2024
Inpatient Use of Guideline-Directed Medical Therapy During Heart Failure Hospitalizations Among Community-Based Health Systems
Zheng J, Sandhu A, Bhatt A, Collins S, Flint K, Fonarow G, Fudim M, Greene S, Heidenreich P, Lala A, Testani J, Varshney A, Wi R, Ambrosy A. Inpatient Use of Guideline-Directed Medical Therapy During Heart Failure Hospitalizations Among Community-Based Health Systems. JACC Heart Failure 2024 PMID: 39269395, DOI: 10.1016/j.jchf.2024.08.004.Peer-Reviewed Original ResearchCommunity-based health systemQuality improvement registryHealth systemGuideline-directed medical therapyGuideline-directed medical therapy useEligible hospitalsImprovement registryNational quality improvement registryElectronic health record dataHealth record dataEvidence-based medicationsHF hospitalizationHeart failurePostdischarge strategiesHFrEF patientsFailure hospitalizationMedical therapyCommunity-basedAngiotensin receptor-neprilysin inhibitorSodium-glucose cotransporter 2 inhibitorsInpatient useRecord dataRenin-angiotensin system inhibitorsMineralocorticoid receptor antagonistsWorsening renal function
2023
Outcomes Associated with Sodium-Glucose Cotransporter-2 Inhibitor Use in Acute Heart Failure Hospitalizations Complicated by AKI
Aklilu A, Kumar S, Yamamoto Y, Moledina D, Sinha F, Testani J, Wilson F. Outcomes Associated with Sodium-Glucose Cotransporter-2 Inhibitor Use in Acute Heart Failure Hospitalizations Complicated by AKI. Kidney360 2023, 4: 1371-1381. PMID: 37644648, PMCID: PMC10615381, DOI: 10.34067/kid.0000000000000250.Peer-Reviewed Original ResearchConceptsAcute kidney injuryHeart failure hospitalizationSodium-glucose cotransporter-2 inhibitor useSodium-glucose cotransporter 2 inhibitorsAcute heart failure hospitalizationCotransporter 2 inhibitorsCox regression analysisRenal recoveryFailure hospitalizationAKI diagnosisKidney injuryInhibitor useLower riskStage 5 chronic kidney diseaseTime-varying Cox regression analysisKidney Disease Improving Global OutcomesInverse probability-weighted analysisMulticenter retrospective cohort studyMultivariable Cox regression analysisStage 5 CKDAcute heart failureRetrospective cohort studyChronic kidney diseaseKidney function recoveryGlomerular filtration rate
2022
Association of Acute eGFR Changes With Mortality and Heart Failure Hospitalizations Among Patients Admitted for Acute Heart Failure Requiring Hemodynamic Monitoring
Banlengchit R, Tighiouart H, Gillberg J, Tuttle M, Testani J, Oka T, Kiernan M, Sarnak M, McCallum W. Association of Acute eGFR Changes With Mortality and Heart Failure Hospitalizations Among Patients Admitted for Acute Heart Failure Requiring Hemodynamic Monitoring. Journal Of The American Society Of Nephrology 2022, 33: 349-349. DOI: 10.1681/asn.20223311s1349c.Peer-Reviewed Original ResearchRates of In-Hospital Decongestion and Association with Mortality and Cardiovascular Outcomes Among Patients Admitted for Acute Heart Failure
McCallum W, Tighiouart H, Testani JM, Griffin M, Konstam MA, Udelson JE, Sarnak MJ. Rates of In-Hospital Decongestion and Association with Mortality and Cardiovascular Outcomes Among Patients Admitted for Acute Heart Failure. The American Journal Of Medicine 2022, 135: e337-e352. PMID: 35472391, PMCID: PMC10767835, DOI: 10.1016/j.amjmed.2022.04.003.Peer-Reviewed Original ResearchConceptsB-type natriuretic peptideAcute heart failureHeart failure hospitalizationComposite outcomeHeart failureFailure hospitalizationCardiovascular outcomesCardiovascular mortalityNatriuretic peptideN-terminal pro-B-type natriuretic peptidePro-B-type natriuretic peptideHeart Failure Outcome StudyMultivariable Cox regression modelsResistant heart failureLower hazardCox regression modelRisk of mortalityPropensity-score matchingTolvaptan (EVEREST) trialCause mortalityCardiovascular benefitsVasopressin AntagonismVolume overloadReduced riskOutcome studiesEvidence-Based Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction and Chronic Kidney Disease
