{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzm8dp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzm8dp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;7\\\/5\\\/4\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;7\\\/5\\\/4\u0022}],\u0022ac\u0022:{\u0022spmdc;7\\\/5\\\/4\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;7\\\/5\\\/4\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EApproximately 0.4\u20132% of the European population has heart failure (HF), representing more than 14 million people. Another 4\u20135 million people in the United States are affected. The prognosis for older patients with HF is similar to that for severe malignant diseases, with a median survival of less than 5 years [Thomas et al. \u003Cem\u003EHeart Fail Clin\u003C\/em\u003E 2007]. This article discusses definitions and classification, pharmacologic therapies, prognostic factors, and patient education.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-417926134\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11243\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-2\u0022\u003E\u201cHeart failure is probably the most important cause of death and disability, and the most important [factor] in health economics,\u201d says Kim Fox, MD, Royal Brompton Hospital, London, UK, and 2006\u20132007 President of the European Society of Cardiology (ESC). Approximately 0.4\u20132% of the European population has heart failure (HF), representing more than 14 million people. Another 4\u20135 million people in the United States are affected. The prognosis for older patients with HF is similar to that for severe malignant diseases, with a median survival of less than 5 years [Thomas et al. \u003Cem\u003EHeart Fail Clin\u003C\/em\u003E 2007].\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003E\u201cHeart failure is our most clinically relevant problem,\u201d adds Jeroen Bax, MD, Leiden University Medical Center, the Netherlands, and Chair of the ESC Congress Program Committee. The multifaceted nature of HF adds to the challenge in diagnosis, according to Ken Dickstein, MD, President of the Heart Failure Association of the ESC. \u201cThe complexity of Heart failure is a major obstacle to adequate identification and diagnosis of untreated patients,\u201d he said, explaining that HF is not a disease but a syndrome of many converging etiologies. Ischemic heart disease is the cause of HF in approximately 60\u201370% of patients, especially older patients; dilated cardiomyopathy is a common cause among younger patients.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EDefinition and Classification\u003C\/h2\u003E\n         \u003Cp id=\u0022p-4\u0022\u003E\u201cThere is no globally accepted definition and classification of acute Heart failure,\u201d says Markku Nieminen, MD, University Central Hospital, Helsinki, Finland. Several HF classifications have been established, but each is based on specific sets of clinical features and applies to selected patient populations, he adds. For example, the Killip classification, based on clinical signs and chest x-ray findings, and the Forrester classification, based on clinical signs and hemodynamic characteristics, are best applied to acute \u003Cem\u003Ede novo\u003C\/em\u003E HF [Killip T 3rd et al. \u003Cem\u003EAm J Cardiol\u003C\/em\u003E 1967; Forrester JS et al. \u003Cem\u003EAm J Cardiol\u003C\/em\u003E 1977]. In contrast, the \u201cUS classification,\u201d based on clinical findings, is most applicable to acutely decompensated chronic HF [Nohria A et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2002].\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EBoth \u003Cem\u003Ede novo\u003C\/em\u003E and chronic HF are associated with several distinct clinical conditions, including hypertension, pulmonary edema, cardiogenic shock, high output failure, and right HF. According to the EuroHeart Failure Survey II, the prevalence of these conditions differs between the two types of HF (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 1\u003C\/a\u003E) [Nieminen MS et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2006].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Distribution by Presentation.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-417926134\u0022 data-figure-caption=\u0022Distribution by Presentation.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11245\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EDistribution by Presentation.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EIn addition, acutely decompensated chronic HF is associated with a significantly higher prevalence of background diseases, especially coronary artery disease, atrial fibrillation, valvular disorder, renal failure, anemia, chronic obstructive pulmonary disease, and the presence of a pacemaker. As a result, Prof. Nieminen points out, cases of acutely decompensated chronic HF are complicated, whereas cases of \u003Cem\u003Ede novo\u003C\/em\u003E HF are more severe, but acute.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThe 2005 ESC guidelines clearly delineate the clinical groups and severity manifestations within HF, notes Prof. Nieminen, and therapy and prognosis differ for these clinical groups [Nieminen MS et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2005].