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4 results on '"Deering, Thomas F."'

1. Atrial fibrillation ablation in heart failure patients: Where do we stand in 2023? - State of the art review.

Author

Deering TF, Goyal SK, Bhimani AA, Hoosien M, Karimianpour A, Krishnasamy KP, Nilsson KR, Omar A, Lakkireddy D, Gopinathannair R, Katapadi A, and Sohns C

Subjects
Humans, Prospective Studies, Anti-Arrhythmia Agents therapeutic use, Patients, Treatment Outcome, Atrial Fibrillation, Heart Failure therapy, Catheter Ablation
Abstract

Atrial fibrillation (AF) and heart failure are common overlapping cardiovascular disorders. Despite important therapeutic advances over the past several decades, controversy persists about whether a rate control or rhythm control approach constitutes the best option in this population. There is also considerable debate about whether antiarrhythmic drug therapy or ablation is the best approach when rhythm control is pursued.  A brief historical examination of the literature addressing this issue will be performed. An analysis of several important clinical outcomes observed in the prospective, randomized studies, which have compared AF ablation to non-ablation treatment options, will be discussed. This review will conclude with recommendations to guide clinicians on the status of AF ablation as a treatment option when considering management options in heart failure patients with atrial fibrillation., (© 2023 Wiley Periodicals LLC.)

Published
2024
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2. Chapter 2: Rate Versus Rhythm Control.

Author

Deering TF, Reiffel JA, Solomon AJ, and Tamirisa KP

Subjects
Humans, Anti-Arrhythmia Agents adverse effects, Dronedarone therapeutic use, Hospitalization, Heart Rate, Atrial Fibrillation drug therapy, Heart Failure drug therapy, Catheter Ablation
Abstract

Atrial fibrillation (AF) is a potentially serious health risk, both because of its symptoms and because of its association with an increased risk for heart failure, hospitalization, thromboembolism, and death. Chapter 2 discusses selection of appropriate treatments and when to initiate these therapies. Older trials focused on comparing rate versus rhythm control treatment options for AF. It is now recognized that both rate and rhythm control are important and can be used together. This chapter reviews the historical, pivotal rate versus rhythm control trials that failed to show any overall survival benefit of rhythm over rate control, as well as the trials' now-recognized limitations with respect to modern therapy. In addition, an in-depth discussion of the more recent trials of antiarrhythmic drugs (AAD) and ablation techniques (which have become available since the original rate versus rhythm trials were performed) is included. These updated trials show that when applied to patient- and disease-specific situations, rhythm control can reduce the risk for mortality and hospitalization. The chapter also reviews the guidelines that have been developed to achieve these goals. Chapter 2 is summarized as follows: (1) Rate control is needed (at rest and during exertion) to reduce rate-related symptoms when rhythm control is ineffective or incomplete and to prevent a tachycardia-induced cardiomyopathy. (2) Previous trials with pharmacological therapy alone comparing rate versus rhythm control using the AADs available at that time failed to show any overall survival benefit of rhythm control over rate control. (3) These earlier trials had many methodological limitations and enrolled participants who did not have access to modern therapies. (4) Newer therapies, including those for stroke prevention, dronedarone (the latest approved AAD), and AF ablation, have improved the safety and efficacy of rhythm control strategies., Competing Interests: Declaration of Competing Interest Thomas F. Deering reports institutional research support with no personal reimbursement from Abbott, Biotronik, Boston Scientific, HUYA Pharmaceuticals, Medtronic, and Milestone; a consultant/speaker for CVRx, HeartBeam, PaceMate, Preventice, and Sanofi; and a member of the research committee review for Abbott. James A. Reiffel is an investigator for InCarda Therapeutics, Johnson & Johnson, and Sanofi; a consultant for Acesion Pharma, Amarin Corporation, Medtronic, and Sanofi; and a speaker for Sanofi. Allen J. Solomon is a speaker for Sanofi. Kamala P. Tamirisa is a consultant for Sanofi, and a speaker for Abbott and Medtronic., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Published
2023
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3. Chapter 5: Guideline Recommendations: Which AAD and for Whom?

