Management of heart failure with reduced ejection fraction: challenges in patients with atrial fibrillation, renal disease and in the elderly

Kolben, Yotam; Kessler, Asa; Puris, Gal; Nachman, Dean; Alvarez, Paulino; Briasoulis, Αlexandros; Asleh, Rabea

doi:10.31083/j.rcm2301016

Cited by 9 publications

(8 citation statements)

References 130 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to these findings it is clear that AF may be a marker of increased risk that can be explained by the higher clinical complexity typical of AF patients. 75,76 Incident atrial fibrillation after vascular surgery According to our data vascular surgery for arterial diseases is the noncardiac surgery setting where POAF shows a quite high incidence 77 similar to thoracic surgery. Interestingly, in a recent meta-analysis 4 that excluded patient treated with vascular surgery interventions, the incidence of POAF was 1.7% while we found an almost double pooled incidence of POAF (3.6%; 95% CI 2.0-6.4).…”

Section: Discussionmentioning

confidence: 79%

Atrial fibrillation in vascular surgery: a systematic review and meta-analysis on prevalence, incidence and outcome implications

Malavasi,

Muto,

Ceresoli

et al. 2023

Journal of Cardiovascular Medicine

View full text Add to dashboard Cite

Aims To know the prevalence of atrial fibrillation (AF), as well as the incidence of postoperative AF (POAF) in vascular surgery for arterial diseases and its outcome implications. Methods We performed a systematic review and meta-analysis following the PRISMA statement. Results After the selection process, we analyzed 44 records (30 for the prevalence of AF history and 14 for the incidence of POAF). The prevalence of history of AF was 11.5% [95% confidence interval (CI) 1–13.3] with high heterogeneity (I 2 = 100%). Prevalence was higher in the case of endovascular procedures. History of AF was associated with a worse outcome in terms of in-hospital death [odds ratio (OR) 3.29; 95% CI 2.66–4.06; P < 0.0001; I 2 94%] or stroke (OR 1.61; 95% CI 1.39–1.86; P < 0.0001; I 2 91%). The pooled incidence of POAF was 3.6% (95% CI 2–6.4) with high heterogeneity (I 2 = 100%). POAF risk was associated with older age (mean difference 4.67 years, 95% CI 2.38–6.96; P = 0.00007). The risk of POAF was lower in patients treated with endovascular procedures as compared with an open surgical procedure (OR 0.35; 95% CI 0.13–0.91; P = 0.03; I 2 = 61%). Conclusions In the setting of vascular surgery for arterial diseases a history of AF is found overall in 11.5% of patients, more frequently in the case of endovascular procedures, and is associated with worse outcomes in terms of short-term mortality and stroke. The incidence of POAF is overall 3.6%, and is lower in patients treated with an endovascular procedure as compared with open surgery procedures. The need for oral anticoagulants for preventing AF-related stroke should be evaluated with randomized clinical trials.

show abstract

Section: Discussionmentioning

confidence: 79%

Atrial fibrillation in vascular surgery: a systematic review and meta-analysis on prevalence, incidence and outcome implications

Malavasi,

Muto,

Ceresoli

et al. 2023

Journal of Cardiovascular Medicine

View full text Add to dashboard Cite

show abstract

“…Cardiorenal syndrome (CRS) is a complex pathophysiological disorder of the heart and the kidneys, in which acute or chronic dysfunction in one organ may lead to acute or chronic abnormality in another [ 1 , 2 ]. Kidney disease has emerged as an independent risk factor for the development of congestive heart failure (HF) and acute ischemic cardiomyopathy events [ 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of a New Arterial Intravascular Pump on Aorta Hemodynamic Surrounding: A Numerical Study

