Showing papers on "Management of heart failure published in 2001"
TL;DR: In the United States, nearly 5 million patients in this country have heart failure, and nearly 500,000 patients are diagnosed with heart failure for the first time each year as mentioned in this paper.
Abstract: References......2112
Heart failure (HF) is a major public health problem in the United States. Nearly 5 million patients in this country have HF, and nearly 500,000 patients are diagnosed with HF for the first time each year. The disorder is the underlying reason for 12 to 15 million office visits
1,222 citations
TL;DR: It could be demonstrated that in chronic heart failure patients and during the subacute phase of myocardial infarction, the cardiac natriuretic peptides were best markers to identify heart failure and the most powerful predictors of morbidity and mortality.
Abstract: The long-predicted endocrine function of the heart has been proven by the discovery of atrial natriuretic peptide (atrial natriuretic factor, A-type natriuretic peptide; ANP) 20 years ago. This subsequently led to the description of a whole family of structurally similar but genetically distinct peptides, the natriuretic peptide family, which contributes to cardiovascular homeostasis. These looped peptides promote natriuresis and diuresis, act as vasodilators, and exert antimitogenic effects on cardiovascular tissues. Two members, ANP and brain natriuretic peptide (B-type natriuretic peptide; BNP) are secreted by the heart mainly in response to myocardial stretch induced by volume load. The natriuretic peptides are synthesized as preprohormones. The C-terminal endocrinological active peptides (ANP, BNP) and their N-terminal prohormone fragments are found in plasma. The natriuretic peptide system is activated to its highest degree in ventricular dysfunction. However, natriuretic peptides are increased in all patients with edematous disorders which lead to an increase in atrial tension or central blood volume, such as renal failure or ascitic liver cirrhosis. It could be demonstrated that in chronic heart failure patients and during the subacute phase of myocardial infarction, of all tested neurohormones, the cardiac natriuretic peptides were best markers to identify heart failure and the most powerful predictors of morbidity and mortality. Natriuretic peptides are independent markers for risk assessment. In comparative studies BNP was superior to ANP and its N-terminal prohormone fragments in myocardial infarction as well as in chronic heart failure patients. Less data on N-terminal proBNP (NT-proBNP) is available, but BNP and NT-proBNP appear to be equivalent markers. For primary care physicians natriuretic peptide measurement is useful to decide which patient with suspected heart failure warrants further investigation, particularly when assessment of left ventricular function is not readily available. Natriuretic peptides have an excellent negative predictive value, particularly in high risk patients. An increase in BNP is serious enough to warrant follow-up examinations. For the cardiologists the natriuretic peptides are helpful for guidance of therapy and monitoring disease course in heart failure patients and for risk stratification in heart failure and myocardial infarction.
274 citations
TL;DR: Routine use of inotropes as heart failure therapy is not indicated in either the acute or chronic setting because of a lack of high-quality randomized evidence and the data that inotropic therapy improves quality of life are mixed.
235 citations
TL;DR: Carvedilol as an adjunct to standard therapy for pediatric heart failure improves symptoms and left ventricular function and side effects are common but well tolerated.
171 citations
TL;DR: Potential feasibility of reversal of heart failure should renew efforts to develop more targeted pharmaceutical intervention within the apoptotic cascade and allow newer paradigm for the management ofHeart failure.
80 citations
TL;DR: A clear and concise set of clinical recommendations has been prepared by a group of clinicians with practical expertise in the management of heart failure to provide practical guidance for non‐specialists in order to support the implementation of evidenced‐based therapy for heart failure.
Abstract: Surveys of prescribing in both hospitals and primary care have shown delays in translating improved survival data from clinical trials into clinical practice thereby denying patients the benefits of proven treatments, such as the angiotensin converting enzyme inhibitors. This may be due to unfamiliarity with clinical guidelines and concerns about adverse events. Recent trials have shown that substantial improvements in survival are associated with spironolactone and beta-blocker therapy. In order to accelerate the uptake of these treatments, and to ensure that all eligible patients should receive the most appropriate medications, a clear and concise set of clinical recommendations has been prepared by a group of clinicians with practical expertise in the management of heart failure. The objective of these recommendations is to provide practical guidance for non-specialists in order to support the implementation of evidenced-based therapy for heart failure. These practical recommendations are meant to supplement rather than replace existing guidelines.
