Pub Date : 2001-11-01DOI: 10.1111/J.1527-5299.2001.00273.X
E. Havranek, F. Masoudi, G. L. Smith, P. Wolfe, D. Ralston, H. Krumholz, D. Ordin
This column is the seventh in a series reporting on the efforts of the Center for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration, to improve care for Medicare beneficiaries with heart failure. In previous columns we have described the overall structure of Medicare quality improvement efforts, detailed the structure of the national inpatient fee-for-service program known as the National Heart Failure project, and discussed the baseline quality indicator rates for the project, which are focused on rates of ejection fraction documentation and angiotensin-converting enzyme inhibitor prescription. In more recent columns, we reported on quality improvement projects from several participating hospitals, and on a pilot project exploring quality improvement efforts for heart failure based in physicians' offices. This column will focus on ways in which systematic examination of data, such as those from the National Heart Failure project, might shape future quality improvement and research efforts. The National Heart Failure project's quality indicator data are collected primarily to guide and evaluate the efforts of the CMS contractor peer-review organizations to facilitate quality improvement efforts in hospitals throughout the United States. (c)2001 CHF, Inc.
{"title":"Lessons learned from the national heart failure project: a center for medicare and medicaid services initiative to improve the care of medicare beneficiaries with heart failure.","authors":"E. Havranek, F. Masoudi, G. L. Smith, P. Wolfe, D. Ralston, H. Krumholz, D. Ordin","doi":"10.1111/J.1527-5299.2001.00273.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00273.X","url":null,"abstract":"This column is the seventh in a series reporting on the efforts of the Center for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration, to improve care for Medicare beneficiaries with heart failure. In previous columns we have described the overall structure of Medicare quality improvement efforts, detailed the structure of the national inpatient fee-for-service program known as the National Heart Failure project, and discussed the baseline quality indicator rates for the project, which are focused on rates of ejection fraction documentation and angiotensin-converting enzyme inhibitor prescription. In more recent columns, we reported on quality improvement projects from several participating hospitals, and on a pilot project exploring quality improvement efforts for heart failure based in physicians' offices. This column will focus on ways in which systematic examination of data, such as those from the National Heart Failure project, might shape future quality improvement and research efforts. The National Heart Failure project's quality indicator data are collected primarily to guide and evaluate the efforts of the CMS contractor peer-review organizations to facilitate quality improvement efforts in hospitals throughout the United States. (c)2001 CHF, Inc.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"1 1","pages":"334-336"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90725133","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 : 2001-11-01DOI: 10.1111/J.1527-5299.2001.01378.X
M. Silver
{"title":"Yet another milestone for CHF!","authors":"M. Silver","doi":"10.1111/J.1527-5299.2001.01378.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.01378.X","url":null,"abstract":"","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"11 1","pages":"294-295"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79949294","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 : 2001-11-01DOI: 10.1111/J.1527-5299.2001.01167.X
C. Leier, Young Jb, T. Levine, I. Piña, P. Armstrong, M. Fowler, L. Warner-Stevenson, J. Cohn, J. O’Connell, M. Bristow, J. Nicklas, J. De, J. Howlett, H. Ventura, T. Giles, B. Greenberg, K. Chatterjee, R. Bourge, C. Yancy, Gottleib Ss
{"title":"Nuggets, pearls, and vignettes of master heart failure clinicians. Part 2-the physical examination.","authors":"C. Leier, Young Jb, T. Levine, I. Piña, P. Armstrong, M. Fowler, L. Warner-Stevenson, J. Cohn, J. O’Connell, M. Bristow, J. Nicklas, J. De, J. Howlett, H. Ventura, T. Giles, B. Greenberg, K. Chatterjee, R. Bourge, C. Yancy, Gottleib Ss","doi":"10.1111/J.1527-5299.2001.01167.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.01167.X","url":null,"abstract":"","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"113 1","pages":"297-308"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89462986","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 : 2001-11-01DOI: 10.1111/J.1527-5299.2001.00261.X
A. Serdar, D. Yeşilbursa, Z. Serdar, M. Dirican, B. Turel, J. Cordan
Chronic heart failure is a common, disabling disorder with high mortality. Oxidative stress may have both functional and structural effects on the myocardium, leading to myocardial decompensation. In this study, the authors examined the relationship of oxidative stress and functional capacity in patients with varying degrees of heart failure. Fifty-one patients with chronic heart failure and 31 control subjects were studied. The functional capacity of patients was determined. Plasma malondialdehyde, vitamin E, and beta-carotene levels were measured. The malondialdehyde levels were significantly different between control subjects and heart failure patients (p=0.03). There was a positive correlation between patients' malondialdehyde levels and New York Heart Association functional class (r=0.59; p<0.0001). There was a negative correlation between the functional class and vitamin E and beta-carotene levels (r=20.43; p<0.0001 and r=20.25; p<0.01, respectively). These data demonstrate that oxidative stress is increased systemically in patients with chronic heart failure. It seems that this increase correlates with functional class. (c)2001 CHF, Inc.
