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2.
Sensors (Basel) ; 21(3)2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-33525556

RESUMEN

Heart failure (HF) is a major health care issue, and the incidence of HF is only expected to grow further. Due to the frequent hospitalizations, HF places a major burden on the available hospital and healthcare resources. In the future, HF care should not only be organized solely at the clinical ward and outpatient clinics, but remote monitoring strategies are urgently needed to guide, monitor, and treat chronic HF patients remotely from their homes as well. The intuitiveness and relatively low costs of non-invasive remote monitoring tools make them an appealing and emerging concept for developing new medical apps and devices. The recent COVID-19 pandemic and the associated transition of patient care outside the hospital will boost the development of remote monitoring tools, and many strategies will be reinvented with modern tools. However, it is important to look carefully at the inconsistencies that have been reported in non-invasive remote monitoring effectiveness. With this review, we provide an up-to-date overview of the available evidence on non-invasive remote monitoring in chronic HF patients and provide future perspectives that may significantly benefit the broader group of HF patients.


Asunto(s)
Continuidad de la Atención al Paciente/tendencias , Insuficiencia Cardíaca/terapia , Monitoreo Fisiológico/métodos , Telemedicina/tendencias , Insuficiencia Cardíaca/diagnóstico , Humanos , Pandemias , Telemetría , Teleenfermería
5.
JAMA ; 325(6): 542-551, 2021 02 09.
Artículo en Inglés | MEDLINE | ID: mdl-33560320

RESUMEN

Importance: Endurance exercise is effective in improving peak oxygen consumption (peak V̇o2) in patients with heart failure with preserved ejection fraction (HFpEF). However, it remains unknown whether differing modes of exercise have different effects. Objective: To determine whether high-intensity interval training, moderate continuous training, and guideline-based advice on physical activity have different effects on change in peak V̇o2 in patients with HFpEF. Design, Setting, and Participants: Randomized clinical trial at 5 sites (Berlin, Leipzig, and Munich, Germany; Antwerp, Belgium; and Trondheim, Norway) from July 2014 to September 2018. From 532 screened patients, 180 sedentary patients with chronic, stable HFpEF were enrolled. Outcomes were analyzed by core laboratories blinded to treatment groups; however, the patients and staff conducting the evaluations were not blinded. Interventions: Patients were randomly assigned (1:1:1; n = 60 per group) to high-intensity interval training (3 × 38 minutes/week), moderate continuous training (5 × 40 minutes/week), or guideline control (1-time advice on physical activity according to guidelines) for 12 months (3 months in clinic followed by 9 months telemedically supervised home-based exercise). Main Outcomes and Measures: Primary end point was change in peak V̇o2 after 3 months, with the minimal clinically important difference set at 2.5 mL/kg/min. Secondary end points included changes in metrics of cardiorespiratory fitness, diastolic function, and natriuretic peptides after 3 and 12 months. Results: Among 180 patients who were randomized (mean age, 70 years; 120 women [67%]), 166 (92%) and 154 (86%) completed evaluation at 3 and 12 months, respectively. Change in peak V̇o2 over 3 months for high-intensity interval training vs guideline control was 1.1 vs -0.6 mL/kg/min (difference, 1.5 [95% CI, 0.4 to 2.7]); for moderate continuous training vs guideline control, 1.6 vs -0.6 mL/kg/min (difference, 2.0 [95% CI, 0.9 to 3.1]); and for high-intensity interval training vs moderate continuous training, 1.1 vs 1.6 mL/kg/min (difference, -0.4 [95% CI, -1.4 to 0.6]). No comparisons were statistically significant after 12 months. There were no significant changes in diastolic function or natriuretic peptides. Acute coronary syndrome was recorded in 4 high-intensity interval training patients (7%), 3 moderate continuous training patients (5%), and 5 guideline control patients (8%). Conclusions and Relevance: Among patients with HFpEF, there was no statistically significant difference in change in peak V̇o2 at 3 months between those assigned to high-intensity interval vs moderate continuous training, and neither group met the prespecified minimal clinically important difference compared with the guideline control. These findings do not support either high-intensity interval training or moderate continuous training compared with guideline-based physical activity for patients with HFpEF. Trial Registration: ClinicalTrials.gov Identifier: NCT02078947.


