Frailty syndrome (FS) is an independent predictor of mortality in cardiovascular disease and is found in 15–74% of patients with heart failure (HF). The syndrome has a complex, multidimensional aetiology and contributes to adverse outcomes. Proper FS diagnosis and treatment determine prognosis and support the evaluation of treatment outcomes. Routine FS assessment for HF patients should be included in daily clinical practice as an important prognostic factor within a holistic process of diagnosis and treatment. Multidisciplinary team members, particularly nurses, play an important role in FS assessment in hospital and primary care settings, and in the home care environment. Raising awareness of concurrent FS in patients with HF patients and promoting targeted interventions may contribute to a decreased risk of adverse events, and a better prognosis and quality of life.

Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient’s prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF (“cardiac cachexia”).

PurposeThe aim of this study was to gain a deeper insight into patients’ perception of chronic heart failure (CHF) symptoms by analyzing their compliance with nonpharmacological recommendations.Patients and methodsThis was a prospective, single-center survey-based registry. Patients included in this study were hospitalized between December 2014 and January 2016 at the 1st Department of Cardiology, University Hospital of Lord’s Transfiguration, Poznań University of Medical Sciences, and had been diagnosed with CHF at least 3 months prior to inclusion. Participants were divided according to New York Heart Association (NYHA) functional class into mild CHF (NYHA I and II) and severe CHF (NYHA III and IV), and according to age into young (<50 years), middle-aged (50–70 years) and old (>70 years). The survey included information about the patients’ sex, age, education, length of the illness and 12 questions about their perception of CHF. This study included 201 patients. The mean age was 58±15 years.ResultsThe younger the patients, the more often they thought that CHF is curable. The patients presenting with severe CHF tended to think that CHF is incurable significantly more often than those with mild CHF. Most of the patients considered loss of appetite, cough and vomiting the least alarming symptoms. Significantly more patients with severe CHF exercised less and reported reduced sexual activity more often in comparison to the mild CHF patients. Most of the young patients reported no changes to their sexual activity, body mass index (BMI) or exercise after diagnosis of CHF. Most of the old patients exercised less than before diagnosis of CHF. Significantly more middle-aged patients reduced their BMI, quit smoking and reported lower sexual activity after diagnosis of CHF in comparison to the other groups.ConclusionPatients need to be better educated about the nature of CHF and the importance of lifestyle changes.

Heart Failure (HF) is a cardiovascular disease with continually increasing morbidity and high mortality. The purpose of this study was to analyze nutritional status in patients diagnosed with HF with reduced ejection fraction (HFrEF) and evaluate the impact of malnutrition on their prognosis. The Polish version of MNA form (Mini Nutritional Assessment) was used to assess the patients’ nutritional status. The New York Heart Association (NYHA) class, exacerbation of HF, chosen echocardiographic and biochemical parameters, e.g. natriuretic peptides or serum albumin, were also analyzed. Among the 120 consecutive patients, 47 (39%) had a normal nutritional status, 62 (52%) were at risk of malnutrition and 11 (9%) were malnourished. The patients with malnutrition more frequently presented with HF exacerbation in comparison to those with normal nutritional status (82% vs. 30% respectively, p = 0.004). There were no significant differences between the investigated groups as to natriuretic peptides; however, both the malnourished patients and those at risk of malnutrition tend to show higher B-type natriuretic peptide (BNP) and NT-proBNP concentrations. During the average 344 days of follow-up 19 patients died and 25 were hospitalized due to decompensated HF. Malnutrition or being at risk of malnutrition seems to be associated with both worse outcomes and clinical status in HFrEF patients.

We are constantly looking for new parameters and markers that can help in the assessment of patients with various diseases, including cardiac disorders; this can translate into better care and improved prognosis. Suppression of tumorigenicity 2 (ST2) has recently gained interest as a potential biomarker in many fields: it is involved in many inflammatory diseases and allergies, including asthma, rheumatoid arthritis and inflammatory bowel disease, and it participates in cardiovascular pathophysiology. Suppression of tumorigenicity 2 is being investigated as a promising biomarker in heart diseases. The interaction of interleukin 33 (IL-33) and ST2L is part of a cardioprotective pathway that prevents fibrosis and inhibits inflammatory response, hypertrophy and apoptosis of cardiomyocytes. In this review, we try to summarize the current knowledge about the usefulness of soluble ST2 (sST2) in cardiology. Clinical data show promising results for the possibility of using sST2 in various diseases, such as arrhythmia, hypertension, myocarditis, acute aortic syndrome, and coronary artery disease (CAD). This novel biomarker may also play a role in heart transplantation and perioperative care.

It was demonstrated that the use of sacubitril/valsartan in outpatients with HFrEF is safe and is associated with a significant clinical improvement.

Pulmonary hypertension (PH), second only to left heart diseases (LHD), is a frequent problem in clinical practice. At the same time, left heart diseases represent the most common cause of pulmonary hypertension, and the occurrence of PH in patients with chronic heart failure is usually associated with worse functional class, and prognosis. Right heart catheterization (RHC) is the "gold standard" in the diagnosis and differentiation of PH. It is also essential in the process of qualifying for a heart transplantation. Therefore, right heart catheterization should be performed in expert centers by experienced operators and according to a strict protocol to ensure the reliability and reproducibility of results. Recommendations for pulmonary hypertension due to left heart disease are based on the European Society of Cardiology (ESC) guidelines designed in cooperation with the European Respiratory Society (ERS) and the International Society for Heart and Lung Transplantation (ISHL). The new ESC guidelines for pulmonary hypertension published in 2015 have improved the diagnostic and therapeutic process in patients with left heart diseases.

Digoxin is associated with increased risk of death in HFrEF patients without AF history receiving the guideline- -directed treatment. Digoxin seems to be employed in patients with worse clinical status, which may at least partially explain its association with increased risk of death.