Special Issue:Heart failure
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 (HbA1c) variability is an indicator of long-term blood glucose fluctuation. Therefore, it is of great clinical significance to explore the correlation between HbA1c variability and new-onset atrial fibrillation (AF) in diabetic patients combined with heart failure with preserved ejection fraction (HFpEF) .
To investigate the correlation between HbA1c 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 HbA1c variability was expressed as standard deviation of HbA1c measurement (HbA1c-SD) and HbA1c coefficient of variation (HbA1c-CV). Multivariate Cox regression analysis was used to explore the correlation between HbA1c 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 HbA1c variability predicting new-onset AF in T2DM patients combined with HFpEF was plotted.
The HbA1c-SD and HbA1c-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 HbA1c variability (HbA1c-SD≤0.34%, HbA1c-CV≤4.74%) and high HbA1c variability (HbA1c-SD>0.34%, HbA1c-CV>4.74%) groups according to the median of HbA1c variability. Log-rank test results showed higher incidence of new-onset AF in patients with high HbA1c variability (PHbA1c-SD<0.001, PHbA1c-CV=0.004). Multivariate Cox regression analysis showed that HbA1c-SD〔HR=2.22, 95%CI (1.37, 3.61), P=0.001〕 and HbA1c-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 HbA1c-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 HbA1c-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 HbA1c variability (HbA1c-SD>0.34%, HbA1c-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 (rs=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 (χ2trend=136.502, P<0.001) , but that of antiplatelet treatment increased with age (χ2trend=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.
Heart failure with preserved ejection fraction (HFpEF) is a common type of heart failure (HF) , and previous treatments that primarily target heart failure with reduced ejection fraction (HFrEF) do not benefit the patients with HFpEF because of the differences in their pathophysiological mechanisms, resulting in high mortality and poor prognosis. Whereas depression is one of the most common mental and psychological problems, caused by various reasons and characterized by a pronounced and long-lasting low spirits, with various degrees of cognitive and behavioral changes. Those who are severely ill even present self-injurious and suicidal behavior. With intensive research into HFpEF, it has emerged that depression has become one of the most common comorbidities in HFpEF and that the two interact to contribute to poor prognosis for patients. Currently, relevant studies in HFpEF with depression suggested that some drugs could improve short term symptoms and clinical prognosis in such patients. This paper aimed to review the comorbid mechanism, research status and the latest progress of related treatment of HFpEF complicated with depression. It is found that sodium glucose cotransporter 2 (SGLT2) inhibitors, angiotensin receptor enkephalinase inhibitors (ARNI) and statin drugs play important roles in the field of HF and psychophysiology. They can not only improve the cardiac function and prognosis of HFpEF patients, but also have the effect of anti-depression, thus to provide references for clinical study and treatment.
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.
Sodium-glucose-cotransporter-2 (SGLT2) inhibitors originally developed as hypoglycemic agents, have been shown to reduce type 2 atherosclerotic cardiovascular disease (ASCVD) with or without heart failure hospitalization (HFH) and cardiovascular mortality risk in patients with diabetes mellitus (T2DM) . The just-concluded EMPEROR-Preserved trial evaluated the clinical efficacy of an SGLT2 inhibitor (empagliflozin) in patients with heart failure with preserved ejection fraction (HFpEF) and the results showed that its clinical effect could be further extended to heart failure mildly reduced ejection fraction (HFmrEF) patients. Although SGLT2 inhibitors have ushered in a new era of reducing HF incidence and preventing HF exacerbation, the search for key mechanisms by which SGLT2 inhibitors improve symptoms should continue to protect heart failure patients from the fatal progression of heart failure disease. This paper reviews the application of SGLT2 inhibitors in the treatment of HFmrEF patients, in order to provide theoretical guidance for the treatment of HFmrEF patients.
