A perspective on sympathetic renal denervation in chronic congestive heart failure

Madanieh, Raef; El-Hunjul, Mohammed; Alkhawam, Hassan; Kosmas, Constantine E.; Madanieh, Abed; Vittorio, Timothy J.

doi:10.1007/s10741-015-9516-5

Cited by 6 publications

(8 citation statements)

References 51 publications

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“…These diseases cause millions of hospital admissions each year globally [ 52 – 56 ] and account for about 5% of all emergency admissions in high-income countries [ 57 – 59 ]. Yet, there is evidence of significant variation in the prescribing of some these 11 therapies in the United States and Europe, including under-dosing and under-prescribing [ 60 – 62 ]. Therefore, improving utilisation of these medications could translate to substantial reductions in hospital admissions.…”

Section: Discussionmentioning

confidence: 99%

Medications that reduce emergency hospital admissions: an overview of systematic reviews and prioritisation of treatments

Bobrovitz

Heneghan

Onakpoya

et al. 2018

BMC Med

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BackgroundRates of emergency hospitalisations are increasing in many countries, leading to disruption in the quality of care and increases in cost. Therefore, identifying strategies to reduce emergency admission rates is a key priority. There have been large-scale evidence reviews to address this issue; however, there have been no reviews of medication therapies, which have the potential to reduce the use of emergency health-care services. The objectives of this study were to review systematically the evidence to identify medications that affect emergency hospital admissions and prioritise therapies for quality measurement and improvement.MethodsThis was a systematic review of systematic reviews. We searched MEDLINE, PubMed, the Cochrane Database of Systematic Reviews & Database of Abstracts of Reviews of Effects, Google Scholar and the websites of ten major funding agencies and health charities, using broad search criteria. We included systematic reviews of randomised controlled trials that examined the effect of any medication on emergency hospital admissions among adults. We assessed the quality of reviews using AMSTAR. To prioritise therapies, we assessed the quality of trial evidence underpinning meta-analysed effect estimates and cross-referenced the evidence with clinical guidelines.ResultsWe identified 140 systematic reviews, which included 1968 unique randomised controlled trials and 925,364 patients. Reviews contained 100 medications tested in 47 populations. We identified high-to moderate-quality evidence for 28 medications that reduced admissions. Of these medications, 11 were supported by clinical guidelines in the United States, the United Kingdom and Europe. These 11 therapies were for patients with heart failure (angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers, aldosterone receptor antagonists and digoxin), stable coronary artery disease (intensive statin therapy), asthma exacerbations (early inhaled corticosteroids in the emergency department and anticholinergics), chronic obstructive pulmonary disease (long-acting muscarinic antagonists and long-acting beta-2 adrenoceptor agonists) and schizophrenia (second-generation antipsychotics and depot/maintenance antipsychotics).ConclusionsWe identified 11 medications supported by strong evidence and clinical guidelines that could be considered in quality monitoring and improvement strategies to help reduce emergency hospital admission rates. The findings are relevant to health systems with a large burden of chronic disease and those managing increasing pressures on acute health-care services.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1104-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Medications that reduce emergency hospital admissions: an overview of systematic reviews and prioritisation of treatments

Bobrovitz

Heneghan

Onakpoya

et al. 2018

BMC Med

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“…Catheter-based RD has emerged as a nonpharmacological approach for treatment of refractory hypertension via decreasing sympathetic activities 6 , 11 , 12 , 13 , 14 . In HF, sympathoexcitation is associated with increased mortality and progression of LV dysfunction 3 , 4 .…”

Section: Discussionmentioning

confidence: 99%

“…In patients with HF, increased activity of the sympathetic nervous system is associated with progression of left ventricular (LV) dysfunction and increased mortality 3 , 4 . Both renal afferent and efferent sympathetic nerves have been proposed to contribute to the sympathoexcitation in HF 5 , 6 . In HF, increased central sympathetic neural outflow is associated with cardiac and renal efferent sympathetic nerve activations, and thus, cardiac and renal norepinephrine spillover 7 , 8 , 9 .…”

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confidence: 99%

“…However, activation of renal afferent sympathetic nerves caused by renal hypoxemia and ischemia may also directly induce increased central sympathetic outflow 9 , 10 . Recent development of catheter-based renal nerve ablation for treatment of refractory hypertension has led to a growing interest in renal denervation (RD) for treatment of HF 6 , 11 , 12 , 13 , 14 , 15 , 16 .…”

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confidence: 99%

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Improvement of Myocardial Function Following Catheter-Based Renal Denervation in Heart Failure

Liao

Zhen

Liu

et al. 2017

JACC: Basic to Translational Science

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“…However, RDT-PED trial (randomized open label, NYHA II-III, LVEF > 50%, primary endpoint: changes in symptoms, exercise function, biomarkers, LV filling pressure, and LV remodeling, ClinicalTrials.gov Identifier: NCT01840059) assessed the benefits of RDN on HFpEF but was terminated early because of difficulties in recruitment and was underpowered to detect whether RDN improved the endpoints of quality of life, exercise function, biomarkers, and LV remodeling [14]. The mechanisms in the benefits of RDN for heart failure, technical methodology, selection of patients, and the quality of device itself are premature, and we should do further clinical and basic research to develop the appropriate RDN for heart failure [29].…”

Section: Vagal Nerve Stimulation For Heart Failurementioning

confidence: 99%

Deep and future insights into neuromodulation therapies for heart failure

Kishi

2016

Journal of Cardiology

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Major pathophysiology of heart failure is an autonomic nervous system dysfunction as a result of excess sympathoexcitation and/or withdrawal of vagal nerve activity. Although we already have various pharmacological and non-pharmacological therapies for heart failure, survival of heart failure patients remains around 50%. To achieve further reductions in morbidity and mortality of heart failure, neuromodulations with devices, such as baroreflex activating therapy, vagal nerve stimulation, renal sympathetic denervation, spinal cord stimulation, and left cardiac sympathetic denervation, have been expected. Although all of these neuromodulations have benefits on heart failure, efficacy, and safety in preclinical and small-sized clinical studies, the benefits on heart failure have been insufficient and controversial compared to our expectations in large-sized randomized trials. However, we should develop and apply these novel therapies for the patients with heart failure in the near future.

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A perspective on sympathetic renal denervation in chronic congestive heart failure

Cited by 6 publications

References 51 publications

Medications that reduce emergency hospital admissions: an overview of systematic reviews and prioritisation of treatments

Medications that reduce emergency hospital admissions: an overview of systematic reviews and prioritisation of treatments

Improvement of Myocardial Function Following Catheter-Based Renal Denervation in Heart Failure

Deep and future insights into neuromodulation therapies for heart failure

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