Heart failure with preserved ejection fraction (HFpEF) is a universal and highly fatal global disease, accounting for nearly 50% of patients with heart failure. Innovative methods are needed to protect cardiac function and prevent the progression of HFpEF. Cardiac macrophages (CMs) have emerged as key regulators of the pathophysiology of HFpEF. CMs are a heterogeneous population consisting of subpopulations with distinct lineage origins and gene expression profiles. Several key aspects of HFpEF progression have been shown to be regulated by CMs, including the recruitment of peripheral immune cells, myocardial inflammation, and cardiac electrical conduction. In addition, CMs play a critical role in regulating cardiac fibrosis, epicardial adipose tissue dysfunction, and ventricular diastolic dysfunction. Given the multifaceted roles of CMs in the pathophysiology of HFpEF, targeted regulation of CMs represents a promising therapeutic strategy. Therefore, this article will review the research progress between CMs and the pathophysiological mechanism of HFpEF from the aspects of cardiac inflammation and fibrosis, ventricular diastolic dysfunction, epicardial adipose tissue, cardiac electrical conduction, and clinical intervention.

Heart failure with preserved ejection fraction (HFpEF) is a systemic condition characterized by complex pathophysiological mechanisms, affecting over 50% of all heart failure patients, with a five-year mortality rate ranging from 50% to 75%. HFpEF is highly heterogeneous, with diverse etiologies, pathophysiological mechanisms, and clinical manifestations, all of which complicate its management and treatment. Despite these present challenges, significant progresses have been made in the management of HFpEF in recent years. Certain medications have been shown to improve quality of life and reduce the risk of adverse events in HFpEF patients. This article provides a review of the latest clinical evidence on pharmacological treatments for HFpEF, focusing on the disease's unique pathophysiological mechanisms, thereby offering a solid theoretical foundation and practical guidance for its management.

Heart failure (HF) is a major chronic condition that significantly impacts humanl health. Coronary heart disease (CHD) is the leading cause of HF. Developing risk prediction models for HF in patients with CHD is crucial for enabling healthcare professionals to identify high-risk populations and implement timely interventions.

To systematically evaluate risk prediction models for HF with CHD in Chinese patients, serving as a reference for the development, selection, and dissemination of relevant predictive models.

CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Web of Science and the Cochrane Library were searched for relevant studies on risk prediction models for HF with CHD in Chinese patients up to October 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias and applicability of the included studies using the Prediction Model Risk of Bias Assessment Tool (PROBAST).

A total of 27 studies were included, reporting 64 risk prediction models. The area under the receiver operating characteristic (ROC) curve (AUC) or these models ranged from 0.511 to 0.989, with 63 models achieving an AUC>0.7, indicating good predictive performance. However, PROBAST assessment revealed that all 27 studies had a high risk of bias and low applicability. Key predictive factors included age, left ventricular ejection fraction, history of diabetes, history of hypertension, N-terminal pro-B-type natriuretic peptide, and Gensini score.

The stability and external validity of existing risk prediction models for HF with CHD in Chinese patients require further validation through prospective, large-scale studies. Future model development should adhere strictly to PROBAST guidelines to ensure the design and implementation of high-quality, generalizable predictive models.

The selection of echocardiographic indexes for efficacy evaluation of heart failure with preserved ejection fraction (HFpEF) lacks a uniform standard.

Analyze the echocardiographic outcome measures in randomized controlled trials (RCT) of HFpEF to provide a reference for the development of a standardized efficacy evaluation system for HFpEF.

PubMed, Embase and Cochrane Central Register of Controlled Trials were searched for RCT related to HFpEF from January 1, 2021 to November 3, 2023. Echocardiographic outcome measures and other information were extracted after literature screening according to eligibility criteria. The frequency and percentage of echocardiographic outcome measures were analyzed and an association rule analysis was conducted.

A total of 825 literatures were obtained and 14 literatures were finally included after screening. A total of 39 echocardiographic outcome measures were used in 14 studies. The minimum number of echocardiographic outcome measures used in a single study was 2, and the maximum was 18. The top 10 echocardiographic outcome measures in terms of usage frequency were ratio of mitral peak velocity of early filling (E) to mitral peak velocity of late filling (A), left ventricular ejection fraction (LVEF), average ratio of E to early diastolic mitral annular velocity (e'), left atrial volume index (LAVI), left ventricular end-diastolic diameter (LVEDD), left atrial diameter (LAD), septal E/e', left ventricular mass index (LVMI), E deceleration time (EDT) and tricuspid annular plane systolic excursion (TAPSE). The association rule analysis showed that when different quantitative indicators were combined, the rules with the highest support were respectively average E/e'→LAVI, LVEF+E/A→LVEDD and LAVI+average E/e'+LVEF→LVEDD.

In HFpEF RCT, the commonly used echocardiographic outcome measures are E/A, LVEF, and average E/e'. Moreover, LAVI and LVEDD are often used in combination with the above indicators. Lack of consistency, rationality, recognition and standardization are the problems of echocardiographic outcome measures selection in HFpEF RCT. The development of a core outcome set may be an effective way to solve the above problems.

Heart failure (HF) is the end stage of a variety of cardiovascular diseases, high incidence, poor prognosis, seriously affect the quality of life of patients. The atherogenic index of plasma (AIP) is closely related to atherosclerosis, coronary heart disease and other cardiovascular diseases, and atherosclerosis is an important risk factor for heart failure.

To investigate the effect of the AIP index on the risk of new-onset HF.

This is a retrospective cohort study. 99 755 active and retired employees of Kailuan Group who participated in the health examination of the 11 hospitals affiliated to Kailuan General Hospital from June 2006 to October 2007 were selected as the observation population, and the subjects were divided into 4 groups according to baseline AIP quartile, namely Group Q1: AIP <-0.56 (n=24 937) ; Group Q2: -0.56≤AIP <-0.16 (n=24 940) ; Group Q3: -0.16≤AIP <0.31 (n=24 938) ; Group Q4: AIP≥0.31 (n=24 940). Follow-up continued until 31 December 2021, during which the incidence of HF was recorded once a year. The incidence density of HF in the 4 groups was calculated. The cumulative incidence of HF in the 4 groups was calculated using the Kaplan-Meier method. The effect of AIP on the risk of new-onset HF was analysed by Cox regression.

During a mean follow-up of 14.07 (13.79, 14.24) years, there were 3 337 (3.35%) cases of new HF. There were 675, 734, 940 and 988 cases in group Q1-Q4, respectively, and the incidence density was 1.95/1 000, 2.13/1 000, 2.73/1 000 and 2.87/1 000 years, respectively. The cumulative incidence of new HF in the Q1-Q4 group was 2.47%, 2.68%, 3.48% and 3.63%, respectively. According to the Log-rank test, the differences were statistically significant (χ²=76.90, P<0.001). In multivariate Cox regression analysis, compared with Q1, the risk for new-onset HF in Q3 and Q4 was 1.16 (95%CI=1.05-1.28) and 1.20 (95%CI=1.08-1.33), respectively, and the differences were statistically significant (P<0.05) .

AIP is an independent risk factor for new-onset HF, and the risk of new HF increases with the increase of AIP level. Early screening and evaluation of patients at high risk of HF can be achieved through AIP.

Heart failure with preserved ejection fraction (HFpEF) refers to a clinical syndrome characterized by a left ventricular ejection fraction of ≥50% and the presence of symptoms and clinical signs of heart failure. Currently, approximately 50% of patients with heart failure in clinical practice have heart failure with preserved ejection fraction. An increasing body of evidence suggests that heart failure is a metabolic disease with significant changes in energy metabolism, and the complex energy metabolic network is not yet fully understood. This review will discuss the changes in energy metabolism in heart failure from four aspects: glucose metabolism, lipid metabolism, ketone body metabolism, and amino acid metabolism. By comparing HFpEF with heart failure with reduced ejection fraction (HFrEF), the study further demonstrates the changes and significance of different metabolisms in the energy metabolism of the heart with HFpEF, clarifies the relationship between heart failure and energy metabolism, and provides theoretical bases and new treatment concepts for the precise treatment of different types of heart failure from a metabolic perspective.

Early assessment and prompt treatment for heart failure patients can prevent the occurrence of cardiac adverse events. Effective diagnostic tools are particularly crucial for these patients. Acoustic Cardiography (ACG) , as an efficient and non-invasive bedside screening tool, can be used to evaluate the severity of heart failure.

To investigate the feasibility of using a wearable acoustic-electrocardiographic remote monitoring device for dynamic cardiac function assessment during heart failure treatment.

