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1.
Kardiologiia ; 60(8): 90-97, 2020 Sep 17.
Artigo em Russo | MEDLINE | ID: mdl-33155964

RESUMO

Aim To compare the efficacy of radiofrequency ablation (RFA) and antiarrhythmic therapy (AAT) in patients with atrial fibrillation (AF) and chronic heart failure (CHF) during 12-month observation.Materials and methods This prospective, nonrandomized comparative observational study included 130 patients with AF (men, 65 %; mean age, 62.8±11.8 years) and CHF with left ventricular ejection fraction (LV EF) <50 %. Paroxysmal AF was observed in 60 (46 %) patients and persistent AF was observed in 70 (54 %) patients. According to results of transthoracic echocardiography (EchoCG) 107 (82 %) patients had intermediate LV EF (40-49 %) and 23 (18 %) patients had reduced LV EF (<40 %). RFA of AF was performed for 65 patients whereas 65 patients received an optimal AAT. The 24-h electrocardiogram monitoring, EchoCG, and assessment of the quality of life (QoL) with the SF-36 questionnaire were performed for all patients on admission and at 12 months of observation. Stability of sinus rhythm, EchoCG, QoL, and exercise tolerance were evaluated at 12 months of observation.Results 49 (75%) of patients in the RFA group and 26 (40%) of patients in the AAT group had stable sinus rhythm (SR) at 12 months. Repeated RFA for relapse of AF was performed for 6 (12 %) of 49 patients; repeated cardioversion was performed for 16 (61.5 %) of 26 patients. In the AAT group, there were more interventions for maintaining SR than in the RFA group (p<0.001). In patients with SR of the RFA group at 12 months of observation, LV EF was increased (р<0.001), left ventricular dimension (р<0.001) and volume (р<0.001) were decreased, and mental (р<0.001) and physical (p<0.001) components of health were improved according to the SF-36 questionnaire. In patients with SR of the AAT group, only improvement of mental (р<0.001) and physical (р<0.001) components of health was observed according to the SF-36 questionnaire.Conclusion RFA provided a considerable decrease in the frequency of AF relapse and improvement of LV EF in patients with CHF. The effectiveness of RFA did not depend on the type of arrhythmia. For 12 months of observation, the number of hospitalizations for decompensated CHF and interventions to maintain SR decreased in the RFA group compared to the AAT group.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Cardioversão Elétrica , Insuficiência Cardíaca , Idoso , Fibrilação Atrial/cirurgia , Fibrilação Atrial/terapia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
2.
Kardiologiia ; 60(7): 78-85, 2020 Aug 11.
Artigo em Russo | MEDLINE | ID: mdl-33155944

RESUMO

Aim To compare diagnostic significance of different criteria for complete left bundle branch block (cLBBB) in prediction of reverse left ventricular (LV) remodeling associated with cardiac resynchronization therapy (CRT).Materials and methods This study included 93 patients (men, 81.7 %; mean age at the time of implantation, 56.6±9.3 years). Achievement of a maximum decrease in LV end-systolic volume (ESV) was recorded during the entire follow-up period for evaluation of LV reversibility by CRT. Based on the dynamics of LV ESV, patients were divided into two groups, non-responders (n=27) and responders (n=66). cLBBB was determined by 9 criteria (ESC 2006 and 2013, AHA 2009, Strauss, and MIRACLE, CARE-HF, MADIT-CRT, REVERSE, and RAFT used in large multicenter studies).Results Incidence of cLBBB was significantly higher in the group of responders as demonstrated by the AHA (p=0.001), ESC 2013 (p=0.014), Strauss (p=0.002), MADIT-CRT (p=0.014), REVERSE (p=0.013), and RAFT (p<0.001) criteria. The highest specificity was shown for the AHA and RAFT (92.6 %) criteria, and the highest sensitivity and overall accuracy were shown for the Strauss (80.3 % and 72.04 %, respectively) criterium. The criteria proposed in actual clinical guidelines (AHA and ESC 2013) demonstrated a strong consistency in detecting cLBBB (κ=0.818, 95 % CI, 0.7-0.936; p<0.001). However, the Strauss and ESC 2006 / AHA / ESC 2013 showed the least consistency in identifying cLBBB. For the criteria described in large multicenter studies, consistency in detecting cLBBB was minimal in most cases. However, criteria with moderate or strong consistency were used in the studies, which results have substantiated the use of cLBBB as a selection criterium (MADIT-CRT, REVERSE, and RAFT).Conclusion The reversibility of LV remodeling associated with CRT was different in patients with cLBBB determined by different criteria. All actual cLBBB criteria (AHA, ESC 2013, and Strauss) were significantly more frequently observed in the responder group. Nevertheless, these criteria differed in their sensitivity and specificity. A number of large multicenter studies have used criteria with minimal consistency in detecting cLBBB, which should be taken into account in interpreting results of these studies.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/terapia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Remodelação Ventricular
3.
Kardiologiia ; 60(8): 84-89, 2020 Sep 17.
Artigo em Russo | MEDLINE | ID: mdl-33155963

