Jeffrey L. Anderson, MD, FACC, FAHA, Chair , Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect , Nancy M. Albert, PhD, CCNS, CCRN, FAHA, Biykem Bozkurt, MD, PhD, FACC, FAHA, Ralph G. Brindis, MD, MPH, MACC, Mark A. Creager, MD, FACC, FAHA[§§][1], Lesley H. Curtis, PhD, FAHA, David DeMets, PhD,

http://www.endocardites-aquitaine.fr/fileadmin/documents/documents/2014NISHIMURA.pdf

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons WRITING COMMITTEE MEMBERS*

Heart failure (HF) is a rapidly growing public health issue with an estimated prevalence of >37.7 million individuals globally. HF is a shared chronic phase of cardiac functional impairment secondary to many aetiologies, and patients with HF experience numerous symptoms that affect their quality of life, including dyspnoea, fatigue, poor exercise tolerance, and fluid retention. Although the underlying causes of HF vary according to sex, age, ethnicity, comorbidities, and environment, the majority of cases remain preventable. HF is associated with increased morbidity and mortality, and confers a substantial burden to the health-care system. HF is a leading cause of hospitalization among adults and the elderly. In the USA, the total medical costs for patients with HF are expected to rise from US$20.9 billion in 2012 to $53.1 billion by 2030. Improvements in the medical management of risk factors and HF have stabilized the incidence of this disease in many countries. In this Review, we provide an overview of the latest epidemiological data on HF, and propose future directions for reducing the ever-increasing HF burden.

/pdf/epidemiology-and-aetiology-of-heart-failure-1lp8wsw4r3.pdf

Epidemiology and aetiology of heart failure

In the 21(st) century, rheumatic fever (RF) and rheumatic heart disease (RHD) are neglected diseases of marginalized communities. Globally, RHD remains the most-common cardiovascular disease in young people aged <25 years. Although RF and RHD have been almost eradicated in areas with established economies, migration from low-income to high-income settings might be responsible for a new burden of RHD in high-income countries. The World Heart Federation (WHF) and its Working Group on RF and RHD unites global experts, combines their experience and enthusiasm, and provides a platform for RHD control. This paper is a declaration of the WHF institutional strategic goal--a 25% reduction in premature deaths from RF and RHD among individuals aged <25 years by the year 2025. The position statement affirms WHF commitments to five key strategic targets: comprehensive register-based control programmes, global access to benzathine penicillin G, identification and development of public figures as 'RHD champions', expansion of RHD training hubs, and support for vaccine development. In this paper, we also review existing barriers to RF and RHD control and identify the actions required to change the trajectory of control for these diseases. This approach provides the foundation for governments, civil society, patient advocates, clinicians, researchers, and funding agencies to develop partnerships and unify global efforts to control RF and RHD. The WHF plans to expand this position statement to an operational plan that will be founded on science, research, and quantifiable progress indicators to impact positively on the millions of people who are affected by RHD and its long-term sequelae.

/pdf/position-statement-of-the-world-heart-federation-on-the-t9d76wm4ml.pdf

Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease

Background Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest. However, the benefits of early coronary angiography and revascularization in resuscitated patients w...

Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation

Cardiac arrest systems of care are successfully coordinating community, emergency medical services, and hospital efforts to improve the process of care for patients who have had a cardiac arrest. As a result, the number of people surviving sudden cardiac arrest is increasing. However, physical, cognitive, and emotional effects of surviving cardiac arrest may linger for months or years. Systematic recommendations stop short of addressing partnerships needed to care for patients and caregivers after medical stabilization. This document expands the cardiac arrest resuscitation system of care to include patients, caregivers, and rehabilitative healthcare partnerships, which are central to cardiac arrest survivorship.

Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association

To the Editor: In his Perspective article on rheumatic heart disease in developing countries, Carapetis (Aug. 2 issue)1 correctly notes the important contribution of improved living conditions to the decline in the incidence of acute rheumatic fever over recent decades in wealthy countries. However, he does not acknowledge the contribution of the very substantial decrease in the prevalence of highly rheumatogenic emm types of group A streptococci as causative agents of acute pharyngitis. Our surveillance studies of pediatric pharyngitis group A isolates in the United States and Canada from 2000 through 2005 showed a striking disappearance of emm types 14, 18, 19, and 29 or a marked decrease of emm types 3, 5, and 6. These have been the most important rheumatogenic types from the 1960s (when rheumatic fever was prevalent) to the present decade (when rheumatic fever is quite rare).2 The basis for this marked decline in circulating rheumatogenic types is not clear, but it is very likely to be independent of the changes in living conditions.

