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Proteomics offers great promise in improving risk prediction of patients with heart failure. In this community-based cohort study, 7289 plasma proteins were measured in 1351 patients to derive a protein risk score to predict mortality. The study showed that the protein score outperformed clinical risk tools in predicting mortality. Studies to further validate the score and determine risk thresholds for intervention now seem necessary. Visual Abstract. Development and Validation of a Protein Risk Score for Mortality in Heart Failure: Proteomics offers great promise in improving risk prediction of patients with heart failure. In this community-based cohort study, 7289 plasma proteins were measured in 1351 patients to derive a protein risk score to predict mortality. The study showed that the protein score outperformed clinical risk tools in predicting mortality. Studies to further validate the score and determine risk thresholds for intervention now seem necessary. Background: Heart failure (HF) is a complex clinical syndrome with high mortality. Current risk stratification approaches lack precision. High-throughput proteomics could improve risk prediction. Its use in clinical practice to guide the management of patients with HF depends on validation and evidence of clinical benefit. Objective: To develop and validate a protein risk score for mortality in patients with HF. Design: Community-based cohort. Setting: Southeast Minnesota. Participants: Patients with HF enrolled between 2003 and 2012 and followed through 2021. Measurements: A total of 7289 plasma proteins in 1351 patients with HF were measured using the SomaScan Assay (SomaLogic). A protein risk score was derived using least absolute shrinkage and selection operator regression and temporal validation in patients enrolled between 2003 and 2007 (development cohort) and 2008 and 2012 (validation cohort). Multivariable Cox regression was used to examine the association between the protein risk score and mortality. The performance of the protein risk score to predict 5-year mortality risk was assessed using calibration plots, decision curves, and relative utility analyses and compared with a clinical model, including the Meta‐Analysis Global Group in Chronic Heart Failure mortality risk score and N -terminal pro–B-type natriuretic peptide. Results: The development (n = 855; median age, 78 years; 50% women; 29% with ejection fraction <40%) and validation cohorts (n = 496; median age, 76 years; 45% women; 33% with ejection fraction <40%) were mostly similar. In the development cohort, 38 unique proteins were selected for the protein risk score. Independent of ejection fraction, the protein risk score demonstrated good calibration, reclassified mortality risk particularly at the extremes of the risk distribution, and showed greater clinical utility compared with the clinical model. Limitation: Participants were predominantly of European ancestry, potentially limiting the generalizability of the findings to different patient populations. Conclusion: Validation of the protein risk score demonstrated good calibration and evidence of predicted benefits to stratify the risk for death in HF superior to that of clinical methods. Further studies are needed to prospectively evaluate the score's performance in diverse populations and determine risk thresholds for interventions. Primary Funding Source: Division of Intramural Research at the National Heart, Lung, and Blood Institute of the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Background: The inhibition of sodium-glucose co-transporter 2 (SGLT-2) has been shown to be beneficial in the treatment of diabetic and non-diabetic patients with heart failure. The underlying mechanisms are incompletely understood. The present prospective study investigates for the first time the effect of empagliflozin on various soluble markers of inflammation in patients with reduced ejection fraction (HFrEF). Methods: We included 50 inpatients with HFrEF and diabetes mellitus type 2. A total of 25 patients received a therapy with the SGLT-2-inhibitor empagliflozin in addition to standard medication; the other 25 patients did not receive empagliflozin and were considered the control group. Quality of life, functional status and soluble immunological parameters in serum were assessed at baseline and after 3 months. Results: The baseline characteristics of both groups revealed no significant differences. Patients on empagliflozin demonstrated a significant improvement in the Minnesota living with heart failure questionnaire (baseline 44.2 ± 20.2 vs. 24 ± 17.7; p < 0.001), in distance in the 6-min walk test (baseline 343 ± 145 m vs. 450 ± 115 m; p < 0.001) and in soluble interleukin-6 level (baseline 21.7 ± 21.8 pg/mL vs. 13.7 ± 15.8 pg/mL; p = 0.008). There was no significant change of these or other parameters in the control group (p > 0.05 each). Conclusions: The empagliflozin-induced improvement of quality of life and functional capacity in patients with HFrEF and type 2 diabetes mellitus is accompanied by a substantial reduction of interleukin-6 levels. Thus, anti-inflammatory effects may contribute to the benefits of SGLT-2-inhibitors in heart failure. [ABSTRACT FROM AUTHOR]

The Framingham Heart Study Dementia Risk Score (FDRS) was developed in a general population of older persons. It is unknown how the FDRS variables predict Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) in heart failure and atrial fibrillation populations. We aimed to evaluate the predictive ability of the FDRS variables in population-based cohorts of heart failure and atrial fibrillation and to determine whether the addition of other comorbidities and risk factors improves risk prediction for AD/ADRD. Residents aged ≥50 years from 7 southeastern Minnesota counties with a first diagnosis of heart failure or atrial fibrillation between January 1, 2013, and December 31, 2017, were identified. Patients with AD/ADRD before or within 6 months after index atrial fibrillation or heart failure and patients who died within 6 months after index were excluded. For both cohorts, models were constructed to predict AD/ADRD after index including the variables in the FDRS. Additional comorbidities and risk factors were added to the models. For all models, c-statistics using 5-fold cross-validation were calculated. Among 3052 patients with heart failure (mean age 75 years, 53% male), 626 developed AD/ADRD; among 4107 patients with atrial fibrillation (mean age 74 years, 57% male), 736 developed AD/ADRD. Among patients with heart failure, the FDRS variables predicted AD/ADRD with c-statistic = 0.69. Adding comorbidities and risk factors improved the c-statistic slightly to 0.70. The FDRS variables also performed well (c-statistic = 0.73) in patients with atrial fibrillation; adding comorbidities and risk factors slightly improved performance (c-statistic = 0.75). The variables from the FDRS predict AD/ADRD well in both heart failure and atrial fibrillation populations. The addition of comorbidities and risk factors only modestly improved prediction, indicating that the FDRS variables are appropriate to predict AD/ADRD in patients with heart failure and atrial fibrillation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Garlic may have anti-oxidanmayti-hypertensive and anti-hyperlipidemic properties. However, the effects of its administration on cardiac function in heart failure (HF) patients impact require further investigation. We aimed to evaluate garlic prescription effects on cardiac outcomes and quality of life scores in Iranian HF patients. METHODS: From August to December 2020, a randomized, double-blind clinical trial was conducted. Individuals with heart failure (New York heart association (NYHA) functional class of II and III) referred to private clinics in Isfahan, Iran, were randomly assigned to intervention (n=80) and control (n=80) groups. They have received 500 mg of odorless garlic tablets or the same shape and dosage of placebo twice daily for three months. Laboratory data, cardiac outcomes (end-diastolic diameter, ventricular septal thickness, NYHA functional class, left ventricular ejection fraction), quality of life score (Minnesota living with HF questionnaire), and the Modified Borg Scale (MBS) were all evaluated at the baseline and the end of the trial. RESULTS: The population's mean age was 58.1±13.5 years (55% males). Patients who consumed garlic had remarkably improved functional class compared to placebo takers and their baseline (NYHA practical class of II, 79.4% vs. 50.6%, P<0.001 and 79.4% vs. 54%, P=0.006, respectively). MBS levels were significantly lower among garlic consumers (baseline: 2.52±0.5, after three months: 2.2±1.06, P= 0.040). CONCLUSIONS: Garlic administration may improve cardiac function and breathe in HF patients. Complementary research is necessary to confirm our findings. [ABSTRACT FROM AUTHOR]