This prospective single-arm self-controlled study randomly enrolled 60 patients with acute heart failure admitted to the Department of Cardiology, the first Affiliated Hospital of Kunming Medical University, from October 2020 to December 2020. Key parameters, including electro-mechanical activation time (EMAT) , EMAT percentage (EMAT%) , N-terminal pro-B-type natriuretic peptide (NT-proBNP) , and body weight, were measured on admission days 1, 2, 3, 5, and discharge day. Echocardiographic parameters were assessed on admission and discharge days. Trends in parameter changes and consistency among indicators were analyzed.

Among the 60 patients (35 males, 25 females) , the average hospitalization duration was (7.9±3.2) days. One-way repeated measures ANOVA revealed statistically significant differences in EMAT, EMAT%, NT-proBNP, and body weight across time points (F_EMAT=6.978, P<0.01; F_EMAT%=3.108, P<0.05; F_NT-proBNP=8.678, P<0.01; F_weight=27.246, P<0.01) . Pairwise comparisons demonstrated sequential decreases in these parameters from admission to discharge (P<0.01) . No significant differences were observed in echocardiographic parameters before and after treatment (P>0.05) . Time-adjusted repeated measures ANOVA confirmed consistent trends between EMAT and NT-proBNP changes during hospitalization (Day 1: β=67.724, P<0.01; Day 2: β=56.876, P<0.01; Day 3: β=38.503, P<0.01; Day 5: β=23.969, P<0.01; discharge: β=16.851, P<0.05) .

Compared to bedside echocardiography (e.g., LVEF) and NT-proBNP testing, the wearable acoustic-electrocardiographic remote monitoring device offers non-invasive, convenient, and cost-effective advantages. The device captures dynamic changes in acoustic and electrocardiographic parameters that correlate with clinical improvements in heart failure patients, suggesting its potential for remote cardiac function monitoring and timely detection of disease progression.

The correlation between sleep duration and heart failure has been established, yet the majority of studies are observational in nature, rendering causal inference difficult due to confounding variables.

To explore the causal relationship between both inadequate and excessive sleep durations and heart failure using two-sample Mendelian randomization (MR) .

The research data was derived from the genome-wide association study (GWAS) summary database, wherein inadequate sleep duration consisted of 106 192 samples and excessive sleep duration consisted of 34 184 samples. Appropriate single nucleotide polymorphisms (SNPs) were selected as instrumental variables, and two-sample Mendelian randomization analyses were conducted using inverse variance weighted (IVW), weighted median, Weighted mode and MR-Egger regression to evaluate the causal relationship between sleep duration and heart failure, as measured by the odds ratio. Sensitivity analyses were performed using heterogeneity testing, horizontal pleiotropic test, and leave-one-out analysis.

23 SNPs were identified as being associated with inadequate sleep duration, while 5 SNPs were associated with exessive sleep duration. The IVW analysis revealed that inadequate sleep duration was a risk factor for heart failure [OR (95%CI) =2.347 (1.209-4.555), P=0.012]. After removal of SNPs with multiple testing correction, demonstrated the robustness of MR results.

There is a positive causal relationship between short sleep duration and heart failure, that is, short sleep duration increases the risk of heart failure.

With advances in cancer diagnosis and treatment technologies, as well as the rapid development of anti-cancer drugs, the survival of cancer survivors has significantly improved. Cardiovascular diseases, particularly heart failure, resulting from cancer treatment have become a significant concern. Dapagliflozin, a novel sodium-glucose cotransporter 2 (SGLT2) inhibitor, has demonstrated significant clinical benefits in the treatment of type 2 diabetes and heart failure (HF). However, studies on its prognostic impact in elderly breast cancer survivors with HF with preserved ejection fraction (HFpEF) and type 2 diabetes remain scarce.

To investigate the prognostic impact of dapagliflozin in elderly breast cancer survivors with HFpEF and type 2 diabetes.

Ninety-three elderly female breast cancer survivors with HFpEF and type 2 diabetes admitted to the Affiliated Hospital of Qingdao University from January 2018 to August 2023 were enrolled. Based on the medication regimen, patients were divided into the dapagliflozin group (47 patients) and the control group (46 patients). Baseline data were collected, and patients were followed up for 6 months, with the follow-up period ending in April 2024. The primary endpoint was the occurrence of rehospitalization due to HF during the follow-up. Adverse reactions during the follow-up were also recorded. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was used for comparisons between groups. A multivariate Cox proportional hazards model was employed to analyze the factors influencing rehospitalization events.

The average age of the patients was (70.1±3.8) years. There were no statistically significant differences in baseline characteristics between the two groups (P>0.05). After 6 months of treatment, both the dapagliflozin group and the control group showed decreased levels of fasting plasma glucose (FPG) and glycated hemoglobin (HbA_1c), and increased estimated glomerular filtration rate (eGFR) (P<0.05). At 6 months post-treatment, the dapagliflozin group had lower FPG and HbA_1c levels and higher eGFR levels compared to the control group (P<0.05). Additionally, the left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), early diastolic mitral valve flow velocity (E) /early diastolic mitral annular peak velocity (e'), left atrial volume index (LAVI), and left ventricular mass index (LVMI) decreased in both groups, while the left ventricular ejection fraction (LVEF) increased compared to pre-treatment levels (P<0.05). At 6 months post-treatment, the dapagliflozin group had lower LVEDD, IVST, LVPWT, LVMI, LAVI, and E/e', and higher LVEF compared to the control group (P<0.05). Levels of high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) decreased in both groups after 6 months of treatment (P<0.05). At 6 months post-treatment, the dapagliflozin group had lower hs-cTnI and NT-proBNP levels compared to the control group (P<0.05). During the 6-month follow-up, 5 patients (10.6%) in the dapagliflozin group and 13 patients (28.3%) in the control group were rehospitalized due to HF. Kaplan-Meier survival analysis showed a statistically significant difference in cumulative rehospitalization-free survival rates between the two groups (χ²=4.517 9, P=0.032 6). Multivariate Cox regression analysis results indicated that the use of dapagliflozin (HR=0.325, 95%CI=0.116-0.912, P=0.033), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitors (HR=0.562, 95%CI=0.236-0.949, P=0.035), and spironolactone (HR=0.836, 95%CI=0.710-0.985, P=0.037) were protective factors against rehospitalization events, while increasing age (HR=1.343, 95%CI=1.198-1.506, P<0.001), higher BMI (HR=1.305, 95%CI=1.111-1.532, P=0.001), and the use of anthracyclines (HR=1.197, 95%CI=1.035-1.384, P=0.023) were risk factors for increased rehospitalization events.

In elderly breast cancer survivors with HFpEF and type 2 diabetes, dapagliflozin not only effectively controls blood glucose and improves renal function but also significantly improves cardiac function, enhancing long-term prognosis.

Myocardial fibrosis plays a significant role in the process of myocardial remodeling in patients with heart failure. Periostin is a non-structural protein in the myocardial interstitium, which can bind to other proteins in the myocardial interstitium, promote their deposition in the myocardial interstitium, and cause myocardial fibrosis. However, whether it can serve as a biological marker for myocardial fibrosis remains unclear.

To investigate the correlation between plasma periostin levels and myocardial fibrosis, as well as the relationship with adverse prognosis in patients with chronic heart failure.

Patients with chronic heart failure admitted to the Department of Cardiology of the First Hospital of Lanzhou University from September 2021 to September 2022 were enrolled in this study. General information and laboratory test results of the patients were collected. Plasma periostin levels were measured using enzyme-linked immunosorbent assay. Echocardiography was used to collect cardiac function indicators, and cardiac magnetic resonance imaging and late gadolinium enhancement (LGE) quantitative analysis results were obtained. After discharge, patients were followed up through outpatient visits or telephone calls, with the endpoint events being re-hospitalization for heart failure, worsening of heart failure, and cardiovascular death. Pearson correlation analysis or Spearman rank correlation analysis was used to explore the correlation between plasma periostin levels and clinical parameters. Multiple linear stepwise regression analysis was conducted to identify the influencing factors of plasma periostin levels. Kaplan-Meier survival curves were plotted for patients with different plasma periostin levels, and the curves were compared using the log-rank test. Multivariate Cox regression analysis was performed to investigate the influencing factors of the occurrence of endpoint events.

A total of 98 patients completed the follow-up, including 66 males and 32 females, with a mean age of 51.8±13.7 years and a mean plasma periostin level of 317.5±300.6 ng/mL. The patients were divided into three groups according to the tertiles of plasma periostin levels: Group Q1 (plasma periostin ≤174.1 ng/mL, n=32), Group Q2 (174.1 ng/mL<plasma periostin ≤265.1 ng/mL, n=34), and Group Q3 (plasma periostin >265.1 ng/mL, n=32). There were statistically significant differences among Groups Q1-Q3 in the proportion of atrial fibrillation, homocysteine (Hcy), plasma periostin, left atrial diameter (LAD), LGE%, worsening of heart failure, and composite endpoint events (P<0.05). The correlation analysis showed that LGE%, LAD, serum creatinine, N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), type 2 diabetes mellitus, and New York Heart Association (NYHA) functional class were positively correlated with periostin levels (P<0.05), while left ventricular ejection fraction (LVEF) was negatively correlated with periostin levels (P<0.05). The results of multiple linear stepwise regression analysis indicated that LGE%, LAD, type 2 diabetes mellitus, and NT-proBNP were influencing factors of periostin levels (P<0.05) .