Author

Deering TF, Reiffel JA, Solomon AJ, and Tamirisa KP

Subjects
Humans, Anti-Arrhythmia Agents therapeutic use, Sotalol therapeutic use, Stroke Volume, United States, Atrial Fibrillation drug therapy, Heart Failure drug therapy
Abstract

This chapter discusses the American College of Cardiology/American Heart Association/ Heart Rhythm Society (AHA/ACC/HRS) and European Society of Cardiology (ESC) guidelines for atrial fibrillation (AF) management with particular focus on antiarrhythmic drug (AAD) selection and the identification of individuals for whom AAD treatment is appropriate. Discussion includes AAD indications, when to start an AAD, choosing among AADs, how to minimize proarrhythmic risk, how to determine efficacy, and the use of adjuvant interventions. The indications for all AADs are based on safety; the current AHA/ACC/HRS and ESC guidelines state that the choice of AAD is based on the presence or absence of structural heart disease (SHD), coronary artery disease, or heart failure (HF), with further recommendations in the ESC guidelines based on HF type (e.g., HF with reduced ejection fraction [HFrEF] versus HF with preserved ejection fraction [HFpEF]). The chapter closes with a discussion of the lack of consistent use of guideline-directed care, with a review of supportive data from the recently reported AIM-AF survey-a multinational survey on AF management that involved both cardiologists and electrophysiologists. In AIM-AF, inappropriate drug selection in terms of suitable candidate selection and drug choice occurred with all types of drugs and in most patient groups. Most notable was the overuse of amiodarone in patients without SHD, and the widespread use of sotalol, including its use in patients with HFrEF. Chapter 5 is summarized as follows., Competing Interests: Declaration of Competing Interest Thomas F. Deering reports institutional research support with no personal reimbursement from Abbott, Biotronik, Boston Scientific, HUYA Pharmaceuticals, Medtronic, and Milestone; a consultant/speaker for CVRx, HeartBeam, PaceMate, Preventice, and Sanofi; and a member of the research committee review for Abbott. James A. Reiffel is an investigator for InCarda Therapeutics, Johnson & Johnson, and Sanofi; a consultant for Acesion Pharma, Amarin Corporation, Medtronic, and Sanofi; and a speaker for Sanofi. Allen J. Solomon is a speaker for Sanofi. Kamala P. Tamirisa is a consultant for Sanofi, and a speaker for Abbott and Medtronic., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Published
2023
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4. Cost-impact analysis of baroreflex activation therapy in chronic heart failure patients in the United States.

Author

Bisognano J, Schneider JE, Davies S, Ohsfeldt RL, Galle E, Stojanovic I, Deering TF, Lindenfeld J, and Zile MR

Subjects
Chronic Disease, Cost Savings, Cost-Benefit Analysis, Electric Stimulation Therapy adverse effects, Heart Failure diagnosis, Heart Failure physiopathology, Humans, Models, Economic, Time Factors, Treatment Outcome, United States, Baroreflex, Electric Stimulation Therapy economics, Health Care Costs, Heart Failure economics, Heart Failure therapy, Outcome and Process Assessment, Health Care economics, Pressoreceptors physiopathology
Abstract

Background: The study evaluated the cost of baroreflex activation therapy plus guideline directed therapy (BAT + GDT) compared to GDT alone for HF patients with reduced ejection fraction and New York Heart Association Class III or II (with a recent history of III). Baroreflex activation therapy (BAT) is delivered by an implantable device that stimulates the baroreceptors through an electrode attached to the outside of the carotid artery, which rebalances the autonomic nervous system to regain cardiovascular (CV) homeostasis. The BeAT-HF trial evaluated the safety and effectiveness of BAT., Methods: A cost impact model was developed from a U.S. health care payer or integrated delivery network perspective over a 3-year period for BAT + GDT versus GDT alone. Expected costs were calculated by utilizing 6-month data from the BeAT-HF trial and existing literature. HF hospitalization rates were extrapolated based on improvement in NT-proBNP., Results: At baseline the expected cost of BAT + GDT were $29,526 per patient more than GDT alone due to BAT device and implantation costs. After 3 years, the predicted cost per patient was $9521 less expensive for BAT + GDT versus GDT alone due to lower rates of significant HF hospitalizations, CV non-HF hospitalizations, and resource intensive late-stage procedures (LVADs and heart transplants) among the BAT + GDT group., Conclusions: BAT + GDT treatment becomes less costly than GDT alone beginning between years 1 and 2 and becomes less costly cumulatively between years 2 and 3, potentially providing significant savings over time. As additional BeAT-HF trial data become available, the model can be updated to show longer term effects.

Published
2021
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