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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 (CHF) constitutes a significant clinical issue due to its increasing prevalence in general population and still fatal prognosis. During last twenty years the significance of beta-blockers in the treatment of CHF has changed. It resulted from the hypothesis from 1975 that in the course of CHF it comes to the activation of sympathetic system and renin-angiotensin-aldosterone system. Authors presented the actual views on CHF pathogenesis, mechanisms of favourable action of beta-blockers in CHF and the data from clinical trials on effectiveness of beta-blockers in different stages of CHF (among the others in elderly patients and in comparison with other treatment). Nevertheless, there are still several questions related to beta-blockers treatment in patients with CHF waiting to be resolved. Although the number of patients with CHF treated with beta-blockers is still increasing, the usefulness of conclusions resulting from clinical trials--as it has been shown in IMPROVEMENT-HF--is still insufficient. In contrast, following the recommendations of ESC, AHA and the Section of Heart Failure of Polish Cardiology Association both beta-blockers and ACE inhibitors constitute two main groups of medications that should be undoubtedly used in patients with CHF.
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PMID:[Beta-blockers in chronic heart failure]. 1286 3

Chronic heart failure (CHF) is an important public health care problem and a leading cause of morbidity and mortality world wide. Anemia is a common finding in CHF and known to cause heart failure. Patients with CHF are limited by exercise capacity and fatigue. A low hemoglobin concentration leads to impairment of both. With increasing severity of heart failure, anemia also becomes more frequent and clinically more relevant. There are many potential reasons for development of anemia in chronic heart failure like bone marrow depression, reduced intestinal iron uptake, and the dilution in consequence of sodium and water retention. However, the anemia seen in CHF is generally an "anemia of chronic illness". Furthermore, it has been shown that hemoglobin levels independently predict increased mortality in CHF.
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PMID:Anemia in chronic heart failure--frequency and prognostic impact. 1294 May 40

Chronic heart failure continues to exact a heavy burden on society due to high morbidity and mortality, in spite of advances in management. Beta-adrenergic blockade, by the suppression of sympathetic activity, attenuates the adverse ventricular remodeling seen in heart failure, and decreases mortality and hospitalization rates. Recently reported trials, meta-analyses, and sub-analyses extend the benefit of beta-blockade to severe heart failure, women, elderly patients, and African Americans. In addition, recent data also indicate the cost-effectiveness of beta-blockade in combating this deadly disease. These data indicate the strength of evidence for the use of beta-blockade for most patients with chronic heart failure.
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PMID:Beta-blockade in chronic heart failure: does it work in everyone? 1296 Apr 74

Chronic heart failure (CHF) is a common disease with high associated morbidity and mortality, and the outcome appears to be worse in black compared with white patients. There is currently no clear consensus for basing the pharmacological treatment of CHF on racial differences. Most studies that have investigated the potential effects of racial differences on pharmacological responses in heart failure have been based on African Americans and white participants. Using these data, this review will discuss the current understanding of the effects of racial differences in response to pharmacotherapy in heart failure, possible mechanisms for these observed differences, and how this may impact on patient management. Diuretics have favorable symptomatic benefits in both black and white patients with heart failure with evidence of fluid retention. ACE inhibitors seem to be less effective in the treatment of black patients with heart failure compared with white patients. This may be due to low pre-existing activity of the renin-angiotensin system in blacks. The role of angiotensin receptor blockers (ARBs) in the management of all patients with heart failure is incompletely defined and there are no clear trial data to show any difference in effect between black and white patients with heart failure. There is good evidence for the use of spironolactone in all patients with heart failure, but no evidence for a different effect in black patients. Similarly, there is no conclusive data to suggest a difference in effect of digoxin in different racial groups. The evidence available would suggest that certain beta-adrenoceptor antagonists (certainly carvedilol but not bucindolol) are effective in both black and white patients with CHF. The combination of hydralazine and nitrates would appear to be particularly effective in black patients with CHF though the African American Heart Failure Trial (A-HeFT) trial should provide clearer evidence for the potentially greater beneficial effects of these two drugs in the black population. It is important to accept that racial categorization acts as only a surrogate marker for genetic or other factors responsible for individual responses to drug therapy and that any identified differences will not apply to all members of each stratified group. Nonetheless, in managing a complex, common and often fatal condition such as heart failure, recognizing potential individual differences in drug responses should enable the responsible clinician to provide a tailored and evidence-based approach to patient treatment.
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PMID:Racial differences in responses to drug treatment: implications for pharmacotherapy of heart failure. 1472 54

