Search

Although cardiac resynchronization therapy (CRT) has proven beneficial in several randomized trials, a subset of patients have limited clinical improvement. The AdaptivCRT algorithm provides automated selection between synchronized left ventricular or biventricular pacing with optimization of atrioventricular delays. The rationale and design of the economic analysis of the AdaptResponse clinical trial are described. The costs associated with HF hospitalization are substantial and are compounded by a high rate of readmission. HF hospitalization payments range from $1,001 for Greece to $12,235 for US private insurance. When examining the breakdown of HF-related costs, it is clear that approximately 55% of the hospitalization costs are directly attributable to length of stay. Notably, the mean costs of a CRT patient in need of a HF-related hospitalization are currently estimated to be an average of $10,679. The economic analysis of the AdaptResponse trial has two main objectives. The hospital provider objective seeks to test the hypothesis that AdaptivCRT reduces the incidence of all-cause re-admissions after a heart failure admission within 30 days of the index event. A negative binomial regression model will be used to estimate and compare the number of readmissions after an index HF hospitalization. The payer economic objective will assess cost-effectiveness of CRT devices with the AdaptivCRT algorithm relative to traditional CRT programming. This analysis will be conducted from a U.S. payer perspective. A decision analytic model comprised of a 6-month decision tree and a Markov model for long term extrapolation will be used to evaluate lifetime costs and benefits. AdaptivCRT may offer improvements over traditional device programming in patient outcomes. How the data from AdaptResponse will be used to demonstrate if these clinical benefits translate into substantial economic gains is herein described. [ABSTRACT FROM AUTHOR]

Serum mid-regional pro-atrial natriuretic peptide (MR-proANP) and pro-adrenomedullin (MR-proADM) are novel biomarkers for acute heart failure (AHF). Like other AFH biomarkers, the performance of these tests are affected by the presence of clinical variables such as renal failure and obesity. In a substudy of the Biomarkers from Acute Heart Failure Study, we show that diabetes did not influence the performance of these markers with regards to AHF diagnosis or 90-day all cause death. However, in patients without AHF, increased MR-proADM alone was associated with the presence of diabetes. [ABSTRACT FROM AUTHOR]

The authors reflect on treatment of central sleep apnea-Cheyne-Stokes respiration (CSA-CSR) in heart failure patients. They state that various therapies including adaptive servoventilator, cardiac resynchronization therapy (CRT) and continuous positive airway pressure (CPAP) are effective in treatment of CSA-CSR. An overview of prognosis and diagnosis of CSA-CSR in heart patients is also offered. They suggest that more clinical trials are needed to test the effectiveness of such treatments.

Hospitalizations for acute heart failure syndromes (AHFS) are associated with high post-discharge morbidity and mortality. The potential role of vasopressin antagonists (VA) in AHFS was presented at the 2008 European Society of Cardiology Working Group on Acute Cardiac Care Meeting held in Versailles, France from 25-28 October 2008. This report represents a summary of the presentation at this meeting. [ABSTRACT FROM AUTHOR]

Acute heart failure syndromes (AHFS) resulting in hospitalization are associated with an extremely high post-discharge mortality and readmission rate. There are several important prognostic factors, which includes blood pressure, body weight, renal function, QRS duration, and presence of coronary artery disease. The epidemiology of AHFS, prognostic factors and therapeutic targets were discussed at the 2008 European Society of Cardiology Working Group on Acute Cardiac Care Meeting held in Versailles, France from 25-28 October 2008. This is a brief summary of the lectures presented on these topics at this meeting. [ABSTRACT FROM AUTHOR]

Digitalis preparations have been used for centuries. Digoxin is an agent that is readily available, can be administered acutely and long-term, intravenously or orally, is safe and may be beneficial in both acute and chronic heart failure (HF). It may be an ideal drug for the treatment of acute heart failure syndromes and warrants further investigation in large clinical trials. The role of digoxin in acute and chronic HF was discussed at the 2008 European Society of Cardiology Working Group on Acute Cardiac Care Meeting held in Versailles, France from 25-28 October 2008. This report represents a summary of the presentation at this meeting. [ABSTRACT FROM AUTHOR]

The article offers information on the guidelines for assessing and managing the observation of stay acute heart failure patient. These guidelines, from the Society of Chest Pain Centers, aimed to offer physicians a basis for their clinical judgments applicable to their medical practice. There are three categories of strength to these guidelines: "recommended," "considered" and "not recommended."

The article discusses various reports published within the issue, including one by Martin B. Leon on the cardiovascular interventions.

The author reflects on the significance of Coronary Care Units (CCUs). The author argues that CCUs plays a vital role in the treatment of fatal arrhythmia specially among patients with acute myocardial infarction. However, the author adds that the advent of early invasive reperfusion have rendered CCUs less significant.

The article discusses various reports published within the issue, including one by Mauro Panteghini on biomarker assays and another by Hatem Hamood, Nabeel Makhoul, Ehud Grenadir, Fabio Kusniec and Uri Rosenschein on anchor wire technique.