Showing papers by "Andrea Mortara published in 2018"
TL;DR: Overall serious adverse events after AM were lower than previously reported, however, patients with left ventricular ejection fraction <50%, ventricular arrhythmias, or low cardiac output syndrome at presentation were at higher risk compared with uncomplicated cases that had a benign prognosis and low risk of subsequentleft ventricular systolic dysfunction.
Abstract: Background: There is controversy about the outcome of patients with acute myocarditis (AM), and data are lacking on how patients admitted with suspected AM are managed. We report characteristics, i...
215 citations
Helsinki University Central Hospital1, National and Kapodistrian University of Athens2, Maastricht University3, Vilnius University4, Carol Davila University of Medicine and Pharmacy5, Vanderbilt University6, Université libre de Bruxelles7, French Institute of Health and Medical Research8, Queen's University Belfast9, University of Ljubljana10, University of Barcelona11, Chartered Institute of Management Accountants12, University of Basel13, University of Hasselt14, University of Zurich15, University of Belgrade16, Autonomous University of Barcelona17, Ben-Gurion University of the Negev18, University of Groningen19, Academy for Urban School Leadership20, Imperial College London21
TL;DR: This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non‐invasive approaches.
Abstract: This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non-invasive approaches. Comprehensive inpatient monitoring is crucial to the optimal management of acute heart failure patients. The European Society of Cardiology heart failure guidelines provide recommendations for the inpatient monitoring of acute heart failure, but the level of evidence underpinning most recommendations is limited. Many tools are available for the in-hospital monitoring of patients with acute heart failure, and each plays a role at various points throughout the patient's treatment course, including the emergency department, intensive care or coronary care unit, and the general ward. Clinical judgment is the preeminent factor guiding application of inpatient monitoring tools, as the various techniques have different patient population targets. When applied appropriately, these techniques enable decision making. However, there is limited evidence demonstrating that implementation of these tools improves patient outcome. Research priorities are identified to address these gaps in evidence. Future research initiatives should aim to identify the optimal in-hospital monitoring strategies that decrease morbidity and prolong survival in patients with acute heart failure.
72 citations
TL;DR: The role of HR as a prognostic biomarker and a potential therapeutic target in other scenarios than chronic HF is updated, in patients with coexisting atrial fibrillation (AF), in HF with preserved LVEF (HFpEF), in acute HF, and in patients discharged after an episode of acute HF.
34 citations
TL;DR: In this article, the authors discuss the current role of sacubitril/valsartan in the management of chronic HFrEF, treatment eligibility and the modulating role of patients' characteristics, to clarify the place of this new therapy in the context of global care of heart failure in Italy.
Abstract: Sacubitril/valsartan, the first-in-class angiotensin receptor neprilysin inhibitor (ARNI), is the first medication to demonstrate a mortality benefit in patients with chronic heart failure and reduced ejection fraction (HFrEF) since the early 2000s Sacubitril/valsartan simultaneously suppresses renin-angiotensin-aldosterone system activation through blockade of angiotensin II type 1 receptors and enhances the activity of vasoactive peptides including natriuretic peptides, through inhibition of neprilysin, the enzyme responsible for their degradation In the landmark PARADIGM-HF trial, patients with HFrEF treated with sacubitril/valsartan had a 20% reduction in the primary composite endpoint of cardiovascular death or heart failure hospitalization, a 20% lower risk of cardiovascular death, a 21% to 20% lower risk of a first heart failure hospitalization, and a 16% to 20% lower risk of death from any cause, compared with subjects allocated to enalapril (all p<0001)Following the trial, new international guidelines endorsed sacubitril/valsartan as a class I recommendation for the management of patients with HFrEF who remain symptomatic despite optimal medical management In Italy, sacubitril/valsartan is reimbursed by the National Health Service since March 2017 within criteria set by the Italian Medicines Agency subject to patient inclusion in a dedicated monitoring registry Although numerous post-hoc analyses of the original trial suggested that the benefits of this innovative medication may extend across a variety of subgroups, many questions do not yet have an evidence-based answerIn this position paper, we discuss the current role of sacubitril/valsartan in the management of chronic HFrEF, treatment eligibility and the modulating role of patients' characteristics Moreover, we address concerns elicited by the PARADIGM-HF study and shortcomings of this novel drug, to clarify the place of this new therapy in the context of global care of heart failure in Italy Our aim is to provide clinical cardiologists with a concise and practical guidance on when and how to use sacubitril/valsartan, to assist clinicians in closing the gap between scientific innovation and real-world experience
4 citations
TL;DR: The 2016 European guidelines confirm that inotropes and vasopressors are in class III (not to be used) for patients with systolic blood pressure (SBP)> 90 mmHg, or who are not in cardiogenic shock, and all the available data in the recent literature go in the same direction.
Abstract: Treatment with inotropes for acute heart failure (HF) remains controversial. However, the 2016 European guidelines1 confirm that inotropes and vasopressors are in class III (not to be used) for patients with systolic blood pressure (SBP)> 90 mmHg, or who are not in cardiogenic shock. Nevertheless, many registries have shown that these drugs continue to be used in 15–40% of patients with HF who have no signs of hypoperfusion and often a SBP ≥ 110 mmHg.2–5 Thus the first question is: ‘Why does this occur?’ The international guidelines suggest not to use this class of drugs in patients with acute HF who do not have clinical signs of hypoperfusion or cardiogenic shock. Although these guideline indications are not based on the results of randomized clinical trials, they come from evidence derived from several registries, meta-analyses, retrospective studies, and national or multinational databases. Possibly, in clinical practice, physicians do not consider these investigations sufficiently convincing, or believe they do not have alternative drugs available to treat patients with acute HF, when diuretics are ineffective. Moreover, inotropes and vasopressors have been used for more than 30 years in emergency care units, and both nurses or physicians are familiar with dosages, clinical responses and possible complications of these medications. Indeed, the complex relationship between severity of the patient haemodynamic profile, cardiovascular mortality, and effects of inotropic drugs continues to represent a challenge in the statistical interpretation of the possible cause–effect relationship between these medications and clinical results. However, all the available data in the recent literature go in the same direction and show that, particularly when patients in cardiogenic shock are excluded, inotropes and vasopressors are
2 citations