Circulation. Heart failure
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Comparative Study
Brain natriuretic peptide and cardiac resynchronization therapy in patients with mildly symptomatic heart failure.
There are limited data on the prognostic implications of brain natriuretic peptide (BNP) assessment in patients with mildly symptomatic heart failure (HF) who receive cardiac resynchronization therapy with a defibrillator (CRT-D). ⋯ Our findings suggest that assessment of baseline and follow-up BNP provides important prognostic implications in patients with mildly symptomatic HF who receive CRT.
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Comparative Study
Postdischarge outcomes in heart failure are better for teaching hospitals and weekday discharges.
It is unclear whether teaching status or day of discharge influences outcomes after a heart failure hospitalization. ⋯ Patients discharged from teaching hospitals or on weekdays exhibited better outcomes despite having higher risk profiles. Future studies should focus on distinguishing which discharge processes differ between teaching and nonteaching hospitals and between weekdays and weekends to define those that optimize patient outcomes.
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Comparative Study
Physician volume, specialty, and outcomes of care for patients with heart failure.
There is an urgent need to improve outcomes and reduce costs for patients with heart failure (HF). Physician volume is associated with better outcomes for patients undergoing procedures, but its association with outcomes for medically managed diseases, such as HF, is not well understood. ⋯ Physician volume is associated with lower mortality for HF, particularly in low-volume institutions and among noncardiologist physicians. Our findings suggest that clinician expertise may play an important role in HF care.
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Review
Risk prediction models for mortality in ambulatory patients with heart failure: a systematic review.
Optimal management of heart failure requires accurate assessment of prognosis. Many prognostic models are available. Our objective was to identify studies that evaluate the use of risk prediction models for mortality in ambulatory patients with heart failure and describe their performance and clinical applicability. ⋯ Externally validated heart failure models showed inconsistent performance. The Heart Failure Survival Score and Seattle Heart Failure Model demonstrated modest discrimination and questionable calibration. A new model derived from contemporary patient cohorts may be required for improved prognostic performance.
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Multicenter Study
Right ventricular dysfunction in systemic sclerosis-associated pulmonary arterial hypertension.
Systemic sclerosis–associated pulmonary artery hypertension (SScPAH) has a worse prognosis compared with idiopathic pulmonary arterial hypertension (IPAH), with a median survival of 3 years after diagnosis often caused by right ventricular (RV) failure. We tested whether SScPAH or systemic sclerosis–related pulmonary hypertension with interstitial lung disease imposes a greater pulmonary vascular load than IPAH and leads to worse RV contractile function. ⋯ RV dysfunction is worse in SScPAH compared with IPAH at similar afterload, and may be because of intrinsic systolic function rather than enhanced pulmonary vascular resistive and pulsatile loading.