PIn patients with chronic heart failure, plasma periostin levels are positively correlated with the degree of myocardial fibrosis and are associated with the composite endpoint events of re-hospitalization for heart failure, worsening of heart failure, and cardiovascular death. Elevated levels of plasma periostin can lead to the occurrence of composite endpoint events.

More and more studies have proved that heart failure with supra-normal ejection fraction (HFsnEF) is a new heart failure phenotype with different characteristics, but its study is still in the exploratory stage at home and abroad. The critical value of supernormal ejection fraction (snLVEF) is still controversial, but most studies define it as left ventricular ejection fraction>65%; the proportion of elderly and female patients with HFsnEF is higher, with lower natriuretic peptide values and smaller left ventricles, and valvular disease, arrhythmia, and hypertensive heart disease are the main causes of heart failure; and the relationship between HFsnEF and mortality has a gender-dependent nature, possibly due to the prevalence of coronary microvascular disorders in elderly women, coupled with small heart size and high sympathetic excitability, making them more likely to suffer cardiovascular events; the current diagnosis and treatment of HFsnEF still follows the HFpEF approach. By combing the literature, this paper systematically discusses the research progress of HFsnEF, with a view to providing a reference for the in-depth study of HFsnEF.

Insulin resistance (IR) is associated with atrial fibrillation (AF) and atrial remodeling, and the correlation of triacylglycerol glucose (TyG) index, a novel, simple, and valuable indicator of IR, with the development of AF in patients with chronic heart failure (CHF) has been poorly studied.

To investigate the correlation between TyG index and AF in patients with CHF.

A total of 417 CHF patients hospitalized in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Zhengzhou University from January 2021 to January 2022 were retrospectively selected for the study, and the CHF patients were divided into two groups according to whether they developed AF: the AF group (138 patients) and the non-AF group (279 patients). The TyG index was categorized into four levels based on quartiles: Q1 (TyG index ≤8.20), Q2 (8.20<TyG index≤8.44), Q3 (8.44<TyG index≤8.84), and Q4 (TyG index>8.84). Patients' baseline data, including TyG index and basic information, laboratory test indexes, and echocardiographic data, were collected through the hospital's electronic medical record system. The LASSO regression algorithm was used for variable screening, and multivariate Logistic regression was used to analyze the correlation between TyG index and the risk of AF occurrence in patients with CHF and to construct a regression model. The predictive value of TyG index for the occurrence of AF in CHF patients was also analyzed using the subject work characteristics curve. Restricted cubic spline plots of the correlation between TyG index and the risk of developing AF in CHF patients were plotted.

Patients in the AF group had higher BMI, New York Heart Association cardiac function class Ⅲ-Ⅳ, proportion of hypertension, serum uric acid (SUA), triacylglycerol, blood urea nitrogen (BUN), fasting blood glucose, N-terminal B-type natriuretic peptide precursor, TyG index, left atrial diameter (LAD), the proportions of β-blockers, calcium antagonists, and diuretics were higher than those in the non-AF group; total cholesterol (TC), endogenous creatinine clearance (Ccr), left ventricular ejection fraction, and the proportion of angiotensin-converting enzyme inhibitors/angiotensin Ⅱ receptor blockers (ACEI/ARB) class of drug use was lower than that of the non-AF group (P<0.05). The results of multivariate Logistic regression analysis showed that the combination of hypertension (OR=1.749, 95%CI=1.048-2.918, P=0.032), elevated BUN (OR=1.269, 95%CI=1.104-1.457, P=0.001), elevated SUA (OR=1.002, 95%CI=1.000-1.005, P=0.047), elevated TyG index (OR=2.360, 95%CI=1.397-3.987, P=0.001), elevated LAD (OR=1.065, 95%CI=1.034-1.097, P<0.001), and use of diuretics (OR=4.019, 95%CI=2.140-7.548, P<0.001) were risk factors for the development of AF in patients with CHF; Ccr (OR=0.985, 95%CI=0.975-0.996, P=0.006), TC (OR=0.587, 95%CI=0.445-0.775, P<0.001), and the proportion of ACEI/ARB class of drug (OR=0.427, 95%CI=0.253-0.718, P= 0.001) were protective factors for the development of AF in patients with CHF. After fully adjusting for confounders, the risk of AF occurrence in CHF patients at the Q2, Q3, and Q4 levels of TyG index was 1.902, 2.060, and 2.841 times higher than that at the Q1 level (P<0.05). Restricted cubic spline analysis showed a linear positive correlation between TyG index and the risk of developing AF (P_nonlinear=0.494). The area under the curve of TyG index and LASSO-Logistic regression model for predicting the development of AF in patients with CHF were 0.661 (95%CI=0.608-0.724, P<0.001), 0.843 (95%CI=0.803-0.882, P<0.001). In addition, the correlation between TyG index and AF was consistent across subgroups.

The TyG index is independently associated with the AF in patients with CHF, with significant clinical value in predicting AF.

The comprehensive management of heart failure in conjunction with frailty necessitates a multidimensional approach to frailty assessment. However, the social frailty, despite being an incremental predictor of negative health outcomes in heart failure patients, has not been adequately addressed.

To understand the current status of social frailty in patients with chronic heart failure and analyze its influencing factors.

From September 2022 to July 2023, convenience sampling was used to select patients with chronic heart failure from the First Affiliated Hospital with Nanjing Medical University as the research objects, the general information questionnaire, the HALFT Scale, the Loneliness Scale, the Brief 2-Way Social Support Scale, Personal Mastery Scale, and the Patient Health Questionnaire were used to investigate. Univariate analysis and support vector machine-feature recursive elimination were used to filter the feature, SVM classification model was constructed, and SHAP value was introduced to analyze the influencing factors.

A total of 228 patients were screened in this study, of which 8 patients refused to fill in. A total of 220 questionnaires were distributed and 213 valid questionnaires were returned, with an effective recovery rate of 96.81%. The proportion of pre-social frailty and social frailty in patients with chronic heart failure was 46.0% (98/213) and 17.8% (38/213), respectively. Statistically significant differences were observed among chronic heart failure patients with different degrees of social frailty in terms of education level, place of residence, working status, economic burden of disease, personal monthly income, course of disease, exercise habits, medical satisfaction, traffic, the UCLA Loneliness Scale score, the Brief 2-Way Social Support Scale score, the PMS score, and the PHQ-9 score. When the SVM-RFE model play the best performance, the optimal feature subset was used to construct the SVM classification prediction model and perform SHAP interpretability analysis. The accuracy of the model was 0.73 in the training set and 0.63 in the test set, respectively. At this time, the ranking of feature importance from high to low was no exercise habit (+), personal mastery (-), heavy economic burden of disease (+), 2-way social support (-), depression (+), loneliness (+), unemployment (+) .

Patients with chronic heart failure experiencing severe social frailty. Healthcare providers should prioritize identifying and addressing the resource deficits of patients and the underlying factors contributing to social frailty. Targeted interventions should be implemented to mitigate social frailty in patients with heart failure by enhancing external support systems, fostering positive beliefs, addressing negative emotional experiences, developing comprehensive management plans, coordinating medical resources, and implementing strategies to delay or reverse social frailty progression. These interventions aim to enhance the prognosis and quality of life for patients with heart failure.

Heart failure patients are prone to depression, and interact with each other, leading to lower quality of life and poor prognosis of patients. As the largest microecosystem in the human body, changes in the composition, structure and function of the gut microbiota are closely related to the physiological and pathological states of the host. Currently, the "gut-heart/brain axis" has been used to explain the link between gut microbiota, cardiovascular diseases, and mood states, which is an important comorbid basis for heart failure and depression. In this paper, we reviewed the mechanisms of gut microbiota, metabolites, and vagus nerve in the development of heart failure and depression, and propose that mediterranean diet, probiotics, and microbiota transplantation have the potential to improve the "microbiota-gut-heart/brain axis", providing a new perspective for the treatment of heart failure patients comorbid with depression.

Nowadays, cardiac rehabilitation is mostly transferred from the hospital to a home environment. Mobile health applications assist patients in bridging the support gap from hospital to home environment, which encourages home-based recovery processes. Unfortunately, numerous quality difficulties accompany its promise, and the service quality of cardiac rehabilitation applications must be ＂confirmed＂ as soon as possible.

