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2.
Eur J Heart Fail ; 2019 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-31129923

RESUMO

The European Society of Cardiology (ESC) has published a series of guidelines on heart failure (HF) over the last 25 years, most recently in 2016. Given the amount of new information that has become available since then, the Heart Failure Association (HFA) of the ESC recognized the need to review and summarise recent developments in a consensus document. Here we report from the HFA workshop that was held in January 2019 in Frankfurt, Germany. This expert consensus report is neither a guideline update nor a position statement, but rather a summary and consensus view in the form of consensus recommendations. The report describes how these guidance statements are supported by evidence, it makes some practical comments, and it highlights new research areas and how progress might change the clinical management of HF. We have avoided re-interpretation of information already considered in the 2016 ESC/HFA guidelines. Specific new recommendations have been made based on the evidence from major trials published since 2016, including sodium-glucose co-transporter 2 inhibitors in type 2 diabetes mellitus, MitraClip for functional mitral regurgitation, atrial fibrillation ablation in HF, tafamidis in cardiac transthyretin amyloidosis, rivaroxaban in HF, implantable cardioverter-defibrillators in non-ischaemic HF, and telemedicine for HF. In addition, new trial evidence from smaller trials and updated meta-analyses have given us the chance to provide refined recommendations in selected other areas. Further, new trial evidence is due in many of these areas and others over the next 2 years, in time for the planned 2021 ESC guidelines on the diagnosis and treatment of acute and chronic heart failure.

3.
Eur J Cardiovasc Nurs ; : 1474515119851615, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117812

RESUMO

BACKGROUND: The role of clinical guidelines is to provide patients with the best quality, evidence-based care. Nurses are actively involved in the development of the European Society of Cardiology guidelines. A number of the guidelines include specific recommendations relating to nursing duties and, hence, nurses require necessary knowledge and skills for their implementation. Inclusion of the guidelines in the curricula for university nursing programmes could facilitate their implementation to everyday practice. AIM: The purpose of this study was to determine the awareness and opinions of Polish nursing students who participated in a guideline-based Master of Science education programme about the usefulness of the European Society of Cardiology guidelines. METHODS: A prospective and cross-sectional research design was used and Strengthening the Reporting of Observational studies in Epidemiology guidelines were followed. A total of 188 nursing students (mean age 31.18±10.41 years) who met the inclusion criteria were invited to complete the BeGuideWell survey. This instrument included 16 questions: five on participants' demographics and 11 addressing the issues associated with the European Society of Cardiology guidelines. The Yates chi-squared test or Fisher exact test were used for statistical analysis. RESULTS: The majority of students had become familiar with the diagnostics and treatment of acute and chronic heart failure. Nearly half of the students documented that they had never heard of the European Society of Cardiology guidelines before starting the Master of Science programme. Most students found the European Society of Cardiology guidelines helpful for their university education. Most respondents stated that the guidelines were useful in their everyday practice and believed that they contributed to better quality of patient care. CONCLUSIONS: Students can become more familiar with the European Society of Cardiology guidelines during the course of their post-graduate education, preparing them to implement the European Society of Cardiology guidelines in their everyday practice.

4.
Eur J Heart Fail ; 21(5): 553-576, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30989768

RESUMO

Cardiomyopathies are a heterogeneous group of heart muscle diseases and an important cause of heart failure (HF). Current knowledge on incidence, pathophysiology and natural history of HF in cardiomyopathies is limited, and distinct features of their therapeutic responses have not been systematically addressed. Therefore, this position paper focuses on epidemiology, pathophysiology, natural history and latest developments in treatment of HF in patients with dilated (DCM), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies. In DCM, HF with reduced ejection fraction (HFrEF) has high incidence and prevalence and represents the most frequent cause of death, despite improvements in treatment. In addition, advanced HF in DCM is one of the leading indications for heart transplantation. In HCM, HF with preserved ejection (HFpEF) affects most patients with obstructive, and ∼10% of patients with non-obstructive HCM. A timely treatment is important, since development of advanced HF, although rare in HCM, portends a poor prognosis. In RCM, HFpEF is common, while HFrEF occurs later and more frequently in amyloidosis or iron overload/haemochromatosis. Irrespective of RCM aetiology, HF is a harbinger of a poor outcome. Recent advances in our understanding of the mechanisms underlying the development of HF in cardiomyopathies have significant implications for therapeutic decision-making. In addition, new aetiology-specific treatment options (e.g. enzyme replacement therapy, transthyretin stabilizers, immunoadsorption, immunotherapy, etc.) have shown a potential to improve outcomes. Still, causative therapies of many cardiomyopathies are lacking, highlighting the need for the development of effective strategies to prevent and treat HF in cardiomyopathies.