63 citations
Journal Article•
TL;DR: An evidence-based guideline to assist primary care physicians in evaluating and treating patients with heart failure and a new paradigm of heart failure is described and guidance for diagnostic testing is offered.
Abstract: Over the past decade, the conceptual understanding of heart failure has changed significantly. Several large clinical trials have demonstrated that pharmacologic interventions can dramatically reduce the morbidity and mortality associated with heart failure. These trials have extended the therapeutic paradigm for treating heart failure beyond the goal of limiting congestive symptoms of volume overload. This two-part article presents an evidence-based guideline to assist primary care physicians in evaluating and treating patients with heart failure. Part I describes the new paradigm of heart failure and offers guidance for diagnostic testing. Part II presents a treatment guideline.
58 citations
Journal Article•
TL;DR: The barriers to the effective management of heart failure in general practice are complex and it is recommended that further research is recommended to establish whether multifaceted intervention programmes based on the findings can improve the management ofheart failure in primary care.
Abstract: BACKGROUND: Several studies have shown that most patients with heart failure are not investigated and treated according to published guidelines. More effective management could reduce both mortality and morbidity from heart failure. AIM: To identify the reasons for gaps between recommended and actual management of heart failure in general practice. DESIGN OF STUDY: A nominal group technique was used to elicit general practitioners' (GPs') perceptions of the reasons for differences between observed and recommended practice. SETTING: Ten Medical Research Council General Practice Framework practices in the North Thames region. METHOD: Data were collected on the investigation and treatment of heart failure in the 10 participating practices and presented to 49 GPs and 10 practice nurses from those practices. RESULTS: Of the 674 patients requiring echocardiograms, 226 were referred for echocardiography (34%), and 183/391 (47%) with probable heart failure were prescribed angiotensin-converting enzyme inhibitors. A wide variety of barriers were elicited. The main barrier to the use of echocardiograms in the diagnosis of heart failure was lack of open access. The main barrier to the use of angiotensin-converting enzyme inhibitors in treating heart failure was GPs' concerns about their possible adverse effects. CONCLUSION: The barriers to the effective management of heart failure in general practice are complex. We recommend further research to establish whether multifaceted intervention programmes based on our findings can improve the management of heart failure in primary care.
54 citations
Journal Article•
TL;DR: The mid-term results of ACSD for patients with symptomatic heart failure suggest that ventricular containment may be useful for preventing further cardiac dilation in patients with ischemic cardiomyopathy.
Abstract: The acorn cardiac support device (ACSD) is a device designed to treat heart failure by containing the heart to prevent further dilation. Six patients with symptomatic heart failure due to ischemic cardiomyopathy were treated surgically with ACSD. All patients simultaneously underwent coronary artery bypass grafting. Ventricular reconstruction was also performed in 5 of the 6 patients. We followed up the patients for 12 months postoperatively, monitoring the left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), mitral regurgitation, and NYHA classification. Both the LVEDD and LVESD were significantly improved one month postoperatively (from 63.2 to 50.6 mm, p=0.004, and from 51.6 to 39.5 mm, p=0.025, respectively). These dimensions did not change significantly over the next 11 months. NYHA functional class improved significantly from a mean of 3 to 1.4 at 12 months (p=0.012). Mitral regurgitation improved from a mean of 2.7 preoperatively to 1.4 at 12 months and the average LVEF also improved from 27% preoperatively to 35.9% at 12 months after surgery. However these latter two results were not statistically significant. There were no late deaths and no readmissions for heart failure. Repeat coronary angiography at 6 months revealed patent grafts in all patients. The mid-term results of ACSD for patients with symptomatic heart failure suggest that ventricular containment may be useful for preventing further cardiac dilation in patients with ischemic cardiomyopathy. Randomized, long-term studies are needed to assess the efficacy and possible role of ASCD in the future management of heart failure.
