heart failure

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How the Immune System Favors Females in Pulmonary Artery Hypertension? Another Regulatory T Cell Story.

Dalia Gaddis, PhD

While it is commonly thought that cardiovascular disease is a man’s disease, CVD is the number one killer of women with the same number of deaths per year as cancer, diabetes and respiratory disease combined (according to 2015 statistical data from AHA). In addition, women exhibit different and more silent symptoms of heart attacks. There is a lot of interest in the difference between how males and females respond to CVD. A lot of emphasis is put on hormonal differences, but the immune system also seems to play an important role in this disparity. Females have a more robust immune system and therefore respond faster to infections providing more protection than in males. However, a more responsive immune system also means a more reactive immune system that can result in increased incidence of autoimmune diseases, such as rheumatoid arthritis and lupus.

Part of the difference in the immune system response in females can be attributed to the fact that multiple immune-related genes are expressed on the X chromosome. Since females have two alleles of the X chromosomes and males have only one, it is evident that females express more genes that regulate immune system functions. One of these genes is Foxp3, the key transcription factor for regulatory T cells, an adaptive immune cell which I have discussed before in a previous post. Regulatory T cells play an important protective role in CVD, especially in atherosclerosis and hypertension.

Pulmonary artery hypertension (PAH) is a fatal cardio-pulmonary disorder where the pulmonary arterioles narrow leading to a right ventricular fibrosis, heart failure and death. Regulatory T cells play an important role in this disease as animal models that lack regulatory T cells are more susceptible to PAH. Adding regulatory T cells back prevents the development of PAH showing the protective power of these cells. A recent study published in the journal Circulation Research, shows that in the absence of regulatory T cells, females rats are more prone to PAH than male animals due to a lower levels of PGI2, a pulmonary vasodilator, and the lack of the enzyme COX-2 that regulated PGI2. The researchers conducting the study show that by transferring regulatory T cells into these rats, these immune cells were sufficient to restore the levels of COX-2 and PGI2, as well as other immune inhibitory molecules PDL1 and IL-10. The authors suggest that regulatory T cells have both a direct and indirect effects on the arteries. The direct effects are exerted on the endothelial cells directly via COX-2 and PGI2, and the indirect effect is through the release of inhibitory molecules such as IL-10 and TGF, both of which would result in immune suppression and preventing inflammation. The results from this report suggested that females are more reliant on regulatory T cells for protection against PAH.

These new findings highlight the subtlety of immune regulation between females and males and further proves that in addition to hormonal differences, immune regulation disparities between genders that can alter the outcome of cardiovascular diseases. By understanding more about gender differences in CVD and the immune system, and figuring out ways to manipulate these subtle differences, scientists hope to achieve a more personalized and effective therapies to women versus men to combat CVD.

 

Dalia Gaddis Headshot

Dalia Gaddis is a postdoctoral fellow at the La Jolla Institute for Allergy and Immunology. She has a Ph.D. in microbiology and immunology. She is currently working on understanding the interactions between the immune system and atherosclerosis development

 
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Nursing research at Heart Failure congress 2018 in Vienna, Austria

Leonie Klompstra, MSc, PhD

The 26th-29th of May I went to the Heart Failure Congress 2018, Including the World Congress on Acute Heart Failure in Vienna, Austria. The congress had over 5,750 participants from over 80 countries. To see all the tweets during this congress, search for the #HeartFailure2018.

This year there were a lot of interesting talks and I would like to highlight a few in this blog.

Dr. Tiny Jaarsma gave a talk about sex and heart disease. Pointing out that heart disease can lead to sexual problems. Furthermore, patients think that sexual counseling should be part of cardiac rehabilitation, which is often not a subject that is discussed. Patients prefer to receive written material and/or individual discussions.