Rheumatic Heart Disease in Developing Countries

Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States

Background Though some data from in-hospital or selected populations are available, there are no studies reporting community-level prevalence of Severe Hypertension (SH) in sub-Saharan Africa. Methods Study participants were recruited within the framework of The Heart Fund's global health initiative. Data were collected in August 2016 from 6 randomly selected sites, ensuring representativeness of both urban and rural areas. Blood pressure (BP) was measured twice, 10 ​min apart, after optimal resting time. SH was defined as systolic blood pressure ≥180 and/or diastolic blood pressure ≥110 ​mmHg ​at both readings. Demographics and data on cardiovascular history/risk factors were collected in the field. Results Among 1785 subjects examined, 1182 aged between 18 and 75 years were included in this analysis. The prevalence of SH was 14.1% (12.5% females vs 17.0% males; P ​= ​.03) (Fig. 1). Among participants with severe hypertension, 28.9% were either undiagnosed or untreated. Alarmingly, subjects at high cardiovascular risk (age ​≥ ​60 years and/or obese) had even higher prevalence of overall SH (29.6% and 24.9%, respectively) as well as undiagnosed/untreated SH (29.4% and 24.6%). SH prevalence was almost double in urban compared to rural areas (17.0% vs. 9.2%, P ​= ​.02); however, conversely, undiagnosed/untreated SH was significantly higher in rural areas (50.4% vs 21.9%). Conclusion (s): Our community-based study revealed very high prevalence of SH among adults in Abidjan area, with almost one out of every seven having SH. This underscores SH as a growing public health problem in sub-Saharan Africa.

Prevalence of severe hypertension in a Sub-Saharan African community.

BACKGROUND
The frequency, characteristics and outcomes of primary prevention implantable cardioverter defibrillator (ICD) recipients who eventually undergo heart transplantation (HT) during follow-up have not been well described.


AIMS
In a cohort of patients with heart failure implanted with an ICD for primary prevention of sudden cardiac death, to identify those at high risk of subsequent HT and evaluate ICD usefulness.


METHODS
Between 2002 and 2012, 5539 patients received a primary prevention ICD across 12 centers, and were enrolled in the DAI-PP programme, including 5427 with full HT information available.


RESULTS
During a median follow-up of 1024 days (interquartile range 484-1702 days), 176 (3.2%) patients underwent HT. Median duration between ICD implantation and HT was 484 days (IQR 169-1117 days). Among those aged≤65 years (theoretical age limit for HT registration in France), the overall incidence per 1000 person-years was 18.03 (95% confidence interval [CI]: 15.32-20.74). Left ventricular ejection fraction<25% (hazard ratio [HR]: 3.43, 95% CI: 2.34-5.04; P<0.0001), younger age (HR: 0.95, 95% CI: 0.93-0.96; P<0.0001), New York Heart Association (NYHA) class III-IV (HR: 2.67, 95% CI: 1.79-4.00; P<0.0001) and no cardiac resynchronization therapy (HR: 2.09, 95% CI: 1.39-3.14; P=0.0004) were independently associated with HT. Patients with these three characteristics (excluding age) had a 1-year HT rate of 15.2%. Incidence of appropriate ICD therapies was 92.7 per 1000 person-years for patients who underwent HT versus 76.1 for those who did not (P=0.64).


CONCLUSIONS
The overall incidence of HT in this primary prevention population was relatively high, especially among young patients with a very low ejection fraction, an advanced NYHA class and were unsuitable for cardiac resynchronization therapy (up to 15% annually). Patients awaiting HT experienced a significant rate of appropriate ICD therapies, reinforcing the importance of specific cardiac rhythm management in these patients.

Iconographies supplémentaires de l'article : Prophylactic implantable cardioverter defibrillators for primary prevention: From implantation to heart transplantation

Sudden cardiac death (SCD) during sports activities accounts for a small but significant proportion of all SCD, with recent studies consistently reporting around 5% of overall SCD occurring during sporting activity. The emphasis on young competitive athletes as opposed to recreational sports participants is discordant with the relative magnitudes of the respective problems, which was recently highlighted by several recent population-based studies. There is a crucial need to focus attention on this large at-risk population of subjects. Although coronary artery disease represents the vast majority of underlying mechanisms in recreational middle age cases, cardiomyopathies and inherited electrical disorders remain significant among the youngest. Strategies to reduce SCD burden related to sports should incorporate targeted screening, public education and consideration of warming symptoms, improving rates of bystander CPR and early AED use.

Incidence and Causes of Sudden Cardiac Death in Recreational Athletes

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