To develop a quality assessment indicator system for home-based rehabilitation APP services for heart failure patients, and to provide a model for standardizing and increasing the quality of mobile health APP.

This study was conducted from July 2022 to January 2023, using semi-structured interviews, literature review, the expert consultation method and analytic hierarchy process (AHP) to determine the content of indicator system and the weight for each index.

2 rounds of expert consultations resulted in the effective response rates of 100%, with the authority coefficients of 0.867, and the coordination coefficients of 0.128-0.154 and 0.151-0.197 respectively (P<0.001). As a result, an assessment indicator system for home-based rehabilitation APP services for heart failure patients was developed from three dimensions: software usability, medical professionalism, and behavioral science, with 7 primary indicators, 24 secondary indicators, and 51 tertiary indicators.

The developed quality assessment indicator system for home-based rehabilitation APP services for heart failure patients is comprehensive and scientific, and can be useful for assessing and measuring the quality of heart rehabilitation APP services, as well as facilitating the benign development of similar APP services.

The maintenance of exercise rehabilitation effect in patients with chronic heart failure depends on good adherence to exercise rehabilitation. It is of great practical significance to evaluate the adherence to exercise rehabilitation effectively and scientifically, however, there is still a lack of accepted tools to evaluate the adherence to exercise rehabilitation in patients with chronic heart failure at home and abroad.

To develop an exercise rehabilitation adherence scale for patients with chronic heart failure, and provide a scientific and appropriate tool for the rapid and convenient evaluation of adherence to exercise rehabilitation in patients with chronic heart failure.

Based on the previous summary of the best evidence and qualitative research on exercise rehabilitation of patients with chronic heart failure, the initial pool of entries was formed through literature review, combining the opinions of the research group; the clinical test version of the scale was formed based on a small sample pre-survey and Delphi expert correspondence. Patients with stable chronic heart failure who were treated in the cardiovascular department from three tertiary-level hospitals in Jiangsu Province from November 2020 to January 2021 were selected as the study subjects using a convenience sampling method. In the first phase, 274 valid scales were recovered, aiming to screen the items of the scale and conduct exploratory factor analysis by combining item response theory and classical test theory to form the official version of the scale; in the second phase, 282 valid scales were recovered, aiming to perform confirmatory factor analysis and test on reliability and validity of the official version of the scale to form the final version of the scale.

The formal scale consisted of 11 items in 2 dimensions. The difficulty of each item was reasonable without no inverse threshold, and the item differentiation, item information content, and item characteristic curve were all superior. The total Cronbach's α coefficient of the exercise rehabilitation adherence scale for patients with chronic heart failure was 0.905, of which the dimension of "prescription adherence" was 0.895, the dimension of "monitoring adherence" was 0.910. The total Spearman-Brown split reliability coefficient of the scale was 0.724, and the retest reliability was 0.902. The results of exploratory factor analysis showed that the two factors could explain 70.231% of the total variation. The results of further confirmatory factor analysis showed that the model was better fitted with each parameter.

The exercise rehabilitation adherence scale for patients with chronic heart failure developed in the study is reasonable in terms of item difficulty, differentiation, the information content of the items is good with high reliability and validity, which can be used as an evaluation tool for adherence to exercise rehabilitation in patients with chronic heart failure.

Heart failure is a cardiovascular disease that poses a serious health risk to the global population and is characterised by a chronic and prolonged disease course. Effective management centered on home care is essential for controlling symptoms and improving patient prognosis. Electronic health (e-health) technology is one of the hotspots in the research field of home management of heart failure, with the advantage of overcoming temporal and spatial barriers, and can achieve continuous monitoring, intelligent assessment, and dynamic management of the health status of patients at home. This paper systematically sorts out the related research on e-health in home management of patients with heart failure, and discusses its application value in drug management, exercise rehabilitation, symptom management, risk profile, and other aspects of patients with heart failure. It also analyzes and prospects the limitations of the e-health system such as poor digital inclusion, imperfect operation system, and risk of data security. The purpose of this study is to provide reference for the innovation of home management model for patients with heart failure.

As a crucial component of the cardiac autonomic nervous system, the cardiac vagus nerve plays a significant role in the management of chronic heart failure. In recent years, several studies have found that vagus nerve stimulation protects cardiac function and delays the progression of chronic heart failure by reducing the expression of inflammatory factors and related proteins, apoptosis-related proteins, and improving myocardial function and ventricular remodeling. However, there are limited reports related to the mechanism of inflammation and apoptosis of the vagus nerve in chronic heart failure. Hence, this article reviews the anatomy of the cardiac vagus nerve, potential treatment mechanisms, practical parameters of vagus nerve stimulation, and the recent applications and clinical progress of vagus nerve stimulation in inflammation and apoptosis mechanisms in chronic heart failure, in order to provide a reference for the future related research.

Diuretic resistance is associated with increased mortality in patients with heart failure (HF). Qi Li Qiang Xin Jiao Nang, a Traditional Chinese Medicine, are used in the treatment of HF. However, clinical evidence of their effectiveness in improving diuretic resistance is lacking.

To investigate whether Qi Li Qiang Xin Jiao Nang can reduce the risk of diuretic resistance and improve prognosis in patients with acute decompensated chronic heart failure (ADCHF) .

This study included 374 HF patients treated in the CICU ward of Tianjin University Chest Hospital from January 2018 to June 2022. Patients were divided into diuretic resistance (118 patients) and non-diuretic resistance groups (256 patients) based on the occurrence of diuretic resistance. Patient data and laboratory results were collected. A 12-month follow-up was conducted to observe rehospitalization due to cardiovascular events or all-cause mortality. Kaplan-Meyer survival curves were plotted for each group, and the Log-rank test was used for comparison. Multivariate Logistic regression analysis was performed to explore factors influencing diuretic resistance. Multivariable Cox regression analysis was used to explore factors affecting the occurrence of endpoint events in ADCHF patients.

The diuretic resistance group showed higher age, body mass, NT-proBNP, blood urea nitrogen, creatinine, uric acid, and international normalized ratio (INR) but lower 24-hour fluid intake, estimated glomerular filtration rate (eGFR), lymphocyte count, and usage of Qi Li Qiang Xin Jiao Nang. Multivariate Logistic regression analysis indicated that the use of Qi Li Qiang Xin Jiao Nang (OR=0.363, 95%CI=0.186-0.708, P=0.003) and increased 24-hour fluid intake (OR=0.286, 95%CI=0.177-0.461, P<0.001) were protective factors against diuretic resistance in ADCHF patients. Increased body mass (OR=1.064, 95%CI=1.040-1.088, P<0.001) and elevated uric acid (OR=1.002, 95%CI=1.000-1.004, P=0.027) were risk factors. Log-rank test results showed that the average survival time without endpoint events was shorter in the diuretic resistance group (χ²=11.866, P=0.001) and in patients not using Qi Li Qiang Xin Jiao Nang (χ²=6.502, P=0.011). Multivariable Cox regression analysis revealed that the use of Qi Li Qiang Xin Jiao Nang (HR=0.536, 95%CI=0.308-0.933, P=0.027) and angiotensin receptor enkephalase inhibitors/angiotensin converting enzyme inhibitors/angiotensin receptor blockers (HR=0.435, 95%CI=0.229-0.826, P=0.011) were protective factors against endpoint events, while increased total bilirubin (HR=1.019, 95%CI=1.008-1.030, P=0.001) and total bile acids (HR=1.029, 95%CI=1.002-1.058, P=0.036) were risk factors.

The use of Qi Li Qiang Xin Jiao Nang in addition to standard HF treatment can reduce the risk of diuretic resistance in patients with ADCHF and decrease the risk of rehospitalization due to cardiovascular events or all-cause mortality within one year.

There are many tools for symptom assessment of patients with heart failure, but there is a lack of standardized evaluation studies on the quality of such tools, which brings difficulties to the selection of tools.

To evaluate the measurement property and methodological quality of symptom assessment tools in patients with heart failure, and to provide reference for relevant personnel to choose symptom assessment tools.

The Chinese and English databases such as PubMed, Embase, and CNKI were searched for relevant studies from the date of library construction to July 30, 2023. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline was employed to evaluate the scale and form recommendations.

Eleven studies were included for quality assessment, including eight tools for assessing symptoms in patients with heart failure: Chinese version of Memorial Symptom Assessment Scale Heart Failure (MSAS-HF), Heart Failure Somatic Perception Scale (HF-SPS), M.D.Anderson Symptom Inventory Heart Failure (MDASI-HF), Symptom Status Questionnaire Heart Failure (SSQ-HF), Shortness of Breath in Heart Failure Instrument (SOB-HF), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Chronic Heart Failure Assessment Tool (CHAT) and Kansas City Cardiomyopathy Questionnaire (KCCQ). Regarding the measurement property, scales such as Chinese version of MSAS-HF, MDASI-HF, MLHFQ, and KCCQ were demonstrated a "sufficient" level of content validity. Conversely, HF-SPS, SSQ-HF, and SOB-HF were exhibited an "uncertain" level of content validity, while CHAT was categorized as having "insufficient" content validity. Finally, Chinese version of MSAS-HF and MLHFQ were recommended as level A, and the other six scales were recommended as level B.

