bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends of Medicare reimbursement rates for gender affirmation procedures
Authors: Siotos Charalampos , Underhill Joshua M , Sykes Jennifer , Jones Kody B , Schechter Loren , Dorafshar Amir H , Hamidian Jahromi Alireza 
Published: December 2023

Abstract

Background
While nearly 1 in 5 Americans receives health insurance coverage through Medicare, literature suggests that Medicare reimbursement is lagging behind inflation for many plastic surgery procedures.

Aim
This article evaluates trends in Medicare reimbursement for gender affirmation procedures.

Methods
The most common gender affirmation procedures performed at an urban academic medical center were identified in this cross-sectional study (level 4 evidence). Five nongender surgery codes were evaluated for reference. A standardized formula utilizing relative value units (RVUs) was used to calculate monetary data. Differences in reimbursement between 2014 and 2021 were calculated for each procedure.

Outcome
The main outcome was inflation-adjusted difference of charges from 2014 to 2021.

Results
Between 2014 and 2021, Medicare reimbursement for gender affirmation procedures had an inflation-unadjusted average change of –0.09% (vs +5.63% for the selected nongender codes) and an inflation-adjusted change of –10.03% (vs –5.54% for the selected nongender codes). Trends in reimbursement varied by category of gender-affirming procedure. The overall average compound annual growth rate had a change of –0.99% (vs –0.53% for the selected nongender codes). The average changes in work, facility, and malpractice RVUs were –1.05%, +9.52%, and –0.93%, respectively.

Clinical Implications
Gender surgeons and patients should be aware that the decrease in reimbursement may affect access to gender-affirming care.

Strengths and Limitations
Our study is one of the first evaluating the reimbursement rates associated with the full spectrum of gender affirmation surgery. However, our study is limited by its cross-sectional nature.

Conclusions
From 2014 to 2021, Medicare reimbursement for gender affirmation procedures lagged inflation.
Universal definition of heart failure
Authors: Coats Andrew JS , Bozkurt Biykem , Seferović Petar M 
Published: December 2023

Abstract
In early 2021, the Heart Failure Society of America, the Heart Failure Association of European Society of Cardiology, and the Japanese Heart Failure Society (JHFS) proposed a new universal definition of heart failure (UDHF). Four other associations endorsed the proposal: the Canadian Heart Failure Society, the Cardiac Society of Australia and New Zealand, the Heart Failure Association of India, and the Chinese Heart Failure Association. The reasons underlying the UDHF were many but importantly included the need to define heart failure (HF) easily and reproducibly as an essential step for standardization, so that accurate comparisons can be made across geographies, health systems, and timelines. A reliable UDHF will also aid in research, clinical practice, and quality and safety improvement activities. Unlike chronic kidney disease (CKD), HF cannot be defined by a numerical abnormality in any single parameter. HF is a clinical syndrome involving a commonly accepted composite of signs, symptoms, and investigative findings that are recognized as forming an identifiable disease state. This chapter reviews the history of HF definitions and outlines the advantages of the 2021 UDHF proposed by several international cardiology societies. It outlines how staging of HF can be aided by the UDHF and how the four-stage classification of the American College of Cardiology Foundation/American Heart Association can be adapted to the UDHF, and how this can aid our appreciation of the progression from risk factors for HF through early asymptomatic disease through to mildly and severely symptomatic disease. The chapter also reviews the many uses of left ventricular ejection fraction (LVEF) to subclassify HF and also its limitations, and describe four classes of HF according to ejection fraction (EF), HF with reduced EF (HFrEF), HF with mid-range EF (HFmrEF), HF with preserved EF (HFpEF), and HF with improved EF (HFimpEF). The chapter discusses the concept and usefulness of HF disease trajectories and finally outlines future uses of the UDHF in clinical practice, registries, audit, research, advocacy, and patient education.
Restrictive cardiomyopathy
Authors: Rapezzi Claudio , Aimo Alberto , Linhart Ales , Keren Andre 
Published: December 2023

