patients suitable for RT after discharge. Methods: The proportion of patients eligible for RT based on the basic inclusion and exclusion criteria of the STRONG-HF trial (systolic blood pressure [SBP] ≥100 mm Hg, heart rate [HR] ≥60 min−1, serum potassium ≤5 mmol/L, estimated glomerular filtration rate [eGFR] ≥30 mL/min/1.73 m2, discharge N-terminal pro-B type natriuretic peptide [NT-proBNP] >1,500 pg/mL) was assessed in a consecutive patient cohort at a tertiary referral centre between April 01, 2021, and December 31, 2023. Results: Data from 408 consecutive patients were analysed (male: 71%; age: 62 [51–72] years; left ventricular ejection fraction: 27 [20–35]%; HF with reduced ejection fraction: 82%; hypertension: 67%; diabetes: 36%; atrial fibrillation: 47%). 78% of the patients were suitable for RT based on the SBP criterion, 93% on HR, 89% on serum potassium, and 91% on eGFR values. Thus, 60% were eligible for RT using the combined assessment of these parameters. When including the NT-proBNP value as well (60%), 34% of the cohort were eligible for RT. Conclusions: Based on our study, the proportion of patients suitable for RT of GDMT ranged from 34% to 60% based on the basic eligibility indicators of the STRONG-HF trial. Our results highlight the strategic importance of careful selection of patients eligible for RT. [ABSTRACT FROM AUTHOR]

(1) Background: Besides the use of guideline-directed medical therapy (GDMT), multidisciplinary heart failure (HF) outpatient care (HFOC) is of strategic importance in HFrEF. (2) Methods: Data from 257 hospitalised HFrEF patients between 2019 and 2021 were retrospectively analysed. Application and target doses of GDMT were compared between HFOC and non-HFOC patients at discharge and at 1 year. 1-year all-cause mortality (ACM) and rehospitalisation (ACH) rates were compared using the Cox proportional hazard model. The effect of HFOC on GDMT and on prognosis after propensity score matching (PSM) of 168 patients and the independent predictors of 1-year ACM and ACH were also evaluated. (3) Results: At 1 year, the application of RASi, MRA and triple therapy (TT: RASi + βB + MRA) was higher (p < 0.05) in the HFOC group, as was the proportion of target doses of ARNI, βB, MRA and TT. After PSM, the composite of 1-year ACM or ACH was more favourable with HFOC (propensity-adjusted HR = 0.625, 95% CI = 0.401–0.974, p = 0.038). Independent predictors of 1-year ACM were age, systolic blood pressure, application of TT and HFOC, while 1-year ACH was influenced by the application of TT. (4) Conclusions: HFOC may positively impact GDMT use and prognosis in HFrEF even within the first year of its initiation.

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: The aim of the study was to assess the incidence and predictive factors of the development of heart failure with improved ejection fraction (HFimpEF) category during a 1 year follow‐up period in a heart failure with reduced ejection fraction (HFrEF) patient population managed in a heart failure outpatient clinic. Methods and results: The study evaluated data from patients enrolled in the Hungarian Heart Failure Registry (HHFR). The incidence and predictive factors of the development of the HFimpEF category after 1 year follow‐up were assessed in the group of patients who had HFrEF at baseline. We evaluated the incidence and predictors of the development of HFimpEF after a 1 year follow‐up in relation to time since diagnosis of HFrEF in patients diagnosed within 3 months, between 3 months and 1 year, and beyond 1 year. The predictive factors of the development of HFimpEF were analysed using univariate and multivariate logistic regression analysis. Of the 833 HFrEF patients enrolled in the HHFR, the development of HFimpEF was observed in 162 patients (19.5%) during 1 year follow‐up. In the whole patient population, independent predictors of the development of HFimpEF were female gender [odds ratio (OR): 1.73; 95% confidence interval (CI): 1.01–2.96; P < 0.05], non‐ischaemic aetiology (OR: 1.95; 95% CI: 1.15–3.30; P < 0.05), and left ventricular end‐diastolic diameter (LVEDD) <60 mm (OR: 2.04; 95% CI: 1.18–3.51; P < 0.05). The 1 year incidence of HFimpEF decreased in relation to time since diagnosis of HFrEF. The incidence of HFimpEF was 27.1% in patients diagnosed within 3 months, 18.4% in patients diagnosed between 3 months and 1 year, and 12.2% in patients diagnosed beyond 1 year. Non‐ischaemic aetiology (OR: 4.76; 95% CI: 1.83–12.4; P < 0.01) and QRS width (OR: 0.81; 95% CI: 0.71–0.94; P < 0.01) for patients diagnosed within 3 months, LVEDD (OR: 0.54; 95% CI: 0.32–0.90; P < 0.05) and left atrial diameter ≤45 mm (OR: 5.44; 95% CI: 1.45–20.4; P < 0.05) for patients diagnosed between 3 months and 1 year, and LVEDD < 67 mm (OR: 2.71; 95% CI: 1.07–6.88; P < 0.05) for patients diagnosed beyond 1 year were found to be independent predictive factors. Conclusions: In our study, in this HFrEF patient population managed in a heart failure outpatient clinic, the 1 year incidence of HFimpEF was found to be ~20%. The 1 year incidence of HFimpEF decreased in relation to time since diagnosis of HFrEF. The most important predictors of the development of HFimpEF were female sex, non‐ischaemic aetiology, narrower QRS width, and smaller diameter of the left ventricle and left atrium. [ABSTRACT FROM AUTHOR]

