Pub Date : 2001-05-01DOI: 10.1111/J.1527-5299.2001.00240.X
J. Kosowsky, W. Abraham, A. Storrow
A wide range of patients with symptomatic heart failure seek treatment in the emergency department. While there is no single approach to the diversity of patients with acutely decompensated heart failure, certain overarching principles apply. For patients with acute pulmonary edema or cardiogenic shock, the first priority must be rapid stabilization and treatment of reversible problems. For patients with less dramatic presentations, a more systematic search for precipitating factors may be required. Therapy, in general, is directed at reversing dyspnea and/or hypoxemia caused by pulmonary edema, improving systemic perfusion, and reducing myocardial oxygen demand. While morphine and diuretics still have their traditional roles, vasodilators and inotropic agents play an increasingly important part in the modern pharmacologic approach to decompensated heart failure in the emergency department. After evaluation and stabilization in the emergency department, most patients will require hospital admission, although a subset of low-risk patients may be appropriate for discharge to home following a period of observation. Strategies to optimize emergency department care are likely to have an impact upon patient outcomes and upon resource utilization.
{"title":"Evaluation and Management of Acutely Decompensated Chronic Heart Failure in the Emergency Department","authors":"J. Kosowsky, W. Abraham, A. Storrow","doi":"10.1111/J.1527-5299.2001.00240.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00240.X","url":null,"abstract":"A wide range of patients with symptomatic heart failure seek treatment in the emergency department. While there is no single approach to the diversity of patients with acutely decompensated heart failure, certain overarching principles apply. For patients with acute pulmonary edema or cardiogenic shock, the first priority must be rapid stabilization and treatment of reversible problems. For patients with less dramatic presentations, a more systematic search for precipitating factors may be required. Therapy, in general, is directed at reversing dyspnea and/or hypoxemia caused by pulmonary edema, improving systemic perfusion, and reducing myocardial oxygen demand. While morphine and diuretics still have their traditional roles, vasodilators and inotropic agents play an increasingly important part in the modern pharmacologic approach to decompensated heart failure in the emergency department. After evaluation and stabilization in the emergency department, most patients will require hospital admission, although a subset of low-risk patients may be appropriate for discharge to home following a period of observation. Strategies to optimize emergency department care are likely to have an impact upon patient outcomes and upon resource utilization.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"3 1","pages":"124-136"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80342386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-01DOI: 10.1111/J.1527-5299.2001.00247.X
D. Sica
Angiotensin-converting enzyme (ACE) inhibitors are used in the management of a wide range of cardiovascular conditions, including congestive heart failure (CHF). Although the experimental evidence in support of their use in CHF is incontrovertible, their pattern of usage has failed to keep pace with the research findings. One factor that has fueled the hesitancy to use ACE inhibitors in CHF has been the concern that renal function might worsen upon their receipt. Although the glomerular filtration rate may decline when ACE inhibitor or angiotension receptor blocker therapy is started in CHF, in most cases it is not a reason to discontinue therapy other than temporarily. Although ACE inhibitors and angiotensin receptor blockers may differ theoretically in their renal effects, published information to date has not shown such a difference. (c)2001 by CHF, Inc.