41 citations
Book•
15 Jan 2001
TL;DR: Addresses innovations in heart failure treatment and management, dealing with issues such as quality of life, treatment compliance, patient and family education, nonpharmacologic therapy, and new health care delivery models for improving management of heart failure.
Abstract: Addresses innovations in heart failure treatment and management, dealing with issues such as quality of life, treatment compliance, patient and family education, nonpharmacologic therapy, and new health care delivery models for improving management of heart failure. Overviews the state of knowledge
38 citations
TL;DR: The relationship between processes and outcomes of care and quality indicators that may be applied in evaluating vulnerable elders with heart failure are investigated and four studies demonstrated the efficacy of ACE inhibitors in preventing heart failure in patients with vascular disease or diabetes are identified.
Abstract: Heart failure contributes to substantial morbidity and mortality in elderly persons, and its prevalence increases with age. This review investigates the relationship between processes and outcomes ...
Journal Article•
TL;DR: The authors recommend that, if tolerated and not contraindicated, the following agents be used in patients with left ventricular systolic dysfunction: an angiotensin-converting enzyme inhibitor in all patients; a beta blocker in all customers; and spironolactone in patients who have symptoms at rest or who have had such symptoms within the past six months.
Abstract: Several large clinical trials conducted over the past decade have shown that pharmacologic interventions can dramatically reduce the morbidity and mortality associated with heart failure. These trials have modified and enhanced the therapeutic paradigm for heart failure and extended treatment goals beyond limiting congestive symptoms of volume overload. Part II of this two-part article presents treatment recommendations for patients with left ventricular systolic dysfunction. The authors recommend that, if tolerated and not contraindicated, the following agents be used in patients with left ventricular systolic dysfunction: an angiotensin-converting enzyme inhibitor in all patients; a beta blocker in all patients except those who have symptoms at rest; and spironolactone in patients who have symptoms at rest or who have had such symptoms within the past six months. Diuretics and digoxin should be reserved, as needed, for symptomatic management of heart failure. Other treatments or treatment programs may be necessary in individual patients.
TL;DR: Patients with insulin resistance or type 2 diabetes have a particularly high risk for heart failure and a poor prognosis once they develop heart failure, and much work is needed to establish the safety and efficacy of various oral antidiabetic agents, especially the TZDs.
Journal Article•
Journal Article•
TL;DR: Nesiritide is a new class of therapeutic peptide for the treatment of heart failure that appears to offer unique and safe hemodynamic properties and its efficacy and safety are critiqued.
Abstract: Nesiritide is the generic name for recombinant human B-type natriuretic peptide. This drug represents the first of a new class of agents for the treatment of decompensated congestive heart failure. The properties of B-type natriuretic peptide include a balanced arterial and venous vasodilatation and a marked natriuresis and diuresis, making it an excellent drug for the management of heart failure. We review the physiology and pathophysiology of the natriuretic peptides and the clinical data for nesiritide. In addition, the hemodynamic effects of the drug as well as its efficacy and safety in the treatment of heart failure are critiqued. Nesiritide is a new class of therapeutic peptide for the treatment of heart failure that appears to offer unique and safe hemodynamic properties.
TL;DR: The cause ofheart failure among patients with end-stage renal disease and the effect of heart failure on survival are described and the impact of renal failure on the medical management of these patients is discussed.
TL;DR: Overall clinical impression from the reports is that the operation may serve as a relatively inexpensive bridge to transplantation especially in the patients with idiopathic dilated cardiomyopathy, and further study is required to determine the procedure's exact role in the treatment of congestive heart failure.
