Andrew A. McCue

Physical activity in the prevention of coronary heart disease: implications for the clinician

Cardiovascular disease (CVD) continues to be a leading cause of death worldwide. Because regular physical activity (PA) independently decreases the risk of coronary heart disease (CHD) while also having a positive, dose-related impact on other cardiovascular (CV) risk factors, it has increasingly become a focus of CHD prevention. Current guidelines recommend 30 min of moderate-intensity PA 5 days a week, but exercise regimens remain underused. PA adherence can be fostered with a multilevel approach that involves active individual participation, physician counselling and health coaching, community involvement, and policy change, with incorporation of cardiac rehabilitation for patients requiring secondary prevention. Viewing exercise quantity as a vital sign, prescribing PA like a medication, and using technology, such as smartphone applications, encourage a global shift in focus from CVD treatment to prevention. Community-wide, home-based and internet-based prevention initiatives may also offer a developing pool of resources that can be tapped into to promote education and PA compliance. This review summarises the underlying rationale, current guidelines for and recommendations to cultivate a comprehensive focus in the endorsement of PA in the primary and secondary prevention of CHD.

Nonadherence in the Advanced Heart Failure Population

The number of patients living with heart failure (HF) in the USA now exceeds 5 million. Although HF is a disease readily treated by medications and lifestyle interventions, nonadherence is common, leading to worse clinical outcomes and increased healthcare costs. While adherence to medical therapy and clinician recommendations is key in the management of HF, it is perhaps more critical in patients with the most advanced disease, including those receiving home inotropic infusion, heart transplantation, or a left ventricular assist device. Yet, there is a paucity of data on the effects of nonadherence on the advanced heart failure population and little information on the most effective management strategies in these patients. Future studies of nonadherence in HF should utilize uniform definitions of adherence and, ideally, more objective measurements of adherence such as the novel “digital pill” technology.

De novo DQ donor‐specific antibodies are associated with worse outcomes compared to non‐DQ dnDSA following heart transplantation

Antibody‐mediated rejection (AMR) resulting from de novo donor‐specific antibodies (dnDSA) leads to adverse outcomes following heart transplantation (HTx). It remains unclear what role dnDSA to specific HLA antigens play in adverse outcomes. This study compares outcomes in patients developing dnDSA to DQ antigens with those developing non‐DQ dnDSA and those free from dnDSA.

INTERMACS PROFILES AND MORTALITY AMONG AMBULATORY PATIENTS WITH SYSTOLIC HEART FAILURE

The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles classify patients with heart failure (HF) considered for mechanical circulatory support (MCS). Limited data exist on the value of these profiles in the general HF population. We evaluated 3-yr mortality in a

TRANSITION TO STAGE D HEART FAILURE AMONG STABLE OUTPATIENTS WITH SYSTOLIC HEART FAILURE

Incidence rates and risk factors for transition to Stage D heart failure (HF) among patients with stable, Stage C HF with reduced ejection fraction (HFrEF) have not been reported. We evaluated 3-year transition to clinically determined Stage D HF, after accounting for competing mortality, in 919