The American Heart Association (AHA) , American College of Cardiology (ACC) and Heart Failure Society of America (HFSA) jointly released the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure (hereinafter referred to as the 2022 Guideline) . In the light of the latest evidence, the essentials updated in the 2022 Guideline encompass the prevention, stages, classification, drug treatment and device-based treatment of heart failure. The 2022 Guideline is content-enriched, evidence-based, practical, and easily operable, which may greatly contribute to clinical practice in China. In response to the most concerns of clinicians, we overviewed and discussed the updates in stages, classification and drug treatment of heart failure in the new guideline.
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.
Advances in Mechanism of Coexistence and Pharmaceutical Treatment of Chronic Heart Failure and Depression
The coprevalence of chronic heart failure (CHF) and depression is 10%-79%, the pathogenesis of these two diseases is related to the activation of immune inflammatory system, insulin resistance and intestinal flora imbalance, and relevant regulation is bidirectional and complex. There is a lack of efficient drugs for both CHF and depression recommended by available diagnosis and treatment guidelines and present clinical practice. But it has recently been reported that some drugs (sacubitril/valsartan, new antidepressants, shensongyangxin and qiliqiangxin capsules, regulators of the intestinal flora) may be partially effective for CHF with depression.We reviewed the mechanism of coexistence and pharmaceutical treatment of CHF and depression, providing new ideas and evidence for clinical diagnosis and treatment of CHF and depression.
Reliability and Validity of the Chinese Version of the Partners in Health Scale in Patients with Chronic Heart Failure
Chronic heart failure (CHF) is a common cardiovascular disease. Improving the self-management ability of CHF patients will contribute to quality of life improvement and reduction of rehospitalization and mortality rates. The Partners in Health (PIH) Scale is a measure designed by Flinders University, Australia, to assess the generic knowledge, attitudes, behaviors, and impacts of self-management in chronic disease patients, and is mainly used to assess the implementation effect of self-management projects in chronic disease patients.
To translate the PIH Scale into Chinese, then test the reliability and validity of the Chinese version in CHF patients, providing CHF patients with a tool for precisely assessing their self-management abilities.
The PIH was translated into Chinese with the guidance of the Brislin's translation model, then was revised according to the results of the review of a panel of experts, and a pre-test, and then the Chinese version of PIH (C-PIH) was developed. The demographic questionnaire, C-PIH, and Minnesota Living with Heart Failure Questionnaire (MLHFQ) were used in two surveys (one was conducted between April and June 2010, and another between April and June 2011) with 410 CHF patients selected from two grade A tertiary hospitals in Beijing using convenience sampling. Measurement of ceiling and floor effects, and item-total correlation were used for item analysis. Expert evaluation was used to evaluate the content validity analysis. Spearman's rank correlation coefficient was used to measure the criterion-related validity. KMO test, Bartlett's test of sphericity, exploratory factor analysis and confirmatory factor analysis were used for construct validity analysis. Monofactor analysis was used for validity analysis of known-groups. Reliability analysis was estimated by using the Cronbach's α.
Item analysis indicated that only item 3 (level of adhering to medication) of the C-PIH showed ceiling effect. Item-total correlation coefficients of the scale ranged from 0.424 to 0.761 (P<0.001) . The scale-level content validity index of the scale was 0.966. Item-level content validity indices ranged from 0.800 to 1.000. C-PIH was positively correlated with MLHFQ in terms of total score (rs=0.200, P<0.05) . The KMO value was 0.872 and Bartlett's test of sphericity was χ2=1 139.142 (P<0.001) , indicating that the sample size was appropriate for factor analysis. By exploratory factor analysis, 3 factors with an eigenvalue greater than 1.000 were extracted, including knowledge (7 items) , coping (3 items) and adherence (2 items) , explaining 66.514% of the total variance. The loadings of items on each factor ranged from 0.571 to 0.869. The original model fit indices did not reach the critical value. After adding the suggested covariance correlation between errors-in-variables e1 and e2, e6 and e7, the fitting indices of the modified model were acceptable (χ2/df=2.393, RMSEA=0.0851, CFI=0.968, NFI=0.953, NNFI=0.963, GFI=0.905, AGFI=0.854, RFI=0.932, IFI=0.966) . Known-groups analysis demonstrated that the C-PIH total score varied significantly by level of education, economic income, NYHA class, and treatment (inpatient or outpatient) in CHF patients (P<0.001) . Good internal consistency was indicated with a scale Cronbach's α of 0.890, and three factors' (knowledge, coping and adherence) Cronbach's α of 0.894, 0.807, and 0.511.
