RESUMO
Heart failure (HF) is a progressive disease characterized by variable durations of symptomatic stability often punctuated by episodes of worsening despite continued therapy. These periods of clinical worsening are increasingly recognized as a distinct phase in the history of HF, termed worsening HF (WHF). The definition of WHF continues to evolve from a historical focus solely on hospitalization to now include nonhospitalization events (eg, need for intravenous diuretic therapy in the emergency or outpatient setting). Most HF clinical trials to date have had HF hospitalization and death as primary endpoints, and only recently, some studies have included other WHF events regardless of location of care. This article reviews the evolution of the WHF definition, highlights the importance of considering the onset of WHF as an event that marks a new phase of HF, summarizes the latest clinical trials investigating novel therapies, and outlines unmet needs regarding identification and treatment of WHF.
Assuntos
Insuficiência Cardíaca , Humanos , Doença Aguda , Progressão da Doença , Diuréticos/uso terapêutico , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/história , Insuficiência Cardíaca/terapia , HospitalizaçãoRESUMO
Over the centuries, iconographic representations of St Anthony of Padua, one of the most revered saints in the Catholic world, have been inspired by literary sources, which described the Saint as either naturally corpulent or with a swollen abdomen due to dropsy (i.e. fluid accumulation in the body cavities). Even recent attempts to reconstruct the face of the Saint have yielded discordant results regarding his outward appearance. To address questions about the real appearance of St Anthony, we applied body mass estimation equations to the osteometric measurements taken in 1981, during the public recognition of the Saint's skeletal remains. Both the biomechanical and the morphometric approach were employed to solve some intrinsic limitations in the equations for body mass estimation from skeletal remains. The estimated body mass was used to assess the physique of the Saint with the body mass index. The outcomes of this investigation reveal interesting information about the body type of the Saint throughout his lifetime.
Assuntos
Edema/diagnóstico , Insuficiência Cardíaca/diagnóstico , Obesidade/diagnóstico , Aparência Física , Santos/história , Gordura Abdominal/fisiopatologia , Índice de Massa Corporal , Restos Mortais/anatomia & histologia , Diagnóstico , Diagnóstico Diferencial , Edema/história , Edema/fisiopatologia , Insuficiência Cardíaca/história , Insuficiência Cardíaca/fisiopatologia , História do Século XXI , História Medieval , Humanos , Itália , Obesidade/história , Obesidade/fisiopatologia , Religião e MedicinaRESUMO
John Hay was born in a small mid-western town and sent by his physician father to Brown University for his education. He returned to Springfield IL where he was hired by Abraham Lincoln as a personal secretary and stayed with Lincoln through the assassination. He then returned to private life, married into a wealthy family and developed a successful literary and investment career. In 1879, he joined the State Department and later became Secretary under presidents McKinley and Roosevelt. He negotiated many important treaties including those related to building the Panama Canal. Later in life, his health deteriorated with symptoms of angina pectoris and heart failure. Limited medical understanding of these matters at the time are reviewed but were then of little benefit. Probably his most effective therapy was rest during weeks of carbonated baths at Bad Nauheim. Hay died suddenly, shortly after arriving home from the last of these trips.
Assuntos
Angina Pectoris/história , Pessoas Famosas , Insuficiência Cardíaca/história , Internacionalidade/história , História do Século XIX , História do Século XX , Cooperação Internacional/história , Estados UnidosAssuntos
Pesquisa Biomédica/história , Cardiologia/história , Insuficiência Cardíaca/história , Diester Fosfórico Hidrolases/história , Escolha da Profissão , AMP Cíclico/história , AMP Cíclico/metabolismo , Insuficiência Cardíaca/enzimologia , Insuficiência Cardíaca/fisiopatologia , História do Século XX , História do Século XXI , Humanos , Isoenzimas , Diester Fosfórico Hidrolases/metabolismo , Sistemas do Segundo MensageiroRESUMO
Heart failure (HF) patients experience a high burden of symptoms and functional limitations, and morbidity and mortality remain high despite successful therapies. The majority of HF drugs in the United States are approved for reducing hospitalization and mortality, while only a few have indications for improving quality of life, physical function, or symptoms. Patient-reported outcomes that directly measure patient's perception of health status (symptoms, physical function, or quality of life) are potentially approvable endpoints in drug development. This paper summarizes the history of endpoints used for HF drug approvals in the United States and reviews endpoints that measure symptoms, physical function, or quality of life in HF patients.
