Remote telemonitoring for patients with heart failure did not prevent hospitalizations
New Kaiser Permanente study highlights the need to closely evaluate outcomes associated with the implementation of new technologies.
Temporal trends in the prevalence and severity of aortic stenosis within a contemporary and diverse community-based cohort
Data on the epidemiology of aortic stenosis (AS) are primarily derived from single center experiences and administrative claims data that do not delineate by degree of disease severity. An observational cohort study of adults with echocardiographic AS was conducted January…
Polypharmacy and Optimization of Guideline-Directed Medical Therapy in Heart Failure: The GUIDE-IT Trial
Polypharmacy is common among patients with heart failure with reduced ejection fraction (HFrEF). However, its impact on the use of optimal guideline-directed medical therapy (GDMT) is not well established. This study sought to evaluate the association between polypharmacy and odds…
Better outcomes seen in people with severe aortic stenosis who have scheduled common valve procedure
New research from Kaiser Permanente finds patients who need an emergency transcatheter aortic valve replacement have greater risks.
Intravenous iron infusion in patients with heart failure: a systematic review and study-level meta-analysis
There is considerable variability in the effect of intravenous iron on hard cardiovascular (CV)-related outcomes in patients with heart failure (HF) in randomized controlled trials (RCTs). We use a meta-analytic approach to analyse data from existing RCTs to derive a…
Association Between Serum Albumin and Outcomes in Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial
Low serum albumin levels are associated with poor prognosis in numerous chronic disease states but the relationship between albumin and outcomes in patients with heart failure (HF) and secondary mitral regurgitation (SMR) has not been described. The randomized COAPT trial…
Improving Care by Defining the Role of ElectroNic HealTh Record-Based Alerts In a Fully Integrated Health Care Delivery SYstem for Worsening Heart Failure (IDENTIFY-WHF)
IDENTIFY-WHF is a prospective, virtual, parallel-group, randomized, quality improvement intervention of EHR-based alerts for worsening heart failure (WHF) to improve the adoption of guideline-directed medical therapy (GDMT) within an integrated and learning health care delivery system. Approximately 1,000 participants will…
Predictors of Incident Heart Failure Diagnosis Setting: Insights From the Veterans Affairs Healthcare System
Early recognition of heart failure (HF) can reduce morbidity, yet HF is often diagnosed only after symptoms require urgent treatment. The authors sought to describe predictors of HF diagnosis in the acute care vs outpatient setting within the Veterans Health…
Predicting Short-term Outcomes After Transcatheter Aortic Valve Replacement for Aortic Stenosis
The approved use of transcatheter aortic valve replacement (TAVR) for aortic stenosis has expanded substantially over time. However, gaps remain with respect to accurately delineating risk for poor clinical and patient-centered outcomes. Our objective was to develop prediction models for…
Heart failure during the COVID-19 pandemic: clinical, diagnostic, management, and organizational dilemmas
The coronavirus 2019 (COVID-19) infection pandemic has affected the care of patients with heart failure (HF). Several consensus documents describe the appropriate diagnostic algorithm and treatment approach for patients with HF and associated COVID-19 infection. However, few questions about the…
Characteristics and Outcomes of Suspected Digoxin Toxicity and Immune Fab Treatment Over the Past Two Decades-2000-2020
The role of digoxin in clinical practice has narrowed over time. Data on digoxin toxicity trends and outcomes are variable and lack granularity for treatment outcomes. This study aimed to address data gaps in digoxin toxicity trends and outcomes in…
Trajectory of PRimary and SEcondAry HospitalizaTions for Worsening Heart Failure (TREAT-WHF)
The primary objective of the TREAT-WHF study is to leverage a diverse and contemporary heart failure cohort with rigorously adjudicated worsening heart failure events to describe the crude rate of all-cause and cause-specific health care utilization and the independent association…
Variation in Heart Failure Risk by HIV Severity and Sex in People With HIV Infection
HIV is an independent risk factor for heart failure (HF). However, the association of HIV severity with incident HF and the potential interaction with sex are incompletely understood. Integrated health care system. We conducted a cohort study of people with…
Effect of Medically Tailored Meals on Clinical Outcomes in Recently Hospitalized High-Risk Adults
Inability to adhere to nutritional recommendations is common and linked to worse outcomes in patients with nutrition-sensitive conditions. The purpose of this study is to evaluate whether medically tailored meals (MTMs) improve outcomes in recently discharged adults with nutrition-sensitive conditions…
Analysis of Worsening Heart Failure Events in an Integrated Health Care System
There is growing interest to disentangle worsening heart failure (WHF) from location of care and move away from hospitalization as a surrogate for acuity. The purpose of this study was to describe the incidence of WHF events across the care…
Long-Term Cardiovascular Effects of COVID-19: Emerging Data Relevant to the Cardiovascular Clinician
COVID-19 is now a global pandemic and the illness affects multiple organ systems, including the cardiovascular system. Long-term cardiovascular consequences of COVID-19 are not yet fully characterized. This review seeks to consolidate available data on long-term cardiovascular complications of COVID-19…
Prognostic Value of Echocardiography for Heart Failure and Death in Adults with Chronic Kidney Disease
Adults with chronic kidney disease (CKD) are at increased risk of heart failure (HF) morbidity and mortality. Despite well-characterized abnormalities in cardiac structure in CKD, it remains unclear how to optimally leverage echocardiography to risk stratify CKD patients. We evaluated…
A Randomized Controlled Trial of Renin-Angiotensin-Aldosterone System Inhibitor Management in Patients Admitted in Hospital with COVID-19
Renin-angiotensin aldosterone system inhibitors (RAASi) are commonly used among patients hospitalized with a severe acute respiratory syndrome coronavirus 2 infection coronavirus disease 2019 (COVID-19). We evaluated whether continuation versus discontinuation of RAASi were associated with short term clinical or biochemical…
Cholesterol Lowering via Bempedoic Acid, an ACL-Inhibiting Regimen in Acute Coronary Syndrome (CLEAR ACS) Study
The overall objective of the Cholesterol Lowering via Bempedoic Acid/Ezetimibe, an ACL-Inhibiting Regimen in Acute Coronary Syndrome ACS (CLEAR ACS) study is to determine the efficacy, safety, and tolerability of bempedoic acid/ezetimibe (BA/E) in a contemporary and real-world population, enriched…
Trends and characteristics of hospitalizations for heart failure in the United States from 2004 to 2018
Hospitalization for heart failure (HF) constitutes a major healthcare and economic burden. Trends and characteristics of hospitalizations for HF for the recent years are not clear. We sought to determine the trends and characteristics of hospitalization for HF in the…
Global assessment improves risk stratification for major adverse cardiac events across a wide range of triglyceride levels: Insights from the KP REACH study
