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1.
Rev Med Suisse ; 16(680): 257-259, 2020 Feb 05.
Artigo em Francês | MEDLINE | ID: mdl-32022489

RESUMO

We present the case of a 72-year-old patient, with multiple cardiovascular risk factors, investigated for exertional dyspnea. The diagnostic workup led to a percutaneous coronary intervention. During the procedure, catheter-induced iatrogenic coronary artery dissection (CICAD) resulted in cardiorespiratory arrest. This article reviews the key elements and the risk assessment at each step of the diagnostic strategy of stable coronary syndromes in accordance to the latest 2019 European Society of Cardiology guidelines.


Assuntos
Cardiologia/normas , Doença da Artéria Coronariana/diagnóstico , Idoso , Humanos , Intervenção Coronária Percutânea , Medição de Risco
2.
Pneumologie ; 74(1): 24-34, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31863422

RESUMO

Sarcoidosis is a multisystemic granulomatous disorder which affects the respiratory system in the majority of the cases. Symptomatic cardiac manifestations are found in less than 10 % of the affected cohorts and show a large heterogeneity based on the ethnic background. Cardiac sarcoidosis is not only found in patients with rhythmogenic heart disease, such as atrial and ventricular fibrillation but also in all phenotypes of cardiomyopathy. The overall morbidity and mortality caused by cardiac sarcoidosis in Germany remains unclear and large prospective international observational studies.underline the importance of this disease entity. This consensus paper on diagnostic and therapeutic algorithms for cardiac sarcoidosis is based on a current literature search and forms an expert opinion statement under the auspices of the German Respiratory Society and the German Cardiac Society. The rationale of this statement is to provide algorithms to facilitate clinical decision-making based on the individual case situation.


Assuntos
Cardiologia/normas , Guias de Prática Clínica como Assunto , Sarcoidose Pulmonar/diagnóstico , Sarcoidose Pulmonar/terapia , Cardiomiopatias , Consenso , Alemanha/epidemiologia , Humanos , Comunicação Interdisciplinar , Pneumologia/normas , Sociedades Médicas
3.
Presse Med ; 48(12): 1387-1392, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31679896

RESUMO

The GERS-P (Exercise Rehabilitation Sports Prevention Group of the French Society of Cardiology) has decided to update current guidelines regarding the practice of EKG stress tests. Since the last update dates from 1997, the GERS judged it necessary to integrate data from new works and advancements made in the last 20 years. Good clinical practices and safety conditions are better defined regarding the structure, location, material, staff competency, as well as convention with hospital structures. The diagnosis of coronary artery disease remains the principal indication for a stress test. Interpretation of the results is crucial - it must be multivariate and provide either a low, intermediate or strong probability of the existence of coronary lesions, taking into account the studied population (risk factors, age, sex and symptoms). We no longer have to talk about a "positive, negative or litigious" test. Several new indications for a stress test have been defined for the assessment of cardiac pathologies. With such indications, the use of gas expiration measurements is highly recommended in order to provide a precise prognosis for all the various cardiac pathologies : congenital, ischemic, valvular, cardiomyopathy, congestive heart failure, rhythm and conduction disorders, pacemaker fine-tuning, or pulmonary hypertension. Indications for stress tests and contraindications are defined according to different population subgroups, for instance : athletes, women, children, the elderly, asymptomatic patients, diabetics, hypertensive patients, peripheral arteritis disease patients, or in the context of a non-cardiac surgery pre-op visit. The new guidelines are considerably different from those dating from 1997 and further pinpoint the relevance and importance of an EKG stress test within the arsenal of complementary cardiologic exams. With the improvements made in providing diagnostic value in CAD, as well as better prognostic value for any underlying pathology, the indication for an EKG stress test has extended to all cardiovascular disease.


Assuntos
Cardiologia/normas , Teste de Esforço/normas , Cardiologia/organização & administração , Doença da Artéria Coronariana/diagnóstico , Técnicas de Diagnóstico Cardiovascular/normas , Exercício/fisiologia , Teste de Esforço/métodos , Humanos , Prognóstico , Sociedades Médicas/normas
5.
Presse Med ; 48(12): 1393-1400, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31471091

RESUMO

An ECG is recommended by the French Society of Cardiology in the screening of a competitive athlete. An intense and prolonged physical activity (>4 hours of intense sport/week) can lead to a physiological electric remodeling. In addition to physical activity (type, intensity, duration), the ECG should be interpreted according to the athlete's ethnicity and age. It is necessary to know the physiological modifications related to sport practice to avoid either false reassurances or the realization of unjustified additional examinations because of a wrong interpretation. The latest athlete ECG classification published in 2017 can be used to identify in which athlete additional tests are recommended (figure 1).


