More Protein Associated With Moderate Increase in Heart Failure in Men (except for fish and eggs) Interview with:
“mmmm Meat” by Glen MacLarty is licensed under CC BY 2.0
Jyrki Virtanen, PhD
Adjunct professor of nutritional epidemiology
Heli Virtanen, MSc

University of Eastern Finland
Institute of Public Health and Clinical Nutrition
Kuopio, Finland What is the background for this study? What are the main findings?

Response: Previous studies have found that animal sources of protein may have an adverse impact on the risk of cardiovascular diseases, like myocardial infarct, whereas plant sources of protein have had an opposite impact.

In this study we investigated that how protein intake from different dietary sources is associated with developing heart failure in men during the study’s follow-up. During the mean follow-up time of about 22 years, 334 men developed heart failure.

The main finding of the study was that higher protein intake was associated with a moderately higher risk of heart failure and the findings were similar with protein from most dietary sources, although the association was stronger with protein from animal sources. Only protein from fish and eggs were not associated with the risk in our study. Continue reading

Which Diabetes Meds Reduce Heart Failure and Death? Interview with:

Sean Lee Zheng BM BCh MA MRCP Cardiovascular Division King's College Hospital London British Heart Foundation Centre of Research Excellence London, UK

Dr. Zheng

Sean Lee Zheng BM BCh MA MRCP
Cardiovascular Division
King’s College Hospital London
British Heart Foundation Centre of Research Excellence
London, UK What is the background for this study? What are the main findings?

Response: The growing prevalence of type 2 diabetes and its associated burden on cardiovascular disease is a global problem. A number of drug treatments effective in lowering blood glucose are now available, with the three latest drug classes developed being the DPP-4 inhibitors, GLP-1 agonists and SGLT-2 inhibitors. While the use of medications from these three classes are increasing, it remains unknown how they compare in lowering the risk of death or cardiovascular disease. This leads to clinical uncertainty when it comes to introducing new medicines for our patients. Our study aimed to use data from randomized clinical trials in a network meta-analysis, allowing these three drug classes to be compared with one another.

Our study, which included 236 studies enrolling 176310 participants, showed that the use of SGLT-2 inhibitors or GLP-1 agonists were associated with a lower risk of death than with DPP-4 inhibitors. SGLT-2 inhibitors had additional beneficial effects on heart failure events compared with the other two drug classes.

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Sacubitril/Valsartan Reduces Physical and Social Limitations in Heart Failure Patients Interview with:
Dr. Alvin Chandra  MD first author  and
Dr. Scott David Solomon M.D.
Director, Noninvasive Cardiology
Professor, Harvard Medical School
Cardiovascular Medicine
Brigham and Women’s Hospital
Boston, Massachusetts What is the background for this study? What are the main findings?

Response: In general, the quality of life of heart failure with reduced ejection fraction patients is quite impaired, and  similar to that of patients on dialysis.

PARADIGM-HF was the largest trial of heart failure patients and showed that sacubitril/valsartan was superior to the gold-standard enalapril in reducing cardiovascular death, heart failure hospitalization and all-cause mortality. In addition, patients on sacubitril/valsartan, when compared to enalapril, showed significant improvement in overall quality of life.

In this study we looked in more detail at the individual components of “quality of life” and found that in virtually all domains and activities, patients who were randomized to sacubitril/valsartan reported improvement in their limitations  compared to those who were randomized to enalapril. These activities included jogging, doing hobbies, and household chores, with the largest improvement seen in  sexual activities limitations.

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Readmissions After LVAD For Heart Failure High, Mostly For Non-Cardiac Causes Interview with:
Dr. Sahil Agrawal, MBBS MD

Division of Cardiology, St. Luke’s University Health Network, Bethlehem, PA
Dr Lohit Garg MD
Division of Cardiology
Lehigh Valley Health Network, Allentown What is the background for this study?

Response: Readmissions among advanced heart failure patients are common and contribute significantly to heath care related costs. Rates and causes of readmissions, and their associated costs among patients after durable left ventricular assist device (LVAD) implantation have not been studied in a contemporary multi-institutional setting. We studied the incidence, predictors, causes, and costs of 30-day readmissions after LVAD implantation using Nationwide Readmissions Database (NRD) in our recently published study.