The C-PIH exhibited good reliability and validity, which may be used as a general self-management assessment tool in patients with CHF.
Heart Failure with Mid-range Ejection Fraction——a Comprehension of the Disease
Heart failure is the final main battlefield of various cardiovascular diseases with huge harm, which can cause all kinds of arrhythmias and even sudden cardiac death. The 2016 ESC guidelines formally define heart failure with mid-range ejection fraction (LVEF) in the range of 40% to 49%, aiming to refine the classification of heart failure, in order to arouse the attention of clinicians to the pathophysiology of heart failure and carry out more clinical research to better guide diagnosis and treatment. At present, there are still many controversies about the pathophysiology and treatment of HFmrEF. This article explains the characteristics of patients with HFmrEF from the aspects of epidemiology, clinical characteristics, pathophysiology, and treatment. It is found that HFmrEF is more like a transition between HFpEF and HFrEF patients than a unique phenotype. Four new drugs in the field of heart failure (ARNI, SGLT-2i, SGC, OM) and atrial septal shunts have shown different degrees of benefit in the treatment of HFmrEF patients. In the future, more clinical studies on HFmrEF (such as the HFmrEF subgroup study based on the changing trend of LVEF) are needed to deepen clinicians' understanding and understanding of HFmrEF, so as to better guide treatment.
Characteristics and Prognosis of Herat Failure with Improved Ejection Fraction
Left ventricular ejection fraction (LVEF) is often used to classify heart failure (HF) . Some HF patients were observed to have improved ejection fraction after treatment, thus giving rise to the concept of HF with improved EF (HFimpEF) . However, most relevant studies have focused on European countries and the US, and there are few reports on the clinical characteristics and diagnosis of this population in China.
To analyze the clinical characteristics, prognosis and prognostic predictors in Chinese HFimpEF patients.
Participants included in this case-control study were chronic HF inpatients who were recruited from Department of Heart Center, Hebei General Hospital from June 1, 2018, to May 1, 2020. Demographic data and baseline clinical information were obtained from the electronic medical record, in particular, clinical phenotypes of HF classified by baseline and follow-up LVEF included four: HF with preserved EF (HFpEF) , HF with mid-range EF (HFmrEF) , HF with reduced EF (HFrEF) and HFimpEF. Follow-up was conducted via electronic medical record review, outpatient department and telephone since the last reexamination with echocardiography. The follow-up continued through 2021-06-01, with all-cause death and all-cause readmission as endpoint events. Predictors of HFimpEF were explored by binary Logistic regression. Kaplan-Meier estimator was used to describe the survival of patients with all-cause death and all-cause readmission. Cox regression model was used to identify risk factors for all-cause death and all-cause readmission.
A total of 530 cases were included, including 245 (46.2%) with HFpEF, 55 (10.4%) with HFmrEF, 133 (25.1%) with HFrEF, and 97 (18.3%) with HFimpEF. HFimpEF patients had lower mortality than did HFpEF patients (P=0.014) and HFmrEF patients (P<0.001) . The readmission rate was lower in HFimpEF patients than that of HFpEF (P=0.011) or HFmrEF patients (P=0.001) . Elevated systolic blood pressure〔OR=1.036, 95%CI (1.019, 1.053) , P<0.001〕, and left ventricular end-systolic diameter (LVESD) ≤37 mm〔OR=0.245, 95%CI (0.118, 0.507) , P<0.001〕 at baseline, and treatments with beta-blockers〔OR=2.868, 95%CI (1.304, 6.305) , P=0.009〕 and aldosterone antagonists〔OR=2.691, 95%CI (1.316, 5.503) , P=0.007〕 were associated with increased probability of LVEF improvement. HFrEF, older age, heart valve disease, chronic kidney disease, anemia, non-use of beta-blockers and oral anticoagulants were independently associated with increased risk of all-cause death in HF patients (P<0.05) . HFpEF, HFmrEF and chronic kidney disease were independently associated with increased risk of all-cause readmission in HF patients (P<0.05) . Concomitant valvular heart disease〔HR=6.499, 95%CI (1.504, 28.089) , P=0.012〕and anemia〔HR=4.884, 95%CI (1.242, 19.208) , P=0.023〕were independently associated with increased risk of all-cause death in HFimpEF patients. The use of beta-blockers〔HR=2.868, 95%CI (1.304, 6.305) P=0.009〕 and aldosterone antagonists〔HR=2.691, 95%CI (1.316, 5.503) , P=0.007〕 were associated with increased probability of LVEF improvement.
