Sympathetic activation and outcomes in chronic heart failure: Does the neurohormonal hypothesis apply to mid-range and preserved ejection fraction patients?

Jiménez-Marrero, Santiago; Moliner, Pedro; Rodríguez-Costoya, Iris; Enjuanes, Cristina; Alcoberro, L; Yun, Sergi; González‐Costello, José; Garay, Alberto; Tajes, Marta; Calero, E; Hidalgo, E; Guerrero, Carmen; García‐Romero, Elena; Díez‐López, Carles; Cainzos‐Achirica, Miguel; Comín‐Colet, Josep

doi:10.1016/j.ejim.2020.07.008

Cited by 18 publications

(12 citation statements)

References 28 publications

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“…The study cohort consisted initially of 96 patients prospectively recruited (between June 2015 and December 2018) for the intervention arm. In addition, to define neurohormonal activation, myocardial function, genomic expression, and clinical outcomes in patients with HF, 96 matched controls were selected from 442 patients included in the DAMOCLES study, whose methodology has previously been published by our group 28–30 . Both this MI study and the DAMOCLES study were conducted in the same healthcare area and share the same design in terms of inclusion criteria, exclusion criteria, and follow-up.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Motivational Interviewing on Self-care and Health-Related Quality of Life in Patients With Chronic Heart Failure

et al. 2021

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BackgroundSelf-care is an integral component of successful chronic heart failure (HF) management. Structured educational programs have already been shown to be effective in improving self-care, but some patients show resistance and little motivation for change.ObjectiveThe objective of this study was to compare efficacy in improving self-care and health-related quality of life (HRQoL) for an educational intervention based on motivational interviewing (MI) compared with a conventional educational intervention.MethodsThis experimental pretest-posttest study with an equivalent historical control group included 93 patients in the intervention group and 93 matched patients in the control group. Participants attended a first visit after HF hospitalization discharge and 6 to 7 follow-up visits during 6 months. The European Heart Failure Self-care Behavior scale and the Minnesota Living with Heart Failure Questionnaire were used to assess self-care and HRQoL, respectively. Data on mortality and hospital readmissions were collected as adverse events.ResultsSelf-care improved significantly more in the MI-based intervention group than in the control group (P = .005). Although both self-care and HRQoL improved in both groups over time (P < .05), there was no significant between-group difference in terms of HRQoL improvement over time (P = .13).ConclusionsOur findings suggest that MI delivered by MI-trained nurses is effective in significantly improving self-care by patients with HF. Nonetheless, further studies are required to evaluate the impact of MI on other outcomes, such as HRQoL and adverse clinical events.

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Section: Methodsmentioning

confidence: 99%

The Impact of Motivational Interviewing on Self-care and Health-Related Quality of Life in Patients With Chronic Heart Failure

et al. 2021

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“…Previous research has also assessed the degree of neurohormonal activation across the EF spectrum, showing higher circulating neurohormone levels in patients with HFrEF than in those with HFmrEF or HFpEF 80 , 97 , 98 . The higher neurohormonal activation in HFrEF might reflect the greater HF severity and be a marker of higher rates of cardiovascular events in patients with HFrEF than in patients with HFmrEF or HFpEF, as well as the observed efficacy of neurohormonal inhibition in patients with HFrEF, and potentially in those with HFmrEF, but not in patients with HFpEF (as discussed below) 26 , 72 , 99 .…”