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Cardiovascular Trials Need Better Characterization of Heart Failure in Diabetics Interview with:

Stephen J. Greene, MD Division of Cardiology Duke University Medical Center Durham, NC

Dr. Greene

Stephen J. Greene, MD
Division of Cardiology
Duke University Medical Center
Durham, NC What is the background for this study? What are the main findings?

Response: In 2008, the United States FDA issued an industry guidance specifying that diabetes drugs should routinely be tested in large cardiovascular outcome trials to confirm cardiovascular safety. The guidance specifically mentioned cardiovascular safety in terms of MACE, or major adverse cardiac events, including cardiovascular death, myocardial infarction, and stroke.  Largely because of this, these trials have traditionally had a focus on cardiovascular disease in terms of atherosclerotic events. Heart failure was not mentioned in the FDA document and these trials have had a lesser focus on it.

As the years have gone by, we have learned more and more about the connection between diabetes and heart failure. There is tremendous overlap between the two patient populations. Also, as more and more of the large cardiovascular outcome trials have been completed, we have seen multiple examples of various glucose lowering therapies either increasing or decreasing risk of heart failure events. Given all these data on heart failure/ diabetes interactions, the goal of our research was to carefully examine all of the completed large cardiovascular outcome trials of diabetes therapies to systematically describe the type of heart failure-related data they capture. As an initial step in improving heart failure characterization in these trials, we wanted to first describe what trials have already been doing and where the gaps in understanding heart failure in these trials exist.

Overall, we found major gaps in the amount and quality of the heart failure data capture in these trials. We looked at 21 large trials, including over 150,000 patients. Rates of patients with baseline heart failure were inconsistently provided, and among those trials that did provide it, heart failure patients tended to be underrepresented compared to the general population. Patients with baseline heart failure were also poorly characterized, with minimal data on functional status, ejection fraction, or heart failure medications. Only 6 trials reported rates of new-onset heart failure and the definitions used were non-specific. Most trials tended to report rates of heart failure hospitalization, but did not include data on fatal or other types of heart failure events. Only 2 trials included heart failure events within the primary study endpoint. More details are included in our full manuscript, which was published in the Journal of the American College of Cardiology to coincide with our presentation at the ACC conference.

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Women Who Walk Briskly At Least Twice Per Week Have Lower Risk of Heart Failure Interview with:
Dr. Somwail Rasla, MD

Primary Care Center
Brown University, Pawtucket, RI What is the background for this study? What are the main findings?

Response: Heart failure (HF) is a major global epidemic. The risk of heart failure rises with age, It triples for women above age 60.
Studies have found an inverse relationship between the risk of heart failure hospitalization and midlife fitness.Walking is the most common form of physical activity reported in women
and older adults. T
his study aims at exploring the association of walking pace (speed), walking frequency and duration with the risk of incident acute hospitalized HF (HHF).

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Risk Factors For Sudden Death in Heart Failure with Preserved Ejection Fraction Interview with:

Muthiah Vaduganathan, MD MPH Heart and Vascular Center Brigham and Women's Hospital 

Dr. Vaduganathan

Muthiah Vaduganathan, MD MPH
Heart and Vascular Center
Brigham and Women’s Hospital What is the background for this study? What are the main findings?

Response: The prevalence of heart failure with preserved ejection fraction (HFpEF) is rising globally, yet no medical therapies are currently available to alter its natural history and its progression remains incompletely understood.

Sudden death may represent a target for therapy in this disease entity. In 1,767 patients with HFpEF enrolled in the Americas region of the TOPCAT trial, we found that sudden death accounts for ~20% of all deaths. Male sex and insulin-treated diabetes mellitus identify patients at higher risk for sudden death. Sudden death was numerically lower but not statistically reduced in those randomized to spironolactone.

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Decision Aids Can Help Heart Failure Patients Determine If They Want an LVAD Interview with:

A left ventricular assist device (LVAD) pumping blood from the left ventricle to the aorta, connected to an externally worn control unit and battery pack. Wikipedia image

A left ventricular assist device (LVAD) pumping blood from the left ventricle to the aorta, connected to an externally worn control unit and battery pack.
Wikipedia image

Larry A. Allen, MD, MHS
Associate Professor, Medicine
Associate Head for Clinical Affairs, Cardiology
Medical Director, Advanced Heart Failure
Aurora, CO 80045 What is the background for this study? What are the main findings?

Response: Deciding whether or not to get a left ventricular assist device (LVAD) is one of the most challenging medical decisions created by modern medicine.

