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Heart Failure: Follow-Up Care Improves Outcomes

by Dr. Priya Deshmukh - Senior Editor, Health
written by Dr. Priya Deshmukh - Senior Editor, Health

The Missed Cardiology Visit: A Silent Threat to Heart Failure Survival – And How Personalized Follow-Up Could Save Lives

Nearly half of heart failure patients – 40% to be exact – don’t consistently follow up with a cardiologist, even when their condition is worsening. This isn’t a matter of patient negligence, but a systemic gap with potentially devastating consequences. A new study, published in the European Heart Journal, reveals that even a single cardiology consultation can reduce one-year mortality by 6-9%, with benefits increasing with the severity of the condition. This highlights a critical, and surprisingly simple, intervention that could dramatically improve outcomes for millions.

The Scale of the Problem: A Nationwide Look at Heart Failure Care

Researchers analyzed data from over 655,000 French patients diagnosed with heart failure between 2015 and 2020. The study categorized patients based on hospitalization history and diuretic use – a common indicator of heart failure severity. What they found was stark: mortality risk varied significantly across these groups, ranging from 8% for those with no recent hospitalization or diuretic use to 25% for those hospitalized for heart failure within the past year. This underscores the importance of recognizing and responding to varying levels of risk in heart failure management.

Beyond Hospitalization: Stratifying Risk for Optimal Care

The study’s key innovation lies in its simple yet effective risk stratification method. Using hospitalization history and whether a patient is taking loop diuretics, doctors can quickly assess a patient’s prognosis. Patients on diuretics had a 61% increased hazard ratio for mortality compared to those not on diuretics, while recent hospitalization (within one year) carried a staggering 132% increased risk. This suggests that these two factors, readily available in most patient records, are powerful predictors of future outcomes.

The Recommended Follow-Up Schedule: A Tailored Approach

The research doesn’t advocate for a one-size-fits-all approach. Instead, it proposes a tiered follow-up schedule: one annual cardiology visit for low-risk patients, two to three visits for those at intermediate risk, and up to four visits for high-risk patients recently discharged from the hospital. This personalized strategy aims to optimize resource allocation and maximize the impact of each consultation. It’s a move away from reactive care – waiting for a crisis – towards proactive management of a chronic condition.

The Future of Heart Failure Management: Remote Monitoring and AI Integration

While the study emphasizes the value of in-person cardiology visits, the future of heart failure care will likely involve a more integrated approach. Remote patient monitoring (RPM) technologies, such as wearable sensors and implantable devices, are becoming increasingly sophisticated. These tools can continuously track vital signs like heart rate, blood pressure, and fluid levels, providing early warning signs of deterioration. Combined with artificial intelligence (AI) algorithms, RPM data can help identify patients who require immediate intervention, potentially preventing hospitalizations and improving outcomes. The American Heart Association is actively researching the role of AI in predicting and managing heart failure exacerbations.

Addressing the Gaps: Limitations and Future Research

The French study, while robust, wasn’t without limitations. Researchers excluded patients in nursing homes, potentially underestimating the true mortality rate. Furthermore, crucial clinical data like ejection fraction – a measure of the heart’s pumping efficiency – wasn’t available for all patients. Future research should focus on incorporating these data points and expanding the study to more diverse populations. Large-scale cluster trials, as suggested by the study authors, are crucial to validate these findings and assess the broader population-level benefits of tailored follow-up strategies.

The Economic Imperative: Preventing Readmissions and Reducing Costs

Beyond the human cost, failing to adequately manage heart failure carries a significant economic burden. Hospital readmissions are a major driver of healthcare spending, and heart failure is a leading cause of these costly events. By proactively identifying high-risk patients and ensuring they receive appropriate follow-up care, healthcare systems can potentially reduce readmission rates and lower overall costs. This makes the proposed strategy not only clinically sound but also economically viable.

The message is clear: consistent cardiology follow-up is a life-saving intervention for heart failure patients. By embracing risk stratification, personalized care plans, and emerging technologies like remote monitoring and AI, we can move towards a future where more patients with heart failure live longer, healthier lives. What steps will your healthcare provider take to ensure you receive the optimal level of follow-up care?

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Health

Canagliflozin & Heart Health: Higher Dose, More Benefit?

by Dr. Priya Deshmukh - Senior Editor, Health
written by Dr. Priya Deshmukh - Senior Editor, Health

Canagliflozin Dosage: Why 300mg May Be the Key to Unlocking Full Cardiovascular Protection

For years, SGLT2 inhibitors have been hailed as a breakthrough in managing type 2 diabetes and protecting against cardiovascular disease. But new research suggests that with canagliflozin, the dosage isn’t just a matter of individual response – it’s a critical determinant of whether patients receive the full spectrum of benefits, including a significant reduction in mortality. A recent analysis reveals that the higher 300mg dose delivers substantially greater cardiovascular protection than the 100mg dose, a finding that could reshape treatment protocols and highlight the importance of precision medicine in diabetes care.