Asunto(s)
Terapia por Ejercicio/métodos , Ejercicio Físico , Insuficiencia Cardíaca/metabolismo , Entrenamiento de Intervalos de Alta Intensidad , Consumo de Oxígeno , Anciano , Medicina Basada en la Evidencia , Tolerancia al Ejercicio , Femenino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Volumen Sistólico
6.
Rev Med Liege ; 76(1): 23-30, 2021 Jan.
Artículo en Francés | MEDLINE | ID: mdl-33443325

RESUMEN

Even though, it has long been considered as a passive channel allowing communication between the systemic and pulmonary circulations, it is now clearly established that the right ventricle plays an essential role in cardio-pulmonary couple physiology. Its failure results in a clinical presentation that reflects the systemic congestion and reduced cardiac output. It is the consequence of two pathological situations frequently encountered in intensive care including pulmonary vascular resistance increase and right ventricle contraction alteration. Mechanical ventilation, certain drugs and volume overload can also participate. The management of the acute right heart failure is based on the combination of supportive treatment and causal treatment, specific to the etiology. Supportive therapy aims to optimize filling pressures, reduce afterload and support cardiac contractibility. With the growing number of therapeutic options used according to co-morbidities, decision-making by a multidisciplinary heart team seems essential.


Asunto(s)
Insuficiencia Cardíaca , Disfunción Ventricular Derecha , Cuidados Críticos , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Ventrículos Cardíacos , Humanos , Respiración Artificial , Disfunción Ventricular Derecha/etiología , Disfunción Ventricular Derecha/terapia
7.
Heart ; 107(5): 366-372, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33431425

RESUMEN

The incidence of heart failure (HF) remains high and patients with HF are at risk for frequent hospitalisations. Remote monitoring technologies may provide early indications of HF decompensation and potentially allow for optimisation of therapy to prevent HF hospitalisations. The need for reliable remote monitoring technology has never been greater as the COVID-19 pandemic has led to the rapid expansion of a new mode of healthcare delivery: the virtual visit. With the convergence of remote monitoring technologies and reliable method of remote healthcare delivery, an understanding of the role of both in the management of patients with HF is critical. In this review, we outline the evidence on current remote monitoring technologies in patients with HF and highlight how these advances may benefit patients in the context of the current pandemic.


Asunto(s)
Insuficiencia Cardíaca , Tecnología de Sensores Remotos , Telemedicina , /epidemiología , Control de Enfermedades Transmisibles , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Humanos , Telemedicina/instrumentación , Telemedicina/métodos , Telemedicina/tendencias
8.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431455

RESUMEN

Takayasu's arteritis (TA) is a vasculitis with a predilection for young women. Left ventricular pseudoaneurysm (PSA) in TA is a rare phenomenon. We report a 36 years old Filipina who presented with heart failure symptoms. Years prior, she had a recurrent fever, headache, myalgia and left arm claudication. On workup, a 2D echo revealed a left ventricular PSA with mural thrombus and moderate mitral regurgitation. Cardiac MRI further characterised the PSA with a sac diameter of 8×7.5×8.4 cm (CC×T×AP). Carotid Duplex Scan revealed total occlusion of the mid to distal right common carotid artery and left subclavian artery. She was started on immunosuppresants and guideline-directed medical therapy (GDMT) for heart failure and subsequently underwent successful endoventricular patch closure and mitral valve repair. This case highlights the importance of actively searching for cardiac complications of TA which although very rare, can dominate the clinical picture and may carry a dismal prognosis if left untreated.


