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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Congestive heart failure is common, affecting 4-5 million American's with more than 500,000 new cases each year. A number of therapies have been proposed for the treatment of CHF; some have been found useful and some not. Digoxin therapy long a mainstay of therapy has been found beneficial, but lower doses and caution with its use in women has been recently advised based on new information. Converting enzyme inhibitors and beta blockers both add benefit when used in combination. The addition of aldosterone antagonists to the digoxin, diuretic, ACE, and beta-blocker combination appears to offer benefit and the use of the new less toxic eplerone will become more frequently employed in selected patients. Sudden death is also an important contributor to mortality in CHF patients. Use of a amiodarone and ICD's have both been reported to offer benefit. Selecting the optimum cost effective therapy is a challenge to those treating heart failure patients. ICD's are recommended in class II, III CHF with EF < 30 and amiodarone may be the therapy of choice in selected class IV patients and in patients with EF > 30%.
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PMID:The pharmacologic treatment of heart failure. 1554 89

This article summarises key presentations relevant to the pathophysiology, prevention or treatment of heart failure, from the Heart Failure Society of America annual meeting held in Toronto, Canada. Data from the EnoxiMone in intravenous inOTropE-dependent subjects (EMOTE) study suggest that the oral PDE-3 inhibitor enoximone may be effective for weaning severe heart failure patients from intravenous inotropic therapy. Hawthorn Extract Randomised Blinded Trial in CHF (HERB-CHF) failed to show a benefit of hawthorn extract added to conventional heart failure therapy. A genetic sub-group analysis of the Blocker Evaluation of Survival Trial (BEST) study showed that bucindolol reduced mortality and hospitalisations in patients who were homozygous for the Arg389 variant of the beta(1) adrenoceptor. In the Resynchronisation Hemodynamic Treatment for Heart Failure Management (RHYTHM-ICD) study, patients randomised to cardiac resynchronisation therapy (CRT) showed an improvement in symptoms and functional capacity compared to the control group.
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PMID:Clinical trials update from the Heart Failure Society of America: EMOTE, HERB-CHF, BEST genetic sub-study and RHYTHM-ICD. 1555 58

Vital statistics for coronary heart disease (CHD) were dramatically influenced by the tenth revision of the International Classification of Diseases (ICD-10) in 1995. To better understand the accuracy of death certificate diagnosis of CHD and heart failure, validation studies in Japan were reviewed. Positive predictive values and sensitivity, calculated as validation measures, varied widely between studies, differing with regard to autopsy rates, amount of information on medical records, and period investigated. However, heart failure, which has been frequently assigned on death certificates in Japan, was validated in some studies. Half of these were evaluated to be sudden deaths, including coronary deaths. Because autopsy-based studies on sudden deaths indicated that 30-50% of these were accounted for by CHD deaths, deaths assigned to heart failure should be taken into consideration in order to determine the actual number of CHD deaths in Japan. Focusing on changes in vital statistics after the 1995 ICD revision, the Oita Cardiac Death Surveys (OCDS) allowed interpretation of its effects on CHD and heart failure. Much of the increase in CHD deaths on vital statistics reflects more false positive cases, particularly for out-of-hospital deaths. Considering the Japanese features of vital statistics for CHD, further epidemiological validation studies are needed in order to confirm the accuracy of CHD death certificate diagnoses and to monitor actual CHD trends in Japan.
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PMID:Review of death certificate diagnosis of coronary heart disease and heart failure in Japan. 1567 82

As for the preceding years, important studies regarding several remaining clinical issues for electrophysiologists have been reported in 2004. Large randomized studies have underlined the need for an EP study in asymptomatic patients with overt ventricular preexcitation. In addition to a short antegrade refractory period, arrhythmia induction (atrial fibrillation or reciprocating tachycardia) argues for accessory pathway ablation. Although currently leading to fairly good results, atrial fibrillation ablation technique is still evolving. Encircling pulmonary vein and the surrounding atrial tissue seems to give better long term clinical results as compared to ostial pulmonary vein disconnection. Large series have confirmed that whatever cardiomyopathy etiology, prophylactic ICD implantation was associated with a reduction of sudden arrhythmic death during follow-up in patients with low ejection fraction. However, in order to save one patient more and more patients have to be implanted because of the increasing efficacy of pharmacological treatment for heart failure. Three clinical series of arrhythmogenic right ventricular dysplasia implanted with AICD have been published this year. The prognostic factors for the occurrence of severe ventricular arrhythmia are hemodynamically ill tolerated ventricular tachycardia, and VT induction during EP study. Management of patients with Brugada syndrome is still far from being well defined. Interestingly in a recent report, hydroquinidine has been found to reduce the incidence of ventricular arrhythmia in the follow-up as well as the rate of ventricular arrhythmia induction in the EP lab. Yet, prophylactic ICD implantation remains the treatment of choice in symptomatic and inducible patients.
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PMID:[The best of arrhythmia in 2004]. 1571 65