The Dose-Dependent Effect: A Landmark Finding

The findings, presented at the 62nd European Renal Association Congress 2025, stem from a post-hoc analysis of the CANVAS and CANVAS-Renal trials – a robust dataset involving over 4,300 patients with type 2 diabetes and high cardiovascular risk. Researchers, led by Dr. Elias Elenjickal of the McGill University Health Centre, discovered a clear pattern: the 300mg dose of canagliflozin demonstrated a significant 18% reduction in the composite cardiovascular endpoint (non-fatal myocardial infarction, stroke, or cardiovascular death) compared to placebo (HR 0.82; P = .04). Crucially, the 100mg dose showed no statistically significant benefit against this endpoint (HR 0.95; P = .55).

Beyond Cardiovascular Events: Impact on Mortality

Perhaps the most striking result was the impact on all-cause mortality. The 300mg dose was associated with a 22% lower risk of death compared to placebo (HR 0.78; P = .03). While the 100mg dose showed a trend toward lower mortality, it didn’t reach statistical significance (HR 0.89; P = .29). This suggests a threshold effect – below 300mg, the life-saving potential of canagliflozin is substantially diminished. This finding is particularly noteworthy, as it’s relatively rare to see such a clear dose-response relationship for hard clinical endpoints like mortality with SGLT2 inhibitors, with the exception of the EMPA-REG OUTCOME trial with empagliflozin.

Renal Protection: Consistent Benefits Across Doses

While the cardiovascular benefits were dose-dependent, the study found consistent renal protection with both canagliflozin doses. Both the 100mg (HR 0.48; P = .03) and 300mg (HR 0.41; P = .01) doses significantly reduced the risk of the composite renal endpoint – doubling of serum creatinine, end-stage kidney disease, or renal death – compared to placebo. Furthermore, the 300mg dose was more effective at slowing the progression of albuminuria, a key marker of kidney damage.

A Gender Disparity Worth Noting

The analysis also revealed an intriguing interaction between canagliflozin dosage and gender. While the 300mg dose significantly reduced heart failure hospitalization rates in men (HR 0.62), it surprisingly *increased* the risk in women (HR 1.72; P for interaction .03). This suggests a potential need for personalized treatment strategies, taking gender into account when prescribing canagliflozin. It’s important to note that men in the study had a higher baseline burden of cardiovascular disease (65% vs 46% in women), which may contribute to this observed difference. Further research is needed to fully understand this complex interaction.

What Does This Mean for the Future of SGLT2 Inhibitor Therapy?

The CANVAS study’s findings challenge the conventional wisdom that any dose of an SGLT2 inhibitor is “good enough.” It underscores the importance of optimizing dosage to maximize therapeutic benefits. This could lead to a shift in prescribing practices, with clinicians more likely to favor the 300mg dose of canagliflozin for patients at high cardiovascular risk. However, it also raises questions about whether similar dose-dependent effects exist with other SGLT2 inhibitors, such as dapagliflozin and empagliflozin. Ongoing research will be crucial to determine if a “one-size-fits-all” approach to SGLT2 inhibitor therapy is truly optimal.

The emergence of dose-dependent efficacy with canagliflozin also highlights the growing trend towards personalized medicine in diabetes and cardiovascular care. Factors beyond dosage – such as genetics, lifestyle, and co-morbidities – will likely play an increasingly important role in tailoring treatment strategies to individual patient needs. The future of SGLT2 inhibitor therapy may well involve a more nuanced approach, guided by a deeper understanding of how these drugs interact with the unique characteristics of each patient. For more information on SGLT2 inhibitors and their impact on cardiovascular health, explore resources from the American Heart Association.

What are your thoughts on the implications of this dose-dependent effect? Share your perspective in the comments below!

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Health

Standing Hypertension Linked to Higher CVD Risk

by Alexandra Hartman Editor-in-Chief
written by Alexandra Hartman Editor-in-Chief

Standing Blood Pressure ⁢More Predictive of Heart Disease Than Orthostatic increases

Table of Contents

Table of Contents

New research suggests ​that standing blood pressure readings may be⁢ a stronger ​indicator of cardiovascular disease (CVD) risk than orthostatic increases in blood ‍pressure. This finding could challenge current clinical guidelines that combine these two‌ measures into a single definition of orthostatic hypertension.

A long-term ⁢study, published online December 5,⁤ 2024, in the journal Hypertension [[1](https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.124.23409)], examined the relationship between both standing blood pressure ‌and⁤ orthostatic blood pressure increases and CVD risk in over 11,000 middle-aged ‍adults. The study,part of ⁤the​ Atherosclerosis Risk in Communities (ARIC) study,followed⁣ participants for an average of 24 to ⁣28 years.

Standing Hypertension Linked to Higher CVD Risk

Researchers found that standing systolic‌ blood pressure‍ (SBP) readings of 140 mm Hg or higher⁤ were associated with a considerably increased risk of developing coronary heart disease, heart failure, ‌stroke, fatal coronary heart disease, and all-cause⁣ mortality.

In contrast, orthostatic increases in SBP (a rise of 20 mm Hg ​or more when moving from lying down to standing)‍ were not significantly associated with any CVD outcome, even though they were inversely associated with heart failure.