Abstract
Restrictive cardiomyopathy (RCM) is a heterogeneous group of diseases characterized by a restrictive left ventricular physiology, that is, a rapid rise in ventricular pressure with only small increases in filling volumes because of increased myocardial stiffness. Beyond this shared haemodynamic hallmark, the phenotypic spectrum of RCM is wide. The disorders manifesting as RCM can be classified according to four main underlying disease mechanisms: (1) interstitial fibrosis or intrinsic myocardial dysfunction; (2) infiltration of extracellular spaces; (3) accumulation of storage material within cardiomyocytes; and (4) endomyocardial fibrosis. Many disorders do not show a restrictive physiology throughout their natural history, but only in the initial stage (with evolution towards a hypokinetic and dilated phenotype) or in the terminal stage (often progressing from a hypertrophic phenotype). Furthermore, elements of both hypertrophic and restrictive phenotypes may coexist in some patients, making the classification challenging. The restrictive physiology can be easily demonstrated by cardiac catheterization or Doppler echocardiography. The single conditions may usually be diagnosed based on clinical data, 12-lead electrocardiography, echocardiography, or cardiac magnetic resonance, but further investigations may be needed, including endomyocardial biopsy. The spectrum of therapies is also wide and heterogeneous, but disease-modifying treatments are available only for cardiac amyloidosis and partially for iron overload cardiomyopathy.
Prevention of heart failure
Authors: Piepoli Massimo Francesco , Matrone Maria Benedetta , Dendale Paul , Zieroth Shelley 
Published: December 2023

Abstract
Because of rapid ageing of the population, the incidence of heart failure is expected to increase in the coming years. Therefore, a key issue in modern medicine is prevention of the development of heart failure to reduce hospital admission rates. This chapter aims to provide practical evidence-based information to support the implementation of effective preventive measures. After reviewing the most common risk factors, potential interventions are proposed and discussed.
Molecular and cellular mechanisms
Authors: Xiao Junjie , Thum Thomas , Condorelli Gianluigi , Backs Johannes 
Published: December 2023

Abstract
Understanding the molecular and cellular mechanisms that control myocardial homeostasis and function is a prerequisite to establish new druggable targets for the development of innovative heart failure therapeutics. Excitation–contraction coupling, sarcomere function, autophagy, and cell–cell communication are all cardiac processes that are disturbed in heart failure patients and in several heart failure models. Numerous mediators link inherited or acquired causes of heart failure to these processes, as well as associate these processes with each other. Gene expression is altered not only in chronic disease states, but also in acute situations, and has turned out to be disease-causing. In particular, signal transduction events, transcriptional and translational regulation, epigenetic and epitranscriptomic modifications, and non-coding RNAs have emerged as druggable regulatory mediators. This chapter summarizes selected milestones in this exciting research area and discusses future directions.
Alterations in myocardial metabolism
Authors: Bertero Edoardo , Maack Christoph 
Published: December 2023

Abstract
The heart requires enormous amounts of energy in the form of adenosine triphosphate (ATP) that is mostly produced in mitochondria via oxidative phosphorylation. As an ‘omnivore’, the heart flexibly utilizes fatty acids, glucose, amino acids, lactate, and ketones. In patients with heart failure (HF), reduced phosphocreatine-to-ATP ratios predict adverse outcomes, coining the term of the failing heart as an ‘engine out of fuel’. However, metabolic dysfunction in HF goes far beyond a mere energetic deficit and involves alterations in substrate utilization, intermediary metabolism, and mitochondrial redox regulation that conspire to alter excitation–contraction (EC) coupling and dysregulate nutrient signalling pathways through epigenetic or post-translational control mechanisms. In contrast, defects in EC coupling and pathological cardiac workload in HF deteriorate energy supply-and-demand matching, to which the Krebs cycle with its key role in energy conversion, antioxidation, and production of metabolic intermediates is central. This chapter integrates cardiac metabolism with function and explains how this intricate relation is perturbed in the failing heart.
Alterations in renal haemodynamics and function in heart failure
Authors: Rossignol Patrick , Damman Kevin 
Published: December 2023