beta-Adrenoceptor antagonists (beta-blockers) provide multiple benefits to patients with coronary artery disease. The 2001 American Heart Association and American College of Cardiology (AHA/ACC) guidelines for secondary prevention of myocardial infarction (MI) recommend initiating beta-adrenoceptor blockade in all post-MI patients and continuing therapy indefinitely. Atenolol and metoprolol have been shown to decrease vascular mortality in the acute-MI period. In the post-MI period timolol provided a 39% reduction in mortality in the Norwegian Multicenter Study group and propranolol was associated with a 26% reduction in mortality in BHAT (Beta-blocker Heart Attack Trial). beta-Adrenoceptor antagonist therapy results in reduction of myocardial oxygen demand and is therefore also effective for the treatment of angina pectoris. In CAST (Cardiac Arrhythmia Suppression Trial) beta-adrenoceptor antagonist therapy was associated with a significant reduction in arrhythmic death or cardiac arrest. In the post-MI amiodarone trials EMIAT (European Myocardial Infarct Amiodarone Trial) and CAMIAT (Canadian Amiodarone Myocardial Infarction Trial) there was a mortality benefit and decreased arrhythmic death in patients who received both amiodarone and beta-adrenoceptor antagonist therapy, compared with patients receiving amiodarone therapy alone. In the post-MI defibrillator (implantable cardioverter defibrillator [ICD]) trials, AVID (Antiarrhythmic Versus Implantable Defibrillator) and MUSTT (Multicenter Unsustained Tachycardia Trial), beta-adrenoceptor antagonist therapy was independently associated with improved overall survival. The exception was the ICD patients in MUSTT, and the benefit was attenuated in the amiodarone and ICD patients in AVID.AHA/ACC guidelines recommend the use of beta-adrenoceptor antagonists in all patients with symptomatic left ventricular dysfunction, based on several large, controlled heart failure trials. Extended-release metoprolol succinate reduced all-cause mortality by 34% in MERIT-HF (Metoprolol Controlled-Release/Extended-Release Randomized Intervention Trial in Heart Failure). Bisoprolol was associated with a 34% mortality benefit in CIBIS-II (Cardiac Insufficiency Bisoprolol Study II) and carvedilol was associated with a 35% mortality reduction in the COPERNICUS (Carvedilol Prospective Randomized Cumulative Survival) trial. beta-Adrenoceptor antagonists reduce perioperative mortality in patients undergoing cardiac as well as non-cardiac surgery; however, they remain underutilised. Contraindications to beta-adrenoceptor antagonist therapy include severe bradycardia, high-grade atrioventricular block, marked sinus node dysfunction and acute exacerbations of heart failure. Many of the perceived adverse effects of beta-adrenoceptor antagonists have not been substantiated by large clinical trials.beta-Adrenoceptor antagonists differ with regard to receptor selectivity, receptor affinity, lipophilicity and intrinsic sympathomimetic activity. Beneficial properties of beta-adrenoceptor antagonists may not always be extrapolated as a class effect, and patient selection and drug preparations should follow trial guidelines. The beneficial effects of beta-adrenoceptor antagonists are clearly proven in cardiac patients and those at risk for cardiac disease. They are indicated for heart failure and proven beneficial in patients undergoing cardiac and non-cardiac surgery. These benefits appear to be consistent across most patient subgroups. beta-Adrenoceptor antagonists are generally well tolerated, yet significant morbidity and mortality result from their continued underutilisation.
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PMID:Optimising the use of beta-adrenoceptor antagonists in coronary artery disease. 1581 91

Patients who present with an impaired left ventricular (LV) function of nonischemic origin (EF < or = 35%), should first undergo intensified heart failure therapy with angiotensin-converting enzyme (ACE) inhibitors, beta-blockers and diuretics. If the impairment of LV function persists for 3-9 months despite adequate therapy, the implantation of a defibrillator (ICD) seems to be reasonable for the primary prevention of sudden cardiac death in these patients. If patients present with non-sustained ventricular tachycardias, ICD implantation and treatment with amiodarone are probably equally effective and better than mere heart failure therapy. In patients presenting with an indication for biventricular pacing, a biventricular ICD should be used.
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PMID:[Idiopathic dilated cardiomyopathy--an appraisal in 2005]. 1587 96

