Category: Journal of Cardiac Failure

Heart failure with preserved ejection fraction (HFpEF) is a growing public health challenge, yet underlying mechanisms remain poorly understood. One consistent epidemiologic observation is that the prevalence of HFpEF is markedly higher in women than men. Recent evidence suggests that reproductive factors such as early age of menopause and nulliparity may contribute to the female susceptibility to HFpEF.1 Infertility, a common reproductive factor that affects over 15% of reproductive-aged women in the United States, is consistently underrecognized with respect to cardiovascular risk.

Congestion represents a prevalent yet deleterious pathophysiologic state of heart failure (HF) across the spectrum of disease stages or etiologies. While it was once simply described as the buildup of fluid in the intravascular compartment or interstitial space, the contemporary understanding of congestion has evolved. It encompasses elevated filling pressures that are unrelated to excessive volume (i.e. pressure-volume discordance) and abnormal fluid distribution, primarily arising from reduced venous capacitance [1].

HeartLogic™ is an algorithm that uses ICD/CRT-D sensor data for the prediction of heart failure (HF) events. The algorithm integrates heart sounds, respiration, thoracic impedance, heart rate, and activity measures. When early changes suggestive of decompensation are identified alerts are sent remotely to healthcare providers. The algorithm was developed and validated in separate cohorts of CRT-D patients from the MultiSENSE study1. In the present study we sought to re-validate algorithm performance in an independent cohort, including ICD patients, by using a novel real-world data approach.

Imagine a future where advanced heart failure (HF) patients no longer need a chronic indwelling catheter to receive intravenous (IV) inotropic therapy. For decades, IV milrinone has remained the cornerstone of inotropic therapy for patients with advanced HF. Milrinone is a phosphodiesterase-3 inhibitor and an inodilator, effecting cardiac inotropy, lusitropy and peripheral vasodilation. Continuous IV milrinone can be used as a bridge to heart transplant, durable mechanical circulatory support, or palliative therapy in patients with advanced HF who are unable to be weaned from inotropes.

In this issue of JCF, Jiang Et al. evaluated the impact of HF treatment settings—namely inpatient, observation, emergency department (ED), and outpatient—on 30-day mortality, hospitalizations, and costs.1 The study identified trends over six years, revealing a marked increase in the use of IV diuresis in observation settings and the emergency department, while usage in inpatient and outpatient settings remained generally stable. Patients being treated in the ED and discharged had increased 30-day mortality and readmissions.