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email article An international committee proposed a universal definition for heart failure (HF) and two standard classifications that go beyond reduced and preserved left ventricular ejection fraction (LVEF). HF is a clinical syndrome with symptoms and or signs caused by a structural and or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and or objective evidence of pulmonary or systemic congestion, according to the consensus document from the Heart Failure Society of America (HFSA), European Society of Cardiology, and Japanese Heart Failure Society. This is a slight difference from the definition of HF from the American College of Cardiology (ACC) and American Heart Association: a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. ....
email article Sacubitril/valsartan (Entresto) became the first drug to get a broad heart failure indication that reaches into the normal ejection fraction range for prevention of cardiovascular death and hospitalization, Novartis announced. FDA granted the drug an expanded indication to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure. Benefits are most clearly evident in patients with left ventricular ejection fraction (LVEF) below normal. An advisory committee weighing approval in December voted unanimously in favor of expanding the angiotensin receptor–neprilysin inhibitor s indication beyond that in heart failure with reduced ejection fraction (HFrEF) based on the PARAGON-HF trial. ....
email article High-intensity interval training (HIIT) did not beat traditional exercise in raising exercise capacity for sedentary patients with heart failure with preserved ejection fraction (HFpEF), according to the OptimEx-Clin trial. HIIT and moderate continuous training groups yielded similar improvements in peak oxygen consumption (VO 2) from baseline to 3 months (+1.1 vs +1.6 mL/kg/min) both too modest to meet a prespecified minimal clinically-important threshold in comparison with controls (-0.6 mL/kg/min). Neither HIIT nor traditional exercise remained associated with improved exercise capacity at 12 months compared with controls, who got no supervised exercise training, only guideline-directed advice on physical activity, reported Martin Halle, MD, of the Technical University of Munich, Germany, and colleagues online in ....
email article One theory for why the medications tested in heart failure with preserved ejection fraction (HFpEF) trials have not shown efficacy: inclusion of too many unrecognized cases of cardiac amyloidosis (CA). The specific hemodynamic and pathophysiological features of CA result in poor tolerance of heart failure medications and in worse outcomes compared with other causes of heart failure, according to Silvia Oghina, MD, of Hôpital Henri-Mondor in Créteil, France, and colleagues. Studies have shown CA in up to 29% of patients with HFpEF. This finding is unsurprising, as criteria used to diagnose HFpEF include the presence by echocardiography of left ventricular hypertrophy with left atrial enlargement and/or diastolic dysfunction, which are typical features of CA, they wrote in a state-of-the-art paper published online in ....
email article Medicare reimbursement for transcatheter mitral valve repair (TMVR) was extended to include secondary (functional) mitral regurgitation resulting from heart failure, according to a revised National Coverage Determination (NCD). The Centers for Medicare & Medicaid Services (CMS) renamed the TMVR NCD to cover mitral valve Transcatheter Edge-to-Edge Repair for people with secondary mitral regurgitation who remain symptomatic despite guideline-directed medical therapy. Notably, registry participation continues to be required as part of the Coverage with Evidence Development (CED) policy. This comes in response to considerable backlash on a draft proposal to remove the CED requirement in the new NCD. Public commenters also disagreed with the proposed plan to establish coverage for primary (degenerative) mitral regurgitation at the discretion of Medicare Administrative Contractors. ....