Background Increased red blood cell distribution width （RDW） is associated with adverse outcomes in patients with heart failure （HF）. The objective of this study was to compare the differences in the predictive va...Background Increased red blood cell distribution width （RDW） is associated with adverse outcomes in patients with heart failure （HF）. The objective of this study was to compare the differences in the predictive value of RDW in patients with HF due to different causes. Methods We retrospectively investigated 1,021 HF patients from October 2009 to December 2011 at Fuwai Hospital （Beijing, China）. HF in these patients was caused by three diseases; coronary heart disease （CHD）, dilated cardiomyopathy （DCM） and valvular heart disease （VHD）. Patients were followed-up for 21 ~ 9 months. Results The RDW, mortality and survival duration were significantly different among the three groups. Kaplan-Meier analysis showed that the cumulative survival decreased significantly with increased RDW in patients with HF caused by CHD and DCM, but not in those with HF patients caused by VHD. In a multivariable model, RDW was identified as an independent predictor for the mortality of HF patients with CHD （P 〈 0.001, HR 1.315, 95% CI 1.122-1.543）. The group with higher N-terminal pro-brain natriuretic peptide （NT-proBNP） and higher RDW than median had the lowest cumulative survival in patients with HF due to CHD, but not in patients with HF due to DCM. Conclusions RDW is a prognostic indicator for patients with HF caused by CHD and DCM; thus, RDW adds important information to NT-proBNP in CHD caused HF patients.展开更多
To the editor We read the article entitled Cognitive impairment in heart failure patients＇ by Leto, et al. with great interest. In this review, they demonstrated pathophysiological determinants of cognitive impairmen...To the editor We read the article entitled Cognitive impairment in heart failure patients＇ by Leto, et al. with great interest. In this review, they demonstrated pathophysiological determinants of cognitive impairment in heart failure （HF） population.展开更多
Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure （HF）. Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Pa...Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure （HF）. Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Patients who were aged 65 or over, diagnosed with HF of New York Heart Association Class III or IV symptoms, and mentally sound were eligible to the study. The Edmonton Symptom Assessment Scale, the overall quality of life single item scale, and the McQill Quality of Life Questionnaire （MQoL）, were used for measurement. Multi- ple regression analysis was performed to determine factors for predicting quality of life. Results A convenience sample of 112 patients was recruited. Their age was 81.5 ± 8.5 years. The three most distressing symptoms reported by the patients were tiredness （5.96 ± 2.78）, drowsiness （5.47± 2.93）, and shortness of breath （5.34 ± 2.96）. Their mean overall quality of life single item scale score was 4.72 ± 2.06 out of 10. The mean MQoL physical subscale score was the lowest （4.20 ± 1.767）, whereas their mean psychological subscale was the highest （7.14 ±2.39）. However, in a multivariate analysis model, quality of life was significantly associated with existential wellbeing, physical wellbeing, psychological wellbeing and educational level. Conclusions The findings highlight that spiritual concerns are significant palliative care needs among elderly patients with advanced HF, in addition to symptom management. This is in line with the argument that palliative care that places great emphasis on holistic care should be integrated to the care of this group of patients.展开更多
Chronic heart failure （CHF） is predominantly seen in older patients, and therefore real life medicine often requires the extrapolation of findings from trials conducted in much younger populations. Prescribing patte...Chronic heart failure （CHF） is predominantly seen in older patients, and therefore real life medicine often requires the extrapolation of findings from trials conducted in much younger populations. Prescribing patterns and potential benefits in the elderly are heavily influenced by polypharmacy and co-morbid pathologies. Increasing longevity may become less relevant in the frail elderly, whereas improving quality of life （QoL） often becomes priority; the onus being on improving wellbeing, maintaining independence for longer, and delaying institution- alisation. Specific studies evaluating elderly patients with CHF are lacking and little is known regarding the tolerability and side-effect profile of evidence