Dr. Cecilia Line from @karolinskaint pointed out that one third of patients with an ICD are not aware that they can deactivate their ICD. Furthermore, patients with ICDs would like to be informed especially when the life expectancy is short. And we should remember, according to Dr. Anna Strömberg, that patients with an LVAD are going through a transition in life and that there are psychosocial challenges in patients with an LVAD. See her take-home messages in the pictures below.

managing patients psychosocial distress slide

Some talks highlighted the importance of frailty in cardiac patients. Dr. Inger Ekman from @SahlgrenskaAcad discussed the importance of screening for frailty in cardiac patients and suggested existing instruments to do so (see picture below). Dr. Kentaro Kamiya’s research showed that frailty is associated with clinical outcomes in elderly patients hospitalized for heart failure, which indicates that frailty is useful for prognosis in in hospital settings.

frailty instruments slide

In the late breaking trials, the results of the HF-Wii study were discussed. This study proves that exergaming (being physical active through video gaming) has positive influence with the exercise capacity and wellbeing of patients with heart failure. See an interview about this study during the interview. In a poster presenting a sub-study of the HF-Wii showed that exergaming could also be feasible for patients with an LVAD, and patients especially liked to exergame with their grandchildren.

conclusion slide

There was also a great session on alternative ways to be physically active in patients with heart failure. One of the alternative ways was presented by Dr. Anna Strömberg: medi-yoga. Read more about medi-yoga. A second alternative way to exercise was presented by Dr. Taylor-Piliae: Tai-Chi. And a third way presented by Dr. Tiny Jaarsma was exergaming. In this session Dr. Von Haehling pointed out that testosterone therapy could increase exercise capacity. Dr. Massimo Piepoli concluded that half of the patients with heart failure are denied a highly recommended therapy and that scientific societies should strongly promote a well-recognized therapeutic tool to improve exercise capacity, quality of life and outcomes in patients with heart failure.

exergaming has physical and quality of life benefits for heart patients flier

And last but not least, I would like to congratulate Lilas Ali, who won the nursing investigator award session with her research that showed that person-centered telephone-support is effective in patients with chronic obstructive pulmonary disease and/or chronic heart failure (see picture below).

photo of women receiving award

Please save the date for next years’ Heart Failure congress 2019, 25-28th of May 2019 in Athens, Greece.

save the date for heart failure and world congress on active heart failure

Leonie Klompstra Headshot

Leonie Klompstra is a Nurse Scientist at the Linköping University in Sweden. Her primary focus is on heart failure and rehabilitations.
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When and how do we discuss prognosis and end-of-life with patients with heart failure?

Leonie Klompstra, MSc, PhD

A topic that is lately much discussed on cardiac congresses is the discussion of prognosis and end-of-life with patients with heart failure. Who is responsible to discuss these difficult topics? When should these topics be discussed and how do patients like to discuss this in their heart failure care?

In a recent doctoral thesis, Lisa Hjelmfors explored the prevalence and practice of nurses discussing prognosis and end-of-life care with patients with heart failure and the nurses’ perspectives regarding discussing prognosis and end-of-life care.
One of the articles presented in her thesis was accepted for a poster presentation at #AHA17 (see picture).

 Prof. Lorraine Evangelista, Prof. Tiny Jaarsma, Prof. Anna Strömberg
Prof. Lorraine Evangelista, Prof. Tiny Jaarsma, Prof. Anna Strömberg

Her research showed that most nurses discussed prognosis and end-of-life care with a patient with heart failure at some point in their clinical practice. Although they found that they have a role in these discussions, they found that the main responsibility for this discussion is with the physician. Together with sexuality, discussing prognosis and end-of-life are the least frequently discussed topics in heart failure clinics. I addressed in an earlier blog on sexual counselling in cardiac rehabilitation.

Lisa Hjelmfors points out that end-of life care should be included as a part of the daily routine at heart failure clinics and nurses should be encouraged to take more responsibility for discussing prognosis and end-of-life with patients and their care-givers.

Communication with patients with heart failure should always be tailored, this is strengthened by the findings in her research that patients have different preferences in discussing prognosis and end-of-life.

But a lot of research is yet to come. We have to find good ways to make it easier to discuss end-of-life and prognoses for both nurses and patients. End-of-life simulations could provide successful and appreciated learning situations for nursing students, teaching them communication skills in challenging situation.  A prompt list could help patients to initiate discussion. Research is also needed on how to include care-givers in discussing end-of-life and prognosis and look at their perspectives on these discussions.

