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Introduction: The VICTORIA (Vericiguat Global Study in Subjects with HF with Reduced EF) trial included 5050 patients in 3 discrete subgroups reflecting their index worsening heart failure (HF) event: Methods: We compared primary composite (CV death and HFH) and secondary (all-cause death and HFH) outcomes across index event subgroups, both before and after adjusting for clinical covariates (HF duration, NYHA class, medical history, heart rate, HF medications and laboratory values including baseline NT-proBNP), as well as their response to vericiguat. Results: Baseline characteristics were balanced between treatment arms within each subgroup. Over a median follow up of 10.8 months, the absolute primary event rates were high in all subgroups (20.5 - 42.5 per 100 patient-years, Figure). Compared to the IV diuretic group highest relative risk was in HFH Conclusions: Among patients with worsening chronic HF, those within a 3 month window of HFH had almost a 1.5 times risk of CV death or HFH compared to those requiring IV diuretics but not HFH , irrespective of age or clinical risk factors. Vericiguat added to standard therapy was associated with similar benefit across the spectrum of risk in worsening HF.

Background—Despite evidence supporting the use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering therapies in eligible patients, adoption of these secondary prevention measures after coronary artery bypass grafting has been inconsistent. We sought to rigorously test on a national scale whether low-intensity continuous quality improvement interventions can be used to speed secondary prevention adherence after coronary artery bypass grafting. Methods and Results—A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Database and treating 361 328 patients undergoing isolated coronary artery bypass grafting were randomized to either a control or an intervention group. The intervention group received continuous quality improvement materials designed to influence the prescription of the secondary prevention medications at discharge. The primary outcome measure was discharge prescription rates of the targeted secondary prevention medications...

Introduction: Exercise training improves outcomes in patients with chronic, stable heart failure (HF). However, little is known regarding patients with acute decompensated HF (ADHF) who are typically elderly, frail, with multiple co-morbidities and frequent rehospitalizations. Hypothesis: A novel rehabilitation intervention in older patients hospitalized for ADHF will be feasible and safe, improve physical function and reduce rehospitalizations. Methods: This was a 3-site, randomized, attention-controlled pilot study of a tailored, progressive, multi-domain (strength, balance, mobility and endurance) rehabilitation intervention beginning in the hospital and continuing for 12 weeks post-discharge. The primary outcome was the Short Physical Performance Battery (SPPB) score, a standardized measure of physical function in frail elderly, assessed by a blinded observer; the secondary outcome was rehospitalizations. Results: We enrolled 27 patients aged 60-98 years: 59% women, 56% African-American, 41% preserved EF. Patients had ~ 5 co-morbidities and markedly impaired physical function; > 50% were frail. Characteristics were similar between groups. Study retention (89%) and intervention adherence (93%) were excellent. Figure 1 shows change in SPPB score and 6-minute walk distance. All-cause rehospitalizations were reduced by 29% (1.16±0.35 vs. 1.64±0.39) and all-cause rehospitalization days were reduced by 47% (6.0± 2.5 vs. 11.4±2.8) at 6 month follow-up. The change in SPPB score explained 90% of the reduction in all-cause rehospitalizations. There were no adverse events related to the intervention. Conclusions: These findings support the feasibility, safety and potential efficacy of a novel multi-domain rehabilitation intervention to improve physical function and reduce rehospitalizations in older, frail ADHF patients with multiple comorbidities. An NIH-funded multi-center trial is being launched to confirm these findings.

The recent 2012 update of the Heart Disease and Stroke Statistics from the American Heart Association (AHA) emphasizes the continuing burden of cardiovascular disease (CVD) in the United States, with a prevalence of CVD nearing 40% in those approaching 60 years of age and exceeding 70% in older ages.1 Direct and indirect costs of CVD in the United States exceeded $300 billion in 2008, and the projected total costs of CVD in 2015 and 2030 are more than $500 billion and nearly $1200 billion, respectively.2 Recently, the AHA developed year 2020 impact goals to achieve ideal cardiovascular health, which is influenced greatly by key health behaviors of being physically active, maintaining appropriate dietary habits, and not smoking.3 The obesity epidemic in the United States has been a substantial contributor to the CVD burden, with current estimates of obesity prevalence being ≈20% in US children and adolescents and >33% in adults 20 to 74 years of age. It is well accepted that for most people, obesity is a direct outcome of an energy-rich diet, lack of sufficient physical activity (PA), or both. Another consequence of both obesity and insufficient PA is a reduction in cardiorespiratory (or aerobic) fitness (CRF) levels. Collectively, this evidence emphasizes that an individual’s health behaviors have a major role in the prevention of CVD, which is of critical importance in the United States and worldwide from a medical and economic perspective. Increasing attention is being given to the importance of PA and physical fitness (PF), both muscular fitness and especially CRF, for decreasing chronic diseases, promoting overall cardiovascular and general health, improving quality of life, and delaying CVD and mortality in the US population.4,5 Clearly, PF and CRF in particular are an underpinning for academic achievement, job productivity, and overall maintenance …