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1.
Ther Adv Cardiovasc Dis ; 14: 1753944719895902, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31918629

RESUMEN

Acute right heart failure is associated with impaired prognosis in cardiogenic shock. Since most pharmacological therapies are not evaluated for the failing right ventricle, or even contraindicated, there is a need for rapid minimal invasive circulatory right heart support. The PERKAT RV is such a device for acute therapy in congestive heart failure. It reduces the central venous pooling by pumping blood from the inferior vena cava into the pulmonary artery with flow rates of up to 4 litres/min. The device was evaluated in an animal model of acute pulmonary embolism after careful in vitro tests. PERKAT RV increased cardiac output by 59% in sheep suffering from acute right heart failure. We await the first human implantation in the near future. Based on the PERKAT concept, future devolvement will also focus on left heart support.


Asunto(s)
Insuficiencia Cardíaca/terapia , Corazón Auxiliar , Flujo Pulsátil , Disfunción Ventricular Derecha/terapia , Función Ventricular Derecha , Animales , Modelos Animales de Enfermedad , Insuficiencia Cardíaca/fisiopatología , Humanos , Diseño de Prótesis , Oveja Doméstica , Disfunción Ventricular Derecha/fisiopatología
2.
Isr Med Assoc J ; 22(1): 8-12, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927798

RESUMEN

BACKGROUND: Heart failure centers with specialized nurse-supervised management programs have been proposed to improve prognosis. The Heart Failure Center in Beit Shemesh, Israel, is located within a large primary care facility. The specialist team supervised the managememt of patients both within the frame of the center and while they were hospitalized. OBJECTIVES: To evaluate the health services utilization by heart failure patients treated at a heart failure center and their clinical outcome. METHODS: In this retrospective study, we compared the clinical outcome of patients treated at a heart failure center to patients who received the standard care in 2013-2014. The clinical outcome included primary care visits, emergency room visits, hospitalizations, and death. RESULTS: The study comprised 430 heart failure patients; 82 were treated at the heart failure center and 348 under standard care. At baseline, no significant differences were seen in clinical parameters between the groups. Healthcare utilization was higher among the study group. No significant changes in healthcare utilization were found. During follow-up, patients treated in a heart failure center were more likely to get recommended heart failure medications. Mortality was significantly lower in patients treated in the heart failure center compared with those receiving standard care 3.6% vs. 24%, respectively (P = 0.001), hazard ratio 0.19, 95% confidence interval 0.06-0.62, P = 0.005. CONCLUSIONS: Joint management of heart failure by primary clinics and a specialized community heart failure center reduced mortality. There was no decrease in healthcare utilizations among heart failure center patients, despite the reduction in mortality.


Asunto(s)
Centros Comunitarios de Salud/estadística & datos numéricos , Insuficiencia Cardíaca/terapia , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos
3.
Rev Med Suisse ; 16(678): 113-116, 2020 Jan 22.
Artículo en Francés | MEDLINE | ID: mdl-31967752

RESUMEN

This selective overview of articles describes new concepts, therapeutic measures and pharmacological agents that may modify current practice in internal medicine. Implications for management of cardiovascular disease, such as heart failure, diabetes and infectious diseases figure prominently.


Asunto(s)
Enfermedades Cardiovasculares , Insuficiencia Cardíaca , Medicina Interna , Enfermedades Cardiovasculares/terapia , Insuficiencia Cardíaca/terapia , Humanos , Medicina Interna/tendencias
4.
BMJ ; 368: l6831, 2020 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-31941686