{"title":"Relation of functional capacity with the oxidative stress and antioxidants in chronic heart failure.","authors":"A. Serdar, D. Yeşilbursa, Z. Serdar, M. Dirican, B. Turel, J. Cordan","doi":"10.1111/J.1527-5299.2001.00261.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00261.X","url":null,"abstract":"Chronic heart failure is a common, disabling disorder with high mortality. Oxidative stress may have both functional and structural effects on the myocardium, leading to myocardial decompensation. In this study, the authors examined the relationship of oxidative stress and functional capacity in patients with varying degrees of heart failure. Fifty-one patients with chronic heart failure and 31 control subjects were studied. The functional capacity of patients was determined. Plasma malondialdehyde, vitamin E, and beta-carotene levels were measured. The malondialdehyde levels were significantly different between control subjects and heart failure patients (p=0.03). There was a positive correlation between patients' malondialdehyde levels and New York Heart Association functional class (r=0.59; p<0.0001). There was a negative correlation between the functional class and vitamin E and beta-carotene levels (r=20.43; p<0.0001 and r=20.25; p<0.01, respectively). These data demonstrate that oxidative stress is increased systemically in patients with chronic heart failure. It seems that this increase correlates with functional class. (c)2001 CHF, Inc.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"2 1","pages":"309-311"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86745492","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 : 2001-11-01DOI: 10.1111/J.1527-5299.2001.00274.X
D. Sica
Angiotensin II is the effector peptide of the renin-angiotensin system and is involved in a wide range of physiologic functions that relate to volume control. In this regard, angiotensin II maintains and regulates salt and water balance, is critically involved in cardiovascular function, and governs thirst. When present in excess, angiotensin II can pathologically influence each of these functions. The role of angiotensin II in controlling sodium balance, in both renal insufficiency states and congestive heart failure, is clearly recognized. Alternatively, it is poorly appreciated that angiotensin II plays an important role in both normal and pathologic thirst states. The latter is a potential problem in both end-stage renal disease and congestive heart failure. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists (AT1-RAs) have both been shown to reduce abnormal thirst drive. Whether an ACE inhibitor or an AT1-RA lessens thirst drive to any significant degree relates to its capacity to penetrate the blood-brain barrier. Head-to-head comparisons of ACE inhibitors and AT1-RAs, as to their effect on thirst drive, have not been undertaken in a systematic fashion; thus, until otherwise established, the effect of these compounds on thirst should be viewed as a class effect, albeit one that is likely to be dosedependent.
{"title":"Angiotensin II and Thirst: Therapeutic Considerations","authors":"D. Sica","doi":"10.1111/J.1527-5299.2001.00274.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00274.X","url":null,"abstract":"Angiotensin II is the effector peptide of the renin-angiotensin system and is involved in a wide range of physiologic functions that relate to volume control. In this regard, angiotensin II maintains and regulates salt and water balance, is critically involved in cardiovascular function, and governs thirst. When present in excess, angiotensin II can pathologically influence each of these functions. The role of angiotensin II in controlling sodium balance, in both renal insufficiency states and congestive heart failure, is clearly recognized. Alternatively, it is poorly appreciated that angiotensin II plays an important role in both normal and pathologic thirst states. The latter is a potential problem in both end-stage renal disease and congestive heart failure. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists (AT1-RAs) have both been shown to reduce abnormal thirst drive. Whether an ACE inhibitor or an AT1-RA lessens thirst drive to any significant degree relates to its capacity to penetrate the blood-brain barrier. Head-to-head comparisons of ACE inhibitors and AT1-RAs, as to their effect on thirst drive, have not been undertaken in a systematic fashion; thus, until otherwise established, the effect of these compounds on thirst should be viewed as a class effect, albeit one that is likely to be dosedependent.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"36 1","pages":"325-328"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82751387","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 : 2001-11-01DOI: 10.1111/J.1527-5299.2001.00270.X
K. Parker, N. Houston Miller, R. Debusk
Spironolactone has recently been shown to have a favorable impact on the prognosis and functional status of patients with left ventricular systolic dysfunction and severe symptoms who are receiving standard therapy. However, participants in clinical studies of spironolactone represent a selected group. Clinicians managing a less selected group must be mindful of selection criteria and appropriate methods to monitor patients who are initiated on these medications. In this review, two case studies are described that demonstrate the importance of careful selection of candidates for spironolactone, the need for close laboratory and symptom monitoring, and the need for patients' active participation in reporting changes in their clinical status. (c)2001 CHF, Inc.