Assuntos
Fármacos Cardiovasculares/história , Desenvolvimento de Medicamentos/história , Nível de Saúde , Insuficiência Cardíaca/história , Fármacos Cardiovasculares/farmacologia , Aprovação de Drogas/história , Insuficiência Cardíaca/tratamento farmacológico , História do Século XX , História do Século XXI , Humanos , Estados UnidosRESUMO
The new Imperial era, Reiwa, started in May, 2019. After World War II, Reiwa is the third Imperial era following Showa and Heisei. In each era, we had specific healthcare problems in cardiovascular medicine and implemented preventive strategies against them. Furthermore, nationwide healthcare policies such as a universal healthcare insurance system (kaihoken) and health check-up system largely contribute to overcoming these problems. Here, we summarize the specific issues in cardiovascular medicine and nationwide strategies policies against them in each era. We also describe what we should do in the new Imperial era from the cardiovascular viewpoint.
Assuntos
Cardiologia/tendências , Política de Saúde/tendências , Insuficiência Cardíaca/terapia , Assistência de Saúde Universal , Cobertura Universal do Seguro de Saúde/tendências , Cardiologia/história , Previsões , Política de Saúde/história , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/história , História do Século XX , História do Século XXI , Humanos , Japão/epidemiologia , Formulação de Políticas , Fatores de Tempo , Cobertura Universal do Seguro de Saúde/históriaAssuntos
Pesquisa Biomédica/história , Cardiologia/história , Insuficiência Cardíaca/história , Contração Miocárdica , Miocárdio , Sarcômeros , Animais , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , História do Século XX , História do Século XXI , Humanos , Miocárdio/patologia , Sarcômeros/patologiaAssuntos
Pesquisa Biomédica/história , Cardiologia/história , Insuficiência Cardíaca/história , RNA não Traduzido/história , Animais , Insuficiência Cardíaca/genética , Insuficiência Cardíaca/metabolismo , História do Século XX , História do Século XXI , Humanos , RNA não Traduzido/genética , RNA não Traduzido/metabolismoAssuntos
Insuficiência Cardíaca , Infarto do Miocárdio , Medicina de Precisão/história , Ensaios Clínicos como Assunto , Insuficiência Cardíaca/história , Insuficiência Cardíaca/prevenção & controle , Insuficiência Cardíaca/terapia , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Infarto do Miocárdio/história , Infarto do Miocárdio/prevenção & controle , Infarto do Miocárdio/terapiaAssuntos
Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Volume Sistólico/fisiologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita/fisiologia , Insuficiência Cardíaca/história , História do Século XX , História do Século XXI , Humanos , Modelos Cardiovasculares , Resistência Vascular/fisiologia , Disfunção Ventricular Esquerda/história , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/história , Função Ventricular Esquerda/fisiologiaAssuntos
Inibidores da Enzima Conversora de Angiotensina/história , Ensaios Clínicos como Assunto/história , Insuficiência Cardíaca/história , Pesquisa Translacional Biomédica/história , Disfunção Ventricular Esquerda/história , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Animais , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , História do Século XX , História do Século XXI , Humanos , Disfunção Ventricular Esquerda/tratamento farmacológico , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacosAssuntos
Pesquisa Biomédica/história , Cardiologia/história , Insuficiência Cardíaca/história , Agonistas de Receptores Adrenérgicos alfa 1/história , Agonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Escolha da Profissão , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , História do Século XX , História do Século XXI , Humanos , Receptores Adrenérgicos alfa 1/história , Reprodutibilidade dos Testes , Carga de TrabalhoAssuntos
Pessoas Famosas , Insuficiência Cardíaca/história , Poliomielite/história , Avaliação da Deficiência , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/prevenção & controle , História do Século XX , Humanos , Poliomielite/complicações , Poliomielite/fisiopatologia , Poliomielite/prevenção & controle , Vacinas contra Poliovirus/administração & dosagem , Vacinas contra Poliovirus/história , Fatores de Proteção , Fatores de Risco , Vacinação/históriaRESUMO
Some philosophers of medicine argue that there are objective facts about the biological function of organs, and that these facts are used to objectively define diseases. The function of the heart is taken to be particularly obvious and well established. Contrary to this, I argue that the function of the heart is not fixed by nature, but rather that it is historically contingent. The disease heart failure results from the dysfunction of the heart. In opposition to the common-sense intuitions of philosophers, medics do not define heart failure simply as a reduced cardiac output, and up to half of patients with heart failure have a normal cardiac output. The present day medical definition of heart failure is thus counter-intuitive. In the early twentieth century, however, medics did define heart failure as a reduced cardiac output. This view was opposed in the 1930s, when a similar definition of heart failure to the one used today was put forward. I look closely at this historical episode, in order to explore the reasons for this development. I use this history to argue that present day knowledge of heart failure is not the inevitable result of careful observation of patients, but rather is historically contingent.
