Browsing by Author "Givertz, Michael M."

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    What’s Next for Acute Heart Failure Research?
    (Wiley, 2017) Collins, Sean P.; Levy, Phillip D.; Fermann, Gregory J.; Givertz, Michael M.; Martindale, Jennifer M.; Pang, Peter S.; Storrow, Alan B.; Diercks, Deborah D.; Felker, G. Michael; Fonarow, Gregg C.; Lanfear, David J.; Lenihan, Daniel J.; Lindenfeld, JoAnn M.; Peacock, W. Frank; Sawyer, Douglas M.; Teerlink, John M.; Butler, Javed; Emergency Medicine, School of Medicine
    Each year over one million patients with acute heart failure (AHF) present to a United States emergency department (ED). The vast majority are hospitalized for further management. The length of stay and high postdischarge event rate in this cohort have changed little over the past decade. Therapeutic trials have failed to yield substantive improvement in postdischarge outcomes; subsequently, AHF care has changed little in the past 40 years. Prior research studies have been fragmented as either “inpatient” or “ED-based.” Recognizing the challenges in identification and enrollment of ED patients with AHF, and the lack of robust evidence to guide management, an AHF clinical trials network was developed. This network has demonstrated, through organized collaboration between cardiology and emergency medicine, that many of the hurdles in AHF research can be overcome. The development of a network that supports the collaboration of acute care and HF researchers, combined with the availability of federally funded infrastructure, will facilitate more efficient conduct of both explanatory and pragmatic trials in AHF. Yet many important questions remain, and in this document our group of emergency medicine and cardiology investigators have identified four high-priority research areas.
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    Worsening renal function in acute heart failure in the context of diuretic response
    (Wiley, 2022) Emmens, Johanna E.; Ter Maaten, Jozine M.; Matsue, Yuya; Figarska, Sylwia M.; Sama, Iziah E.; Cotter, Gad; Cleland, John G.F.; Davison, Beth A.; Felker, G. Michael; Givertz, Michael M.; Greenberg, Barry; Pang, Peter S.; Severin, Thomas; Gimpelewicz, Claudio; Metra, Marc; Voors, Adriaan A.; Teerlink, John R.; Emergency Medicine, School of Medicine
    Background: For patients with acute heart failure (AHF), substantial diuresis after administration of loop diuretics is generally associated with better clinical outcomes but may cause creatinine to rise, suggesting renal function decline. We investigated the interaction between diuretic response and worsening renal function (WRF) on clinical outcomes in patients with AHF. Methods and results: In two AHF cohorts (PROTECT, n = 1698 and RELAX-AHF-2, n = 5586 in current analysis), the prognostic impact of WRF (creatinine ≥0.3 mg/dl increase baseline-day 4; sensitivity analyses incorporated baseline renal function) by diuretic response (kg weight loss/40 mg furosemide equivalent baseline-day 4) was investigated with regard to (cardiovascular) death or cardiovascular/renal hospitalization using subpopulation treatment effect pattern plots (STEPP) and survival analyses. WRF occurred in 286 (16.8%) and 1031 (18.5%) patients in PROTECT and RELAX-AHF-2, respectively. Patients with WRF had higher left ventricular ejection fraction and lower estimated glomerular filtration rate at baseline (p < 0.05), and received higher doses of loop diuretics and had a worse diuretic response (p < 0.001). In patients with a poor diuretic response (≤0.35 kg weight loss/40 mg furosemide equivalent as identified by STEPP), WRF was associated with higher risk of (cardiovascular) death or cardiovascular/renal hospitalization (p < 0.001 both cohorts), but this was not the case for patients with a good diuretic response (p = 0.900 both cohorts). Conclusion: In two large cohorts of patients with AHF, WRF in the first 4 days was not associated with worse outcomes when patients had a good diuretic response. The occurrence of WRF in patients with AHF should therefore be considered in the context of diuretic response.