Showing papers by "Mariell Jessup published in 2015"

2013 ACCF/AHA Guideline for the Management of Heart Failure A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American College of Chest Physicians, Heart Rhythm Society and International Society for Heart and Lung Transplantation Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation WRITING COMMITTEE MEMBERS*

Abstract: Jeffrey L. Anderson, MD, FACC, FAHA, Chair; Alice K. Jacobs, MD, FACC, FAHA, Immediate Past Chair[‡‡][1]; Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect; Nancy M. Albert, PhD, CCNS, CCRN, FAHA; Biykem Bozkurt, MD, PhD, FACC, FAHA; Ralph G. Brindis, MD, MPH, MACC; Mark A. Creager, MD, FACC,

Acquisition, Analysis, and Sharing of Data in 2015 and Beyond: A Survey of the Landscape A Conference Report From the American Heart Association Data Summit 2015

Abstract: Background A 1.5‐day interactive forum was convened to discuss critical issues in the acquisition, analysis, and sharing of data in the field of cardiovascular and stroke science. The discussion will serve as the foundation for the American Heart Association's (AHA's) near‐term and future strategies in the Big Data area. The concepts evolving from this forum may also inform other fields of medicine and science. Methods and Results A total of 47 participants representing stakeholders from 7 domains (patients, basic scientists, clinical investigators, population researchers, clinicians and healthcare system administrators, industry, and regulatory authorities) participated in the conference. Presentation topics included updates on data as viewed from conventional medical and nonmedical sources, building and using Big Data repositories, articulation of the goals of data sharing, and principles of responsible data sharing. Facilitated breakout sessions were conducted to examine what each of the 7 stakeholder domains wants from Big Data under ideal circumstances and the possible roles that the AHA might play in meeting their needs. Important areas that are high priorities for further study regarding Big Data include a description of the methodology of how to acquire and analyze findings, validation of the veracity of discoveries from such research, and integration into investigative and clinical care aspects of future cardiovascular and stroke medicine. Potential roles that the AHA might consider include facilitating a standards discussion (eg, tools, methodology, and appropriate data use), providing education (eg, healthcare providers, patients, investigators), and helping build an interoperable digital ecosystem in cardiovascular and stroke science. Conclusion There was a consensus across stakeholder domains that Big Data holds great promise for revolutionizing the way cardiovascular and stroke research is conducted and clinical care is delivered; however, there is a clear need for the creation of a vision of how to use it to achieve the desired goals. Potential roles for the AHA center around facilitating a discussion of standards, providing education, and helping establish a cardiovascular digital ecosystem. This ecosystem should be interoperable and needs to interface with the rapidly growing digital object environment of the modern‐day healthcare system.

Left Ventricular Assist Devices in the Management of Heart Failure.

Abstract: Mechanical circulatory support has emerged as an important therapy for advanced heart failure, with more than 18,000 continuous flow devices implanted worldwide to date. These devices significantly improve survival and quality of life and should be considered in every patient with end-stage heart failure with reduced ejection fraction who has no other life-limiting diseases. All candidates for device implantation should undergo a thorough evaluation in order to identify those who could benefit from device implantation. Long-term management of ventricular assist device patients is challenging and requires knowledge of the characteristic complications with their unique clinical presentations.

‟Frailty, Thy Name Is Woman” Syndrome of Women With Heart Failure With Preserved Ejection Fraction

Abstract: Heart failure (HF) is the most common cause for hospitalization among patients aged ≥65 years, affecting ≈6 million Americans; at 40 years, American men and women have a 1 in 5 lifetime risk of developing HF.1 There are 2 distinct HF phenotypes: a syndrome with normal or near-normal left ventricular ejection fraction (LVEF) referred to as HF with preserved EF (HFpEF)2 and the phenotype associated with poor cardiac contractility or HF with reduced EF (HFrEF). HFrEF is frequently caused by coronary artery disease with a male predominance; evidence-based strategies have been established for more than a decade. In contrast, the precise clinical criteria for HFpEF are not universally agreed on, the syndrome disproportionally affects women in 2:1 ratio, and there are no proven treatments.3–5 There are some commonalities between HFrEF and HFpEF in addition to the classic symptoms of breathlessness, edema, and fatigue: older age, diabetes mellitus, and a history of valvular disease are risk factors that are predictive of both clinical phenotypes.6 Risk factors associated with HFpEF include female sex, especially women with diabetes mellitus,7 higher body mass index, smoking, hypertension, concentric LV hypertrophy (LVH), and atrial fibrillation (AF).6,8,9 Risk factors associated with HFrEF include male sex, higher total cholesterol and heart rate, eccentric LVH, coronary artery disease, and left bundle-branch block.6,9 A remarkable lack of consensus exists with respect to the phenotypic characteristics of HFpEF, as evidenced by the divergent definitions of the European Study Group on Diastolic Heart Failure,10 the Framingham Group,11 and the European Society of Cardiology,12 to name just a few (Table).13 All include symptoms or signs but vary in specificity and a requirement for objective data. The definition of preserved LVEF is also inconsistent …

Rethinking the Focus of Heart Failure Quality Measures

Abstract: By the early 2000s, several landmark trials had demonstrated clear morbidity and mortality benefit for neurohormonal antagonists and vasodilators in patients with heart failure and reduced ejection fraction (HFrEF), including beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), aldosterone antagonists (AldA), and the combination of hydralazine and isosorbide dinitrate (H-ISDN). These therapies were justifiably assimilated into guidelines for the treatment of patients with HFrEF, but evidence emerged documenting wide variability in compliance with evidence-based therapies and clinical outcomes. 1 At the same time, important studies highlighted that patients started on ACEi and BB while hospitalized for heart failure (HF) were much more likely to remain on these therapies during follow-up than if initiation was deferred to the outpatient setting. 2, 3 Hospital-based interventions to improve compliance with HF therapies suggested clinical benefit with reduced HF readmissions and mortality 4 , and support for this inpatient strategy was buttressed by similar efforts aimed at patients with coronary artery disease. 5

End-Stage Diastolic and Systolic Heart Failure: Evaluation and Timing of Heart Transplantation

Abstract: End stage hypertrophic cardiomyopathy occurs in an estimated 3–15 % of patients and can present as either systolic or diastolic dysfunction. Risk factors for developing end stage disease include a family history of end stage disease, younger age at initial diagnosis, increased wall thickness and persistent arrhythmia. The classic form of adverse remodeling includes left ventricular cavity dilation with regression of hypertrophy and decrease in ejection fraction. Standard medical therapy for systolic heart failure and consideration of prophylactic defibrillator is indicated when LVEF is less than 50 %. Heart transplant is a viable option for patients with end stage hypertrophic cardiomyopathy, including those with systolic heart failure, diastolic heart failure or refractory arrhythmia. Strategies used to bridge patients to transplant include continuous inotropic infusion, left ventricular assist device, intra-aortic balloon pump, and in rare cases extracorporeal membrane oxygenation. Survival after heart transplant for hypertrophic cardiomyopathy is equal to or better than survival for patients who have other types of cardiomyopathies.