Abstract: End-stage heart failure is associated with high rates of mortality. Obviously, heart transplantation is the ultimate surgical intervention for its treatment. However, this surgical option is severely limited by immunosuppressive drug morbidity and inadequate donor organ availability. Partial left ventriculectomy, the so called Batista procedure, has been proposed for the treatment of dilated cardiomyopathy and other end-stage heart failure. Although initial reports lacked significant information on the safety and efficacy of this procedure, overall clinical impression from the reports is that the operation may serve as a relatively inexpensive bridge to transplantation especially in the patients with idiopathic dilated cardiomyopathy. In order to select an exact procedure to resect appropriate amount of scar tissue, dobutamine echocardiographic study, intraoperative volume reduction test using cardiopulmonary bypass, positron emission tomography, or magnetic resonance imaging scans can be used. To avoid the late deterioration related to the development of significant mitral valve regurgitation, definitive mitral valve repair or replacement at the time of the partial left ventriculectomy may be advised. Further study is required to determine the procedure's exact role in the treatment of congestive heart failure. This would have to be a multicenter, randomized, and long-term follow-up study.
TL;DR: Despite major advances in inotropic medications and understanding of their proper use, surgical management of heart failure is the fastest-growing aspect of cardiovascular surgery and innovative devices have been created to meet this clinical need, but they must provide adequate quality of life.
TL;DR: Commercial immunoassays are now coming to the market and an increased use of these measurements in the clinical routine is expected, and the plasma concentration of natriuretic peptides or their propeptides is primarily determined by the secretion from the heart.
Abstract: The discovery by Adolfo deBold of the endocrine function of the heart in 1980 is of relevance both for diagnosis and therapy of heart failure 1 . Atrial natriŽ . uretic peptide ANP and brain natriuretic peptide Ž . Ž BNP have biological effects diuresis, vasodilatation, renin-angiotensin inhibition, inhibition of smooth . muscle growth that are potentially advantageous for treatment of hypertension and heart failure. Drugs exploiting these mechanisms are currently in clinical trials 2 . In the area of diagnosis the natriuretic peptides or Ž the N-terminal part of their propeptides Nt-proANP, . Nt-proBNP have been investigated as markers of cardiac function. At the National Hospital in Oslo, measurement of plasma Nt-proANP has been routinely offered to general practitioners since 1993. During the last 15 years we have seen a steady accumulation of documentation regarding the utility of these measurements. Commercial immunoassays are now coming to the market and an increased use of these measurements in the clinical routine is expected. The plasma concentration of natriuretic peptides or their propeptides is primarily determined by the secretion from the heart. Changes in the clearance from plasma, as in the case of advanced renal failure, will also influence the plasma concentration. Cardiac secretion is primarily regulated by myocyte stretch, i.e. wall stress. Since increases in wall stress is a common phenomenon in many cardiac diseases, natriuretic peptide plasma concentration can provide information with regard to the presence of cardiac disease as well as its severity. 2. Diagnosis of heart failure
TL;DR: The three cases presented in this article illustrate some common scenarios encountered and clinical decisions made when β-blockers are used in the management of heart failure.
TL;DR: The maladaptive neurohumoral activation found in heart failure can be antagonised by the use of beta-blockers, angiotensin converting enzyme inhibitors and spironolactone, all of which reduce mortality and improve symptoms.
01 Jan 2001
01 Jan 2001
TL;DR: It is hypothesized that some aspects of heart failure may be mediated by reversible alterations of cardiac function and structural changes in the ventricle induced by cytokines.
Abstract: Congestive heart failure (CHF) may be produced by a variety of disorders, including dilated cardiomyopathy, hypertensive heart disease, and ischemic heart disease. We have developed experimental models of these diseases. In a murine model of myocarditis, inflammatory cytokines were induced rapidly in the myocardium, and remained expressed during the chronic stage, when the heart had developed the typical characteristics of dilated cardiomyopathy. In the pressure-overloaded ventricle, the myocardium developed adaptive hypertrophy before its transition to heart failure, a process in which cytokines appeared to play a significant role by accelerating myocyte growth and down-modulating cardiac function. In the ischemic heart, the non-ischemic myocardium developed hypertrophy associated with progression of scarring in the ischemic area. This remodeling process initially represents an important compensatory mechanism to preserve ventricular function, though later leads to the development of heart failure. During this phase of healing from acute ischemia, inflammatory cytokines were persistently upregulated in the non-ischemic myocardium. Thus, we hypothesized that some aspects of heart failure may be mediated by reversible alterations of cardiac function and structural changes in the ventricle induced by cytokines. In the respect, several drugs used routinely in clinical practice have been proved to modulate the production of cytokines, suggesting that immunomodulating or anticytokine therapy may represent a new approach to the management of heart failure [1].