{"title":"Pharmacotherapy in congestive heart failure: Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in congestive heart failure: do they differ in their renal effects in man?","authors":"D. Sica","doi":"10.1111/J.1527-5299.2001.00247.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00247.X","url":null,"abstract":"Angiotensin-converting enzyme (ACE) inhibitors are used in the management of a wide range of cardiovascular conditions, including congestive heart failure (CHF). Although the experimental evidence in support of their use in CHF is incontrovertible, their pattern of usage has failed to keep pace with the research findings. One factor that has fueled the hesitancy to use ACE inhibitors in CHF has been the concern that renal function might worsen upon their receipt. Although the glomerular filtration rate may decline when ACE inhibitor or angiotension receptor blocker therapy is started in CHF, in most cases it is not a reason to discontinue therapy other than temporarily. Although ACE inhibitors and angiotensin receptor blockers may differ theoretically in their renal effects, published information to date has not shown such a difference. (c)2001 by CHF, Inc.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"78 1","pages":"156-161"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83127472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-01DOI: 10.1111/j.1527-5299.2001.00250.x
M. Silver
Marc A. Silver, MD, Co-Editor in Chief, Chairman andClinical Professor, Department of Medicine; Director, HeartFailure Institute; Director, Cardiovascular Disease Fellow-ship, Advocate Christ Medical Center, Oak Lawn, ILAddress for correspondence/reprint requests: Marc A. Silver, MD, Advocate Christ Medical Center,4440 West 95
Marc A. Silver，医学博士，联合主编，医学系主任和临床教授;心脏衰竭研究所主任;主任，心血管疾病奖学金，倡导基督医疗中心，橡树草坪，伊利诺伊州，通信地址/转载请求:马克A.银，医学博士，倡导基督医疗中心，4440西95
{"title":"Thinking of heart failure as a medical emergency.","authors":"M. Silver","doi":"10.1111/j.1527-5299.2001.00250.x","DOIUrl":"https://doi.org/10.1111/j.1527-5299.2001.00250.x","url":null,"abstract":"Marc A. Silver, MD, Co-Editor in Chief, Chairman andClinical Professor, Department of Medicine; Director, HeartFailure Institute; Director, Cardiovascular Disease Fellow-ship, Advocate Christ Medical Center, Oak Lawn, ILAddress for correspondence/reprint requests: Marc A. Silver, MD, Advocate Christ Medical Center,4440 West 95","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"20 1","pages":"123"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74887381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-01DOI: 10.1111/J.1527-5299.2001.00246.X
R. J. Delaney, E. Havranek, D. Ordin, J. Taylor
The Health Care Financing Administration, with its National Heart Failure project, has made heart failure care one of its targets for quality improvement. Previous columns have highlighted the clinical and epidemiologic background for the National Heart Failure project. This column provides "real-world" examples of hospitals improving care for their heart failure patients. (c)2001 by CHF, Inc.
{"title":"Profiles of quality improvements in heart failure care.","authors":"R. J. Delaney, E. Havranek, D. Ordin, J. Taylor","doi":"10.1111/J.1527-5299.2001.00246.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00246.X","url":null,"abstract":"The Health Care Financing Administration, with its National Heart Failure project, has made heart failure care one of its targets for quality improvement. Previous columns have highlighted the clinical and epidemiologic background for the National Heart Failure project. This column provides \"real-world\" examples of hospitals improving care for their heart failure patients. (c)2001 by CHF, Inc.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"11 1","pages":"166-169"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83351958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-01DOI: 10.1111/J.1527-5299.2001.00249.X
I. Pahlevan, Helen Longergan‐Thomas, S. Ande, J. Burks, E. Robin, T. Petropulos, M. Silver
While originally thought to be uncommon, familial dilated cardiomyopathy may occur quite often. Aside from symptoms of heart failure, these forms of dilated cardiomyopathy may be associated with arrhythmias and sudden death. The case detailed describes such a patient and emphasizes the importance of a careful family history. Also discussed is the importance of screening of first- and second-degree relatives of these patients.
{"title":"Familial Dilated Cardiomyopathy","authors":"I. Pahlevan, Helen Longergan‐Thomas, S. Ande, J. Burks, E. Robin, T. Petropulos, M. Silver","doi":"10.1111/J.1527-5299.2001.00249.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00249.X","url":null,"abstract":"While originally thought to be uncommon, familial dilated cardiomyopathy may occur quite often. Aside from symptoms of heart failure, these forms of dilated cardiomyopathy may be associated with arrhythmias and sudden death. The case detailed describes such a patient and emphasizes the importance of a careful family history. Also discussed is the importance of screening of first- and second-degree relatives of these patients.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"1 1","pages":"163-165"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83071164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-01DOI: 10.1111/J.1527-5299.2001.00242.X
K.-l. Wong, D. Kocovic, E. Loh
Despite advances in medical therapy for patients with congestive heart failure, morbidity and mortality remain high. Conduction abnormalities, such as left bundle branch block, right bundle branch block, and nonspecific conduction delay, are observed commonly in patients with dilated cardiomyopathy. In patients with heart failure, the presence of intraventricular conduction delay is associated with more severe mitral regurgitation and worsened left ventricular systolic and diastolic function, and is an independent risk factor for increased mortality. Conventional dual-chamber (right atrial and right ventricular) pacing with a short atrioventricular delay was initially introduced as therapy for patients with advanced congestive heart failure to improve diastolic dysfunction and reduce mitral regurgitation. The acute beneficial hemodynamic effects observed in early, uncontrolled studies were not confirmed in subsequent randomized, controlled studies with longer follow-up. Cardiac resynchronization with novel biventricular (left and right ventricular) pacing systems has resulted in hemodynamic and functional benefits in patients with congestive heart failure and an underlying intraventricular conduction delay. Improvements in cardiac index, systolic blood pressure, and functional class have been reported with biventricular pacing, both acutely and at more than 1 year of follow-up. These encouraging preliminary results with biventricular pacing in patients with congestive heart failure will be validated in two prospective, randomized, controlled trials, Multicenter InSync Randomized Clinical Evaluation (MIRACLE) and Comparison of Medical Therapy, Pacing, and Defibrillation in Chronic Heart Failure (COMPANION). These studies are designed to evaluate the long-term efficacy of biventricular pacing in improving exercise capacity and in reducing morbidity and mortality in patients with advanced, symptomatic congestive heart failure. (c)2001 by CHF, Inc.