Aims: Interventional transcatheter edge-to-edge mitral valve repair (TMVR) is an established treatment option for patients with severe mitral regurgitation (MR) and high operative risk. Cognitive impairment is one of the most common conditions among often extensive comorbidities in these patients. The specific patterns of cognitive decline and particularly the effect of TMVR are not well described. Thus, this study aimed to investigate into the impact of TMVR on cognitive impairment, exercise capacity, and quality of life. Methods: Cognitive function (executive, naming, memory, attention, language, abstraction, and orientation) was assessed with the standardized Montreal Cognitive Assessment test (MoCA; range between 0 and 30 points) before and 3 months after TMVR in 72 consecutive patients alongside echocardiographic examination and assessment of exercise capacity (six-minute walk test) as well as quality-of-life questionnaires (Minnesota living with heart failure questionnaire, MLHF-Q). Results: Patients' median age was 81 [76.0; 84.5] years, 39.7% were female with a median EuroScore II of 4.4% [2.9; 7.7]. The assessment of cognitive function showed a significant improvement of the cumulative MoCA-Test result (from 22.0 [19.0; 24.5] to 24 [22.0; 26.0]; p < 0.001) with significant changes in the subcategories executive (p < 0.001), attention (p < 0.001), abstraction (p < 0.001), and memory (p < 0.001). In addition, quality of life (from 47.5 [25.0; 69.3] to 24.0 [12.0; 40.0]; p < 0.001) and exercise capacity (from 220.0 m [160.0; 320.0] to 280.0 m [200.0; 380.0]; p = 0.003) increased significantly 3 months after the TMVR procedure. Conclusions: TMVR leads to a significant improvement of cognitive function, exercise capacity, and quality of life in patients with chronic heart failure in 3 months follow up and again highlights the benefit of the evermore established TMVR procedure for patients with high operative risk. [ABSTRACT FROM AUTHOR]

To investigate the impact of Xuefu Zhuyu decoction on cardiac remodeling and quality of life of patients with heart failure and middle-range coronary heart disease with ejection fraction is the main objective of the study. 116 heart failure patients with coronary heart disease in the middle range of ejection fraction were divided as observation or control group. Clinical efficacy of both groups was observed and changes in traditional Chinese medicine symptom scores, cardiac function classification, exercise tolerance, cardiac ultrasound indexes and quality of life were compared before and after treatment between both groups. Relative to before treatment, left ventricular ejection fraction of two groups enhanced dramatically (p<0.05) and the left ventricular enddiastolic diameter increased significantly (p<0.05). Serum N-terminal pro-B-type natriuretic peptide and left ventricular end-systolic diameter significantly declined (p<0.05). Relative to before treatment, physical limitation, physical condition, emotional change, social limitation score and total score in each dimension of Minnesota living with heart failure questionnaire scale obviously declined in both groups (p<0.05), compared with control group following treatment. The above scores decreased in observation group relative to control group (p<0.05). Xuefu Zhuyu decoction can significantly enhance cardiac function and exercise tolerance of such cases, inhibit or reverse cardiac remodeling, and be beneficial to the improvement of quality of life. [ABSTRACT FROM AUTHOR]

Background: Mental health illnesses are associated with frequent hospitalisation and an increased risk of all-cause mortality. Despite the high prevalence of depression in patients with chronic heart failure (CHF), there is a paucity of data on this subject from low and middle-income countries (LMIC). The aim of this study was to determine the prevalence of depression, anxiety, and stress symptoms in patients attending a dedicated CHF clinic. Methods: A prospective study was conducted at an outpatient heart failure clinic in a tertiary academic centre. The study participants completed a Depression, Anxiety and Stress (DASS-21) questionnaire to screen for the presence and severity of depression, anxiety and stress symptoms. Furthermore, the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was completed and used to evaluate the impact of CHF on health-related quality of life (QoL). Descriptive statistics were used to describe patients' characteristics and logistic regression analysis to identify predictors of symptoms of depression. Results: The study population comprised of 103 patients, predominantly female (62.1%) with a median age of 53 (interquartile range 38–61) years. Symptoms of depression were reported by 52.4%, with 11.6% reporting symptoms suggestive of extremely severe depression. Anxiety was diagnosed in 53.4% of patients and extremely severe anxiety was reported by 18.4% of patients. Fifty patients were classified as stressed, and only 7.7% had extremely severe stress. More than half of the patients (54.4%) were in New York Heart Association functional class I. The mean left ventricular ejection fraction in the entire cohort was 30% (SD = ± 11.1%). In the multivariable logistic regression model, the MLHFQ score [odds ratio (OR) 1.04, 95% CI:1.02–1.06, p = 0.001] and the six-minute walk test [OR 0.99, 95% CI: 0.98–0.99, p = 0.014] were identified as independent predictors of depression. Conclusion: Depression and anxiety symptoms were found in over half of patients attending the CHF clinic. We recommend that mental health screening should be routinely performed in patients with CHF. Prospective, adequately powered, multicentre studies from LMIC investigating the impact of depression, anxiety and stress on CHF outcomes such as health-related QoL, hospitalisation and mortality are required. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a severe and self-limiting syndrome. Its signs and symptoms are believed to predict poorer health-related quality of life scores, which are mainly influenced by deterioration in physical capacity. In the present study we try to analyze the influence of clinical and socioeconomic characteristics and physical capacity on the quality of life of people with HF diagnosis.Methods: A longitudinal study was conducted over 2 years with patients diagnosed with HF. To evaluate the patients the method of face-to-face visit and telephone monitoring was used. In the evaluations were applied: the Clinical and Socioeconomic Characterization Questionnaire, the Minnesota Living With Heart Failure Questionnaire (MLHFQ) for quality of life evaluation and the Veterans Specific Activity Questionnaire (VSAQ) for cardiopulmonary fitness analysis. Measures of central tendency, proportion, normality test, confidence intervals, comparison of data through paired Student t test and Wilcoxon or Mann Whitney test were performed and correlations were verified through Spearman coefficient.Results: The study included 108 patients, most of them female (50.90%) and mean age of 66.62 ± 11.33 years. The median time of HF diagnosis was 5 ± 6 years, being Chagas' disease the main etiologic cause for the disease (57.40%). As for the clinical condition, functional classes II (44.40%) and III (48.10%) of the New York Heart Association (NYHA) were the most frequent. There was a low cardiopulmonary fitness, with loss of capacity to perform daily activities (3 ± 1 to 3 ± 3) over the time of clinical follow-up. There was an increase in the MLHFQ instrument scores, from 50.98 ± 15.52 to 61.76 ± 19.95, over the analysis time. The analysis of correlations demonstrated that variables such as schooling, NYHA class, echocardiographic alterations and the drug profile have a significant relationship with the constructs of quality of life and physical fitness.Conclusion: Individuals in HF have significant impairment of cardiorespiratory capacity and tend to present worsening of QL along the evolution of the disease. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine whether deficiencies of water-soluble vitamin intake predicted health-related quality of life (HRQOL) and the composite end point of all-cause mortality or cardiac- or heart failure (HF)-related hospitalization in HF patients. Patients with HF may be at risk for inadequate consumption of water-soluble vitamins due to poor appetite and dietary sodium restriction. Because water-soluble vitamins are important in metabolic processes, inadequate dietary intake of these vitamins may negatively affect health outcomes. Methods: We consecutively recruited patients with HF from outpatient clinics affiliated with academic medical centers. Patients were referred by providers to investigators who verified their eligibility. Patients with HF completed a four-day food diary to determine dietary deficiencies of water-soluble vitamins and the Minnesota Living with HF questionnaire to assess HRQOL at baseline. Patients were followed to determine an event. Results: A total of 216 patients were included. Patients with a higher number of dietary deficiencies of water-soluble vitamins had poorer HRQOL (unstandardized coefficient = 4.92, 95% confidence interval 2.20–7.27). Cox regression showed that for each additional deficiency of a water-soluble vitamin intake, there was a 30% increase in risk for an event (95% confidence interval 1.03–1.75), controlling for demographic and clinical variables. Conclusion: Inadequate dietary consumption of water-soluble vitamins was associated with poor HRQOL and prognosis and in HF. Our findings highlight that clinicians should understand the importance of encouraging patients to consume water-soluble vitamin-rich foods, which may result in enhancing outcomes in HF. [ABSTRACT FROM AUTHOR]