Asunto(s)
Aneurisma Falso/diagnóstico , Aneurisma Cardíaco/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia de la Válvula Mitral/diagnóstico , Arteritis de Takayasu/diagnóstico , Adulto , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Ecocardiografía Doppler en Color , Electrocardiografía , Femenino , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/cirugía , Insuficiencia Cardíaca/terapia , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/cirugía , Humanos , Inmunosupresores/uso terapéutico , Imagen por Resonancia Magnética , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/cirugía , Imagen de Perfusión Miocárdica , Arteritis de Takayasu/complicaciones , Arteritis de Takayasu/tratamiento farmacológico , Arteritis de Takayasu/inmunología
10.
Curr Heart Fail Rep ; 18(1): 12-22, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33420917

RESUMEN

PURPOSE OF REVIEW: Wireless hemodynamic monitoring in heart failure patients allows for volume assessment without the need for physical exam. Data obtained from these devices is used to assist patient management and avoid heart failure hospitalizations. In this review, we outline the various devices, mechanisms they utilize, and effects on heart failure patients. RECENT FINDINGS: New applications of these devices to specific populations may expand the pool of patients that may benefit. In the COVID-19 pandemic with a growing emphasis on virtual visits, remote monitoring can add vital ancillary data. Wireless hemodynamic monitoring with a pulmonary artery pressure sensor is a highly effective and safe method to assess for worsening intracardiac pressures that may predict heart failure events, giving lead time that is valuable to keep patients optimized. Implantation of this device has been found to improve outcomes in heart failure patients regardless of preserved or reduced ejection fraction.


Asunto(s)
/epidemiología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Monitorización Hemodinámica/instrumentación , Arteria Pulmonar , Monitorización Hemodinámica/métodos , Humanos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Interfaz Usuario-Computador
11.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33462057

RESUMEN

Acute heart failure (HF) is commonly caused by a cardiomyopathy with one or more precipitating factor. Here, a case in which a cardiomyopathy is precipitated by pulmonary embolism (PE). A 77-year-old man is admitted for breathlessness and leg swelling. A mild reduction of left ventricular (LV) ejection fraction is found, with moderately increased LV wall thickness and pulmonary hypertension; clinical examination revealed signs of congestion with bilateral leg swelling, and mild signs of left HF with the absence of pulmonary congestion on chest X-ray. The ECG showed Mobitz I second-degree atrioventricular block. The clinical scenario led us to the diagnosis of infiltrative cardiomyopathy due to cardiac amyloidosis (CA) precipitated by PE. Pulmonary embolism is an overlooked precipitant of HF and can be the first manifestation of an underlying misdiagnosed cardiomyopathy, especially CA. 3,3-Diphosphono-1,2-propanodicarboxylic acid scan is a cornerstone in the diagnosis of Transthyretin amyloidosis (ATTR) cardiac amyloidosis.


Asunto(s)
Neuropatías Amiloides Familiares/complicaciones , Neuropatías Amiloides Familiares/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico , Anciano , Neuropatías Amiloides Familiares/terapia , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Embolia Pulmonar/terapia
14.
JACC Heart Fail ; 9(1): 65-73, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33384064