Patients with risk factors for or established atherosclerotic cardiovascular disease (ASCVD) remain at high risk for subsequent ischemic events despite statin therapy. Triglyceride (TG) levels may contribute to residual ASCVD risk, and the performance of global risk assessment calculators across…
Clinical Characteristics and Outcomes of Patients with Asymptomatic, Moderate Severity Aortic Stenosis (ASSESS-AS)
The prevalence of aortic stenosis (AS), currently estimated to be 4% among adults 70 years of age and over is projected to double by 2040 and triple by 2060. However, the prevalence, clinical characteristics, and outcomes of the condition have…
Food security, diet quality, nutritional knowledge, and attitudes towards research in adults with heart failure during the COVID-19 pandemic
The impact of the novel coronavirus disease 2019 (COVID-19) pandemic on diet and nutrition among older adults with chronic medical conditions have not been well-described. We conducted a survey addressing (1) food access, (2) diet quality and composition, (3) nutritional…
A Machine Learning Methodology for Identification and Triage of Heart Failure Exacerbations
Inadequate at-home management and self-awareness of heart failure (HF) exacerbations are known to be leading causes of the greater than 1 million estimated HF-related hospitalizations in the USA alone. Most current at-home HF management protocols include paper guidelines or exploratory…
Loop and thiazide diuretic use and risk of chronic kidney disease progression: a multicentre observational cohort study
To evaluate the association between diuretic use by class with chronic kidney disease (CKD) progression and onset of end-stage renal disease (ESRD). Retrospective cohort study. Large integrated healthcare delivery system in Northern California. Adults with an estimated glomerular filtration rate…
Trends in Hospitalizations for Heart Failure, Acute Myocardial Infarction, and Stroke in the United States from 2004-2018
To determine the trends in hospitalizations for heart failure (HF), acute myocardial infarction (AMI), and stroke in the United States (US). A retrospective analysis of the National Inpatient Sample weighted data between January 1, 2004 and December 31, 2018 which…
Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature
Cardiogenic shock (CS) is a complex multifactorial clinical syndrome, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large phenotypic variability in CS, as a…
Hospitalizations for worsening heart failure are likely higher than current statistics suggest
Kaiser Permanente study led by research scientists Andrew Ambrosy, MD, and Alan Go, MD, used artificial intelligence to scan the electronic medical records of patients with a history of heart failure.
Human immunodeficiency virus infection and risks of morbidity and death in adults with incident heart failure
Human immunodeficiency virus (HIV) increases the risk of heart failure (HF), but whether it influences subsequent morbidity and mortality remains unclear. We investigated the risks of hospitalization for HF, HF-related emergency department (ED) visits, and all-cause death in an observational…
A Natural Language Processing-Based Approach for Identifying Hospitalizations for Worsening Heart Failure Within an Integrated Health Care Delivery System
The current understanding of epidemiological mechanisms and temporal trends in hospitalizations for worsening heart failure (WHF) is based on claims and national reporting databases. However, these data sources are inherently limited by the accuracy and completeness of diagnostic coding and/or…
Triglyceride Levels and Residual Risk of Atherosclerotic Cardiovascular Disease Events and Death in Adults Receiving Statin Therapy for Primary or Secondary Prevention: Insights From the KP REACH Study
Background Patients with risk factors or established atherosclerotic cardiovascular disease remain at high-risk for ischemic events. Triglyceride levels may play a causal role. Methods and Results We performed a retrospective study of adults aged ≥45 years receiving statin therapy, with a…
Timing of AKI after urgent percutaneous coronary intervention and clinical outcomes: a high-dimensional propensity score analysis
Acute kidney injury is a common complication of percutaneous coronary intervention and has been associated with an increased risk of death and progressive chronic kidney disease. However, whether the timing of acute kidney injury after urgent percutaneous coronary intervention could…
Implications of the Landmark ISCHEMIA Trial on the Initial Management of High-Risk Patients with Stable Ischemic Heart Disease
In the decades following the advent of percutaneous coronary intervention, the optimal treatment strategy for managing stable ischemic heart disease has remained a topic of debate. The purpose of this review is to discuss current literature that provides insight into…
A Randomized Trial of Icosapent Ethyl in Ambulatory Patients with COVID-19
The coronavirus disease 2019 (COVID-19) pandemic remains a source of considerable morbidity and mortality throughout the world. Therapeutic options to reduce symptoms, inflammatory response, or disease progression are limited. This randomized open-label trial enrolled 100 ambulatory patients with symptomatic COVID-19…
Safety and Efficacy of Intravenous Ferric Derisomaltose Compared to Iron Sucrose for Iron Deficiency Anemia in Patients with Chronic Kidney Disease With and Without Heart Failure
Ferric derisomaltose (FDI) is an intravenous (IV) high-dose iron formulation approved in the US for the treatment of iron deficiency anemia in adults who are intolerant of/have had an unsatisfactory response to oral iron, or who have non-dialysis-dependent chronic kidney…
Growth differentiation factor-15, treatment with liraglutide, and clinical outcomes among patients with heart failure
Associations between growth differentiation factor-15 (GDF-15), cardiovascular outcomes, and exercise capacity among patients with a recent hospitalization for heart failure (HHF) and heart failure with reduced ejection fraction (HFrEF) are unknown. We utilized data from the 'Functional Impact of GLP-1…
Pregnancy-Associated Spontaneous Coronary Artery Dissection: Clinical Characteristics, Outcomes, and Risk During Subsequent Pregnancy
Spontaneous coronary artery dissection (SCAD) is a common cause of pregnancy-associated myocardial infarction. This study compares the clinical course and longitudinal follow-up of 22 cases of pregnancy-associated SCAD (P-SCAD) with 285 cases of non-pregnancy SCAD (NP-SCAD) from Kaiser Permanente Northern…
Randomized Placebo-Controlled Trial of Ferric Carboxymaltose in Heart Failure With Iron Deficiency: Rationale and Design
Iron deficiency (ID) has a prevalence of ≈40% to 50% among patients in heart failure (HF) with reduced ejection fraction and is associated with worse prognosis. Several trials demonstrated that intravenous ferric carboxymaltose leads to early and sustained improvement in…
Rationale and Design of the Pragmatic Randomized Trial of Icosapent Ethyl for High Cardiovascular Risk Adults (MITIGATE)
The MITIGATE study aims to evaluate the real-world clinical effectiveness of pre-treatment with icosapent ethyl (IPE), compared with usual care, on laboratory-confirmed viral upper respiratory infection (URI)-related morbidity and mortality in adults with established atherosclerotic cardiovascular disease (ASCVD). IPE is…
Improving care for people with heart failure
KP Research Radio spoke with cardiovascular research scientists Alan Go, MD, and Andrew Ambrosy, MD, about research aimed at improving care for people with heart failure.