The purpose of this analysis was to develop and validate computable phenotypes for heart failure (HF) with preserved ejection fraction (HFpEF) using claims-type measures using the Rochester Epidemiology Project. This retrospective study utilized an existing cohort of Olmsted County, Minnesota residents aged ≥ 20 years diagnosed with HF between 2007 and 2015. The gold standard definition of HFpEF included meeting the validated Framingham criteria for HF and having an LVEF ≥ 50%. Computable phenotypes of claims-type data elements (including ICD-9/ICD-10 diagnostic codes and lab test codes) both individually and in combinations were assessed via sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with respect to the gold standard. In the Framingham-validated cohort, 2,035 patients had HF; 1,172 (58%) had HFpEF. One in-patient or two out-patient diagnosis codes of ICD-9 428.3X or ICD-10 I50.3X had 46% sensitivity, 88% specificity, 84% PPV, and 54% NPV. The addition of a BNP/NT-proBNP test code reduced sensitivity to 35% while increasing specificity to 91% (PPV = 84%, NPV = 51%). Broadening the diagnostic codes to ICD-9 428.0, 428.3X, and 428.9/ICD-10 I50.3X and I50.9 increased sensitivity at the expense of decreasing specificity (diagnostic code-only model: 87% sensitivity, 8% specificity, 56% PPV, 30% NPV; diagnostic code and BNP lab code model: 61% sensitivity, 43% specificity, 60% PPV, 45% NPV). In an analysis conducted to mimic real-world use of the computable phenotypes, any one in-patient or out-patient code of ICD-9 428/ICD-10 150 among the broader population (N = 3,755) resulted in lower PPV values compared with the Framingham cohort. However, one in-patient or two out-patient instances of ICD-9 428.0, 428.9, or 428.3X/ICD-10 150.3X or 150.9 brought the PPV values from the two cohorts closer together. While some misclassification remains, the computable phenotypes defined here may be used in claims databases to identify HFpEF patients and to gain a greater understanding of the characteristics of patients with HFpEF. [ABSTRACT FROM AUTHOR]

Purpose: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is a widely used condition-specific measure of quality of life (QoL) in patients with heart failure. To use information from the MLHFQ in an economic evaluation, the MLHFQ must be mapped onto a preference-based measure of QoL. This study aims to develop a mapping algorithm between the MLHFQ and the Assessment of Quality of Life (AQoL) 8D utility instrument in patients with dilated cardiomyopathy (DCM).Methods: MLHFQ and AQoL-8D data were collected on 61 Australian adults with idiopathic DCM or other non-hypertrophic cardiomyopathies. Three statistical methods were used as follows: ordinary least squares (OLS) regression, the robust MM estimator, and the generalised linear models (GLM). Each included a range of explanatory variables. Model performance was assessed using key goodness-of-fit measures, the mean absolute error (MAE), and the root-mean-square error (RMSE).Results: The MLHFQ summary score and AQoL-8D utility scores were strongly correlated (r =  - 0.83, p < 0.0001) and the two subscales of the MLHFQ were correlated with the eight dimensions of the AQoL-8D. Utility scores were predicted with acceptable precision based on responses to the MLHFQ physical, emotional, social, and other subscales. OLS and GLM performed similarly with MAE and RMSE ranging 0.086-0.106 and 0.114-0.130, respectively.Conclusion: The mapping algorithm developed in this study allows the derivation of AQoL-8D utilities from MLHFQ scores for use in cost-effectiveness analyses and most importantly, enables the economic evaluation of alternative heart failure therapy options when only the MLHFQ has been collected. [ABSTRACT FROM AUTHOR]

Background: Heart failure is a leading cardiac morbidity prevalent across the globe. Its incidence is rising in direct proportion to increasing longevity all over the world. Demographic variables are important predictors of quality of life, morbidity, rehospitalization, and mortality due to systolic heart failure. The objective of our study was to assess the association of demographic variables with quality of life of systolic heart failure in patients presenting at Cardiology Out Patient Department, Hayatabad Medical Complex, Peshawar. Our study aims to inform policy making as it highlights some important demographics factors associated with quality of life. Methods: A cross sectional method was employed in the study to examine systolic heart failure and its prevalence across various demographic variables such as age, gender, marital status, activity, number of children, education, employment status, and BMI at cardiology OPD of a medical teaching institution in Peshawar. Consecutive sampling was used and data were collected through a structured questionnaire from 368 Systolic Heart Failure patients. Data were analyzed using SPSS version 22. Results: We had 368 participants, a majority of whom (n=290; 78.8%), were in NYHA class III. The rest (n=78; 21.2%) were in class IV. Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to categorize quality of life into 'Good', 'Moderate' and 'Poor'. Most participants were in the 'poor' category with MLHFQ scores >45 (n=193; 52.4%). Those who had scores between 25 -45 were categorized as 'moderate' (n=116; 31.5%), and participants who scored < 24 were categorized as having a 'good' quality of life (n=59; 16%). Reliability of tools was checked by Cronbach alpha which was 0.86 Conclusion: It was concluded that demographic variables have a significant effect on the overall morbidity of heart failure patients and heart failure related quality of life. [ABSTRACT FROM AUTHOR]

Background: Differences in comorbid conditions in patients with heart failure compared with population controls, and whether differences exist by type of heart failure or age, have not been well documented.Methods: The prevalence of 17 chronic conditions were obtained in 2643 patients with incident heart failure from 2000 to 2013 and controls matched 1:1 on sex and age from Olmsted County, Minnesota. Logistic regression determined associations of each condition with heart failure.Results: Among 2643 matched pairs (mean age 76.2 years, 45.6% men), the comorbidities with the largest attributable risk of heart failure were arrhythmia (48.7%), hypertension (28.4%), and coronary artery disease (33.9%); together these explained 73.0% of heart failure. Similar associations were observed for patients with reduced and preserved ejection fraction, with the exception of hypertension. The risk of heart failure attributable to hypertension was 2-fold higher in patients with heart failure with preserved ejection fraction (38.7%) than in patients with heart failure with reduced ejection fraction (17.8%). Hypertension, coronary artery disease, arrhythmia, and diabetes were more strongly associated with heart failure in younger (≤75 years) compared to older (>75 years) persons.Conclusions: Patients with heart failure have a higher prevalence of many chronic conditions than controls. Similar associations were observed in patients with reduced and preserved ejection fraction, with the exception of hypertension, which was more strongly associated with heart failure with preserved ejection fraction. Finally, some cardiometabolic risk factors were more strongly associated with heart failure in younger persons, highlighting the importance of optimizing prevention and treatment of risk factors and, in particular, cardiometabolic risk factors. [ABSTRACT FROM AUTHOR]