Abstract
Chronic kidney disease is a highly prevalent condition among patients with heart failure and is associated with worse clinical outcomes. Acute and chronic heart failure are inherently unstable conditions, encompassing a subtle (dis)equilibrium with kidney (dys)function within cardiorenal syndromes. Keeping in mind that lifesaving drugs (e.g. renin–angiotensin–aldosterone system inhibitors, including mineralocorticoid receptor antagonists, angiotensin receptor–neprilysin inhibitors, and/or sodium–glucose cotransporter 2 inhibitors) may alter kidney function without compromising clinical outcomes in heart failure patients with reduced ejection fraction, the practising physician must be ready to adapt the patient’s ongoing heart failure drug treatment (especially loop diuretics) at any point in time, based on the clinical status of the patient, and to accurately interpret kidney function variations.
Clinical phenotypes of heart failure with reduced ejection fraction
Authors: Halliday Brian P , Lüscher Thomas F 
Published: December 2023

Abstract
Following the use of left ventricular ejection fraction (LVEF) in early trials to select patients thought most likely to gain benefit from therapies, heart failure has been classified based on this measure. Indeed, more recent trials have confirmed the remarkable ability of LVEF to select patients with reduced systolic function who are most likely to benefit from pharmacological therapies. Additional classification of patients with heart failure with reduced ejection fraction (HFrEF) is often based on the presence or absence of ischaemic heart disease significant enough to cause the degree of myocardial impairment. However, both ischaemic and non-ischaemic mechanisms may also coexist. Further characterization of the phenotype is based on the clinical history, simple investigations including electrocardiography, and multimodality imaging, as well as genetic and family evaluation. While LVEF is likely to play an important ongoing role in the selection of therapy, this is likely to be complemented by in-depth phenotypic characterization, as we move into the era of precision medicine.
Heart failure with preserved ejection fraction
Authors: de Boer Rudolf A , Pieske Burkert , Borlaug Barry A 
Published: December 2023

Abstract
Heart failure with preserved ejection fraction (HFpEF) makes up for approximately 50% of all heart failure (HF) presentations. Current European Society of Cardiology (ESC) (and American College of Cardiology (ACC)/American Heart Association (AHA)) guidelines define HFpEF as a clinical syndrome with HF signs and/or symptoms, impaired diastolic function, and preserved systolic function (left ventricular ejection fraction ≥50%). The clinical risk factors and presentation of HFpEF are different from those of HF with (mildly) reduced ejection fraction. Generally, patients with HFpEF are older, more often female, and often have hypertension and atrial fibrillation as underlying causes, whereas HF with reduced ejection fraction more often occurs in younger males with ischaemic heart disease. Patients with multiple cardiovascular risk factors ánd HFpEF have far worse symptoms and worse outcome than those with similar cardiovascular risk burden without HFpEF, so that HFpEF cannot be regarded as an innocent complication of its associated comorbidities. In recent years, it has become increasingly evident that HFpEF is a heterogeneous disorder, with various underlying causes and precipitants, and that the diagnostic and therapeutic approach has been too simplistic. This chapter discusses the epidemiology, pathophysiology, diagnosis, and treatment options of HFpEF.
Biomarkers in diagnostic and prognostic assessment
Authors: Boer Rudolf A de , Bayes-Genis Antoni , Januzzi James L 
Published: December 2023

Abstract
Heart failure (HF) is a complex diagnosis, consisting of numerous syndromes with a common presentation (typically with signs and symptoms of congestion and/or low cardiac output), but with variable prognosis. Given the challenging nature that HF poses to clinicians, measurement of circulating biomarkers has been increasingly used to diagnose HF more accurately, estimate its severity, and evaluate treatment adequacy. Central to the use of biomarkers in HF patients is the understanding that biomarkers are a supplement to clinical judgement. However, biomarkers such as natriuretic peptides have revolutionized how the diagnosis of HF is regarded. Newer biomarkers such as cardiac troponins, soluble ST2, genomic markers (such as microRNA), and multi-biomarker panels developed through proteomics may provide even greater future value to better understand the complex diagnosis and management of HF.
Nuclear medicine
Authors: Neglia Danilo , Gimelli Alessia 
Published: December 2023

