Some HF Patients Discard LVAD After ‘Heart Recovery’ Protocol

Although structural and functional heart “recovery” sometimes follows implantation of a left ventricular assist device (LVAD) in patients with end-stage heart failure (HF), allowing pump removal, such cases are rare in practice and the supportive medical therapy and monitoring isn’t standardized.

But what if there were a protocol for aiming patients with an LVAD specifically toward the goal of myocardial recovery followed by pump explantation, one featuring an especially aggressive drug regimen to promote reverse remodeling? Many more patients, potentially, might receive a pump with bridge to recovery as the intent and eventually have their devices removed, propose researchers who published their experience with such a strategy October 26 in Circulation.

About half of 40 adult patients who had received HeartMate II (Thoratec, now Abbott) axial-flow pumps at six major LVAD centers participating in the prospective Remission from Stage D Heart Failure (RESTAGE-HF) study were able to have their pumps explanted after following the protocol.

Their rate of survival free from transplantation or another LVAD implantation was about 90% 1 year after explantation and 77% 3 years after.

The heart recovery rate after LVAD explantation exceeds what has been previously reported, and such recoveries were achieved at all participating centers, “a key component for its broader application,” the group writes. “This suggests that the explant rate after LVAD could be much higher if this strategy were more widely used, and supports promoting and testing systematically for recovery after LVAD implantation.”

The findings build on a recent published experience in which 18 patients with LVADs explanted on a similar protocol achieved results at cardiopulmonary exercise testing comparable to those in 97 healthy control participants.

The current protocol’s key elements included optimization of the LVAD speed, or rate of continuous flow, for as much ventricular unloading as safely possible; a drug regimen designed to intensify the reverse remodeling process; close echocardiographic follow-up, the scans obtained at reduced pump speeds to capture native contractile function; and functional testing as needed.

The drug regimen, initiated with uptitration once the patient is implanted and weaned off inotropic agents, is so aggressive it wouldn’t normally be tolerated in a patient with HF not on mechanical circulatory support, observed lead author Emma Birks, PhD, MBBS, University of Kentucky, Lexington, for theheart.org | Medscape Cardiology.

Initially, ventricular unloading on the LVAD itself rests the heart and sets the stage for recovery, so it’s important that the pump be set to a speed that optimizes that process, Birks explained. The other crucial element is the intensive use of conventional HF medications, which at standard dosages the patients no longer tolerated. “They dropped their blood pressure and affected their kidneys,” she said.

But as soon as the pump is engaged, “all of a sudden they’re supported, the kidneys are better. So you can not only use the drugs, we use them at huge doses.”

The regimen, started and uptitrated as soon as the newly implanted patient weans off inotropic agents, features carvedilol, digoxin, spironolactone, an ACE inhibitor (lisinopril),

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Coronavirus and road to recovery: Time is the only best medicine we have

However, medical research is gradually learning more about how this virus behaves.However, medical research is gradually learning more about how this virus behaves.

Last month, Robert R Redfield, the chief of the Centers for Disease Control and Prevention (CDC), said that the completion of general vaccine distribution and the return of ‘regular life’ is probably not realistic until mid-2021.

With vaccine expectations still unclear, news reports suggest that India is buying 100 million doses of Covid vaccine Sputnik V from Russia with an agreement signed between Russian Direct Investment Fund and Dr Reddy’s Laboratories. Sputnik V has made Russia the first country to claim a breakthrough in developing a vaccine for Covid-19. Many other developers-Pfizer Inc, Johnson & Johnson, AstraZeneca-Oxford University, Novavax and Moderna-have trials over the next few weeks.

But a new dimension to the rising post-Covid complications has made all look for a fast procurement of a vaccine. A case in point is the Union home minister Amit Shah’s return to the All India Institute of Medical Sciences in Delhi after he complained of fatigue and body ache-four days after he tested negative for coronavirus in September. Veteran Congress leader and former Assam chief minister Tarun Gogoi was also admitted to the ICU in September after his blood oxygen level drastically went down in post-Covid-19 complications. The 85-year-old had tested positive for the virus in August.

Medical experts and doctors have stressed on the magnitude of the disease, which was earlier restricted to the lungs, but has now turned into a multi-system disease affecting the body. In July, Natalie Lambert, research professor of medicine at Indiana University in the US, warned against complications such as extreme fatigue, breathlessness and hair loss. The CDC in the US reported its own survey results a few weeks later and acknowledged that at least 35% of those surveyed had not returned to their usual state of health.

Mild yet critical

While most people have relatively mild and manageable symptoms, those with illnesses such as diabetes or heart disease are more at risk. Major complications include a condition known as cytokine release syndrome, where an infection triggers the immune system to flood the bloodstream with inflammatory proteins called cytokines, which can kill tissue and damage organs, including lungs, heart and kidneys. Other complications include acute respiratory failure, pneumonia, acute respiratory distress syndrome (ARDS), acute liver, cardiac or kidney injury, septic shock and disseminated intravascular coagulation.

The younger populace might suffer from multisystem inflammatory syndrome in children (MIS-C) or paediatric multisystem inflammatory syndrome (PMIS) with symptoms like fever, belly pain, vomiting, diarrhoea, rash, headache and confusion.

Talking about the sub-acute morbidities, NITI Aayog member and head of the national task force on Covid-19, VK Paul explained in a news briefing: “Post-Covid sub-acute morbidities are a new dimension. Scientific and medical communities are keeping an eye on it.”