Click here to read Lisa her whole doctoral thesis.

Sketch of Communication about the heart failure trajectory in patients, their families and health care providers

 

Leonie Klompstra Headshot

Leonie Klompstra is a Nurse Scientist at the Linköping University in Sweden. Her primary focus is on heart failure and rehabilitations.

 
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Appetite: An Important Symptom To Assess In Patients With Heart Failure

Leonie Klompstra, MSc, PhD

Today I attended an impressive defense of Christina Andrea (@C_Andreae) of her PhD dissertation on appetite in patients with heart failure. She highlighted the importance of a symptom in patients with heart failure, that is rarely assessed: Appetite.

Appetite in patients with heart failure cover

Appetite, or the desire to eat, is a common problem in patients with heart failure. Appetite is important in patient with heart failure for maintaining food intake and a healthy weight. There is a lack of knowledge on the significance of problems with decreased appetite and on which factors that might contribute to decreased appetite and whether decreased appetite has an influence on patients’ health status.

In her studies she found that 38% of patients with heart failure (despite that the majority had mild to moderate heart failure symptoms i.e., NYHA class II) experienced an appetite level that put them at risk of weight loss.

In one of her studies, which she presented last year on the #AHA17 congress, she found that patients with heart failure who were more physically active have better appetites compared to patients who are less physically active.

physical activity and appetite in patients poster

Other factors that she found which are associated with loss of appetite were older age, symptoms of depression, sleep problems, impaired cognitive function and suboptimal medical treatment and should be recognized in all these patients. Loss of appetite needs attention as it is likely to lead to worsened nutrition, but also because she found that loss of appetite is associated with lower health status.

So what should we do with this new information?

Christina suggest that the assessment of appetite should be incorporated as routine in nutritional care. For instance, an instrument that could be used is CNAQ: Council on Nutrition Appetite Questionnaire. The results could be used as a basis for communicating appetite with patients and their family members. Furthermore, she found a lot of factors associated with appetite, health care professionals should pay attention to patients who are older, as well as patients with depressive symptoms, sleeping problems, cognitive decline, low physical activity and patients with suboptimal treatment.

Leonie Klompstra Headshot

Leonie Klompstra is a Nurse Scientist at the Linköping University in Sweden. Her primary focus is on heart failure and rehabilitations.
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Sexual Counselling In Rehabilitation For Cardiac Patients

Leonie Klompstra, MSc, PhD

In most rehabilitation programs, sexual counseling is not given to cardiac patients. This while the cardiac disease could influence the sex life of patients. There are physiological and pharmacological causes that can influence sex life of patients. Also, the disease can increase fear, anxiety & depression and relationships could change. If the disease negatively influences a patients’ sex life, this could impact their quality of life and well-being. Patients could choose to skip medication in the case sexual problems occur, order online PDE5 inhibitors, or experience side effects of other treatments than their cardiac treatment (e.g. herbal treatment). A changing sex life will not only impact a patient’s life, but also their partner’s, who report sexual concerns as a significant stressor. We have to realize that sexual satisfaction and communication satisfaction is associate with marital satisfaction. The sex life of patients with heart failure deteriorate in 25% of the patients, where half of these patients consider this as a serious problem.

Two-third of patients report that sex was never discussed in their cardiac care, where about half of the patients would like to have to opportunity, or more opportunity to discuss sex with a health professional.

The question now is not if, but how we should provide sexual counselling in cardiac care. It is important to find the underlying reasons why the disease influence the sex life of the patients, assess the patient’s expectation and unravel misconceptions.

Patients at two months post myocardial infarction preferred written material (69%), individual discussion (57%), video tape for home viewing (55%), consultation telephone line (23%) or group discussions for sexual counselling (19%). There are a lot of brochures with information of sex and cardiac disease. For patients with heart failure, there is a nice web-site where they could find information on sex and heart failure:

Sex and heart failure - excerpt ffrom heartfailurematters.org
Excerpt from heartfailurematters.org

There are also questionnaires that could be used in practice, such as the multidimensional sexual-concept inventory or the sexual adjustment subscale. But you could also just ask. An example how you could ask is:
      – Some people with cardiac disease have problems with resuming sex after diagnose. How is this for you?
      – Some people report sexual problems as a result of prescribing medication. If you feel this is the case for you, please feel free to talk to me about this.

