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

Each year about 550,000 new patients are diagnosed as having congestive heart failure, which for acutely symptomatic patients is also referred to as acutely decompensated heart failure. The incidence of congestive heart failure is approximately 10 per 1000 for Americans over the age of 65 years. Men and women are affected in equal numbers, and 5-year mortality has been reported to be as high as 50%. Increased longevity increases the likelihood that heart failure will develop as a consequence of pathophysiologic processes that gradually weaken the myocardium and the vascular system. Patients who present to the emergency department with complaints of shortness of breath, dyspnea on exertion, increasing lower extremity edema, and/or worsening fatigue should have heart failure included in the differential diagnosis. Heart failure patients experiencing symptoms consistent with cardiac ischemia, hypoxia, potentially lethal arrhythmias, marked hypertension, or hypotension should be immediately triaged to a critical care area. The approval of nesiritide by the U.S. Food and Drug Administration in 2001 has stimulated the development of revisions in strategies for the emergency department treatment of acute decompensated heart failure patients. The early use of nesiritide, along with topical nitroglycerin and a loop diuretic, may lead to more rapid resolution of these patients' acute symptoms and hemodynamic dysfunction.
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PMID:Acutely decompensated heart failure: opportunities to improve care and outcomes in the emergency department. 1243 25

Heart failure affects 4.8 million people in the United States. Patients depressed after myocardial infarction have increased morbidity and mortality. Only a few studies have investigated the effects of depression in patients with heart failure. The incidence of depression in heart failure ranges from 13% to 77.5%. Men with heart failure are more likely to become depressed than the general population. Depression incidence is higher in hospitalized patients with heart failure than in stabilized outpatients. In patients with heart failure, depression is associated with mortality. Physiologic changes, which occur in depressed patients, have been implicated as possibly contributing to the increased mortality. Nurses have a major role in the management of patients with heart failure and can be pivotal in the detection and treatment of depression in these patients. Reduction in depression is likely to decrease morality in patients with heart failure.
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PMID:Depression in patients with heart failure: physiologic effects, incidence, and relation to mortality. 1257 98

Between 1994-1998, we retrospectively studied a cohort of 396 consecutive patients with dilated cardiomyopathy, mean age 53 +/- 15 years, 74% men. The history of alcohol intake was abstracted from the medical records. During a follow-up period of 42 +/- 26 months, 83 (76% men) patients died and 15 (80% men) underwent cardiac transplantation. Men were younger and more likely to have a history of excessive alcohol intake compared with women. Gender significantly modified the risk of alcohol consumption on mortality. Although alcohol intake increased the mortality risk in women, it was protective toward death in men (hazards ratios for death were 7.3 vs. 0.44). The effect of alcohol intake on outcome was reassessed after classifying the patients into 4 groups: group 1: life-long nondrinkers; group 2: former drinkers; group 3: moderate drinkers; and group 4: heavy drinkers. Similar findings were seen. This study demonstrated that the risk of reported alcohol intake on mortality is related to gender in patients with nonischemic heart failure. Our findings deserve further study, including a larger number of females, as a possible way to improve outcome in such patients.
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PMID:Influence of gender and reported alcohol intake on mortality in nonischemic dilated cardiomyopathy. 1271 75

In a series of papers the authors analyze literature data on the use of cardiac glycosides for long term treatment of chronic heart failure. Data obtained in prospective placebo controlled trial DIG show that digoxin significantly increases mortality of all patients with sinus rhythm and intact left ventricular systolic function (ejection fraction > 45%) and of women with left ventricular systolic dysfunction (ejection fraction < or = 45%). Men with left ventricular systolic dysfunction represent the only category of patients with chronic heart failure in sinus rhythm in whom long term administration of digoxin is justified. Digoxin does not affect mortality of these patients however it reduces requirements in hospitalizations due to worsening of heart failure.
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PMID:[The place of cardiac glycosides in the treatment of chronic heart failure. Part III. The DIG trial]. 1600 36