{"title":"Optimal use of spironolactone for treatment of heart failure.","authors":"K. Parker, N. Houston Miller, R. Debusk","doi":"10.1111/J.1527-5299.2001.00270.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00270.X","url":null,"abstract":"Spironolactone has recently been shown to have a favorable impact on the prognosis and functional status of patients with left ventricular systolic dysfunction and severe symptoms who are receiving standard therapy. However, participants in clinical studies of spironolactone represent a selected group. Clinicians managing a less selected group must be mindful of selection criteria and appropriate methods to monitor patients who are initiated on these medications. In this review, two case studies are described that demonstrate the importance of careful selection of candidates for spironolactone, the need for close laboratory and symptom monitoring, and the need for patients' active participation in reporting changes in their clinical status. (c)2001 CHF, Inc.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"10 1","pages":"315-318"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72935553","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 : 2001-11-01DOI: 10.1111/J.1527-5299.2001.00272.X
G. Mansoor, A. Abiose, W. White
Ambulatory blood pressure monitoring has become a widely used method of blood pressure and heart rate evaluation in the free-living subject. Recently, ambulatory monitoring has become covered by Medicare for the evaluation of "white-coat" hypertension. Although the technique provides only intermittent readings throughout the 24-hour period, average blood pressures obtained in this way correlate well with a variety of hypertensive disease processes and are also a better prognostic marker for future cardiovascular events than office blood pressure. Ambulatory blood pressure averages also correlate well with indices of diastolic dysfunction. In patients with congestive cardiac failure and systolic dysfunction, ambulatory monitoring suggests an impaired circadian blood pressure profile with high nocturnal blood pressure. Further research is needed on the relationship between ambulatory blood pressure and cardiac dysfunction, as well as the impact of observed circadian blood pressure changes on outcome. (c)2001 CHF, Inc.
{"title":"Ambulatory blood pressure monitoring: technique and application in the study of cardiac dysfunction and congestive heart failure.","authors":"G. Mansoor, A. Abiose, W. White","doi":"10.1111/J.1527-5299.2001.00272.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00272.X","url":null,"abstract":"Ambulatory blood pressure monitoring has become a widely used method of blood pressure and heart rate evaluation in the free-living subject. Recently, ambulatory monitoring has become covered by Medicare for the evaluation of \"white-coat\" hypertension. Although the technique provides only intermittent readings throughout the 24-hour period, average blood pressures obtained in this way correlate well with a variety of hypertensive disease processes and are also a better prognostic marker for future cardiovascular events than office blood pressure. Ambulatory blood pressure averages also correlate well with indices of diastolic dysfunction. In patients with congestive cardiac failure and systolic dysfunction, ambulatory monitoring suggests an impaired circadian blood pressure profile with high nocturnal blood pressure. Further research is needed on the relationship between ambulatory blood pressure and cardiac dysfunction, as well as the impact of observed circadian blood pressure changes on outcome. (c)2001 CHF, Inc.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"3 1","pages":"319-324"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89031697","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 : 2001-11-01DOI: 10.1111/J.1527-5299.2001.00259.X
D. Kremastinos
Heart failure remains the main cause of death in β-thalassemia despite the progress that has been made. Myocardial iron deposition alone does not affect left ventricular relaxation but directly causes left ventricular myocardial restriction with considerably elevated pulmonary pressure. This leads to symptoms and signs of predominantly right-sided heart failure, which is usually observed in elderly and severely hemosiderotic populations. Left ventricular systolic dysfunction and failure, which occurs in younger, less hemosiderotic populations, seems to be multifactorial in etiology. Apart from iron loading, immunogenetic risk factors trigger the mechanisms of left-sided heart failure development in the context of dilated-type cardiomyopathy.