Certainly, both Chinese version of MSAS-HF and MLHFQ demonstrate a remarkable level of reliability. Considering the distinct attributes of assessment tools, it is highly advisable to utilize Chinese version of MSAS-HF for the purpose of symptom assessment in patients suffering from heart failure.

Insulin resistance (IR) is closely related to the development and progression of cardiovascular disease, and several studies have now demonstrated that IR is highly prevalent in patients with heart failure (HF) and is associated with adverse cardiovascular outcomes, whereas the association between the Metabolic Score of Insulin Resistance (Mets-IR), an indicator reflecting IR, and the poor prognosis in patients with chronic heart failure (CHF) is currently unknown.

To analyse the correlation between Mets-IR and poor prognosis in patients with CHF.

This was a retrospective study, and 313 patients who were diagnosed with CHF in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Zhengzhou University from January 2020 to January 2021 were selected as study subjects. The patients were divided into two groups according to whether all-cause mortality occurred: the all-cause mortality group (61 cases) and the control group (252 cases). Mets-IR was analysed as a categorical variable, and Mets-IR was classified into two categories by median: low level Mets-IR (Mets-IR<37.28) and high level Mets-IR (Mets-IR≥37.28). Patients' baseline data, which included Mets-IR and their age, serum biomarkers and echocardiographic indices, were collected and followed up until 2022-12-31, and patients' prognosis was collected through our electronic medical record system or telephone follow-up, with the primary endpoint event being all-cause mortality and the secondary endpoint event being readmission due to HF. Survival curves for all-cause mortality and readmission due to HF in patients with different levels of Mets-IR were analysed using Kaplan-Meier plots and Log-rank tests. Cox proportional hazards regression model was applied to analyse the correlation between Mets-IR and the risk of all-cause mortality and readmission due to HF. Receiver operating characteristic (ROC) curves were constructed to analyse the predictive value of Mets-IR for the risk of all-cause mortality and readmission due to HF in CHF patients.

At a median follow-up of 25.0 (9.0, 28.5) months, 61 (19.5%) all-cause mortality and 121 (38.7%) readmissions due to HF occurred in 313 CHF patients. Patients in the all-cause mortality group had higher age, BMI, fasting glucose, Mets-IR, N-terminal B-type natriuretic peptide precursor, blood uric acid, neutrophil count, erythrocyte distribution width, atrial fibrillation, hypertension, diuretics, aldosterone receptor antagonist, and New York Heart Association classification than controls, and triacylglycerol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, albumin, haemoglobin, blood sodium, left ventricular ejection fraction, and angiotensin-converting enzyme inhibitor/angiotensin receptor antagonist /angiotensin receptor-enkephalinase inhibitor were lower than those of the control group (P<0.05) .The results of the log-rank test showed that the all-cause mortality rate and the readmission rate due to HF were both higher in the patients with high-level Mets-IR than those with low-level Mets-IR (P<0.001). Cox proportional hazards regression analysis after adjusting for several confounders showed that compared with low-level Mets-IR patients, high-level Mets-IR patients had higher risks of all-cause mortality (HR=2.90, 95%CI=1.51-5.54, P=0.001) and readmission due to HF (HR=1.55, 95%CI=1.04-2.30, P=0.030). The area under the ROC curve for Mets-IR to predict the risk of all-cause mortality and the risk of readmission due to HF were 0.68 (95%CI=0.62-0.75) and 0.62 (95%CI=0.55-0.68) .

Elevated Mets-IR levels may increase the risk of all-cause mortality and readmission due to HF in patients with CHF, and can be used for risk stratification of CHF patients.

Heart failure (HF) is known to be one of the major problems in the cardiovascular field needed to be urgently addressed due to its high incidence, high mortality and poor prognosis. Searching for the optimal risk assessment method is currently a priority effort in this field. Recent studies have identified inflammation as one of the important pathophysiological mechanisms in the development and progress of HF, the detection and evaluation of multiple inflammatory indicators may be an important method to predict the regression of HF, therefore, exploration of simple and easy-to-perform inflammatory predictors with the optimal comprehensive performance is becoming a focus of attention.

To explore the predictive value of (neutrophil + monocyte) /lymphocyte ratio (NMLR) in peripheral blood on the in-hospital mortality of HF patients.

A total of 583 patients with HF admitted to Puyang Oilfield General Hospital from January 2020 to September 2022 were collected and divided into the survival group (n=564) and the death group (n=19) according to the occurrence of all-cause death during hospitalization. The baseline data was collected including demographic characteristic, complications, primary disease and laboratory test results; multivariate Cox analysis was used to explore the influencing factors of in-hospital mortality in HF patients; restrictive cubic spline (RCS) was used to determine the relationship between NMLR and in-hospital mortality in HF patients; receiver operating characteristic (ROC) curve was plotted to explore the predictive value of NMLR for in-hospital mortality of HF patients and calculate the optimal cut-off value; Kaplan-Meier method was used to plot the survival curves of patients with different NMLR values.

The NMLR at admission in the death group〔8.36 (3.15, 9.55) 〕 was higher than that in the survival group〔5.00 (3.23, 8.72) 〕 (P<0.05), The results of multivariate Cox proportional hazards regression model showed that NMLR was the influencing factor of in-hospital mortality in HF patients〔HR=1.003, 95%CI (1.001, 1.005), P<0.05〕; the area under ROC curve for NMLR to predict in-hospital mortality of HF patients was 0.704〔95%CI (0.652, 0.757) 〕, with the optimal cut-off value of 7.93. The RCS showed a non-linear positive correlation between the NMLR value and the risk of in-hospital mortality in patients with HF (P<0.05). The in-hospital survival was lower in patients with NMLR≥7.93 than those with NMLR<7.93 (χ²=111.843, P<0.001) .

The elevated NMLR value at admission maybe an independent predictor of in-hospital mortality in HF patients.

The intestinal flora and its metabolites play an important role in the pathology of chronic heart failure (CHF), which is a severe manifestation or terminal stage of various cardiovascular diseases. Increasing evidence has shown that dysbiosis of the intestinal flora and its metabolites can lead to bacterial translocation, release of mediators, inflammatory response and consequently aggravation of CHF.

To analyze the changes of intestinal flora and its metabolite phenylacetylglutamine (PAGln) in patients with CHF and explore the role played by gut microbiota in heart failure.

A total of 58 patients with heart failure admitted to the Department of Cardiology of the South Branch of the Sixth People's Hospital of Shanghai Jiaotong University were selected as the CHF group, and 46 patients with the same CHF risk factors but without clinical symptoms and past medical history of CHF were selected as the control group from June 2021 to June 2022. Plotting ROC curves of brain natriuretic peptide (BNP) and PAGln for the diagnosis of CHF. The abundance and diversity of intestinal flora in the two groups were analyzed using 16S rRNA sequencing. Liquid chromatography with tandem mass spectrometry (LC-MS/MS) was used to detect PAGln concentrations in the plasma of samples from both two groups.

The left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), BNP, and PAGln in the CHF group were higher than the control group, and the left ventricular ejection fraction (LVEF) was lower than the control group (P<0.05). The area under curve (AUC) of BNP and PAGln levels for the diagnosisof CHF patients was 0.995 and 0.913, respectively. Venn diagram showed that the number of OTUs specific to the CHF group was less than the control group. Alpha diversity analysis showed that the Chao1 index was lower in the CHF group than the control group (P<0.05). β diversity analysis showed that the overall structure of the intestinal flora differed between the two groups. At the genus level, the relative abundances of Escherichia-Shigella, Megamonas, Klebsiella, Bifidobacterium, Parabacteroides, and Romboutsia were higher in the CHF group than the control group (P<0.05), and the relative abundances of Solimonas and Dorea were lower than the control group (P<0.05). The results of LEfSe analysis showed that Lachnospiraceae, Solimonadaceae, Solimonas, Dorea, and Burkholderiaceae were elevated in the control group (P<0.05), and Enterobacteriaceae, Escherichia, Bifidobacterium, Bifidobacteriaceae, Klebsiella, Lactobacillaceae, Lactobacillus, Megamonas, Rikenellaceae, Alistipes, Parabacteroides, and Tannerellaceae were elevated in the CHF group (P<0.05). Typical correlation analysis (CCA) showed that BNP, PAGln, LVEDD, and LVESD were significantly correlated with the CHF group, with BNP having the greatest effect on community changes. Correlation analysis showed that Escherichia-Shigella was positively correlated with BNP and PAGln (P<0.05) ; Bacteroides was negatively correlated with BNP; Romboutsia, Fusobacterium, and Phascolarctobacterium were negatively correlated with BNP and PAGln (P<0.05) .