6.
J Cardiovasc Nurs ; 33(6): 527-535, 2018 Nov/Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29727378

RESUMO

BACKGROUND: Rate of implantable cardioverter defibrillator (ICD) implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendations, discussions addressing deactivation occur infrequently. AIM: The aim of this article is to explore patient and professional factors that impact perceived likelihood and confidence of healthcare professionals to discuss ICD deactivation. METHODS AND RESULTS: Between 2015 and 2016, an international sample of 262 healthcare professionals (65% nursing, 24% medical) completed an online factorial survey, encompassing a demographic questionnaire and clinical vignettes. Each vignette had 9 randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, a retrospective case note review, and a qualitative exploratory study. Results showed that most healthcare professionals agreed that deactivation discussions should be initiated by a cardiologist (95%, n = 255) or a specialist nurse (81%, n = 215). In terms of experience, 84% of cardiologists (n = 53) but only 30% of nurses (n = 50) had previously been involved in a deactivation decision. Healthcare professionals valued patient involvement in deactivation decisions; however, only 50% (n = 130) actively involved family members. Five of 9 clinical factors were associated with an increased likelihood to discuss deactivation including advanced age, severe heart failure, presence of malignancy, receipt of multiple ICD shocks, and more than 3 hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision making. CONCLUSIONS: Guidelines recommend that healthcare professionals discuss ICD deactivation; however, practice is suboptimal with multifactorial factors impacting on decision making. The role and responsibility of nurses in discussing deactivation require clarity and improvement.

7.
Eur J Heart Fail ; 20(7): 1081-1099, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29710416

RESUMO

This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non-invasive approaches. Comprehensive inpatient monitoring is crucial to the optimal management of acute heart failure patients. The European Society of Cardiology heart failure guidelines provide recommendations for the inpatient monitoring of acute heart failure, but the level of evidence underpinning most recommendations is limited. Many tools are available for the in-hospital monitoring of patients with acute heart failure, and each plays a role at various points throughout the patient's treatment course, including the emergency department, intensive care or coronary care unit, and the general ward. Clinical judgment is the preeminent factor guiding application of inpatient monitoring tools, as the various techniques have different patient population targets. When applied appropriately, these techniques enable decision making. However, there is limited evidence demonstrating that implementation of these tools improves patient outcome. Research priorities are identified to address these gaps in evidence. Future research initiatives should aim to identify the optimal in-hospital monitoring strategies that decrease morbidity and prolong survival in patients with acute heart failure.

8.
Eur J Heart Fail ; 20(1): 3-15, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28925073

RESUMO

Traditionally, the main indication for cardiopulmonary exercise testing (CPET) in heart failure (HF) was for the selection of candidates to heart transplantation: CPET was mainly performed in middle-aged male patients with HF and reduced left ventricular ejection fraction. Today, CPET is used in broader patients' populations, including women, elderly, patients with co-morbidities, those with preserved ejection fraction, or left ventricular assistance device recipients, i.e. individuals with different responses to incremental exercise and markedly different prognosis. Moreover, the diagnostic and prognostic utility of symptom-limited CPET parameters derived from submaximal tests is more and more considered, since many patients are unable to achieve maximal aerobic power. Repeated tests are also being used for risk stratification and evaluation of intervention, so that these data are now available. Finally, patients, physicians and healthcare decision makers are increasingly considering how treatments might impact morbidity and quality of life rather than focusing more exclusively on hard endpoints (such as mortality) as was often the case in the past. Innovative prognostic flowcharts, with CPET at their core, that help optimize risk stratification and the selection of management options in HF patients, have been developed.


Assuntos
Cardiologia , Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Insuficiência Cardíaca/fisiopatologia , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas , Volume Sistólico/fisiologia , Europa (Continente) , Insuficiência Cardíaca/diagnóstico , Humanos
9.
Eur J Heart Fail ; 20(1): 16-37, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29044932

RESUMO

There is an unmet need for effective treatment strategies to reduce morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF). Until recently, attention in patients with HFpEF was almost exclusively focused on the left side. However, it is now increasingly recognized that right heart dysfunction is common and contributes importantly to poor prognosis in HFpEF. More insights into the development of right heart dysfunction in HFpEF may aid to our knowledge about this complex disease and may eventually lead to better treatments to improve outcomes in these patients. In this position paper from the Heart Failure Association of the European Society of Cardiology, the Committee on Heart Failure with Preserved Ejection Fraction reviews the prevalence, diagnosis, and pathophysiology of right heart dysfunction and failure in patients with HFpEF. Finally, potential treatment strategies, important knowledge gaps and future directions regarding the right side in HFpEF are discussed.