Management of Renin-Angiotensin-Aldosterone System blockade in patients admitted to hospital with confirmed coronavirus disease (COVID-19) infection (The McGill RAAS-COVID- 19): A structured summary of a study protocol for a randomized controlled trial
The aim of the RAAS-COVID-19 randomized control trial is to evaluate whether an upfront strategy of temporary discontinuation of renin angiotensin aldosterone system (RAAS) inhibition versus continuation of RAAS inhibition among patients admitted with established COVID-19 infection has an impact…
The Use of Natural Language Processing to Characterize Episodes of Outpatient Worsening Heart Failure within an Integrated Health Care Delivery System
This study will assess the accuracy of using a natural language processing-based approach to retrospectively identify episodes of outpatient worsening heart failure in unstructured electronic health record data within an integrated health care delivery system and assess the burden and…
Implications of peripheral oedema in heart failure with preserved ejection fraction: a heart failure network analysis
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous condition, and tissue congestion manifested by oedema is not present in all patients. We compared clinical characteristics, exercise capacity, and outcomes in patients with HFpEF with and without oedema. This…
The Degree of the Predischarge Pulmonary Congestion in Patients Hospitalized for Worsening Heart Failure Predicts Readmission and Mortality
Prediction of readmission and death after hospitalization for heart failure (HF) is an unmet need. We evaluated the ability of clinical parameters, NT-proBNP level and noninvasive lung impedance (LI), to predict time to readmission (TTR) and time to death (TTD).…
Baseline Functional Capacity and Transcatheter Mitral Valve Repair in Heart Failure With Secondary Mitral Regurgitation
The aim of this study was to determine the prognostic utility of baseline functional status and its impact on the outcomes of transcatheter mitral valve repair (TMVr) in patients with heart failure (HF) with secondary mitral regurgitation (SMR). The COAPT…
Outpatient Worsening Heart Failure in an Integrated Health Care Delivery System: An Innovative Approach to Characterizing a Novel Clinical Entity
While the Affordable Care Act-mandated Hospital Readmission Reduction Program launched in 2012 has modestly reduced readmissions, an unintended consequence has been the shift of a significant fraction of heart failure (HF)-related care to the outpatient setting. However, little is known…
Angiotensin-Neprilysin Inhibition in Black Americans: Data From the PIONEER-HF Trial
This study compared the efficacy and safety of sacubitril/valsartan to enalapril in Black and non-Black Americans with acute decompensated heart failure (ADHF). Black patients have a different response to treatment with angiotensin-converting enzyme inhibitors compared with other racial and ethnic…
Sacubitril/Valsartan in Advanced Heart Failure With Reduced Ejection Fraction: Rationale and Design of the LIFE Trial
The PARADIGM-HF (Prospective Comparison of Angiotensin II Receptor Blocker Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial reported that sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor, significantly reduced mortality and heart failure…
Angiotensin Receptor-Neprilysin Inhibition Based on History of Heart Failure and Use of Renin-Angiotensin System Antagonists
The PIONEER-HF (comParIson Of sacubitril/valsartaN versus Enalapril on Effect on nt-pRo-bnp in patients stabilized from an acute Heart Failure episode) trial demonstrated the efficacy and safety of sacubitril/valsartan (S/V) in stabilized patients with acute decompensated heart failure (HF) and reduced ejection…
New virtual, innovative clinical trial for adults at high risk for respiratory illnesses
Kaiser Permanente researchers will see if a drug used to reduce risk of heart attack and stroke can also prevent or reduce complications from viral respiratory illnesses in older adults with heart disease.
Transcatheter Mitral-Valve Repair in Patients with Heart Failure and Functional Mitral Regurgitation – Potential Scope and Clinical Benefit of Early Adoption at an Integrated Healthcare Delivery System
This study will look at the clinical benefit of early adoption of the MitraClip device in patients with heart failure in a real-world setting. Previous research showed patients who have the MitraClip procedure have 50% fewer hospitalizations for heart failure…
Evaluating Inpatient and OutpatIent Encounters Within a Learning and Integrated Health Care Delivery Organization Due to Worsening Heart Failure (UTILIZE-WHF)
This study will assess the inpatient and outpatient health care utilization and mortality of patients with heart failure and how it relates to their degree of systolic dysfunction.