The structural composition of the intestinal flora in patients with CHF was significantly different from the patients with the same co-morbidities but without clinical manifestations and previous medical history of CHF, with a decrease in flora diversity and a significant increase in the abundance of pathogenic intestinal bacteria, which may lead to an increase in the level of PAGln in CHF patients and participate in the development of CHF.

Diabetes mellitus has been a major concern as a common risk factor for cardiovascular disease. Glycated hemoglobin (HbA_1c) variability is an indicator of long-term blood glucose fluctuation. Therefore, it is of great clinical significance to explore the correlation between HbA_1c variability and new-onset atrial fibrillation (AF) in diabetic patients combined with heart failure with preserved ejection fraction (HFpEF) .

To investigate the correlation between HbA_1c variability and new onset AF in type 2 diabetes mellitus (T2DM) patients combined with HFpEF.

The clinical data of 317 T2DM patients combined with HFpEF diagnosed in the Department of Cardiology, the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2019 were retrospectively analyzed. The follow-up was performed until February 2022, with a mean follow-up time of 3.4 years. The included patients were divided into the AF group (34 cases) and non-AF group (283 cases) based on the presence of new-onset AF during the follow-up period. The HbA_1c variability was expressed as standard deviation of HbA_1c measurement (HbA_1c-SD) and HbA_1c coefficient of variation (HbA_1c-CV). Multivariate Cox regression analysis was used to explore the correlation between HbA_1c variability and new-onset AF in T2DM patients combined with HFpEF. The survival curves were plotted by the Kaplan-Meier (K-M) method. The receiver operating characteristic (ROC) curve of HbA_1c variability predicting new-onset AF in T2DM patients combined with HFpEF was plotted.

The HbA_1c-SD and HbA_1c-CV of patients in the AF group were higher than those in the non-AF group (P<0.05). The included patients were divided into the low HbA_1c variability (HbA_1c-SD≤0.34%, HbA_1c-CV≤4.74%) and high HbA_1c variability (HbA_1c-SD>0.34%, HbA_1c-CV>4.74%) groups according to the median of HbA_1c variability. Log-rank test results showed higher incidence of new-onset AF in patients with high HbA_1c variability (P_HbA1c-SD<0.001, P_HbA1c-CV=0.004). Multivariate Cox regression analysis showed that HbA_1c-SD〔HR=2.22, 95%CI (1.37, 3.61), P=0.001〕 and HbA_1c-CV〔HR=1.65, 95%CI (1.01, 2.67), P=0.001〕 were independent influencing factors for new-onset AF in T2DM patients combined with HFpEF. The AUC of HbA_1c-SD for predicting AF in T2DM patients combined with HFpEF was 0.784 〔95%CI (0.713, 0.855), P=0.001〕, with the optimum cutoff value of 0.36%, sensitivity and specificity of 79.4% and 73.1%, respectively. The AUC of HbA_1c-CV for predicting AF in patients with T2DM and HFpEF was 0.694 〔95%CI (0.591, 0.797), P<0.001〕, with the optimal cutoff value of 4.97%, sensitivity and specificity of 73.5% and 72.1%, respectively.

High HbA_1c variability (HbA_1c-SD>0.34%, HbA_1c-CV>4.74%) is independently associated with an increased risk of new-onset AF in T2DM patients combined with HFpEF, with significant clinical value in predicting AF.

The serum reverse triiodothyronine (rT₃) values of heart failure patients who died during hospitalization were found significantly higher than the upper limit of the biological reference interval in the clinical work of the author. The prediction of thyroid hormones, especially rT₃, on death during hospitalization of heart failure patients was rare reported in the previous studies, it is of great clinical significance to explore the indicators with predictive value for death during hospitalization in patients with heart failure.

To investigate the relationship between serum thyroid hormones and prognosis during hospitalization in patients with heart failure.

A total of 197 patients with heart failure admitted to Dongzhimen Hospital of Beijing University of Chinese Medicine from April 2019 to April 2022 were included in the study. Baseline data of the study subjects were collected by the electronic medical record system. Fasting venous blood of all subjects was collected within 24 h after admission for total triiodothyronine (TT₃), total thyroxine (TT₄), free triiodothyronine (FT₃), free thyroxine (FT₄), thyroid stimulating hormone (TSH), rT₃ and N-terminal brain natriuretic peptide precursor (NT-pro-BNP). Subjects were divided into death group (n=18) and non-death group (n=179) according to the occurrence of death during hospitalization. Multivariate Logistic regression analysis was used to investigate the influencing factors of death during hospitalization in patients with heart failure. Receiver operating curve (ROC curve) was plotted to evaluate the predictive value of related indicators on death during hospitalization in patients with heart failure, and the area under curve (AUC) of each indicator was calculated and compared by Delong test.

The age and rT₃ of death group were higher than those of non-death group, while FT₃, TT₃ and TSH of death group were lower than those of non-death group, with statistically significant differences (P<0.05). In the non-death group, 66 patients had normal thyroid function, 87 patients had low T₃ syndrome, 15 patients had high FT₄ alone, 3 patients had high TT₄ alone, 5 patients had both high TT₄ and FT₄, 1 patient had low TT₄ alone, 1 patient had high TT₃ alone, and 1 patient had high FT₃ alone. In the death group, 1 patient had normal thyroid function, 14 patients had low T₃ syndrome, and 3 patients had high FT₄ alone. There was significant difference in the incidence of low T₃ syndrome between the two groups (P<0.05). The results of multivariate Logistic regression analysis showed that rT₃ was an influencing factor for death during hospitalization in patients with heart failure〔OR=5.245, 95%CI (2.283, 12.050), P<0.05〕. ROC curve results showed that the AUC of rT₃ was 0.914〔95%CI (0.865, 0.962) 〕, which was higher than that of age (Z=3.137, P=0.002), FT₃ (Z=2.389, P=0.017), TT₃ (Z=2.123, P=0.034) and TSH (Z=3.056, P=0.002) .

Low T₃ syndrome may be a risk factor for death during hospitalization in patients with heart failure. Serum rT₃ is of high predictive value for the prognostic evaluation of patients with heart failure during hospitalization, which need more attention in clinical work.

There are numerous patients with diabetes complicated with heart failure. Dapagliflozin is a new hypoglycemic drug that has been used for heart failure according to guideline recommendation, however, its mechanism of improving heart function has not been fully defined.

To study the effects of dapagliflozin on the expression of plasma miRNA-423-5p and cardiac function in patients with type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) .

Fifty patients with T2DM complicated with CHF admitted to the 960th Hospital of PLA from April 1 to November 30, 2021 were enrolled and randomly divided into dapagliflozin group (n=25) and control group (n=25) . Both groups received the same treatment for six months except that dapagliflozin group received dapagliflozin 10 mg/d per day, and the control group received other hypoglycemic drugs. They were compared to healthy physical examinees with normal cardiac function (healthy group, n=25) . Basic data of the patients were collected through the electronic medical record system, including age, sex, smoking history, hypertension, blood pressure level, body mass index (BMI) , blood lipid, blood glucose, creatinine (Cr) , amino-terminal pro-B-type natriuretic peptide precursor (NT-proBNP) , alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , NYHA class, results of cardiac color ultrasound and drug combination. Blood samples were collected for the detection of miRNA-423-5p. A six-month follow-up was given to the patients with the time of first administration of dapagliflozin after inclusion as the starting point, during which patients' cardiac function indices and miRNA-423-5p were measured and collected at the end of four weeks of treatment, and their cardiac function indices, blood pressure level, ALT, AST, and Cr were measured at six months of treatment. Pearson correlation analysis or Spearman rank correlation analysis was used to analyze the correlation between miRNA-423-5p expression level and cardiac function indices of the patients.

After 6 months of intervention, left ventricular ejection fraction (LVEF) , stroke output (SV) and left ventricular short-axis shortening rate (LVFS) in daglizin group were higher than those in control group, while left ventricular end-diastolic diameter (LVEDD) was lower than those in control group (P<0.05) . After 4 weeks and 6 months of intervention, LVEDD in 2 groups was lower than before intervention, while LVEF, SV and LVFS in 2 groups were higher than before intervention (P<0.05) . After 4 weeks of intervention, the level of NT-proBNP and miRNA-423-5p in Dagliegine group was lower than that in control group (P<0.05) , the level of NT-proBNP and miRNA-423-5p in two groups after intervention was lower than that before intervention in the same group (P<0.05) . The results of correlation analysis showed that the expression level of miRNA-423-5p was positively correlated with the level of NT-proBNP (r_s=0.609, P<0.05) , and negatively correlated with the level of LVEF (r=-0.406, P<0.05) .

