Cardiologia Croatica, Journal Year: 2024, Volume and Issue: 19(7-8), P. 270 - 293
Published: June 1, 2024
SAŽETAK: Uznapredovalo zatajivanje srca (ZS) karakterizirano je refraktornim simptomima i učestalim rehospitalizacijama unatoč primjeni optimalne medikamentne terapije (OMT).Prevalencija terminalnog ZS-a u porastu zbog sve većega broja bolesnika s čimbenicima rizika za kardiovaskularne bolesti starenja populacije te velik klinički izazov opterećenje zdravstveni sustav
The Journal of Heart and Lung Transplantation, Journal Year: 2023, Volume and Issue: 43(4), P. 554 - 562
Published: Nov. 14, 2023
Language: Английский
Citations
5
Medicine, Journal Year: 2023, Volume and Issue: 102(50), P. e36607 - e36607
Published: Dec. 15, 2023
Chronic heart failure (CHF) is the terminal stage of several diseases. The present study aimed to investigate impact palliative care on physical and mental status quality life patients with CHF.This single-center randomized controlled clinical trial was conducted at Xiangtan Central Hospital. A total 103 cases were included divided into a group (n = 54) control 49). received usual care, whereas plus care. Statistical analyses Simplified Coping Style Questionnaire, negative emotions, Minnesota Living Heart Failure Questionnaire scores, nursing satisfaction before after intervention in 2 groups.After intervention, positive coping style score research higher than that group, while lower (P < .05). After Beck Anxiety Inventory Depression Inventory-II scores groups decreased compared had those Nursing (94.44%) (81.63%) .05).Adopting intervene CHF can effectively regulate their state, alleviate transform styles towards disease, improve life, high patient satisfaction.
Language: Английский
Citations
5
Journal of Cardiovascular Medicine, Journal Year: 2023, Volume and Issue: 25(2), P. 149 - 157
Published: Dec. 22, 2023
Background Hospitalization is associated with poor outcomes in patients heart failure, but its prognostic role advanced failure still unsettled. We evaluated the of hospitalization failure. Methods The multicenter HELP-HF registry enrolled consecutive and at least one high-risk ‘I NEED HELP’ marker. Characteristics were compared between who hospitalized for decompensated (inpatients) or not (outpatients) time enrolment. primary endpoint was composite all-cause mortality first hospitalization. Results Among 1149 included [mean age 75.1 ± 11.5 years, 67.3% men, median left ventricular ejection fraction (LVEF) 35% (IQR 25–50%)], 777 (67.6%) inpatients As outpatients, had lower LVEF, higher natriuretic peptides a worse clinical profile. 1-year rate 50.9% versus 36.8% outpatients [crude hazard ratio 1.70, 95% confidence interval (CI) 1.39–2.07, P < 0.001]. At multivariable analysis, inpatient status independently risk (adjusted 1.54, CI 1.23–1.93, 0.001). inpatients, independent predictors older age, SBP, association criteria glomerular filtration 30 ml/min/1.73 m 2 less. Conclusion marker an extremely prognosis supporting need specific interventions, such as mechanical circulatory support transplantation.
Language: Английский
Citations
5
ESC Heart Failure, Journal Year: 2024, Volume and Issue: 11(4), P. 1816 - 1818
Published: June 24, 2024
Congestion is a major clinical sign of acute heart failure (AHF), and loop diuretics remain the first-line treatment option for decongestion in phase disease.1 Even though facilitate water sodium excretion and, therefore, enable more effective decongestion, we need to keep mind that there are several drawbacks related their use. First all, due mode action, remove through sodium-related mechanisms, which long run may lead depletion. Although it has never been demonstrated, at least part ominous signs failure—hyponatremia hypochloremia—may be chronic exposure diuretics.2-4 On other hand, because needed an adequate diuretic response (to diuretics), same time, from body, sort vicious circle created hinders run. In this mechanism (sodium depletion), probably indirectly activate renin-angiotensin-aldosterone (RAA) system, meant homeostasis our body. addition, were shown directly excite RAA system by blocking macula densa thus promoting renin release. Furthermore, excessive (diuretic mediated) loss counterbalanced with thirst, another created.5 Some premises exist effect most drugs (especially SGLT-2) gets blunted time once some adaptive mechanisms come into play.6, 7 This why advanced HF patients (patients who take longer periods time) higher doses drugs.8 The also highly neurohormonal drive, can identify disrupted pathophysiology worse outcomes.9-11 Several studies have demonstrated association between dose outcomes, but casual-effect manner as data retrospective analyses or registries.12, 13 Unfortunately, moment, lack objective measures allow us adjust patients. Thus, all modifications (up- down-titrations) made based on physician's subjective decisions, bias. Finally, no evidence supports notion improve outcomes HF. recently, novel hypotheses about different ways decongest AHF effectiveness, such using SGLT-2 inhibitors, ARNI, optimizing guideline-directed medical therapy (GDMT), STRONG-HF trial.14-16 Taking consideration those aspects, not surprising growing interest de-escalation congestion residual (in particular) associated outcomes. But again, direct causality cannot derived observations observational studies. It is, very likely much difficult sicker patients, creates unfavourable Diuretic responsiveness efficiency net results advancement disease blunt rather than drug characteristics themselves. Both these aspects studied recent paper published ESC Heart Failure.17 Croset et al. down-titration discharge hospital safe patients.17 authors retrospectively analysed cohort mostly (80%) preserved ejection fraction hospitalized single centre. admission recorded compared. led identification two profiles: down titration stable/up-titration during hospitalization. Importantly, both profiles comparison status, defined score biomarkers. There important takes paper. Firstly, was increased risk composite endpoint (time all-cause death and/or rehospitalization) whole population. clinically relevant information clinicians reluctant down-titrate only fear potential side effects, namely, fluid retention subsequent decompensation. However, authors, case cohort. Secondly, approximately one out eight had down-titrated account well-described pharmacological inertia, circumstances (patient degree congestion), 'natural' reluctance optimize hospitalization, reported number quite high. We must hospitalization great (but usually unused misused) opportunity modify pharmacotherapy patients.18, 19 Thirdly, stress group started high median 100 mg discharged 50 mg. increase/stable up-titration 40 80 differences changes seem significant perspective. they Lastly, caveat emphasized. subgroup lower clinical/laboratory congestion. crucial key understanding presented results. study endpoints congestion, BNP (>985 pg/mL), elevated Ca125 (>120 U/mL) admission. confirms individualized management, long-term success. presents clear message, consider its limitations. single-centre analysis type analysis. underpowered detect small groups, follow-up might reveal additional information. To conclude, real unmet markers guide dosing (both down- up-titration) use natriuretic-guided first step therapy, still way go. Moreover, prognostic spot urine discharge, makes even complicated.20 subpopulation safe, deterioration. prospective randomized would provide definitive
Language: Английский
Citations
1
Cardiologia Croatica, Journal Year: 2024, Volume and Issue: 19(7-8), P. 270 - 293
Published: June 1, 2024
SAŽETAK: Uznapredovalo zatajivanje srca (ZS) karakterizirano je refraktornim simptomima i učestalim rehospitalizacijama unatoč primjeni optimalne medikamentne terapije (OMT).Prevalencija terminalnog ZS-a u porastu zbog sve većega broja bolesnika s čimbenicima rizika za kardiovaskularne bolesti starenja populacije te velik klinički izazov opterećenje zdravstveni sustav
Citations
1