Background: Patients with heart failure (HF) are heterogeneous with multiple complex phenotypes across the ejection fraction (EF) spectrum. Phenotype-specific response to various treatments have not been well-described. Hypothesis: Clinical response to specific interventions will vary according to HF phenotype. Methods: Using latent class analysis, six cluster-based HF phenotypes across the EF spectrum were previously identified using patient data from 2130 patients enrolled in HF-ACTION (LVEF ≤ 35%) and 1767 patients enrolled from the Americas in TOPCAT (LVEF ≥ 45%) based on age, sex, race, CAD, BMI, hyperlipidemia, hypertension, diabetes mellitus, atrial fibrillation, COPD, anemia, and renal function, but not LVEF. Response to aerobic exercise training vs. usual care (HF-ACTION) and spironolactone vs. placebo (TOPCAT) were quantified by phenotype. The primary outcome was a composite of cardiovascular mortality (CVM) or HF hospitalization (HFH). Secondary outcomes included CVM, HFH, and all-cause mortality (ACM). Change in peak VO2 at 3 and 12 months were also analyzed in HF-ACTION. Results: Of the established phenotypes, the phenotype composed of elderly non-ischemic patients as well as the non-white/non-ischemic/hypertensive phenotype experienced improvement in combined CVM and HFH, ACM and exercise capacity (28% vs 38%, HR: 0.66 [0.46-0.94], 8% vs 16% HR: 0.49 [0.27-0.91], change in VO2: 1.06±3.01 vs 0.04±3.14, p<0.05). Elderly patients with non-ischemic HFrEF enrolled in HF-ACTION randomized to therapeutic exercise program demonstrated significantly improved exercise capacity compared to usual care (change in VO2: 1.45±2.82 vs -0.09±2.49 and 1.25±3.18 vs 0.66±3.64 respectively, p<0.05). Elderly non-ischemic patients treated with spironolactone in TOPCAT had a lower risk of the primary outcome CVM and HFH (20% vs 27%, HR: 0.67 [0.48-0.95]), driven mostly by reduced CVM (9% vs 17%, HR: 0.52 [0.32-0.84]). Conclusions: Response to varied treatments such as exercise training and spironolactone varies among complex HF phenotypes in both HFpEF and HFrEF. Additional investigation which further characterizes phenotype-specific treatments may help select specific interventions most likely to benefit specific phenotypes.

Introduction: Polymorphisms of adrenergic receptors (AR) may affect susceptibility for heart failure with reduced ejection fraction (HFrEF) and response to beta-blockers. One such polymorphism is d...

This study examined effects of local economic conditions on individuals' attitudes toward midpregnancy marriages using an experimental vignette method. Adults (N = 460) were each shown two vignettes about a hypothetical couple expecting a baby; within each vignette pair, vignettes randomly varied as to whether the couple lived in a community that had recently experienced job losses or had stable employment. Respondents indicated if the couple should and will get married before the baby's birth. Results showed that worse local economic conditions led people to believe that marriage would be less common. Among more socio-economically disadvantaged respondents, if the hypothetical couple lived in a community with job loss, fewer respondents also thought that the couple should marry. In contrast, among more socioeconomically advantaged respondents, slightly more respondents thought that the couple should marry. When economic conditions worsen, low-socioeconomic-status individuals may believe that financial prerequisites for marriage become harder to meet.

This article reports the results of two studies that examined the relationship between (central) auditory processing ([C]AP) - as measured by a (C)AP test battery, and understanding connected speech-in-noise - as measured by The University of Queensland Understanding Everyday Speech Test (UQUEST), in school-aged children referred for a (C)AP assessment. Study 1 involved 25 children (16 boys and 9 girls aged 7-17 years) and Study 2 involved 19 children (13 boys and 6 girls aged 7-14 years), all of whom had normal hearing sensitivity on the day of testing. The (C)AP assessments were conducted at signal levels of 50 dB HL (dial) in both studies, using low pass filtered speech (LPFS), two-pair dichotic digits (DD), competing sentences (CS; 35 dB HL [dial] target sentence and 50 dB HL [dial] competing sentence) and frequency patterns (with linguistic and nonlinguistic report: FPT-L and FPT-NL respectively). UQUEST assessments were conducted at signal levels of 65 dB HL (dial) in Study l, and 50 dB HL (dial) in Study 2, and at signal-to-noise (SNR) ratios of +5 and 0 dB HL (dial) in both studies. For Study 1 (UQUEST signal level = 65 dB HL [dial]), Spearman's rank correlation analyses showed no significant (p < .05) correlations between (C)AP and UQUEST scores, and Mann-Whitney analyses showed no significant (p < .05) differences in UQUEST scores between the at risk and not at risk for (C)APD groups for any of the three (C)APD diagnostic criteria used. For Study 2 (UQUEST signal level= 50 dB HL [dial]), moderate correlations were observed between UQUEST+5 and CSR (r = .55, p < .05) and FP-LL (r = 0.56, p < .05), and UQUEST0 and CSL (r =.57, p < .05); and significant (p < .01 or better) differences were observed between the UQUEST+5 scores of at risk and not at risk for (C)APD groups for two of three different diagnostic criteria used. These results suggest the (C)AP tests and the UQUEST+5 presented at 50 dB HL (dial) were measuring related processes, and this presentation of the UQUEST could serve as a useful screening tool for (C)APD under certain diagnostic criteria.