Asunto(s)
Bloqueo Atrioventricular/diagnóstico , Bloqueo Atrioventricular/prevención & control , Terapia de Resincronización Cardíaca/métodos , Errores Diagnósticos/prevención & control , Electrocardiografía/métodos , Terapia Asistida por Computador/métodos , Dispositivos de Terapia de Resincronización Cardíaca , Diagnóstico por Computador/métodos , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Heart failure (HF) is responsible for an immense burden on our healthcare system. The prevalence of this disease continues to increase as a result of an aging population, successful treatment of acute coronary syndrome, and the use of new pharmacotherapies. Although pharmacotherapy with angiotensin converting enzyme inhibitors and beta-blockers shows improvement in morbidity and mortality, the overall prognosis of these patients remains poor. Cardiac transplant has limited applicability. Conduction disturbances are frequent in patients with advanced heart failure and may cause worsening systolic function and ventricular dyssynchrony. Biventricular pacing to achieve cardiac resynchronization is a recent and promising therapy for HF patients with an intraventricular conduction defect. Randomized clinical trials have substantiated that cardiac resynchronization therapy (CRT) through biventricular pacing offers significant benefit in morbidity and mortality in a select group of HF patients. Because of the high incidence of sudden cardiac death in patients with severe HF, the combination biventricular pacing with implantable cardioverter defibrillator therapy will provide additional benefit. This article provides an overview of CRT with the intent of describing ventricular dyssynchrony, the benefits of CRT, and the implications for advanced practice nurses.
Asunto(s)
Arritmias Cardíacas/terapia , Estimulación Cardíaca Artificial/métodos , Muerte Súbita Cardíaca/prevención & control , Insuficiencia Cardíaca/complicaciones , Arritmias Cardíacas/etiología , Muerte Súbita Cardíaca/etiología , Desfibriladores Implantables , Insuficiencia Cardíaca/fisiopatología , HumanosRESUMEN
Patient surveys are commonly distributed at the end of a multicenter clinical trial. This Antiarrhythmics Versus Implantable Defibrillators (AVID) substudy prospectively explored the relationship between methods used in distributing a survey and the quantity of responses received. AVID was a multicenter, randomized trial comparing survival in arrhythmia patients treated with antiarrhythmic drugs versus implantable defibrillators. At study termination, a patient satisfaction survey was mailed to the 664 surviving participants. Questions included reasons for study participation, study benefits and problems and quality of care. Survey mailings were stratified by four factors in a 2x2x2x2 factorial design: delivery mode (overnight vs. regular mail), certificate of appreciation, timing of administration ("early" vs. "late") and cover letter signed by a physician versus coordinator. Patients were randomly assigned to received one of 16 combinations of these four factors. Clinical characteristics and response rates were evaluated. Patients were more likely to return surveys delivered by overnight mail (75% vs. 68%, p=0.04), with no certificate of appreciation enclosed (75% vs. 68%, p=0.05) and administered close to the time of study closeout (79% vs. 72%, p=0.085). Compared to the 184 nonrespondents, the 456 (71%) respondents were older, Caucasian, lived with others, were high school graduates and less likely to have Medicare/Medicaid or HMO insurance (p<0.03). Physician recommendation was the most common reason cited for trial participation. Main benefits included increased knowledge of their medical condition and improved health. Reported problems included parking, transportation and excess clinic wait time. This randomized study demonstrated that methods of patient survey distribution affect the survey return rate. Additional studies should explore mechanisms for maximizing return rates.