Beldhuis IE, Lam CSP, Testani JM, Voors AA, Van Spall HGC, Maaten J, Damman K. Evidence-Based Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction and Chronic Kidney Disease. Circulation 2022, 145: 693-712. PMID: 35226558, PMCID: PMC9074837, DOI: 10.1161/circulationaha.121.052792.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsChronic kidney diseasePresence of CKDSevere chronic kidney diseaseHeart failure hospitalizationReduced ejection fractionHFrEF therapyHeart failureFailure hospitalizationEjection fractionMedical therapyKidney diseaseDrug classesSodium-glucose cotransporter 2 inhibitorsEvidence-based medical therapyGlucose cotransporter 2 inhibitorsStrong independent risk factorEnd pointCKD stage 3bPoor cardiovascular outcomesCKD stage 5Combined end pointCotransporter 2 inhibitorsIndependent risk factorSevere heart failureGlomerular filtration rateChanges in inferior vena cava area represent a more sensitive metric than changes in filling pressures during experimental manipulation of intravascular volume and tone
Ivey‐Miranda J, Wetterling F, Gaul R, Sheridan S, Asher JL, Rao VS, Maulion C, Mahoney D, Mebazaa A, Gray AP, Burkhoff D, Cowie MR, Cox ZL, Butler J, Fudim M, McDonald K, Damman K, Borlaug BA, Testani JM. Changes in inferior vena cava area represent a more sensitive metric than changes in filling pressures during experimental manipulation of intravascular volume and tone. European Journal Of Heart Failure 2022, 24: 455-462. PMID: 34837447, PMCID: PMC9306514, DOI: 10.1002/ejhf.2395.Peer-Reviewed Original ResearchConceptsInferior vena cavaCardiac filling pressuresPulmonary artery pressureIntravascular volumeFilling pressureArtery pressureVolume statusVascular toneCardiac functionCross-sectional areaLeft-sided cardiac filling pressuresIVC cross-sectional areaHeart failure hospitalizationRight heart catheterizationChronic HFFailure hospitalizationHeart catheterizationCardiac dysfunctionVenous conduitsColloid infusionVena cavaVenous systemRapid pacingIVC areaVolume loading
2021
Renal negative pressure treatment as a novel therapy for heart failure-induced renal dysfunction
Rao VS, Maulion C, Asher JL, Ivey-Miranda J, Cox ZL, Moreno-Villagomez J, Mahoney D, Turner JM, Wilson FP, Wilcox CS, Testani J. Renal negative pressure treatment as a novel therapy for heart failure-induced renal dysfunction. AJP Regulatory Integrative And Comparative Physiology 2021, 321: r588-r594. PMID: 34405731, DOI: 10.1152/ajpregu.00115.2021.Peer-Reviewed Original ResearchConceptsRenal plasma flowGlomerular filtration rateCongestive HFTubular pressureHeart failure hospitalizationPara-aminohippurate clearanceCentral venous pressureHigh fractional excretionNegative pressure therapyUrinary collecting systemNegative pressure treatmentSimilar diuresisFailure hospitalizationRenal dysfunctionCardiac tamponadeIothalamate clearanceFractional excretionRenal parametersKidney functionRenal congestionRenal responseRight kidneyVenous pressurePressure therapyControl kidneysSpot urine sodium in acute heart failure: differences in prognostic value on admission and discharge
Biegus J, Zymliński R, Fudim M, Testani J, Sokolski M, Marciniak D, Ponikowska B, Guzik M, Garus M, Urban S, Ponikowski P. Spot urine sodium in acute heart failure: differences in prognostic value on admission and discharge. ESC Heart Failure 2021, 8: 2597-2602. PMID: 33932273, PMCID: PMC8318409, DOI: 10.1002/ehf2.13372.Peer-Reviewed Original ResearchConceptsHazard ratioComposite endpointAHF rehospitalizationPrognostic significancePrognostic utilityAcute heart failure hospitalizationSpot urine sodiumAcute heart failureHeart failure hospitalizationMortality hazard ratioCourse of hospitalizationConfidence intervalsDifferent prognostic significanceEarly phaseAHF patientsOral furosemideCause mortalityFailure hospitalizationIndex hospitalizationUrine sodiumSodium excretionHeart failureStudy endpointClinical statusPrognostic value
2019
Loop diuretic resistance complicating acute heart failure
Cox ZL, Testani JM. Loop diuretic resistance complicating acute heart failure. Heart Failure Reviews 2019, 25: 133-145. PMID: 31520280, DOI: 10.1007/s10741-019-09851-9.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsLoop diuretic resistanceDiuretic resistanceHeart failureAcute heart failure hospitalizationMechanism-based classification systemAcute heart failureHeart failure hospitalizationOngoing clinical trialsUniversal clinical applicationDiuretic strategyFailure hospitalizationDiuretic efficacyClinical trialsWorse outcomesTreatment pathwaysAnatomical locationClinical applicationCurrent literatureResistance mechanismsCurrent best practiceOutcomesClassification systemLiterature reviewHospitalizationPatientsLoop Diuretic Resistance in a Patient with Acute Heart Failure