Assuntos
Cardiologia , Insuficiência Cardíaca , Guias de Prática Clínica como Assunto , Sociedades Médicas , Volume Sistólico/fisiologia , Disfunção Ventricular Direita , Europa (Continente) , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia
11.
Eur J Cardiovasc Nurs ; 15(1): 20-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25903823

RESUMO

BACKGROUND: The implantable cardioverter defibrillator (ICD) is a cornerstone in the treatment of life-threatening arrhythmias. As rates of device implantation continue to rise throughout Europe, European and International guidelines recommend professionals discuss deactivation with patients. In reality the appropriate therapeutic management of an ICD at the end-of-life remains uncertain in the minds of professionals and patients. AIM: To identify current practice and examine professional decision-making for patients with an ICD from time of implantation to final documentation and demise. METHODS: Retrospective case note review of patients with an ICD who died during a 12 month period at a regional implantation centre. RESULTS: Fifty-nine patients were identified and medical notes of 44 of these patients were successfully retrieved. The majority of patients were male, mean age at time of death 73 years with one-third diagnosed with a malignancy prior to death. There was no documented evidence patients were informed about deactivation prior to ICD implantation. End-of-life management was discussed with 23 patients and on 17 occasions deactivation was included. Median time from discussion to death was seven days. In total 62.5% of patients who experienced a shock had an active ICD at death, while 93.7% who had their ICD deactivated never had a shock (p=0.003). CONCLUSION: Patients were not adequately informed regarding device deactivation prior to implantation, nor when their health deteriorated. The experience of a shock potentially affects professional decision making regarding device deactivation.


Assuntos
Arritmias Cardíacas/terapia , Desfibriladores Implantáveis/psicologia , Pessoal de Saúde/psicologia , Preferência do Paciente/psicologia , Pacientes/psicologia , Assistência Terminal/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Atitude Frente a Morte , Tomada de Decisões , Europa (Continente) , Feminino , Guias como Assunto , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Palliat Med ; 29(4): 310-23, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25239128

RESUMO

BACKGROUND: Individualised care at the end of life requires professional understanding of the patient's perception of implantable cardioverter defibrillator deactivation. AIM: The aim was to evaluate the evidence on patients' perception of implantable cardioverter defibrillator deactivation at end of life. DESIGN: Systematic narrative review of empirical studies was published during 2008-2014. DATA SOURCES: Data were collected from six databases, citations from relevant articles and expert recommendations. RESULTS: In all, 18 studies included with collective population of n = 5810. Concept mapping highlighted three themes: (1) Diverse preferences regarding discussion and deactivation. Deactivation was rarely discussed pre-implantation, with some studies demonstrating patients' reluctance to discuss implantable cardioverter defibrillator deactivation at any stage. Two studies found the majority of patients valued such discussions. Diversity was reflected in patients' willingness to deactivate, ranging from 12% (n = 9) in Irish cohort to 79% (n = 195) in Dutch study. (2) Ethical and legal considerations were predominant in Canadian and American literature as patients wanted to contribute but felt the decision should be a doctor's responsibility. Advance directives were uncommon in Europe, and where they existed the implantable cardioverter defibrillator was not mentioned. (3) 'Living in the now' was evident as despite deteriorating symptoms many patients maintained a positive outlook and anticipated surviving more than 10 years. Several studies asserted living longer was more important than quality of life. CONCLUSION: Patients regard the implantable cardioverter defibrillator as a complex and solely beneficial device, with little insight regarding its potential impact on a peaceful death. This review confirms the need for professionals to discuss with patients and families implantable cardioverter defibrillator functionality and deactivation at appropriate opportunities.


Assuntos
Atitude Frente a Saúde , Desfibriladores Implantáveis , Assistência Terminal , Comunicação , Pesquisa Empírica , Humanos , Preferência do Paciente , Percepção , Relações Médico-Paciente , Qualidade de Vida
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