Pragmatic RandomIzed Trial of Icosapent Ethyl for High-Cadiovascular Risk Adults (MITIGATE)
The MITIGATE Study will evaluate the real-world clinical effectiveness of icosapent ethyl (Vascepa®) compared to usual care in patients with established atherosclerotic cardiovascular disease. The study will evaluate whether the drug, which is used to reduce the risk of heart…
Association between systolic ejection time and outcomes in heart failure by ejection fraction
Worsening heart failure (HF) is associated with shorter left ventricular systolic ejection time (SET), but there are limited data describing the relationship between SET and clinical outcomes. Thus, the objective was to describe the association between SET and clinical outcomes…
A reduced transferrin saturation is independently associated with excess morbidity and mortality in older adults with heart failure and incident anemia
Low transferrin saturation (TSAT) or reduced serum ferritin level are suggestive of iron deficiency but the relationship between iron parameters and outcomes has not been systematically evaluated in older adults with heart failure (HF) and anemia. We identified a multicenter…
Periprocedural Risk and Survival Associated With Implantable Cardioverter-Defibrillator Placement in Older Patients With Advanced Heart Failure
Little is known about the utilization rates and outcomes of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) placement among patients with advanced heart failure (HF). To examine utilization rates, patient characteristics, and outcomes of ICD and CRT-D placements…
Large decrease in hospitalized heart attack patients seen during COVID-19 pandemic
New research by Kaiser Permanente shows the weekly number of patients admitted to Kaiser Permanente Northern California hospitals with acute myocardial infarction (heart attacks) fell to nearly half of what would be expected after the onset of the COVID-19 pandemic.
Effects of Liraglutide on Worsening Renal Function Among Patients With Heart Failure With Reduced Ejection Fraction: Insights From the FIGHT Trial
The FIGHT (Functional Impact of GLP-1 [glucagon-like peptide-1] for Heart Failure Treatment) trial randomized 300 patients with heart failure with reduced ejection fraction (HFrEF) and a recent hospitalization for heart failure to liraglutide versus placebo. While there was no difference…
One-year mortality after implantable cardioverter-defibrillator placement within the Veterans Affairs Health System
Implantable cardioverter-defibrillator (ICD) therapy reduces mortality in patients with heart failure and current guidelines advise implantation of ICDs in patients with a life expectancy of >1 year. We examined trends in all-cause mortality in patients who underwent primary or secondary prevention…
Statin Therapy and Risk of Incident Diabetes Mellitus in Adults With Cardiovascular Risk Factors
The association between statins and diabetes mellitus (DM) remains controversial. The Kaiser Permanente CHAMP Study identified adults without DM who had cardiovascular (CV) risk factors and no previous lipid lowering therapy (LLT) between 2008 and 2010. The CV risk factors…
Large study finds physical inactivity as dangerous as smoking for heart disease, stroke
A broad look at an ethnically diverse sample of nearly 1 million Kaiser Permanente patients compared the individual contributions of major risk factors for heart attacks and stroke and found physical inactivity a greater risk than expected.
Initiation of Angiotensin-Neprilysin Inhibition After Acute Decompensated Heart Failure: Secondary Analysis of the Open-label Extension of the PIONEER-HF Trial
In PIONEER-HF, among stabilized patients with acute decompensated heart failure (ADHF), the in-hospital initiation of sacubitril/valsartan was well tolerated and led to improved outcomes compared with enalapril. However, there are limited data comparing the strategies of in-hospital vs postdischarge initiation…
Are existing and emerging biomarkers associated with cardiorespiratory fitness in patients with chronic heart failure?
Cardiorespiratory fitness (CRF) is closely linked to health status and clinical outcomes in heart failure (HF) patients. We aimed to test whether biomarkers can reflect CRF and its change over time. This post hoc analysis used data from ambulatory cohorts…
Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017
A deceleration in the rate of decrease of heart disease (HD) mortality between 2011 and 2014 has been reported. In the context of the rapid increase in the population of adults aged 65 years and older, extending the examination of…
KP Research Radio: Epidemic of deaths due to heart failure underway in U.S.
Deaths due to heart failure are increasing in the United States, particularly among the over-age-65 population, according to Kaiser Permanente research published today in JAMA Cardiology.
Incident Anemia in Older Adults with Heart Failure Rate, Etiology, and Association with Outcomes
Limited data exist on the epidemiology, evaluation, and prognosis of otherwise unexplained anaemia of the elderly in heart failure (HF). Thus, we aimed to determine the incidence of anaemia, to characterize diagnostic testing patterns for potentially reversible causes of anaemia,…
Spironolactone in Acute Heart Failure Patients With Renal Dysfunction and Risk Factors for Diuretic Resistance: From the ATHENA-HF Trial
Acute heart failure (HF) patients with renal insufficiency and risk factors for diuretic resistance may be most likely to derive incremental improvement in congestion with the addition of spironolactone. The Aldosterone Targeted Neurohormonal Combined with Natriuresis Therapy in Heart Failure…
Healthy Eating as a Means for Active Living in Heart Failure (HEAL-HF) Study
There is an unmet clinical need to better understand the impact of lifestyle choices with respect to diet and nutrition in high-risk heart failure patients who have been recently hospitalized. We will conduct a survey-based project using a combination of…
5 Questions for… Drew Ambrosy
"To this day, my research interests and clinical practice remain intimately linked, and I firmly believe patient care drives the scientific process, and vice versa."
Disparities in Residual Risk in Patients Receiving Statins for Primary or Secondary Prevention at an Integrated Health Care Delivery System
Patients with risk factors for or established atherosclerotic cardiovascular disease (ASCVD) remain at high risk for first-time or recurrent nonfatal and fatal events, despite guideline-directed medical therapy for primary and secondary prevention. In fact, even among patients who are appropriately…
Trends in Readmissions and Length of Stay for Patients Hospitalized With Heart Failure in Canada and the United States
Over the past decade, reducing 30-day readmission rates has been emphasized in the United States (including via the implementation of the Hospital Readmissions Reduction Program) but not Canada. To examine changes that occurred from April 1, 2005, to December 31,…
Identifying responders to oral iron supplementation in heart failure with a reduced ejection fraction: a post-hoc analysis of the IRONOUT-HF trial
The IRONOUT-HF trial previously demonstrated that oral iron supplementation minimally increased iron stores and did not improve exercise capacity in patients with heart failure with a reduced ejection fraction (HFrEF) and iron deficiency. The IRONOUT-HF trial was a double-blind, placebo-controlled,…
Burden of medical co-morbidities and benefit from surgical revascularization in patients with ischaemic cardiomyopathy
The landmark STICH trial found that surgical revascularization compared to medical therapy alone improved survival in patients with heart failure (HF) of ischaemic aetiology and an ejection fraction (EF) ≤ 35%. However, the interaction between the burden of medical co-morbidities and…
Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure
Acute decompensated heart failure accounts for more than 1 million hospitalizations in the United States annually. Whether the initiation of sacubitril-valsartan therapy is safe and effective among patients who are hospitalized for acute decompensated heart failure is unknown. We enrolled…
Is Time From Last Hospitalization for Heart Failure to Placement of a Primary Prevention Implantable Cardioverter-Defibrillator Associated With Patient Outcomes?
