Inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices as well as practical and political issues restrict the global applicability of currently available guidelines. There is a need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our iCARDIO Alliance Global Implementation Guidelines emphasize the incorporation of novel therapies, while integrating standard of care with the most up-to-date evidence to enable clinicians to optimize patient care. This document is about heart failure (HF), including acute and chronic heart failure, heart failure with reduced ejection fraction and heart failure with preserved ejection fraction as well as cardiomyopathies. Context-specific recommendations tailored to individual patient needs are highlighted providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged. Most importantly these guidelines also provide recommendations on a number of issues where resource limitations may put constraints on the care provided to HF patients. Such "economic adjustment" recommendations aim to provide guidance for situations when "Resources are somewhat limited" or when "Resources are severely limited". Hence, this document presents not only a comprehensive but also concise update to HF management guidelines thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, invasive and interventional management of this significant global health challenge that is applicable to the needs of healthcare around the globe.
As the population ages, the incidence and prevalence of heart failure (HF) and tumors are increasing, making them the most deadly non-communicable diseases (NCDs) worldwide. Studies have shown that patients with HF are at increased risk of developing tumors, while patients with tumors are at significantly higher risk of developing HF, and various anti-neoplastic treatments are cardiotoxic. In this paper, we will investigate the mechanism of the association between HF and tumor development based on epidemiological data, basic and clinical studies, with the aim of providing new ideas for the early prevention and treatment of both.
Objective:To investigate the incidence and predictors of left ventricular reverse remodeling (LVRR) in elderly patients with dilated cardiomyopathy (DCM) after standard drug therapy.Methods:Elderly patients hospitalized due to heart failure in Xuzhou Central Hospital from August 2018 to April 2019 with the diagnosis of DCM were retrospectively enrolled. The general clinical data and echocardiographic data of the patients were collected. According to the improvement of cardiac function and echocardiographic results during the follow-up at 6 months after treatment, patients were divided into LVRR group which was defined as the improvement of NYHA function class to I or II and an absolute increase in LVEF>15%, or the absolute value of LVEF≥50% at follow-up, or the LVEF increased twice than the baseline value. The incidence of LVRR was calculated, and the baseline predictors of LVRR were identified by multivariate logistic regression analysis.Results:A total of 93 elderly DCM patients were enrolled and the incidence of LVRR was 12.9% (12/93) at 6 months follow-up, of which the LVEF increased from (31.17±9.09) % at baseline to (49.67±7.34) % at follow-up ( P<0.001), accompanied by a decrease in LVEDD from (66.50±7.59) mm at baseline to (55.75±7.55) mm at follow-up ( P<0.001). Multivariate logistic regression analysis showed that medication compliance [odds ratio ( OR) 1.937, 95% confidence interval ( CI) 1.026-3.660, P=0.042] was an independent predictor of LVRR in elderly DCM patients. Conclusion:After standard anti-heart failure drug treatment, the incidence of LVRR in elderly patients with DCM is 12.9%, and treatment compliance is an independent predictor of LVRR in elderly DCM patients.
Myocardial hypertrophy is an important pathological change in the development of heart failure and other cardiovascular diseases. In recent years, a large number of studies have shown that p53 is closely related to the occurrence and development of myocardial hypertrophy, and p53 regulates myocardial hypertrophy by mediating myocardial cell apoptosis, fibrosis, inflammatory response, autophagy and angiogenesis. In this review, the regulatory effects of p53 on myocardial hypertrophy were reviewed, with the aim to provide theoretical reference for potential treatment of myocardial hypertrophy.
Objective:To investigate the relationship between serum uric acid on admisson and prognosis of patients hospitalized with acute heart failure (AHF).Methods:Patients hospitalized with AHF in the Department of Cardiology, Shanghai Tenth People′s Hospital, Tongji University and the Departmnt of Cardiology, Jiangsu Province Qidong people′s Hospital from January 4, 2017 to January 9, 2019 were enrolled in the present study and divided into hyperuricemia group defined as serum uric acid(SUA) on admisson >420 μmol/L or 7.0 mg/dL and normal SUA group defined as SUA on admisson ≤420 μmol/L or 7.0 mg/dL. The baseline characteristics of the these two groups were compared, the difference in survival between the two groups was evaluated by Kaplan-Meier survival curve analysis with log-rank test. Multivariate Cox regression analysis was used to evaluate the prognostic value of SUA level on admisson in AHF patients.Results:A total of 1 018 patients with AHF were enrolled in the study, including 410 cases (40.3%) in the hyperuricemia group and other 608 cases (59.7%) in the normal SUA group. Compared to patients in the normal SUA group, those with hyperuricemia had a higher proportion of males, a higher body mass index (BMI), a higher proportion of smoking history, and a higher proportion of New York Heart Association (NYHA) functional classes III/IV. After admission, the levels of N-terminal B-type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), C-reactive protein (CRP), creatinine and blood urea nitrogen were higher, while the levels of high-density lipoprotein cholesterol and estimated glomerular filtration rate (eGFR) were lower (all P<0.001). Left ventricular ejection fraction (LVEF) was lower and left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were larger measured by echocardiography (all P<0.001). More patients with hyperuricemia had dilated cardiomyopathy and chronic kidney disease (both P<0.05), while more patients with normal SUA had ischemic heart disease and stroke (both P<0.05). Patients with hyperuricemia were more likely to use spironolactones and diuretics at discharge (both P<0.001) and were less likely to use statins ( P=0.005). Among the study population, 16 patients died during hospitalization, and the other 1 002 patients were followed up with a median duration of 1 021 days, and 95 patients (9.5%) died due to cardiovascular causes. Kaplan-Meier survival curve analysis showed that the cardiovascular mortality and all-cause mortality in hyperuricemia patients were significantly higher than those in the normal SUA group (log-rank test, both P<0.001). Multivariate Cox regression analysis showed that age, blood uric acid, Ln cTnT, Ln NT-proBNP, diabetes, diuretics and statins were independent risk factors of cardiovascular death, while Age, blood uric acid, Ln cTnT, Ln NT-proBNP, diabetes mellitus, spironolactone and statins were independent risk factors for all-cause death. Conclusion:SUA is an independent risk factor of cardiovascular death and all-cause death for patients with AHF.