RESUMEN

OBJECTIVES: To determine whether patients discharged after hospital admissions for conditions covered by national readmission programs who received care in emergency departments or observation units but were not readmitted within 30 days had an increased risk of death and to evaluate temporal trends in post-discharge acute care utilization in inpatient units, emergency departments, and observation units for these patients. DESIGN: Retrospective cohort study. SETTING: Medicare claims data for 2008-16 in the United States. PARTICIPANTS: Patients aged 65 or older admitted to hospital with heart failure, acute myocardial infarction, or pneumonia-conditions included in the US Hospital Readmissions Reduction Program. MAIN OUTCOME MEASURES: Post-discharge 30 day mortality according to patients' 30 day acute care utilization; acute care utilization in inpatient and observation units and the emergency department during the 30 day and 31-90 day post-discharge period. RESULTS: 3 772 924 hospital admissions for heart failure, 1 570 113 for acute myocardial infarction, and 3 131 162 for pneumonia occurred. The overall post-discharge 30 day mortality was 8.7% for heart failure, 7.3% for acute myocardial infarction, and 8.4% for pneumonia. Risk adjusted mortality increased annually by 0.05% (95% confidence interval 0.02% to 0.08%) for heart failure, decreased by 0.06% (-0.09% to -0.04%) for acute myocardial infarction, and did not significantly change for pneumonia. Specifically, mortality increased for patients with heart failure who did not utilize any post-discharge acute care, increasing at a rate of 0.08% (0.05% to 0.12%) per year, exceeding the overall absolute annual increase in post-discharge mortality in heart failure, without an increase in mortality in observation units or the emergency department. Concurrent with a reduction in 30 day readmission rates, stays for observation and visits to the emergency department increased across all three conditions during and beyond the 30 day post-discharge period. Overall 30 day post-acute care utilization did not change significantly. CONCLUSIONS: The only condition with increasing mortality through the study period was heart failure; the increase preceded the policy and was not present among patients who received emergency department or observation unit care without admission to hospital. During this period, the overall acute care utilization in the 30 days after discharge significantly decreased for heart failure and pneumonia, but not for acute myocardial infarction.


Asunto(s)
Unidades de Observación Clínica/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Insuficiencia Cardíaca , Infarto del Miocardio , Neumonía , Atención Subaguda , Anciano , Anciano de 80 o más Años , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Humanos , Revisión de Utilización de Seguros , Masculino , Uso Excesivo de los Servicios de Salud/prevención & control , Medicare/estadística & datos numéricos , Mortalidad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/terapia , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Neumonía/mortalidad , Neumonía/terapia , Estudios Retrospectivos , Atención Subaguda/métodos , Atención Subaguda/organización & administración , Atención Subaguda/tendencias , Estados Unidos/epidemiología
5.
Rev Esp Cardiol (Engl Ed) ; 73(1): 69-77, 2020 Jan.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31761573

RESUMEN

Heart failure is a complex entity, with high morbidity and mortality. The clinical course and outcome are uncertain and difficult to predict. This document, instigated by the Heart Failure and Geriatric Cardiology Working Groups of the Spanish Society of Cardiology, addresses various aspects related to palliative care, where most cardiovascular disease will eventually converge. The document also establishes a consensus and a series of recommendations with the aim of recognizing and understanding the need to implement and progressively apply palliative care throughout the course of the disease, not only in the advanced stages, thus improving the care provided and quality of life. The purpose is to improve and adapt treatment to the needs and wishes of each patient, who must have adequate information and participate in decision-making.


Asunto(s)
Cardiología , Consenso , Insuficiencia Cardíaca/terapia , Cuidados Paliativos/normas , Sociedades Médicas , Anciano , Toma de Decisiones , Humanos , España
6.
Rev Esp Cardiol (Engl Ed) ; 73(1): 78-83, 2020 Jan.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31611151

RESUMEN

Heart failure (HF) is a progressive condition with high mortality and heavy symptom burden. Despite guideline recommendations, cardiologists refer to palliative care at rates much lower than other specialties and very late in the course of the disease, often in the final 3 days of life. One reason for delayed referral is that prognostication is challenging in patients with HF, making it unclear when and how the limited resources of specialist palliative care will be most beneficial. It might be more prudent to consider palliative care referrals at critical moments in the trajectory of patients with HF. These include: a) the development of poor prognostic signs in the outpatient setting; b) hospitalization or intensive care unit admission, and c) at the time of evaluation for certain procedures, such as left ventricular assist device placement and ablation for refractory ventricular arrhythmias, among others. In this review, we also summarize the results of clinical trials evaluating palliative interventions in these settings.


Asunto(s)
Insuficiencia Cardíaca/terapia , Cuidados Paliativos/métodos , Guías de Práctica Clínica como Asunto , Derivación y Consulta/normas , Humanos
7.
Heart Fail Clin ; 16(1): 81-97, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735318

RESUMEN

Abnormal fluid handling leads to physiologic abnormalities in multiple organ systems. Deranged hemodynamics, neurohormonal activation, excessive tubular sodium reabsorption, inflammation, oxidative stress, and nephrotoxic medications are important drivers of harmful cardiorenal interactions in patients with heart failure. Accurate quantitative measurement of fluid volume is vital to individualizing therapy for such patients. Blood volume analysis and pulmonary artery pressure monitoring seem the most reliable methods for assessing fluid volume and guiding decongestive therapies. Still the cornerstone of decongestive therapy, diuretics' effectiveness decreases with progression of heart failure. Extracorporeal ultrafiltration, an alternative to diuretics, has been shown to reduce heart-failure events.


