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Latest & greatest articles for heart failure
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A blood test threshold for diagnosing heartfailure in general practice is reviewed A blood test threshold for diagnosing heartfailure in general practice is reviewed Discover Portal Discover Portal A blood test threshold for diagnosing heartfailure in general practice is reviewed Published on 3 May 2017 doi: The cut-off level for the blood test NTproBNP appears to provide the best balance of detecting true cases while excluding false positives when lowered to 125 pg/ml. The trial supported (...) by the NIHR included a sample of people presenting to their GP with suspected heartfailure. It aimed to see which method was best for identifying those who needed referral: the blood test alone; clinical decision rules based on clinical symptoms; or the combination of both. The blood test alone at the 125 pg/ml cut-off correctly identified 94% of people with heartfailure but led to 50% of people who did not have heartfailure being referred for further investigation. This threshold is lower than
Cost-Effectiveness of a Home Visit Program for Patients with HeartFailure in Brazil: Evidence from a Randomized Clinical Trial. Estimate the cost-effectiveness of a nurse-led home visit (HV) intervention as compared with the standard HF management, within a randomized clinical trial in Brazil.Cost-effectiveness study within a randomized trial.To assess the cost-effectiveness of four home visits and four telephone calls by nurses in the management of patients with HF within a randomized
Chronic congestive heartfailure Chronic congestive heartfailure - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Chronic congestive heartfailure Last reviewed: February 2019 Last updated: January 2019 Summary A complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. It is a major and growing public health (...) problem. It is the only cardiovascular disease that is increasing in incidence and prevalence, partly because the population is ageing, but also because of improved cardiovascular interventions for disease processes that reduce early mortality but may result in cardiac changes that lead to heartfailure. The key manifestations are dyspnoea and fatigue, which may limit exercise tolerance, and fluid retention, which may lead to pulmonary congestion and peripheral oedema. Diagnosis is largely clinical
Disease management interventions for heartfailure. Despite advances in treatment, the increasing and ageing population makes heartfailure an important cause of morbidity and death worldwide. It is associated with high healthcare costs, partly driven by frequent hospital readmissions. Disease management interventions may help to manage people with heartfailure in a more proactive, preventative way than drug therapy alone. This is the second update of a review published in 2005 and updated (...) in 2012.To compare the effects of different disease management interventions for heartfailure (which are not purely educational in focus), with usual care, in terms of death, hospital readmissions, quality of life and cost-related outcomes.We searched CENTRAL, MEDLINE, Embase and CINAHL for this review update on 9 January 2018 and two clinical trials registries on 4 July 2018. We applied no language restrictions.We included randomised controlled trials (RCTs) with at least six months' follow-up
(CABG) or percutaneous coronary intervention (PCI)) should be considered in patients with HF and suitable coronary anatomy. Key message 7: Asymptomatic LV Dysfunction ? Identify patients who are at high risk of developing LV dysfunction and treat the underlying disease appropriately. ? ACE-I and ß-blockers (post MI) have been shown to slow down the onset of symptoms and reduce cardiac morbidity. Key message 8:HeartFailure with Preserved LV Function (HFpEF) ? HFpEF is a common cause of HF (...) bypass graft (CABG) or percutaneous coronary intervention (PCI)) should be considered in patients with HF and suitable coronary anatomy. Key message 7: Asymptomatic LV Dysfunction ? Identify patients who are at high risk of developing LV dysfunction and treat the underlying disease appropriately. ? ACE-I and ß-blockers (post MI) have been shown to slow down the onset of symptoms and reduce cardiac morbidity. Key message 8:HeartFailure with Preserved LV Function (HFpEF) ? HFpEF is a common cause
Motivational interviewing can support physical activity in elderly patients with diastolic heartfailure: results from a pilot study. Patients suffering from heartfailure with preserved ejection fraction (HFpEF) report similar symptoms and reduction in quality of life to those with reduced ejection fraction but remain largely untreated. We conducted a preliminary evaluation of the acceptance, feasibility, and efficacy of a motivational interviewing (MI) intervention to support elderly patients (...) suffering from HFpEF in maintaining or starting physical activity.At the conclusion of the exercise training in diastolic heartfailure parent trial that examined the effects of supervised exercise, patients with HFpEF were offered participation in a two-group pilot study. Based on their preference, consenting patients were assigned to either a 6 month MI intervention group (n = 19) or their physicians' usual care (n = 20). To support participants in increasing and/or maintaining their physical activity
