Heart Failure: Monthly Essentials January 2017

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The 3 essential studies on Heart Failure this month, selected from 880 peer-reviewed studies

1. Cancer care has improved, bringing another set of challenges, including prevention and management of treatment-related cardiac dysfunction. Clinicians need guidance on how to prevent and manage these adverse events. See our essential synopsis of the article from J Clin Oncol below.

2. Heart failure risk models fail badly at predicting individual risk of death, but they are OK at population-level predictions. See our essential synopsis of the article from JAMA Cardiol below.

3. Women with heart failure may also have urinary incontinence that treatment can exacerbate. See our essential synopsis of the article from Int J Clin Pract below.

 

See December's Monthly Essentials on Heart Failure»
See yesterday's Monthly Essentials on Pneumonia and Influenza»

 
1

New guidelines on treatment-related heart failure in cancer survivors

Source: J Clin Oncol

Takeaway 
  • Heart failure (HF) and other cardiac dysfunction among adult cancer survivors mean clinicians need guidance for how to prevent and manage these adverse events related to cancer therapy.

Key results

  • The guideline asks and answers 5 questions, summarized as follows: Which patients are at increased risk? Which strategies minimize risk before and during therapy? Which surveillance and monitoring approaches to use during and after treatment?
  • Recommendations identify patient groups at risk, which can include those receiving chemotherapy or radiation or a combination and with risk factors like older age.
  • The guidelines also suggest preventive strategies before treatment, such as seeking appropriate alternatives to cardiotoxic therapies and decision making based on comprehensive assessment of cardiovascular risk factors.
  • During-treatment strategies include managing modifiable risk factors.
  • During- and posttreatment surveillance includes cardiovascular risk assessment, diagnostic workup as indicated by symptoms and findings, and cardiologist referral as needed.

Study design

  • Expert panel used systematic review (104 studies) to develop guidelines.
  • Funding: Some disclosures made.

Why this matters

  • As cancer care has improved, survivorship is growing, which brings another set of challenges to address, including prevention and management of treatment-related effects, including cardiac dysfunction.

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2

HF risk models offer no special MAGGIC at predicting individual mortality

Source: JAMA Cardiol

Takeaway

  • In this large cohort study, heart failure (HF) risk models fail pretty badly at predicting individual risk for death within the coming year, but they are OK at population-level predictions.

Key results

  • Models (Seattle Heart Failure Model [SHFM], Meta-Analysis Global Group in Chronic Heart Failure [MAGGIC]), respectively, gave a 50% chance or greater of dying within a year to only 8 and 52 of 1661 patients who died during the study.
  • They also, respectively, gave a 50% chance or greater probability of dying to 5 and 63 patients who did not die within a year.

Study design

  • 10,930 ambulatory patients with HF; 3 health systems.
  • Funding: National Heart, Lung, and Blood Institute.

Why this matters

  • Guidelines call for the use of these models in evaluating prognosis, which also informs decisions about care and management (eg, end-of-life care planning, etc).

View Abstract

 
3

Are you asking your female patients with HF about urinary incontinence distress?

Source: Int J Clin Pract

Takeaway

  • Women with heart failure (HF) may also have urinary incontinence that treatment can exacerbate and should be asked about this comorbidity.

Key results

  • Two-thirds of women developed urinary incontinence after their HF diagnosis.
  • 83% also have hypertension, more than half have diabetes, and almost half have severe depression.
  • Three-quarters rated their health as fair or poor.
  • 92% are receiving diuretics.

Study design

  • Secondary analysis of data for 100 women with HF.

Why this matters

  • Urinary incontinence is associated with reduced quality of life and depression, as is HF, and women in particular are susceptible to incontinence issues.

View Abstract