Chronic heart failure is a slowly progressive disease. Hemodynamic deterioration activates various neuro-humoral factors and increases stresses, such as catecholamine, angiotensin II (AII), cytokines, endothelin, wall stress, ischemia, tachycardia, and oxidative stress. These factors affect the myocardium to cause phenotype switching, leading to ventricular remodeling. We investigated the effects of pharmacological blocking for neuro-humoral factors in rats with dilated cardiomyopathy. Experimental autoimmune myocarditis (EAM) was elicited in Lewis rats by immunization with cardiac myosin. After acute inflammation healed, rats were treated with angiotensin converting enzyme inhibitors (ACEI), type 1 AII receptor blockers, and amiodarone. These agents had favorable effects on hemodynamics and myocardial contractility, prevented fibrosis, suppressed the expression of ANP, and reversed phenotypic change of cardiac myosin. AII receptor blockers were less effective than ACEI. In order to prevent ventricular remodeling in chronic heart failure, wide and complete blocking of neuro-humoral factors is important.
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PMID:[Effects of humoral factors on left ventricular remodeling under chronic heart failure]. 1474 25

Chronic heart failure is a common disorder placing significant burdens on patients and health-care services. Noninvasive imaging plays a central role in accurate diagnosis, determination of etiology and prognosis, and in monitoring therapy. Advances in technology mean cardiovascular magnetic resonance (CMR) imaging has established itself as both a valuable clinical and research tool in this arena. Not only is CMR the new gold standard for accurate and reproducible assessment of ventricular volumes and mass, but by using gadolinium contrast, underlying pathology can often be determined. In ischemic cardiomyopathy a 'one stop' assessment can be made of function, perfusion and mass. Continuing advances such as myocardial tagging and the increasing availability of CMR mean that it will become an increasingly important and useful tool for clinicians looking after patients with cardiomyopathy and heart failure.
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PMID:The role of cardiovascular magnetic resonance in the evaluation of patients with heart failure. 1503 13

Chronic heart failure is a major cause for mortality and morbidity in western civilizations. Previous hypothesises regarding the pathogenesis of chronic heart failure did not sufficiently explain the aetiology and the progression of the disease. However, it has been shown that a group of peptides called cytokines are expressed during chronic heart failure and that cytokines might play an important role for the pathogenesis. The expression of cytokines can be modulated from specific ACE-inhibitors as well as from different beta-blockers and angiotensin type 1 antagonists. Numerous investigations have shown that cytokines depress left ventricular function and can be responsible for different characteristics of chronic heart failure. The present article resumes experimental and clinical investigations and recent pharmacologic attempts for the treatment of chronic heart failure. The previous results demonstrate the importance to further investigate anti-inflammatory approaches to treat chronic heart failure.
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PMID:[Cytokines and heart failure]. 1509 67

Chronic heart failure secondary to ventricular dysfunction is characterized by neurohormonal activation, reflected mainly as increased sympathetic and renin-angiotensin system activation. Increased plasma levels of several neurohormones have been associated with increased morbidity and mortality. Neurohormone activation is part of the mechanism of compensation that is activated to maintain hemodynamic stability when heart output is reduced. Despite the initial benefits of this mechanism, neurohormone activation has been shown to contribute to progressive impairment of ventricular function and symptoms of heart failure, such that the greater the degree of activation, the worse the prognosis.Despite their important implications for prognosis, plasma neurohormone levels are not measured in clinical practice as part of the clinical evaluation of patients with heart failure. Medical treatment with ACE inhibitors and beta blockers, by lowering the plasma levels of some neurohormones, reduces their prognostic usefulness in establishing risk. Thus, no ideal biomarker is yet available that is stable and easy to measure, and that accurately established risk in patients with heart failure. Such a marker should also have an acceptable cost/benefit ratio.
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PMID:[Clinical use of markers of neurohormonal activation in heart failure]. 1510 89

Chronic heart failure is a prevalent condition associated with high morbidity, high mortality and reduced quality of life. Chronic heart failure is the end-stage of various forms of heart disease. The prognosis is poor, worse than for patients with various forms of cancer. The diagnosis of heart failure is made in the presence of multiple symptoms and signs combined with objective evidence of cardiac dysfunction. Treatment consists of pharmacological as well as non-pharmacological approaches. ACE inhibitors and beta-blockers are the basis of treatment, while diuretics and other medications are given on an individual basis. The aim of treatment is to reduce progression of the underlying disease and to reduce mortality and morbidity.
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PMID:[Modern diagnosis and treatment of heart failure]. 1511 90

Chronic heart failure (HF) is a growing epidemic, and therapy options are becoming more complex. Specifically, device management of HF represents a new "class" of therapy that can reduce mortality and alleviate morbidity of the disease syndrome. Heart failure training programs seldom provide structured opportunities for trainees to gain competence in device implantation and management. This curriculum outlines a new approach to training interventional HF cardiologists and internal medicine HF specialists to meet the growing demands for specially trained health care providers.
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PMID:The evolving challenge of chronic heart failure management: a call for a new curriculum for training heart failure specialists. 1596 18


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