RESUMEN

OBJECTIVES: The purpose of this study was to evaluate in-hospital outcomes among patients with a history of heart failure (HF) hospitalized with coronavirus disease-2019 (COVID-19). BACKGROUND: Cardiometabolic comorbidities are common in patients with severe COVID-19. Patients with HF may be particularly susceptible to COVID-19 complications. METHODS: The Premier Healthcare Database was used to identify patients with at least 1 HF hospitalization or 2 HF outpatient visits between January 1, 2019, and March 31, 2020, who were subsequently hospitalized between April and September 2020. Baseline characteristics, health care resource utilization, and mortality rates were compared between those hospitalized with COVID-19 and those hospitalized with other causes. Predictors of in-hospital mortality were identified in HF patients hospitalized with COVID-19 by using multivariate logistic regression. RESULTS: Among 1,212,153 patients with history of HF, 132,312 patients were hospitalized from April 1, 2020, to September 30, 2020. A total of 23,843 patients (18.0%) were hospitalized with acute HF, 8,383 patients (6.4%) were hospitalized with COVID-19, and 100,068 patients (75.6%) were hospitalized with alternative reasons. Hospitalization with COVID-19 was associated with greater odds of in-hospital mortality as compared with hospitalization with acute HF; 24.2% of patients hospitalized with COVID-19 died in-hospital compared to 2.6% of those hospitalized with acute HF. This association was strongest in April (adjusted odds ratio [OR]: 14.48; 95% confidence interval [CI]:12.25 to 17.12) than in subsequent months (adjusted OR: 10.11; 95% CI: 8.95 to 11.42; pinteraction <0.001). Among patients with HF hospitalized with COVID-19, male sex (adjusted OR: 1.26; 95% CI: 1.13 to 1.40) and morbid obesity (adjusted OR: 1.25; 95% CI: 1.07 to 1.46) were associated with greater odds of in-hospital mortality, along with age (adjusted OR: 1.35; 95% CI: 1.29 to 1.42 per 10 years) and admission earlier in the pandemic. CONCLUSIONS: Patients with HF hospitalized with COVID-19 are at high risk for complications, with nearly 1 in 4 dying during hospitalization.


Asunto(s)
/epidemiología , Insuficiencia Cardíaca/epidemiología , Hospitalización/estadística & datos numéricos , Pandemias , Anciano , Comorbilidad , Femenino , Insuficiencia Cardíaca/terapia , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Factores de Riesgo , Estados Unidos/epidemiología
15.
Int Heart J ; 62(1): 78-86, 2021 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-33390564

RESUMEN

Left bundle branch pacing (LBBP) has been adopted as a new pacing therapy whether in routine pacing or patients with heart failure, but the criteria for a completely captured LBBP are too complicated and have a low success rate in routine clinical practice.Consecutive patients with pacing therapy indications were enrolled. Left bundle branch area pacing (LBBAP) was conducted, and the presence of LBB potential, paced QRS duration, stimulus to left ventricular activation time (Stim-LVAT), and LBB potential to left ventricular activation time (LBB po-LVAT) were determined and utilized to characterize LBBAP modalities. Pacing parameters and safety were assessed at 6-month follow-up. LBBAP succeeded in 95.6% of patients (103/106) who completed the 6-month follow-up. Complete LBBP was achieved in 21 (20%) patients, characterized with a short Stim-LVAT equal to LBB po-LVAT. Incomplete LBBP was achieved in 58 (56%) patients with a short Stim-LVAT equal to LBB po-LVAT at a high pacing output and a relatively longer Stim-LVAT at a low pacing output. Deep septal pacing (DSP) characterized with no LBB potential and a longer Stim-LVAT (83.3 ± 7.7 ms) than that in LBBP (71.37 ± 7.1 ms, P < 0.01 versus DSP) was observed in 24 (23%) patients. Complete LBBP had a longer total procedure time and longer fluoroscopic time than the other two groups.This study describes the similarities and differences in electrophysiological characteristics and the possible mechanisms of the different types of LBBAP, classified into 3 modalities in routine clinical practice, each with narrow paced QRS duration and stable parameters, indicating LBBAP can be a near-physiological pacing modality.