To read and hear more about this subject, please watch the web seminar on sexual counselling of cardiac patients: theory and practice by Dr. Molly Byrne and professor Tiny Jaarsma.

 

Leonie Klompstra Headshot
Leonie Klompstra is a Nurse Scientist at the Linköping University in Sweden. Her primary focus is on heart failure and rehabilitations.
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Letting Go

Megan Kamath, MD

Recently, I was reminded of one of my unique roles as an advanced heart failure cardiologist. 

As a physician in such a highly specialized field, I often have the opportunity to offer patients life-saving measures that can only be performed at highly trained qualified quaternary medical centers. This may span the gamut from a wireless hemodynamic monitor placed in the pulmonary artery to a temporary or durable ventricular assist device to an organ transplant.

I often think of the times that I have been able to be the first person to share with my patient and their family that we have finally found a suitable donor organ for them. The initial joy and sheer euphoria followed by the nervous anticipation for the next step of the journey that began often several years prior. I remember the tight hug of the patient’s wife, the embrace from a usually stoic patient, the high five from the patient who loves sports analyses. Burned into my memory, each of these patient’s experiences have been a beautiful addition to my own formation as a physician, clinician, and truly, as a human being. 

Frequently, however, are times where I have to traverse a path of palliation with patient and families. In this role, I help to guide families through quite literally the worst times of their lives.

While we have the invaluable assistance of specially trained palliative care and hospice providers, I have also found in my experience that patients’ families truly value the input and guidance from our heart failure team whom they have often had continuity with spanning both inpatient and outpatient care. I have witnessed tears and raw emotion from the healthcare teams who have invested so much of themselves in the care of the patient and are connected like family.  

The depths of these emotions however, the unparalleled highs tempered by the valleys of sadness, have molded me; sometimes shaken me to my core. Along my own journey forward I carry with me the stories and teachings of those who we have helped survive and those who   we have helped to die with dignity. It is in these times, where the lines between medicine and humanity are blurred, that I am reminded of my sacred privilege of being a physician.

Megan Kamath Headshot

Megan Kamath is a Fellow in Advanced Heart Failure and Transplant Cardiology at the University of California, Los Angeles. Her research interests include outcomes in advanced heart failure, decision making and relational medicine, and utilizing technology in healthcare. She is now tweeting @MeganKamath, so follow her on there!
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Valsartan-Sacubitril: The Next “Best Thing” In Systolic Heart Failure?

Christian Perzanowski, MD

“Realists do not fear the results of their study” Fyodor Dostoevsky
 
Heart failure is a problem. In fact, it is a massive problem1. Over five million adults in the United States live with heart failure2. Mozzafarian et al reported in their 2016 update on heart disease and stroke statistics that nearly half the patients diagnosed with heart failure (HF) will be deceased within five years1. That is a sobering fact. For today’s article, I will reference a novel agent which is becoming widely adopted for systolic HF. Although the past two decades saw a dramatic improvement in the understanding of HF mechanisms, there have been only a number of new pharmacologic “game changers.” Today, I will succinctly discuss the combination agent valsartan-sacubitril (VS) which is an “angiotensin receptor-neprilysin inhibitor” marketed as Entresto (Novartis).
 
Briefly, valsartan is an angiotensin II receptor blocker which counters vasoconstriction and aldosterone secretion; sacubitril is a pro-drug which is ultimately modified to an active component which inhibits neprilysin, a neutral endopeptidase responsible for the degradation of natriuretic peptides leading to their increased plasma levels. The end result of these cumulative effects is vasodilatation, prevention of sodium retention and accumulation of extracellular fluid3-5.
 
