Congestive heart failure and omega-3-fatty acids

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Congestive Heart Failure Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

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History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

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Cardiac MRI

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Exercise Stress Test

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Cardiac Catheterization

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Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kalsang Dolma, M.B.B.S.[2]

Omega-3 Fatty Acid

Therapeutic Role of Omega-3 Fatty Acid in Congestive Heart Failure

Landmark Studies

The GISSI-HF Trial (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico)
  • A double blind, placebo controlled trial by GISSI-HF investigator randomly assigned 6975 patients with chronic heart failure of New York Heart Association (NYHA) class II-IV to n-3 PUFA 1 g daily(n=3494) or placebo(n=3481) and were followed up for a median of 3.9 years. The study showed reduced death from any cause in n-3 PUFA group (27%) as compared to placebo group (29%). Also, the end points of deaths and admission to hospitals for cardiovascular reasons is lower in n-3 PUFA group (57%) in comparison to placebo group (59%).[1]
  • A substudy of GISSI-HF trial done in 608 chronic heart failure patients indicates an increase in LV ejection fraction in n-3 PUFA group by 8.1% at 1st year, 11.1% at 2 years and 11.5% at 3 years as compare to placebo group with increase of 6.3% at 1 year, 8.2% at 2 years and 9.9% at 3 years. This small but statistically significant advantage in terms of LV function by n-3 PUFA supplementation has been seen in patients with symptomatic heart failure of any etiology.[2]

Preventive Role of Omega-3 Fatty Acid in Congestive Heart Failure

Limited data suggests the preventive role of n-3 PUFA supplementation in lowering the incidence of heart failure. Controlled studies with omega-3 fish oil has suggest its cordioprotective role in heart failure. The American Heart association has recently recommended use of fish and/or fish oil supplements for all patients with cardiovascular diseases.

Landmark Studies

  • A prospective cohort study in 4738 adults of >65 years without heart failure at baseline have shown that consumption of tuna and other broiled or baked fish is associated with lower incidence of heart failure, no such association is found in individuals consuming fried fish.[3]
  • Another prospective cohort study in 2735 US adults without prevalent heart disease have shown that plasma phospholipid eicosapentanoic acid (EPA) concentration is inversely related with incident CHF. This result also supports that participants with higher levels of omega-3 fatty acid are less likely to develop congestive heart failure in follow up.[4]

References

  1. Tavazzi L, Maggioni AP, Marchioli R; et al. (2008). "Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial". Lancet. 372 (9645): 1223–30. doi:10.1016/S0140-6736(08)61239-8. PMID 18757090. Unknown parameter |month= ignored (help)
  2. Ghio S, Scelsi L, Latini R; et al. (2010). "Effects of n-3 polyunsaturated fatty acids and of rosuvastatin on left ventricular function in chronic heart failure: a substudy of GISSI-HF trial". Eur. J. Heart Fail. 12 (12): 1345–53. doi:10.1093/eurjhf/hfq172. PMID 20952767. Unknown parameter |month= ignored (help)
  3. Mozaffarian D, Bryson CL, Lemaitre RN, Burke GL, Siscovick DS (2005). "Fish intake and risk of incident heart failure". J. Am. Coll. Cardiol. 45 (12): 2015–21. doi:10.1016/j.jacc.2005.03.038. PMID 15963403. Unknown parameter |month= ignored (help)
  4. Mozaffarian D, Lemaitre RN, King IB; et al. (2011). "Circulating long-chain ω-3 fatty acids and incidence of congestive heart failure in older adults: the cardiovascular health study: a cohort study". Ann. Intern. Med. 155 (3): 160–70. doi:10.1059/0003-4819-155-3-201108020-00006. PMC 3371768. PMID 21810709. Unknown parameter |month= ignored (help)

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