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Background: Randomized controlled trials have established the efficacy of aldosterone antagonists in patients with heart failure and reduced ejection fraction (HFrEF). However, there is limited evidence of their clinical effectiveness in real-world eligible patients with HFrEF (PMID: 23188026). We

Background: A combination of hydralazine and isosorbide dinitrate is recommended to self-described African American patients with HFrEF receiving optimal therapy with ACE inhibitors and beta-blockers, unless contraindicated. We examined the association of the use of both hydralazine and nitrates

The CHA2DS2-Vasc score was developed to predict stroke and other adverse clinical events in patients with atrial fibrillation. There is also interest in assessing its performance in patients with systolic heart failure (HF) in sinus rhythm, such as those enrolled in the WARCEF trial. CHA2DS2-Vasc

Heart failure (HF) is the leading cause of 30-day all-cause readmission. It has been suggested that early 30-day readmissions may reflect suboptimal care during index hospitalization and may provide opportunities to improve outcomes. We examined the association of early (vs. late) 30-day all-cause

SummaryChronic heart failure (HF) with either reduced or preserved left ventricular (LV) ejection fraction is common and remains an extremely serious disorder with a high mortality and morbidity. Many complications related to heart failure can be related to thrombosis. Epidemiological and pathophysiological data also link HF to an increased risk of thrombosis, leading to the clinical consequences of sudden death, stroke, systemic thromboembolism and/or venous thromboembolism. This executive summary of a joint consensus document of the Heart Failure Association (EHFA) of the European Society of Cardiology (ESC) and the ESC Working Group on Thrombosis reviews the published evidence, summarises ‘best practice’, and puts forward consensus statements that may help to define evidence gaps and assist management decisions in everyday clinical practice. In HF patients with atrial fibrillation, oral anticoagulation is clearly recommended, and the CHA2DS2-VASc and HAS-BLED scores should be used to determine the likely risk-benefit ratio (thromboembolism prevention versus risk of bleeding) of oralnticoagulation. In HF patients with reduced LV ejection fraction who are in sinus rhythm there is no evidence of an overall benefit of vitamin K antagonists (e.g. warfarin) on mortality, with risk of major bleeding. Whilst there is the potential for a reduction in ischaemic stroke, there is currently no compelling reason to routinely use warfarin for these patients. Risk factors associated with increased risk of thromboembolic events should be identified and decisions regarding use of anticoagulation individualised. Patient values and preferences are important determinants when balancing the risk of thromboembolism against bleeding risk. Novel oral anticoagulants that offer a different risk-benefit profile compared with warfarin may appear as an attractive therapeutic option, but this would need to be confirmed in clinical trials.Note: The editorial process for this article was fully handled by Prof. Christian Weber, Editor in Chief.

We investigated the effect of the angiotensin type 1 (AT-1) receptor antagonist, irbesartan, on matrix metalloproteinase (MMP) activity and cardiac cytokines in an animal model of diabetic cardiomyopathy. Diabetes was induced in 20 C57/bl6 mice by injection of streptozotocin (STZ). These animals were treated with irbesartan or placebo and were compared with nondiabetic controls. Left ventricular (LV) function was measured by pressure-volume loops with parameters for systolic function (end systolic elastance [Ees]) and diastolic function (cardiac stiffness) 8 weeks after STZ treatment. The cardiac protein content of interleukin (IL)1beta and transforming growth factor (TGF)beta1 were measured by enzyme-linked immunosorbent assay. The total cardiac collagen content and collagen type 1 and 3 were measured by histochemistry, and MMP-2 activity was measured by gelatin zymography. LV dysfunction was documented by impaired Ees and diastolic stiffness in STZ mice compared with controls. This was accompanied by increased TGFbeta, IL1beta, and fibrosis and decreased MMP-2 activity. Treatment with irbesartan attenuated LV dysfunction, IL1beta, TGFbeta, and cardiac fibrosis compared with untreated diabetic animals and normalized MMP activity. These findings present evidence that AT-1 receptor antagonists attenuate cardiac failure by decreasing cardiac inflammation and normalizing MMP activity, leading to normalized cardiac fibrosis in STZ-induced diabetic cardiomyopathy.

Iron deficiency (ID) is an ominous co-morbidity commonly found in patients with systolic heart failure (HF), and iron therapy is presumed to bring clinical benefits. We performed a meta-analysis of all randomized control trials that compared the effects of intravenous iron therapy with either no

Medical management of heart failure with preserved ejection fraction (HFPEF) remains unclear. This analysis was to assess the benefit of ACE-inhibitors (ACEi) and beta blockers (BB) in patients with HFPEF and in heart failure with reduced ejection fraction (HFREF). The BACH (Biomarkers in Acute