{"title":"Heart Failure in β‐Thalassemia","authors":"D. Kremastinos","doi":"10.1111/J.1527-5299.2001.00259.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00259.X","url":null,"abstract":"Heart failure remains the main cause of death in β-thalassemia despite the progress that has been made. Myocardial iron deposition alone does not affect left ventricular relaxation but directly causes left ventricular myocardial restriction with considerably elevated pulmonary pressure. This leads to symptoms and signs of predominantly right-sided heart failure, which is usually observed in elderly and severely hemosiderotic populations. Left ventricular systolic dysfunction and failure, which occurs in younger, less hemosiderotic populations, seems to be multifactorial in etiology. Apart from iron loading, immunogenetic risk factors trigger the mechanisms of left-sided heart failure development in the context of dilated-type cardiomyopathy.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"12 1","pages":"312-314"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85528502","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 : 2001-09-01DOI: 10.1111/J.1527-5299.2001.00307.X
C. Leier, M. Silver, B. Massie, J. Young, M. Fowler, H. Ventura, R. E. Hershberger
Last fall, the Editors of the journal Congestive Heart Failure, Drs. Marc Silver and John Strobeck, asked me to serve as Guest Editor for an issue of the journal. Accepting this honor was linked to the requirement that I had to generate a meaningful theme. The thought of delivering another series of articles on CHF trials and their interpretation, bench-to-bedside (and vice-versa) topics in heart failure, and similar efforts did little to excite me and, in fact, it threatened to exacerbate my narcoleptic condition. Besides, we have many colleagues more skilled at delivering this information and they truly enjoy doing so. We have fortunately entered the era of “evidence-based medicine” this theme will likely remain with us for the entire lifetime of health care delivery. While most physicians have now joined this movement, it is remarkable how much of the day-to-day medical care of the patient with heart failure has not yet been addressed by statistically powered (i.e., evidence-based) trials. Much (probably most) of what we do to keep patients as healthy and functional as possible is still based on our experience as clinicians and on the information shared by colleagues (personal contact, consultation, conferences, written material). It is not often that data from a large treatment trial assist me in determining the optimal dose of a drug or doses of combinations in an individual patient, in optimizing the immediate care and management of a complexly ill patient, in addressing the emergency phone call at 2 a.m., and so forth. Until statistically powered trials can address all aspects and details of patient care, “experience-based medicine” must fill the knowledge void. Unfortunately, much of this information is not available in