Asunto(s)
Bloqueo de Rama/terapia , Estimulación Cardíaca Artificial/métodos , Sistema de Conducción Cardíaco/fisiopatología , Insuficiencia Cardíaca/terapia , Anciano , Anciano de 80 o más Años , Bloqueo de Rama/fisiopatología , Electrofisiología Cardíaca/métodos , Ecocardiografía/métodos , Electrocardiografía/métodos , Fenómenos Electrofisiológicos , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Tabique Interventricular/fisiopatología
16.
Angiology ; 72(1): 9-15, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32757767

RESUMEN

The endothelium plays a crucial role in maintaining cardiovascular homeostasis. Shear stress generated by flowing blood regulates the release of substances that provide adequate tissue perfusion. The extent of damage to endothelial cells depends on locally disturbed shear stress caused by the deteriorated flow. Patients with heart failure have reduced cardiac output, which results in reduced blood flow and negative shear stress. Reduced shear stress also affects microcirculation and reduces tissue perfusion. Consequently, the production of free oxygen radicals is increased and bioavailability of nitric oxide is additionally decreased. Therefore, endothelial dysfunction is involved in the progression of heart failure and cardiovascular events. Left ventricular assist devices (LVAD) are used for the treatment of patients with advanced heart failure. Older pulsatile flow LVADs were mostly substituted by continuous-flow LVADs (cf-LVADs). Despite the advantages of the cf-LVADs, the loss of pulsatility leads to different complications on the micro- and macrovascular levels. One of the pathogenetic mechanisms of cardiovascular complications with cf-LVADs may be endothelial dysfunction, which after the implantation of the device does not improve and may even deteriorate. In contrast, the pulsatile pattern of LVADs on blood flow could preserve endothelial function.


Asunto(s)
Endotelio Vascular/fisiopatología , Corazón Auxiliar , Enfermedad de la Arteria Coronaria/fisiopatología , Circulación Coronaria/fisiología , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , Inflamación/fisiopatología , Flujo Pulsátil/fisiología , Flujo Sanguíneo Regional/fisiología , Estrés Mecánico
17.
Br J Community Nurs ; 26(1): 18-25, 2021 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-33356934

RESUMEN

Heart failure as a comorbidity in the older population with COVID-19 poses an additional threat to those affected. Patients with both COVID-19 and heart failure share similar risk factors, which result in magnification of pathological outcomes. These include a common inflammatory pathology and related coagulopathy. Both illnesses pose a risk of arrhythmia. Polypharmacy further complicates safe drug administration and worsens the risk of medication-induced arrhythmia. Additionally, both conditions present challenges regarding attaining and maintaining an appropriate nutritional state. Exploration of the interplay between these factors demonstrates the gravity of the co-existence of these conditions and helps understand the difficulties faced when caring for this patient group. Although care provided to COVID-19 patients is primarily related to symptom presentation, based on the analysis conducted, there are some recommendations for practice in relation to evidence and guidelines when managing heart failure patients in primary care within the context of the COVID-19 pandemic.


Asunto(s)
/complicaciones , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/terapia , /genética , Arritmias Cardíacas/etiología , /epidemiología , Síndrome de Liberación de Citoquinas/fisiopatología , Dieta , Expresión Génica , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Humanos , Pandemias , Polifarmacia , Atención Primaria de Salud , Factores de Riesgo , /patogenicidad
18.
Ann Emerg Med ; 77(2): 237-248, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33349492