Background: Mapping algorithms can be used to convert scores from a non-preference based instrument to health state utilities. The objective of this study was to develop mapping algorithms which will enable the Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores to be converted into EQ-5D-5L utility scores that can be used in heart failure related cost utility studies.Method: Patients diagnosed with heart failure were recruited from Australia. Mapping algorithms were developed using both direct and indirect response mapping approach. Three model specifications were considered to predict the EQ-5D-5 L utility score using MLHFQ total score (Model 1), MLHFQ domain scores (Model 2), or MLHFQ item scores (Model 3). Six regression techniques, each of which has the capability to cope with either skewness, heteroscedasticity, ceiling effects and/or the potential presence of outliers in the data set were used to identify the optimal mapping functions for each of the three models. Goodness-of-fit of the models were assessed using six indicators. In the absence of an external validation dataset, predictive performance of was assessed using three-fold cross validation method. In the indirect response mapping, EQ. 5D 5 L responses were predicted separately using the MLHFQ item scores using ordered logit model.Results: A total of 141 patients participated in the study. The lowest mean absolute error (MAE) was recorded from the multivariable fractional polynomials (MFP) model in all three-model specifications. Regarding the indirect response mapping, results showed that the performance was comparable with the direct mapping approach based on root mean squared error (RMSE) but was worse based on MAE.Conclusion: The MLHFQ can be mapped onto EQ-5D-5 L utilities with good predictive accuracy using both direct and indirect response mapping techniques. The reported mapping algorithms would facilitate calculation of health utility for economic evaluations related to heart failure. [ABSTRACT FROM AUTHOR]

To examine the association between health-related quality of life (HRQoL) and mortality in patients with heart failure (HF). The potential association of HRQoL and mortality in patients with HF is unclear. We investigated this association in The Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators (ICD) in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH). In DANISH, a total of 1116 patients with non-ischemic systolic HF on guideline-recommended therapy were randomized to ICD therapy or usual clinical care. HRQoL was assessed at randomization using the disease-specific Minnesota Living with Heart Failure Questionnaire (MLHFQ, 0–105, high score indicating worse HRQoL). Multivariable Cox proportional hazard models were used to compare hazard ratios (HR) for all-cause mortality according to MLHFQ above or below 45, as recommended by a recent meta-analysis, to identify patients with poor HRQoL. HRQoL was completed by 935 (84%) patients at baseline with a median follow-up of 67 months (IQR 47–83). Patients with poor HRQoL (MLHFQ score > 45, median 60 (IQR 53–71) , n = 350) had a higher incidence of all-cause mortality than patients with moderate/good HRQoL (MLHFQ ≤45, median 23 (IQR 13–33), n = 585), respectively 26% vs. 18% with an unadjusted HR of 1.57 (95% CI 1.19–2.08, p =.002), and an adjusted HR of 1.39 (95% CI 1.01–1.91, p =.04). Poor HRQoL was associated with an increased risk of all-cause mortality after adjustment for traditional risk factors. https: // clinicaltrials.gov/ct2/show/NCT00542945 (DANISH). • Poor quality of life is associated with mortality in patients with nonischemic heart failure • The association was obtained following adjustment for multiple traditional risk factors • Cardiovascular mortality was likewise associated to poor quality of life in crude models • Patients who experienced deteriorating quality of life within 8 months had a higher rate of mortality [ABSTRACT FROM AUTHOR]

Purpose: 1) To compare levels of emotional symptoms and health-related quality of life between patients with heart failure and their family caregivers; and 2) to examine whether patients' and caregivers' emotional symptoms were associated with their own, as well as their partner's health-related quality of life. Method: In this cross-sectional study, 41 patients-caregiver dyads (78% male patients, aged 68.6 years; and 83% female caregivers, aged 65.8 years) completed all nine dimensions of the Brief Symptom Inventory and the Minnesota Living with Heart failure Questionnaire. Dyadic data were analysed for 6 sub-scales of the Brief Symptom Inventory, using the Actor–Partner Interdependence Model. Results: There were no statistically significant differences in emotional symptoms and health-related quality of life between patients with heart failure and their caregivers. Patients' and caregivers' emotional symptoms were associated with their own health-related quality of life. Caregivers' anxiety, phobic anxiety, obsession-compulsion, depression and hostility negatively influenced their partner's (i.e. the patient's) health-related quality of life. There were no partner effects of patients' emotional symptoms on the health-related quality of life of caregivers. Conclusions: The results of this study suggest that patients may be particularly vulnerable to the emotional distress, i.e. thoughts, impulses and actions of their caregivers. It may be possible to improve patients' health-related quality of life by targeting specific detrimental emotional symptoms of caregivers. [ABSTRACT FROM AUTHOR]

Aims: Chronic Chagas disease (ChD) has high morbimortality and loss in quality of life due to heart failure (HF). Pharmaceutical care (PC) optimizes clinical treatment and can improve quality of life in HF. We evaluated if PC improves quality of life of patients with ChD and HF. Methods: Single‐blinded, randomized, controlled trial that assigned adult patients with ChD and HF (81 patients; 61 ± 11 years; 48% male) to PC (n = 40) or standard care (n = 41). Quality of life according to SF‐36 and Minnesota living with HF questionnaires, incidence of drug‐related problems (DRPs), and adherence to medical treatment were determined at baseline and at every 3 months for 1 year. Intention‐to‐treat analyses were performed by mixed linear model to verify the treatment effect on the changes of these variables throughout the intervention period. Results: Relative changes from baseline to 1 year of follow‐up of the domains physical functioning (+16.6 vs –8.5; P <.001), role‐physical (+34.0 vs +5.2; P =.01), general health (+19.4 vs –6.1; P <.001), vitality (+11.5 vs. –5.8; P =.003), social functioning (+7.5 vs –13.3; P =.002), and mental health (+9.0 vs –3.7; P =.006) of the SF‐36 questionnaire and the Minnesota living with HF questionnaire score (−12.7 vs +4.8; P <.001) were superior in the PC group than in the standard care group. Adherence to medical treatment increased as early as after 3 months of follow‐up and DRPs incidence decreased after 6 months of follow‐up only in the PC group. Conclusions: Patients with ChD and HF who received PC presented improved quality of life, decrease in DRP frequency, and increase in medication adherence. [ABSTRACT FROM AUTHOR]

Aims: Surgical ventricular reconstruction to remodel, reshape, and reduce ventricular volume is an effective therapy in selected patients with chronic heart failure (HF) of ischaemic aetiology. The BioVentrix Revivent TC System offers efficacy comparable to conventional surgical ventricular reconstruction and is less invasive utilizing micro-anchor pairs to exclude scarred myocardium on the beating heart. Here, we present 12-months follow-up data of an international multicenter study.Methods and Results: Patients were considered eligible for the procedure when they presented with symptomatic HF [New York Heart Association (NYHA) class ≥II], left ventricular (LV) dilatation and dysfunction caused by myocardial infarction, and akinetic and/or dyskinetic transmural scarred myocardium located in the anteroseptal, anterolateral, and/or apical regions. A total of 89 patients were enrolled and 86 patients were successfully treated (97%). At 12 months, a significant improvement in LV ejection fraction (29 ± 8% vs. 34 ± 9%, P < 0.005) and a reduction of LV volumes was observed (LV end-systolic and end-diastolic volume index both decreased: 74 ± 28 mL/m2 vs. 54 ± 23 mL/m2 , P < 0.001; and 106 ± 33 mL/m2 vs. 80 ± 26 mL/m2 , respectively, P < 0.0001). Four patients (4.5%) died in hospital and survival at 12 months was 90.6%. At baseline, 59% of HF patients were in NYHA class III compared with 22% at 12-month follow-up. Improvements in quality of life measures (Minnesota Living with Heart Failure Questionnaire 39 vs. 26 points, P < 0.001) and 6-min walking test distance (363 m vs. 416 m, P = <0.001) were also significant.Conclusions: Treatment with the Revivent TC System in patients with symptomatic HF results in significant and sustained reduction of LV volumes and improvement of LV function, symptoms, and quality of life. [ABSTRACT FROM AUTHOR]