Utilizing the inherently unpredictable nature of quantum mechanics, quantum random number generators (QRNGs) can provide randomness for applications where quality entropy (like in the case of cryptography) is essential. We present a post-processing scheme utilizing min-entropy estimation and hashing for optical QRNGs based on measuring individual photon arrival times. Our method allows for the handling of possible errors due to non-ideal components or even a potential attacker, given some basic assumptions to reliably produce a safe, good quality, uniformly distributed bitstream as output. We validate our results with an intentionally non-ideal measurement setup to show robustness, while also statistically testing our final output with four popular statistical test suites. [ABSTRACT FROM AUTHOR]

Background: Kidney dysfunction (KD) is a main limiting factor of applying guideline‐directed medical therapy (GDMT) and reaching the recommended target doses (TD) in heart failure (HF) with reduced ejection fraction (HFrEF). Hypothesis: We aimed to assess the success of optimization, long‐term applicability, and adherence of neurohormonal antagonist triple therapy (TT:RASi [ACEi/ARB/ARNI] + βB + MRA) according to the KD after a HF hospitalization and to investigate its impact on prognosis. Methods: The data of 247 real‐world, consecutive patients were analyzed who were hospitalized in 2019−2021 for HFrEF and then were followed‐up for 1 year. The application and the ratio of reached TD of TT at hospital discharge and at 1 year were assessed comparing KD categories (eGFR: ≥90, 60−89, 45−59, 30−44, <30 mL/min/1.73 m2). Moreover, 1‐year all‐cause mortality and rehospitalization rates in KD subgroups were investigated. Results: Majority of the patients received TT at hospital discharge (77%) and at 1 year (73%). More severe KD led to a lower application ratio (p <.05) of TT (92%, 88%, 80%, 73%, 31%) at discharge and at 1 year (81%, 76%, 76%, 68%, 40%). Patients with more severe KD were less likely (p <.05) to receive TD of MRA (81%, 68%, 78%, 61%, 52%) at discharge and a RASi (53%, 49%, 45%, 21%, 27%) at 1 year. One‐year all‐cause mortality (14%, 15%, 16%, 33%, 48%, p <.001), the ratio of all‐cause rehospitalizations (30%, 35%, 40%, 43%, 52%, p =.028), and rehospitalizations for HF (8%, 13%, 18%, 20%, 38%, p =.001) were significantly higher in more severe KD categories. Conclusions: KD unfavorably affects the application of TT in HFrEF, however poorer mortality and rehospitalization rates among them highlight the role of the conscious implementation and up‐titration of GDMT. [ABSTRACT FROM AUTHOR]

Introduction: Hospitalization due to heart failure (HF) progression is associated with poor prognosis. This highlights the role of the implementation of guideline-directed medical therapy (GDMT) in improving the morbidity and mortality of patients with heart failure with reduced ejection fraction (HFrEF). There are limited data about the intrahospital applicability of GDMT in real-world circumstances. We aimed to assess retrospectively the use of cornerstone GDMT including RASi (ACEI/ARB/ARNI), βB, MRA, and SGLT2i treatment in a consecutive real-world HFrEF patient population admitted with signs and symptoms of HF to the HF Unit of a Hungarian tertiary cardiac center between 2019 and 2021. The independent predictors of therapy optimization and the applicability of new HFrEF medication (ARNI, SGLT2i, vericiguat) were also investigated. Methods: Statistical comparison of admission and discharge medication was accomplished with Fisher's exact test. The independent predictors of the introduction of triple therapy (RASi + βB + MRA) were analyzed using univariate and multivariate logistic regression. The proportion of patients eligible for vericiguat based on the inclusion and exclusion criteria of the VICTORIA trial was also investigated, as well as the number of patients suitable for ARNI and SGLT2i, taking into account the contraindications of application contained in the ESC 2021 HF Guidelines. Results: 238 patients were included. During hospitalization, the use of RASi (69% vs. 89%) (ACEI/ARBs [58% vs. 70%], ARNI [10% vs. 19%]), βBs (69% vs. 85%), and MRAs (61% vs. 95%) increased significantly (p < 0.05) compared to at admission, and the use of SGLT2i (3% vs. 11%) also rose (p = 0.0005). The application ratio of triple (RASi + βB + MRA; 43% vs. 77%) and quadruple (RASi + βB + MRA + SGLT2i; 2% vs. 11%) therapy increased as well (p < 0.0001). The independent predictors of discharge application of triple therapy revealed through multivariate logistic regression analysis were age, duration of hospitalization, eGFR, NTproBNP, and presence of diabetes mellitus. Sixty-eight percent of the cohort would have been suitable for vericiguat, 83% for ARNI, and 84% for SGLT2i. Conclusion: High rates of application of disease-modifying drugs are achievable among hospitalized HFrEF patients in severe clinical condition; thus, awareness of the need for their initiation must be raised. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Law Enforcement / Magyar Rendészet is the property of National University of Public Service and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)