| 1. |
|
|
| 2. |
- Cowie, MR, et al.
(författare)
-
Clinical applications of B-type natriuretic peptide (BNP) testing
- 2003
-
Ingår i: European Heart Journal. - 0195-668X .- 1522-9645. ; 24:19, s. 1710-1718
-
Tidskriftsartikel (refereegranskat)abstract
- Many claims have been made in recent years regarding the utility of plasma B-type natriuretic peptide (BNP) concentration measurements in the diagnosis, risk stratification and monitoring of patients with heart failure. This paper summarizes the current evidence and provides guidance for practising clinicians. Overall, plasma BNP testing appears to be of most value in the diagnostic arena, where it is likely to improve the performance of non-specialist physicians in diagnosing heart failure. In clinical practice, BNP testing is best used as a 'rule out' test for suspected cases of new heart failure in breathless patients presenting to either the outpatient or emergency care settings, it is not a replacement for echocardiography and full cardiological assessment, which will be required for patients with an elevated BNP concentration. Although work is ongoing in establishing the 'normal' values of BNP, heart failure appears to be highly unlikely below a plasma concentration of 100 pg/ml. However, as BNP levels rise with age and are affected by gender, comorbidity and drug therapy, the plasma BNP measurement should not be used in isolation from the clinical context.
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
- Dahlström, Ulf, et al.
(författare)
-
Heart Failure Pilot protocol
- 2010
-
Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 31:18, s. 2184-2186
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
|
|
| 6. |
- Edner, Magnus, et al.
(författare)
-
Association between renin-angiotensin system antagonist use and mortality in heart failure with severe renal insufficiency: a prospective propensity score-matched cohort study
- 2015
-
Ingår i: European Heart Journal. - : OXFORD UNIV PRESS. - 0195-668X .- 1522-9645. ; 36:34, s. 2318-2326
-
Tidskriftsartikel (refereegranskat)abstract
- Aims In heart failure (HF) with reduced ejection fraction (EF), renin-angiotensin receptor (RAS) antagonists reduce mortality. However, severe renal insufficiency was an exclusion criterion in trials. We tested the hypothesis that RAS antagonists are associated with reduced mortality also in HF with severe renal insufficiency. Methods and results We studied patients with EF less than= 39% registered in the prospective Swedish Heart Failure Registry. In patients with creatinine greater than221 mu mol/L or creatinine clearance less than30 mL/min, propensity scores for RAS-antagonist use were derived from 36 variables. The association between RAS antagonist use and all-cause mortality was assessed with Cox regression in a cohort matched 1:1 based on age and propensity score. To assess consistency, we performed the same analysis as a positive control in patients without severe renal insufficiency. Between 2000 and 2013, there were 24 283 patients of which 2410 [age, mean (SD), 82 (9), 45% women] had creatinine greater than221 mu mol/L or creatinine clearance less than30 mL/min and were treated (n = 1602) or not treated (n = 808) with RAS antagonists. In the matched cohort of 602 vs. 602 patients [age 83 (8), 42% women], RAS antagonist use was associated with 55% [95% confidence interval (CI) 51-59] vs. 45% (41-49) 1-year survival, P less than 0.001, with a hazard ratio (HR) for mortality of 0.76 (95% CI 0.67-0.86, P less than 0.001). In positive control patients without severe renal insufficiency [n = 21 873; age 71 (12), 27% women], the matched HR was 0.79 (95% CI 0.72-0.86, P less than 0.001). Conclusion In HF with severe renal insufficiency, the use of RAS antagonists was associated with lower all-cause mortality. Prospective randomized trials are needed before these findings can be applied to clinical practice.
|
|
| 7. |
|
|
| 8. |
- Lund, Larrs H., et al.
(författare)
-
Prevalence, correlates, and prognostic significance of QRS prolongation in heart failure with reduced and preserved ejection fraction
- 2013
-
Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34:7, s. 529-539
-
Tidskriftsartikel (refereegranskat)abstract
- AimsThe independent clinical correlates and prognostic impact of QRS prolongation in heart failure (HF) with reduced and preserved ejection fraction (EF) are poorly understood. The rationale for cardiac resynchronization therapy (CRT) in preserved EF is unknown. The aim was to determine the prevalence of, correlates with, and prognostic impact of QRS prolongation in HF with reduced and preserved EF.Methods and resultsWe studied 25 171 patients (age 74.6 ± 12.0 years, 39.9% women) in the Swedish Heart Failure Registry. We assessed QRS width and 40 other clinically relevant variables. Correlates with QRS width were assessed with multivariable logistic regression, and the association between QRS width and all-cause mortality with multivariable Cox regression. Pre-specified subgroup analyses by EF were performed. Thirty-one per cent had QRS ≥120 ms. Strong predictors of QRS ≥120 ms were higher age, male gender, dilated cardiomyopathy, longer duration of HF, and lower EF. One-year survival was 77% in QRS ≥120 vs. 82% in QRS <120 ms, and 5-year survival was 42 vs. 51%, respectively (P < 0.001). The adjusted hazard ratio for all-cause mortality was 1.11 (95% confidence interval 1.04-1.18, P = 0.001) for QRS ≥120 vs. <120 ms. There was no interaction between QRS width and EF.ConclusionQRS prolongation is associated with other markers of severity in HF but is also an independent risk factor for all-cause mortality. The risk associated with QRS prolongation may be similar regardless of EF. This provides a rationale for trials of CRT in HF with preserved EF.
|
|
| 9. |
- Savarese, Gianluigi, et al.
