Hospitalisation costs associated with heart failure with preserved ejection fraction (HFpEF): a systematic review

One of the characteristics of the failing human heart is a significant alteration in its energy metabolism. Recently, a ketone body, β-hydroxybutyrate (β-OHB) has been implicated in the failing heart’s energy metabolism as an alternative “fuel source.” Utilization of β-OHB in the failing heart increases, and this serves as a “fuel switch” that has been demonstrated to become an adaptive response to stress during the heart failure progression in both diabetic and non-diabetic patients. In addition to serving as an alternative “fuel,” β-OHB represents a signaling molecule that acts as an endogenous histone deacetylase (HDAC) inhibitor. It can increase histone acetylation or lysine acetylation of other signaling molecules. β-OHB has been shown to decrease the production of reactive oxygen species and activate autophagy. Moreover, β-OHB works as an NLR family pyrin domain-containing protein 3 (Nlrp3) inflammasome inhibitor and reduces Nlrp3-mediated inflammatory responses. It has also been reported that β-OHB plays a role in transcriptional or post-translational regulations of various genes’ expression. Increasing β-OHB levels prior to ischemia/reperfusion injury results in a reduced infarct size in rodents, likely due to the signaling function of β-OHB in addition to its role in providing energy. Sodium-glucose co-transporter-2 (SGLT2) inhibitors have been shown to exert strong beneficial effects on the cardiovascular system. They are also capable of increasing the production of β-OHB, which may partially explain their clinical efficacy. Despite all of the beneficial effects of β-OHB, some studies have shown detrimental effects of long-term exposure to β-OHB. Furthermore, not all means of increasing β-OHB levels in the heart are equally effective in treating heart failure. The best timing and therapeutic strategies for the delivery of β-OHB to treat heart disease are unknown and yet to be determined. In this review, we focus on the crucial role of ketone bodies, particularly β-OHB, as both an energy source and a signaling molecule in the stressed heart and the overall therapeutic potential of this compound for cardiovascular diseases.

show abstract

“…The treatment of HFpEF is concentrated on comorbidities management (Clark et al, 2021). HFrEF and HFpEF have different metabolic patterns.…”

Section: β-Ohb Is Cardioprotective In Humansmentioning

confidence: 99%

Beta-Hydroxybutyrate, Friend or Foe for Stressed Hearts

2021

View full text Add to dashboard Cite

show abstract

“…Studies have shown that HFpEF is associated with a higher risk of mortality and frequent hospitalization relative to heart failure with reduced ejection fraction (HFrEF) ( 6 – 8 ). HFpEF has become a serious public health problem and has brought a huge economic burden to society ( 9 , 10 ). However, in sharp contrast, there is a lack of effective drugs for the treatment of HFpEF.…”

Section: Introductionmentioning

confidence: 99%

Effect of Sodium-Glucose Cotransporter 2 Inhibitors for Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Zhou

Peng

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…Нами продемонстрирована высокая нагрузка на систему здравоохранения, ассоциированная с СН -4,2% от всех обращений за медицинской помощью составили обращения пациентов с СН, при этом каждая пятнадцатая госпитализация и каждый десятый вызов скорой медицинской помощи приходится на пациента с СН. Высокая потребность в медицинской помощи с частыми обращениями определяют расходы на СН на уровне 1-2% от расходов со стороны системы здравоохранения [23]. Наибольшие затраты (до 80%) приходятся на госпитализации с СН, с высоким средним койко-днем и частыми повторными госпитализациями [23,24].…”

Section: Discussionunclassified

“…Высокая потребность в медицинской помощи с частыми обращениями определяют расходы на СН на уровне 1-2% от расходов со стороны системы здравоохранения [23]. Наибольшие затраты (до 80%) приходятся на госпитализации с СН, с высоким средним койко-днем и частыми повторными госпитализациями [23,24]. На протяжении последних лет число госпитализаций с СН неуклонно растет [25].…”

Section: Discussionunclassified

ICD-10 code-based definition of heart failure in Saint Petersburg electronic health records: prevalence, health care utilization and outcomes

et al. 2021

View full text Add to dashboard Cite

Aim. To analyze prevalence of heart failure (HF), clinical and demographic characteristics, health care utilization, and outcomes according to the used International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes in regional integrated electronic health record database in Saint Petersburg.Material and methods. The retrospective analysis of the Saint Petersburg regional integrated electronic health record database for 2019 was performed. At least one of the following ICD-10 codes has been considered as HF case: I50.x (standard coding) and/or I11.0, I13.0, I13.2, I25.5, I42.0, I42.9, I09.9, I43.0, I43.1, I43.2, I43.8, I42.5, I42.6, I42.7, I42.8 (extended coding).Results. A total of 64070 adult patients with HF had medical encounters in 2019, 34,5% of whom were identified using standard coding, 65,5% — using extended coding. The combination of codes was observed in 9,9% of cases. HF prevalence/mortality was 1,4%/6,8% in general, as well as 0,49%/15,7% and 0,93%/2,1% with standard and extended coding, respectively. HF patients had high healthcare utilization with the mean number of 14 encounters per patient per year. Actually, 24% of patients had more than 20 both inpatient and outpatient encounters and 54% of patients — at least 1 all-cause hospitalization during the year. Encounters of patients with HF accounted for 4,3% of all visits, 6,5% of all hospitalizations, 4,1% of all outpatient visits and 9,7% of all emergency contacts during the year. Patients identified by the standard coding compared with the extended coding had older age and higher incidence of comorbidities, as well as greater hospitalization and death rates, but lower number of outpatient visits.Conclusion. The prevalence of HF among the adult population of Saint. Petersburg in 2019 was 1,4%. HF was characterized by a high health care utilization and mortality rate reaching 15,7 % per year. The use of different approaches to coding presumably could help to identify different groups of patients with HF, which requires the adaptation of healthcare models and an active monitoring system to reduce the risk of adverse events.

show abstract

Hospitalisation costs associated with heart failure with preserved ejection fraction (HFpEF): a systematic review

Cited by 20 publications

References 49 publications

Beta-Hydroxybutyrate, Friend or Foe for Stressed Hearts

Beta-Hydroxybutyrate, Friend or Foe for Stressed Hearts

Effect of Sodium-Glucose Cotransporter 2 Inhibitors for Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

ICD-10 code-based definition of heart failure in Saint Petersburg electronic health records: prevalence, health care utilization and outcomes

Contact Info

Product

Resources

About