Dapagliflozin could improve cardiac function, reduce the levels of NT-proBNP and LVEDD, and increase the levels of LVEF, SV and LVFS in patients with T2DM and CHF, and the mechanism of action may be related to its regulation of the expression of plasma miRNA-423-5p .

Atrial fibrillation (AF) is a common clinical tachyarrhythmia with high prevalence, and a predisposing factor of stroke. In addition, it has a causal relationship with heart failure (HF) . Treatment options for AF have changed recently owing to the emergence of new drugs. Many investigations are focused on anticoagulant therapies for AF, but relevant multicenter investigations on AF and HF are rare.

To investigate the clinical characteristics and treatment of patients with AF combined with HF in Chongqing, China.

A total of 4 011 patients with AF and HF who were discharged from 21 hospitals in Chongqing in 2018 were included. Data were collected through the electronic medical record system of the hospitals, including sex, age, basic comorbid conditions, type of AF, NYHA class, thromboembolism history, bleeding history, Color Doppler echocardiography results, HF type and use of drugs (including antithrombotic drugs, rhythm/ventricular rate-control drugs, ACEIs/ARBs, cardiotonic drugs) . The risk of thromboembolism and bleeding were assessed using admission CHA₂DS₂-VASc score and HAS-BLED score. Sex, basic comorbid conditions, AF type, NYHA class, admission CHA₂DS₂-VASc score and HAS-BLED score, left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, endpoint events (thromboembolism and bleeding) , HF type, and treatment options were compared across three age groups (<65, 65-75, >75) and across patients by the level of hospitalized hospital (secondary and tertiary) .

In terms of clinical characteristics, the patients had an average age of (74.0±10.6) years, 2 279 (56.8%) were female. The top three prevalent basic comorbid conditions were coronary heart disease (65.1%) , hypertension (51.0%) , and diabetes (17.5%) . 3 346 (83.4%) patients with nonvalvular atrial fibrillation (NVAF) . NYHA class was Ⅲ and Ⅳ in 3 059 patients (76.3%) , thromboembolism events occurred in 531 patients (13.2%) , and bleeding events occurred in 176 patients (4.4%) . In Color Doppler echocardiography results, The average left atrial diameter was (44.12±9.21) mm. The average left ventricular end-diastolic diameter was (48.45±10.06) mm. The average left ventricular ejection fraction was (54.23±11.94) mm. The main type of HF was HF with preserved ejection fraction, accounting for 66.2%. The average CHA₂DS₂-VASc score was (3.9±1.5) points, and the admission CHA₂DS₂-VASc score was positively correlated with age (r=0.589, P<0.001) . The average HAS-BLED score was (1.7±1.0) points. 3 641 (90.8%) patients were at high risk of thromboembolism and 723 (18.0%) patients were at high risk of bleeding. In terms of antithrombotic treatment, the overall prevalence of anticoagulation treatment was 47.1%, warfarin was the main anticoagulant (37.8%) , the prevalence of use of the new oral anticoagulant was only 9.3%. The overall prevalence of antiplatelet treatment was 44.6%, most of them were monoclonal antiplatelet agents (13.2%) . The prevalence of anticoagulation treatment decreased with age (χ²_trend=136.502, P<0.001) , but that of antiplatelet treatment increased with age (χ²_trend=135.730, P<0.001) . The prevalence of anticoagulation treatment, and use of warfarin and new oral anticoagulants in secondary hospitals was significantly lower than that in tertiary hospitals (P<0.001) . A total of 3 162 (78.8%) patients with atrial fibrillation received ventricular rate control. The prevalence of use of beta-blockers, digoxin and ACEIs/ARBs was 61.6%, 17.6%, and 59.7%, respectively.

The majority of patients with AF complicated with HF in Chongqing are elderly, and the proportion of women is relatively high. HFpEF is the main type of atrial fibrillation, and the NYHA classification is mainly classⅢandⅣ. Most were at high risk for thromboembolism, but less than 1/4 were at high risk of bleeding. The prevalence of antithrombotic treatmentin all ages and levels of hospitals was unsatisfactory, and there was a large gap between current treatment and guideline recommendations in improving HF. In view of this, hospitalphysicians should increase their awareness and capability of standardized diagnosis and treatmentregarding AF with HF.

The prevalence of heart failure (HF) is growing in a rapidly increased number of older adults (≥60 years) , which, together with older age, produces an impact on nutritional status of the HF cases. But there are relatively few studies on the impact of nutritional status on the prognosis in elderly patients with chronic HF.

To investigate the association of nutritional status with prognosis in elderly patients with HF with preserved ejection fraction (HFpEF) and coronary heart disease.

A retrospective cohort study was conducted. Inpatients with HFpEF and coronary heart disease (≥60 years old, NYHA gradeⅡ-Ⅳ) treated in Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University between 2017 and 2019 were enrolled. Clinical and laboratory data were collected. HF-related readmission and all-cause mortality within one year after discharge were followed up. Nutritional status was evaluated by controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) . Patients were divided into non-malnutrition group (CONUT score 0-1, n=42) , low malnutrition risk group (CONUT score 2-4, n=181) and medium-high malnutrition risk group (CONUT score 5-12, n=156) . The differences in clinical data and prognosis among the three groups were compared. Univariate and multivariate logistic regression analyses were used to explore the influencing factors of readmission due to HF and all-cause mortality within one year after discharge. ROC analysis was used to analyze the prognostic value of CONUT score, GNRI and PNI for readmission due to HF and all-cause mortality within 1 year after discharge.

Age, proportion of elderly patients, sex, BMI, bed rest, length of hospital stay, NYHA grade, hemoglobin, lymphocytes, urea nitrogen, creatinine, total protein, albumin, triacylglycerol, total cholesterol, low density lipoprotein cholesterol, B-type brain natriuretic peptide (BNP) , all-cause death within 1 year were compared among the three groups, and there were statistically significant differences (P<0.05) ; among them, age, proportion of elderly patients, bed rest, length of hospital stay, NYHA grade, old myocardial infarction, urea nitrogen, creatinine, BNP, and all-cause death within 1 year in the no-malnutrition risk group and the low-malnutrition risk group were significantly lower than those in the medium-high malnutrition risk group (P<0.05) , and BMI, hemoglobin, lymphocytes, total protein, albumin, triacylglycerol, total cholesterol and low-density lipoprotein cholesterol were significantly higher than those in the medium-high malnutrition risk group (P<0.05) . Univariate logistic regression analysis showed that age, bed rest, length of stay, NYHA grade, hemoglobin, albumin, BNP, left ventricular ejection fraction, CONUT score, GNRI and PNI are the influencing factors of readmission due to HF and all-cause death within 1 year (P<0.05) . Multivariate logistic regression analysis showed that CONUT score〔OR=1.567, 95%CI (1.302, 1.885) , P<0.05〕 is an influence factor of all-cause death within 1 year (P<0.05) . ROC analysis estimating the performance in predicting all-cause mortality within one year after discharge showed that the AUC of CONUT score was 0.780〔95%CI (0.714, 0.845) 〕 with 0.723 sensitivity and 0.722 specificity when the optimal cut-off value was determined as 7.5, the AUC of GNRI was 0.695〔95%CI (0.604, 0.786) 〕with 0.532 sensitivity and 0.833 specificity when the optimal cut-off value was determined as 89, and the AUC of PNI was 0.722〔95%CI (0.643, 0.800) 〕 with 0.723 sensitivity and 0.654 specificity when the optimal cut-off value was determined as 41.

CONUT score can be used as the preferred nutritional evaluation tool for mortality risk assessment in elderly patients with HFpEF and coronary heart disease, and nutritional intervention may become one of the therapeutic targets for reducing mortality in the future.

Tolvaptan is widely used in elderly patients with chronic heart failure (CHF) , but the effect of different doses of tolvaptan on the prognosis of elderly CHF patients is unclear.

To investigate the effect of two commonly used doses of tolvaptan, 7.5 mg/d and 15.0 mg/d, on the prognosis of elderly patients with CHF.

This is a retrospective cohort study. This study selected patients (age≥80 years) with CHF treated with tolvaptan in the health care ward of the 960th Hospital of PLA Joint Logistics Support Force of China from February 2016 to February 2022, and analyzed their clinical data. The patients were divided into 7.5 mg/d and 15.0 mg/d groups based on the dose of tolvaptan. The end point of follow-up was the occurrence of all-cause mortality or cardiovascular mortality or until the end of follow-up. This study used Kaplan-Meier method to perform survival curves analysis and used Cox proportional hazards regression models to analyze the effect of two doses of tolvaptan on all-cause mortality and cardiovascular mortality in elderly patients with CHF.