based drug therapies in this population. There has been recent interest on the impact of heart rate in patients with symptomatic CHF. Ivabradine, with selective heart rate lowering capabilities, is of benefit in patients with CHF and left ventricular systolic dysfunction in sinus rhythm, resulting in reduction of heart failure hospitalisation and cardiovascular death. This manuscript will focus on CHF and the older patient and will discuss the impact of heart rate, drug therapies and tolerability. It will also highlight the tmmet need for specific studies that focus on patient-centred study end points rather than mortality targets that characterise most therapeutic trials. An on-going study evalu- ating the impact of ivabradine on QoL that presents a unique opportunity to evaluate the tolerability and impact of an established therapy on a wide range of real life, older patients with CHF will be discussed.展开更多
AIM:To establish the frequency of hyperphosphate-mia following the administration of sodium phosphate laxatives in low-risk patients. METHODS:One hundred consecutive ASAⅠ-Ⅱindividuals aged 35-74 years,who were under...AIM:To establish the frequency of hyperphosphate-mia following the administration of sodium phosphate laxatives in low-risk patients. METHODS:One hundred consecutive ASAⅠ-Ⅱindividuals aged 35-74 years,who were undergoing colonic cleansing with oral sodium phosphate(OSP) before colonoscopy were recruited for this prospective study.Exclusion criteria:congestive heart failure, chronic kidney disease,diabetes,liver cirrhosis,intestinal obstruction,decreased bowel motility,increased bowel permeability,and hyperparathyroidism.The day before colonoscopy,all the participants entered a 24-h period of diet that consisted of 4 L of clear fluids with sugar or honey and 90 mL(60 g)of OSP in two 45-mL doses,5 h apart.Serum phosphate was measured before and after the administration of the laxative. RESULTS:The main demographic data(mean±SD) were:age,58.9±8.4 years;height,163.8±8.6 cm; weight,71±13 kg;body mass index,26±4;women, 66%.Serum phosphate increased from 3.74±0.56 to 5.58±1.1 mg/dL,which surpassed the normal value (2.5-4.5 mg/dL)in 87%of the patients.The highest serum phosphate was 9.6 mg/dL.Urea and creatinine remained within normal limits.Post-treatment OSP se-rum phosphate concentration correlated inversely with glomerular filtration rate(P<0.007,R 2=0.0755),total body water(P<0.001,R 2=0.156)and weight(P< 0.013,R 2=0.0635). CONCLUSION:In low-risk,well-hydrated patients, the standard dose of OSP-laxative-induced hyperphos-phatemia is related to body weight.展开更多
Objectives To identify symptom clusters among patients with advanced heart failure （HF） and the independent relationships with their quality of life （QoL）. Methods This is the secondary data analysis of a cross-se...Objectives To identify symptom clusters among patients with advanced heart failure （HF） and the independent relationships with their quality of life （QoL）. Methods This is the secondary data analysis of a cross-sectional study which interviewed 119 patients with advanced HF in the geriatric unit of a regional hospital in Hong Kong. The symptom profile and QoL were assessed by using the Edmonton Symptom Assessment Scale （ESAS） and the McGill QoL Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Hier- archical regression analysis was used to examine the independent relationships with their QoL, after adjusting the effects of age, gender, and comorbidities. Results The patients were at an advanced age （82.9± 6.5 years）. Three distinct symptom clusters were identified： they were the distress cluster （including shortness of breath, anxiety, and depression）, the decondition cluster （fatigue, drowsiness, nausea, and reduced appetite）, and the discomfort cluster （pain, and sense of generalized discomfort）. These three symptom clusters accounted for 63.25% of variance of the patients＇ symptom experience. The small to moderate correlations between these symptom clusters indicated that they were rather independent of one another. After adjusting the age, gender and comorbidities, the distress （β = -0.635, P 〈 0.001）, the decondition （β = -0.148, P = 0.01）, and the discomfort （β = -0.258, P 〈 0.001） symptom clusters independently predicted their QoL. Conclusions This study identified the distinctive symptom clusters among patients with advanced HF. The results shed light on the need to develop palliative care interventions for optimizing the symptom control for this life-limiting disease.展开更多
