Candida Fonseca

European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions

The European Society of Cardiology Heart Failure Long‐Term Registry (ESC‐HF‐LT‐R) was set up with the aim of describing the clinical epidemiology and the 1‐year outcomes of patients with heart failure (HF) with the added intention of comparing differences between participating countries.

Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry

The objectives of the present study were to describe epidemiology and outcomes in ambulatory heart failure (HF) patients stratified by left ventricular ejection fraction (LVEF) and to identify predictors for mortality at 1 year in each group.

Levosimendan beyond inotropy and acute heart failure: Evidence of pleiotropic effects on the heart and other organs: An expert panel position paper

Levosimendan is a positive inotrope with vasodilating properties (inodilator) indicated for decompensated heart failure (HF) patients with low cardiac output. Accumulated evidence supports several pleiotropic effects of levosimendan beyond inotropy, the heart and decompensated HF. Those effects are not readily explained by cardiac function enhancement and seem to be related to additional properties of the drug such as anti-inflammatory, anti-oxidative and anti-apoptotic ones. Mechanistic and proof-of-concept studies are still required to clarify the underlying mechanisms involved, while properly designed clinical trials are warranted to translate preclinical or early-phase clinical data into more robust clinical evidence. The present position paper, derived by a panel of 35 experts in the field of cardiology, cardiac anesthesiology, intensive care medicine, cardiac physiology, and cardiovascular pharmacology from 22 European countries, compiles the existing evidence on the pleiotropic effects of levosimendan, identifies potential novel areas of clinical application and defines the corresponding gaps in evidence and the required research efforts to address those gaps.

A case of fulminant Type 1 diabetes following anti-PD1 immunotherapy in a genetically susceptible patient

Programmed cell death-1 protein (PD-1) is an immune checkpoint that has gained popularity in the treatment of several advanced cancers. Inhibiting this checkpoint is known to enhance immune response, but is also known to diminish immune tolerance and to increase autoimmune toxicity. We discuss a case of rapid onset fulminant Type 1 diabetes induced by treatment with anti-programmed cell death-1 monoclonal antibody, nivolumab, in a patient with late-stage non-small-cell lung adenocarcinoma. The patient had no history of previous diabetes but did reveal a high-risk genotype for Type 1 diabetes development (DR3-DQ2; DR4-DQ8). This finding supports that acute Type 1 diabetes can be an important adverse effect of immunotherapies targeting T-cell activation regulation. Because of the severity of this adverse effect, physicians should be aware of it, and studies directed to the detection of new biomarkers for early risk stratification (e.g., HLA) should be sought.

The Implication of Socioeconomic Profile on Prognosis and Management Programs in Heart Failure Patients~!2009-05-26~!2009-11-02~!2010-02-24~!

Introduction: Little is known about the obstacles to patients’ compliance to Heart Failure (HF) treatment. Heart Failure management programs seem to be a strategy to overcome these problems. Aim: To evaluate in HF outpatients the role that socioeconomic characteristics and knowledge about the disease play in their compliance to treatment and long term mortality. Population and methods: We conducted a prospective study of consecutive HF outpatients attending our HF Clinic. Structured questionnaires directed to the patient or care giver were used. Patients ́ socio-economic characteristics and understanding of the disease, as well as, predictors of long term mortality were accessed. Results: We included 59 consecutive NYHA II-III HF patients, age 70.5±11.9 years. Sixty three percent were male and 59.3% had left ventricular systolic dysfunction. Most patients had multiple comorbidities, were polymedicated, lived with their family and belonged to middle-low or low Graffar socioeconomic class. Eighty five percent were retired, median monthly income was 350 , 41.5% had primary education and 22.6% were illiterate. More than half did not know they had HF, what HF was nor its main symptoms/ signs. Four year mortality was 23.6 %. Not knowing “what HF is” was the unique predictor of long-term mortality (p= 0.035; OR 0.097; CI: 0.011-0.846). Conclusions: In our study Heart Failure patients were elderly, retired, and frequently dependent. Literacy was predominantly low. The need of polypharmacy, poor income and poor understanding of the disease were the rule. The later was even a predictor of long term mortality. Heart Failure management programs must be tailored to the needs of their users, taking into account their social environment.