Showing papers by "John P. Boehmer published in 2002"
TL;DR: An overview of arrhythmias in patients with heart failure is presented and the prevalence, prognostic significance, complications, mechanisms, and trials that have formed the current therapies presently used are discussed.
Abstract: Both atrial and ventricular arrhythmias are very common in patients with congestive heart failure, and their presence is associated with symptoms, significant morbidity, and mortality. Studies have attempted to determine the prognostic significance of atrial and ventricular arrhythmias in patients with heart failure. Whether atrial fibrillation is an independent risk factor of mortality remains controversial. The presence of ventricular arrhythmias in patients with ischemic cardiomyopathy identifies patients at high risk for sudden death. However, in patients with nonischemic cardiomyopathy there is not a strong correlation between ventricular arrhythmias and increased risk for sudden death. Multiple trials using antiarrhythmic drugs, pharmacologic therapy, and implantable cardioverter defibrillators have been performed in an attempt to improve survival in patients 1) post-myocardial infarction; 2) with congestive heart failure, with and without nonsustained ventricular tachycardia; and 3) with sustained ventricular tachycardia and those who have survived an out-of-hospital cardiac arrest. The purpose of this article is to present an overview of arrhythmias in patients with heart failure and discuss the prevalence, prognostic significance, complications, mechanisms, and trials that have formed the current therapies presently used.
20 citations
TL;DR: The acute hemodynamic studies suggest that resynchronization pacing therapy may predict a positive long-term benefit for many patients with congestive heart failure.
Abstract: With 550,000 new cases each year, congestive heart failure is a major medical problem. Several medical therapies, including digoxin, angiotensin-converting enzyme inhibitors, and beta-blockers, have reduced the number of re-hospitalizations and slowed the progression of congestive heart failure. Angiotensin-converting enzyme inhibitors, some beta-blockers, and the combination of hydralazine with nitrates have improved survival. Despite these benefits, medical therapy frequently fails to improve quality of life. Biventricular pacing has been introduced to resynchronize mechanical and electrical asynchrony frequently observed in patients with heart failure. The most recent pacing trials show an improvement in quality of life and functional class. Long-term data are needed to determine the effect of biventricular pacing on survival. The acute hemodynamic studies suggest that resynchronization pacing therapy may predict a positive long-term benefit for many patients with congestive heart failure.
7 citations
3 citations
01 Jan 2002
TL;DR: Despite advances in the medical therapy of heart failure, the projected 5-year mortality remains greater than 50% at 5 years and new treatments are needed.
Abstract: Chronic heart failure is a global public health problem. The incidence of heart failure is very high among developed nations and contributes significantly to the cost of medical care. It is a very common cause of hospitalization for elderly patients [1]. In addition to the morbidity associated with heart failure, it remains very lethal. Despite advances in the medical therapy of heart failure, the projected 5-year mortality remains greater than 50% at 5 years [2]. Accordingly, new treatments are needed.
01 Jan 2002
TL;DR: Prophylactic therapies have been studied as a primary preventative strategy in post-MI patients, with less than a 20% survival probability if an out-of-hospital cardiac arrest should occur.
Abstract: After a patient survives a myocardial infarction (MI), his or her risk of death from nonarrhythmic and arrhythmic cardiac causes averages 5%–10% per year. Sudden cardiac death accounts for about half of these deaths. The highest risk is in patients with the largest infarction (lowest ejection fractions) and is increased further in patients with concomitant ventricular arrhythmias, latent ischemia, and other noninvasive risk stratifiers such as an abnormal signal average electrocardiogram (SAECG), decreased heart rate variability, abnormal reflex baroreceptor sensitivity, or the presence of repolarization alternans [1]. Although a single positive test may predict future events in 15%–30% of patients, even the addition of several positive tests is only predictive in 30%–40% of patients. Given this group’s enhanced risk of reinfarction and sudden death, with less than a 20% survival probability if an out-of-hospital cardiac arrest should occur, prophylactic therapies have been studied as a primary preventative strategy in post-MI patients.