المؤلفون: Abel, Alexandra A I, Samuel, Nathan A, Cuthbert, Joseph J, Brown, Oliver I, Pellicori, Pierpaolo, Kazmi, Syed, Cleland, John G F, Johnson, Miriam J, Clark, Andrew L

المصدر: European Heart Journal - Quality of Care and Clinical Outcomes; March 2024, Vol. 10 Issue: 2 p168-175, 8p

المؤلفون: Cuthbert, Joseph James, Soyiri, Ireneous, Lomax, Stephanie Jayne, Turgoose, John, Fuat, Ahmet, Cohen, Judith, Clark, Andrew L

المصدر: Heart; 2024, Vol. 110 Issue: 12 p854-862, 9p

مستخلص: BackgroundLoop diuretics are commonly prescribed in the community, not always to patients with a recorded diagnosis of heart failure (HF). The rate of HF events in patients prescribed loop diuretics without a diagnosis of HF is unknown.MethodsThis was a propensity-matched cohort study using data from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office of National Statistics in the UK. Patients prescribed a loop diuretic without a diagnosis of HF (loop diuretic group) between 1 January 2010 and 31 December 2015 were compared with patients with HF (HF group)—analysis A, and patients with risk factors for HF (either ischaemic heart disease, or diabetes andhypertension—at-risk group)—analysis B. The primary endpoint was an HF event (a composite of presentation with HF symptoms, HF hospitalisation, HF diagnosis (analysis B only) and all-cause mortality).ResultsFrom a total population of 180 384 patients (78 968 in the loop diuretic group, 28 177 in the HF group and 73 239 in the at-risk group), there were 59 694 patients, 22 352 patients and 57 219 patients in the loop diuretic, HF and at-risk groups, respectively, after exclusion criteria were applied. After propensity matching for age, sex and comorbidities, patients in the loop diuretic group had a similar rate of HF events as those in the HF group (71.9% vs 72.1%; HR=0.92 (95% CI 0.90 to 0.94); p<0.001), and twice as those in the at-risk group (59.2% vs 35.7%; HR=2.04 (95% CI 2.00 to 2.08); p<0.001).ConclusionsPatients prescribed a loop diuretic without a recorded diagnosis of HF experience HF events at a rate comparable with that of patients witha recorded diagnosis of HF; many of these patients may have undiagnosed HF.

المؤلفون: Osmanska, Joanna, Brooksbank, Katriona, Docherty, Kieran F, Robertson, Stacy, Wetherall, Kirsty, McConnachie, Alex, Hu, Jerry, Gardner, Roy S, Clark, Andrew L, Squire, Iain B, Kalra, Paul R, Jhund, Pardeep S, Muntendam, Pieter, McMurray, John J V, Petrie, Mark C, Campbell, Ross T

المصدر: European Heart Journal - Cardiovasular Pharmacotherapy; January 2024, Vol. 10 Issue: 1 p35-44, 10p

مستخلص: Graphical Abstract

المؤلفون: Sze, Shirley, Pellicori, Pierpaolo, Zhang, Jufen, Weston, Joan, Clark, Andrew L

المصدر: European Heart Journal - Quality of Care and Clinical Outcomes; November 2023, Vol. 9 Issue: 7 p731-739, 9p

مستخلص: Graphical AbstractA summary of pros and cons of different frailty tools and their prognostic value using KaplanMeier curves to illustrate the relation between frailty tools and all-cause mortality.

المؤلفون: Clark, Andrew L.

المساهمون: Clark, Andrew L., Gardner, Roy S., McDonagh, Theresa A.

المصدر: Oxford Textbook of Heart Failure ; page 9-26

الوصف: Heart failure is a protean condition, presenting acutely to hospital in most cases, but often presenting with a more insidious course to primary care physicians. Patients may only be diagnosed as having a primary cardiac problem after being seen by respiratory physicians or even, on occasion, after gastrointestinal work-up for hepatomegaly (with or without jaundice) or weight loss. Nevertheless, there are common presenting clinical syndromes in patients with heart failure which should prompt different initial treatment strategies. The diagnosis of heart failure is most commonly made during an admission to hospital; with successful treatment, patients go on to have chronic heart failure. A particular challenge is so-called ‘heart failure with preserved (or more accurately, normal) ejection fraction’. The term does not describe a single condition and it is difficult to diagnose with the consequence that all clinical trials of treatment have been unsuccessful so far.

الإتاحة: https://doi.org/10.1093/med/9780198766223.003.0002Test

المؤلفون: Gardner, Roy S., McDonagh, Theresa A., Clark, Andrew L.

المساهمون: Clark, Andrew L., Gardner, Roy S., McDonagh, Theresa A.

المصدر: Oxford Textbook of Heart Failure ; page 851-858

الوصف: This chapter looks at some of the approaches in the pipeline for heart failure. Heart failure continues to be an exciting field for healthcare professionals, and is no longer a diagnosis of despair for patients. Even though therapy has advanced considerably, new innovations continue to come forward and offer further hope to patients. The renin–angiotensin–aldosterone system (RAAS) can now be modulated at all stages of the pathway, and RAAS inhibition is still key to the management of chronic heart failure. The most promising advances in manipulating the RAAS probably lie with evermore selective mineralocorticoid receptor antagonists, and the use of agents that can prevent or treat hyperkalaemia. The chapter then considers the failure of expensive vasodilators in patients with acute heart failure to alter clinical or hard end-points. It also examines modulation of cardiac contractility, myocyte function, and mitochondrial function. The success of cardiac resynchronization therapy and implantable defibrillators has also generated a huge interest in the potential of device therapy.