Background: Although both hospitalization and mortality due to heart failure (HF) have been widely studied, less is known about the impact of HF on disability and quality of life.Aim: To assess the degree of disability and quality of life in HF patients attended at family medicine centres.Design and Setting: Cross-sectional study of a cohort of HF patients attended at family medicine centres.Methods: Disability was assessed with the WHODAS 2 questionnaire, which provides a global and six domain scores that is understanding and communication, getting around, self-care, getting along with people, life activities and participation in society. Quality of life was assessed with the Minnesota Living with Heart Failure Questionnaire, which furnishes a global and two domain scores, physical and emotional.Results: A breakdown of the results showed that 28% of patients had moderate disability and 16.7% had severe disability, with the most important areas affected being: life activities, 8.9% extreme disability and 30.3% severe disability; getting around, 34.6% severe disability and 2% extreme disability; and participation in society, 53.3% moderate-severe disability. Quality of life was mildly affected. New York Heart Association (NYHA) Functional Classification and sex were the major determinants of disability and quality of life. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists were associated with better scores in the "getting around" and "life activity" domains.Conclusion: HF patients in primary care show an important degree of disability and an acceptable quality of life. [ABSTRACT FROM AUTHOR]

Background: Meta-analyses of randomized controlled trials comparing atrial fibrillation (AF) ablation to medical therapy in patients with heart failure (HF) reported improvement in left ventricular ejection fraction (LVEF), quality of life using the Minnesota Living with HF Questionnaire (MLWHFQ), and 6-minute walk test (6MWT). Nonetheless, there was significant heterogeneity not accounted for suggesting that not all HF patients derive the same effect from AF ablation. Objectives: To evaluate if baseline LVEF or the etiology of the cardiomyopathy would moderate the efficacy of AF ablation. Methods: We performed random effects meta-regression using the mean baseline LVEF and total percentage of patients with nonischemic cardiomyopathy (NICMP) in the placebo arms as moderator variables. Results: Six trials with a total of 687 patients were included. The baseline LVEF in the control arm of trials ranged from 25% - 42.9%, and the percentage of patients with NICMP within each trial varied from 35% to 100%. When baseline LVEF was used as the moderator variable, no significant change in heterogeneity was observed for any of the outcomes of interest (R2 0.00 - 0.02). However, when controlling for NICMP, heterogeneity dropped substantially for the outcomes of LVEF (I2 44.7%, R2 0.91), and MLWHFQ (I2 0.00%, R2 1.00) but not 6MWT (I2 67.4%, R2 0.00). This indicates that improvement in LVEF and MLWHFQ was greater in the AF ablation group when more patients with NICMP were included in the trials. Conclusions: In patients with systolic HF, AF ablation may be more beneficial in patients with NICMP. [ABSTRACT FROM AUTHOR]

Background: Some patients with heart failure (HF) are more prone to systemic congestion than others. The goal of this study was to identify clinical and humoral factors linked to congestion and its prognostic impact in HF patients. Methods: A total of 371 advanced HF patients underwent physical examination, echocardiography, right heart catheterization, blood samplings, and Minnesota Living with HF Questionnaire. Subjects were followed-up for adverse events (death, urgent transplantation, or assist device implantation without heart transplantation). Results: Thirty-one percent of patients were classified as prone to congestion. During a median follow-up of 1,093 days, 159 (43%) patients had an adverse event. In the Cox analysis, the congestion-prone (CP) status was associated with a 43% higher event risk. The CP status was strongly (p ˂ 0.001) associated with body weight loss, right ventricular dysfunction (RVD), dilated inferior vena cava (IVC), diuretics, and beta-blockers prescription and the majority of tested hormones in the univariate analysis. In the multivariate analysis, the only independent variables associated with the CP status were adiponectin, albumin, IVC diameter, and RVD. Adiponectin by itself was predictive of adverse events. In a multivariate model, CP status was no longer predictive of adverse events, in contrast to adiponectin. Conclusions: CP patients experienced more severe symptoms and had shorter survival. Potential role of adiponectin, a new independent predictor of CP status, should be further examined. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency is prevalent in patients with heart failure. This meta-analysis was performed to evaluate the therapeutic effects of iron in patients with systolic heart failure and iron deficiency.Methods: We searched PubMed, Embase, and Cochrane databases through March 2018 and included 10 randomized controlled trials involving 1404 heart failure patients who underwent iron or placebo treatment. Odds ratio (OR) and weighted mean differences (WMD) were calculated using fixed- or random-effects models.Results: Our results showed that iron supplementation significantly reduced hospitalization for worsening heart failure (OR 0.39; 95% confidence interval [CI], 0.19-0.80) and the combined endpoint of death and heart failure hospitalization (OR 0.47; 95% CI, 0.32-0.69). In addition, iron treatment was found to improve New York Heart Association class, 6-minute walk distance, left ventricular ejection fraction, and peak oxygen consumption. Iron therapy was also associated with improvements in Patient Global Assessment, Kansas City Cardiomyopathy Questionnaire score, European Quality of Life-5 Dimensions score, and Minnesota Living with Heart Failure Questionnaire score. Moreover, serum levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) were markedly decreased in patients with iron repletion compared with placebo treatment (WMD: -332.48 pg/mL; 95% CI, -497.48 to -167.47; WMD: -4.64 mg/L; 95% CI, -6.12 to -3.17, respectively).Conclusions: Our meta-analysis suggests that iron therapy can reduce heart failure hospitalization, increase cardiac function, improve quality of life, and decrease serum levels of NT-proBNP and CRP in patients with heart failure. [ABSTRACT FROM AUTHOR]

Aims: Medication non-adherence is frequent and is associated with high morbidity and mortality in patients with chronic heart failure (CHF). We investigated whether an interdisciplinary intervention improves adherence in elderly CHF patients.Methods and Results: The study population (mean age 74 years, 62% male, mean left ventricular ejection fraction 47%, 52% in New York Heart Association class III) consisted of 110 patients randomized into the pharmacy care and 127 into the usual care group. The median follow-up was 2.0 years (interquartile range 1.2-2.7). The pharmacy care group received a medication review followed by regular dose dispensing and counselling. Control patients received usual care. The primary endpoint was medication adherence as proportion of days covered (PDC) within 365 days for three classes of heart failure medications (beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and mineralocorticoid receptor antagonists). The main secondary outcome was the proportion of adherent patients (PDC ≥ 80%). The primary safety endpoint was days lost due to unplanned cardiovascular hospitalizations (blindly adjudicated) or death. Pharmacy care compared with usual care resulted in an absolute increase in mean adherence to three heart failure medications for 365 days [adjusted difference 5.7%, 95% confidence interval (CI) 1.6-9.8, P = 0.007]. The proportion of patients classified as adherent increased (odds ratio 2.9, 95% CI 1.4-5.9, P = 0.005). Pharmacy care improved quality of life after 2 years (adjusted difference in Minnesota Living with Heart Failure Questionnaire scores -7.8 points (-14.5 to -1.1; P = 0.02), compared to usual care. Pharmacy care did not affect the safety endpoints of hospitalizations or deaths.Conclusion: Pharmacy care safely improved adherence to heart failure medications and quality of life. [ABSTRACT FROM AUTHOR]