{"title":"Cardiac resynchronization: a novel therapy for heart failure.","authors":"K.-l. Wong, D. Kocovic, E. Loh","doi":"10.1111/J.1527-5299.2001.00242.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00242.X","url":null,"abstract":"Despite advances in medical therapy for patients with congestive heart failure, morbidity and mortality remain high. Conduction abnormalities, such as left bundle branch block, right bundle branch block, and nonspecific conduction delay, are observed commonly in patients with dilated cardiomyopathy. In patients with heart failure, the presence of intraventricular conduction delay is associated with more severe mitral regurgitation and worsened left ventricular systolic and diastolic function, and is an independent risk factor for increased mortality. Conventional dual-chamber (right atrial and right ventricular) pacing with a short atrioventricular delay was initially introduced as therapy for patients with advanced congestive heart failure to improve diastolic dysfunction and reduce mitral regurgitation. The acute beneficial hemodynamic effects observed in early, uncontrolled studies were not confirmed in subsequent randomized, controlled studies with longer follow-up. Cardiac resynchronization with novel biventricular (left and right ventricular) pacing systems has resulted in hemodynamic and functional benefits in patients with congestive heart failure and an underlying intraventricular conduction delay. Improvements in cardiac index, systolic blood pressure, and functional class have been reported with biventricular pacing, both acutely and at more than 1 year of follow-up. These encouraging preliminary results with biventricular pacing in patients with congestive heart failure will be validated in two prospective, randomized, controlled trials, Multicenter InSync Randomized Clinical Evaluation (MIRACLE) and Comparison of Medical Therapy, Pacing, and Defibrillation in Chronic Heart Failure (COMPANION). These studies are designed to evaluate the long-term efficacy of biventricular pacing in improving exercise capacity and in reducing morbidity and mortality in patients with advanced, symptomatic congestive heart failure. (c)2001 by CHF, Inc.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"16 1 1","pages":"139-144"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80204112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-01DOI: 10.1111/J.1527-5299.2001.00243.X
M. Møller, C. Torp-Pedersen, L. Køber
INTRODUCTION. Atrial fibrillation is a frequent cause of worsening of symptoms in patients with congestive heart failure. The drugs currently available for maintenance of sinus rhythm all have major side effects. METHODS. In 34 Danish coronary care units, 1518 patients with congestive heart failure and reduced left ventricular systolic function were randomized to receive either placebo or a new class III antiarrhythmic drug, dofetilide. The dose of dofetilide was adjusted according to the presence of atrial fibrillation, the length of the QT interval, and renal function. Patients were continuously monitored electrocardiographically for the first 3 days of the study. The primary end point was all-cause mortality and follow-up was for at least 1 year. RESULTS. In the dofetilide/placebo groups, 311/317 patients died (41%/42%). The hazard ratio for dofetilide treatment was 0.95 (95% confidence interval, 0.81-1.11). Treatment with dofetilide reduced worsening of heart failure significantly (hazard ratio, 0.75; 0.63-0.89). After 1 year, 61% of patients with atrial fibrillation at the start of the study had converted to sinus rhythm on dofetilide, vs. 33% in the placebo group. After conversion to sinus rhythm, 78%/43% of patients in the dofetilide/placebo groups remained in sinus rhythm for at least 1 year. There were 25 instances (3%) of torsade de pointes ventricular tachycardia in the dofetilide group and none in the placebo group. CONCLUSION. In patients with congestive heart failure, dofetilide can effectively convert atrial fibrillation to sinus rhythm and maintain sinus rhythm after conversion. Hospitalization for congestive heart failure is reduced. Dofetilide does not affect mortality. (c)2001 by CHF, Inc.
