Page 45 - JCTR-9-5

Journal of Clinical and Translational Research 2023; 9(5): 347-356

Journal of Clinical and Translational Research

Journal homepage: http://www.jctres.com/en/home

REVIEW ARTICLE

Heart failure research paradigms using bedside observation on endothelial

muscle common denominators to highlight important translational
questions

Pupalan Iyngkaran *, Fahad Hanna , Maximilian De Courten , Sharmalar Rajendran 4
3
1,2
2
2
1 Melbourne Clinical School, The University of Notre Dame, Melbourne, Victoria, Australia, Program of Public Health, Torrens University Australia,
Melbourne, Victoria, Australia, Mitchell Institute, Victoria University, Melbourne, Victoria, Australia, Northern Adelaide Local Health Network,
4
3
South Australia, Australia
ARTICLE INFO ABSTRACT
Article history: Background and Aim: Congestive heart failure (CHF) imposes a relevant burden on healthcare
Received: January 11, 2023 systems, as it is associated with high morbidity and mortality rates and considerable costs. Within
Revised: July 17, 2023 the last three to four decades, there have been revolutionary advancements, particularly in the
Accepted: August 16, 2023 pharmaceutical industry. In addition, health services research at the population level has also delivered.
Published: September 30, 2023 A third avenue for advancing the clinical management of CHF is to explore established therapies with
a new approach. In this perspective, we explore these established concepts and provide impetus for
Keywords: using bedside observations to find improvements in CHF outcomes.
Clinical translation Conclusion: There are potentially new concepts that can be brought to established solutions for CHF.
Congestive heart failure Encouraging observations when delivering established guideline-directed medical therapies are issues
Endothelial dysfunction that the evidence-based medicine community should factor alongside novel discoveries to improve
Nitric oxide CHF prognosis. An emphasis on innovating on the known can be considered as an important paradigm
Skeletal muscle for discovery.
Relevance for Patients: Patients with CHF receiving current available treatments have improved
*Corresponding author: outcomes; however, those not improving could be considered under evolving research paradigms.
Pupalan Iyngkaran
Melbourne Clinical School, The University of
Notre Dame, Melbourne, Victoria, Australia.
Program of Public Health, Torrens University, 1. Introduction
Melbourne, Victoria Australia.
E-mail: pupalan.iyngkaran@student.torrens. Congestive heart failure (CHF) as a syndrome has advanced considerably with the
edu.au understanding of pathophysiology and in delivering prognostic treatments. The latest
guidelines published by American and European cardiac societies provide a comprehensive
© 2023 Author(s). This is an Open-Access outline of strategies and proven therapies for holistic CHF disease management [1,2].
article distributed under the terms of the Guideline-directed medical therapies (GDMTs) will improve outcomes, nonetheless, the
Creative Commons Attribution-Noncommercial debate will continue in regions where there are poorer outcomes. Thus, there is merit
License, permitting all non-commercial use,
distribution, and reproduction in any medium, in reflecting on what has been achieved. In particular, understanding where and why
provided the original work is properly cited. there are gaps in achieving trial findings when GDMTs are prescribed at the population
level [3-6]. Clinical translation and health services research has addressed some of these
external validity factors [7,8]. A second factor on validity that may be intrinsic to patients
is not easily standardised for in trials and randomisation and can be masked when data is
pooled; importantly, it can be assessed at the bedside when treatments are administered, and
responses are observed [9]. There is thus the intersection with post-trial prescribing in the
clinical domain, and to fully capture what transpires requires a collaborative mindset and
an administrative framework to deliver to patients the GDMT and learn of emerging gaps.
DOI: http://dx.doi.org/10.18053/jctres.09.202305.23-00010