Clinical inertia in the treatment of heart failure: a major issue to tackle

AbstractDespite an enormous improvement in heart failure management during the last decades, the hospitalization and mortality rate of heart failure patients still remain very high. Clinical inertia, defined as the lack of treatment intensification in a patient not at evidence-based goals for care, is an important underlying cause. Clinical inertia is extensively described in hypertension and type 2 diabetes mellitus, but increasingly recognized in heart failure as well. Given the well-established guidelines for the management of heart failure, these are still not being reflected in clinical practice. While the absolute majority of patients were treated by guideline-directed heart failure drugs, only a small percentage of these patients reached the correct guideline-recommended target dose of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and angiotensin receptor-neprilysin inhibitors. This considerable under-treatment leads to a large number of avoidable hospitalizations and deaths. This review discusses clinical inertia in heart failure and explains its major contributing factors (i.e., physician, patient, and system) and touches upon some recommendations to prevent clinical inertia and ameliorate heart failure treatment.
Source: Heart Failure Reviews - Category: Cardiology Source Type: research

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AbstractChronic heart failure (HF) is rare in the young and common in the elderly in the Western world. HF in the young is usually due to specific causes, predominantly or exclusively affecting the heart (adult congenital heart disease, different types of cardiomyopathies, myocarditis, or cardiotoxicity). In contrast, the mechanisms underlying HF development in the elderly have not been completely delineated. We propose that in most elderly patients, HF, regardless of the left ventricular ejection fraction (LVEF), is the consequence of the acceleration of cardiovascular aging by specific risk factors (usually hypertension,...
Source: Heart Failure Reviews - Category: Cardiology Source Type: research
AbstractThe heart failure (HF) epidemic is growing and approximately half of the HF patients have heart failure with preserved ejection fraction (HFpEF). HFpEF is a heterogeneous syndrome, characterized by a preserved left ventricular ejection fraction (LVEF ≥ 50%) with diastolic dysfunction, and is associated with high morbidity and mortality. Underlying comorbidities of HFpEF, i.e., hypertension, type 2 diabetes mellitus, obesity, and renal failure, lead to a systemic pro-inflammatory state, thereby affecting normal cardiac function. Increased inf lammatory biomarkers predict incident HFpEF and are higher in pa...
Source: Journal of Cardiovascular Translational Research - Category: Cardiology Source Type: research
Abstract Human health and environmental risks are increasing following air pollution associated with vehicular and industrial emissions in which particulate matter is a constituent. The purpose of this review was to assess studies on the health effects and mortality induced by particles published for the last 15 years. The literature survey indicated the existence of strong positive associations between fine and ultrafine particles' exposure and cardiovascular, hypertension, obesity and type 2 diabetes mellitus, cancer health risks, and mortality. Its exposure is also associated with increased odds of hypertensive...
Source: Environmental Science and Pollution Research International - Category: Environmental Health Authors: Tags: Environ Sci Pollut Res Int Source Type: research
This study aims to investigate the plasma and saliva levels of U-II at diagnosis and after 3-month metformin treatment in recently diagnosed Type 2 DM patients and compare these levels to those of healthy volunteers. METHODS: Our study compared 30 recently diagnosed Type 2 DM patients to their states after 3-month metformin treatment and 30 healthy volunteers. RESULTS: When compared with the control group, there was no significant increase in the plasma and saliva U-II levels of recently diagnosed Type 2 DM patients. We determined a statistically significant increase in the plasma and saliva ureotensin-2 levels o...
Source: Endokrynologia Polska - Category: Endocrinology Authors: Tags: Endokrynol Pol Source Type: research
CONCLUSIONS: Our data suggest a potential use of treprostinil as an early treatment for mild metabolic syndrome-associated PH-HFpEF and that combined treatment with treprostinil and metformin may improve hyperglycemia and cardiac function in a more severe disease. PMID: 32268788 [PubMed - as supplied by publisher]
Source: Arteriosclerosis, Thrombosis and Vascular Biology - Category: Cardiology Authors: Tags: Arterioscler Thromb Vasc Biol Source Type: research
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Source: Johnson and Johnson - Category: Pharmaceuticals Source Type: news
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Source: Circulation - Category: Cardiology Authors: Tags: Circulation Source Type: research
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Source: The British Journal of Surgery - Category: Surgery Authors: Tags: Br J Surg Source Type: research
AimsAsymptomatic patients with coronary artery disease (CAD), hypertension and/or type 2 diabetes mellitus (T2DM) are at greater risk of developing heart failure (HF). Fibrosis, leading to myocardial and vascular dysfunction, might be an important pathway of progression. The Heart OMics in AGing (HOMAGE) trial aims to investigate the effects of spironolactone on serum markers of collagen metabolism and on cardiovascular structure and function in people at risk of developing HF and potential interactions with a marker of fibrogenic activity, galectin ‐3.Methods and resultsThe HOMAGE trial is a prospective, randomised, ope...
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Study Design Source Type: research
SUMMARY Type 2 diabetes mellitus is an important public health problem, with a significant impact on cardiovascular morbidity and mortality and an important risk factor for chronic kidney disease. Various hypoglycemic therapies have proved to be beneficial to clinical outcomes, while others have failed to provide an improvement in cardiovascular and renal failure, only reducing blood glucose levels. Recently, sodium-glucose cotransporter-2 (SGLT2) inhibitors, represented by the empagliflozin, dapagliflozin, and canagliflozin, have been showing satisfactory and strong results in several clinical trials, especially regarding...
Source: Revista da Associacao Medica Brasileira - Category: General Medicine Source Type: research
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