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

Chronic heart failure and atrial fibrillation often occur together. The aim of the study is to review the available literature on the impact of atrial fibrillation on mortality in patients with heart failure. Using MEDLINE six full papers were identified. In the studies with severe heart failure atrial fibrillation did not emerge as an independent predictor of mortality beyond standard clinical variables. In contrast, atrial fibrillation was associated with increased mortality in case of mild-to-moderate heart failure.
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PMID:Impact of atrial fibrillation on mortality in patients with chronic heart failure. 1241 98

Chronic heart failure is a major health problem, which is growing parallel to the increasing proportion of elderly in the population. Recurrent hospitalizations occur in about half of the subjects within 6 months after the initial admission. Several co-morbidities usually coexist in these patients and influence resource utilization and outcome. The high re-admission rates and low proportion of patients who are currently enrolled in specific follow-up programs underscore the existing pitfalls in outpatient care, and the lack of co-operation between hospital departments and out-of-hospital clinics or general practitioners. As a consequence, up to half of the hospital admissions may be caused by potentially preventable factors. As worldwide health-care cost-containment escalates, it becomes crucial to develop new cost-effective strategies to improve the quality of care of more severe patients. The implementation of clinic-based heart failure programs showed some evidence of an improvement in functional status and in the frequency of hospital readmissions. However, patients referred to Heart Failure Clinics represent a selected population of patients compared to the overall population of "real-world" elderly patients with incapacitating symptoms, serious co-morbidities and frequent inability to attend an outpatient clinic. Few trials are currently available to verify the efficacy of a clinic-based approach in such patients, with discordant results. Other studies have extended the multidisciplinary program to the patient's home. These strategies might be particularly appropriate and cost-effective if targeted to elderly and higher-risk patients, and appear to be of particular relevance given the phenomenon of progressive aging of the general population. The results of our intensive, nurse-monitored, homecare surveillance on quality of life and hospitalization rate in elderly patients with refractory heart failure who previously failed to reach the goal of clinical stability with a clinic-based program extend the effectiveness of heart failure programs, in terms of quality of life and hospital readmission, to terminally ill subjects with short life expectancy and very high resource utilization.
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PMID:[Integrated models between hospital and field for patients with heart failure]. 1241 28

Chronic heart failure (CHF) is increasing in prevalence worldwide, particularly in the elderly. Accordingly, this epidemic is likely to translate into a major increase in healthcare costs. Systolic heart failure is the most common cause of CHF presentations. Although the causes vary, the most common single aetiological factor is ischaemic heart disease, which accounts for approximately 50% of heart failure presentations. Research into CHF pharmacotherapy has been copious, with the focus principally centred on systolic heart failure. The evidence base for pharmacotherapy in CHF is amongst the largest currently in clinical medicine. There have been multiple trials establishing the mortality and morbidity benefits of pharmacotherapy. Amongst these, large scale trials of angiotensin-converting enzyme inhibitors, beta-blockers and spironolactone have provided a sound basis for evidence-based treatment approaches to the CHF patient. Recently research interest has increased in biomedical engineering with studies being performed in biventricular pacing and mechanical hearts. Early data with biventricular pacing or cardiac resynchronisation therapy is encouraging. Diastolic heart failure alone accounts for at least 20 - 40% of CHF presentations and whilst it may occur in isolation, is most commonly seen in association with systolic heart failure. In this study, we present a broad overview of the current therapeutic modalities for the management of CHF, with particular emphasis on pharmacotherapy.
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PMID:Clinical treatment regimens for chronic heart failure: a review. 1243 91

Chronic heart failure continues to increase in incidence and prevalence despite many pharmacologic advances over the previous decade. Morbidity and mortality remain high, with the number of hospitalizations for worsening heart failure in 1999 approaching 1 million. In addition to investigation of new therapies for the treatment of heart failure, attention must be placed on identifying effective methods for increasing the adoption of proven therapies. First, the potential barriers to implementation of evidence-based medicine must be recognized. Subsequently, strategies to overcome such barriers can be developed. Published guidelines may be helpful in educating practitioners on current standards of care. Other tools may also be considered, and testing the influence of such tools on the implementation of optimal therapy may help the scientific community better understand the factors that influence decision-making among clinicians.
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PMID:Treatment gaps in the pharmacologic management of heart failure. 1244 57

Chronic heart failure is linked to high rate of death and hospitalization. Some studies have highlighted the beneficial effect of heart failure clinics on morbidity and mortality. We have developed this type of structure at CHR Dubos since 3 years and we have recently created an heart failure clinic (10 beds). It's based on a concept including an experienced medical and nurse team, patient's and patient's family education and evaluation of the structure.
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PMID:[Heart failure clinics. Concept, organization, results]. 1251