RESUMO

Aim To compare Russian versions of the scales for assessment of self-care ability in patients with chronic heart failure (CHF), European Heart Failure Self-Care Behavior Scale (EHFScBS_9) and The Self-Сare of Heart Failure Index (SCHFI, version 6.2).Materials and methods Assessment of the self-care ability was performed with Russian versions of EHFScBS_9 and SCHFI (version 6.2) scales in 130 patients with NYHA functional class II-IV CHF primarily of ischemic origin (78.5 %). Mean age of patients was 63.2±9.6 years; most of the patients were men (n=92; 70.8 %). Patients were managed in accordance with effective guidelines ESC / HFA 2016 and Russian guidelines 2018.Results Along with an increase in SСHFI scores, a decrease in EHFScBS_9 scores was observed (r= -0.31, p<0.001). The patients participating in the study showed a low self-care ability at baseline according to results of both scales.Conclusion The presence of certain differences between the study scales does not exclude a possibility of using them alone or together for more detailed assessment of the self-care ability.


Assuntos
Insuficiência Cardíaca , Autocuidado , Idoso , Doença Crônica , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Federação Russa , Inquéritos e Questionários
4.
Kardiologiia ; 60(8): 106-114, 2020 Sep 17.
Artigo em Russo | MEDLINE | ID: mdl-33155966

RESUMO

Chronic heart failure (CHF) is a wide-spread disease (from 7 to 10% in the Russian Federation) and tends to grow. Frequent, repeated hospitalizations of CHF patients are due to insufficient compliance of patients with the treatment and the absence of continuity in management of patients between the hospital and out-patient clinic. Developing a structure of specialized care could provide improvement of treatment quality, a decrease in the number of hospitalizations, and better prognosis. International experience shows that creation of specialized clinics for heart failure improves quality of medical care in CHF and decreases the frequency of re-hospitalizations and mortality. In the Russian Federation, such clinics were created in Nizhniy Novgorod, Ufa, Saint Petersburg, and several other cities. The article presents an expert consensus on the structure, functions, and equipment of departments and offices for patients with heart failure.


Assuntos
Insuficiência Cardíaca , Doença Crônica , Cidades , Insuficiência Cardíaca/terapia , Hospitalização , Humanos , Federação Russa
5.
Kyobu Geka ; 73(10): 757-763, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130761