textbooks, review articles, the Internet and other media. As the passionate fervor of evidence-based medicine soars to its fever pitch, there will be even less incentive to share in print potentially helpful information based on clinical experience. In his submission to this issue, Thomas D. Giles, MD, wrote, “I am fearful that valuable contributions to patient care will be lost and sacrificed on the altar of ‘evidenced-based’ medicine (usually referring to data from clinical trials). While I certainly believe that important concepts emanate from clinical trials, I also believe that there are other sources of guidance for the care of patients. The Reverend Bayes reminded us that intuition and prior experience are an integral part of the analysis of data.” Parenthetically, most of the questions addressed by trials and the design of trials are largely based on information gleaned from clinical experience. It is in this spirit that the Editors, Drs. Silver and Strobeck, CHF, Inc., and I present to you the first installment in a four-part series. The fuel for this project has both a historical and a pragmatic thrust; “it would be a shame” if we allowed our venerable colleagues to advance into the autumn of
去年秋天，《充血性心力衰竭》(充血性心力衰竭)杂志的编辑、马克·西尔弗和约翰·斯特罗贝克，邀请我做一期杂志的客座编辑。接受这一荣誉意味着我必须创造一个有意义的主题。一想到要发表另一系列关于心力衰竭试验及其解释的文章，从临床到临床(反之亦然)的主题，以及类似的努力，我几乎没有感到兴奋，事实上，它有可能加剧我的发作性睡病。此外，我们有许多同事更擅长传递这些信息，而且他们真的很喜欢这样做。幸运的是，我们已经进入了“循证医学”的时代，这一主题可能会伴随我们整个医疗保健服务的生命周期。虽然大多数医生现在都加入了这一运动，但值得注意的是，有多少心力衰竭患者的日常医疗护理尚未得到统计支持(即基于证据的)试验的解决。我们为保持病人的健康和功能所做的很多(可能是大多数)工作仍然是基于我们作为临床医生的经验和同事分享的信息(个人接触、咨询、会议、书面材料)。大型治疗试验的数据通常不会帮助我确定单个患者的药物或组合剂量的最佳剂量，优化对复杂患者的即时护理和管理，处理凌晨2点的紧急电话，等等。在统计试验能够解决病人护理的所有方面和细节之前，“基于经验的医学”必须填补知识空白。不幸的是，这些信息在教科书、评论文章、互联网和其他媒体上都找不到。随着对循证医学的热情高涨到狂热的程度，人们分享基于临床经验的潜在有用信息的动力就更少了。医学博士Thomas D. Giles在提交给这个问题的意见书中写道:“我担心对病人护理的宝贵贡献将会丧失，并被‘循证’医学(通常指临床试验数据)的祭坛所牺牲。”虽然我当然相信重要的概念来自临床试验，但我也相信还有其他的指导病人护理的来源。贝叶斯牧师提醒我们，直觉和先前的经验是数据分析不可或缺的一部分。”顺便说一句，试验所解决的大多数问题和试验的设计在很大程度上是基于从临床经验中收集的信息。正是本着这种精神，编辑们、博士们。Silver and Strobeck, CHF, Inc.和我向您呈现的是四部分系列的第一部分。这个项目的动力既有历史意义，也有现实意义;如果我们让我们尊敬的同事进入职业生涯的秋天，甚至退休，而没有了解他们对病人护理的见解、想法和热情，这将是一种耻辱，这些都是几十年专注、紧张的临床经验积累起来的。我们需要从博士那里听到更多，而不是更少。查特吉，科恩，阿姆斯特朗和他的同事。本系列不打算作为一个全面的论述心力衰竭的管理。事实上，作者假设读者相当精通这一领域的研究和实践。编辑和工作人员没有对每位作者提交的内容进行实质性的修改。我们和其他合著者可能对任何提交的任何分歧都被搁置一边，以便允许自由和公开地呈现观点和意见。作为读者，我们要求你自己判断和决定，在你的实践和对心力衰竭患者的日常护理中，哪些“金块和珍珠”是令人愉快和有用的。为了让您更好地了解本系列的格式和内容，我与您分享我在邀请函中发给每位作者的指示:我希望您贡献一篇关于多年来在评估，管理和治疗CHF方面对您(和您的患者)有帮助的有用提示，建议，操作和方法。一切都是公平的。很多材料之前都没有发表过，当然也没有证据。基本上，我们在日常管理心力衰竭患者中所做的大部分工作仍然与简单的临床经验有关，做有效的事情，以及我们自己的“交易技巧”。“我打算把这些想法、经历和想法付梓。该出版物应作为临床见解、经验和信息的丰富来源，并可能作为进一步研究和产生证据的试验的跳板。 除了截止日期外，对于你的投稿没有任何规则(参考作者通常的编辑指导)!在这个国家和加拿大有数百名心力衰竭专家，选择作者是一个严峻的挑战。入选的目标医师和科学家至少有20年的心力衰竭经验，在心力衰竭的同行评议研究中有重要的发表记录，并且在人类心力衰竭的床边有知名的、精通的临床专业知识。在客座编辑的指示下，我利用自己缺乏判断力的优势，把自己的名字加到了作者名单上。被邀请的人中有几个人不能为手稿做出贡献，因此有些作者缺席。编辑和我向那些由于我们的疏忽而没有被邀请投稿的人深表歉意。如果这次冒险是成功的，并受到好评，你很可能是类似的努力计划在未来几年的一部分。我和合著者将这些见解和观点献给我们的老师，他们共同组成了我们的病人、学生、同事和导师。我感谢西尔弗博士和斯特罗贝克博士给我的荣誉，我感谢我尊敬的合著者和同事们让我有了一次有教育意义和愉快的经历。
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