Aims Our aim is to describe the clinical characteristics and management of patients hospitalized with acute heart failure (HHF) and ambulatory patients with chronic heart failure (CHF) in Egypt and compare them with heart failure (HF) patients from other countries in the European Society of Cardiology-Heart Failure (ESC-HF) registry. Methods and resultsThe ESC-HF Long-term Registry is a prospective, multi-centre, observational study of patients presenting to cardiology centres in member countries of the ESC. From April 2011 to February 2014, a total of 2145 patients with HF were recruited from 20 centres all over Egypt. Of these patients, 1475 (68.8%) were hospitalized with HHF, while 670 (31.2%) had CHF. Less than one-third (32.1%) of all patients were females. HHF patients {median age of 61 years [interquartile range (IQR), 53-69]} were older than CHF patients [median age of 57 years (IQR,46-64)]; P < 0.0001. They had more diabetes mellitus (45.4% vs. 31.8%; P < 0.0001). Left ventricular ejection fraction > 45% was present in 22% of HHF vs. 25.6% of CHF (P = 0.17). Atrial fibrillation existed in about a quarter of all patients (24.5%). Ischaemic heart disease was the main cause of HF in Egyptian patients. All-cause in-hospital mortality was 5%. Egyptian patients presented at a much earlier age than in other regions in the registry. They had more diabetes mellitus. Atrial fibrillation prevalence was remarkably lower. Other co-morbidities (renal dysfunction, stroke, and peripheral arterial disease) occurred less frequently.Conclusion Patients in the Egyptian cohort exhibited distinct features from HF patients in other countries in the ESC-HF Long-term Registry.

ObjectiveTo determine if individualized education before Ramadan results in a safer fast for people with type 2 diabetes.MethodsPatients with type 2 diabetes who received care from participating clinics in Egypt, Iran, Jordan and Saudi Arabia and intended to fast during Ramadan 2014 were prospectively studied. Twelve clinics participated. Individualized education addressed meal planning, physical activity, blood glucose monitoring and acute metabolic complications and when deemed necessary, provided an individualized diabetes treatment plan.Results774 people met study criteria, 515 received individualized education and 259 received usual care. Those who received individualized education were more likely to modify their diabetes treatment plan during Ramadan (97% vs 88%, p<0.0001), to perform self-monitoring of blood glucose at least twice daily during Ramadan (70% vs 51%, p<0.0001), and to have improved knowledge about hypoglycemic signs and symptoms (p=0.0007). Those who received individualized education also reduced their body mass index (−1.1±2.4 kg/m2 vs −0.2±1.7 kg/m2, p<0.0001) and glycated haemoglobin (−0.7±1.1% vs −0.1±1.3%, p<0.0001) during Ramadan compared those who received usual care. There were more mild (77% vs 67%, p=0.0031) and moderate (38% vs 19%, p<0.0001) hypoglycemic events reported by participants who received individualized education than those who received usual care, but fewer reported severe hypoglycemic events during Ramadan (23% vs 34%, p=0.0017).ConclusionsThis individualized education and diabetes treatment program helped patients with type 2 diabetes lose weight, improve glycemic control and achieve a safer fast during Ramadan.

Aims To assess the proportion of patients with heart failure and reduced ejection fraction (HFrEF) who are eligible for sacubitril/valsartan (LCZ696) based on the European Medicines Agency/Food and Drug Administration (EMA/FDA) label, the PARADIGM‐HF trial and the 2016 ESC guidelines, and the association between eligibility and outcomes. Methods and results Outpatients with HFrEF in the ESC‐EORP‐HFA Long‐Term Heart Failure (HF‐LT) Registry between March 2011 and November 2013 were considered. Criteria for LCZ696 based on EMA/FDA label, PARADIGM‐HF and ESC guidelines were applied. Of 5443 patients, 2197 and 2373 had complete information for trial and guideline eligibility assessment, and 84%, 12% and 12% met EMA/FDA label, PARADIGM‐HF and guideline criteria, respectively. Absent PARADIGM‐HF criteria were low natriuretic peptides (21%), hyperkalemia (4%), hypotension (7%) and sub‐optimal pharmacotherapy (74%); absent Guidelines criteria were LVEF>35% (23%), insufficient NP levels (30%) and sub‐optimal pharmacotherapy (82%); absent label criteria were absence of symptoms (New York Heart Association class I). When a daily requirement of ACEi/ARB ≥ 10 mg enalapril (instead of ≥ 20 mg) was used, eligibility rose from 12% to 28% based on both PARADIGM‐HF and guidelines. One‐year heart failure hospitalization was higher (12% and 17% vs. 12%) and all‐cause mortality lower (5.3% and 6.5% vs. 7.7%) in registry eligible patients compared to the enalapril arm of PARADIGM‐HF. Conclusions Among outpatients with HFrEF in the ESC‐EORP‐HFA HF‐LT Registry, 84% met label criteria, while only 12% and 28% met PARADIGM‐HF and guideline criteria for LCZ696 if requiring ≥ 20 mg and ≥ 10 mg enalapril, respectively. Registry patients eligible for LCZ696 had greater heart failure hospitalization but lower mortality rates than the PARADIGM‐HF enalapril group.

Men and women with AHF differ significantly in baseline clinical characteristics and management but not in adverse outcomes. These findings emphasize the importance of individualized management and need for more comprehensive recruitment of women in clinical trials.

Background:Myocardial perfusion imaging (MPI) is a powerful diagnostic and prognostic tool for evaluating coronary artery disease (CAD). Several studies have shown Type 2 diabetics are at increased risk for having CAD. In addition, insulin resistance is generally considered to be of major importance in the pathophysiology of Type 2 diabetes mellitus. However, the area of screening prediabetics for CAD remains unclear. Given that glucose intolerance and insulin resistance precede the development of overt diabetes, these factors would be associated with CAD.Aim:This study was designed to evaluate the state of myocardial perfusion in prediabetic adults detected by single photon emission computed tomography (SPECT) in relation to insulin resistance.Patients and Methods:A descriptive study was performed. Out of 113 consecutive prediabetic adults, 32 had insulin resistance (Group A) and 81 had insulin sensitivity (Group B). All were subjected to full medical history and clinical examination including blood pressure, waist circumference, and body mass index. Biochemical studies including lipids profile, fasting blood glucose, and homeostasis model assessments (HOMA) test. Exercise treadmill technetium (99mTC) sestamibi SPECT scintigraphy were done for assessment of myocardial perfusion assessed by summed difference score as well as occurrence of transient left ventricular dilatation.Results:Significant increase in summed difference score as well as transient left ventricular dilatation was observed in Group A than Group B. It is correlated with insulin resistance, and the correlation appears to be independent of glucose tolerance status and obesity. Similar correlations were observed with age, triglycerides, and waist circumference.Conclusion:Prediabetics have myocardial perfusion defects which represent a pattern of cardiovascular risk. These are predominantly observed in prediabetics with increased HOMA IR and visceral obesity independent of glucose levels.