We consider that HFimpEF is a clinical phenotype of HF manifested as milder clinical symptoms, less ventricular remodelling and a better prognosis. Elevated systolic blood pressure, LVESD≤37 mm and treatments with beta-blockers and aldosterone receptor antagonists may be independent predictors of improved LVEF, while valvular heart disease and anaemia may be risk factors for all-cause death in HFimpEF patients.
Efficacy and Safety Combined with Conventional and Western Medicine Treatments on Coronary Heart Disease Complicated with Heart Failure：a Systematic Review
Anti-atherosclerotic and anti-heart failure therapies are the key to the treatment of coronary heart disease (CHD) , a common cardiovascular disease. At present, there are few comprehensive evaluation and analysis on the efficacy and safety of Sofren Injection (SI) in the treatment of coronary heart disease complicated with heart failure.
To systematically evaluate the efficacy and safety of SI combined with conventional and western treatment in the treatment of heart failure in complicated with CHD.
PubMed, The Cochrane Library, EMBase, CNKI, CQVIP, SinoMed, Wanfang Data and other databases were searched from inception to June 7, 2020 . Randomized controlled trials (RCTs) of the application of SI in heart failure with CHD were screened and grouped, SI combined with conventional and western treatment as the experimental group, conventional and western treatment as the control group. Primary outcome indicators included left ventricular ejection fraction (LVEF) , left ventricular end-diastolic diameter (LVEDD) , left ventricular end-systolic diameter (LVESD) , left atrial end-diastolic diameter (LAEDD) , serum carbon monoxide (CO) , and NT-pro-brain natriuretic peptide (NT-proBNP) . Secondary outcome indicators included endothelin-1 (ET-1) , serum nitric oxide (NO) , overall clinical response rate, and incidence of adverse reactions. The Cochrane risk bias assessment tool was used to evaluate the quality of the included studies, and the RevMan 5.3 software was used for meta-analysis.
Eight documents meeting the criteria and 1 075 patients were included. Meta-analysis indicated that the experimental group was superior to the control group in improving heart function index: LVEF〔MD=-8.63, 95%CI (-12.33, -4.93) , P<0.05〕; LVEDD〔MD=5.71, 95%CI (4.82, 6.61) , P<0.05〕; LAEDD〔MD=6.62, 95%CI (5.36, 7.88) , P<0.05〕; LVESD〔MD=3.15, 95%CI (1.84, 4.46) , P<0.05〕; CO〔MD=-0.44, 95%CI (-0.62, -0.25) , P<0.05〕. The experimental group also had better effects on improving NT-proBNP 〔SMD=2.87, 95%CI (1.77, 3.97) , P<0.05〕. Moreover, the experimental group improved endothelial function index of ET-1〔MD=28.32, 95%CI (23.95, 32.68) , P<0.05〕, and NO〔MD=-16.74, 95%CI (-20.13, -13.35) , P<0.05〕 more significantly. The total clinical effective rate of the experimental group was better than that of the control group 〔RR=1.25, 95%CI (1.18, 1.32) , P<0.05〕.
The clinical efficacy of the experimental group on coronary heart disease combined with heart failure is better than that of the control group, which can improve heart function, heart failure markers, endothelial function indicators with good safety. However, the number of existing clinical studies is small and the quality is low, and more high-quality clinical studies are still needed for verification.
Special Issue:Heart failure