Background The data on the prognostic values of high sensitivity C-reactive protein （hsCRP） levels in patients with advanced symp-tomatic heart failure （HF） receiving cardiac resynchronization therapy （CRT） are ...Background The data on the prognostic values of high sensitivity C-reactive protein （hsCRP） levels in patients with advanced symp-tomatic heart failure （HF） receiving cardiac resynchronization therapy （CRT） are scarce. The aim of present study was to investigate the association of serum hsCRP levels with left ventricle reverse remodeling after six months of CRT as well as long-term outcome. Methods A total of 232 CRT patients were included. The assessment of hsCRP values, clinical status and echocardiographic data were performed at baseline and after six months of CRT. Long-term follow-up included all-cause mortality and hospitalizations for HF. Results During the mean follow-up periods of 31.3 ± 31.5 months, elevated hsCRP （〉3 mg/L） prior to CRT was associated with a significant 2.39-fold increase （P=0.006） in the risk of death or HF hospitalizations. At 6-month follow-up, patients who responded to CRT showed significant reductions or maintained low in hsCRP levels （–0.5 ± 4.1 mg/L reduction） compared with non-responders （1.7 ± 6.1 mg/L increase, P=0.018）. Com-pared with patients in whom 6-month hsCRP levels were reduced or remained low, patients in whom 6-month hsCRP levels were increased or maintained high experienced a significantly higher risk of subsequent death or HF hospitalizations （Log-rank P〈0.001）. The echocardio-graphic improvement was also better among patients in whom 6-month hsCRP levels were reduced or remained low compared to those in whom 6-month hsCRP levels were raised or maintained high. Conclusions Our findings demonstrated that measurement of baseline and follow-up hsCRP levels may be useful as prognostic markers for timely potential risk stratification and subsequent appropriate treatment strategies in patients with advanced HF undergoing CRT.展开更多
Chronic heart failure （CHF） is a complex clinical syndrome resulting from inefficient myocardial pumping, and is characterised by a typical progressively deteriorating trajectory punctuated by serious episodes of ac...Chronic heart failure （CHF） is a complex clinical syndrome resulting from inefficient myocardial pumping, and is characterised by a typical progressively deteriorating trajectory punctuated by serious episodes of acute disease decompensation.High prevalence of hospital admission has been reported.[2] However, around 40% of hospital admissions was avoidable if patients demonstrate consistent self-care.展开更多
Recent studies have suggested that patients with high CHA2DS2VASc-score [Congestive Heart failure, hyperten- sion, Age ≥ 75 years （doubled）, Diabetes, Stroke （doubled）, Vascular disease, Age 65-74 years, Sex cate...Recent studies have suggested that patients with high CHA2DS2VASc-score [Congestive Heart failure, hyperten- sion, Age ≥ 75 years （doubled）, Diabetes, Stroke （doubled）, Vascular disease, Age 65-74 years, Sex category （female sex）] thromboembolic complications occurred irrespective of the presence of atrial fibrillation （AF） and anticoagulant therapy may be initiated irrespective of documented AF.展开更多
Objective Doppler derived mitral peak early diastolic filling velocity to deceleration time ratio （E/DT） has been proposed as parameter for predicting prognosis in general population. This study prospectively invest...Objective Doppler derived mitral peak early diastolic filling velocity to deceleration time ratio （E/DT） has been proposed as parameter for predicting prognosis in general population. This study prospectively investigates the incremental prognostic value of E/DT over clinical, conven- tional eehocardiographic and mitral-Doppler variables in patients hospitalized for decompensated heart failure （HF）. Methods We analyzed 95 HF patients （mean age 64.8 ± 12.2 years） hospitalized at our institution from January 2010 to March 2012. The primary end-point was cardiac death or hospitalization, whichever occurred first. Cox regression analysis was performed to identify significant predictors of outcomes. Results During follow-up （median 37.7 months） 13 patients died and 44 were hospitalized for a cardiac event. At univariable analysis, New York Heart Association （NYHA） functional class, furosemide dosage, lateral tricuspidal annular plane systolic excursion, deceleration lime and E/DT were predictive of outcome. At multivariable analysis, E/DT was the only predictor of prognosis （hazard ratio = 1.02, P = 0.018）, giving incremental prognostic information to clinical and other echocardio-graphic measures （global chi-square from 15.4 to 25.2; P = 0.032）. Conclusions FJDT gives independent and incremental prognostic information in HF patients.展开更多