Abstract
Nuclear imaging is an evidence-based and broadly used approach for the detection and characterization of myocardial ischaemia and viability. Since coronary artery disease is still the leading cause of heart failure (HF), nuclear modalities are established for the diagnostic workup, risk stratification, and management of patients with suspected or known ischaemic cardiac dysfunction. Nuclear imaging has also an emerging role for the recognition and characterization of mechanisms or processes involved in non-ischaemic HF such as infection, inflammation, infiltration, and innervation. Nuclear modalities are advantaged by the availability of tracers able to interrogate specific molecular pathways. Imaging glucose metabolism of inflammatory cells or amyloid deposition in the myocardium, the function of sympathetic nerve endings, or myocardial receptors offers the capability of early diagnosis, risk stratification, and guide to treatment. Further developments in nuclear molecular tracers and hybrid imaging technologies will contribute to a more individualized management of patients with HF.
Computed tomography in heart failure
Authors: Achenbach Stephan , Rakisheva Amina G 
Published: December 2023

Abstract
Computed tomography (CT) with modern multidetector row systems offers high-resolution cross-sectional imaging of the heart. The main application remains visualization of the coronary arteries to identify and rule out coronary artery stenoses, but increasingly, CT is also used for morphological and functional imaging of the heart. In the context of heart failure, CT imaging may be applied to analyse left and right ventricular function when other methods do not suffice. It may be used for pericardial imaging if constriction is suspected, and can be highly valuable for the assessment of left ventricular assist device complications. Furthermore, CT coronary angiography may be used to rule out ischaemic cardiomyopathy, and whenever structural heart interventions are considered in patients with heart failure, CT is an indispensable tool for pre-procedural planning.
Vasodilators in heart failure
Authors: Polyzogopoulou Eftihia , Nikolaou Maria , Parissis John , Mebazaa Alexandre 
Published: December 2023

Abstract
Intravenous vasodilators are traditionally used agents, considered as complementary therapy to diuretics in the acute heart failure setting, in order to reduce symptoms of pulmonary and/or peripheral congestion. Current bibliography highlights primarily their beneficial impact on symptom relief and haemodynamic improvement, whereas their positive effects on short endpoints and long-term outcomes remains unproved. Moreover, oral vasodilators have been used as an alternative therapeutic approach for symptomatic improvement and reduction of death risk in chronic heart failure patients with intolerance to renin–angiotensin–aldosterone system inhibitors. This chapter summarizes the mechanism of action of vasodilators based on the pathophysiology of heart failure and emphasizes each agent’s unique characteristics. Also, it outlines the current recommendations on optimal and individualized utilization of vasodilators according to the appropriate clinical phenotype of the heart failure patient in order to achieve maximum favourable effects.
Inotropes and inodilators
Authors: Biegus Jan , Ponikowski Piotr , Maack Christoph 
Published: December 2023

Abstract
In patients with heart failure with reduced ejection fraction (HFrEF), defects in excitation–contraction (EC) coupling deteriorate the heart’s ability to supply the organism with sufficient amounts of blood and oxygen. For decades, drug development has aimed to increase cardiac contractility and output, especially in patients with acute, but also chronic, heart failure. However, although many approaches have succeeded in improving inotropy acutely, long-term prognosis is often adverse. Therefore, use of classical inotropes is generally limited to patients with acute heart failure and signs of hypoperfusion. More recently, compounds directly targeting sarcomeres have been developed which improve cardiac function, but also morbidity, in patients with chronic HFrEF, even when initiated during hospitalization. This chapter discusses the identification of patients requiring inotropic support, as well as the modes of action and clinical results of inotropes, to help physicians tailor treatments towards their patients’ clinical and haemodynamic situation.
Sodium–glucose cotransporter 2 inhibitors
Authors: Seferović Petar M , Cosentino Francesco , Rosano Giuseppe , Januzzi James 
Published: December 2023