Association of Rivaroxaban With Thromboembolic Events in Patients With HeartFailure, Coronary Disease, and Sinus Rhythm: A Post Hoc Analysis of the COMMANDER HF Trial. Whether anticoagulation benefits patients with heartfailure (HF) in sinus rhythm is uncertain. The COMMANDER HF randomized clinical trial evaluated the effects of adding low-dose rivaroxaban to antiplatelet therapy in patients with recent worsening of chronic HF with reduced ejection fraction, coronary artery disease (CAD
High vs. low oxygen therapy in patients with acute heartfailure: HiLo-HF pilot trial. Most patients with acute heartfailure (AHF) are treated with supplemental oxygen during hospitalization. In this study, we investigated the effect of oxygen titrated to high vs. low pulse oximetry targets in patients hospitalized with AHF.In a pilot, open-label randomized controlled trial (RCT), 50 patients who were admitted with AHF were randomized to either high (≥96%) or low (90-92%) SpO2 targets. Oxygen (...) , -1253) pg/mL in the high SpO2 group and -2093 (-5692, -353) pg/mL in the low SpO2 group (P = 0.46), and the 72 h to baseline NT-proBNP ratio was similar between groups (0.7 vs. 0.6, P = 0.51). There were no differences between arms in change in dyspnoea VAS (P = 0.86), PGA (P = 0.91), PEF (P = 0.52), in-hospital mortality (4.0% vs. 8.0%, P = 0.50), or 30 day heartfailure readmission rates (20.8% vs. 8.7%, P = 0.22).In this study, no differences were observed in the primary or secondary outcomes
General medicine: Angiotensin receptor neprilysin inhibitors in older patients with heartfailure Angiotensin receptor neprilysin inhibitors in older patients with heartfailure | BMJ Evidence-Based Medicine Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers (...) of institutional accounts Username * Password * your user name or password? You are here Angiotensin receptor neprilysin inhibitors in older patients with heartfailure Article Text EBM opinion and debate General medicine Angiotensin receptor neprilysin inhibitors in older patients with heartfailure Anthony T Sharkey 1 , Mohd Zaquan Ghafar 1 , Shaun T O’Keeffe 1 , Eamon C Mulkerrin 1 , 2 Statistics from Altmetric.com Introduction Heartfailure affects approximately 1.5% of the adult population in developed
Linagliptin Effects on HeartFailure and Related Outcomes in Individuals With Type 2 Diabetes Mellitus at High Cardiovascular and Renal Risk in CARMELINA Individuals with type 2 diabetes mellitus are at increased risk for heartfailure (HF), particularly those with coexisting atherosclerotic cardiovascular disease and/or kidney disease. Some but not all dipeptidyl peptidase-4 inhibitors have been associated with increased HF risk. We performed secondary analyses of HF and related outcomes
Meta-Analysis of Effects of Digoxin on Survival in Patients with Atrial Fibrillation or HeartFailure: An Update In 2015, 3 independent meta-analyses raised concerns about digoxin therapy being associated with an increased mortality risk in patients with atrial fibrillation (AF) and with heartfailure (HF). Although several other studies have been published since then fostering these safety issues, the most recent 2016 European guidelines for AF still recommend this therapy as a class I (...) with an increased mortality risk in the subgroup of patients with AF (n = 627,620, HR 1.23, 95% CI, 1.17 to 1.30, p <0.01), and in the subgroup of patients with HF (n = 197,441, HR 1.11, 95% CI, 1.06 to 1.16, p<0.01). A sensitivity analysis of studies reporting data on new digoxin users (n = 41,687) demonstrated an even higher risk for all-cause mortality compared with patients not receiving cardiac glycosides (HR 1.47, 95% CI, 1.15 to 1.88, p <0.01). In conclusion, this updated meta-analysis confirms
categories with either a reduced or preserved ejection fraction. Symptoms are classified according to severity using the New York Heart Association (NYHA) functional classification. The most common underlying cause is coronary artery disease. Complications include arrhythmias, depression, cachexia, chronic kidney disease, sexual dysfunction, and sudden cardiac death. About 50% of people with heartfailure die within 5 years of diagnosis, and about 40% of people admitted to hospital with heartfailure die (...) nocturnal dyspnoea). Fluid retention (ankle swelling, bloated feeling, abdominal swelling, or weight gain). Fatigue, decreased exercise tolerance, or increased recovery time after exercise. Light headedness or history of syncope. Ask about risk factors: Coronary artery disease including previous history of myocardial infarction, hypertension, atrial fibrillation, and diabetes mellitus. Drugs, including alcohol. Family history of heartfailure or sudden cardiac death under the age of 40 years. Examine
