Heart Failure

Dyspnea, or difficulty breathing, is a key symptom in acute heart failure. Lack of relief can result in longer hospital stays and poorer outcomes.

A study of the PrimeADVANCED neurostimulator will determine whether spinal cord stimulation can play a key role in the treatment of heart failure.

The second in my series of trips down memory lane over the last 30 years is on the treatment of congestive heart failure (CHF).

There were several very good studies presented during this poster session at ACC.10. Here, the best are highlighted.

These CME programs explore key concepts in the clinical presentation, diagnosis, and management of heart failure in children and adults.

In "Getting Past Denial — The High Cost of Health Care in the United States," the authors observe, again, Jack Wennberg's (Dartmouth) dictum written about extensively at the end of the last century and earlier—the cost differences between regions and practices may be unwarranted.

A new study has found that regular exercise in patients with heart failure is not only safe, but may also lower the risk of hospitalization or death.

Expanded use of electronic detailing and other portable media would offer drug marketers and physicians opportunities to connect outside of the traditional in-person rep visits.

Nonadherence to beta blockers, statins, or angiotensin-converting enzyme inhibitors is common (21%-29%) among patients with coronary artery disease (CAD). Patients who do not adhere to their medication regimens are at increased risk of mortality, cardiovascular hospitalizations, and revascularization procedures; thus, medication nonadherence should be a target for quality improvement interventions to maximize the outcomes of CAD patients.

In a well-done recent study, Dr P. Michael Ho and colleagues confirm previous data and clinical observations that many patients are nonadherent to their cardiac medications, and, importantly, this nonadherence adversely impacts outcomes, including cardiovascular mortality.

There should be a "clarion call to action for universal health coverage. But expanded coverage needs to be coupled with comprehensive change in how health care is provided and how it is reimbursed," said Dr. Steven Safyer.

Chronic heart failure and coronary heart disease are chronic conditions that are frequently encountered in primary care and are often inadequately diagnosed and managed.

There is no doubt that prevention of VTE by use of thromboprophylaxis (medical or mechanical) has clear benefits in both acute and long-term morbidity and mortality.

Researchers at the Methodist Hospital in Houston, TX; Baylor University Medical Center in Dallas, TX; and The University of Utah School of Medicine in Salt Lake City, UT, are enrolling patients in a new clinical trial designed to help find the answer to that question.

The incidence of atrial fibrillation (AF), which is the most frequently encountered sustained cardiac arrhythmia, is increasing in the United States.

Francis Spinale, MD, PhD, MUSC, discusses his research on new techniques for detecting heart remodeling in early heart failure.

Using data from 8,725 participants in the Framingham Heart Study who were followed for 176,166 person-years, we estimate that the lifetime risk of developing atrial fibrillation (AF) is 1 in 4 for men and women aged 40 years and older. Even when there is no antecedent congestive heart failure or myocardial infarction, the lifetime risk of AF is high (1 in 6). This significant lifetime risk highlights the major public health problem resulting from AF and the need for further study into causes, prevention, and treatment.

Data from the Framingham study provide yet more valuable prognostic information, this time related to the most common cardiac arrhythmia, atrial fibrillation.

We evaluated the risk and timing of sudden death among high-risk patients after myocardial infarction (MI). Among survivors of acute MI with reduced left ventricular systolic function or heart failure, or both, the risk of sudden death from cardiac causes was highest in the first 30 days after MI. These findings indicate a need for early intervention to prevent sudden death during this vulnerable period.

The prevalence of obesity and heart failure has been increasing. A report linking the 2 found an increased risk of heart failure of 5% for men and 7% for women for each increment of 1 in body mass index (BMI).

In an era when high-tech procedures are becoming increasingly common in cardiology, it's refreshing to see continued interest in one of the lowest-tech diagnostic/prognostic procedures currently available: the 6-minute walk test.

The development of new and innovative mechanical and pharmacologic therapies for the broad spectrum of cardiovascular disease has led to dramatic changes in the makeup of clinical practice.

We evaluated how well patients taking spironolactone were monitored for hyperkalemia, as well as the association between spironolactone and hyperkalemia. Only two thirds of patients received testing for serum potassium and creatinine levels, and higher baseline serum creatinine levels predicted a high risk of hyperkalemia. These results indicate that appropriate patient selection and close monitoring are essential, especially for patients with renal impairment.

In 1999 Pitt and colleagues published the results of the RALES trial, an important study showing that the addition of a relatively small dose of the aldosterone antagonist spironolactone to a regimen that included angiotensin-converting enzyme (ACE) in­hibitors for patients with severe congestive heart failure (NYHA Class III-IV) had a striking benefit on mortality

We compared the use of early, minimally invasive ultrafiltration with usual care in patients with acute decompensated heart failure in a randomized controlled trial. Ultrafiltration therapy resulted in greater fluid removal than standard therapy and was shown to be a safe and effective alternative to loop diuretics for sodium and fluid homeostasis in patients with heart failure. More research is needed to identify those patients most likely to benefit from this approach.