The prognosis of heart failure （HF） patients has significantly improved in the last 20 years, given the advent of therapies such as angiotensin-converting enzyme （ACE） inhibitors/angiotensin receptor blockers （A...The prognosis of heart failure （HF） patients has significantly improved in the last 20 years, given the advent of therapies such as angiotensin-converting enzyme （ACE） inhibitors/angiotensin receptor blockers （ARBs）, beta-block- ers, and implantable cardioverter-defibrillator （ICD）/cardiac resynchronization therapy devices （CRT）. In addition to these promising therapies, proper nursing-care is also important. Here we summarize recent progress of nursing-care strategies in older HF patients, including routine nursing care, transitional care model, self-care, and role of exercise training in old patients with HF.展开更多
Author＇s reply We read with great interest the letter of Yiginer, et al.regarding the influence of atrial fibrillation （AF） in the development of cognitive impairment in heart failure （HF） patients. The comment ...Author＇s reply We read with great interest the letter of Yiginer, et al.regarding the influence of atrial fibrillation （AF） in the development of cognitive impairment in heart failure （HF） patients. The comment is related to the review published in the Journal by Leto, et al. that was a systematic overview about cognition, pathophysiology of cognitive impairment in heart failure patients. In the letter, Yiginer, et al.展开更多
文摘Background Increased red blood cell distribution width （RDW） is associated with adverse outcomes in patients with heart failure （HF）. The objective of this study was to compare the differences in the predictive value of RDW in patients with HF due to different causes. Methods We retrospectively investigated 1,021 HF patients from October 2009 to December 2011 at Fuwai Hospital （Beijing, China）. HF in these patients was caused by three diseases; coronary heart disease （CHD）, dilated cardiomyopathy （DCM） and valvular heart disease （VHD）. Patients were followed-up for 21 ~ 9 months. Results The RDW, mortality and survival duration were significantly different among the three groups. Kaplan-Meier analysis showed that the cumulative survival decreased significantly with increased RDW in patients with HF caused by CHD and DCM, but not in those with HF patients caused by VHD. In a multivariable model, RDW was identified as an independent predictor for the mortality of HF patients with CHD （P 〈 0.001, HR 1.315, 95% CI 1.122-1.543）. The group with higher N-terminal pro-brain natriuretic peptide （NT-proBNP） and higher RDW than median had the lowest cumulative survival in patients with HF due to CHD, but not in patients with HF due to DCM. Conclusions RDW is a prognostic indicator for patients with HF caused by CHD and DCM; thus, RDW adds important information to NT-proBNP in CHD caused HF patients.
文摘To the editor We read the article entitled Cognitive impairment in heart failure patients＇ by Leto, et al. with great interest. In this review, they demonstrated pathophysiological determinants of cognitive impairment in heart failure （HF） population.
文摘Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure （HF）. Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Patients who were aged 65 or over, diagnosed with HF of New York Heart Association Class III or IV symptoms, and mentally sound were eligible to the study. The Edmonton Symptom Assessment Scale, the overall quality of life single item scale, and the McQill Quality of Life Questionnaire （MQoL）, were used for measurement. Multi- ple regression analysis was performed to determine factors for predicting quality of life. Results A convenience sample of 112 patients was recruited. Their age was 81.5 ± 8.5 years. The three most distressing symptoms reported by the patients were tiredness （5.96 ± 2.78）, drowsiness （5.47± 2.93）, and shortness of breath （5.34 ± 2.96）. Their mean overall quality of life single item scale score was 4.72 ± 2.06 out of 10. The mean MQoL physical subscale score was the lowest （4.20 ± 1.767）, whereas their mean psychological subscale was the highest （7.14 ±2.39）. However, in a multivariate analysis model, quality of life was significantly associated with existential wellbeing, physical wellbeing, psychological wellbeing and educational level. Conclusions The findings highlight that spiritual concerns are significant palliative care needs among elderly patients with advanced HF, in addition to symptom management. This is in line with the argument that palliative care that places great emphasis on holistic care should be integrated to the care of this group of patients.