This study enrolled 212 elderly patients with CHF, and the follow-up was 374.5 (155.5, 940.5) days. 124 (58.5%) patients died from all-cause mortality and 54 (25.5%) patients died from cardiovascular mortality during the follow-up. Kaplan-Meier survival curve showed that 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality compared with 7.5 mg/d group (P=0.004 3, P=0.001 2) . Multivariate Cox proportional hazards regression model analysis showed that after adjusting for age, NYHA cardiac functional class, chronic kidney disease, diabetes, hypertension, coronary artery disease, diuretics, albumin (ALB) , serum N-terminal brain natriuretic peptide precursor (NT-proBNP) and estimated glomerular filtration rate (eGFR) , 15.0 mg/d group had a 1.03-fold increased risk of all-cause mortality〔HR=2.03, 95%CI (1.34, 2.99) 〕and 1.51-fold increased risk of cardiovascular mortality〔HR=2.51, 95%CI (1.40, 4.50) 〕compared with 7.5 mg/d group. This study stratified analysis by eGFR, age, ALB, and NT-proBNP, the results showed that tolvaptan 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality.

Tolvaptan 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality compared with tolvaptan 7.5 mg/d in elderly CHF patients (age≥80 years) . We may recommend using low-dose tolvaptan.

Due to long treatment cycle and medication dependence, patients with chronic heart failure (CHF) face many risks of out-of-hospital medication. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based patient safety tool, which has been studied rarely in the management of out-of-hospital medication safety in CHF patients.

To discuss the role of TeamSTEPPS in the out-of-hospital medication safety management in CHF patients.

A total of 134 CHF patients hospitalized in the First Affiliated Hospital of Chongqing Medical University from June 2019 to June 2020 were selected, and were divided into the intervention group (n=62) and control group (n=61) according to the number of ward, receiving routine medication safety management, and TeamSTEPPS-based medication safety management, respectively. The medication error was evaluated before discharge and 6 months after discharge by the Medication Error Questionnaire developed by us. The medication knowledge, attitude and practice (KAP) were evaluated before discharge, 1, 3 and 6 months after discharge by a self-developed Medication KAP Scale. Cardiac function, dyspnea and edema were evaluated before discharge, 3 and 6 months after discharge. The readmission and all-cause mortality were collected 3 and 6 months after discharge. The safety attitude of medical workers was measured before intervention and 6 months after intervention by the Chinese version of the Safety Attitudes Questionnaire (SAQ-C) .

The prevalence of ignoring the content of the prescription, omission error, wrong time error, wrong dose error, taking medication without a doctor's advice and unauthorized drug withdrawal differed between the two groups 6 months after discharge (P<0.05) . The readmission rates of the intervention group 3 and 6 months after discharge were lower than those of the control group (P<0.05) . The scores of teamwork climate, safety climate, perceptions of management, job satisfaction and stress recognition in medical workers providing services for the intervention group 6 months after intervention were higher than those before intervention (P<0.05) . The results of two-factor repeated measures ANOVA showed that the duration and type of medication safety management had significant interaction effects on the medication KAP scores, NYHA class, dyspnea and edema in two groups (P<0.05) . The duration of medication safety management had an significant main effect on the medication KAP scores, dyspnea and edema in two groups (P<0.05) . The type of medication safety management had a significant main effect on the medication KAP and edema in two groups (P<0.05) . The medication knowledge scores of the intervention group 3 and 6 months after discharge were higher than those of the control group (P<0.05) . The intervention group had higher medication attitude score but lower medication practice score than the control group 1, 3 or 6 months after discharge (P<0.05) . The medication knowledge and medication attitude scores increased in both groups 1, 3, 6 months after discharge (P<0.05) . The medication practice score increased in the intervention group 1, 3, 6 months after discharge, but decreased in the control group at 1 month after discharge (P<0.05) . The medication knowledge score at 1 month after discharge was lower than that 3 or 6 months after discharge in the intervention group (P<0.05) , but the opposite was found in the control group (P<0.05) . The dyspnea score at 6 months after discharge was lower than that before discharge in the intervention group (P<0.05) . The edema score before discharge was higher than that 3 and 6 months after discharge in the intervention group (P<0.05) . The intervention group had higher edema score 3 and 6 months after discharge than the control group (P<0.05) .

The use of TeamSTEPPS in out-of-hospital medication safety management in CHF patients could improve the medication safety and symptoms in patients as well as enhance the safety culture of the healthcare team.

Chronic heart failure is a syndrome occurring at the end-stage of multiple cardiovascular diseases. In the condition, nutritional and metabolic problems such as loss of appetite, diarrhea, abdominal distension, and constipation are highly prevalent, which in turn affect the prognosis of heart failure. The relationship of nutritional assessment results with prognosis in chronic heart failure has been studied extensively, while nutritional assessment for older adults with chronic heart failure has been rarely studied, and there is no clinically recognized assessment method.

To perform a comparative analysis of four nutritional assessment methods in terms of clinical prognosis prediction in elderly patients with chronic heart failure.

Eligible older inpatients with chronic heart failure (n=199) were recruited from Department of Cardiology, ICU, and Department of Geriatrics, Linyi People's Hospital from June 2018 to June 2020. Data were collected via reviewing the medical records and telephone-based follow-ups, including sex, age, height, weight, serum albumin (ALB) level, BMI, Geriatric Nutritional Risk Index (GNRI) , and result of Nutrition Risk Screening 2002 (NRS2002) , as well as prognosis〔containing three classifications: in-hospital deaths (n=43) and in-hospital survivors (n=156) ; one-year deaths (n=51) and one-year survivors (n=148) ; readmission within half a year (n=69) and readmission after half a year (n=130) 〕. Multivariate Logistic regression analysis was used to explore the prognostic factors of chronic heart failure. The analysis of ROC curve with AUC value was carried out to comparatively estimate prognosis predictive values of the nutritional assessment methods.

There were significant differences in mean age, serum ALB, GNRI and NRS2002 score between in-hospital deaths and survivors (P<0.05) . The mean age, height, serum ALB, GNRI and NRS2002 score were also significantly different between one-year deaths and survivors (P<0.05) . Those with readmission within half a year had significantly different mean BMI, serum ALB, GNRI and NRS2002 score compared with those with readmission after half a year (P<0.05) . For predicting in-hospital death, the AUC of serum ALB was 0.76〔95%CI (0.68, 0.84) , P<0.001〕, and that of NRS2002 score was 0.80〔95%CI (0.73, 0.86) , P<0.001〕. In predicting one-year death, the AUC of serum ALB was 0.75〔95%CI (0.67, 0.82) , P<0.001〕, and that of NRS2002 score was 0.82〔95%CI (0.76, 0.88) , P<0.001〕. The AUC of NRS2002 score in predicting readmission within half a year was 0.73〔95%CI (0.65, 0.80) , P<0.001〕.

On the whole, NRS2002 score could be the first choice for prognostic assessment in elderly patients with chronic heart failure, for it was more effective in predicting the risks of in-hospital death, one-year death and readmission within half a year than serum ALB level, GNRI and BMI.

Cognitive impairment (CI) is a common complication of chronic heart failure (CHF) , which may significantly increase the risk of poor prognosis, so early identification of associated factors of CI in CHF is of great significance. Although there have been many relevant studies recently, their conclusions are inconsistent.

To perform a systematic review of the influencing factors of CI in CHF.

In August 2021, studies relevant to influencing factors of CI among patients with CHF were searched in databases including PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, PsychINFO, CNKI, Wanfang Data, CQVIP, and SinoMed from inception to August 2021. Two researchers independently screened studies based on the inclusion and exclusion criteria, extracted data, and performed risk of bias assessment using the Newcastle-Ottawa Scale and The Agency for Healthcare Research and Quality methodology checklist, then conducted a descriptive analysis of the factors associated with CI in CHF. RevMan 5.3 was adopted for meta-analysis.

Fourteen studies were included, involving 6 324 cases of CHF, and 1 753 of them also with CI. Descriptive analysis indicated that five factors decreased the risk of CI in CHF, and 22 factors increased the risk, but the influence of sex and systolic blood pressure on CI is still far from inclusive. Meta-analysis demonstrated that education level〔OR=0.45, 95%CI (0.30, 0.70) 〕, age〔OR=1.17, 95%CI (1.10, 1.24) 〕, diabetes〔OR=2.17, 95%CI (1.17, 4.01) 〕, anemia〔OR=3.03, 95%CI (1.80, 5.10) 〕and left ventricular ejection fraction〔OR=0.91, 95%CI (0.88, 0.94) 〕were associated with CI in CHF.

High education level lowered the risk of CI in CHF, while older age, diabetes, anemia and decreased left ventricular ejection fraction increased the risk. Due to limited number and quality of included studies, the above-mentioned conclusion still needs to be verified by more high-quality studies.