RESUMO

The lower preoperative left ventricular ejection fraction( LVEF), the more postoperative death. The perioperative management for cardiovascular patients with heart failure (LVEF<40%) is of great importance in cardiac surgery. The failing heart is characterized by intracellular Ca2+ handling abnormalities during excitation/contraction coupling( i.e., less amount of cytosolic Ca2+ recruitment in systole and insufficient cytosolic Ca2+ extrusion in diastole), which are caused by increased reverse-mode Na+/ Ca2+ exchange activity and abnormal sarcoplasmic reticular Ca2+ channels (ryanodine receptors) and Ca2+ pumps (adenosine triphosphatase:ATPases). Myocardial ischemia/reperfusion (I/R) damage is characterized by intracellular acidosis followed by Ca2+ overload during I/R. The failing/hypertrophied myocardium has a low coronary vascular density, leading to low oxygen supply to the cardiomyocyte, and is vulnerable to Ca2+ load during I/R. Based on those abnormalities, hypothermic cardioplegia is recommended to suppress myocardial oxygen demand in open heart surgery for patients with heart failure(low LVEF). Optimal medical managements using adrenergic stimulators, vasodilators, antiarrhythmics, cardiac pacing, NO inhalation, or myocardial Ca2+ sensitizers under preload adjustment may be essential for hemodynamic improvement of postoperative low cardiac output syndrome. On a case-bycase basis, mechanical circulatory support systems should be utilized before the development of multiple organ failure.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Insuficiência Cardíaca , Cálcio/metabolismo , Coração , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Retículo Sarcoplasmático/metabolismo , Trocador de Sódio e Cálcio , Volume Sistólico , Função Ventricular Esquerda
6.
Kyobu Geka ; 73(10): 855-861, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130779

RESUMO

Recent changes in the demographics of surgical candidates, in terms of age, have increased the number of patients with surgical risk factors. In patients with preoperative cardiac diseases such as myocardial ischemia, arrhythmia, or congestive heart failure, it is important to offer any necessary preoperative medical examinations and treatments because postoperative cardiac failure is more of a concern in patients with already abnormal cardiac physiology, undergoing significant lung resection. Thoracic surgeons should be challenged by another conundrum to accurately select the best candidates for surgical treatment. Usually perioperative management of antithrombotic therapy in patients who need general thoracic operations such as lung cancer surgery after coronary artery stent placement or valve replacement have made recommendations, and heparinization is needed for patients with atrial fibrillation for prevention of thrombo-embolism. It is sometimes used in clinical practice as bridging therapy during the period of discontinuation of antiplatelet therapy for patients with cardiac complications after several cardiac surgery. As points to be aware of regarding surgical operations, minimal invasive surgery probably should be performed if possible.


Assuntos
Doença da Artéria Coronariana , Cardiopatias , Insuficiência Cardíaca , Cirurgia Torácica , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Assistência Perioperatória , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco
7.
J Assoc Physicians India ; 68(11): 66-68, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33187040

RESUMO

COVID-19 has been the biggest pandemic which the world has seen in recent times. The SARS-Cov-2 infection has the potential to cause multi-organ dysfunction. Though the virus predominantly affects the lungs, it can affect the heart in myriad ways. Heart failure (HF) is one such complication caused by the virus, both in patients with and without cardiovascular diseases. Different mechanisms have been proposed for the pathogenesis of HF in COVID-19 ranging from direct viral injury to indirect immune mediated damage. Patients can have different clinical presentations with either acute heart failure or chronic heart failure. Early recognition and prompt management is the need of the hour to prevent any mortality and morbidity. Summary: COVID-19 can affect the heart in many ways. This article describes the mechanisms, clinical presentations and management of heart failure caused by COVID-19 infection.


Assuntos
Infecções por Coronavirus , Coronavirus , Insuficiência Cardíaca , Pandemias , Pneumonia Viral , Betacoronavirus , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos
8.
Saudi Med J ; 41(11): 1211-1216, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33130841

RESUMO

OBJECTIVES: To study the impact of curfews during the COVID-19 pandemic, on the physical activity in patients of heart failure implanted withcardiac implantable electronic devices (CIEDs). METHODS: This was a retrospective single-center study of heart failure patients inserted with remote monitoring (RM)-capable CIED. We analyzed the transmitted data of physical activity and fluid volume status of all patients, before, and during the lockdown periods between February and April 2020. The clinical status of the patients was also evaluated.  Results: Device data from 429 patients implanted with CIED capable of RM were initially evaluated. Patients with an implantable loop recorder, Brugada or Long QT syndromes, and patients with incomplete transmissions were excluded. Eighty-two patients with heart failure were included. The median age was 65 years (58-72), and 53 (64.6%) subjects were men. There was a 27.1% decline in physical activity, and the median physical activity of patients significantly declined from 2.4 to 1.8 hours/day (p=0.000010).  Conclusion: Data obtained by remotely monitored CIED in heart failure patients suggests a significant decline in physical activity during the country lockdown due to the pandemic. Awareness of the future potential hazards in this group of patients is warranted.