The prevalence of obstructive sleep apnea syndrome in patients up to the age of 60 is known to be two times higher in men then in women. Hormonal changes during menopause might underlie changes in this relationship in the elderly. This study was designed to detect differences in the type and frequency of sleep-disordered breathing between women and men over the age of 65 years, having the same body mass index. The study was conducted using a matched-pair approach consisting of a sample population of 40 pairs of patients over the age of 65. All patients met the following exclusion criteria: age below 65, heart failure, chronic obstructive lung disease. Polygraphy was conducted by means of a portable recorder. All measured indices were higher in men than in women. The apnea index was 2.8 +/-4.1 in men and 0.6 +/-1.4 in women. The apnea/hypopnea index was 10.2 +/-11.4 and 4.8 +/-3.9, respectively. These differences were significant (P<0.05). Significant differences also were observed when central (men 8.1 +/-13.1, women 3.1 +/-8.2), mixed (men 5.1 +/-11.4, women 0.4 +/-1.3), and obstructive (women men 8.6 +/-20.1, 1.0 +/-4.3) apnea indices were compared. In conclusion, the study demonstrates that elderly patients showed gender-dependent differences in the type and frequency of sleep-related breathing disorders. Men suffered from all kinds of apnea more frequently than women.
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PMID:Sleep disordered breathing in the elderly: comparison of women and men. 1620 80

Heart failure studies have suggested important differences between women and men both in heart failure etiology and in survival. Clinical trials and long-standing perceptions of the typical heart failure patient have related far more to men than to women, while more women than men in the United States may be hospitalized with heart failure. The goal of this study was to analyze ADHERE Registry data, the largest database of acute decompensated heart failure (ADHF) patient hospitalizations available, to gain insight into the effect of gender on medical history, clinical characteristics, and discharge counseling. This preliminary study analyzed the 85,617 ADHF hospitalizations in the ADHERE Registry as of October 2003, with 44,340 (52%) women and 41,276 (48%) men included. Women were significantly older (mean age 74.6 +/- 13.7 years) than men (mean age 70.2 +/- 13.9 years, P < .0001). Women were more likely to have a history of hypertension (75% vs. 69%, P < .0001) and a systolic blood pressure > 140 mm Hg (56% vs. 44%, P < .0001). History of coronary artery disease was more common in men (64% vs. 51%, P < .0001). Other risk factors for atherosclerosis, including smoking (17% vs. 10%, P < .0001) and hyperlipidemia (37% vs. 32%, P < .0001), were also more common in men. Men had a significantly lower mean left ventricular ejection fraction (32.9%, N = 30,831) than women (42.1%, N = 29,744); 51% of women had preserved left ventricular function (EF > 40%) compared to only 28% of men (P < 0.0001). At discharge, adherence to 3 of the 4 JCAHO standardized measures of quality of care far heart failure patients were documented more frequently for men than for women. A significantly smaller proportion of women received discharge instructions on management of diet, weight, and medications (30.1% vs. 32.8%); received or were scheduled for assessment of left ventricular function (81.5% vs. 85.6%); or were discharged with an angiotensin converting enzyme inhibitor prescription if appropriate (72.6% vs. 73.9%). Real-world data from the ADHERE Registry may lead to better recognition of the signs and symptoms of heart failure in women, increase the proportion of women who are correctly diagnosed, and may help to support gender-specific considerations in heart failure guidelines.
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PMID:Reshaping our perception of the typical hospitalized heart failure patient: a gender analysis of data from the ADHERE Heart Failure Registry. 1648 29