Chronic heart failure (CHF) is a modern-day epidemic in most developed countries. As such, it is both common and costly. Contrary to the impression given by clinical trial data, CHF mainly affects older individuals with approximately equal numbers of men and women and concurrent disease profiles likely to complicate or even prohibit the application of proven treatments. It is within this context that there has been an increasing interest in specific CHF-management programmes designed to limit costly hospital use in typically older individuals at high risk for poor quality of life, recurrent readmissions and premature death. This paper examines the evidence to suggest that CHF programmes involving individualised multidisciplinary post-discharge healthcare, with a major focus on specialist nurse management to ensure that the patient receives optimal treatment, are clinically and economically effective in reducing the typical burden imposed by CHF. These programmes appear to be most effective in 'high-risk' patients who typically have recurrent readmissions in high-cost units. Overall, the literature suggests that these programmes are able to reduce recurrent hospital stay by 30-50% relative to usual care (even in the presence of gold-standard treatment) in the short to medium term with comparable cost benefits. Recent data from a management programme involving a cohort of typically older and fragile patients with CHF in Australia showed that at 3 years post index admission, hospital utilisation costs were reduced by one-third relative to usual care. The potential for enormous cost benefits (both in terms of absolute cost savings and in terms of facilitating a more efficient healthcare system) if a specialist nurse programme of care was applied in the form of a UK-wide heart failure service was also recently examined. Based on year 2000 activity levels, it was found that for each specialist heart failure nurse appointed in the UK (with a caseload of 200-250 patients per annum), nominal savings of pound 49 000 per annum could be generated in order to make the healthcare system more efficient.
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PMID:Specialist nurse management programmes: economic benefits in the management of heart failure. 1260 Feb 18

Chronic heart failure (CHF) is associated with an increase in the production and secretion of various regulatory hormones that are initially beneficial, but become deleterious when elevated for prolonged periods. The neurohumoral excitation that occurs in the CHF state is mediated, in part, by abnormal inhibitory cardiovascular reflexes, such as the arterial baroreflex and the cardiopulmonary reflex. In addition, two sympatho-excitatory reflexes have been shown to be enhanced in CHF: the arterial chemoreflex and the cardiac sympathetic afferent reflex. While these reflexes may play a role in the sympatho-excitation of the CHF state, there is an important central modulation of sympathetic outflow by a variety of hormones that are elevated in CHF and have been shown to have neural effects. These include angiotensin II (Ang II), nitric oxide (NO), and endothelin-1. In fact, experimental animal data suggest that a central reciprocal relationship exists between Ang II and NO in their ability to modulate sympathetic outflow. These substances may also participate in the beneficial effects of exercise training in the CHF state. Exercise training lowers sympathetic nerve activity and plasma Ang II, and enhances arterial baroreflex function. This review emphasizes the neurohormonal and reflex regulation of sympathetic outflow in heart failure. While abnormal reflex regulation may predict a poor outcome, new treatment options may emerge from a better understanding of reflex regulation in CHF.
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PMID:Novel mechanisms of sympatho-excitation in chronic heart failure. 1263 82

Chronic heart failure is an epidemic disorder in the elderly population. The frequent coexistence of comorbid illnesses and psychosocial issues in older persons often makes diagnosis and management difficult. Physicians must be aware of the current diagnostic modalities and proven therapies as they apply to elderly patients in order to achieve optimal outcomes. This article reviews new approaches to the diagnosis of heart failure, and discusses the latest evidence for both pharmacologic and nonpharmacologic treatment for this condition. Multidisciplinary strategies for the management of heart failure and end-of-life care are also briefly discussed.
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PMID:Management of heart failure in the elderly. 1269 41

Chronic heart failure shows an increasing prevalence and extremely high rate of both hospital admission and readmission. Thus, in recent years there has been a growing interest in the development of more effective strategies for disease management. The existing literature shows programs involving multidisciplinary teams, specialized clinics, that employ a systematic approach and provide continuity of care, frequently involving a specialized nurse dedicated to comprehensive management. These experiences reported a favourable effects on clinically relevant outcome, including readmission, quality of care and cost of care. A recent randomized trial conducted by Krumholtz and colleagues emphasises the importance of patient's education and support intervention, without medical management components. This model was effective in reducing readmissions and in-hospital costs. On the basis of these data, patients education and support should be considered a "non-pharmacological therapy" for heart failure patients.
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PMID:[Educating and communicating: non-pharmacologic treatment for patients with chronic heart failure?]. 1269 70

Chronic heart failure is an increasingly common cause of premature death and poor quality of life. Community-based epidemiological studies have provided much-needed information on the demography of chronic heart failure, providing insight into its influence on public health. In most patients, chronic heart failure is accompanied by a range of concomitant disorders that both contribute to the cause of the disease and have a key role in its progression and response to treatment. Information on the most common comorbidities in chronic heart failure--ischaemic heart disease, hypertension, and diabetes mellitus--is presented for prespecified subgroups in the reports of many large-scale, multicentre trials; despite their limitations, these subanalyses provide guidance in therapeutic decision-making. Similarly, because chronic heart failure is commonly an endpoint in intervention trials of both hypertension and diabetes, such studies afford important information on the prevention of chronic heart failure in these common diseases.
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PMID:Demographics and concomitant disorders in heart failure. 1367 91


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