Kosin Medical Journal

Original articles

A single-center analysis of guideline-directed medical therapy in patients with heart failure with mildly reduced or preserved ejection fraction according to current heart failure guidelines: Bong-Joon Kim, Suhyun Bae, Soo-Jin Kim, Sung-Il Im, Jung-Ho Heo; Kosin Med J. 2025;40(4):280-289. Published online December 26, 2025; DOI: https://doi.org/10.7180/kmj.25.124

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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.

Citations

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Bridging the gap between guidelines and real-world practice for heart failure with mildly reduced or preserved ejection fraction
Hidenori Yaku
Kosin Medical Journal.2025; 40(4): 239. CrossRef

Early effects of PCSK9 inhibitors: evolocumab versus alirocumab: Su-Hyun Bae, Bong-Joon Kim, Soo-Jin Kim, Sung-Il Im, Hyun-Su Kim, Jung-Ho Heo; Kosin Med J. 2025;40(1):49-54. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.24.145

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Background
The significance of risk modification in patients with acute coronary syndrome (ACS) is well recognized; however, the optimal timing for adminstering PCSK9 inhibitors remains unclear. Additionally, the lipid-lowering efficacy of evolocumab and alirocumab has not been fully established. This study evaluated the lipid-lowering effects of these two PCSK9 inhibitors.
Methods
Patients diagnosed with ACS, including unstable angina, ST-segment elevation myocardial infarction, and non-ST-segment elevation myocardial infarction, who were treated with a PCSK9 inhibitor (evolocumab or alirocumab) during hospitalization for ACS between 2021 and 2023 were retrospectively analyzed. Baseline low-density lipoprotein cholesterol (LDL-C) levels were assessed, and changes in LDL-C levels during the acute and subacute phases after PCSK9 inhibitor administration were compared between the evolocumab and alirocumab groups.
Results
Among 80 patients diagnosed with ACS, 36 received evolocumab, while 44 were treated with alirocumab. The mean baseline LDL-C level was 123 mg/dL in the evolocumab group and 128 mg/dL in the alirocumab group (p=0.456). In the subacute phase, the mean follow-up LDL-C levels were 47.05 mg/dL in the evolocumab group and 49.5 mg/dL in the alirocumab group (p=0.585). The mean percentage reduction in LDL-C levels during the subacute phase was 60.41% in the evolocumab group and 58.51% in the alirocumab group (p=0.431). These differences were not statistically significant.
Conclusions
No significant differences were observed between evolocumab and alirocumab. LDL-C levels exhibited a similar trend, characterized by a rapid decline in the acute phase, followed by a slight rebound in the subacute phase.

Citations

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Efficacy and safety of proprotein convertase subtilisin/kexin type 9 inhibitors for adults with familial hypercholesterolemia: A network meta-analysis
Weiwei Ding, Lingyao Sun, Yun Shi, Lei Tian
International Journal of Cardiology Cardiovascular Risk and Prevention.2026; 28: 200568. CrossRef

Review article

The role of the interatrial shunt device in the treatment of patients with heart failure with preserved ejection fraction: experience from the REDUCE LAP-HF studies: Bong-Joon Kim; Kosin Med J. 2025;40(2):88-95. Published online February 17, 2025; DOI: https://doi.org/10.7180/kmj.24.150

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Abstract PDF PubReader ePub: Heart failure with preserved ejection fraction (HFpEF) is characterized by increased left ventricular filling pressure and elevated left atrial pressure. Despite advances in medical treatments, the management of HFpEF patients is often challenging due to multiple comorbidities, leading to polypharmacy and associated side effects. Consequently, there is an increasing demand for procedural or device-based therapies in HFpEF management. Over the past decade, the transcatheter interatrial shunt device (IASD), designed to create a passage between the left atrium and the right atrium, has emerged as a novel therapeutic option. The IASD offers potential benefits by reducing left atrial pressure at rest and during exercise. The efficacy and safety of the IASD were demonstrated in the REDUCE LAP-HF (Reduce Left Atrial Pressure in Patients with Heart Failure) study series. Furthermore, IASD has been shown to support positive cardiac remodeling. With the availability of more data, appropriate indications for the use of IASDs are becoming more evident, and criteria for patient selection in future studies are needed.

Case report

Disseminated Staphylococcus aureus infection and acute bacterial pericarditis: a case report: Su Hyun Bae, Song-Hyun Lee, Joon-Young Choi, Bong-Joon Kim, Soo-Jin Kim, Sung-Il Im, Hyun-Su Kim, Jung-Ho Heo; Kosin Med J. 2023;38(2):134-137. Published online August 16, 2022; DOI: https://doi.org/10.7180/kmj.22.021

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We experienced a case of disseminated Staphylococcus aureus infection with bacterial pericarditis that progressed to septic shock and multiorgan failure despite pericardiocentesis and surgical removal of the original abscess with intensive antibiotic therapy. We report this case because of the patient’s very rare and remarkable echocardiographic findings and highly turbid pericardial effusion.

Citations

Citations to this article as recorded by

Case Report: Acute methicillin-sensitive Staphylococcus aureus pericarditis in a diabetic patient
Daniel J. Lim, Richard Lu, Edwin C. Y. Sng, Felix M. Uy, Wei L. Huang, Siang C. Chai, Anthony Yii, Ing X. Soo, Jenn N. Khoo, X. Ruan
Frontiers in Cardiovascular Medicine.2025;[Epub] CrossRef

Review article

Role of biomarkers in the heart failure clinic: Bong-Joon Kim, Jae-Hyeong Park; Kosin Med J. 2022;37(1):4-17. Published online March 29, 2022; DOI: https://doi.org/10.7180/kmj.22.019

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Heart failure (HF) is a common cardiovascular disease that has a complex pathophysiology. Because it is the final stage of many cardiovascular diseases, proper diagnosis and treatment are crucial for prolonging patients’ survival and improving their well-being. Several biomarkers have been identified in HF, and their roles in diagnosis and prognostication have been widely investigated. Among them, natriuretic peptides are key for diagnosing HF, predicting its prognosis, and monitoring the effectiveness of HF treatment. Moreover, natriuretic peptides can also be used to treat HF. In addition to natriuretic peptides, several other biomarkers were included in the most recent HF management guidelines. Thus, we reviewed the role of the biomarkers included in these guidelines and discussed future perspectives.

Citations

Citations to this article as recorded by

Impact of Pharmacotherapy Optimization on Health-related Quality of Life in a Long-term Follow-up Program for Patients with Heart Failure
Rasa Paleckiene, Diana Zaliaduonyte, Jurate Macijauskiene
Open Medicine Journal.2025;[Epub] CrossRef
The role of the interatrial shunt device in the treatment of patients with heart failure with preserved ejection fraction: experience from the REDUCE LAP-HF studies
Bong-Joon Kim
Kosin Medical Journal.2025; 40(2): 88. CrossRef

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