文摘Chronic heart failure （CHF） is predominantly seen in older patients, and therefore real life medicine often requires the extrapolation of findings from trials conducted in much younger populations. Prescribing patterns and potential benefits in the elderly are heavily influenced by polypharmacy and co-morbid pathologies. Increasing longevity may become less relevant in the frail elderly, whereas improving quality of life （QoL） often becomes priority; the onus being on improving wellbeing, maintaining independence for longer, and delaying institution- alisation. Specific studies evaluating elderly patients with CHF are lacking and little is known regarding the tolerability and side-effect profile of evidence based drug therapies in this population. There has been recent interest on the impact of heart rate in patients with symptomatic CHF. Ivabradine, with selective heart rate lowering capabilities, is of benefit in patients with CHF and left ventricular systolic dysfunction in sinus rhythm, resulting in reduction of heart failure hospitalisation and cardiovascular death. This manuscript will focus on CHF and the older patient and will discuss the impact of heart rate, drug therapies and tolerability. It will also highlight the tmmet need for specific studies that focus on patient-centred study end points rather than mortality targets that characterise most therapeutic trials. An on-going study evalu- ating the impact of ivabradine on QoL that presents a unique opportunity to evaluate the tolerability and impact of an established therapy on a wide range of real life, older patients with CHF will be discussed.
文摘AIM:To establish the frequency of hyperphosphate-mia following the administration of sodium phosphate laxatives in low-risk patients. METHODS:One hundred consecutive ASAⅠ-Ⅱindividuals aged 35-74 years,who were undergoing colonic cleansing with oral sodium phosphate(OSP) before colonoscopy were recruited for this prospective study.Exclusion criteria:congestive heart failure, chronic kidney disease,diabetes,liver cirrhosis,intestinal obstruction,decreased bowel motility,increased bowel permeability,and hyperparathyroidism.The day before colonoscopy,all the participants entered a 24-h period of diet that consisted of 4 L of clear fluids with sugar or honey and 90 mL(60 g)of OSP in two 45-mL doses,5 h apart.Serum phosphate was measured before and after the administration of the laxative. RESULTS:The main demographic data(mean±SD) were:age,58.9±8.4 years;height,163.8±8.6 cm; weight,71±13 kg;body mass index,26±4;women, 66%.Serum phosphate increased from 3.74±0.56 to 5.58±1.1 mg/dL,which surpassed the normal value (2.5-4.5 mg/dL)in 87%of the patients.The highest serum phosphate was 9.6 mg/dL.Urea and creatinine remained within normal limits.Post-treatment OSP se-rum phosphate concentration correlated inversely with glomerular filtration rate(P<0.007,R 2=0.0755),total body water(P<0.001,R 2=0.156)and weight(P< 0.013,R 2=0.0635). CONCLUSION:In low-risk,well-hydrated patients, the standard dose of OSP-laxative-induced hyperphos-phatemia is related to body weight.
文摘Objectives To identify symptom clusters among patients with advanced heart failure （HF） and the independent relationships with their quality of life （QoL）. Methods This is the secondary data analysis of a cross-sectional study which interviewed 119 patients with advanced HF in the geriatric unit of a regional hospital in Hong Kong. The symptom profile and QoL were assessed by using the Edmonton Symptom Assessment Scale （ESAS） and the McGill QoL Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Hier- archical regression analysis was used to examine the independent relationships with their QoL, after adjusting the effects of age, gender, and comorbidities. Results The patients were at an advanced age （82.9± 6.5 years）. Three distinct symptom clusters were identified： they were the distress cluster （including shortness of breath, anxiety, and depression）, the decondition cluster （fatigue, drowsiness, nausea, and reduced appetite）, and the discomfort cluster （pain, and sense of generalized discomfort）. These three symptom clusters accounted for 63.25% of variance of the patients＇ symptom experience. The small to moderate correlations between these symptom clusters indicated that they were rather independent of one another. After adjusting the age, gender and comorbidities, the distress （β = -0.635, P 〈 0.001）, the decondition （β = -0.148, P = 0.01）, and the discomfort （β = -0.258, P 〈 0.001） symptom clusters independently predicted their QoL. Conclusions This study identified the distinctive symptom clusters among patients with advanced HF. The results shed light on the need to develop palliative care interventions for optimizing the symptom control for this life-limiting disease.