In September 2014, McMurray and colleagues published the result of the industry-sponsored PARADIGM-HF trial which compared VS (at that time known as LCZ696) to enalapril. Subjects with NYHA II-IV heart failure and originally a left ventricular ejection fraction of <40% (then amended to <35%) were randomly assigned to the study drug or the ACE-inhibitor. The study which enrolled over 8,000 patients, was terminated early due to a marked survival advantage of the VS arm with regards to the composite end point of death from cardiovascular causes or hospitalization for HF6.
 
Not only was there a survival advantage in patients assigned to the VS arm, but there was a 21% less risk of hospitalization for decompensated HF. Although the absolute risk reduction for cardiovascular death was only 3.2%, the data which was statistically significant, remained solidly in favor of ARB neprilysin inhibition superiority over ACE-inhibitor therapy6. From a clinician’s perspective, VS is being used increasingly to treat systolic HF patients with seemingly good results. Whether or not an indication will be given for a HF population with preserved left ventricular ejection fraction remains to be seen7.
 
There appears to be well-founded science supporting VS use in the vulnerable systolic HF population. Hopefully, insurance carriers and third-party payors will provide coverage for this novel agent.
 
References

  1. Mozzafarian D, Benjamin EJ, Go AS, et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:e38-e360
  2. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm
  3. Hubers SJ, Brown NJ. Combined Angiotensin Receptor Antagonism and Neprilysin Inhibition. Circulation. 2016;133(11):1115-24
  4. Ansara AJ, Kolanczyk DM, Koehler JM. Neprilysin inhibition with sacubitril/valsartan in the treatment of heart failure: mortality bang for your buck. J Clin Pharm Ther. 2016;41:119-27 5.
  5. Jhund PS, McMurray JJ. The neprilysin pathway in heart failure: a review and guide on the use of sacubitril/valsartan. Heart. 2016;102:1342-7
  6. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR; PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014 11;371:993-1004
  7. Solomon SD, Rizkala AR, Gong J, Wang W, Anand IS, Ge J, Lam CSP, Maggioni AP, Martinez F, Packer M, Pfeffer MA, Pieske B, Redfield MM, Rouleau JL, Van Veldhuisen DJ, Zannad F, Zile MR, Desai AS, Shi VC, Lefkowitz MP, McMurray JJV. Angiotensin Receptor Neprilysin Inhibition in Heart Failure With Preserved Ejection Fraction: Rationale and Design of the PARAGON-HF Trial. JACC Heart Fail. 2017;5:471-482

Christian Perzanowski Headshot

Christian Perzanowski is an electrophysiologist in Tampa, FL. His main interests are in ablation techniques for atrial fibrillation and device therapy for congestive heart failure. He reports no conflicts of interests.

Near Maggie Vallet, NC

Near Maggie Valley, NC 01/18 (CP)

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The Lack Of New Drugs For Rhythm Control Of Atrial Fibrillation: A Stagnant Pipeline

Christian Perzanowski, MD

“It does not matter how slowly you go as long as you do not stop”
– Confucius
 
Atrial fibrillation (AF) is the most common arrhythmia in the world1. This potentially malignant condition can dramatically raise the risk for stroke. Many patients are symptomatic, and those with congestive heart failure may suffer worse outcomes when afflicted with AF2. Undoubtedly with these patients, avoidance and prevention of AF is desirable. Anticoagulants are a mainstay for stroke prevention, and there are several to choose from. Today my article addresses the rhythm control drugs, or lack of. Here lies the problem: the (few) available oral agents are often not well tolerated, and antiarrhythmic drugs (AAD) are notorious for their potential for adverse effects.
 
Patients nowadays are internet savvy and very commonly will “research” their prescription medications. I cannot even begin to estimate how many patients with highly symptomatic AF I have met who were reluctant or downright refused to take a prescribed antiarrhythmic after reading the potential side effect profile. Amiodarone is one such drug. Largely accepted as effective, many practitioners are wary of long-term use and the development of pulmonary toxicity or hepatic insufficiency although rare. Other agents such as flecainide and propafenone may cause fatigue and dizziness due to bradycardia and ancillary effects. These agents are contraindicated in patient’s structural cardiac abnormalities given concerns for heart failure and risk for ventricular tachycardia.
 