Landmark studies have demonstrated the safety and efficacy of implantable cardioverter-defibrillators (ICDs) in selected stable ambulatory patients with heart failure (HF) with a reduced ejection fraction receiving optimal medical therapy. It is not known whether a recent hospitalization for HF…
Reassessing the Role of Surrogate End Points in Drug Development for Heart Failure
With few notable exceptions, drug development for heart failure (HF) has become progressively more challenging, and there remain no definitively proven therapies for patients with acute HF or HF with preserved ejection fraction. Inspection of temporal trends suggests an increasing…
Liraglutide and weight loss among patients with advanced heart failure and a reduced ejection fraction: insights from the FIGHT trial.
AIMS: Obesity is present in up to 45% of patients with heart failure (HF). Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor antagonist, facilitates weight loss in obese patients. The efficacy of liraglutide as a weight loss agent among patients with HF…
Natural History of Patients Postacute Coronary Syndrome Based on Heart Failure Status.
The natural history of patients hospitalized for acute coronary syndrome (ACS) with pre-existing versus (vs) de novo heart failure (HF) has not been previously reported over an extended duration of follow-up. The IMPROVE-IT trial enrolled 18,144 patients hospitalized for ACS…
TRANSFORM-HF (ToRsemide compArisoN with furoSemide FOR Management of Heart Failure) Study
Patients with heart failure will be randomized 1:1 to either oral torsemide or oral furosemide prior to hospital discharge. The primary endpoint will be all-cause mortality over the follow-up period. Secondary endpoints are hospitalizations, quality of life, and depression.
Renal Function and Exercise Training in AmbulatoryHeart Failure Patients With a Reduced Ejection Fraction.
Patients with chronic kidney disease (CKD) and/or end-stage renal disease are less active and experience significant functional limitations. The impact of a structured aerobic exercise intervention on outcomes in ambulatory heart failure (HF) patients with comorbid CKD is unknown. HF-ACTION…
Sudden Death After Hospitalization for Heart Failure With Reduced Ejection Fraction (from the EVEREST Trial).
Patients with chronic heart failure with reduced ejection fraction (HFrEF) benefit from medical and device therapies targeting sudden cardiac death (SCD). Contemporary estimates of SCD risk after hospitalization for heart failure are limited. We describe the incidence, timing, and clinical…
Is Time of the Essence? The Impact of Time of Hospital Presentation in Acute Heart Failure: Insights From ASCEND-HF Trial.
OBJECTIVES: As the largest acute heart failure (AHF) trial conducted to date, the global ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial database presented an opportunity to systematically describe the relationship among time of hospital…
The role of angiotensin receptor-neprilysin inhibitors in cardiovascular disease-existing evidence, knowledge gaps, and future directions.
Although traditional renin-angiotensin system antagonists including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have revolutionized the treatment of cardiovascular disease (CVD), the pivotal PARADIGM-HF trial demonstrated that sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), was superior to an angiotensin-converting enzyme inhibitor…
Predictors of Post-discharge Mortality Among Patients Hospitalized for Acute Heart Failure.
Acute Heart Failure (AHF) is a " multi-event disease" and hospitalisation is a critical event in the clinical course of HF. Despite relatively rapid relief of symptoms, hospitalisation for AHF is followed by an increased risk of death and re-hospitalisation.…
Expanded algorithm for managing patients with acute decompensated heart failure.
Heart failure is a complex disease process, the manifestation of various cardiac and noncardiac abnormalities. General treatment approaches for heart failure have remained the same over the past decades despite the advent of novel therapies and monitoring modalities. In the…
Rationale and design of the comParIson Of sacubitril/valsartaN versus Enalapril on Effect on nt-pRo-bnp in patients stabilized from an acute Heart Failure episode (PIONEER-HF) trial.
OBJECTIVE: The objective is to assess the safety, tolerability, and efficacy of sacubitril/valsartan compared with enalapril in patients with heart failure (HF) with a reduced ejection fraction (EF) stabilized during hospitalization for acute decompensated HF.BACKGROUND: Sacubitril/valsartan, a first-in-class angiotensin receptor-neprilysin…
Aetiology, timing and clinical predictors of early vs. late readmission following index hospitalization for acute heart failure: insights from ASCEND-HF.
AIMS: Patients hospitalized for heart failure (HF) are at high risk for 30-day readmission. This study sought to examine the timings and causes of readmission within 30 days of an HF hospitalization.METHODS AND RESULTS: Timing and cause of readmission in the…
Lessons learned in acute heart failure.
Acute heart failure (HF) is a global pandemic with more than one million admissions to hospital annually in the US and millions more worldwide. Post-discharge mortality and readmission rates remain unchanged and unacceptably high. Although recent drug development programmes have…
Pre-discharge and early post-discharge troponin elevation among patients hospitalized for heart failure with reduced ejection fraction: findings from the ASTRONAUT trial.
AIMS: Troponin levels are commonly elevated among patients hospitalized for heart failure (HF), but the prevalence and prognostic significance of early post-discharge troponin elevation are unclear. This study sought to describe the frequency and prognostic value of pre-discharge and post-discharge…
Hospitalization for Recently Diagnosed Versus Worsening Chronic Heart Failure: From the ASCEND-HF Trial.
BACKGROUND: It is unclear how patients hospitalized for acute heart failure (HF) who are long-term chronic HF survivors differ from those with more recent HF diagnoses.OBJECTIVES: The goal of this study was to evaluate the influence of HF chronicity on…
Body Weight Change During and After Hospitalization for Acute Heart Failure: Patient Characteristics, Markers of Congestion, and Outcomes: Findings From the ASCEND-HF Trial.