Asunto(s)
Síndrome Cardiorrenal/etiología , Diuréticos/uso terapéutico , Insuficiencia Cardíaca/complicaciones , Hemodinámica/fisiología , Ultrafiltración/métodos , Síndrome Cardiorrenal/terapia , Progresión de la Enfermedad , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos
8.
Nat Rev Cardiol ; 17(1): 22-36, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31249403

RESUMEN

Conventional right ventricular (RV) pacing, particularly RV apical pacing, can have deleterious effects on cardiac function. Long-term RV apical pacing has been associated with increased risk of atrial fibrillation, hospitalization for heart failure, pacing-induced cardiomyopathy and associated death. His bundle pacing (HBP) results in physiological ventricular activation and has generated tremendous research interest and enthusiasm. By stimulating the His-Purkinje network directly, HBP results in synchronized ventricular activation, which might translate into improved clinical outcomes compared with dyssynchronous ventricular activation with RV apical pacing. HBP can also overcome bundle branch block patterns, and data are accumulating on the benefit of HBP for cardiac resynchronization therapy. In this Review, we summarize the anatomy of the His bundle and early clinical observations, implantation techniques and available outcome data associated with permanent HBP. We also highlight the challenges with HBP and the need for additional tools and more randomized data before widespread application of permanent HBP.


Asunto(s)
Arritmias Cardíacas/terapia , Fascículo Atrioventricular/fisiopatología , Estimulación Cardíaca Artificial/tendencias , Insuficiencia Cardíaca/terapia , Potenciales de Acción , Animales , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/fisiopatología , Estimulación Cardíaca Artificial/efectos adversos , Estimulación Cardíaca Artificial/mortalidad , Difusión de Innovaciones , Predicción , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Frecuencia Cardíaca , Humanos , Factores de Riesgo , Resultado del Tratamiento
10.
Kardiologiia ; 59(11S): 36-43, 2019 Sep 12.
Artículo en Ruso | MEDLINE | ID: mdl-31884939

RESUMEN

PURPOSE: To assess the quality of life (QoL) changes in patients with congestive heart failure (CHF) one year after cardiac resynchronization therapy (CRT). METHODS: The study included 82 patients (68 males and 14 females) aged from 30 to 74 (mean age 55.8±9.2 years) who underwent implantation of a biventricular cardiac pacemaker for CRT. Depending on the echocardiographic response to CPT, the patients were divided into two groups: 56 people with a positive response (responders) and 26 people with insufficient response (non-responders). The SF-36 questionnaire was used to measure QoL. The results of the questionnaire were represented as scores over the eight subscales: physical functioning (PF), role-physical functioning (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE), and mental health perceptions (MH). The QoL assessment was performed before and one year after CRT. RESULTS: Patients with CHF one year following CRT had significantly higher rates of improvement in PF QoL (before CRT 46.28±26.16; one year after CRT 53.05±27.65, p=0.023). The statistical tendency towards QoL improvement was revealed: VT QoL (before CRT 47.07±20.12, after CRT 51.83±20.07, p=0.081), SF (before СРТ 61.58±25.06, after CRT 67.07±24.57, p=0.088). Group of responders one year after CRT had significantly higher rates of improvement of QoL in PF (45.2±26.0 before CRT vs 57.1±26.4 after CRT, p=0.001); in VT (46.5±20.8 vs 54.4±19.7, p=0.010) and in SF (60.9±26.4 vs 70.8±20.8, p=0.012). The statistical tendency towards QoL improvement was revealed in BP (57.5±25.1 before CRT vs 64.8±23.8 after CRT, p=0.079), in GH (45.3±16.4 vs 49.1±18.0, p=0.079) and in MH (57.7±18.9 vs 62.5±17.7, p=0.081). In the group of nonresponders the statistical tendency towards decrease in QoL was detected during one year after CRT in RE (46.2±45.3 before CRT vs 26.9±41.1 after CRT, p=0.07). No significant differences were found in paired comparisons of other QoL indicators. CONCLUSION: We revealed significant increase in PF index in patients with CHF one year following CRT. The study showed that QoL was generally improving one year following CRT in responders while a tendency towards decrease in RE was detected in non-responders.