Assuntos
Atletas , Eletrocardiografia , Cardiopatias/diagnóstico , Esportes , Cardiologia/métodos , Cardiologia/normas , Diagnóstico Diferencial , Técnicas de Diagnóstico Cardiovascular/normas , Eletrocardiografia/métodos , Eletrocardiografia/normas , Exercício/fisiologia , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Padrões de Referência , Esportes/normas
6.
Arch Cardiovasc Dis ; 112(8-9): 532-542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31378692

RESUMO

BACKGROUND: Unlike previous randomized clinical trials (RCTs), recent trials and meta-analyses have shown that transcatheter closure of patent foramen ovale (PFO) reduces stroke recurrence risk in young and middle-aged adults with an otherwise unexplained PFO-associated ischaemic stroke. AIM: To produce an expert consensus on the role of transcatheter PFO closure and antithrombotic drugs for secondary stroke prevention in patients with PFO-associated ischaemic stroke. METHODS: Five neurologists and five cardiologists with extensive experience in the relevant field were nominated by the French Neurovascular Society and the French Society of Cardiology to make recommendations based on evidence from RCTs and meta-analyses. RESULTS: The experts recommend that any decision concerning treatment of patients with PFO-associated ischaemic stroke should be taken after neurological and cardiological evaluation, bringing together the necessary neurovascular, echocardiography and interventional cardiology expertise. Transcatheter PFO closure is recommended in patients fulfilling all the following criteria: age 16-60 years; recent (≤6 months) ischaemic stroke; PFO associated with atrial septal aneurysm (>10mm) or with a right-to-left shunt>20 microbubbles or with a diameter≥2mm; PFO felt to be the most likely cause of stroke after thorough aetiological evaluation by a stroke specialist. Long-term oral anticoagulation may be considered in the event of contraindication to or patient refusal of PFO closure, in the absence of a high bleeding risk. After PFO closure, dual anti-platelet therapy with aspirin (75mg/day) and clopidogrel (75mg/day) is recommended for 3 months, followed by monotherapy with aspirin or clopidogrel for≥5 years. CONCLUSIONS: Although a big step forward that will benefit many patients has been taken with recent trials, many questions remain unanswered. Pending results from further studies, decision-making regarding management of patients with PFO-associated ischaemic stroke should be based on a close coordination between neurologists/stroke specialists and cardiologists.


Assuntos
Isquemia Encefálica/prevenção & controle , Cateterismo Cardíaco/normas , Cardiologia/normas , Forame Oval Patente/terapia , Prevenção Secundária/normas , Acidente Vascular Cerebral/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Consenso , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Medição de Risco , Fatores de Risco , Dispositivo para Oclusão Septal/normas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento , Adulto Jovem
7.
Gen Thorac Cardiovasc Surg ; 67(9): 731-735, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31327137

RESUMO

OBJECTIVES: We analyzed the mortality and morbidity of congenital heart surgery in Japan by using Japan Cardiovascular Surgery Database (JCVSD). METHODS: The data on congenital heart surgery performed between January 2015 and December 2016 were obtained from JCVSD. From the data obtained, the most frequent 20 procedures were selected, and the mortalities and major morbidities were analyzed. In addition, the institutions were classified into three groups according to the number of cardiopulmonary cases for a year, and the distribution of the major operations was calculated. RESULTS: The mortality of ASD repair and VSD repair was under 1% and the mortality of TOF repair, complete AVSD repair, Rastelli operation, CoA complex repair, bidirectional Glenn and TCPC was 2-3%. The mortality of Norwood procedure and TAPVC repair were over 10%. These difficult operations were mainly performed at relatively high-volume institutions. CONCLUSION: Using the data from JCVSD, the national data of congenital heart surgery, including postoperative complications, were analyzed. Neonatal surgery still has considerable complication rates and further improvement is desired. In addition, it was shown that complicated operations tended to be performed at large volume institutions.


