In a trial involving patients with heart failure and a mildly reduced or preserved ejection fraction, dapagliflozin reduced the risk of worsening heart failure or cardiovascular death.
Hospitalization for heart failure, usually due to volume overload, is among the most common reasons for hospitalization worldwide, and decongestion with loop diuretics is the primary focus of treatment in most patients.1 Despite the ubiquity of this clinical scenario in daily practice, high-quality data from randomized trials evaluating...
More than 6 million adults in the United States have heart failure, accounting for at least 800,000 hospitalizations annually.1 More than half of these persons have heart failure with a preserved left ventricular ejection fraction.1 As the population ages, the overall prevalence of patients with heart...
Ischemic cardiomyopathy represents the pathophysiological convergence of two growing clinical problems: atherosclerotic coronary artery disease and congestive heart failure. When a patient presents with congestive heart failure, it is incumbent on clinicians to undertake an etiologic workup that includes evaluation for a diagnosis of coronary artery disease1 ; simply...
In a randomized trial involving patients with a low LVEF and viable myocardium who received optimal medical therapy, PCI did not lead to a lower incidence of death or hospitalization for heart failure.
In a randomized, placebo-controlled trial, patients with acute decompensated heart failure and volume overload who received intravenous acetazolamide plus a loop diuretic had a higher incidence of decongestion.
- N Engl J Med 2022; 387:67-73
A previously healthy 18-year-old woman presented to a primary care provider with a 2-month history of headaches and midscapular pain. The midscapular pain was worse at night and lessened with exercise.
- N Engl J Med 2022; 387:79-82
In a recent case of xenotransplantation, now described in the Journal, a porcine heart was transplanted into a human patient, an advance made possible through genetic alterations in the animal donor.
- N Engl J Med 2022; 386:2024-2034
Gliflozins — sodium–glucose cotransporter 2 inhibitors — lower blood glucose and glycated hemoglobin in patients with type 2 diabetes without causing hypoglycemia. The agents also improve cardiac function in patients who have heart failure with or without type 2 diabetes and improve renal function, with few adverse effects.
- N Engl J Med 2022; 386:1266-1276
A 78-year-old man was evaluated in the cardiology clinic because of biventricular myocardial wall thickening, mitral regurgitation, and ventricular arrhythmias. In his 20s, hypohidrosis and sports-related exertional dizziness had developed. Echocardiograms obtained over several decades showed thickened ventricles (shown in videos). Diagnostic tests were performed.
- N Engl J Med 2021; 385:1845-1855
In a randomized trial, 5661 patients with acute myocardial infarction and a reduced left ventricular ejection fraction, pulmonary congestion, or both were assigned to receive either sacubitril–valsartan or ramipril. At a median of 22 months, there was no significant difference between the two groups in the incidence of death from...
- N Engl J Med 2021; 385:1451-1461
In a randomized trial, 5988 patients with heart failure with preserved ejection fraction were assigned to receive either empagliflozin or placebo in addition to usual therapy. At a median of 26 months, the empagliflozin group had a lower incidence of cardiovascular death or hospitalization for heart failure than the placebo...
SGLT2 Inhibition in Heart Failure with a Preserved Ejection Fraction — A Win against a Formidable FoeN Engl J Med 2021; 385:1522-1524
Mark Drazner comments on the findings of the EMPEROR-Preserved trial, which assessed the potential benefit of empagliflozin in patients with a preserved EF. He notes that the findings represent a major win against a medical condition that had previously proved formidable.
- N Engl J Med 2021; 385:1531-1533
In a planned pooled analysis of two trials that evaluated empagliflozin in patients with heart failure, major adverse renal outcomes occurred in 2.8% of the patients who received empagliflozin and in 3.5% of those who received placebo. Results differed between the two trials.
- N Engl J Med 2021; 385:745-754
A 48-year-old man with alcohol use disorder was admitted because of weight gain, fatigue, and swelling in both legs. Sixteen months earlier, he had been hospitalized with mycoplasma pneumonia and, during that admission, had received a diagnosis of diabetes. A diagnostic test was performed.
- N Engl J Med 2021; 385:516-525
Patients with cardiogenic shock were assigned to receive milrinone or dobutamine for inotropic support. There was no significant difference between the two groups in the composite primary outcome of in-hospital death from any cause or cardiovascular or renal events.
- N Engl J Med 2021; 385:203-216
Older patients hospitalized for heart failure were randomly assigned to a rehabilitation intervention (which included multiple function domains) or control; the intervention began during, or early after, hospitalization and continued for 3 months. At 3 months, physical function, as assessed by the Short Physical Performance Battery, was better in the...
- N Engl J Med 2021; 385:276-277
Exercise rehabilitation has a long history in the management of chronic heart failure, with the first randomized trial of exercise training dating back to 19901 — and by the late 1990s, it had become an integral part of therapy.2 There is solid evidence from multiple trials...
- N Engl J Med 2021; 384:1248-1260
In patients with type 2 diabetes and established cardiovascular disease (or in those with a high risk of cardiovascular disease) in whom glycemic goals are not achieved with metformin, agents from the GLP-1 receptor agonist or SGLT2 inhibitor classes with demonstrated cardiovascular benefit constitute the recommended treatment.
- N Engl J Med 2021; 384:129-139
In a trial involving 10,584 patients with diabetes and chronic kidney disease, sotagliflozin resulted in fewer total deaths from cardiovascular causes, hospitalizations for heart failure, and urgent visits for heart failure than placebo. Diarrhea, mycotic infections, and diabetic ketoacidosis occurred with sotagliflozin.