01 Jan 2001
TL;DR: Drugs considered to be standard of care in management of systolic hear t failure are discussed, and the New York Heart Association (NYHA) classification for indications for specific drug classes is noted.
Abstract: Heart failure (HF) is associated with very high morbidity and mortality. Until recently, patients with HF were managed with a combination of digoxin and diuretics. These drugs alleviated symptoms but were not shown to affect mortality. In the last 10 years, many studies have shown evidence of decreased mortality among patients with HF using new (angiotensin II‐converting enzyme [ACE] inhibitors, angiotensin I‐ or II‐receptor blockers) and old (spironolactone, hydralazine, and nitrates) classes of drugs, as well as drugs previously thought to be contraindicated (β-blockers). A MEDLINE search using “heart failure” and the subheading “drug therapy” looked for large (> 1000 patients, where possible) double-blind, controlled studies. Those found were supplemented from the reference lists of previously published articles. This article discusses drugs considered to be standard of care in management of systolic hear t failure. Where applicable, the New York Heart Association (NYHA) classification for indications for specific drug classes is noted. This article will deal solely with systolic dysfunction (left ventricular ejection fraction [LVEF] < 40%); HF will refer only to systolic heart failure. We know that patients with HF develop compensator y mechanisms in response to low cardiac output. The sympathetic nervous system is activated, as is the r enin-angiotensin aldosterone system. Such activation eventually worsens the load on the heart and worsens the HF. Most current therapies are aimed at these compensatory systems. 1 Angiotensin II‐converting enzyme inhibitors
01 Jan 2001
TL;DR: Clinical trials and community data suggest a 50% mortality rate within 3–5 years of diagnosis, a prognosis approximating that observed with many common malignancies.
Abstract: The management of heart failure has undergone considerable advances over the past 15 years. Clinical trials have demonstrated that treatment with a number of different agents can relieve symptoms, reduce hospitalisation and increase life expectancy [1–5]. However, despite these successes, the prevalence of heart failure is rising partly due to ageing of the population, partly due to better secondary prevention which prolongs life after myocardial infarction and partly due to an improvement in the prognosis of heart failure itself [6]. Furthermore, the condition continues to be associated with high morbidity and mortality. Indeed, clinical trials [5,7,8] and community data [6, 9, 10] suggest a 50% mortality rate within 3–5 years of diagnosis, a prognosis approximating that observed with many common malignancies [11].
01 Jan 2001
TL;DR: The results indicated that there was a positive weak relationship between perceived knowledge o f heart failure and adherence to taking the prescribed medication dose and to exercise and Orem’s self-care theory provided the framework for this study.
Abstract: PERCEIVED KNOWLEDGE OF HEART FAILURE AND ADHERENCE TO SELFCARE RECOMMENDATIONS By Cheryl L. Van Ess During the last decade, research has indicated that patient education is an essential component in the comprehensive management of heart failure. However, few data are available that evaluate how effective that education is and the relationship between knowledge and self-care adherence. Therefore, the purpose o f this study was to examine the relationship between patients’ perceived knowledge o f heart failure and their reported self-care adherence with diet, exercise, and medication in the management o f their chronic disease. Orem’s self-care theory provided the framework for this study. This study was a secondary analysis of the baseline data collected from a selfreporting questionnaire used in the experimental study conducted by Kay Setter Kline, PhD, RN and colleagues. The results from the participants (n = 86) indicated that there was a positive weak relationship between perceived knowledge o f heart failure and adherence to taking the prescribed medication dose and to exercise. No significant differences were found between length of heart failure diagnosis and perceived knowledge or adherence to self-care recommendations to diet, exercise, and medications.