Abstract
Sodium–glucose cotransporter 2 (SGLT2) inhibitors were initially developed as a novel therapy for type 2 diabetes mellitus (T2DM). However, several SGLT2 inhibitors demonstrated favourable effects on cardiovascular and kidney events, as well as attenuation in hospitalization for heart failure (HF), in patients with T2DM, including those with chronic kidney disease (CKD). In patients with HF with reduced ejection fraction, dapagliflozin and empagliflozin proved effective in reducing the risk of cardiovascular mortality and HF hospitalization, regardless of T2DM status or background therapy. Sotagliflozin reduced HF events and cardiovascular mortality in patients with T2DM and recent hospitalization for worsening HF. In patients with HF and preserved or mildly reduced ejection fraction, with or without T2DM, empagliflozin provided a significant reduction in cardiovascular mortality or HF hospitalization. The present chapter summarizes the mechanisms of cardiovascular protection with SGLT2 inhibitors and provides an overview of their role as cardiovascular medications essential for the prevention and treatment of HF.
Cardiac surgery (bypass surgery and remodelling surgery)
Authors: Schoenrath Felix , Neumann Franz-Josef , Uva Miguel Sousa , Falk Volkmar 
Published: December 2023

Abstract
Coronary artery disease is a root cause of de novo heart failure with impaired left ventricular systolic function and requires a full diagnostic workup. Despite an increased operative risk in patients with poor left ventricular function, coronary artery bypass grafting can provide not only symptomatic relief, but also a prognostic benefit in the setting of acute and chronic heart failure. Surgical ventricular reconstruction is a therapeutic option for patients with a left ventricular ejection fraction of ≤35% in combination with coronary artery bypass graft surgery or as a stand-alone procedure. The decision-making process should be guided by a specialized heart failure team, with a thorough understanding of the risks and benefits of all available medical, percutaneous, and surgical treatment options.
Cardiovascular rehabilitation and lifestyle modifications
Authors: Volterrani Maurizio , Cohen-Solal Alain , Adamopulos Stamatis , Miliopoulos Dimitris , Iellamo Ferdinando , Piepoli Massimo 
Published: December 2023

Abstract
Non-pharmacological management represents an important contribution to heart failure (HF) therapy. Education and counselling are instrumental in helping patients, their families, and caregivers in acquiring necessary skills for self-care and improvement in treatment adherence. Dietary sodium and fluid restrictions are important in control of congestion. Muscle wasting and cachexia are common in HF and have a significant impact on the clinical course. Nutritional advice and exercise training have proven to be effective in reducing mortality and hospitalization and improving quality of life (QoL) in cachectic patients. In addition, exercise training is highly recommended for all HF patients, regardless of the left ventricular ejection fraction. It was shown to improve functional capacity and QoL, and to reduce all-cause and HF-related mortality and hospitalization. Observational data suggest that smoking is associated with HF development and should be regarded as a modifiable risk factor. Nutritional deficiencies also need to be appropriately addressed.
Palliative care in the heart failure trajectory
Authors: Jaarsma Tiny , Fitzsimons Donna , Hjelmfors Lisa , Hill Loreena , Lambrinou Ekaterini , Strömberg Anna 
Published: December 2023

Abstract
Although it is generally recognized that heart failure (HF) is a serious condition and equivalent to cancer in terms of symptom burden and prognosis, only a limited number of these patients receive care that prepares them to make plans and cope through the stages of the illness. Across the course of the HF trajectory, most patients will go through several phases which can be marked by different goals for treatment and care and different issues in communication. Open and clear communication is vital to ensure good quality of care for patients, their family, and caregivers. Ethical issues include communication on difficult decisions, issues related to implantation and deactivation of devices, and deprescribing medication. There are numerous ways to organize palliative care in the HF trajectory but a coordinated interdisciplinary approach is vital.