Publications by authors named "Federica Guidetti"
The identification of patients with advanced heart failure (HF) remains challenging, often leading to delayed referrals and suboptimal use of advanced therapies such as long-term mechanical circulatory support (MCS) or heart transplantation (HT). This delay contributes to worse outcomes and missed opportunities for timely intervention. Many eligible patients are not recognized early enough in their clinical trajectory, either due to the complexity of the condition, overlapping HF phenotypes, or limited awareness of referral criteria among non-specialist clinicians.
View Article and Find Full Text PDFDifferences in the management of heart failure with preserved ejection fraction among physicians from Europe, the Middle East and North Africa: an international survey.
Open Heart
August 2025
Background: Heart failure with preserved ejection fraction (HFpEF) poses global diagnostic and therapeutic challenges, with potential regional differences in clinical practice that remain underexplored. This study aimed to map physician-reported HFpEF diagnostic and management practices across Europe and the Middle East-North Africa (MENA) region to identify similarities, differences and opportunities for improved care.
Methods: An independent, academically developed survey consisting of 29 questions was designed through expert collaboration to capture detailed information on physician demographics, diagnostic strategies, screening practices, pathophysiological understanding and treatment approaches for HFpEF.
Aims: To assess pharmacological treatment patterns and outcomes according to the coexistence of heart failure (HF) and type 2 diabetes (T2DM).
Methods: Two cohorts were derived: HF patients with/without T2DM and T2DM patients with/without HF, by linking the Swedish HF Registry, the National Diabetes Registry and other national registries in 2017-2021.
Results: In 37,903 patients with HF (35% females, median age 74), T2DM was independently associated with a 10-fold higher use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and less likely use of mineralocorticoid receptor antagonists (MRA) irrespective of ejection fraction (EF), and of renin-angiotensin inhibitors (RASi)/angiotensin receptor-neprilysin inhibitors (ARNi) in HF with reduced and mildly reduced EF.
Background: Trials in heart failure with preserved ejection fraction (HFpEF) frequently apply baseline diuretic use as enrichment criterion. However, the role of thiazides and loop diuretic dose for enrichment is unclear. We aimed to assess baseline loop and thiazide diuretic use, loop diuretic dose, and associations with cardiovascular (CV) outcomes in HFpEF.
View Article and Find Full Text PDFBackground: Limited evidence exists on the prognostic role of continuing medical therapy in patients with heart failure (HF) and an ejection fraction (EF) that has improved over time. This study assessed rates of, patient profiles, and associations with morbidity/mortality of renin-angiotensin inhibitors (RASi), angiotensin receptor-neprilysin inhibitors (ARNi), beta-blockers (BBL), and mineralocorticoid receptor antagonists (MRA) withdrawal in patients with HF with improved EF.
Methods: Patients with a first recorded EF <40% and a later EF ≥40% from the Swedish HF registry between June 11, 2000, and December 31, 2023, were included in this retrospective observational study.
Article Synopsis
- Cardiac amyloidosis (CA) is an often overlooked cause of heart failure (HF), highlighting the importance of early detection and timely therapy for better patient outcomes.
- A global survey with 1,460 physicians revealed that while many have experience diagnosing CA in patients with preserved ejection fraction (HFpEF), systematic screening is not widely practiced, with only 10% conducting routine checks.
- There is significant variability in screening and management strategies for CA, indicating a need for better education and access to disease-modifying therapies within the HF community.
Diagnostic and therapeutic practice for Heart Failure with preserved ejection fraction around the world: An international survey.
Curr Probl Cardiol
December 2024
Article Synopsis
- A survey was conducted among physicians globally to evaluate the real-world practices for diagnosing and treating heart failure with preserved ejection fraction (HFpEF), highlighting a knowledge gap in clinical implementation.
- 1,460 physicians from 95 countries participated, primarily cardiologists, with most using a 50% ejection fraction cut-off for HFpEF diagnosis; however, only 47.2% utilized formal diagnostic scores.
- The results showed that while natriuretic peptides were commonly used (87.4%), SGLT2 inhibitors led as the preferred first treatment (54.4%), indicating a need for better education on HFpEF management.
Article Synopsis
- * A global survey conducted in 2023 revealed that non-cardiologists and cardiologists were less likely than heart failure specialists to utilize certain diagnostic tools and parameters like natriuretic peptides and specific echocardiographic techniques for diagnosing HFpEF.
- * While SGLT2 inhibitors and diuretics were commonly preferred medications across specialties, there was a notable variation in the selected first-choice drug for HFpEF, with heart failure specialists favoring SGLT2 inhibitors more than cardiologists
Article Synopsis
- - The study investigated how heart failure (HF) and atrial fibrillation (AF) occur together, focusing on their prevalence, incidence, and treatment strategies in patients with different ejection fraction levels.
- - Analyzed data from over 195,000 patients showed an increase in AF prevalence for both HF and non-HF patients from 2006 to 2021, with HF patients, especially those with reduced ejection fraction (HFrEF), receiving more AF treatments.
- - Despite higher rates of AF in HF patients, particularly those with preserved ejection fraction (HFpEF), the overall treatment for AF in HF patients is still considered low, suggesting a need for improved management strategies.