Assuntos
Infecções por Coronavirus/prevenção & controle , Desfibriladores Implantáveis/estatística & dados numéricos , Exercício Físico/fisiologia , Insuficiência Cardíaca/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/estatística & dados numéricos , Telemetria/métodos , Idoso , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Prognóstico , Quarentena/métodos , Estudos Retrospectivos , Medição de Risco , Arábia Saudita , Comportamento Sedentário , Taxa de Sobrevida
9.
Medicine (Baltimore) ; 99(45): e22951, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157936

RESUMO

INTRODUCTION: The efficacy of baroreflex activation therapy for heart failure is elusive. This meta-analysis aims to evaluate the impact of baroreflex activation therapy on treatment efficacy of heart failure. METHODS: Several databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases have been searched, and we include randomized controlled trials (RCTs) regarding the efficacy of baroreflex activation therapy for patients with heart failure. RESULTS: This meta-analysis includes 4 RCTs. Baroreflex activation therapy shows significantly positive impact on the quality of life score (standard mean difference SMD = -4.61; 95% confidence interval CI = -6.24 to -2.98; P < .00001), 6-minute hall walk (6MHW) distance (SMD = 2.83; 95% CI = 1.44- 4.22; P < .0001), New York Heart Association (NYHA) Class (SMD = -3.23; 95% CI = -4.76 to -1.69; P < .0001), N-terminal pro-brain natriuretic peptide (NT-proBNP) (SMD = -1.24; 95% CI = -1.58 to -0.89; P < .00001) and the duration of hospitalization (SMD = -1.65; 95% CI = -2.90 to -0.39; P = .01) compared with control group for heart failure, but has no obvious effect on left ventricular ejection fraction (LVEF) (SMD = 1.43; 95% CI = -0.15-3.01; P = .08), or the number of hospitalization per year (SMD = -1.17; 95% CI = -2.56-0.22; P = .10). CONCLUSIONS: Baroreflex activation therapy can improve the treatment efficacy for heart failure.


Assuntos
Barorreflexo , Terapia por Estimulação Elétrica , Insuficiência Cardíaca/terapia , Humanos , Neuroestimuladores Implantáveis , Tempo de Internação , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Teste de Caminhada
12.
Anatol J Cardiol ; 24(5): 334-342, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33122486

RESUMO

OBJECTIVE: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1). METHODS: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. RESULTS: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001]. CONCLUSION: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42).


Assuntos
Infecções por Coronavirus/epidemiologia , Infarto do Miocárdio/terapia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Angiografia Coronária/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea/estatística & dados numéricos , Prognóstico , Sistema de Registros , Análise de Regressão , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Fatores de Tempo , Resultado do Tratamento , Turquia/epidemiologia
13.
Yonsei Med J ; 61(11): 942-950, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107237