文摘Background The data on the prognostic values of high sensitivity C-reactive protein （hsCRP） levels in patients with advanced symp-tomatic heart failure （HF） receiving cardiac resynchronization therapy （CRT） are scarce. The aim of present study was to investigate the association of serum hsCRP levels with left ventricle reverse remodeling after six months of CRT as well as long-term outcome. Methods A total of 232 CRT patients were included. The assessment of hsCRP values, clinical status and echocardiographic data were performed at baseline and after six months of CRT. Long-term follow-up included all-cause mortality and hospitalizations for HF. Results During the mean follow-up periods of 31.3 ± 31.5 months, elevated hsCRP （〉3 mg/L） prior to CRT was associated with a significant 2.39-fold increase （P=0.006） in the risk of death or HF hospitalizations. At 6-month follow-up, patients who responded to CRT showed significant reductions or maintained low in hsCRP levels （–0.5 ± 4.1 mg/L reduction） compared with non-responders （1.7 ± 6.1 mg/L increase, P=0.018）. Com-pared with patients in whom 6-month hsCRP levels were reduced or remained low, patients in whom 6-month hsCRP levels were increased or maintained high experienced a significantly higher risk of subsequent death or HF hospitalizations （Log-rank P〈0.001）. The echocardio-graphic improvement was also better among patients in whom 6-month hsCRP levels were reduced or remained low compared to those in whom 6-month hsCRP levels were raised or maintained high. Conclusions Our findings demonstrated that measurement of baseline and follow-up hsCRP levels may be useful as prognostic markers for timely potential risk stratification and subsequent appropriate treatment strategies in patients with advanced HF undergoing CRT.
文摘Chronic heart failure （CHF） is a complex clinical syndrome resulting from inefficient myocardial pumping, and is characterised by a typical progressively deteriorating trajectory punctuated by serious episodes of acute disease decompensation.High prevalence of hospital admission has been reported.[2] However, around 40% of hospital admissions was avoidable if patients demonstrate consistent self-care.
文摘Recent studies have suggested that patients with high CHA2DS2VASc-score [Congestive Heart failure, hyperten- sion, Age ≥ 75 years （doubled）, Diabetes, Stroke （doubled）, Vascular disease, Age 65-74 years, Sex category （female sex）] thromboembolic complications occurred irrespective of the presence of atrial fibrillation （AF） and anticoagulant therapy may be initiated irrespective of documented AF.
文摘Objective Doppler derived mitral peak early diastolic filling velocity to deceleration time ratio （E/DT） has been proposed as parameter for predicting prognosis in general population. This study prospectively investigates the incremental prognostic value of E/DT over clinical, conven- tional eehocardiographic and mitral-Doppler variables in patients hospitalized for decompensated heart failure （HF）. Methods We analyzed 95 HF patients （mean age 64.8 ± 12.2 years） hospitalized at our institution from January 2010 to March 2012. The primary end-point was cardiac death or hospitalization, whichever occurred first. Cox regression analysis was performed to identify significant predictors of outcomes. Results During follow-up （median 37.7 months） 13 patients died and 44 were hospitalized for a cardiac event. At univariable analysis, New York Heart Association （NYHA） functional class, furosemide dosage, lateral tricuspidal annular plane systolic excursion, deceleration lime and E/DT were predictive of outcome. At multivariable analysis, E/DT was the only predictor of prognosis （hazard ratio = 1.02, P = 0.018）, giving incremental prognostic information to clinical and other echocardio-graphic measures （global chi-square from 15.4 to 25.2; P = 0.032）. Conclusions FJDT gives independent and incremental prognostic information in HF patients.
文摘The prognosis of heart failure （HF） patients has significantly improved in the last 20 years, given the advent of therapies such as angiotensin-converting enzyme （ACE） inhibitors/angiotensin receptor blockers （ARBs）, beta-block- ers, and implantable cardioverter-defibrillator （ICD）/cardiac resynchronization therapy devices （CRT）. In addition to these promising therapies, proper nursing-care is also important. Here we summarize recent progress of nursing-care strategies in older HF patients, including routine nursing care, transitional care model, self-care, and role of exercise training in old patients with HF.
基金This work was supported by grants from the National Natural Science FoundationQ6 of China （81273968 and 81471027）, the ministerial projects of the National Working Commission on Aging （QLB2014W002）, and the four htmdred project of 301 （YS201408）.
文摘Author＇s reply We read with great interest the letter of Yiginer, et al.regarding the influence of atrial fibrillation （AF） in the development of cognitive impairment in heart failure （HF） patients. The comment is related to the review published in the Journal by Leto, et al. that was a systematic overview about cognition, pathophysiology of cognitive impairment in heart failure patients. In the letter, Yiginer, et al.