Aims: Guidelines divide patients with heart failure (HF) into 3 distinct groups based on left ventricular ejection fraction (LVEF) We used the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to quantify the health-related quality of life in patients with HF. Methods: Patients were stratified into three cohorts: preserved LVEF (>50%), mid-range LVEF (40–49%) and reduced LVEF (<40%). The MLHFQ scores were evaluated using one-way ANOVA, and differences were observed among the groups. The association of New York Heart Association (NYHA) class with the physical scores was analyzed by Spearman’s correlation analysis. The predictive utility of the total MLHFQ scores was assessed with Kaplan-Meier curves for death and HF-related hospitalization. The Cox proportional hazards model was used to identify the risk factors for prognosis. Internal reliability was assessed with Cronbach’s α. Results: There were significant differences in the total MLHFQ scores and the MLHFQ subscale scores among the three groups (p<0.05). MLHFQ domains demonstrated high internal consistency among the three groups (Cronbach’s α = 0.92, 0.96 and 0.93). The MLHFQ physical subscale scores were significantly associated with NYHA class in HFrEF (r = 0.59, p<0.001) and HFmrEF patients (r = 0.537, p<0.001). The survival analysis indicated that there was a significant difference among the three groups regarding high MLHFQ scores (p = 0.038). In the groups with low MLHFQ scores, the HFmrEF group exhibited significantly increased rates of death and HF-related hospitalization compared with the HFpEF group (p = 0.035). Conclusions: The features and clinical outcomes varied among heart failure patients with different EF values. The MLHFQ appears to be a valid and reliable measurement of health status and offers excellent prognostic ability. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) and heart failure (HF) are two common conditions that often coexist and predispose each to one another. AF increases hospitalization rates and overallmortality in patients with HF. The current available therapeutic options for AF in patients with HF are diverse and guidelines do not provide a clear consensus regarding the best management approach. To determine if catheter ablation for AF is superior tomedical therapy alone in patients with coexisting HF,we conducted this systematic reviewand meta-analysis. The primary outcomes evaluated are left ventricular ejection fraction (LVEF), Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores, 6-minute walk test (6MWT) distance, heart failure hospitalizations, and mortality. The results are presented as a mean difference for continuous outcome measures and odds ratios for dichotomous outcomes (using Mantel- Haenszel randomeffects model). 7 full textsmet inclusion criteria, including 856 patients. AF catheter ablation was associated with a significant increase in LVEF (mean difference 6.8%; 95% CI: 3.5 - 10.1; P<0.001) and 6MWT (mean difference 29.3; 95% CI: 11.8 - 46.8; P = 0.001), and improvement in MLWHFQ (mean difference -12.1; 95% CI: -20.9 - -3.3; P = 0.007). The risk of all-cause mortality was significantly lower in the AF ablation arm (OR 0.49; 95% CI: 0.31 - 0.77; P = 0.002). In conclusion, atrial fibrillation ablation in patients with systolic heart failure is associated with significant improvement in LVEF, quality of life, 6MWT, and overall mortality. [ABSTRACT FROM AUTHOR]

Introduction – In heart failure (HF) anxiety and depression were relatively ignored by researchers, even if the measurement of quality of life (QoL) in these patients have become important tools to quantify disease severity. The objective of the present study was to quantify psychological stress and QoL in patients with chronic stable HF, and correlate the scores obtained with severity of heart failure and vitamin D levels. Materials and methods – The study included 45 patients with HF who performed clinical evaluation, biochemical analysis, echocardiography, determination of quality of life scores according to the Minnesota Living with Heart Failure questionnaire (MLHFQ) and the Hospital anxiety-depression scale (HAD). Results – It was found a significant correlation between the severity of HF versus vitamin D levels (p <0.001), HAD-A scores (p<0.011), HAD-D scores (p<0.033), also for the MLHFQ (p<0.001). The results of the study demonstrated a significant correlation between the MLHFQ scores and levels of vitamin D (p <0.001). Conclusions – The results obtained in this study showed that vitamin D deficiency in patients with chronic heart failure is significantly correlated with the severity of heart failure and decreased quality of life, anxiety and depression and could be used as a marker of increased risk. Keywords: vitamin D, heart failure, quality of life, anxiety, depression. [ABSTRACT FROM AUTHOR]

Objectives: To characterize the individual and combined effects of multimorbidity and functional limitation on healthcare use and mortality in a large, community cohort of individuals with heart failure (HF). Design: Prospective cohort study. Setting: Eleven southeastern Minnesota counties. Participants: Individuals (mean age 74, 54% male) with a first‐ever HF code (International Classification of Diseases, Ninth Revision code 428 or Tenth Revision code I50) between January 1, 2013 and March 31, 2016 (N=2,692). Measurements: Eight activities of daily living measured using a survey on a Likert scale (1=without any difficulty, 5=unable to do; median=8). Participants with a score greater than 8 were categorized as having functional limitation. Multimorbidity was defined as having 2 or more noncardiac comorbidities. Results: Twenty‐five percent of participants had neither multimorbidity nor functional limitation, 35% had multimorbidity, 9% had functional limitation, and 31% had both. After adjustment, participants with multimorbidity and functional limitation had greater risks of all outcomes (death: hazard ratio (HR)=4.92, 95% confidence interval (CI)=3.03–8.00; emergency department (ED) visit: HR=3.67, 95% CI=2.94–4.59; hospitalization: HR=3.66, 95% CI=2.85–4.70; outpatient visit: HR=1.73, 95% CI=1.52–1.96) than those with neither. Participants with functional limitation alone had greater risks of death (HR=4.84, 95% CI=2.78–8.43), ED visits (HR=2.35, 95% CI=1.75–3.16), and hospitalizations (HR=2.10, 95% CI=1.52–2.88) but not outpatient visits. Those with multimorbidity alone had similar risks of ED visits and hospitalizations as those with functional limitation alone but were more likely to have outpatient visits (HR=1.50, 95% CI=1.34–1.67). Conclusion: Individuals with both multimorbidity and functional limitation have the highest risk of death and healthcare use. Individuals with only functional limitation have similar rates of hospitalizations and ED visits as those with only multimorbidity, underscoring the need to consider both when managing individuals with HF. [ABSTRACT FROM AUTHOR]