RESUMO

PURPOSE: Implantable cardioverter defibrillators (ICD) are the standard of care for primary prevention (PP) in patients with ischemic cardiomyopathy (ICM). However, PP ICD implantation is underused in Asian countries. This study investigated ICD implantation rates and factors associated with appropriate PP ICD implants for ICM. MATERIALS AND METHODS: In this prospective multicenter observational registry (ADVANCE-ICM registry), ICM patients who were eligible for PP ICD were screened and enrolled. Factors associated with appropriate ICD implantation, including hospital and clinical factors, were investigated. RESULTS: Of the 1453 ICM patients eligible for PP ICD [1111 male; median age, 71.0 (61.0-78.0) years], only 76 (5.2%) patients underwent ICD implantation. Among hospital factors, a non-monetary incentive for referral (72.4% vs. 52.9%, p=0.001) and total hospital system score (6.0 vs. 5.0, p=0.013) were higher in the ICD than in the no-ICD group. In multivariate analysis, total hospital system score [odds ratio (OR), 1.28; 95% confidence interval (CI), 1.10-1.50] was an independent factor for predicting ICD implantation, along with clinical factors, including high New York Heart Association class (≥III: OR, 7.29; 95% CI, 2.97-17.87) and younger age (<70 years: OR, 2.14; 95% CI, 1.30-3.53). CONCLUSION: PP ICD implantation for ICM patients is underused in Korea. Hospital factors were important for improving PP ICD implantation rate, suggesting that new screening and referral systems for ICM patients would improve the PP ICD implantation rate (Clinical trial registration No. NCT03590925).


Assuntos
Cardiomiopatias/prevenção & controle , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/instrumentação , Insuficiência Cardíaca/terapia , Isquemia Miocárdica/prevenção & controle , Prevenção Primária/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatias/epidemiologia , Cardiomiopatias/terapia , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/terapia , Prevenção Primária/métodos , Estudos Prospectivos , Sistema de Registros , República da Coreia/epidemiologia , Fatores de Risco , Resultado do Tratamento
14.
Medicine (Baltimore) ; 99(42): e22710, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080723

RESUMO

BACKGROUND: Exercise therapies has been shown to be safe and effective as a non-pharmacological management for treating heart failure, At the same time, many clinical trials, systematic review, and meta-analyses have demonstrated the advantages of exercise therapies in heart failure. However, the methodological quality of these systematic reviews and the differences in efficacy between different exercise modes are unclear. Therefore, this study intends to overview of systematic reviews and network meta-analysis of exercise therapies intervention in heart failure, and finally to rank the effects of exercise therapies in the intervention of heart failure, so as to provide certain reference for clinical decision-making. METHODS: From the seven databases: PubMed, EMBASE.com, Web of Science, the Cochrane Library, Chinese biomedical literature database (CBM), Chinese National Knowledge Infrastructure (CNKI), Wan fang Database, and Chongqing VIP (CQVIP) databases. To search for systematic or meta-analysis of different exercise therapies for heart failure from inception to August 2020. According to the inclusion criteria and exclusion criteria, the two researchers independently selected articles and extracted data. In case of differences, a third party shall be sought for settlement. The AMSTAR2 scale, PRISMA scale and GRADE were used to assess the quality and evidence grade of the literature. The eligible randomized controlled trials (RCTs) were selected from the included systematic reviews and updated RCTs from the above systematic reviews to August 2020. GRADE was used for the risk of bias of the included RCTs. Pairwise meta-analyses were performed using the random-effects model, and network meta-analysis of the included RCTs were performed the frequentist framework. All data analyses were completed in Stata 15.0. RESULTS: Finally, a total of 33 articles related to systematic review and meta-analysis were included, there are 28 articles in Chinese and 5 articles in English. The results of this overview and network meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION: This review will provide a comprehensive overview of existing systematic reviews of exercise therapies interventions for heart failure and provide recommendations for clinical practice or guidelines. PROTOCOL REGISTRATION: INPLASY202080118.