Section: Clinical Characteristics Of Hfmrefmentioning

confidence: 99%

Heart failure with mid-range or mildly reduced ejection fraction

et al. 2021

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Left ventricular ejection fraction (EF) remains the major parameter for diagnosis, phenotyping, prognosis and treatment decisions in heart failure. The 2016 ESC heart failure guidelines introduced a third EF category for an EF of 40–49%, defined as heart failure with mid-range EF (HFmrEF). This category has been largely unexplored compared with heart failure with reduced EF (HFrEF; defined as EF <40% in this Review) and heart failure with preserved EF (HFpEF; defined as EF ≥50%). The prevalence of HFmrEF within the overall population of patients with HF is 10–25%. HFmrEF seems to be an intermediate clinical entity between HFrEF and HFpEF in some respects, but more similar to HFrEF in others, in particular with regard to the high prevalence of ischaemic heart disease in these patients. HFmrEF is milder than HFrEF, and the risk of cardiovascular events is lower in patients with HFmrEF or HFpEF than in those with HFrEF. By contrast, the risk of non-cardiovascular adverse events is similar or greater in patients with HFmrEF or HFpEF than in those with HFrEF. Evidence from post hoc and subgroup analyses of randomized clinical trials and a trial of an SGLT1–SGLT2 inhibitor suggests that drugs that are effective in patients with HFrEF might also be effective in patients with HFmrEF. Although the EF is a continuous measure with considerable variability, in this comprehensive Review we suggest that HFmrEF is a useful categorization of patients with HF and shares the most important clinical features with HFrEF, which supports the renaming of HFmrEF to HF with mildly reduced EF.

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“…Therefore, the response of HFmrEF patients to neurohormonal therapy is similar to that of HFrEF rather than HFpEF. 29 Other studies also confirmed that patients with LVEF between 40 and 49% respond to drug therapy more similarly to patients with reduced LVEF rather than those with preserved LVEF, not only for β-blockers, but also for RAAS inhibitors. 25,27 These observations were consistent with the findings of our real-world study and reinforce an important role for increasing neurohormonal blockade treatment intensity in improving clinical outcomes in patients with HFmrEF.…”

Section: Discussionmentioning

confidence: 83%

Efficacy of guideline‐directed medical treatment in heart failure with mildly reduced ejection fraction

et al. 2022

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Aims Heart failure with mildly reduced ejection fraction (HFmrEF) has received increasing attention following the publication of the latest ESC guidelines in 2021. However, it remains unclear whether patients with HFmrEF could benefit from guideline-directed medical treatment (GDMT), referring the combination of ACEI/ARB/ARNI, β-blockers, and MRAs, which are recommended for those with reduced ejection fraction. This study explored the efficacy of GDMT in HFmrEF patients. Methods This was a retrospective cohort study of HFmrEF patients admitted to The First Affiliated Hospital of Dalian Medical University between 1 September 2015 and 30 November 2019. Propensity score matching (1:2) between patients receiving triple-drug therapy (TT) and non-triple therapy (NTT) based on age and sex was performed. The primary outcome was all cause death, cardiac death, rehospitalization from any cause, and rehospitalization due to worsening heart failure. Results Of the 906 patients enrolled in the matched cohort (TT group, n = 302; NTT group, N = 604), 653 (72.08%) were male, and mean age was 61.1 ± 11.92. Survival analysis suggested that TT group experienced a significantly lower incidence of prespecified primary endpoints than NTT group. Multivariable Cox regression showed that TT group had a lower risk of all-cause mortality (HR 0.656, 95% CI 0.447-0.961, P = 0.030), cardiac death (HR 0.599, 95% CI 0.380-0.946, P = 0.028), any-cause rehospitalization (HR 0.687, 95% CI 0.541-0.872, P = 0.002), and heart failure rehospitalization (HR 0.732, 95% CI 0.565-0.948, P = 0.018). Conclusions In patients with HFmrEF, combined use of neurohormonal antagonists produces remarkable effects in reducing the occurrence of the primary outcome of rehospitalization and death. Thus, the treatment of HFmrEF should be categorized as HFrEF due to the similar benefit of neurohormonal blocking therapy in HFrEF and HFmrEF.

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Sympathetic activation and outcomes in chronic heart failure: Does the neurohormonal hypothesis apply to mid-range and preserved ejection fraction patients?

Cited by 18 publications

References 28 publications

The Impact of Motivational Interviewing on Self-care and Health-Related Quality of Life in Patients With Chronic Heart Failure

The Impact of Motivational Interviewing on Self-care and Health-Related Quality of Life in Patients With Chronic Heart Failure

Heart failure with mid-range or mildly reduced ejection fraction

Efficacy of guideline‐directed medical treatment in heart failure with mildly reduced ejection fraction

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