الإتاحة: https://doi.org/10.1093/med/9780198766223.003.0069Test

المؤلفون: Clark, Andrew L., Coletta, Alison P., Cleland, John G. F.

المساهمون: Clark, Andrew L., Gardner, Roy S., McDonagh, Theresa A.

المصدر: Oxford Textbook of Heart Failure ; page 587-604

الوصف: Currently, diuretics are the most important family of treatments for patients with heart failure and one of the most under-researched. Diuretic management resides firmly in the era of opinion-based medicine, perhaps because it is nigh on impossible to manage the congestion without them. Now that tools for measuring congestion have improved and are widely available for clinical practice, we should investigate how to use diuretics more effectively. The introduction of diuretics, particularly loop diuretics, revolutionized the management of fluid retention. Observational studies show that patients who do not require treatment with loop diuretics have a much better prognosis than those who do, and that higher doses of loop diuretics are strongly associated with a worse prognosis. Such findings have led to recommendations that the dose and use of diuretics for heart failure should be minimized. However, more careful analyses of the data suggest that the use and dose of loop diuretics is merely a surrogate marker for the severity of congestion and that it is the congestion that is lethal. This argues that a sufficient dose of diuretic to control congestion effectively should be used.

الإتاحة: https://doi.org/10.1093/med/9780198766223.003.0047Test

المؤلفون: Cuthbert, Joseph J., Clark, Andrew L.

المساهمون: Clark, Andrew L., Gardner, Roy S., McDonagh, Theresa A.

المصدر: Oxford Textbook of Heart Failure ; page 651-660

الوصف: This chapter focuses on digoxin, one of many cardiac glycosides (also known as cardiotonic steroids) that have been studied to varying degrees over the years. Digoxin is used for ventricular rate control in patients with atrial fibrillation (AF), a common co-morbidity in patients with heart failure. A patient with heart failure who is taking digoxin is likely taking it for rate control rather than for heart failure itself. Digoxin remained the only treatment for heart failure until the introduction of intravenous mercurial diuretics in the 1950s. The use of digoxin as a treatment for patients with heart failure has declined ever since, with the emergence of medications with proven prognostic benefit. Despite the decline in its use, digoxin is still cautiously recommended by the European Society of Cardiology in its guidelines both for heart failure and for AF. In the heart failure guidelines, digoxin is recommended for the treatment of heart failure in patients in sinus rhythm who are symptomatic despite ‘triple therapy’ or for ventricular rate control in patients with heart failure and AF when other options have been exhausted.

الإتاحة: https://doi.org/10.1093/med/9780198766223.003.0053Test

المؤلفون: Clark, Andrew L.

المساهمون: Clark, Andrew L., Gardner, Roy S., McDonagh, Theresa A.

المصدر: Oxford Textbook of Heart Failure ; page 3-8

الوصف: This chapter provides an overview of heart failure. The term ‘heart failure’ is usually used freely between clinicians to describe what is wrong with individual patients, yet despite the fact that heart failure is so very common, it is very difficult to define it satisfactorily. Some difficulties arise because of the effects of modern treatment: while it might be reasonable to define acute heart failure in terms of some haemodynamic variable, the situation becomes very different in chronic treated heart failure. Ultimately, heart failure is a clinical syndrome characterized by a constellation of symptoms and signs, and not a discrete diagnosis. The chapter then highlights the importance of natriuretic peptide testing in diagnosing heart failure. It also looks at how the clinical pattern of heart failure can be viewed as a consequence of mammalian evolution, and considers some older descriptions of heart failure. Finally, the chapter details the clinical course of heart failure and identifies three models—the haemodynamic model, neurohormonal model, and peripheral model—which are helpful in thinking about the pathophysiology of heart failure and in suggesting avenues for therapeutic development.

الإتاحة: https://doi.org/10.1093/med/9780198766223.003.0001Test

المؤلفون: Clark, Andrew L.

المساهمون: Clark, Andrew L., Gardner, Roy S., McDonagh, Theresa A.

المصدر: Oxford Textbook of Heart Failure ; page 401-410

الوصف: Most discussions of heart failure focus on the left ventricle and its dysfunction. The right heart is, of course, commonly affected in patients with heart failure: both by the same disease processes that affect the left heart, or as a consequence of left heart disease. The right heart itself is much less commonly affected in isolation, but patients with heart disease do frequently present with ‘right heart failure’. This chapter will focus on the miscellaneous conditions affecting predominantly the right heart. Pulmonary arterial disease, primary lung disease, some forms of congenital heart disease, valvular heart disease, and, in particular, constrictive pericarditis and their treatment will be considered.

الإتاحة: https://doi.org/10.1093/med/9780198766223.003.0030Test