Catheter Ablation of Atrial Fibrillation in Patients With HeartFailure: A Meta-analysis of Randomized Controlled Trials. Atrial fibrillation (AF) and heartfailure (HF) frequently coexist and are associated with increased morbidity and mortality risk.To compare benefits and harms between catheter ablation and drug therapy in adult patients with AF and HF.ClinicalTrials.gov, PubMed, Web of Science (Clarivate Analytics), EBSCO Information Services, Cochrane Central Register of Controlled Trials (...) %; risk ratio [RR], 0.52 [95% CI, 0.33 to 0.81) and HF hospitalizations (16.4% vs. 27.6%; RR, 0.60 [CI, 0.39 to 0.93]). Ablation improved left ventricular ejection fraction (LVEF) (mean difference, 6.95% [CI, 3.0% to 10.9%]), 6-minute walk test distance (mean difference, 20.93 m [CI, 5.91 to 35.95 m]), peak oxygen consumption (Vo2max) (mean difference, 3.17 mL/kg per minute [CI, 1.26 to 5.07 mL/kg per minute]), and quality of life (mean difference in Minnesota Living with HeartFailure Questionnaire
Association of the Hospital Readmissions Reduction Program With Mortality Among Medicare Beneficiaries Hospitalized for HeartFailure, Acute Myocardial Infarction, and Pneumonia. The Hospital Readmissions Reduction Program (HRRP) has been associated with a reduction in readmission rates for heartfailure (HF), acute myocardial infarction (AMI), and pneumonia. It is unclear whether the HRRP has been associated with change in patient mortality.To determine whether the HRRP was associated
will then titrate the medication according to a predetermined protocol. Depending on hospital policy, the heartfailure nurse may or may not consult with a cardiologist. In the home visit setting, similar processes are used. These nurses are advanced practice nurses and employed as a nurse practitioner or senior cardiac nurse. They must have institutional approval to titrate these medications. None of the studies described the training undertaken by the heartfailure nurses. In clinical practice, provided (...) Specialist nurses can manage heartfailure drug dosing successfully Specialist nurses can manage heartfailure drug dosing successfully Discover Portal Discover Portal Specialist nurses can manage heartfailure drug dosing successfully Published on 9 February 2016 doi: Use of specialist nurses to optimise drug dosages using protocols in people with heartfailure was more effective than dose monitoring by other health professionals. These nurses had advanced practice certification. This finding
Telehealth can help people with heartfailure avoid hospital admission Telehealth can help people with heartfailure avoid hospital admission Discover Portal Discover Portal Telehealth can help people with heartfailure avoid hospital admission Published on 18 January 2016 doi: Home telephone or telemonitoring support can bring some aspects of specialised care and monitoring into the homes of people with heartfailure. This updated Cochrane review confirmed that people with heartfailure who (...) received home telehealth support were less likely to die or go into hospital for problems relating to their heartfailure than those getting usual care. Usual care involved visiting a GP surgery or hospital for care and monitoring, which may be difficult for frail people with limited mobility. The review included seventeen new trials since the last review was published five years ago. More evidence is needed on which people would gain most benefit, particularly considering that people with heart
Association of Renin-Angiotensin Inhibitor Treatment With Mortality and HeartFailure Readmission in Patients With Transcatheter Aortic Valve Replacement. Data are lacking on the effect of a renin-angiotensin system (RAS) inhibitor prescribed after transcatheter aortic valve replacement (TAVR). Treatment with a RAS inhibitor may reverse left ventricular remodeling and improve function.To investigate the association of prescription of a RAS inhibitor and outcomes after TAVR.Retrospective cohort (...) outcomes were all-cause death and readmission due to heartfailure at 1 year after discharge, which were considered separately. The secondary outcome was health status assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ; score range: 0-100, with a higher score indicating less symptom burden and better quality of life; a small effect size was defined as 5 points) at 1 year.Among 21 312 patients who underwent TAVR at 417 US sites, 8468 patients (39.7%) were prescribed a RAS inhibitor
Chronic HeartFailure and Exercise Rehabilitation: A Systematic Review and Meta-Analysis The aim of this systematic review was to identify the effect of specific exercise parameters on physical function and quality of life (QOL) in people with chronic heartfailure living in the community.A total of 5 electronic databases were searched for relevant studies published after 1994.The screening process was completed by 2 independent researchers, with a third independent reviewer for conflict (...) -regression, including 27 randomized control trials and 13 cohort studies. Exercise was shown to have a positive effect on QOL outcomes (standardized mean difference 1.16; 95% confidence interval [CI], 0.76-1.56) with the most commonly used measure, the Minnesota Living with HeartFailure Questionnaire, showing a clinically significant change of 8.5 points. Physical function was improved postexercise intervention in the 23 included studies (standardized mean difference 0.89; 95% CI, 0.40-1.38