Background: Recent landmark trials have shown that several pharmacologic therapies improve outcomes in patients with heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF), leading to updates in heart failure (HF) management guidelines. However, real-world adherence to guideline-directed medical therapy (GDMT) in these populations remains uncertain. This study evaluated GDMT prescription patterns in patients with HFmrEF or HFpEF based on the 2022 Korean Heart Failure Society guidelines. Methods: This single-center observational study included patients newly diagnosed with HF between January and December 2023, identified using International Classification of Diseases codes. Patients without recent echocardiographic or N-terminal pro–brain natriuretic peptide data, those with reduced ejection fraction, or those with end-stage renal disease were excluded. Electronic medical records were reviewed to assess GDMT prescription rates. Results: Among 615 patients (mean age, 68.9 years; 52.4% female), 568 had HFpEF and 47 had HFmrEF. Common comorbidities included hypertension (75.5%), diabetes mellitus (50.9%), ischemic heart disease (43.7%), and chronic kidney disease (22.6%). Overall prescription rates were 73.3% for renin–angiotensin system inhibitors, 83.7% for beta-blockers, 41.1% for mineralocorticoid receptor antagonists (MRAs), and 42.9% for sodium–glucose cotransporter 2 inhibitors (SGLT2is). SGLT2i use was significantly higher in patients with diabetes than in those without (71.6% vs. 13.2%; p<0.001). Angiotensin receptor–neprilysin inhibitors and MRAs were more frequently prescribed in HFmrEF than HFpEF. Beta-blocker use was lower in patients aged ≥75 years. Conclusions A substantial gap persists between guideline recommendations and real-world GDMT use in patients with HFmrEF and HFpEF, particularly for SGLT2is. Multicenter studies are warranted to further characterize and address this treatment gap.

BACKGROUND: The sensitivities and specificities of interferon-gamma release assays (IGRAs) vary among different population studies, and the data on the routine use of IGRAs are limited. The aim of this study was to evaluate the role of QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of active tuberculosis. METHODS: We conducted a prospective study, enrolling 77 patients with suspected pulmonary tuberculosis (TB), at a secondary care teaching hospital in Seoul. RESULTS: In total, 12 (15.6%) patients showed indeterminate results due to positive control failure on the QFT-GIT test. Indeterminate results were significantly associated with the elderly, history of the intensive care unit stay, lymphocytopenia, especially low CD4 count, increased C-reactive protein and decreased protein levels. Of the 77 patients, 44 (57.1%) were diagnosed with active pulmonary tuberculosis, and the percentage of false negative results of the QFT-GIT was 36.4% (vs. 31.8% with TST). In the TB group with >65 years old (n=12), the proportions of the indeterminate (33.3% vs. 3.1%) and the false negative results (58.3% vs. 25.0%) of the QFT-GIT were significantly higher than in the younger TB group (n=32). CONCLUSION: Indeterminate and false negative results of QFT-GIT test were not infrequent in tuberculosis, especially in the elderly. Care should be considered for the interpretation with the elderly, immunocompromised, chronic and severely diseased patients.
Aged ; C-Reactive Protein ; CD4 Lymphocyte Count ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Interferon-gamma Release Tests ; Lymphopenia ; Prospective Studies ; Secondary Care ; Tuberculin Test ; Tuberculosis ; Tuberculosis, Pulmonary

Vocal cord dysfunction is characterized by the paradoxical adduction of the vocal cord during inspiration, causing relapsing wheezing or stridor, chest tightness, shortness of breath, and coughing. If the patient exhibiting symptoms of asthma is not responsive to treatment, there is a need to test whether vocal cord dysfunction is complicated by asthma. Herein, we report a case of vocal cord dysfunction with acute respiratory failure in old age with underlying disease. The patient presented with resting dyspnea, an audible wheeze, and was first diagnosed with acute exacerbation of bronchial asthma. However, her symptoms were not controlled with medical treatment and laryngoscopy showed paradoxical adduction of the vocal cords. Sudden cardiopulmonary arrest occurred after meal on the day of laryngoscopic examination. Although successful cardiopulmonary resuscitation, the patient developed ventilator-associated pneumonia, and multiple organ failure, eventually leading to death. Because the case was fatal, a report is being issued.
Asthma ; Cardiopulmonary Resuscitation ; Cough ; Dyspnea ; Heart Arrest ; Humans ; Laryngoscopy ; Meals ; Multiple Organ Failure ; Pneumonia, Ventilator-Associated ; Respiratory Insufficiency ; Respiratory Sounds ; Thorax ; Vocal Cords