Asunto(s)
Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca , Adulto , Anciano , Ecocardiografía , Femenino , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Encuestas y Cuestionarios , Resultado del Tratamiento
11.
Rev Med Chil ; 147(6): 787-789, 2019 Jun.
Artículo en Español | MEDLINE | ID: mdl-31859832

RESUMEN

Heart failure is one of the first diseases in which stem cells were used for regenerative medicine. Since 2001, many publications have shown that stem cell therapy has the potential to mitigate heart diseases, but there is no solid scientific evidence to fully support its clinical application at present. The future of regenerative medicine requires validated clinical trials with standardized platforms and transdisciplinary efforts to enable the development of safe and effective regenerative therapies to protect patients and to promote the ethical application of this new and highly promising therapy. Doctors and scientists have a responsibility to discuss with patients the current reality of regenerative therapies. They also have a responsibility to discourage the indiscriminate and commercial use of these therapies, which are sometimes based on false hopes, since their inappropriate use can harm vulnerable patients as well as research efforts. Although regenerative medicine may be the medicine of the future and might bring the hope of cure for chronic diseases, it is not yet ready for its wide clinical application.


Asunto(s)
Insuficiencia Cardíaca/terapia , Trasplante de Células Madre/ética , Humanos , Medicina Regenerativa/ética , Medicina Regenerativa/tendencias , Trasplante de Células Madre/tendencias
12.
Soins ; 64(841): 12-17, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31864504

RESUMEN

Heart failure is a chronic pathology resulting in repeated hospitalisations and has a significant impact on the patient's quality of life. Therapeutic patient education (TPE) forms part of patients' global care to improve their health status. A study was carried out at Bégin military teaching hospital of hospitalised patients with heart failure to identify their educational needs and create a TPE programme which best meets their expectations.


Asunto(s)
Insuficiencia Cardíaca/terapia , Evaluación de Necesidades , Educación del Paciente como Asunto , Humanos
13.
Tex Heart Inst J ; 46(3): 199-202, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31708703

RESUMEN

Substantial technological advances in mechanical circulatory support have caused a shift in the management of end-stage heart failure. From the 1970s through the 1990s, heterotopic heart transplantation was routinely performed in patients in whom orthotopic transplantation was likely to fail. Heterotopic heart transplantation is now performed less often because modern mechanical circulatory assist devices are routinely used as bridges to orthotopic transplantation; regardless, the operation has helped numerous patients who would not otherwise have received adequate allografts. We describe the case of a man with idiopathic nonischemic cardiomyopathy who, at age 17, was given an ABO- and size-matched heterotopic allograft that was a complete human leukocyte antigen mismatch. The graft functioned normally for 20 years until the patient had a myocardial infarction that necessitated placement of a coronary artery stent. Subsequent treatments involved many interventions, including insertion of an intra-aortic balloon pump, medical therapy for heart failure, implantation of a total artificial heart, and, ultimately, orthotopic transplantation. To our knowledge, our patient is the longest surviving recipient of a heterotopic heart transplant, with a remarkable 25-year graft survival despite poor histocompatibility and an almost complete lack of native heart function. The strategies used for his treatment make him a living case study that can add valuable information to the history of cardiac support.


Asunto(s)
Insuficiencia Cardíaca/terapia , Trasplante de Corazón/métodos , Corazón Auxiliar , Contrapulsador Intraaórtico/métodos , Adolescente , Estudios de Seguimiento , Supervivencia de Injerto , Insuficiencia Cardíaca/diagnóstico , Humanos , Masculino , Factores de Tiempo , Tomografía Computarizada por Rayos X , Trasplante Heterotópico
14.
Pan Afr Med J ; 33: 251, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31692700

RESUMEN

Introduction: Acute Heart Failure (AHF) is a specific syndromic disorder grouping several heterogeneous clinical conditions frequently seen in the emergency department. This study aimed to describe the epidemiological, clinical, therapeutic and prognostic features of patients with AHF admitted to the emergency department. Methods: We conducted a prospective, descriptive study in the emergency department. It included all patients admitted with AHF. We studied the epidemiological, clinical, therapeutic and prognostic features of these patients. Results: The study enrolled 180 patients with AHF admitted to the emergency department. Sex ratio was 1.27. The average age of patients was 66±12 years. Eighty-two percent of patients were hypertensive and 69% were known diabetic patients. The causes of decompensation included primarily hypertensive crisis (61.7% of patients), acute coronary syndrome (24% of patients). Respiratory support was mainly provided by CPAP (Continuous Positive Airway Pressure) in 73.3% of cases. Pharmacological treatment was based on nitrate derivatives (70% of cases) and diuretic (40.5% of cases). Acute heart failure incidence at one month was 21.7% (n=39 patients) and mortality rate at 3 months was 13.3%. Conclusion: Patients with AHF treated in the emergency department mainly had hypertensive crisis. Treatment is primarily based on CPAP, vasodilators and diuretics. Recurrence rate and mortality rate were high.