Article Synopsis
- The analysis aimed to assess the comorbidity burden in heart failure (HF) patients by examining both cardiovascular (CV) and non-CV conditions across different ejection fractions (EF).
- The study included 91,463 HF patients from the Swedish HF Registry, revealing that nearly all had at least one comorbidity, with HF patients having preserved EF (HFpEF) showing more comorbidities than those with reduced EF.
- The findings indicated that certain comorbidities, especially dementia, chronic kidney disease, and chronic obstructive pulmonary disease, significantly increased the risk of death, while obesity appeared to reduce that risk; the presence of multiple comorbidities was tied to higher mortality, with varying impacts on
Aims: Mineralocorticoid receptor antagonists (MRAs) improve outcomes in heart failure with reduced ejection fraction (HFrEF) but remain underused and are often discontinued especially in patients with chronic kidney disease (CKD) due to concerns on renal safety. Therefore, in a real-world HFrEF population we investigated the safety of MRA use, in terms of risk of renal events, any mortality and any hospitalization, across the estimated glomerular filtration rate (eGFR) spectrum including severe CKD.
Methods And Results: We analysed patients with HFrEF (ejection fraction <40%), not on dialysis, from the Swedish Heart Failure Registry.
Article Synopsis
- The Heart Failure Association of the European Society of Cardiology aims to enhance medical treatments for heart failure patients by analyzing specific patient profiles.
- Researchers studied heart failure patients in Sweden from 2013 to 2021, identifying 93 profiles based on factors like kidney function and heart rhythm, finding that specific groups had higher risks of cardiovascular issues.
- The study suggests that most patients fit easily into recognizable profiles and highlights the potential for targeted treatment strategies based on these profiles to improve outcomes.
Article Synopsis
- * There is a shortage of donor organs, leading to long wait times and a mortality rate of about 20% for those on the waiting list.
- * The review discusses current treatments, recent innovations, and future trends in managing advanced heart failure, emphasizing mechanical support and heart transplantation.
Role of Cardiac Rehabilitation After Ventricular Assist Device Implantation.
Heart Fail Clin
April 2021
Article Synopsis
- - Patients with heart failure experience challenges in their heart's ability to fill and pump blood, leading to decreased exercise capacity due to issues like low oxygen transfer and anemia.
- - Ventricular assist devices are a reliable treatment option for individuals with end-stage heart failure, improving heart function and overall health.
- - Cardiac rehabilitation for patients with these devices is crucial as it focuses on reducing physical limitations and enhancing the ability to engage in daily activities.
The prognostic significance of the right ventricle (RV) has recently been recognised in several conditions, primarily those involving the left ventricle, the lungs and their vascular bed, or the right-sided chambers. Recent advances in imaging techniques have created new opportunities to study RV anatomy, physiology and pathophysiology, and contemporary research efforts have opened the doors to new treatment possibilities. Nevertheless, the treatment of RV failure remains challenging.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the presence of calcium in aortic cusps and mitral annulus (AOC_MAC) as a potential predictor of cardiovascular events and mortality, focusing on its role in primary prevention irrespective of atrial fibrillation (AF).
- 1389 participants, mostly older adults with various cardiovascular risk factors, were monitored over 32 months, revealing a higher rate of cardiovascular hospitalizations and deaths among those with AOC_MAC compared to those without.
- AOC_MAC was found to be an independent predictor of negative outcomes in patients in sinus rhythm, whereas it had no significant impact on prognosis for patients with AF, highlighting the need for differentiated approaches in risk assessment.
Is anti-platelet therapy always necessary in asymptomatic 30-40% carotid stenosis?
J Cardiovasc Med (Hagerstown)
January 2017
Asymptomatic mild carotid artery stenosis is relatively frequent and associated with an increased risk of cardiovascular events. Its recognition is clinically relevant for appropriate prevention strategies. These include a healthy lifestyle approach and a careful pharmacologic control of cardiovascular risk factors, such as hypertension, hypercholesterolemia, and diabetes.
View Article and Find Full Text PDFEffects of oral amino Acid supplements on functional capacity in patients with chronic heart failure.
Clin Med Insights Cardiol
June 2014
Article Synopsis
- Patients with heart failure (HF) experience reduced availability of amino acids, leading to issues in muscle metabolism and lower quality of life; this study explores the impact of supplementing essential and semi-essential amino acids over three months.
- A total of 13 patients with stable chronic HF showed significant improvements in exercise capacity, measured by cardiopulmonary stress tests and the six-minute walking test, after three months of amino acid supplementation.
- Despite the improvements in exercise tolerance, the study found no significant changes in quality of life or substantial reductions in NT-proBNP levels, indicating that while amino acid treatment is safe and well-tolerated, it primarily benefits physical performance rather than overall well-being.
Article Synopsis
- Heart failure is a major health issue in developed countries, leading to high death rates, hospitalizations, and healthcare costs, with a need for more effective treatments beyond medications and devices.
- Nutrition plays a critical role in managing heart failure by reducing cardiovascular risks early on and helping manage symptoms in advanced stages through diet adjustments.
- Dietary supplements like omega-3 fatty acids and amino acids may enhance heart function and prognosis, while increasing caloric and protein intake can help combat muscle loss in severe cases.