OBJECTIVES: This study sought to examine the relationships between in-hospital and post-discharge body weight changes and outcomes among patients hospitalized for acute heart failure (AHF).BACKGROUND: Body weight changes during and after hospitalization for AHF and the relationships with outcomes have…
Global Variations in Patient Populations and Outcomes in Heart Failure Clinical Trials.
PURPOSE OF REVIEW: Heart failure is a global pandemic and there has been a growing effort to enroll patients from different geographical regions in randomized controlled trials. In this review, we examined regional variation in both patient characteristics and outcomes…
Aerobic exercise training and general health status in ambulatory heart failure patients with a reduced ejection fraction-Findings from the Heart Failure and A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION)trial.
BACKGROUND: Although aerobic exercise improves quality of life as assessed by a disease-specific instrument in ambulatory HF patients with a reduced ejection fraction (EF), the impact of an exercise intervention on general health status has not been previously reported.METHODS: A…
Natriuretic peptide-guided management in heart failure.
Heart failure is a clinical syndrome that manifests from various cardiac and noncardiac abnormalities. Accordingly, rapid and readily accessible methods for diagnosis and risk stratification are invaluable for providing clinical care, deciding allocation of scare resources, and designing selection criteria…
Changes in Dyspnea Status During Hospitalization and Postdischarge Health-Related Quality of Life in Patients Hospitalized for Heart Failure: Findings From the EVEREST Trial.
BACKGROUND: Dyspnea is the most common symptom among hospitalized patients with heart failure and represents a therapeutic target. However, the association between short-term dyspnea relief and postdischarge clinical outcomes and health-related quality of life (HRQOL) remains uncertain.METHODS AND RESULTS: A…
Heart Failure Clinical Trials in East and Southeast Asia: Understanding the Importance and Defining the Next Steps.
Heart failure (HF) is a major and increasing global public health problem. In Asia, aging populations and recent increases in cardiovascular risk factors have contributed to a particularly high burden of HF, with outcomes that are poorer than those in…
Influence of Clinical Trial Site Enrollment on Patient Characteristics, Protocol Completion, and End Points: Insights From the ASCEND-HF Trial (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure).
BACKGROUND: Most international acute heart failure trials have failed to show benefit with respect to key end points. The impact of site enrollment and protocol execution on trial performance is unclear.METHODS AND RESULTS: We assessed the impact of varying site…
Influence of atrial fibrillation on post-discharge natriuretic peptide trajectory and clinical outcomes among patients hospitalized for heart failure: insights from the ASTRONAUT trial.
AIMS: Change in NT-proBNP level is a common surrogate endpoint in early phase heart failure (HF) trials, but whether this endpoint is influenced by atrial fibrillation/flutter (AFF) is unclear.METHODS AND RESULTS: This analysis included 1358 patients from the ASTRONAUT trial,…
In-Hospital Diuretic Agent Use and Post-Discharge Clinical Outcomes in Patients Hospitalized for Worsening Heart Failure: Insights From the EVEREST Trial.
OBJECTIVES: The aim of this study was to characterize the association between decongestion therapy and 30-day outcomes in patients hospitalized for heart failure (HF).BACKGROUND: Loop diuretic agents are commonly prescribed for the treatment of symptomatic congestion in patients hospitalized for…
Serum Osmolality and Postdischarge Outcomes After Hospitalization for Heart Failure.
Serum osmolality may fluctuate with neurohormonal activation and in response to certain therapeutics in patients with heart failure (HF). The clinical relevance of osmolality in patients with HF has not been defined. In this post hoc analysis of the Efficacy…
The clinical course of health status and association with outcomes in patients hospitalized for heart failure: insights from ASCEND-HF.
AIMS: A longitudinal and comprehensive analysis of health-related quality of life (HRQOL) was performed during hospitalization for heart failure (HF) or soon after discharge.METHODS AND RESULTS: A post-hoc analysis was performed of the ASCEND-HF trial. The EuroQOL five dimensions questionnaire…
Identifying Barriers and Practical Solutions to Conducting Site-Based Research in North America: Exploring Acute Heart Failure Trials As a Case Study.
Although the prognosis of ambulatory heart failure (HF) has improved dramatically there have been few advances in the management of acute HF (AHF). Despite regional differences in patient characteristics, background therapy, and event rates, AHF clinical trial enrollment has transitioned…
Hospitalized Heart Failure in the United States: Lessons Learned from Clinical Trial Populations.
Hospitalized heart failure (HHF) patients carry a prognosis comparable to many cancers and constitute more than 1 million hospital admissions annually in the United States. To date, North Americans have comprised a minority of those included in prior hospitalized HF…
Pulmonary Oedema-Therapeutic Targets.
Pulmonary oedema (PO) is a common manifestation of acute heart failure (AHF) and is associated with a high-acuity presentation and with poor in-hospital outcomes. The clinical picture of PO is dominated by signs of pulmonary congestion, and its pathogenesis has…
Length of hospital stay and 30-day readmission following heart failure hospitalization: insights from the EVEREST trial.
AIMS: Previous reports have provided conflicting data regarding the relationship between length of stay (LOS) and subsequent readmission risk among patients hospitalized for heart failure (HF).METHODS AND RESULTS: We performed a post-hoc analysis of the Efficacy of Vasopressin Antagonism in…
International REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT-HF): rationale for and design of a global registry.
AIMS: The clinical characteristics, initial presentation, management, and outcomes of patients hospitalized with new-onset (first diagnosis) heart failure (HF) or decompensation of chronic HF are poorly understood worldwide. REPORT-HF (International REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment…
Effect of minor liver function test abnormalities and values within the normal range on survival in heart failure.
Liver function test (LFT) abnormalities are often observed in patients with heart failure (HF). However, the relation of LFTs with outcomes has not been well described. Patients of the VA Palo Alto Health Care System (3 inpatient facilities and 7…
Epidemiology, pathophysiology, and in-hospital management of pulmonary edema: data from the Romanian Acute Heart Failure Syndromes registry.
AIM: The objective of this study was to evaluate the clinical presentation, inpatient management, and in-hospital outcome of patients hospitalized for acute heart failure syndromes (AHFS) and classified as pulmonary edema (PE).METHODS: The Romanian Acute Heart Failure Syndromes (RO-AHFS) study…
Global perspectives in hospitalized heart failure: regional and ethnic variation in patient characteristics, management, and outcomes.
