Ayumi Goda

Background: SGLT2 (sodium–glucose cotransporter‐2) inhibitors (SGLT2is) improve outcomes in heart failure (HF), but evidence in patients with frailty and acute HF (AHF) is limited. This study investigated the association between SGLT2i use at discharge and outcomes in patients with AHF, with a focus on frailty. Methods: We analyzed 5579 patients hospitalized for AHF enrolled between 2018 and 2024 in the prospective WET‐HF2 (West Tokyo Heart Failure 2) registry in Japan (age 79 years, 43% women, body mass index 23.1, 23% ischemic cause, left ventricular ejection fraction 45%, 24% SGLT2is at discharge). Frailty was assessed using the Clinical Frailty Scale (≥4; 63%), and complementary analyses were performed using frailty‐related factors (low body mass index, reduced activities of daily living, malnutrition, and dementia). The primary outcome was a composite of cardiac death or HF rehospitalization within 1 year, which occurred in 766 patients (18%). A propensity score was calculated using variables associated with SGLT2i prescription. Results: After propensity score–based inverse probability of treatment weighting adjustment, SGLT2i use was associated with a lower risk of the primary outcome (hazard ratio [HR], 0.76, P =0.045). This association was more pronounced in patients with frailty (HR, 0.59, P =0.005), but not in patients without frailty (HR, 1.18; P _interaction =0.010). Analyses using frailty‐related factors yielded similar patterns. At 1 year, SGLT2i use at discharge was not associated with deterioration in body mass index or nutritional status. Conclusions: In this observational registry, SGLT2i use at discharge was associated with improved outcomes in patients with AHF, particularly those with frailty, without evidence of nutritional harm. These findings support the potential safety of SGLT2is in patients with frailty and AHF.

Background: Although the “I NEED HELP” criteria facilitate timely consideration of advanced heart failure (HF) therapies, patient classification based on the variables included in the criteria are scarcely investigated. This study aimed to identify phenotypically distinct subgroups of patients with advanced HF using unsupervised cluster analysis based on the variables included in these criteria. Methods: A multicenter registry was used to identify patients hospitalized with HF who met at least 1 I NEED HELP criterion. Latent class analysis was performed on 9 variables from the criteria. Results: A total of 2520 patients (mean age, 74±13 years; 40% women) were included in this study. Latent class analysis identified 3 phenotypes: more de novo HF with the lowest number of applicable criteria (phenotype 1, 31%); younger age with the lowest left ventricular ejection fraction and highest number of applicable criteria (phenotype 2, 19%); and older age with more comorbidities and poorer renal function (phenotype 3, 49%). After multivariable adjustment, phenotypes 2 and 3 were associated with a higher incidence of composite all‐cause death or rehospitalization for HF (phenotype 2: hazard ratio [HR], 1.96 [95% CI, 1.58–2.42]; phenotype 3: HR, 1.54 [95% CI, 1.28–1.84]; phenotype 1: reference) during the follow‐up period (median, 461 [interquartile range, 130–730] days). Conclusions: This study describes a novel phenotypical classification based on the I NEED HELP criteria, with significantly different prognoses identified for patients with advanced HF. These classifications may facilitate risk stratification in this population with a complicated clinical profile.

Background: The prognostic impact of worsening renal function (WRF) during the vulnerable phase following discharge after hospitalization for acute decompensated heart failure (HF) remains unclear. This study investigated the determinants of WRF 1 year after discharge (1Y‐WRF) and its association with clinical outcomes in patients with acute decompensated HF. Methods: Data were analyzed for 1753 patients hospitalized with acute decompensated HF from WET‐HF2 (West Tokyo Heart Failure 2), a multicenter registry. 1Y‐WRF was defined as a ≥25% decrease in estimated glomerular filtration rate (eGFR). The primary end point was a composite of all‐cause mortality and HF rehospitalization beyond 1 year after discharge. Exploratory subgroup analyses were conducted based on age, sex, left ventricular ejection fraction, diabetes, eGFR, HF rehospitalization, and loop diuretic intensification within 1 year after discharge, anemia, and renin‐angiotensin‐aldosterone system inhibitors use. Results: Of the 1753 patients (median age 76 years, 39.9% female, median eGFR 50.7 mL/min per 1.73 m ² at discharge), 285 (16.3%) developed 1Y‐WRF. Female sex, anemia, higher New York Heart Association class, and higher eGFR at discharge were associated with 1Y‐WRF. Over a median follow‐up of 1 year, 1Y‐WRF was associated with an increased risk of the composite end point (adjusted hazard ratio, 1.34 [95% CI, 1.02–1.75], P =0.035), primarily driven by HF rehospitalization. The adverse prognostic impact was notable in young patients and those with high eGFR and no HF rehospitalization within 1 year after discharge. Conclusions: In a contemporary cohort of acute decompensated heart failure 1Y‐WRF was relatively common and associated with subsequent worse clinical outcomes.