Device-based anti-arrhythmic therapy is one of the most dynamically evolving branches of the medicine. Brady- and tachyarrhythmias can be treated efficiently and cost-effective with current pacemakers and ICDs. Beside conventional indications new indications have appeared in the last years: resynchronization treatment of severe congestive heart failure with biventricular pacing, primary prevention of sudden cardiac death with ICD, reduction of intraventricular gradient in hypertrophic obstructive cardiomyopathy. Several large clinical studies have investigated the efficacy of treatment in conventional indications, so the role of pacemaker therapy in carotid sinus hyperaesthesia or sinus node disease has been elucidated. Newer studies are trying to clarify the type or programming of the pacemaker in a given indication: physiological pacemakers have a more beneficial effect on the quality of life and decrease the incidence of atrial fibrillation. The implanted devices have frequency adaptation with new sensors, and they are even able to detect heart failure in an early phase. In the near future the number of pacemaker and ICD implantations will grow exponentially based on current trend. This will be due to the aging population, the simplification and increasing safety of implantation, and the widening of the indications for antiarrhythmic device implantation.
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PMID:[Latest results of treatment with pacemaker and implantable cardioverter defibrillators]. 1594 37

The number of patients eligible for implantable cardioverter defibrillator implantation is large and growing. Results of the Multicenter Automatic Defibrillator Implantation Trial-II, Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure trial, and Sudden Cardiac Death in Heart Failure Trial will have a major impact on health care expenditure and economics in all countries. Therefore, one of the most important challenges in today's cardiology is finding more specific and accurate risk stratification strategies (rather than simply ejection fraction) for primary prevention of sudden cardiac death in patients who have suffered myocardial infarction. We hereby reviewed the existing data on potential risk stratifiers and assessed their impact on every day decision making and patient selection for ICD implantation.
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PMID:Risk stratification for arrhythmic death after myocardial infarction: current perspective and future direction. 1596 87

This article provides information and a commentary on trials presented at the European Society of Cardiology meeting held in September 2005, relevant to the pathophysiology, prevention and treatment of heart failure. All reports should be considered as preliminary data, as analyses may change in the final publication. In the CARE-HF extension study, the benefits of cardiac resynchronisation therapy (CRT) observed in the original study were maintained over an increased follow-up period. A study of oral enoximone (25-50 mg t.i.d.) in advanced heart failure (ESSENTIAL) showed limited benefit compared to placebo. The CIBIS-III study showed that heart failure therapy could be safely initiated with bisoprolol followed by the addition of enalapril. A subcutaneous ICD system (S-ICD) showed potential as an alternative to a transvenous ICD. In the ISSUE-2 study, an implantable loop recorder was used to guide therapy in patients with recurrent syncope. The selective endothelin antagonist sitaxsentan improved 6-MWT and functional class in patients with pulmonary arterial hypertension in the STRIDE-2 study. In SOFA, fish oil had no beneficial effect on the incidence of life-threatening arrhythmias in patients with an ICD. In IMAGINE, quinapril showed no benefit when administered to patients following CABG. Perindopril reduced cardiac remodelling in post-MI patients with normal LV function in PREAMI. SIRIUS-II showed encouraging results for the use of intravenous ularitide in symptomatic decompensated chronic heart failure. The ACTIVE W study of warfarin versus aspirin plus clopidogrel in atrial fibrillation has been stopped due to superiority of warfarin.
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PMID:Clinical trials update from the European Society of Cardiology meeting 2005: CARE-HF extension study, ESSENTIAL, CIBIS-III, S-ICD, ISSUE-2, STRIDE-2, SOFA, IMAGINE, PREAMI, SIRIUS-II and ACTIVE. 1648 69

This review focuses on hypertrophic (HCM), restrictive (RCM) and arrhythmogenic right ventricular cardiomyopathies (ARVC). The clinical phenotype of HCM depends not only on the gene mutations involved, but also on "modifier genes". It is characterized by an asymmetrical hypertrophy. Investigations of endomyocardial biopsies (EMBs) typically reveal a disarray of the hypertrophied cardiomyocytes. Percutaneous septum ablation has gained relevance as the treatment of choice in hypertrophic obstructive cardiomyopathy. Myocardial and endomyocardial RCM-forms can be differentiated. Enlargement of the atria in concert with normal dimensions of the ventricles and almost normal systolic contractility as well as the dip-plateau phenomenon are characteristic findings in RCM. EMB diagnostics are pivotal to identify the causes underlying secondary RCM types. Treatment is directed at heart failure and specifically at the underlying disease. With ARVC, apoptosis, viral infection/inflammation and genetic dystrophy result in fibrofatty degeneration primarily of the right, and with further progression also of the left ventricle. The primary treatment goal in ARVC is prevention of sudden cardiac death. As for other cardiomyopathies, there is increasing evidence for the superiority of ICD compared with pharmacological approaches.
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PMID:[Cardiomyopathies II. Hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy]. 1623 14


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