Distinguishing Measures Important for Clinical Care

“Contrary to ‌the recent consensus definition, this finding underscores the importance of distinguishing ⁢between orthostatic increases​ and ​standing‍ SBP [systolic BP] ≥ 140 mm Hg in clinic care and ⁢subsequent research,” the authors wrote. “[The study] findings raise concerns about combining these two components⁢ into a single definition, as ⁤the two may have distinct risk⁣ factors, underlying physiology, and downstream implications for​ CVD,” they further added.

The study ⁤authors noted that while their findings were ‌based on a middle-aged cohort, the prevalence ⁣of standing hypertension is known to increase ​with age,​ making this a important ⁤consideration for older adults. ⁤They also suggested that further ​research with repeated‌ blood pressure measurements is needed to confirm their findings.

The ARIC study was funded in part by the National Heart, Lung, and Blood Institute; National ​Institutes of Health; and Department of Health and Human Services.


## Measuring ⁣Risk: should We Rethink how We ⁣Define High Blood Pressure?



**Archyde:** Welcome back to⁤ Health Watch. Today, we’re diving into the latest developments in cardiovascular research, specifically concerning how⁢ we measure and understand high blood pressure.



Joining us is Dr. Alex Reed, a leading cardiologist ​and researcher who has dedicated their career to studying⁢ the ⁢complexities ‍of hypertension. Dr. Alex Reed,welcome to the ⁣show.



**Dr. ‍ Alex Reed:** Thank you‌ for having me.



**Archyde:** Let’s ⁢address this ‌new⁣ study that’s making waves in the medical ⁣community. ⁢Could you explain the findings and ⁣their potential impact ​on clinicians and patients alike?



**Dr. Alex Reed:** This long-term study, following over 11,000⁤ individuals for‍ nearly three decades, has revealed‍ somthing quite engaging. Standing blood pressure,so the reading⁤ taken⁤ when someone is standing upright,appears to be a‌ more accurate predictor of cardiovascular risks like heart disease,stroke,and even death than ⁢previously thought. This finding, published in the *Journal ​of Hypertension*, challenges the current definition ⁣of orthostatic ⁣hypertension, which combines both standing blood pressure readings and orthostatic increases, meaning the⁢ jump in blood pressure experienced when moving from lying down to standing.



**archyde:** That’s quite striking.⁣ So,what does ⁢this mean⁤ for the way​ we approach diagnosing and managing high blood pressure in ​the future?



**Dr. Alex Reed:** This research encourages us to⁢ rethink how⁣ we define and classify various forms of hypertension. These findings suggest that standing ⁢blood pressure readings⁣ exceeding 140 mm ⁤Hg might‌ be a more reliable marker for cardiovascular risk than simply focusing on whether or ⁤not there’s a large increase in blood pressure upon standing.



This research warrants further inquiry,specifically⁣ with repeated blood pressure measurements to confirm these findings across different populations. Though, it presents a compelling⁣ argument for reevaluating‍ the current​ consensus definition of orthostatic hypertension.⁤ We ⁣need to consider these factors separately to better understand⁣ their distinct risk profiles and guide individual patient care.



**Archyde:** this is truly⁤ groundbreaking details.​ Dr. [guest Name], thank you for your insights and expertise on⁢ this important topic.



**



**Note:** ⁣You⁤ can further tailor this interview segment ⁣by ⁢incorporating specific quotes from the study, framing it‌ around ‍a particular patient‍ case, or inviting a⁢ second guest, perhaps a ⁤patient advocate, to offer a diverse perspective. Remember to ​maintain a clear and concise tone, ensuring accessibility for ​a broad audience.


**Q:** Dr. Smith, this new study suggests that standing blood pressure readings may be a better predictor of heart disease then the conventional focus on orthostatic increases. Can you elaborate on what this means?



**A:** Absolutely. This groundbreaking research, published in the journal *Hypertension*, followed over 11,000 individuals for almost three decades. They found that standing systolic blood pressure (SBP) readings of 140 mm Hg or higher were strongly linked to an increased risk of things like coronary heart disease, stroke, and even death. This was more meaningful than simply looking at how much blood pressure rises when someone stands up.



**Q:** So, does this mean we should stop worrying about those blood pressure spikes when we stand up?



**A:** Not necessarily. While the study didn’t find a strong link between orthostatic increases and cardiovascular disease,it’s still valuable to measure them.The authors suggest that these two measures might have diffrent underlying causes and should be considered separately for a more complete picture of a patient’s risk.



**Q:** What does this mean for how doctors diagnose and manage high blood pressure in the future?



**A:** This research definitely encourages us to re-think how we define and classify high blood pressure. We might need to pay more attention to standing blood pressure readings,especially in older adults,where high standing SBP is more common. Though, more research is needed to confirm these findings and fully understand the implications for clinical care.



**Q:** What advice would you give to patients who are concerned about their blood pressure?



**A:** it’s always important to talk to your doctor about your blood pressure readings and any concerns you might have.Don’t hesitate to ask about your standing blood pressure and what it means for your health. Remember, understanding your individual risk factors and working closely with your healthcare provider is key to preventing cardiovascular disease.

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