Background: Functional debility is associated with worse outcomes in the general heart failure population, but the prevalence of difficulty with activities of daily living and clinical significance once patients develop advanced heart failure requires further examination.Methods: This was a population-based, retrospective cohort study of Olmsted County, Minnesota adults with advanced heart failure from 2007-2018. Difficulty with 9 activities of daily living was assessed by questionnaire. Predictors of difficulty were assessed by a proportional odds model. Associations of difficulty with activities of daily living with mortality and hospitalization were examined using Cox and Andersen-Gill models.Results: Among 765 patients with advanced heart failure, 565 (73.9%) reported difficulty with activities of daily living at diagnosis. Of those, 257 (45%) had moderate and 148 (26%) had severe difficulty. Independent predictors of difficulty included female sex (odds ratio [OR] 1.73; 95% confidence interval [CI], 1.26-2.36; P = .001), older age (OR per 10-year increase 1.17; 95% CI, 1.05-1.31; P = .005), dementia (OR 1.85; 95% CI, 1.06-3.24; P = .031), depression (OR 1.75; 95% CI, 1.28-2.40; P = .001), and morbid obesity (OR 1.49; 95% CI, 1.04-2.13; P = .031). Estimated 2-year mortality was 61.5%, 64.2%, and 67.6% in patients with no/minimal, moderate, and severe difficulty, respectively. The adjusted hazard ratios (95% CI) for death were 1.08 (0.90-1.28) and 1.17 (0.95-1.43) for moderate and severe difficulty, respectively, vs no/minimal difficulty (P = .33). There were no statistically significant associations of difficulty with activities of daily living and hospitalization risks.Conclusions: Most patients with advanced heart failure have difficulty completing activities of daily living and are at high risk of mortality regardless of impairment in activities of daily living. [ABSTRACT FROM AUTHOR]

The article presents a study on the impact of placing implantable cardioverter defibrillators (ICD) on health-related quality (HRQL) among patients with nonischemic cardiomyopathy. The study was done by administering 12-item Medical Outcomes Short-Form Health Survey and the Minnesota Living with Heart Failure Questionnaire to 458 patients and the patients were subjected to an ICD or standard medical therapy. The outcomes of the therapy were compared with the use of hierarchical linear regression and it was found out that HRQL was not affected by the implantation of ICD but an association with the reduction in some measures in HRQL was observed among the participants in the evaluation study.

for exercise in heart failure (HF) do not provide clear guidelines in regard to type, intensity, duration and frequency of it. The aim of this study was to evaluate the effectiveness of a new exercise programme (EFICAR) in primary care, for people with HF, compared to the recommended optimal treatment, to improve HRQoL and functional capacity along 12 months. Theory/Methods: Multicenter clinical trial, conducted in 7 public primary care centers in coordination with cardiology and hospitals. Patients with HF in NYHA class II-IV and depressed left ventricular ejection fraction =50%, functional capacity =4 metabolic equivalents (METs) and= 85 years were randomly assigned to EFICAR or optimized standard care groups. EFICAR group received a 3 month progressive exercise programme supervised by primary care nurses with an aerobic (high-intensity intervals) and a strength component; the programme continued linked with community resources for 9 months. The main outcome measure was the in health-related HRQoL measured by the Minnesota Living with Heart Failure Questionnaires (MLHFQ) and the SF-36, at baseline, 3, 6 and 12 months. Intermediate outcomes were changes in functional capacity measured by the 6-Minute Walking Test (6MWT), B-type natriuretic peptides, muscle strength, and body composition. Results: After optimization of treatment, 150 patients were randomly assigned to EFICAR (75) or standard care (75) groups. The clinical evolution over 12 month follow-up was significantly better in the intervention group for functional capacity (p<0.024) but not for HRQoL (p=0.814). The greatest difference for functional capacity was found at three months (adjusted difference: 28 m, 95% confidence interval 9.4 to 46.9). The effect of intervention on HRQoL was positively modified when considering the actual exercise doses performed by patients (p<0.013), EFICAR patients increased 0.45 HRQoL points by each 10 additional MET*hour/quarterly of exercise. Conclusions: EFICAR programme, performed in the context of primary care services with the collaboration of primary care nurses and without high technological requirements, was safe and feasible. Our results showed that EFICAR programme improved functional capacity but it did not translate into HRQoL improvement. This could be due to the limited capacity of the programme to achieve the expected levels of exercise in all the patients, as we found that there was a doseresponse association between exercise and HRQoL improvement. The short term results wears off at 12 months, reflecting the difficulties to link the programme with community resources after the supervised sessions. Limitations: The ceiling effect related to the selection of HF patients with a high baseline HRQoL made improvement more difficult to be sawn. Even so we found positive results. Additionally we will report the low compliance with the exercise protocol, which undermines the capacity of the programme to improve HRQoL. Suggestions for future research: It is necessary to continue advancing in future research on the therapeutic effect of physical exercise in order to determine the optimal components of the exercise programs regarding strength and aerobic intensity that show the adequate dose-response relationship in patients with HF and the compliance. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To assess the quality of life of patients with heart failure, due to left ventricular dysfunction (NYHA class III or IV), taking optimal medical therapy using baseline quality of life assessments from the CArdiac REsynchronisation in Heart Failure (CARE-HF) trial, and to evaluate the appropriateness of using the EQ-5D in patients with heart failure. Methods and results: The quality of life of patients enrolled in CARE-HF was evaluated using the EQ-5D and Minnesota Living with Heart Failure Questionnaire. Response rates for the instruments were >90% and statistical modelling revealed an association between EQ-5D and Minnesota Living with Heart Failure scores. Heart failure is shown to have an important impact on all aspects of quality of life, but particularly on patients'' mobility and usual activities, and leads to significant reductions in comparison with a representative sample of the UK population. Conclusions: The impact of heart failure varies amongst patients but the overall burden of disease appears to be comparable to other chronic conditions such as motor neurone or Parkinson''s disease. The EQ-5D appears to be an acceptable valid measure for use in patients with heart failure although further evidence of the responsiveness of this measure in such patients is required. [Copyright &y& Elsevier]

Introduction: The aim of the study was to assess the effect of complementary supportive therapy (CST) on the quality of life and functional capability in patients with heart failure and reduced ejection fraction (HFrEF). Patients and Methods: We investigated 33 patients with left ventricular dilatation (LVIDd> 60 mm) and reduced ejection fraction (EF <40%) in 76 complementary supportive therapy (CST) periods. Prior to each CST period, therapy was optimized (OMT) for one month. CST consists of a 10-day session. In addition to OMT, the patients were treated with carnitine, L-arginine, magnesium, thiamine, riboflavin, pantothenic acid, niacin, pyridoxal, biotin, lipoic acid, coenzyme Q-10, vitamin E, vitamin C, selenium while lying for 30 minutes inside a pulsating electromagnetic field with intensity up to 30 microteslas and inhaling negatively ionized oxygen. Before and after each CST period, patients were asked to evaluate the quality of life using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the visual analogue scale and EF, LVIDd and NYHA classes were determined. Statistical analysis was based on the t-test, Spearman’s rank correlation coefficient and Wilcoxon’s signed-ranks test. The longest observation period was 122 months. Results: After administering the complementary supportive therapy, a statistically significant improvement (p<0.05) was noticed in the particular items of the MLHFQ, in emotional and physical dimensions. The values of VAS and EF increased whereas NYHA and LVIDd decreased significantly (p<0.001). Conclusion: CST significantly improved the quality of life and functional capacity in patients with HFrEF. [ABSTRACT FROM AUTHOR]