Asunto(s)
Síndrome Coronario Agudo/complicaciones , Presión de las Vías Aéreas Positiva Contínua/métodos , Insuficiencia Cardíaca/epidemiología , Hipertensión/complicaciones , Síndrome Coronario Agudo/epidemiología , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Diuréticos/administración & dosificación , Servicio de Urgencia en Hospital , Femenino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Nitratos/administración & dosificación , Pronóstico , Estudios Prospectivos , Recurrencia , Túnez , Adulto Joven
15.
Int Heart J ; 60(6): 1293-1302, 2019 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-31735786

RESUMEN

The effects of disease management using telemonitoring for patients with heart failure (HF) remain controversial. Hence, we embedded care coordination and enhanced collaborative self-management through interactive communication via a telemonitoring system (collaborative management; CM). This study evaluated whether CM improved psychosocial status and prevented rehospitalization in patients with HF in comparison with self-management education (SM), and usual care (UC).We randomly allocated 59 patients into 3 groups; UC (n = 19), SM (n = 20), and CM (n = 20). The UC group received one patient education session, and the SM and CM groups participated in disease management programs for 12 months. The CM group received telemonitoring concurrently. All groups were followed up for another 12 months. Data were collected at baseline and at 6, 12, 18, and 24 months.The primary endpoint was quality of life (QOL). Secondary endpoints included self-efficacy, self-care, and incidence of rehospitalization. The QOL score improved in CM compared to UC at 18 and 24 months (P < 0.05). There were no significant differences among the 3 groups in self-efficacy and self-care. However, compared within each group, only the CM had significant changes in self-efficacy and in self-care (P < 0.01). Rehospitalization rates were high in the UC (11/19; 57.9%) compared with the SM (5/20; 27.8%) and CM groups (4/20; 20.0%). The readmission-free survival rate differed significantly between the CM and UC groups (P = 0.020).We conclude that CM has the potential to improve psychosocial status in patients with HF and prevent rehospitalization due to HF.


Asunto(s)
Insuficiencia Cardíaca/terapia , Hospitalización , Pautas de la Práctica en Enfermería , Calidad de Vida , Autocuidado , Telemedicina , Anciano , Anciano de 80 o más Años , Femenino , Conductas Relacionadas con la Salud , Insuficiencia Cardíaca/psicología , Humanos , Japón , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Proyectos Piloto , Autoeficacia
16.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(11): 865-874, 2019 Nov 24.
Artículo en Chino | MEDLINE | ID: mdl-31744275