Assuntos
Transposição das Grandes Artérias , Cardiologia/normas , Cardiopatias Congênitas/cirurgia , Procedimentos de Norwood , Cardiologia/métodos , Cardiologia/tendências , Bases de Dados Factuais , Coração , Humanos , Lactente , Recém-Nascido , Japão , Morbidade , Complicações Pós-Operatórias
8.
Congenit Heart Dis ; 14(4): 665-670, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31290585

RESUMO

BACKGROUND: In pediatric cardiac care, many centers participate in multiple, national, domain-specific registries, as a major component of their quality assessment and improvement efforts. Small cardiac programs, whose clinical activities and scale may not be well-suited to this approach, need alternative methods to assess and track quality. METHODS: We conceived of and piloted a rapid-approach cardiac quality assessment, intended to encompass multiple aspects of the service line, in a low-volume program. The assessment incorporated previously identified measures, drawn from multiple sources, and ultimately relied on retrospective chart review. RESULTS: A collaborative, multidisciplinary team formed and came to consensus on quality metrics pertaining to 3 chosen areas of clinical activity in the program. Despite the use of multiple different data sources and the need for manual chart review in data collection, a rich assessment of these program components was completed for presentation in 6 weeks. CONCLUSIONS: While small programs may not participate in the spectrum of cardiac care registries available, these same centers can benefit from them by adapting some of their validated metrics for use in internal, self-maintained quality reports. Our pilot of this alternative approach revealed opportunities for improved quality assessment practices; the product can serve as a baseline for future prospective assessment and reporting, as well as longitudinal internal benchmarking.


Assuntos
Benchmarking/normas , Cardiologia/normas , Cardiopatias Congênitas/terapia , Hospitais com Baixo Volume de Atendimentos/normas , Avaliação de Programas e Projetos de Saúde , Indicadores de Qualidade em Assistência à Saúde , Criança , Humanos , Sistema de Registros , Estudos Retrospectivos , Estados Unidos
10.
J Vasc Surg ; 69(6S): 3S-125S.e40, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159978

RESUMO

Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.


Assuntos
Cardiologia/normas , Medicina Baseada em Evidências/normas , Isquemia/terapia , Doença Arterial Periférica/terapia , Técnicas de Imagem Cardíaca/normas , Doença Crônica , Consenso , Testes de Função Cardíaca/normas , Humanos , Isquemia/diagnóstico , Isquemia/mortalidade , Isquemia/fisiopatologia , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Terminologia como Assunto , Resultado do Tratamento
11.
Monaldi Arch Chest Dis ; 89(2)2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31107036

RESUMO

We do not always accomplish what is best for our patients. Is "more procedures, more drugs" a real synonym of good and always useful medicine? Probably not. Indeed, it has been highlighted that many tests and treatments, widely used in medical practice, do not bring benefits to patients, but they can be harmful. So, why do we keep performing them? Many reasons, surely one of the main is the constant fear of malpractice legal-medical consequences; this led to the development of a defensive medicine, no longer focused on the health of the patient. For this reason, the Italian Association of Cardiac Prevention and Rehabilitation (GICR-IACPR) joined an international project "Choosing Wisely", supported by the Slow Medicine Initiative, a network which states that "Less is more". The purpose of "Choosing Wisely " project is to improve the quality and safety of health services through the reduction of practices that, according to available scientific knowledge, do not bring significant benefits to the patients, but can, on the contrary, expose them to risks. This GICR-IACPR paper proposes to avoid five widespread practices in cardiology, at risk for inappropriateness and lacking of clinical evidence of benefit: • Do not perform routine chest X-ray in patients entering rehabilitation programme after cardiac surgery • Do not perform Computed Tomography for coronary calcium score in patients at high cardiovascular risk • Do not perform Holter electrocardiographic monitoring in patients suffering from syncope, near syncope or dizziness, in whom a non-arrhythmic origin has been documented • Do not routinely prescribe proton pump inhibitors (PPI) for gastrointestinal bleeding prophylaxis in patient with single drug antiplatelet therapy in absence of additional risk factors. • Avoid routine use of infective endocarditis prophylaxis in mild to moderate native valve disease.