Background: Mindfulness-based interventions have been applied across various chronic illnesses, but no tailored program exists for individuals with pulmonary hypertension (PH). Objective: This study aimed to develop and evaluate the feasibility of a mindfulness-based self-management program for patients with PH, delivered online to accommodate their limited mobility. Methods: A single-arm pre-post study was conducted using an 8-session, weekly videoconference program incorporating PH self-management education and elements of mindfulness-based cognitive therapy. A mobile app linked to an Apple Watch was used to support symptom monitoring and mindfulness awareness. Outcomes included PH-related symptoms, quality of life (emPHasis-10), depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder 7-item scale [GAD-7]), resilience (Connor-Davidson Resilience Scale [CD-RISC]), and loneliness (UCLA Loneliness Scale–short version). Assessments occurred at baseline, week 4, and program completion. Exit interviews explored perceived changes and experiences. Results: Twelve participants (mean age 41.8, SD 10.5 years; range 26‐56 years) were enrolled, and 9 completed the program (75% retention). Participants valued the online format and Apple Watch integration, while noting a need for optional on-demand sessions. Qualitative analysis identified themes such as increased self-awareness, use of meditation for pain management, and enhanced self-compassion. Quantitative analysis showed significant changes across 3 time points (baseline, week 4, and week 8) for emPHasis-10 ( χ ² _₂ =9.74; P =.008) and CD-RISC ( χ ² _₂ =7.27; P =.03). Trends toward change were observed for PHQ-9 ( χ ² _₂ =4.75; P =.09) and GAD-7 ( χ ² _₂ =5.07; P =.08), but week 12 data were limited (n=5). No significant changes in loneliness were observed. Conclusions: The program appeared to support patients with PH in managing symptoms and emotions and suggested potential improvements in quality of life. These preliminary findings warrant evaluation in a future randomized controlled trial.

The relationship between exercise tolerance and body composition in chronic thromboembolic pulmonary hypertension (CTEPH) is not well-understood. This study assessed body composition and its link to the 6-min walk distance (6MWD) in 181 patients with CTEPH, analyzing 257 health status assessments from 2018 to 2021. Patients underwent right heart catheterization, bioelectrical impedance analysis for body composition, and 6MWD evaluations. The mean pulmonary arterial pressure and 6MWD were 20 mmHg (interquartile range [IQR]:16–25) and 414 m (IQR:354–490), respectively. The skeletal muscle index (SMI) and phase angle (PhA) were 6.4 kg/m² (IQR: 5.7–7.2) and 4.4° (IQR: 4.0–5.1), respectively. The 6MWD was associated with age (β = –0.19; 95% confidence interval [CI]: –0.32, –0.07; p = 0.003), male sex (β = 0.22; 95% CI: 0.10, 0.34; p < 0.001), mean pulmonary arterial pressure (β = –0.32; 95% CI: –0.42, –0.21; p < 0.001), and PhA (β = 0.21; 95% CI: 0.06, 0.36; p = 0.005). However, SMI did not show any association with 6MWD. The study suggests PhA as a potential simple marker for exercise tolerance in patients with CTEPH, pending further validation for therapeutic targeting.

This study is the first to characterize exercise-induced changes in the PVR-PAC relationship in IPAH and CTEPH. Despite similar PVR, patients with CTEPH showed significantly lower PAC and RC time constant at rest and during exercise. A leftward shift in the inverse PVR-PAC relationship in CTEPH highlights the importance of assessing both PAC and PVR under stress for accurate clinical assessment and tailored management for each subtype of PH.

Background: Depression and anxiety screening has not been adequately examined in patients with pulmonary hypertension (PH). We assessed depression and anxiety prevalence and their determinants in pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH).Methods and Results: This cross-sectional study included 234 patients with PH (age 57 [42–68] years; 75% female; PAH/CTEPH/other: 103/126/5). Overall, 24% and 26% of patients had depression (Hospital Anxiety and Depression Scale [HADS]-depression score ≥8) and anxiety (HADS-anxiety score ≥8) respectively. Depression and anxiety prevalence was 18% and 19% in PAH and 27% and 30% in CTEPH, respectively. Among patients with PAH, depression was significantly associated with higher mean right atrial pressure (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.03–1.32; P=0.013), higher pulmonary vascular resistance (OR 1.08; 95% CI 1.01–1.16; P=0.034), lower arterial oxygen saturation (OR 0.89; 95% CI 0.80–0.98; P=0.021), pulmonary artery oxygen saturation (OR 0.93; 95% CI 0.87–0.99; P=0.020), and reduced use of phosphodiesterase-5 inhibitor (OR 0.30; 95% CI 0.11–0.86; P=0.025). In CTEPH, depression was significantly associated with the presence of a psychiatric disorder (OR 4.71; 95% CI 1.24–17.90; P=0.023). Anxiety was not significantly associated with any of the aforementioned parameters in PAH and CTEPH.Conclusions: Predicting depression and anxiety based on disease severity and hemodynamics was challenging, making individual assessments and approaches crucial.