Iron deficiency anemia (IDA) persists after left ventricular assist device (LVAD) placement and is associated with increased hospitalizations and mortality. Correction of IDA with IV iron replacement in patients with heart failure improves quality of life (QoL), functional capacity, and reduces hospitalizations. Minimal data for IV iron replacement in patients with LVAD exists. We sought to assess the safety and efficacy of protocolized iron deficiency diagnosis and IV iron replacement in newly implanted LVAD recipients. A prospective, observational study of all patients undergoing LVAD implant from 1/1/2019-9/30/2019 was conducted. Iron studies were obtained in all patients prior to index discharge; iron deficiency was defined as ferritin <100 ng/mL or ferritin 100-299 ng/mL with transferrin saturation (TSat) <20%. Patients with IDA received ferric gluconate (FG) 250 mg IV q12h to correction of iron deficit as calculated by the Ganzoni formula. Iron studies were repeated in 4-8 weeks in the ambulatory setting. Functional capacity and QoL were evaluated by the change in 6-minute walk test (6MWT) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) pre-implant, compared to the 3 month follow up clinic visit, respectively. Of the 16 patients who received an LVAD in the study period, 12 (75%) were found to have IDA and received IV FG. Patients were 62±10 years old, 81% were male, and 50% were Caucasian. No infusion-related adverse effects occurred. At a median follow-up of 9.9 weeks, 87.5% were no longer iron deficient. Hemoglobin (HgB), hematocrit (HCT) and Tsat increased significantly; there was no difference in ferritin levels. For the 8 patients with a 3 month post-implant clinic visit, a significant increase in MLHFQ, but not 6MWT, was observed. IV FG infusions immediately after LVAD are well-tolerated and associated with increased HgB/HCT and correction of IDA. Future studies are needed to confirm improvement in clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Angiotensin receptor neprilysin inhibitor (ARNI, sacubitril/valsartan) has demonstrated greater benefit as compared to enalapril in decreasing morbidity and mortality in heart failure with reduced ejection fraction (HFREF). Endothelial dysfunction (ED) plays role in development of impaired coronary and systemic perfusion, exercise intolerance, morbidity and mortality in patients with HFREF. Hypothesis: Switching from valsartan to ARNI might have favorable effects on endothelial function as measured by flow-mediated dilatation (FMD). Methods: A total of 25 patients with HFREF (mean age, 60.2 ± 10.6 years; 18 males, 56% ischemic etiology) were enrolled. All patients had New York Heart Association functional class II-III, left ventricular ejection fraction (LVEF) ≤35% and currently on valsartan treatment (mean total daily dosage: 223 ± 98mg). Endothelial function measured at baseline and 1 month after ARNI treatment by brachial artery ultrasound and expressed as percentage of flow-mediated dilation (FMD%). Minnesota Living with Heart Failure Questionnaire (MLWHFQ) were performed and N-terminal pro-BNP [NT-proBNP] values were measured before and after ARNI treatment. Results: FMD of brachial artery was found to be significantly improved in study population after ARNI treatment (2.69 ± 1.93% vs. 6.83 ± 2.87%, p< 0.001). Use of beta blockers and mineralocorticoid receptor antagonists were similar before and after ARNI. ARNI switch was associated with improvement in MLWHFQ scores (31.5 ± 7.6 vs. 21.9 ± 7.2%, p=0.001) and a decrease of NT-proBNP levels (2172±772 pg/ml to 1173±440 pg/ml, p <0.001). Spearman's correlation analysis revealed moderate correlations of improvement in FMD% with change in NT-proBNP (r=-0.535, p=0.006) and MLWHFQ scores (r=-0.558, p=0.004). Conclusions: Switching from valsartan to ARNI favorably alters endothelial function in HFREF. Furthermore, ARNI reduces symptoms of HFREF assessed by MLWHFQ and lowers NT-proBNP levels. Improvement of FMD were correlated with clinical improvement and NT-proBNP reduction in patients with HFREF. Improvement in ED after ARNI switch might be a consequence of improved hemodynamics and neurohormonal alterations. [ABSTRACT FROM AUTHOR]

Background: Cardiac contractility modulation (CCM) is a promising device therapy for heart failure (HF) patients with reduced ejection fraction and narrow QRS. However, outcomes have varied among different studies. Methods: A systematic review and meta-analysis of published randomized trials between January 2001 and June 2018 was performed. Outcomes of interest were: peak oxygen consumption (peak VO2), quality of life (QOL) measured by Minnesota Living with Heart Failure Questionnaire (MLHFQ), 6 Minute Walk Distance (6MWD), worsening HF hospitalizations, adverse events, and all-cause mortality. Data was expressed as mean difference or random effects DerSimonian-Laird risk ratios (RR) with 95% confidence interval (CI). Results: Four randomized studies enrolling a total of 801 patients, including 394 patients with CCM, were identified. Baseline demographics were: mean age 59.63 ± 0.84 years, 75.3% males, 63.7% ischemic cardiomyopathy, mean ejection fraction 29.14 ± 1.22%, and mean QRS duration 106.23 ± 1.65 msec. CCM was associated with improved peak VO2 (mean difference 0.71, 95% CI 0.20 to 1.21 mL/kg/min, p = 0.006), 6MWD (mean difference 18.34, 95% CI 6.01 to 30.68 meters, p = 0.004) and QOL measured by MLHFQ (mean difference –7.86, 95% CI –10.77 to –4.95, p < 0.00001). There was no difference in HF hospitalizations (RR 0.84, 95% CI 0.66 to 1.06, p = 0.14), adverse events (RR 1.03, 95% CI 0.97 to 1.10, p = 0.33), or mortality (RR 0.79, 95% CI 0.43 to 1.46, p = 0.46) between the CCM and non-CCM groups. Conclusions: In patients with severe heart failure and narrow QRS, CCM improves peak VO2, 6MWD and QOL when compared to optimal medical management alone, but with no mortality benefit. [ABSTRACT FROM AUTHOR]

Background: Heart failure is a common condition that increases in prevalence with age. Better predictive models which remain suitable for routine general clinical care, may improve identification of those patients requiring further specialist input. Our aim was to investigate whether the addition of simple, non-invasive measures of vascular characteristics derived from peripheral pulse-waveforms improve prediction of heart failure in the clinic setting when added to routinely held clinical information. Methods: Men from the British Regional Heart Study 30 year visit (1,722) underwent 12 lead ECG, non-invasive vascular assessment (augmentation pressure [AP], augmentation index [AIx], central blood pressure [CBP] and pulse wave velocity [PWV]) and measurement of NT-proBNP. Associations between vascular measures, Minnesota coded ECG abnormality (ECGab: defined as ≥1 of: left branch bundle block, definite or probable myocardial infarction/ischemia/left ventricular hypertrophy) and NT-ProBNP as a continuous or categorical variable were evaluated using multiple regression analysis. Results: A total of 1,601 men (78.6 ± 4.7 years) were included in the analysis. AP was a significant predictor of NT-proBNP (β 0.019, 95% CI 0.004-0.035) but AIx, CBP and PWV were not. Presence of significant ECGab also predicted NT-proBNP levels (β 0.35, 95% CI 0.19-0.51). When ECGab and each vascular measure were included in the same model only ECGab and AP were significant predictors of NT-ProBNP levels (β 0.340, 95% CI 0.176-0.504 & β 0.018, 95% CI 0.002-0.033 respectively). When using a cut-off for elevated NT-ProBNP of (≥100pg/ml) ECGab, AP and AIx were all strongly associated with elevated NT-ProBNP (OR 1.52, 95% CI 1.13-2.05, OR 1.05 95% CI 1.02-1.08 & OR 1.03 95% CI 1.01-1.05 respectively). Conclusion: These results show that AP and AIx are predictors of NT-ProBNP in elderly men, indicating the importance of the augmentation of blood pressure on the loading of the heart. Simple non-invasive vascular measures have the potential to refine identification of those patients at risk of heart failure who could benefit from further specialist investigation. [ABSTRACT FROM AUTHOR]