Heart failure (HF) is a public health problem of global proportions afflicting more than 25 million patients worldwide. Despite stable or declining per capita hospitalization rates in the USA and several European countries, there are over one million hospitalizations for…
Relation of serum uric acid levels and outcomes among patients hospitalized for worsening heart failure with reduced ejection fraction (from the efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan trial).
We investigated the clinical profiles associated with serum uric acid (sUA) levels in a large cohort of patients hospitalized for worsening chronic heart failure with ejection fraction (EF) ≤40%, with specific focus on gender, race, and renal function based interactions.…
Designing effective drug and device development programs for hospitalized heart failure: a proposal for pretrial registries.
Recent international phase III clinical trials of novel therapies for hospitalized heart failure (HHF) have failed to improve the unacceptably high postdischarge event rate. These large studies have demonstrated notable geographic and site-specific variation in patient profiles and enrollment. Possible…
Patterns of intensive care unit admissions in patients hospitalized for heart failure: insights from the RO-AHFS registry.
AIM: The present study aims to describe the epidemiology, baseline clinical characteristics, in-hospital management, and outcome of patients hospitalized for heart failure admitted directly or transferred to the ICU.METHODS AND RESULTS: The Romanian Acute Heart Failure Syndromes (RO-AHFS) registry prospectively…
Clinical profile and prognostic value of anemia at the time of admission and discharge among patients hospitalized for heart failure with reduced ejection fraction: findings from the EVEREST trial.
BACKGROUND: Anemia has been associated with worse outcomes in patients with chronic heart failure (HF). We aimed to characterize the clinical profile and postdischarge outcomes of hospitalized HF patients with anemia at admission or discharge.METHODS AND RESULTS: An analysis was…
Lipids, statins, and clinical outcomes in heart failure: rethinking the data.
Lower serum lipid levels are paradoxically predictive of poor clinical outcomes in hospitalized and ambulatory patients with heart failure (HF). In large randomized controlled trials, statins did not demonstrate an overall mortality benefit in chronic HF patients. We currently lack…
The use of digoxin in patients with worsening chronic heart failure: reconsidering an old drug to reduce hospital admissions.
Digoxin is the oldest cardiac drug still in contemporary use, yet its role in the management of patients with heart failure (HF) remains controversial. A purified cardiac glycoside derived from the foxglove plant, digoxin increases ejection fraction, augments cardiac output,…
The predictive value of transaminases at admission in patients hospitalized for heart failure: findings from the RO-AHFS registry.
BACKGROUND: Transaminases are commonly elevated in both the inpatient and ambulatory settings in heart failure (HF).AIMS: To determine the prevalence and degree of elevated transaminase levels at admission and to evaluate the association between transaminase levels and in-hospital morbidity and…
The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries.
Heart failure is a global pandemic affecting an estimated 26 million people worldwide and resulting in more than 1 million hospitalizations annually in both the United States and Europe. Although the outcomes for ambulatory HF patients with a reduced ejection…
Relation of serum magnesium levels and postdischarge outcomes in patients hospitalized for heart failure (from the EVEREST Trial).
Serum magnesium levels may be impacted by neurohormonal activation, renal function, and diuretics. The clinical profile and prognostic significance of serum magnesium level concentration in patients hospitalized for heart failure (HF) with reduced ejection fraction is unclear. In this retrospective…
Haemoconcentration, renal function, and post-discharge outcomes among patients hospitalized for heart failure with reduced ejection fraction: insights from the EVEREST trial.
AIMS: Haemoconcentration has been studied as a marker of decongestion in patients with hospitalization for heart failure (HHF). We describe the relationship between haemoconcentration, worsening renal function, post-discharge outcomes, and clinical and laboratory markers of congestion in a large multinational…
The disconnect between phase II and phase III trials of drugs for heart failure.
Hospitalization for heart failure (HF) is a clinical entity associated with high postdischarge morbidity and mortality, yet few therapies are available to improve outcomes in patients with this condition. In the past decade, large phase III studies of HF treatments…
Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial.
AIMS: Signs and symptoms of congestion are the most common cause for hospitalization for heart failure (HHF). The clinical course and prognostic value of congestion during HHF has not been systemically characterized.METHODS AND RESULTS: A post hoc analysis was performed…
Clinical profile and prognostic value of low systolic blood pressure in patients hospitalized for heart failure with reduced ejection fraction: insights from the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) trial.
BACKGROUND: Systolic blood pressure (SBP) is related to the pathophysiologic development and progression of heart failure (HF) and is inversely associated with adverse outcomes during hospitalization for HF (HHF). The prognostic value of SBP after initiating inhospital therapy and the…
Association of arginine vasopressin levels with outcomes and the effect of V2 blockade in patients hospitalized for heart failure with reduced ejection fraction: insights from the EVEREST trial.
BACKGROUND: Arginine vasopressin (AVP) levels are elevated in proportion to heart failure severity and are associated with higher cardiovascular mortality in ambulatory patients. However, the relationship between baseline and trends in AVP with outcomes in patients hospitalized for worsening heart…
Relationship between clinical trial site enrollment with participant characteristics, protocol completion, and outcomes: insights from the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan) trial.
OBJECTIVES: The study investigated whether the number of participants enrolled per site in an acute heart failure trial is associated with participant characteristics and outcomes.BACKGROUND: Whether and how site enrollment volume affects clinical trials is not known.METHODS: A total of…
Prognostic significance of serum total cholesterol and triglyceride levels in patients hospitalized for heart failure with reduced ejection fraction (from the EVEREST Trial).
Lower cholesterol levels are associated with worse outcomes in patients with chronic heart failure (HF) and have been shown to predict in-hospital mortality. The relation between lipid profile and postdischarge outcomes in patients hospitalized for worsening HF is less clear.…
Atrial fibrillation or flutter on initial electrocardiogram is associated with worse outcomes in patients admitted for worsening heart failure with reduced ejection fraction: findings from the EVEREST Trial.
