Early aspirin initiation is independently associated with a significant reduction in the risk of CAV.

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AimsThere are limited data on the effect of low‐dose, intermittent inotropic therapy in an outpatient setting on the quality of life (QOL) in patients with advanced refractory heart failure (HF) symptoms. We aimed to analyse the effect of this treatment modality on QOL and subsequent survival.Methods and resultsThe study population comprised 287 consecutive patients with advanced refractory HF symptoms who were treated with low‐dose, intravenous intermittent inotropic therapy in the HF Day Care Service at Sheba Medical Centre between September 2000 and September 2012. All patients completed a baseline Minnesota Living with Heart Failure Questionnaire (MLWHFQ), and 137 (48%) completed a 1 year follow‐up questionnaire. MLWHFQ scores' means ranged from 0 (better QOL) to 5 (worse QOL). Mean age was 68 ± 12, 86% were men, 77% had ischaemic cardiomyopathy, and the mean left ventricle ejection fraction (LVEF) was 26% ± 13. The mean baseline MLWHFQ score was 3.1 (±1), while the mean at 1 year of treatment was of 2.7 (±1.1), indicating an overall improvement in QOL associated with intermittent low‐dose inotrope therapy (p < 0.01). Multivariate analysis showed that younger age, non‐ischaemic cardiomyopathy, and worse renal function were independently associated with improvement in QOL at 1 year. Improvement in QOL was not associated with a significant survival benefit during subsequent follow‐up.ConclusionsIn patients with advanced refractory HF symptoms, treatment with low‐dose, intermittent intravenous inotropes in an outpatient setting is associated with significant improvement in QOL. However, improvement in QOL in this population does not appear to affect subsequent long‐term survival.

ObjectiveHeart transplantation (HT) is uniquely associated with the potential impact of thyroid hormone therapy at three intersecting levels—donor, operation, and recipient. We aimed to study the effect of thyroid hormone therapy of the donor on primary graft dysfunction (PGD).MethodsA retrospective cohort study was conducted on 209 HT recipients assessed from 1997 to 2018; for 33 of the recipients, the donors had received T4 (DT4 group), and for 176, the donors had not (NoDT4 group). The primary endpoint was PGD defined according to the International Society for Heart and Lung consensus statement.ResultsBoth the incidence (58% vs 35%, P = .022) and the severity of PGD (42% vs 25% moderate/severe, P = .007) were significantly higher in the DT4 recipients. Multivariable analysis showed donor T4 therapy to be independently associated with a ~3.5‐fold increased risk for PGD (OR = 3.44, 95% CI 1.26‐9.86). These results remained consistent after propensity score analysis.ConclusionsDonor thyroid hormone therapy is independently associated with an increased risk of PGD. Hypothesizing a “withdrawal effect” as the cause, we suggest that administration of thyroid hormone to the recipient at time of reperfusion could counter this negative effect. Prospective studies are needed to validate this hypothesis‐generating study.