The acute insult in Covid-19 is systemic and it may progress to involve other systems. Comorbidities like diabetes, hypertension, obesity, coronary artery disease and chronic liver disease (CLD) co-exist in the general population, more so in the middle-aged

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2 new cases and 1 new recovery

MANISTEE COUNTY — Manistee County has had 113 cases of COVID-19 as of Friday’s data. One case was removed from a previous count because the person resides outside of Manistee County’s jurisdiction.

Manistee County has had three deaths, 10 probable cases and 64 recoveries.

Of the cases in the county, the state shows 61 were listed as female and 52 were listed as male.

According to the DHD#10 county profile for September, 34.6% of Manistee County’s cases involved people aged 20 to 29.

In the DHD#10’s 10-county region, most cases were split more or less evenly without any age group contributing an overwhelming majority of COVID-19 cases.


In the department’s coverage areas, people aged 20-29 made up the largest group by percentage at over 20% and was followed by the 0-19 group which made up over 15%.

According to the DHD#10 heatmap, Brown, Springdale, Stronach and Manistee Townships have seen higher rates than the rest of the county.

A STATEWIDE LOOK

Here are some quick facts from the latest Michigan Department of Health and Human Services report.

• There were 152,862 cases and 7,129 deaths statewide during the pandemic.

• This is an increase of 1,826 cases and 18 deaths.

• Case counts are cumulative, not reduced due to recoveries and are listed for the patients’ resident county.

• There have been 109,539 recoveries from COVID-19. This information was published by the state on Oct. 17 and is updated weekly.

• Recovery numbers show that a person is alive after 30 days from the onset of testing or onset of symptoms.

NEIGHBORS AND THE REGION

• Manistee’s neighboring Grand Traverse County reported 645 cases and 13 deaths.

• Wexford County reported 143 cases and four deaths. One case was removed from Friday’s count because the person resides outside of Wexford County.

• Benzie County has seen 106 cases and two deaths, according to the state’s numbers. However, the Benzie-Leelanau District Health Department reports 98 cases in the county as of Friday.

• Lake County has seen 52 cases.

• Mason County has seen 189 cases and one death. One case was removed from a previous count because the person resides outside of Mason County.

• All counties in the state have reported cases of COVID-19.

• Most cases in the northern Lower Peninsula could be found in Grand Traverse County. However, Alpena and Iosco counties lead northern Michigan with deaths at 14.

According to the latest data from the state’s tracking of personal protective equipment and hospital beds, the Munson Health System, which Munson Healthcare Manistee Hospital is a part of, lists 10 COVID-19 patients.

Munson Healthcare halted reporting of its testing information and started posting data published by the state for the northern Michigan region.

Manistee County is considered part of region 7 for tracking by the state.

Region 7 includes: Manistee, Wexford, Missaukee, Roscommon, Benzie, Leelanau, Grand Traverse, Kalkaska, Crawford, Oscoda, Antrim, Otsego, Montmorency, Alpena, Presque Isle, Cheboygan, Emmet and Charlevoix counties.

The region had 23 adult COVID-19

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Giuliana Rancic Gives Coronavirus Recovery Update After Testing Positive: ‘All Better Now’

Matt Winkelmeyer/Getty

Giuliana Rancic has given an update on her and her family’s coronavirus recovery, weeks after first announcing she tested positive.

The longtime E! host, 46, shared a photo on her Instagram page for Breast Cancer Awareness month on Friday and a fan commented asking, “How are you feeling from the Covid?”

“We are through it and all better now,” Rancic replied. “Thank you for asking. We appreciate it.”

Rancic revealed she tested positive for COVID-19 in the preliminary testing required by E! and parent company NBCUniversal prior to the Emmy Awards in September. Rancic announced her absence from the awards show red carpet with a video filmed from her home, in which she also said her husband Bill Rancic, 49, and their son Duke, 8, tested positive.

RELATED: Vivica A. Fox Tests Negative for COVID-19 After Pulling Out of Emmys Due to False Positive

“Hey, everyone. As I go into my 20th year on the E! red carpet I have to say I do not take missing an award show lightly, but unfortunately, this year is just so different,” Rancic said in the video. “As part of E! and NBCUniversal’s very strict testing guidelines, especially before an event like this, I did find out that I tested positive for COVID-19. Now as much as I didn’t want to hear that, I’m very thankful I heard it before I traveled and possibly could have exposed other people. So for that, I’m thankful.”

Rancic continued, “As far as my health, I’m doing well. My husband Bill and our son also did test positive, but we’re all doing well and taking care of each other so I’m going to get back to doing that. But I just want to say I’m wishing you all the best and please protect yourselves and protect those around you. Take good care and I’ll see you on the next red carpet.”

In an appearance on The Doctors shortly after, Bill sat down with Dr. Ian Smith for his first broadcast interview about his coronavirus diagnosis, sharing details about how he and his family were coping.

Bill Rancic The Doctors Exclusive Clip

In the exclusive clip, Bill Rancic discusses COVID-19 diagnosis on The Doctors.

RELATED: Bill Rancic Says Wife Giuliana’s Coronavirus Symptoms Were Less Severe than His: ‘She’s Strong’

Bill admitted that the news of diagnosis came as a shock as the family of three has been quarantined together in Idaho since March, taking precautions to stay healthy during the pandemic.

“Shockingly me, Giuliana and our son Duke, we all tested positive, needless to say we were rather shocked because we were all so cautious wiping every package down,” Rancic said, adding, “We got it while we were in seclusion which tells you anyone can get it … this is not a joke.”

“I had some respiratory symptoms and a little bit of body aches …” he added, before noting that Giuliana, who has a history of breast cancer, had milder symptoms. “Fortunately her

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