Sotalol, a “potassium” (Ikr) blocker is also a very old drug which needs close monitoring to identify electrocardiographic QT prolongation and the proarrhythmic risk of torsades de pointes, a potentially fatal consequence of inadvertently prolonging ventricular repolarization (more on this below). Dofetilide is another Ikr blocker which functions in similar fashion. The protocol for drug initiation requires mandatory hospitalization for the very same reason I just described.
 
Other agents such as disopyramide and quinidine are rarely used. Dronedarone, a form of “amiodarone light” proved to be largely ineffective and cannot be used in heart failure. Ranolazine, a delayed sodium-blocker is being studied for AF control, but its use outside the treatment for angina is off-label. Unfortunately as a whole, the current available antiarrhythmic arsenal cause electrophysiologic effects on ventricular myocardium. To negate the risks associated with the latter, the ideal AAD would have effects solely on atrial tissue.
 
Catheter ablation for AF has emerged has a viable treatment option for AF. The treatment paradigms generally focus on isolation of the pulmonary veins, and occasionally AF triggers outside these structures. With that being said, AF has proven to be a very formidable problem to treat, and not uncommonly repeat procedures or continued antiarrhythmic therapy is required to achieve a favorable result3. Hence the use of an AAD is done with the purpose of lowering AF burden and frequency.
 
Clinicians who care for AF patients were encouraged when the initial studies of vernakalant were published4. The novel drug prolonged atrial refractoriness by blocking multiple channels, including Ikur. The Ikur channel is found exclusively in the atria which made the availability of such a drug in oral form highly attractive4,5 Finally, an atrial-selective AAD with purportedly a very low risk of torsades de pointes might be available. Unfortunately, during a follow-up trial, ACT V, the trial was stopped due to concerns of drug safety. The FDA required revisions to the study protocol. The sponsor could not agree to those terms, and in March 2012 Merck abandoned development of oral vernakalant. It must be noted that the intravenous form of the drug is available in the European Union6.
 
Vanoxerine, a potent dopamine reuptake inhibitor was being studied in the treatment of cocaine addiction. It also was evaluated for and proved to be unsuccessful in treating Parkinsonism and depression7. However, this agent was observed to prolong ventricular repolarization as evidenced by prolongation of the QT on the surface EKG. This lead to interest as a possible antiarrhythmic. The COR-ART trial published in 2015 suggested a high rate of conversion to sinus rhythm. The medicine was in oral form and generally well tolerated. There were no episodes of torsades de pointes8. However, RESTORE SR, a small randomized trial found the drug to pose a risk for ventricular proarrhythmia in patients with structural heart disease [9]. Out of safety concerns, recruitment was terminated, and the manufacturer, Laguna Pharmaceuticals closed operations10,11.
 
While there continue to be marked improvements in mapping and ablation technologies for AF, clinicians are still left with the same limited medical arsenal. Perhaps greater collaboration and determination among the pharmaceutical industry may lead to finally new medical options for AF.
 
References:

