American Heart Association

Slow Adoption and Low Adherence of Sacubitril/Valsartan for HFrEF

Contributor: Nick Hawkes

PARADIGM – HF demonstrated that Sacubitril/Valsartan reduces morbidity and mortality in patients with HFrEF compared to ACE-I/ARB therapy, so why is its adoption in the real world delayed?

Sangaralingham et al. accessed data from OptumLabs Data Warehouse, a large database of de-identified medical and pharmacy claims. Among patients identified based on systolic HF ICD codes, those prescribed sacubitril/valsartan were compared to those who were not. Patient variables included health plan, age, gender, race, region, comorbidities, other prescription medications, and provider specialty. Additionally the costs, out-of-pocket (OOP) and to the health plan, were captured.

HF patient death leads to poor spousal outcomes

Contributor: Elise Vo

Being the spouse of a HF patient is challenging. In a recent study, Dunlay and colleagues explored the link between spousal health and HF patient outcomes. Interestingly, spousal health did not correlate with HF patient death or hospitalization. However, spouse caregivers experienced worse outcomes following the death of their HF partner.

Olmsted County residents were screened for HF between 2002-2012 using ICD-9 codes. 905 patients met study criteria, 586 (65%) males with mean age of 73.3, 96% Caucasian, and average LVEF 47.7%. The spousal characteristics were: 584 (65%) female, mean age of 71, and 96% Caucasian. HF patient charts were reviewed for marriage.

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.

Early right ventricular assist device utilization in patients undergoing continuous-flow left ventricular assist device implantation: Insight from INTERMACS

Contributor: Steven Stroud

Frustrated by limited, single small center risk scores for RV failure? Kiernan and colleagues analyzed the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) to identify factors associated with RV failure following continuous flow left ventricular assist device (CF-LVAD) support.

Not necessary to adjust NT-proBNP thresholds for HFrEF patients with atrial fibrillation

Contributor: Chris Sobowale

Heart failure patients with HFrEF and atrial fibrillation (HFrEF-AF) have higher NT-proBNP than HFrEF patients without atrial fibrillation (AF). This is thought to be a consequence of AF and not necessarily correlated with deleterious clinical outcomes.

HF clinical trials have stipulated different inclusion NT-proBNP levels for patients with HFrEF-AF. It turns out, a defined higher NT-proBNP level for patients with HFpEF-AF may not be necessary.