BACKGROUND: Heart failure (HF) complicated by atrial fibrillation/flutter (AF/AFL) is associated with worse outcomes. However, the clinical profile and outcomes of patients following hospitalization for HF with AF/AFL on initial electrocardiogram (ECG) has not been well studied.METHODS: EVEREST was a…
Predictive value of low relative lymphocyte count in patients hospitalized for heart failure with reduced ejection fraction: insights from the EVEREST trial.
BACKGROUND: Low lymphocyte count has been shown to be an independent prognostic marker in heart failure (HF) in the outpatient setting. Limited data exist regarding whether relative lymphocyte count correlates with postdischarge outcomes in patients hospitalized for HF.METHODS AND RESULTS:…
Influence of documented history of coronary artery disease on outcomes in patients admitted for worsening heart failure with reduced ejection fraction in the EVEREST trial.
AIMS: Data on the prognosis of heart failure (HF) patients with coronary artery disease (CAD) have been conflicting. We describe the clinical characteristics and mode-specific outcomes of HF patients with reduced ejection fraction (EF) and documented CAD in a large…
Capecitabine-induced chest pain relieved by diltiazem.
Five patients with primary colorectal adenocarcinoma or anal squamous cell carcinoma were started on a 2-weeks-on, 1-week-off capecitabine dosing regimen in addition to other chemotherapeutic agents and/or radiation. Within the first few doses, patients experienced chest pain and/or dyspnea at…
Combining SERCA2a activation and Na-K ATPase inhibition: a promising new approach to managing acute heart failure syndromes with low cardiac output.
Heart failure (HF) patients are a medically complex and heterogeneous population with multiple cardiac and non-cardiac comorbidities. Although there are a multitude of etiologic substrates and initiating and amplifying mechanisms contributing to disease progression, these pathophysiologic processes ultimately all lead…
A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days: analysis from the EVEREST trial.
Hospitalization for worsening chronic heart failure results in high post-discharge mortality, morbidity, and cost. However, thorough characterization, soon after discharge of patients with early post-discharge events has not been previously performed. The objectives of this study were to describe the…
Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial.
AIMS: Abnormal liver function tests (LFTs) are common in ambulatory heart failure (HF). The aim of this study was to characterize abnormal LFTs during index hospitalization.METHODS AND RESULTS: A post-hoc analysis was carried out of the placebo group of the…
B-type natriuretic peptide assessment in ambulatory heart failure patients: insights from IMPROVE HF.
BACKGROUND: B-type natriuretic peptide (BNP) levels provide diagnostic and prognostic information in heart failure. This study determined the frequency of BNP assessment and analyzed demographic characteristics, clinical variables and the utilization of guideline-recommended heart failure therapies by BNP level in…
Current management and future directions for the treatment of patients hospitalized for heart failure with low blood pressure.
Although patients hospitalized with heart failure have relatively low in-hospital mortality, the post-discharge rehospitalization and mortality rates remain high despite advances in treatment. Most patients admitted for heart failure have normal or high blood pressure, but 15-25 % have low…
The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST Trial.
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is prevalent in heart failure (HF) patients, yet these patients are poorly characterized. We aimed to describe the characteristics and outcomes of patients with systolic dysfunction and COPD in a contemporary HF randomized trial.METHODS…
Changes in renal function during hospitalization and soon after discharge in patients admitted for worsening heart failure in the placebo group of the EVEREST trial.
AIM: To provide an in-depth clinical characterization and analysis of outcomes of the patients hospitalized for heart failure (HF) who subsequently develop worsening renal function (WRF) during hospitalization or soon after discharge.METHODS AND RESULTS: Of the 4133 patients hospitalized with…
Coronary multidetector computed tomographic angiography to evaluate coronary artery disease in liver transplant candidates: methods, feasibility and initial experience.
AIMS: In patients undergoing orthotopic liver transplantation (OLT), coronary artery disease (CAD), obstructive and nonobstructive, is associated with high morbidity and mortality. In OLT candidates, stress testing for detecting ischemia is often inaccurate, and this patient population often has relative…
The Romanian Acute Heart Failure Syndromes (RO-AHFS) registry.
AIMS: The objective of the RO-AHFS registry was to evaluate the epidemiology, clinical presentation, inpatient management, and hospital course in a population hospitalized for acute heart failure syndromes.METHODS: During a 12-month period, 13 Romanian medical centers enrolled all consecutive patients…
Heart failure in 2010: one step forward, two steps back.
Patients with heart failure (HF) fall into two categories—those who are stable and ambulatory with a relatively low event rate, and patients requiring hospitalization who are characterized by high post-discharge mortality and rates of rehospitalization. HF trials in 2010 contributed…
Acute heart failure syndromes: assessment and reconstructing the heart.
Heart failure is an international health problem, the magnitude of which is expected to continue to grow. It can be broadly divided into chronic (and relatively stable) ambulatory heart failure patients and patients hospitalized for worsening heart failure, also known…
Tolvaptan for the treatment of heart failure: a review of the literature.
INTRODUCTION: It has been > 25 years since it was first discovered that arginine vasopressin levels are elevated in heart failure and this elevation is proportional to the severity of heart failure. Tolvaptan is an oral nonpeptide V₂-selective antagonist and…
Recurrent headaches in children: an epidemiological survey of two middle schools in inner city Chicago.
OBJECTIVES: The aim of this study was to longitudinally evaluate the epidemiological characteristics of headaches in a school-based, community setting and to determine the impact of headache symptoms on the health of children.METHODS: After institutional review board approval, a prospective…
Parent-assisted or nurse-assisted epidural analgesia: is this feasible in pediatric patients?
AIM: The aim of this study was to assess the feasibility of parent-assisted or nurse-assisted epidural analgesia (PNEA) for control of postoperative pain in a pediatric surgical population.METHODS: After the institutional review board (IRB) approval was obtained, an analysis of…
Unilateral groin surgery in children: will the addition of an ultrasound-guided ilioinguinal nerve block enhance the duration of analgesia of a single-shot caudal block?
BACKGROUND: Inguinal hernia repair, hydrocelectomy, and orchidopexy are commonly performed surgical procedures in children. Postoperative pain control is usually provided with a single-shot caudal block. Blockade of the ilioinguinal nerve may lead to additional analgesia. The aim of this double-blind,…