Assuntos
Insuficiência Cardíaca/história , Terminologia como Assunto , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/fisiopatologia , História do Século XIX , História do Século XX , Humanos , Reino Unido , Estados UnidosRESUMO
It is widely believed that the function of the heart is obviously to pump blood. I argue here that it is not. The definition, presentation, and pathophysiological explanation of heart failure, as well as the measurement of cardiac dysfunction, are not as might be expected if the function of the heart was simply to pump blood. Far from being obvious, many central features of heart failure are still being investigated. This has important implications for philosophical debates about health and disease. According to naturalists like Christopher Boorse, medical practice is founded on a well-established body of physiological knowledge, which provides the one true account of the biological function of organs. On this naturalistic view, there should only be one account of the pathophysiology of heart failure in use in medical practice. This account of the pathophysiology of heart failure should be well-established, as opposed to uncertain. Medics should use this physiological knowledge to inform their clinical practice, and not vice versa. Clinical considerations, such as whether patients respond to therapy, should not inform debates about what the pathophysiology of heart failure is. I will show this is not the case. The handling of knowledge of the biological function of the heart in medical practice differs substantially from Boorse's account.
Assuntos
Insuficiência Cardíaca/história , Coração/fisiologia , Filosofia Médica/história , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/fisiopatologia , História do Século XX , História do Século XXI , HumanosRESUMO
On October 17, 1849, Poland's greatest composer, Frédéric Chopin (1810-1849) died aged 39. His cause of death remains unknown. An investigation of the documental sources was performed to reconstruct the medical history of the artist. Since his earliest years, his life had been dominated by poor health. Recurrent episodes of cough, fever, headaches, lymphadenopathy- a series of symptoms that may be attributed to viral respiratory infections- manifested in his teens. Later in life, he had chest pain, hemoptysis, hematemesis, neuralgia, and arthralgia. Exhaustion and breathlessness characterized all his adult life. Coughing, choking, and edema of the legs and ankles manifested four months before his death. Several hypotheses ranging from cystic fibrosis to alpha-1 anti-trypsin deficiency and pulmonary tuberculosis have been proposed to explain Chopin's lifelong illness. We suggest that Chopin had dilated cardiomyopathy with consequent heart failure and cirrhosis that caused his death.
Assuntos
Cardiomiopatia Dilatada/história , Pessoas Famosas , Insuficiência Cardíaca/história , Música/história , Cardiomiopatia Dilatada/complicações , Causas de Morte , Insuficiência Cardíaca/etiologia , História do Século XIX , Humanos , Masculino , PolôniaRESUMO
The current United States heart allocation system faces 2 main challenges: an evolving landscape of device therapy in advanced heart failure and a rapidly increasing transplant waiting list. The proposed new heart allocation system involves expansion of the 3 tiers and enables greater distinction between different types of mechanical circulatory support devices. In this review, we discuss how the proposed revision reconciles key concerns of the current system to create a more fair and equitable allocation of hearts in the United States.
Assuntos
Acesso aos Serviços de Saúde/organização & administração , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Obtenção de Tecidos e Órgãos/organização & administração , Listas de Espera , Tomada de Decisão Clínica , Acesso aos Serviços de Saúde/história , Necessidades e Demandas de Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/história , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/história , Coração Auxiliar , História do Século XX , História do Século XXI , Humanos , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Seleção de Pacientes , Formulação de Políticas , Obtenção de Tecidos e Órgãos/história , Estados UnidosRESUMO
Heart transplantation has become a standard therapy option for advanced heart failure. The translation of heart transplantation from innovative experiments to long-term clinical success has married prescient insights with discipline and organization in the domains of surgical techniques, organ preservation, immunosuppression, organ donation and transplantation logistics, infection control, and long-term graft surveillance. This review explores the key milestones of the past 50 years of heart transplantation and discusses current challenges and promising innovations on the clinical horizon.