{"title":"Dofetilide in patients with congestive heart failure and left ventricular dysfunction: safety aspects and effect on atrial fibrillation. The Danish Investigators of Arrhythmia and Mortality on Dofetilide (DIAMOND) Study Group.","authors":"M. Møller, C. Torp-Pedersen, L. Køber","doi":"10.1111/J.1527-5299.2001.00243.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00243.X","url":null,"abstract":"INTRODUCTION. Atrial fibrillation is a frequent cause of worsening of symptoms in patients with congestive heart failure. The drugs currently available for maintenance of sinus rhythm all have major side effects. METHODS. In 34 Danish coronary care units, 1518 patients with congestive heart failure and reduced left ventricular systolic function were randomized to receive either placebo or a new class III antiarrhythmic drug, dofetilide. The dose of dofetilide was adjusted according to the presence of atrial fibrillation, the length of the QT interval, and renal function. Patients were continuously monitored electrocardiographically for the first 3 days of the study. The primary end point was all-cause mortality and follow-up was for at least 1 year. RESULTS. In the dofetilide/placebo groups, 311/317 patients died (41%/42%). The hazard ratio for dofetilide treatment was 0.95 (95% confidence interval, 0.81-1.11). Treatment with dofetilide reduced worsening of heart failure significantly (hazard ratio, 0.75; 0.63-0.89). After 1 year, 61% of patients with atrial fibrillation at the start of the study had converted to sinus rhythm on dofetilide, vs. 33% in the placebo group. After conversion to sinus rhythm, 78%/43% of patients in the dofetilide/placebo groups remained in sinus rhythm for at least 1 year. There were 25 instances (3%) of torsade de pointes ventricular tachycardia in the dofetilide group and none in the placebo group. CONCLUSION. In patients with congestive heart failure, dofetilide can effectively convert atrial fibrillation to sinus rhythm and maintain sinus rhythm after conversion. Hospitalization for congestive heart failure is reduced. Dofetilide does not affect mortality. (c)2001 by CHF, Inc.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"61 1","pages":"146-150"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84907952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-03-01DOI: 10.1111/J.1527-5299.2001.00235.X
J. Taylor, C. Mulgrew, R. Hayes, D. Ordin, E. Havranek
This column is the fourth in a series describing Health Care Financing Administration initiatives to improve care for Medicare beneficiaries with heart failure. The first three papers addressed the background, design, and baseline results of the Health Care Financing Administration national initiative to improve quality of inpatient care for heart failure through the activities of each state's Health Care Financing Administration contractor Peer Review Organization. This paper describes a smaller-scale but equally important endeavor: the Heart Failure Practice Improvement Effort, a pilot project to test the feasibility of assessing and improving heart failure care in the outpatient setting. (c)2001 by CHF, Inc.
{"title":"Heart failure practice improvement effort in the outpatient setting: a health care financing administration initiative to improve the care of medicare beneficiaries with heart failure.","authors":"J. Taylor, C. Mulgrew, R. Hayes, D. Ordin, E. Havranek","doi":"10.1111/J.1527-5299.2001.00235.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00235.X","url":null,"abstract":"This column is the fourth in a series describing Health Care Financing Administration initiatives to improve care for Medicare beneficiaries with heart failure. The first three papers addressed the background, design, and baseline results of the Health Care Financing Administration national initiative to improve quality of inpatient care for heart failure through the activities of each state's Health Care Financing Administration contractor Peer Review Organization. This paper describes a smaller-scale but equally important endeavor: the Heart Failure Practice Improvement Effort, a pilot project to test the feasibility of assessing and improving heart failure care in the outpatient setting. (c)2001 by CHF, Inc.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"124 3 1","pages":"105-108"},"PeriodicalIF":0.0,"publicationDate":"2001-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80478680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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