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPharmacologic Therapy\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003E\u201cWe need to optimize treatment for patients with acute decompensated chronic heart failure\u201d says John T. Parissis, MD, Attikon University Hospital, Athens, Greece. The goal of treatment, he says, is to improve symptoms without promoting mechanisms of myocardial injury and cardiac remodeling. Vasodilators remain the gold standard. Other classes of drugs commonly used in the initial management of HF include diuretics (furosemide, bumetanide, or torasemide) and inotropic agents (beta-agonists [dobutamine, dopamine] and phosphodiesterase inhibitors [milrinone]). Many of these drugs are useful for the treatment of acute symptoms and have improved short-term hemodynamic characteristics, but several studies have indicated that some are associated with decreases in survival and\/or increases in cardiovascular and renal events.\u003C\/p\u003E\n         \u003Cdiv id=\u0022sec-4\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EVasodilators\u003C\/h3\u003E\n            \u003Cp id=\u0022p-10\u0022\u003ENesiritide is the newest class of vasodilator developed for the treatment of HF. However, Prof. Parissis notes that a meta-analysis has shown that it is associated with significant worsening of renal function and a significantly higher mortality rate [Sackner-Bernstein JD et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2005].\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-5\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EInotropic Agents\u003C\/h3\u003E\n            \u003Cp id=\u0022p-11\u0022\u003ECurrent intravenous inotropic therapies improve clinical symptoms and hemodynamics but have been associated with increased long-term mortality, says Prof. Parissis. Other adverse events include myocardial injury, adverse interaction with beta-blockers, and arrhythmogenesis.\u003C\/p\u003E\n            \u003Cp id=\u0022p-12\u0022\u003EOne new inotropic drug, levosimendan, seems to be more effective than traditional inotropes in improving cardiac mechanical efficiency and reducing congestion without causing cardiomyocyte death or increasing myocardial oxygen uptake. Levosimendan has been evaluated in several large-scale studies, such as LIDO, REVIVE I and II, and SURVIVE. In all of these studies, levosimendan has been associated with improved clinical outcome and hemodynamics; in addition, survival was improved in LIDO [Follath F et al. \u003Cem\u003ELancet\u003C\/em\u003E 2002; DeLuca L et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2006; Mebazaa A et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2007]. In his own study, Prof. Parissis found that levosimendan prevents oxidative damage, which may contribute to HF deterioration [Parissis JT et al. \u003Cem\u003EAtherosclerosis\u003C\/em\u003E 2007].\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-6\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EInvestigational Agents\u003C\/h3\u003E\n            \u003Cp id=\u0022p-13\u0022\u003ESeveral investigational drugs targeted to novel pathophysiologic mechanisms have shown promise in early trials, says Prof. Parissis (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). The findings of ongoing trials will help define their clinical efficacy and safety.\u003C\/p\u003E\n            \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11252\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11252\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11252\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n                  \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003EInvestigational Agents Targeting Novel Pathophysiologic Mechanisms in Heart Failure.\u003C\/p\u003E\n               \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-7\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EStatins\u003C\/h3\u003E\n            \u003Cp id=\u0022p-15\u0022\u003EStatins have been shown to have benefit for HF patients beyond their role in preventing additional acute coronary events [Scirica et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2006; Khush et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2007]. Research indicates that the pleiotropic effects of statins lead to improvement in many of the peripheral maladaptations of chronic HF, says Sandra Erbs, MD, University of Leipzig, Germany (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\n            \u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Pleiotropic Effects of Statins in Peripheral Maladaptations of CHF.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-417926134\u0022 data-figure-caption=\u0022Pleiotropic Effects of Statins in Peripheral Maladaptations of CHF.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/4\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11248\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n                  \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003EPleiotropic Effects of Statins in Peripheral Maladaptations of CHF.\u003C\/p\u003E\n               \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n            \u003Cp id=\u0022p-17\u0022\u003EIn a study of patients with chronic HF, Prof. Erbs and colleagues found that rosuvastatin decreased oxidative stress in the blood and increased the number and function of circulating stem and progenitor cells. \u201cThe rosuvastatin-mediated correction\u2026was linked to a partial reversal of left ventricular remodeling and an improvement in central hemodynamics,\u201d noted Prof. Erbs.\u003C\/p\u003E\n            \u003Cp id=\u0022p-18\u0022\u003EStatins have also been shown to be associated with significantly lower all-cause mortality, according to a study conducted by Professor S. Maini, Taunton Hospital, UK, and colleagues. The effect was irrespective of age, sex, thrombolysis, other drugs, revascularization, or presence of an implantable device. In addition, research led by Ralph Winkler, MD, Medizinische Klinik B, Germany, has shown that statins improve outcomes in both preserved and impaired left ventricular function settings. In evaluating 18,936 patients with ACS-related HF, Prof. Winkler and colleagues found that treatment with statins reduced mortality at 14 months by 50%. \u201cThe lower the left ventricular ejection fraction, the higher the benefit of statin treatment,\u201d says Prof. Winkler, noting that the number needed to treat for an ejection fraction \u0026lt;30% was 8 vs 42 for an ejection fraction \u0026gt;55%.