LVADs improve overall survival but also come with serious risks and lifestyle changes. Particularly for older patients with multiple medical problems, this is a complex choice.

Our research group at the University of Colorado spent years systematically developing unbiased pamphlet and video decision aids for patients and caregivers. We also developed a clinician-directed decision support training for LVAD program staff. The DECIDE-LVAD trial studied the implementation and effectiveness of this decision support intervention with patients and their caregivers in 6 hospitals in the U.S. When compared to previously used education materials, the decision aids appeared to improve patients’ decision quality and lowered the total number of patients getting LVADs.

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Aggressive Systolic Blood Pressure Control In Older Patients With HFpEF Should Be Avoided

“Doctors” by Tele Jane is licensed under CC BY Interview with:
Dr. Apostolos Tsimploulis, Chief Medical Resident
Dr. Phillip H. Lam, Chief Cardiology Fellow
The Washington, DC Veterans Affairs Medical Center, Georgetown University, and
MedStar Washington Hospital Center, Washington, DC What is the background for this study? What are the main findings?

Response: Hypertension is a major risk factor for the development of new heart failure (HF). Findings from multiple randomized controlled trials in hypertension have consistently demonstrated that controlling systolic blood pressure (SBP) to normal levels such as to SBP <120 mm Hg reduces the risk of developing new HF.

However, interestingly, once patients develop heart failure, those with a normal SBP value such as SBP <120 mm Hg tend to have poor outcomes. This paradoxical association – also called reverse epidemiology – although poorly understood – has been described with other HF risk factors such as smoking and obesity. Regarding poor outcomes associated with lower SBP in HF patients with reduced ejection fraction (HFrEF – pronounced Hef-ref), it has been suggested that it may be a marker of weak heart muscle that is unable to pump enough blood. However, less is known about this association in patients with HF and preserved ejection fraction (HFpEF – pronounced Hef-pef) –– the heart muscle is not weak in the traditional sense.

This is an important question for a number of reasons: nearly half of all heart failure patients have HFpEF which accounts for about 2.5 to 3 million Americans. These patients have a high mortality similar to those with HFrEF – but unlike in HFrEF few drugs have been shown to improve their outcomes. Thus, there is a great deal of interest in improving their outcomes. One of those approaches is to control . systolic blood pressure and the 2017 ACC/AHA/HFSA Focused Update of the HF guidelines recommend that SBP “should be controlled in patients with HFpEF in accordance with published clinical practice guidelines to prevent morbidity.”

Thus, our study was designed to answer that simple question: do patients with HFpEF and SBP <120 mmHg, which is considered to be normal SBP, have better outcomes than those with SBP ≥120 mmHg.

Using a sophisticated approach called propensity score matching we assembled two groups of patients with HFpEF – one group with SBP <120 mmHg and the other groups had SBP ≥120 mmHg – and patients in both groups were similar in terms of 58 key baseline characteristics. In this population of balanced patients with HFpEF, those with a normal systolic blood pressure had a higher risk of mortality – starting 30 days post-discharge up to about 6 years. Finding from our restricted cubic spline plots suggest that compared with SBP <120 mm Hg, SBP values ≥120 mm Hg (up to 200 mm Hg) was not associated with a higher risk of death.

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Majority of Older Adults With Heart Failure Have Hearing Loss Interview with:
“Handicapped Hearing Impaired” by Mark Morgan is licensed under CC BY 2.0Madeline Sterling M.D., M.P.H.

Fellow, Department of Medicine
Weill Cornell Medical College – New York Presbyterian Hospital What is the background for this study? What are the main findings?

Response: Heart Failure currently affects 5.8 million people in the United States and is becoming increasingly common as the population ages. Because it has no cure and tends to get progressively worse, physicians recommend that patients control their symptoms by taking multiple medications, maintain a diet low in salt, monitor their weight and blood pressure, and watch for changes in their symptoms.

At the most basic level, in order to understand and follow these instructions, heart failure patients must be able to hear them.  Hearing loss, however, had not been studied in heart failure.  There are a lot of chronic diseases in which hearing loss is more common than in the general population, including coronary heart disease, hypertension, and diabetes. And many adults with heart failure also have these conditions. So, we thought it would be important to understand if hearing loss was prevalent among adults with heart failure, especially since so much of heart failure management revolves around effective communication between patients and their healthcare providers. Continue reading