RESUMEN

Objective: To observe the etiology, comorbidities, clinical features and treatment patterns of hospitalized patients with heart failure (HF) in China. Methods: Data were collected prospectively on hospitalized patients with HF who were enrolled in China Heart Failure Center Registry Study from 169 participating hospitals from January 2017 to August 2018. In this cross-sectional study, patients were stratified by left ventricular ejection fraction (LVEF) category: heart failure with reduced ejection fraction (HFrEF, LVEF<40%); heart failure with mid-ranged ejection fraction (HFmrEF, 40%≤LVEF<50%) and heart failure with preserved ejection fraction (HFpEF, LVEF≥50%). The clinical data were collected, including demographic information, diagnosis, signs, electrocardiogram, echocardiography, laboratory tests, and treatment. Results: A total of 31 356 hospitalized patients with HF were included, 19 072 (60.8%) were males and the average age was (67.9±13.6) years old. The common causes of HF were hypertension (57.2%), coronary heart disease (54.6%), dilated cardiomyopathy (14.7%), valvular heart disease (9.2%). The common complications were atrial fibrillation/atrial flutter (34.1%), diabetes (29.2%), and anemia (26.7%). 32.8% of patients had a history of hospitalization for HF within the previous 12 months. There were 11 034 (35.2%) patients with HFrEF, 6 825 (21.8%) patients with HFmrEF and 13 497 (43.0%) patients with HFpEF. Compared with patients with HFpEF, patients with HFrEF had a lower systolic blood pressure ((124.7±21.1)mmHg(1 mmHg=0.133 kPa) vs. (134.9±22.9)mmHg), faster heart rate ((85±19) beats/minutes vs. (81±19)beats/minutes), and higher percentage of New York Heart Association (NYHA) class Ⅳ, smoking, alcohol, left bundle branch block, and QRS time≥130 ms, and higher levels of blood uric acid, BNP, and NT-proBNP (all P<0.05). Compared with patients with HFmrEF and HFrEF, patients with HFpEF were older, more women, and higher comorbidity burden including hypertension, atrial fibrillation/atrial flutter, anemia and chronic obstructive pulmonary disease (all P<0.05). HFmrEF took a mid-position between HFrEF and HFpEF in age, gender, heart rate, systolic blood pressure, hypertension, atrial fibrillation/atrial flutter, anemia, and chronic obstructive pulmonary disease (all P<0.05). Patients with HFmrEF had the highest proportion of coronary heart disease, myocardial infarction and percutaneous coronary intervention (all P<0.05). During hospitalization, loop diuretics were used in 90.2% of patients, and intravenous inotropics were used in 20.4% of patients. The use of ACEI/ARB/ARNI, ß blockers and aldosterone receptor antagonists at discharge were 71.8%, 79.1% and 83.6% in HFrEF and 69.9%, 75.5% and 72.4% in HFmrEF, respectively. The use of digoxin at discharge was 25.3% (HFrEF 36.7%, HFmrEF 23.1%, HFpEF 17.0%). The rates of cardiac resynchronization therapy and implantable cardioverter defibrillator in HFrEF were 2.7% and 2.1%. Conclusions: Among the hospitalized patients with HF in China, coronary heart disease and hypertension are the mostly prevalent causes. HFpEF accounts for a large proportion of hospitalized patients with HF. HFrEF, HFmrEF and HFpEF have different etiology and clinical features. In real-world, there are still large gaps in the effective application of the guideline recommended therapies to HF patients, especially the non-pharmacological therapy option, which needs to be improved further in China.


Asunto(s)
Insuficiencia Cardíaca , Anciano , Anciano de 80 o más Años , China/epidemiología , Estudios Transversales , Femenino , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Volumen Sistólico
17.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 27(Special Issue): 643-652, 2019 Aug.
Artículo en Ruso | MEDLINE | ID: mdl-31747157

RESUMEN

The article deals with methods of treating patients with bradyarrhythmias, life-threatening tachyarrhythmias and chronic heart failure with the use of implantable antiarrhythmic devices permanent pacemakers, cardioverter defibrillators, and cardio-resynchronizing systems. Methods of instrumental and electrocardiographic diagnosis acceptable for such patients are described. The work defines management approaches to these patients in the postoperative and subsequent periods of life.


Asunto(s)
Desfibriladores Implantables , Insuficiencia Cardíaca , Marcapaso Artificial , Taquicardia , Cardioversión Eléctrica , Electrocardiografía , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Humanos , Taquicardia/diagnóstico , Taquicardia/terapia
20.
Expert Rev Med Devices ; 16(10): 891-898, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31584302

RESUMEN

Introduction: Chronic heart failure is characterized by reduced exercise capacity. Invasive exercise hemodynamics are not routinely performed unless patients undergo transplant or left ventricular assist devices (LVAD) assessment, though now with readily available noninvasive devices, exercise hemodynamics are easily obtained. Our contention is that this is a valuable opportunity to acquire a more accurate measure of cardiac status in heart failure. Exercise hemodynamic measures such as cardiac power output can be carried out cheaply and effectively. Recent studies have highlighted the added value of exercise hemodynamics in prognostication of heart failure, and their role in assessing myocardial recovery in LVADs. Areas covered: In this review, we explore the literature available on Medline until 2019 focusing on resting and exercise hemodynamics alongside the methods of assessment (invasive and noninvasive) in heart failure with reduced ejection fraction and patients with implanted LVADs. Expert opinion: Hemodynamics measured both at rest and exercise are expected to play a significant role in the work up of transplant and LVAD patients. Furthermore, there is the potential to utilize noninvasive assessment in a complimentary fashion to support patient selection and improve the monitoring of response to treatment across the full cohort of heart failure patients.


Asunto(s)
Ejercicio/fisiología , Insuficiencia Cardíaca/fisiopatología , Corazón Auxiliar , Hemodinámica/fisiología , Enfermedad Crónica , Insuficiencia Cardíaca/terapia , Humanos
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