Assuntos
Cardiologia/métodos , Cardiologia/normas , Endocardite/prevenção & controle , Hemorragia Gastrointestinal/prevenção & controle , Melhoria de Qualidade , Procedimentos Desnecessários , Anti-Infecciosos/uso terapêutico , Reabilitação Cardíaca , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia Ambulatorial , Endocardite/etiologia , Hemorragia Gastrointestinal/induzido quimicamente , Doenças das Valvas Cardíacas/complicações , Humanos , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Bomba de Prótons/uso terapêutico , Radiografia Torácica , Fatores de Risco , Síncope/etiologia , Tomografia Computadorizada por Raios X , Calcificação Vascular/diagnóstico por imagem
13.
Circ Res ; 124(4): 491-497, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-31031412

RESUMO

As we commemorate the 70th Anniversary of the National Heart, Lung, and Blood Institute (NHLBI) and celebrate important milestones that have been achieved by the Division of Cardiovascular Sciences (DCVS), it is imperative that DCVS and the Extramural Research community at-large continue to address critical public health challenges that persist within the area of Cardiovascular Diseases (CVD). The NHLBI's Strategic Vision, developed with extensive input from the extramural research community and published in 2016, included overarching goals and strategic objectives that serve to provide a general blueprint for sustaining the legacy of the Institute by leveraging opportunities in emerging scientific areas (e.g., regenerative medicine, omics technology, data science, precision medicine, and mobile health), finding new ways to address enduring challenges (e.g., social determinants of health, health inequities, prevention, and health promotion), and training the next generation of heart, lung, blood, and sleep researchers. DCVS has developed a strategic vision implementation plan to provide a cardiovascular framing for the pursuit of the Institute's overarching goals and strategic objectives garnered from the input of the broader NHLBI community. This plan highlights six scientific focus areas that demonstrate a cross-cutting and multifaceted approach to addressing cardiovascular sciences, including 1) addressing social determinants of cardiovascular health (CVH) and health inequities, 2) enhancing resilience, 3) promoting CVH and preventing CVD Across the lifespan, 4) eliminating hypertension-related CVD, 5) reducing the burden of heart failure, and 6) preventing vascular dementia. These priorities will guide our efforts in Institute-driven activities in the coming years but will not exclude development of other novel ideas or the support of investigator-initiated grant awards. The DCVS Strategic Vision implementation plan is a living document that will evolve with iterative dialogue with the NHLBI community and adapt as the dynamic scientific landscape changes to seize emerging opportunities.


Assuntos
Cardiologia/normas , Doenças Cardiovasculares/terapia , National Heart, Lung, and Blood Institute (U.S.) , Guias de Prática Clínica como Assunto , Cardiologia/economia , Cardiologia/tendências , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Humanos , Estados Unidos
14.
Leadersh Health Serv (Bradf Engl) ; 32(2): 296-308, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-30945595

RESUMO

PURPOSE: The purpose of this study is to gather information about work culture characteristics from four successful pediatric heart programs to better understand how they continue to maintain high standards of quality and safety. DESIGN/METHODOLOGY/APPROACH: For this qualitative study, data were collected through semi-structured in-depth individual interviews with four physician leaders. Those interviews were transcribed and coded for themes, first individually and then across all four. FINDINGS: Three themes emerged from the analysis. According to the experts, the three most salient elements for sustaining a successful work culture that is conducive to maintaining high standards of care are: the 'right' people, an effective leadership team and efficient systems. RESEARCH LIMITATIONS/IMPLICATIONS: This was a small homogenous sample, which is a limitation of the study. All of the programs were from non-profit teaching hospitals in urban areas. This study has important research implications, as it offers descriptive information useful for guiding a future explanatory study. PRACTICAL IMPLICATIONS: Recommendations have been made for leaders in healthcare settings to benchmark against the work being done at these programs that maintain high standards of quality and safety. SOCIAL IMPLICATIONS: This information has important social and practical implications as healthcare leaders continue to work on improving quality and safety that affects patients across the country. ORIGINALITY/VALUE: This study contributes to the literature by offering perspectives on successful work cultures from a diverse compilation of physician leaders and medical institutions across the USA.


