American Heart Association

Precision medicine for cardiac resynchronization: Predicting quality of life benefits

Contributor: Nicholas Hawkes

Who benefits from cardiac resynchronization therapy (CRT)? Studies show that among select HF patients CRT improves longevity, ventricular remodeling, and quality of life (QoL). The precision medicine approach asks the question, “Are there individual factors that predict QoL improvements?” Spertus and colleagues demonstrated that age, baseline QoL, and QRS duration predict individual QoL after CRT.

Octreotide may prevent recurrent GI bleeds in CF-LVAD patients

Contributor: Nick Hawkes

CF-LVAD patients experience high rates of gastrointestinal (GI) bleeding. A multicenter, retrospective analysis by Shah et al demonstrated that patients with a prior GI bleed after CF-LVAD implantation had a lower rate (24% vs 43%) of recurrent GI bleed when receiving octreotide.

Fifty-one patients were identified from 5 participating centers. All patients had one previous GI bleed following CF-LVAD implantation, and received octreotide treatment for at least 6 months following index GI bleed. Octreotide was dosed as a monthly depot injection in 72% of patients or twice daily subcutaneous injection in 28%. Shah et al used a comparison group of HMII CF-LVAD patients who had experienced a GI bleed in clinical trials using HMII bridge-to-transplant (BTT) and destination therapy (DT). Patients were propensity matched based on HF etiology, CF-LVAD indication, CF-LVAD support time, sex, and age. Of the 51 CF-LVAD patients analyzed, 50% were DT. Twelve patients (24%) who received octreotide experienced a recurrent bleed vs 22 (43%) of the comparison group (p<0.04).

Sacubitril/Valsartan improves quality of life in patients with HFrEF

Contributor: Nicholas Hawkes

Quality not quantity. Why not both? It is established that sacubitril/valsartan is superior to enalapril (or dose-equivalent ACE-I) when it comes to mortality and morbidity in HFrEF. But what about quality of life (QoL)? Patients enrolled in PARADIGM-HF had increased quality of life when randomized to sacubitril/valsartan.