(författare)
-
Association between renin-angiotensin system inhibitor use and mortality/morbidity in elderly patients with heart failure with reduced ejection fraction: a prospective propensity score matched cohort study
- 2018
-
Ingår i: European Heart Journal. - : OXFORD UNIV PRESS. - 0195-668X .- 1522-9645. ; 39:48, s. 4257-4265
-
Tidskriftsartikel (refereegranskat)abstract
- Aims In heart failure with reduced ejection fraction (HFrEF), renin angiotensin system inhibitors (RASi) improve morbidity and mortality. However, patients aged amp;gt;80 years constituted a small minority in trials. We assessed the association between RASi use and mortality/morbidity in HFrEF patients aged amp;gt;80 years. Methods and results We included patients with ejection fraction amp;lt;40% and age amp;gt;80 years from the Swedish Heart Failure Registry. Propensity scores for RASi use were calculated from 37 variables. Cox regression models for RASi vs. non-RASi with all-cause mortality and all-cause mortality/heart failure (HF) hospitalization as outcomes were fitted in a 1:1 propensity-score-matched cohort. To assess consistency, the same analyses were performed in a positive control cohort aged amp;lt;= 80 years. Of 6710 patients [median age (interquartile range) 85 (82-87) years; 38% women], 5384 (80%) received RASi. Propensity-score matching yielded 2416 patients, [age 86 (83-91) years]. RASi use was associated with hazard ratio (HR) (95% confidence interval) 0.78 (0.72-0.86) for all-cause mortality and 0.86 (0.79-0.94) for all-cause mortality/HF hospitalization. In positive control patients aged amp;lt;= 80 years (17 842 patients in the overall cohort, 2126 after matching), HR for all-cause mortality was 0.81 (0.71-0.91), whereas it was 0.85 (0.76-0.94) for all-cause mortality/HF hospitalization. Conclusion In HFrEF patients with age amp;gt;80years, RASi were relatively underused compared with in younger patients, despite similar association with reduced morbidity and mortality and no apparent association with risk of syncope-related hospitalization. These results may be interpreted as hypothesis generating for randomized clinical trials on RASi in this elderly HFrEF subpopulation.
|
|
| 10. |
- Savarese, Gianluigi, et al.
(författare)
-
Comparative associations between angiotensin converting enzyme inhibitors, angiotensin receptor blockers and their combination, and outcomes in patients with heart failure and reduced ejection fraction
- 2015
-
Ingår i: International Journal of Cardiology. - : ELSEVIER IRELAND LTD. - 0167-5273 .- 1874-1754. ; 36, s. 22-23
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are recommended in heart failure with reduced ejection fraction (HFREF), but there is limited data on ARB vs. ACE-I and their combination in unselected populations. The purpose of this study was to compare the associations between the use of ACE-I, ARB and their combination, and outcomes in HFREF. Methods and results: We prospectively studied 22,947 patients with HFREF (ejection fraction b 40%) enrolled in the Swedish Heart Failure Registry who received ACE-I but not ARB (n = 15,801, 69%), ARB but not ACE-I (n = 4335, 19%), their combination (n = 571, 2%) or neither (n = 2240, 10%). As compared with ACE-I alone, the hazard ratios (HRs) for ARB alone for all-cause mortality was 0.97 (95% CI = 0.91-1.03; p = 0.27), for HF hospitalization 1.08 (CI = 1.02-1.15; p less than 0.01) and for the composite outcome 1.03 (CI = 0.99-1.08; p = 0.15). ACE-I and ARB combination had for death HR = 0.98 (95% CI = 0.84-1.14; p = 0.76), for HF hospitalization HR = 1.49 (CI = 1.33-1.68; p less than 0.01) and for the composite outcome HR = 1.35 (CI = 1.21-1.50; p less than 0.01). Use of neither ACE-I nor ARB was associated with HR for death 1.41 (CI = 1.33-1.50; p less than 0.01), for HF hospitalization 1.16 (CI = 1.08-1.25; p less than 0.01) and for the composite outcome 1.28 (CI = 1.21-1.35; p less than 0.01). Conclusion: This large generalizable analysis confirms the current recommendation of using ACE-I as first choice in HFREF. ARB can be considered an alternative in patients who cannot use ACE-I but should not routinely replace ACE-I. The combination of ACE-I and ARB was not associated with additional benefit over either one alone, and may potentially be harmful. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
|
|