Wang

et al. 2022

Bioengineering

View full text Add to dashboard Cite

Purpose: The purpose of this study was to investigate the impact of a new arterial intravascular pump on the hemodynamic surroundings within the aorta. Methods: A new arterial intravascular pump was placed in the descending aorta, and the effects of three positions within the aorta, as well as the number (n = 1 to 3) of pumps, on arterial flow features, organ perfusion, and blood trauma were investigated using a computational fluid dynamics (CFD) method. Results: It was found that as the pump position was moved backward, the perfusion in the three bifurcated vessels of the aorta arch increased and the pump suction flow decreased, resulting in a reduced high shear stress and decreased residence time in the three branches of the aortic arch. The further posterior the location of the pump, the better the blood flow perfusion to the kidneys, while the perfusion at the bifurcation of the abdominal aorta was reduced, due to the pump suction effect. Compared to the condition with single pump support, the multi-pump assist model can significantly reduce the pump rotating speed, while keeping the same flow patterns, leading to a decreased volume of high shear stress and flow loss. When increasing the number of pumps, the perfusion to the three branches of the aortic arch increased, accompanied by a diminished residence time, and the perfusion to the other aortic branches was decreased. However, the perfusion to the other aortic branches, especially for the renal arteries and even under a three-pump condition, was close to that without pump assistance. Conclusion: The placement of an intravascular pump near the beginning of the suprarenal abdominal aorta was considered the optimal location, in order to improve the hemodynamic surroundings. Increasing the number of pumps can significantly reduce the rotational speed, while maintaining the same flowrate, with a decreased fluid energy loss and a reduced high shear stress. This arterial intravascular pump can effectively improve renal blood flow.

show abstract

“…HF has been the leading cause of death and disability in the last 20 years and is a highly prevalent disorder worldwide, with its high morbidity and mortality rate leading to increased healthcare costs [ 2 ]. Although daily symptoms of HF, in most cases, are nonspecific and may coexist with those of other clinical conditions, the worsening of common symptoms (e.g., activity limitation and shortness of breath) in patients with HF is associated with reduced exercise capacity, leading to frequent hospital admissions [ 1 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Physicians’ Perceptions of and Barriers to Cardiopulmonary Rehabilitation for Heart Failure Patients in Saudi Arabia: A Cross-Sectional Study

Aldhahir

Alhotye

Alqahtani³

et al. 2022

IJERPH

View full text Add to dashboard Cite

Background: Cardiopulmonary rehabilitation (CR) serves as a core component of the management strategy for patients with heart failure (HF). CR is administered by multidisciplinary healthcare providers, but their perceptions toward delivering CR to HF patients, and the factors and barriers that might influence referral, have not been studied. This study aims to assess physicians’ perceptions toward delivering CR programs to HF patients and identify factors and barriers that might influence their referral decisions. Methods: Between 15 February and 5 June 2022, a cross-sectional online survey with ten multiple-choice items was distributed to all general and cardiac physicians in Saudi Arabia. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. The statistical significance of the difference between categorical variables was determined using the chi-square (2) test. Logistic regression was used to identify referral factors. Results: Overall, 513 physicians (general physicians (78%) and cardiac doctors (22%)) completed the online survey, of which 65.0% (n = 332) were male. Of the general physicians, 236 (59%) had referred patients with HF to CR. Sixty-six (58%) of the cardiac doctors had referred patients with HF to CR. A hospital-supervised program was the preferred mode of delivering CR programs among 315 (79%) general physicians, while 84 (74%) cardiac doctors preferred to deliver CR programs at home. Apart from the exercise component, information about HF disease was perceived by 321 (80%) general physicians as the essential component of a CR program, while symptom management was perceived by 108 (95%) cardiac doctors as the essential component of a CR program. The most common patient-related factor that strongly influenced referral decisions was “fatigue related to disease” (63.40%). The availability of CR centers (48%) was the most common barrier preventing the referral of patients to CR. Conclusions: CR is an effective management strategy for HF patients, but the lack of CR centers is a major barrier to the referral of patients. A hospital-supervised program is the preferred method of delivering CR from the general physicians’ perspective, while cardiac doctors prefer home-based CR programs. Apart from the exercise component, information about HF disease and symptom management is essential components of CR programs from general physicians’ and cardiac doctors’ perspectives, respectively.

show abstract

Management of heart failure with reduced ejection fraction: challenges in patients with atrial fibrillation, renal disease and in the elderly

Cited by 9 publications

References 130 publications

Atrial fibrillation in vascular surgery: a systematic review and meta-analysis on prevalence, incidence and outcome implications

Atrial fibrillation in vascular surgery: a systematic review and meta-analysis on prevalence, incidence and outcome implications

The Impact of a New Arterial Intravascular Pump on Aorta Hemodynamic Surrounding: A Numerical Study

Physicians’ Perceptions of and Barriers to Cardiopulmonary Rehabilitation for Heart Failure Patients in Saudi Arabia: A Cross-Sectional Study

Contact Info

Product

Resources

About