Assuntos
Terapia por Exercício , Insuficiência Cardíaca/terapia , Humanos
15.
Mymensingh Med J ; 29(4): 793-799, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116079

RESUMO

Prevalence of heart failure (HF) among end stage renal disease (ESRD) patients is high and HF remains the main cardiovascular co-morbidity at dialysis initiation. There is paucity of data comparing change of NYHA class, improvement of ejection fraction (EF) and major cardiac events in ESRD patients with concomitant heart failure on haemodialysis to those on peritoneal dialysis. The objective of the study was to compare the cardiac outcome of continuous ambulatory peritoneal dialysis (CAPD) & hemodialysis (HD) in chronic kidney disease 5 (CKD5) patients with HF. This prospective observational study was carried out from March 2018 to February 2019 in seventy CKD 5 patients with HF who opted for CAPD or HD. Seven patients dropped out during the follow-up & sixty three patients (CAPD=31; HD=32) were followed up for symptomatic assessment of cardiac status in terms of NYHA class as well as echocardiography and serum haemoglobin at baseline and at 3rd & 6th month. Major cardiovascular events like non fatal MI, non fatal stroke & death duo to cardiovascular diseases and co-morbidities were recorded during the study period. Statistical analysis was done using SPSS 22.0. Mean age was 53.33±6.38 and 54.23±10.15 years & male to female ratio was 1.81:1 and 1.46:1 in CAPD and HD groups respectively. Both NYHA class & left ventricular ejection fraction (EF) were significantly increased after six months compared to baseline in each group and significantly more increased in the CAPD group than the HD group. Left ventricular internal diameter in diastole (LVIDd) was reduced significantly after six months compared to baseline in both groups and there was no significant difference in LVIDd reduction between the CAPD and HD groups. Major cardiovascular events were found to occur more frequently in the HD group. According to NYHA functional class, echocardiographic findings and major cardiovascular events during six months, improvement of cardiac function in CKD 5 patients with HF was better on CAPD in comparison to HD.


Assuntos
Insuficiência Cardíaca , Falência Renal Crônica , Diálise Peritoneal Ambulatorial Contínua , Insuficiência Renal Crônica , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Volume Sistólico , Função Ventricular Esquerda
16.
Rev Med Liege ; 75(10): 644-648, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-33030839

RESUMO

The diagnosis of heart failure can sometimes be challenging for the clinician because presentation circumstances and heart failure phenotypes are varied. The identification and validation of sensitive and specific biomarkers for this condition are still a subject of intensive research. Among them, natriuretic peptides (ANP, BNP, NTproBNP) are widely used and validated as markers of heart failure. Their appropriate use and correct interpretation, however, require knowledge of their indications, specificities and limitations. The European Society of Cardiology has recently issued recommendations in this regard. This article summarizes them in order to facilitate the understanding and the use of natriuretic peptides in clinical practice. It also discusses their use in the etiological diagnosis of pleural effusions caused by heart failure.


Assuntos
Insuficiência Cardíaca , Derrame Pleural , Biomarcadores , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Peptídeos Natriuréticos , Sensibilidade e Especificidade
17.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(9. Vyp. 2): 85-90, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33076651

RESUMO

Sleep disordered breathing is a frequent comorbidity (50-75%) in patients with chronic heart failure, but it is usually underestimated. This review analyzes sleep disordered breathing in patients with chronic heart failure, demonstrates pathogenetic relationships and the prognostic role of sleep apnea. The authors present modern treatment options for sleep apnea in this cohort (from non-invasive ventilation to implantable devices), highlight the role of drug therapy and outline perspectives of different treatment approaches. This clinical problem is designated as multidisciplinary, which requires a dialogue between researchers and doctors of various specialties to organize comprehensive effective care for this cohort of patients.


Assuntos
Insuficiência Cardíaca , Síndromes da Apneia do Sono , Doença Crônica , Pressão Positiva Contínua nas Vias Aéreas , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Prognóstico , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/terapia
18.
JAMA ; 324(14): 1439-1450, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33048152

