J.M. Cahill

Elimination of early rehospitalization in a randomized, controlled trial of multidisciplinary care in a high-risk, elderly heart failure population: the potential contributions of specialist care, clinical stability and optimal angiotensin-converting enzyme inhibitor dose at discharge.

Despite a growing body of data demonstrating the benefits of multidisciplinary care in heart failure, persistently high rates of readmission, especially within the first month of discharge, continue to be documented.

Is multidisciplinary care of heart failure cost‐beneficial when combined with optimal medical care?

Multidisciplinary care (MDC) of heart failure (HF) can significantly reduce rates of unplanned hospitalisation, the major cost component of HF care.

Doppler-echocardiographic indices of diastolic function in heart failure admissions with preserved left ventricular systolic function

Many patients admitted to hospital with heart failure have preserved left ventricular (LV) systolic function. The incidence of isolated diastolic dysfunction as a cause of such admission remains unclear. We aimed to examine diastolic function in unselected admissions from the community with heart failure using the European Study Group on Diastolic Heart Failure (ESGDHF) Doppler‐echocardiographic indices of diastolic dysfunction. Primary heart failure was confirmed in 210 of 309 sequential admissions with suspected heart failure. Doppler echocardiography was used to assess left ventricular ejection fraction, wall thickness and parameters of diastolic function including E:A ratio, E‐wave deceleration time and isovolumic relaxation time. Of 210 patients studied (118 female), ejection fraction was <45% in 111, leaving a population of 99 with preserved systolic function. We excluded those with significant valvular disease, leaving 56 patients (mean age‐77 years) with an ejection fraction >45% and no other relevant abnormality. Twenty were in atrial fibrillation. E‐wave deceleration time was >280 ms in 42%. E:A was reversed in 30 of 36 patients in sinus rhythm, but only seven met the ESGDHF criterion of E:A<0.5. Isovolumic relaxation time was >105 ms in 38%. Wall thickness was increased in 75% of cases. The ESGDHF Doppler‐echocardiographic criteria for diastolic heart failure were fulfilled in 43%. In clinically confirmed heart failure, 27% of patients had preserved systolic function and no significant valvular disease. Only 43% of this group had confirmed diastolic heart failure by these ESGDHF criteria. The pathophysiological basis of the syndrome in the remaining 57% remains unclear.

Elevated BNP with normal systolic function in asymptomatic individuals at-risk for heart failure: a marker of diastolic dysfunction and clinical risk

BackgroundB-type natriuretic peptide (BNP) is widely accepted in the evaluation of left ventricular systolic dysfunction and heart failure. However, little is known of the implications of elevated BNP levels in individuals with preserved systolic function (PSF).AimsTo investigate the drivers and clinical implications of elevated BNP levels in asymptomatic individuals with established PSF.MethodsWe enrolled 154 individuals who all underwent physical examination, BNP evaluation and Doppler-echocardiographic studies. They were divided into those above and below the median BNP level (50pg/ml).ResultsIndependent predictors of higher BNP were older age, more severe left ventricular hypertrophy (LVH), reduced E/A ratio and ischaemic heart disease. Survival and multivariable analysis demonstrated more death and/or admission in those above the median BNP (HR: 4.79, p = 0.007).ConclusionsElevated BNP is the strongest, independent predictor of serious adverse cardiovascular outcomes in this population and requires closer clinical follow-up.