RESUMEN

STUDY OBJECTIVE: We use variables from a recently derived acute heart failure risk-stratification rule (STRATIFY) as a basis to develop and optimize risk prediction using additional patient clinical data from electronic health records and machine-learning models. METHODS: Using a retrospective cohort design, we identified all emergency department (ED) visits for acute heart failure between January 1, 2017, and December 31, 2018, among adult health plan members of a large system with 21 EDs. The primary outcome was any 30-day serious adverse event, including death, cardiopulmonary resuscitation, balloon-pump insertion, intubation, new dialysis, myocardial infarction, or coronary revascularization. Starting with the 13 variables from the STRATIFY rule (base model), we tested whether predictive accuracy in a different population could be enhanced with additional electronic health record-based variables or machine-learning approaches (compared with logistic regression). We calculated our derived model area under the curve (AUC), calculated test characteristics, and assessed admission rates across risk categories. RESULTS: Among 26,189 total ED encounters, mean patient age was 74 years, 51.7% were women, and 60.7% were white. The overall 30-day serious adverse event rate was 18.8%. The base model had an AUC of 0.76 (95% confidence interval 0.74 to 0.77). Incorporating additional variables led to improved accuracy with logistic regression (AUC 0.80; 95% confidence interval 0.79 to 0.82) and machine learning (AUC 0.85; 95% confidence interval 0.83 to 0.86). We found that 11.1%, 25.7%, and 48.9% of the study population had predicted serious adverse event risk of less than or equal to 3%, less than or equal to 5%, and less than or equal to 10%, respectively, and 28% of those with less than or equal to 3% risk were admitted. CONCLUSION: Use of a machine-learning model with additional variables improved 30-day risk prediction compared with conventional approaches.


Asunto(s)
Servicio de Urgencia en Hospital , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/terapia , Aprendizaje Automático , Medición de Riesgo , Anciano , Registros Electrónicos de Salud , Femenino , Humanos , Masculino , Estudios Retrospectivos
19.
Cardiovasc Pathol ; 50: 107299, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33080399

RESUMEN

In the setting of HeartWare left ventricular assist device (HVAD, Medtronic) implantation, pre-pump blood flow obstruction has been described due to intraventricular thrombus formation occluding the inflow cannula. This phenomenon often evolves in suboptimal pump performance, and requires prompt management to prevent its progression. However, to date, effective strategies and tools for the diagnosis and management of this complication are poorly described. We report a case of HVAD inflow cannula obstruction that drove later in-pump thrombosis and, eventually, complete cannula occlusion, and discuss gap of knowledge and limitations of currently available diagnostic and therapeutic tools in this scenario. Furthermore, we reinforce the value of time-frequency analysis of the HVAD log files to early identify abnormal pump operation associated with inflow cannula obstruction despite unremarkable trends of pump parameters.


Asunto(s)
Obstrucción del Catéter , Insuficiencia Cardíaca/terapia , Corazón Auxiliar , Falla de Prótesis , Trombosis/etiología , Función Ventricular Izquierda , Diagnóstico Precoz , Resultado Fatal , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Diseño de Prótesis , Trombosis/diagnóstico , Trombosis/terapia , Resultado del Tratamiento
20.
BMC Cardiovasc Disord ; 20(1): 522, 2020 12 12.
Artículo en Inglés | MEDLINE | ID: mdl-33308152

RESUMEN

BACKGROUND: The The Roadmap Using Story Telling project used a narrative medicine (NM) framework to assess the perspectives of people with heart failure (HF), their informal caregivers and HF specialists of the impact of HF on the daily life of patients and their carers. METHODS: Italian HF specialists participated on a voluntary basis, completing their own narratives, and inviting patients and their caregivers to write anonymously about their experiences, all on a dedicated online platform. The narratives were analyzed according to standard NM methodology. RESULTS: 82 narratives were collected from patients, 61 from caregivers, and 104 from HF specialists. Analysis of the three points of view revealed the extent of the burden of illness on the entire family, particularly that of the caregiver. The impact was mainly experienced as emotional and social limitations in patients' and their caregivers' daily lives. The analysis of all three points of view highlighted a strong difference between how HF is perceived by patients, caregivers, and HF specialists. CONCLUSIONS: This NM project illustrates the complex issues of living with HF and gave insights to integrate three different perspectives into the HF pathway of care.


Asunto(s)
Actitud del Personal de Salud , Cardiólogos/psicología , Cuidadores/psicología , Costo de Enfermedad , Emociones , Insuficiencia Cardíaca/psicología , Medicina Narrativa , Pacientes/psicología , Conducta Social , Actividades Cotidianas , Anciano , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , Italia , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , Calidad de Vida
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