Cox Z, Testani J. Loop Diuretic Resistance in a Patient with Acute Heart Failure. 2019, 153-173. DOI: 10.1007/978-3-030-21033-5_11.ChaptersLoop diuretic resistanceDiuretic resistanceHeart failureAcute heart failure hospitalizationMechanism-based classification systemAcute heart failureHeart failure hospitalizationHeart failure cohortFailure hospitalizationDiuretic efficacyPatient populationTreatment optionsFailure cohortClassification systemPatientsUniversal definitionHospitalizationUrinary Sodium Profiling in Chronic Heart Failure to Detect Development of Acute Decompensated Heart Failure
Martens P, Dupont M, Verbrugge FH, Damman K, Degryse N, Nijst P, Reynders C, Penders J, Tang WHW, Testani J, Mullens W. Urinary Sodium Profiling in Chronic Heart Failure to Detect Development of Acute Decompensated Heart Failure. JACC Heart Failure 2019, 7: 404-414. PMID: 31047021, DOI: 10.1016/j.jchf.2019.02.011.Peer-Reviewed Original ResearchConceptsChronic HF patientsHF patientsHeart failureSodium excretionAcute decompensated heart failureAcute heart failure hospitalizationLongitudinal changesChronic heart failureDecompensated heart failureHeart failure hospitalizationHigher sodium excretionUrinary sodium concentrationGlomerular filtration rate measurementInterindividual differencesLarge interindividual differencesFiltration rate measurementAHF hospitalizationDyspnea scoreFailure hospitalizationNT-proBNPChronic heartEjection fractionIndependent predictorsClinical endpointsPathophysiologic interactions
2018
Perturbations in serum chloride homeostasis in heart failure with preserved ejection fraction: insights from TOPCAT
Grodin JL, Testani JM, Pandey A, Sambandam K, Drazner MH, Fang JC, Tang WHW. Perturbations in serum chloride homeostasis in heart failure with preserved ejection fraction: insights from TOPCAT. European Journal Of Heart Failure 2018, 20: 1436-1443. PMID: 29893446, DOI: 10.1002/ejhf.1229.Peer-Reviewed Original ResearchConceptsSerum chloride levelsLoop diuretic useHeart failureSerum chlorideCause deathDiuretic useEjection fractionMultivariable Cox proportional hazards modelsCardiac Function Heart FailureCox proportional hazards modelAldosterone Antagonist TrialHeart failure hospitalizationPrimary composite endpointLower serum chlorideProportional hazards modelSerum chloride concentrationChloride levelsSpironolactone useCardiovascular deathFailure hospitalizationMultivariable adjustmentComposite endpointLoop diureticsClinical outcomesHazards model
2017
Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure Current Status and Prospects for Further Research
Costanzo MR, Ronco C, Abraham WT, Agostoni P, Barasch J, Fonarow GC, Gottlieb SS, Jaski BE, Kazory A, Levin AP, Levin HR, Marenzi G, Mullens W, Negoianu D, Redfield MM, Tang WHW, Testani JM, Voors AA. Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure Current Status and Prospects for Further Research. Journal Of The American College Of Cardiology 2017, 69: 2428-2445. PMID: 28494980, PMCID: PMC5632523, DOI: 10.1016/j.jacc.2017.03.528.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsRenal functionAdverse heart failure outcomesVital signsHeart failure hospitalizationHeart failure outcomesHeart failure eventsLower acuity hospital settingsEffective decongestionExtracorporeal ultrafiltrationCreatinine increaseFailure hospitalizationSerum creatinineStandard carePharmacological therapyMore complicationsPoor outcomeDiuretic agentsPatient's vital signsHospital settingSustained benefitFluid removalPredominant causeFailure outcomesUltrafiltration rateFurther research
2015
Influence of Titration of Neurohormonal Antagonists and Blood Pressure Reduction on Renal Function and Decongestion in Decompensated Heart Failure
Kula AJ, Hanberg JS, Wilson FP, Brisco MA, Bellumkonda L, Jacoby D, Coca SG, Parikh CR, Tang WHW, Testani JM. Influence of Titration of Neurohormonal Antagonists and Blood Pressure Reduction on Renal Function and Decongestion in Decompensated Heart Failure. Circulation Heart Failure 2015, 9: e002333. PMID: 26699390, PMCID: PMC4741376, DOI: 10.1161/circheartfailure.115.002333.Peer-Reviewed Original ResearchConceptsBlood pressure reductionDecompensated heart failureNeurohormonal antagonistsRenal functionSBP reductionBlood pressureDiuretic efficiencyHeart failureAcute decompensated heart failure hospitalizationAcute decompensated heart failure treatmentAcute decompensated heart failurePressure reductionChronic oral medicationHeart failure admissionsHeart failure hospitalizationHeart failure treatmentSystolic blood pressureDiuretic doseImproved diuresisFailure hospitalizationOral medicationsFailure treatmentDiuresisFluid outputAdmission