  1. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130:2071-104
  2. Leong-Sit P, Tang AS. Atrial fibrillation and heart failure: a bad combination. Current Opinion in Cardiology. 2015;30:161–167
  3. Duytschaever M1,2, Demolder A1, Philips T3, Sarkozy A3, El Haddad M1,2, Taghji P1, Knecht S1, Tavernier R1, Vandekerckhove Y1, De Potter T4.PulmOnary vein isolation With vs. without continued antiarrhythmic Drug trEatment in subjects with Recurrent Atrial Fibrillation (POWDER AF): results from a multicentre randomized trial. Eur Heart J. 2017 Dec 2. doi: 10.1093/eurheartj/ehx666. [Epub ahead of print]
  4. Torp-Pedersen C, Raev DH, Dickinson G, Butterfield NN, Mangal B, Beatch GN .A randomized, placebo-controlled study of vernakalant (oral) for the prevention of atrial fibrillation recurrence after cardioversion. Circ Arrhythm Electrophysiol. 2011;4:637-43
  5. Camm AJ, Capucci A, Hohnloser SH, Torp-Pedersen C, Van Gelder IC, Mangal B, Beatch GN, AVRO Investigators. A randomized active-controlled study comparing the efficacy and safety of vernakalant to amiodarone in recent-onset atrial fibrillation. J Am Coll Cardiol. 2011;57:313-21
  6. Camm AJ. The Vernakalant Story: How Did It Come to Approval in Europe and What is the Delay in the U.S.A?Curr Cardiol Rev. 2014; 10:309–314
  7. Preti A. New developments in the pharmacotherapy of cocaine abuse. Addict Biol. 2007;12:133-51
  8. Dittrich HC, Feld GK, Bahnson TD, Camm AJ, Golitsyn S, Katz A, Koontz JI, Kowey PR, Waldo AL, Brown AM. COR-ART: A multicenter, randomized, double-blind, placebo-controlled dose-ranging study to evaluate single oral doses of vanoxerine for conversion of recent-onset atrial fibrillation or flutter to normal sinus rhythm.Heart Rhythm. 2015;12:1105-12
  9. Piccini JP, Pritchett EL, Davison BA, Cotter G, Wiener LE, Koch G, Feld G, Waldo A, van Gelder IC, Camm AJ, Kowey PR, Iwashita J, Dittrich HC. Randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of a single oral dose of vanoxerine for the conversion of subjects with recent onset atrial fibrillation or flutter to normal sinus rhythm: RESTORE SR. Heart Rhythm. 2016;13:1777-83
  10. https://www.xconomy.com/san-diego/2015/12/06/heart-drug-safety-concerns-prompt-shutdown-at-laguna-pharmaceuticals/
  11. https://clinicaltrials.gov/ct2/show/NCT02454283

Christian Perzanowski Headshot

Christian Perzanowski is an electrophysiologist in Tampa, FL. His main interests are in ablation techniques for atrial fibrillation and device therapy for congestive heart failure.
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Nursing Poster Sessions

Leonie Klompstra, MSc, PhD

Next to the great talks, there are also great posters at the American Heart Association. Some of these posters I would like to highlight in this blog.
 
Muna Hammash presented that interventions such as psychoeducational before and after ICD insertion may improve perceived control and, in turn, quality of life.

Muna Hammash  
Dr. Misook Chung had an interesting poster on diet quality in patients with heart failure. She found that diet quality was similar in patients with heart failure regardless of their adherence to sodium restriction diet.

Dr. Missook Chung in front of her poster at Scientific Sessions

Missook Chung poster

Solim Lee presented why patients with heart failure don’t respond to early symptoms.

Solim Lee in front of her poster at Scientific Sessions

Solim Lee conclusion

Dr. Jennifer Miller showed that living in a socio economically austere area imparts greater risk for death or hospitalization for ICD recipients.

Dr. Jennifer Miller in front of he rposter at Scientific Sessions

Hiroko Ishida presented a poster on dyad research. She found that health literacy of patients with heart failure and their caregivers was independently associated with caregivers burden. 

Hiroko Ishida in front of her poster at Scientific Sessions

Umama Gorsi had an abstract accepted about cardiac rehabilitation. She found that early outpatient cardiac rehabilitation is associated with reduced total mortality rates after myectomy for treatment of hypertrophic cardiomyopathy.

Umama Gorsi Poster

There were great presentation on self-care in patients with heart failure. Foster Osei Baah found in his research that self-care confidence moderates the relationship between marginalization and self-care maintenance in patients with heart failure.

Foster Osei Baah in front of his poster at Scientific Sessions

In another research on self-care, Miyuki Tsuchihashi-Makeya found that health literacy was associated with poor self-care. Furthermore, she found that perceived control mediated the association between health literacy and self-care behaviors in patients with heart failure.

Miyuki Tsuchihashi-Makeya Poster

I would like to thank all the researchers in this blog for their enthusiasm to discuss their work with me!

Leonie Klompstra Headshot
Leonie Klompstra is a Nurse Scientist at the Linköping University in Sweden. Her primary focus is on heart failure and rehabilitations.