Assuntos
Cardiologia/normas , Liderança , Cultura Organizacional , Pediatria/normas , Médicos/psicologia , Humanos , Entrevistas como Assunto , Segurança do Paciente , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
16.
Cardiovasc Diabetol ; 18(1): 30, 2019 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-30857522

RESUMO

The 4th Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes & Cardiovascular Disease (D&CVD) EASD Study Group was held in Munich on 25-26 October 2018. As in previous years, this summit served as a reference meeting for in-depth discussions on the topic of recently completed and presented CVOTs. This year, focus was placed on the CVOTs CARMELINA, DECLARE-TIMI 58 and Harmony Outcomes. Trial implications for diabetes management and the impact of the new ADA/EASD consensus statement treatment algorithm were highlighted for diabetologists, cardiologists, endocrinologists, nephrologists and general practitioners. Discussions evolved from CVOTs to additional therapy options for heart failure (ARNI), knowledge gained for adjunct therapy of type 1 diabetes and, on the occasion of the 10 year anniversary of the FDA's "Guidance for Industry: "should CVOTs be continued and/or modified?" The 5th Cardiovascular Outcome Trial Summit will be held in Munich on 24-25 October 2019 ( http://www.cvot.org ).


Assuntos
Pesquisa Biomédica/métodos , Cardiologia/métodos , Doenças Cardiovasculares/terapia , Ensaios Clínicos como Assunto/métodos , Diabetes Mellitus/tratamento farmacológico , Endocrinologia/métodos , Hipoglicemiantes/uso terapêutico , Pesquisa Biomédica/normas , Cardiologia/normas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Ensaios Clínicos como Assunto/normas , Comportamento Cooperativo , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Endocrinologia/normas , Humanos , Hipoglicemiantes/efeitos adversos , Comunicação Interdisciplinar , Guias de Prática Clínica como Assunto , Resultado do Tratamento
17.
BMC Health Serv Res ; 19(1): 106, 2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30732612

RESUMO

BACKGROUND: A body of knowledge continues to grow regarding Aboriginal perspectives on current challenges and barriers to health literacy and access to health services. However, less is known from the perspectives of health professionals who work in cardiac care. Given their role in delivering patient education, health practitioners could provide useful insights into potential solutions to improve patient-practitioner communication. The primary aim was to explore perspectives of health professionals who work in coronary care units regarding the enablers, barriers and potential solutions for patient-practitioner communication with patients of Aboriginal and Torres Strait Islanders descent. The secondary aim was to evaluate the acceptability and value of two videos developed with key stakeholders to provide culturally appropriate education. METHODS: Participants were recruited from two major regional hospitals. In-depth, semi-structured interviews were conducted with 17 health professionals (11 Nurses, five Cardiologists and one Aboriginal Health Worker). Interviews were recorded, de-identified and transcribed verbatim. Transcripts were analysed using constant comparison, interpreted through inductive thematic analysis and final themes were agreed through consensus with secondary researcher. RESULTS: Health professionals acknowledged that existing barriers resulted from organisational structures entrenched in the healthcare system, impacted on the practitioners' ability to provide culturally appropriate, patient-centred care. Lack of time, availability of culturally appropriate resources and the disconnection between Western medical and Aboriginal views of health were the most common challenges reported. The two videos evaluated as part of this study were found to be a useful addition to practice. Strengths in the videos design were the use of Aboriginal and Torres Strait Islander actors and positive messaging to convey health related topics. Further improvements included additional information related to common tests and procedures to allow for realistic expectations of patient care. CONCLUSION: Re-modelling of organisational structures is required in order to promote a more culturally-friendly and welcoming environment to encourage Aboriginal and Torres Strait Islanders to engage with mainstream cardiac care services. The videos that were developed using principles that are sensitive to Aboriginal health views, may offer an additional way in which to overcome existing barriers to effective patient-practitioner communication with Aboriginal and Torres Strait Islanders.


Assuntos
Cardiologia , Competência Cultural/educação , Comunicação em Saúde/métodos , Educação em Saúde/métodos , Serviços de Saúde do Indígena , Grupo com Ancestrais Oceânicos/educação , Atitude do Pessoal de Saúde , Austrália , Cardiologia/normas , Barreiras de Comunicação , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino
18.
Cleve Clin J Med ; 86(2): 123-139, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30742582

RESUMO

The 2017 focused update of the 2013 ACC/AHA guideline on heart failure contains new and important recommendations on prevention, novel biomarker uses, heart failure with preserved ejection fraction (HFpEF), and comorbidities such as hypertension, iron deficiency, and sleep-disordered breathing. Potential implications for management of acute decompensated heart failure will also be explored.


Assuntos
Cardiologia/normas , Insuficiência Cardíaca , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Biomarcadores/análise , Pressão Sanguínea , Gerenciamento Clínico , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Humanos , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Peptídeo Natriurético Encefálico/sangue , Volume Sistólico
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