The Year in Heart Failure

Abstract

With health care reform and pay-for-performance measures in the near future, the heart failure (HF) community must critically appraise our practice patterns and processes of care. Ideally, our efforts begin with strategies to prevent HF, followed by therapies to treat HF and approaches to improving the cost-effectiveness of care. It is increasingly apparent that our current model is not sustainable, and we look to the scientists and clinicians in our field to provide innovative yet practical solutions. Herein, we discuss the major published clinical advances in HF over the past academicIn the United States, HF incidence approaches 10 per 1,000 population after 65 years of age (29). Efforts to prevent HF focus on the treatment of established risk factors and the development of risk scores to predict incident HF. One risk prediction score, the Health ABC Heart Failure Model, was validated externally in Cardiovascular Health Study participants, confirming the utility of 9 variables to predict incident HF. The strength of the model is its applicability to real-world practice, in which all of the variables are readily available (30). A separate study suggested that including only common cardiovascular risk factors (coronary disease, hypertension, diabetes, atrial fibrillation, valvular disease, and age) can predict incident HF in men and women during 1,015,794 person-years of follow-up (31). Lam et al. (32) showed that after adjustment for cardiac dysfunction, subclinical dysfunction in each noncardiac organ system was associated with a 30% increased risk for HF.Nevertheless, there is an unmet need to predict risk earlier. A small study by Yan et al. (33) reported the use of cardiac magnetic resonance imaging to detect subclinical, regional left ventricular (LV) dysfunction, as an independent predictor for incident HF and cardiovascular events in the asymptomatic, lower risk MESA (Multi-Ethnic Study of Atherosclerosis) cohort. Another investigation of an elderly cohort revealed an increased risk for LV diastolic dysfunction, independent of LV mass and traditional risk factors, that occurred with increased body mass index (34). These studies suggest that lifestyle counts in HF prevention efforts. Indeed, an analysis of almost 60,000 Finnish subjects free of HF at baseline showed that moderate and high levels of occupational and leisure-time physical activity were associated with a reduced risk for HF (35). BiomarkersThis year saw no new evidence that serial biomarker-guided management of HF could reduce morbidity or mortality. In both the STARBRITE (Strategies for Tailoring Advanced HF Regimens in the Outpatient Setting) and PRIMA (Can Pro-Brain-Natriuretic Peptide Guided Therapy of Chronic HF Improve HF Morbidity and Mortality) trials, the use of natriuretic peptide-guided therapy was associated with increased use of evidence-based medications but no improvement in days alive or decrease in HF hospitalizations (36,37).Several biomarker studies focused on predicting HF incidence in the community. Elevated cardiac tro...

Heart Failure in Sub-Saharan Africa

“…There have been many recent advances in knowledge of HF from around the world [222]. While many of these findings will apply to Africans with HF, there are reasons to specifically study the syndrome of HF in the region including understanding the population-specific disease burden, the vast genetic heterogeneity in SSA, geographic, social and cultural diversity and secular trends that may impact risk factors for various forms of HF [223].…”

Heart Failure and Loss of Metabolic Control

“…48 However, despite the diverse etiologies that trigger heart failure, altered cardiac metabolism is a common theme. 4, 49 Generally, it is agreed that in mild-to-moderate heart failure, phosphocreatine and total creatine stores begin to decline; simultaneously, there is a shift in metabolic substrate utilization from FFA oxidation to glucose oxidation.…”

DPP-4 inhibition has beneficial effects on the heart after myocardial infarction

“…Left ventricular (LV) remodeling, which includes dilatation of the ventricle and increased interstitial fibrosis, is the critical process that underlies the progression to heart failure after MI [2]. Although recent pharmacological therapies are effective, heart failure is still one of the leading causes of death worldwide [3,4]. Therefore, it is important to elucidate a novel approach to prevent LV remodeling and heart failure after MI.…”