RESUMO

Importance: The evidence for palliative care exists predominantly for patients with cancer. The effect of palliative care on important end-of-life outcomes in patients with noncancer illness is unclear. Objective: To measure the association between palliative care and acute health care use, quality of life (QOL), and symptom burden in adults with chronic noncancer illnesses. Data Sources: MEDLINE, Embase, CINAHL, PsycINFO, and PubMed from inception to April 18, 2020. Study Selection: Randomized clinical trials of palliative care interventions in adults with chronic noncancer illness. Studies involving at least 50% of patients with cancer were excluded. Data Extraction and Synthesis: Two reviewers independently screened, selected, and extracted data from studies. Narrative synthesis was conducted for all trials. All outcomes were analyzed using random-effects meta-analysis. Main Outcomes and Measures: Acute health care use (hospitalizations and emergency department use), disease-generic and disease-specific quality of life (QOL), and symptoms, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (range, 0 [worst] to 184 [best]; minimal clinically important difference, 9 points) and symptoms translated to units of the Edmonton Symptom Assessment Scale global distress score (range, 0 [best] to 90 [worst]; minimal clinically important difference, 5.7 points). Results: Twenty-eight trials provided data on 13 664 patients (mean age, 74 years; 46% were women). Ten trials were of heart failure (n = 4068 patients), 11 of mixed disease (n = 8119), 4 of dementia (n = 1036), and 3 of chronic obstructive pulmonary disease (n = 441). Palliative care, compared with usual care, was statistically significantly associated with less emergency department use (9 trials [n = 2712]; 20% vs 24%; odds ratio, 0.82 [95% CI, 0.68-1.00]; I2 = 3%), less hospitalization (14 trials [n = 3706]; 38% vs 42%; odds ratio, 0.80 [95% CI, 0.65-0.99]; I2 = 41%), and modestly lower symptom burden (11 trials [n = 2598]; pooled standardized mean difference (SMD), -0.12; [95% CI, -0.20 to -0.03]; I2 = 0%; Edmonton Symptom Assessment Scale score mean difference, -1.6 [95% CI, -2.6 to -0.4]). Palliative care was not significantly associated with disease-generic QOL (6 trials [n = 1334]; SMD, 0.18 [95% CI, -0.24 to 0.61]; I2 = 87%; Functional Assessment of Chronic Illness Therapy-Palliative Care score mean difference, 4.7 [95% CI, -6.3 to 15.9]) or disease-specific measures of QOL (11 trials [n = 2204]; SMD, 0.07 [95% CI, -0.09 to 0.23]; I2 = 68%). Conclusions and Relevance: In this systematic review and meta-analysis of randomized clinical trials of patients with primarily noncancer illness, palliative care, compared with usual care, was statistically significantly associated with less acute health care use and modestly lower symptom burden, but there was no significant difference in quality of life. Analyses for some outcomes were based predominantly on studies of patients with heart failure, which may limit generalizability to other chronic illnesses.


Assuntos
Demência/terapia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/terapia , Cuidados Paliativos/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Idoso , Viés , Doença Crônica , Demência/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Razão de Chances , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Avaliação de Sintomas/estatística & dados numéricos
19.
Stud Health Technol Inform ; 273: 189-194, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-33087611

RESUMO

The prevalence of Heart Failure is growing exponentially in the last decades, particularly amongst older adults. Heart Failure is a chronic cardiovascular disease that demands self-care management and substantial healthcare resources. For that reason, it is highly associated with hospital readmissions and mortality. Due to increased hospitalization costs, excessive waiting times and lack of specialized healthcare professionals to follow-up this growing population, telemedicine and telemonitoring technologies have become the best solutions to support health providers in the disease management tasks. Telemonitoring technologies offer better and more comfortable care because the elderly do not have to leave the comfort of their home to interact with the doctors, giving and receiving daily feedbacks trough these new applications, wearables, and health care platforms. This paper provides a comprehensive review covering the current progress of research in telemedicine and telemonitoring and their applications to Heart Failure Management services. It presents SmartBEAT, which demonstrated during a pilot phase, a user adherence of 97% for three months. Furthermore, SmartBEAT plus, an improved solution, is described, and the system usability a technology acceptance will be evaluated through a pilot with 40 Heart Failure Patients, involving nurses and cardiologists.


Assuntos
Insuficiência Cardíaca , Telemedicina , Idoso , Doença Crônica , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Hospitalização , Humanos , Readmissão do Paciente
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