Heart Failure in East Asia

Heart failure (HF) carries a major burden of disease in East Asia, with high associated risk of mortality and morbidity. In recent decades, the epidemiology of HF has changed with social and economical development in East Asia. The burden of HF is still severe in East Asia.The prevalence of HF ranges from 1.3% to 6.7% throughout the region. As aetiological factors, ischaemic heart disease has increased and valvular disease reduced in most East Asian countries. Diuretics are the most commonly used drugs (51.0%-97%), followed by renin-angiotensin system (RAS) inhibitors (59%-77%), with angiotensin-converting enzyme inhibitors, ACEI, (32%-52%) and has angiotensin-2 receptor blockers, ARBs (31%-44%) in similar proportions. β-blocker use has also increased in recent years.Total mortality from HF ranges from 2% to 9% in China, Taiwan, Singapore, Thailand, and Japan. Age>65 years, diabetes mellitus, anaemia, renal dysfunction and atrial fibrillation (AF) are associated with adverse outcome. More prospective, region-specific data are still required, particularly regarding new drug therapies such as eplerenone and ivabradine.     

Heart failure as a general pandemic in Asia

Heart failure (HF) is an epidemic in healthcare worldwide, including Asia. It appears that HF will become more serious in the near future, with the epidemiological transition and ageing of the population. However, in contrast to Western countries, information on HF epidemiology is still limited in Asia, particularly in South Asia. In this review, we will briefly summarize available information regarding the current and future burden of HF in Asia, which indicates the importance of both primary prevention of underlying diseases of HF and secondary prevention, including management of ischaemic HF, HF with preserved EF, and HF in the elderly.     

Heart Failure in South Asia

South Asia (SA) is both the most populous and the most densely populated geographical region in the world. The countries in this region are undergoing epidemiological transition and are facing the double burden of infectious and non-communicable diseases. Heart failure (HF) is a major and increasing burden all over the world. In this review, we discuss the epidemiology of HF in SA today and its impact in the health system of the countries in the region. There are no reliable estimates of incidence and prevalence of HF (heart failure) from this region. The prevalence of HF which is predominantly a disease of the elderly is likely to rise in this region due to the growing age of the population. Patients admitted with HF in the SA region are relatively younger than their western counterparts. The etiology of HF in this region is also different from the western world. Untreated congenital heart disease and rheumatic heart disease still contribute significantly to the burden of HF in this region. Due to epidemiological transition, the prevalence of hypertension, diabetes mellitus, obesity and smoking is on the rise in this region. This is likely to escalate the prevalence of HF in South Asia. We also discuss potential developments in the field of HF management likely to occur in the nations in South Asia. Finally, we discuss the interventions for prevention of HF in this region     

Management of Heart Failure,Durable Left Ventricular Assist Device,and Heart Transplant Patients in the COVID-19 Era

Our world is facing recurrent waves of coronavirus disease 2019 (COVID-19) with the emergence of more infectious strains of the novel coronavirus, SARS-CoV-2. Multiple studies have established that heart failure (HF) patients are at high risk of severe disease and poor outcomes with COVID-19. Management of COVID-19 in patients with HF, heart transplant, and those supported with durable left ventricular assist devices present an arduous challenge due to underlying complex health conditions and overlap of symptoms. Based on available data, this review outlines the management of this vulnerable patient population who either present with COVID-19 with preexisting HF or with de novo HF from COVID-19.     

Percutaneous Revascularization Modalities in Heart Transplant Recipients

Accelerated allograft vasculopathy significantly limits the survival of heart transplant recipients. The prevalence of allograft coronary artery disease is as high as 18% by 1 year and 50% by 5 years following heart transplant. Heart failure and sudden cardiac death are the two most common clinical presentations. In heart transplant recipients with severe, discrete focal allograft vascular disease, percutaneous balloon angioplasty is a viable palliative option. However, its application is limited by a significant restenosis rate and progression of allograft disease in nontreated segments. Diffuse disease with tapering of vessels may be approached by debulking devices. Emerging revascularization modalities for focal stenoses and some of the diffuse tapering vessels include coronary stents, rotational atherectomy, various wavelength lasers, and, to a lesser extent, directional atherectomy. Conceivably, stents will reduce restenosis rates related to focal, discrete plaques; yet it is unknown whether they will be efficacious in short- and long-term treatment of diffusely diseased segments affected by allograft disease. Accurate assessment of clinical outcomes and long-term evaluation is imperative prior to acceptance of these devices as fundamental interventional tools for treatment of allograft coronary artery disease. Cathet. Cardiovasc. Intervent. 46:227–237, 1999. © 1999 Wiley-Liss, Inc.     

心力衰竭管理模式探讨

目的:评价不同管理模式对慢性收缩性心力衰竭(心衰)患者神经内分泌、心功能、心脏事件、生活质量和医疗费用的影响。方法:120例慢性心功能不全患者,在常规治疗心衰的前提下,随机分为心衰管理组和心衰非管理组各60例,治疗后两年其对神经内分泌、心功能、心脏事件、生活质量和医疗费用的影响。结果:心衰管理组治疗后心功能、生活质量、神经内分泌较心衰非管理组治疗后改善(P<0.05),心衰恶化再入院减少(P<0.05),心脏事件较心衰非管理组明显减少(P<0.05),年心衰治疗费用较后者减少(P<0.05),差异均有统计学意义。结论:通过心衰管理能改善心功能及生活质量,减少心衰医疗费用、心脏事件的发生。     

心脏康复对慢性心衰患者心率变异性的影响

目的：观察在标准抗心衰药物治疗的基础上联合心脏康复对慢性力衰竭（CHF）患者心率变异性的影响.方法：本院68例心力衰竭住院患者随机分为对照组34例和治疗组34例,对照组采用标准的抗心衰治疗方案;治疗组采用标准抗心衰治疗＋心脏康复;两组均规范用药6个月.所有患者治疗前后进行24h动态心电图检查心率变异性（HRV）.结果：治疗后,治疗组R-R间期的标准差（SDNN）、每5min窦性R-R平均值的标准差（SDANN）、R-R间期差值的均方根（rMSSD）、相邻两正常窦性R-R间期差值＞50ms的个数所占的百分率（PNN50）较对照组显著增加（P＜0.05）.结论：在标准抗心衰药物治疗的基础上联合心脏康复治疗,可降低交感神经过度激活,增加迷走神经的功能,显著改善HRV,从而改善患者的预后.     

心力衰竭患儿心率变异与心功能关系的探讨（附30例报告）

对３０例心力衰竭（下称心衰）患儿和３０例健康儿童的心率变异（ＨＲＶ）进行了检测。结果显示：心衰患儿心率变异性小,体位变化对心率变异性影响小,心衰表现重者的ＨＲＶ小于心衰轻者,射血分数（ＥＦ）和ＨＲＶ系数呈直线正相关（Ｐ〈０．００１）,与高频成分呈直线正相关（Ｐ〈０．００１）,ＥＦ与低频成分呈直线正相关（Ｐ〈０．０１）,认为ＨＲＶ可反映心衰时自主神经功能情况,并与心功能密切相关。