\u003C\/p\u003E\n            \u003Cp id=\u0022p-19\u0022\u003EAlthough current European guidelines for the management of chronic HF do not include recommendations regarding the use of statins, Prof. Winkler notes that they should be prescribed according to guidelines for the treatment of ACS.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-8\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EAgents to Improve Functional Capacity\u003C\/h3\u003E\n            \u003Cp id=\u0022p-20\u0022\u003EDespite advances in treatment, patients with chronic HF have a poor quality of life and low exercise tolerance. To address these issues, investigators have been evaluating the potential of pharmacologic agents to improve functional capacity. Nadine Clausell, MD, Hospital de Clinicas de Porto Alegre, Brazil, reports that treatment with sildenafil for 4 weeks improved the functional capacity and decreased secondary pulmonary hypertension in patients with New York Heart Association (NYHA) class I-III HF and left ventricular ejection fraction \u226440%. After 4 weeks of treatment with sildenafil (50 mg TID), VO\u003Csub\u003E2\u003C\/sub\u003E increased 13% and pulmonary artery systolic pressure decreased 32%.\u003C\/p\u003E\n            \u003Cp id=\u0022p-21\u0022\u003EFunctional capacity was also improved in men older than 60 years with NYHA class I-III HF who received testosterone (one intramuscular injection of undecanoate). Giuseppe Caminiti, MD, IRCCS, San Raffaele, Italy, reports that at 3 months, distance on the 6-minute walk test improved vs baseline for men who had received testosterone and optimal medical therapy (from 387 meters to 499 meters) vs men who received placebo and optimal medical therapy (from 391 meters to 428 meters). Muscle strength and glucose metabolism were also improved. The benefits of testosterone seem to be mediated by metabolic and peripheral effects, says Prof. Caminiti. An important next step would be to test promising therapies such as sildenafil and testosterone in randomized controlled trials designed to assess their effect on clinical outcomes such as rehospitalization for HF and death.\u003C\/p\u003E\n         \u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-9\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPrognostic Factors\u003C\/h2\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EPrognostic models have demonstrated a wide variety of patient-related and disease-related factors that predict mortality in HF. A better understanding of these factors may improve outcomes through enhanced treatment plans.\u003C\/p\u003E\n         \u003Cp id=\u0022p-23\u0022\u003E\u201cTherapy especially targeted at preservation and improvement of renal function may\u2026provide a new possibility to improve prognosis in patients with HF,\u201d says K. Damman, MD, University Medical Center Groningen, the Netherlands. Prof. Damman and colleagues conducted a meta-analysis and found that worsening renal function was associated with an increase in all-cause mortality and hospitalization. Furthermore, the risk of mortality rose with increasing severity of worsening renal function, and patients with impaired renal function at baseline were at increased risk for worsening renal function.\u003C\/p\u003E\n         \u003Cp id=\u0022p-24\u0022\u003EThe importance of monitoring weight in patients with HF was reinforced by the findings of a study in which weight loss and leanness simultaneously predicted poor prognosis in a broad spectrum of HF patients. The study was carried out by Joanna Dobson, MD, London School of Hygiene, UK, who reports that weight loss at 6 months predicted poor prognosis in the long-term. In the study, for every 1% weight loss, there was an 11.2% increase in mortality hazard. Prof. Dobson advocates for more intense monitoring of weight loss as well as optimizing treatment when weight loss is detected.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-10\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPatient Education\u003C\/h2\u003E\n         \u003Cp id=\u0022p-25\u0022\u003EAccording to the Study group on Heart failure Awareness and Perception in Europe (SHAPE) study, only 3% of 7,958 respondents to a European survey could correctly identify HF from a description of typical signs and symptoms [Remme WJ et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2005]. This was much lower than the rates for recognition of any other cardiovascular disease. To address this knowledge gap, the Heart Failure Association of the ESC developed the website \u003Ca href=\u0022http:\/\/www.heartfailurematters.org\u0022\u003Ewww.heartfailurematters.org\u003C\/a\u003E. \u201cThe website is designed to empower patients to know what they can do to help themselves,\u201d says Prof. Dickstein. It offers a description of HF and its treatment in simple language and features an optional narrative guide to help older visitors to the site. Prof. Dickstein encouraged physicians to tell their patients about the website as a way to improve patient compliance with treatment and lifestyle changes that can help enhance their quality of life and improve survival.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/5\/4.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm8dp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm8dp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm8dp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}