Erectile dysfunction (ED) is a common problem in male patients with heart failure (HF). However, no study was found that estimates the prevalence of ED by US ethnic groups with HF. We conducted an observational, cross-sectional study of patients enrolled in a HF disease management program in two sites Louisiana (N=329; 178 white, 99 black) and Florida (N=52; Hispanic). All male patients with an ejection fraction <or=40% were included. The Sexual Health Inventory for Men was used to estimate the prevalence of ED. Overall prevalence of ED was 89% and ED severity did not vary by race/ethnic group. Race/ethnic group differences were found for age, New York Heart Association functional classification, and blood pressure. Hispanic patients had the lowest unadjusted and adjusted prevalence rate of ED (81, 85%) compared to Black (90, 95%) and White (91, 92%) patients. There is a high prevalence of ED in Hispanic, Black and White ethnic groups with HF.
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PMID:The prevalence of erectile dysfunction in heart failure patients by race and ethnicity. 1870 19

In this paper, the authors evaluate gender related differences of myocardial infarction mortality before and after hospital admittance. Myocardial infarction mortality in the Clinical Hospital Split in the seven years period between 2000 and 2006, have been analyzed together with out of hospital sudden death patients with acute myocardial infarction established during autopsy. During the seven year period between 2000 and 2006, 3434 patients were treated for myocardial infarction in the Split Clinical Hospital, 2336 (68%) males and 1098 (32%) females with a 12% total mortality (427 patients). The annual number of hospitalized persons has been increasing during that period (474 in yr. 2000 us. 547 in yr. 2006), while mortality decreased from 15% in 2000 to 9.6% in 2006. Female patients had significantly higher hospital mortality than male patients, (228 or 21% vs. 202 or 9%, p<0.05). Women also had significantly higher total AMI mortality (23.7% vs. 15,7%, p <0.05). Anterior myocardial infarction with ST elevation in precordial leads had significantly higher mortality (19%) compared to patients with lateral (11%), inferior (10%) myocardial infarction with ST elevation and also NSTEMI (4%) mortality p<0.05. Female patients more frequently die in hospital, 84% (230) than out of hospital 16% (43). From the total number of AMI deaths (388) in male patients, 56% (217) were in hospital and 44% (171) out of hospital (p<0.001). Men had significantly higher prehospital mortality rate than women (81% vs. 19%, p<0.05). Men also more frequently died from ventricular fibrillation (22% vs. 10%, p<0.05), while women died more frequently of heart failure, cardiogenic shock, and myocardial rupture (33% vs. 15% p<0.05). Regarding the total number of deaths from myocardial infarction men had significantly higher prehospital mortality compared to women (178 or 7.3% vs. 43 or 3.7%, p<0.05). Anterior myocardial infarction had a significantly higher rate in patients dying pre-hospital (58%), in contrast to inferior (36%) and lateral myocardial infarction with ST elevation (6%) p<0.05. We have concluded that male patients die more frequently within the first few hours of AMI mostly due to malignant arrhythmias, while female patients died in sub acute stage due to heart failure while being hospitalized. Nevertheless total mortality of AMI remains significantly higher in women.
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PMID:Specific and gender differences between hospitalized and out of hospital mortality due to myocardial infarction. 1875 82

The Dietary Approaches to Stop Hypertension (DASH) diet reduces blood pressure, and consistency with the DASH diet has been associated with lower rates of heart failure (HF) in women. We examined the association between consistency with the DASH diet and rates of HF hospitalization or mortality in 38,987 participants in the Cohort of Swedish Men aged 45 to 79 years. The diet was measured using food-frequency questionnaires, and scores were created to assess the consistency with DASH by ranking the intake of the DASH diet components. Cox models were used to calculate the rate ratios of HF (807 incident cases) determined through the Swedish in-patient and cause-of-death registers from January 1, 1998 to December 31, 2006. In multivariate-adjusted analyses, men in the greatest quartile of the DASH component score had a 22% lower rate of HF events than those in the lowest quartile (95% confidence interval 5% to 35%, p for trend = 0.006). In conclusion, greater consistency with the DASH diet was associated with lower rates HF events in men aged 45 to 79 years.
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PMID:Relation of consistency with the dietary approaches to stop hypertension diet and incidence of heart failure in men aged 45 to 79 years. 1989 61

The prevalence of erectile dysfunction (ED) increases with age. ED has organic aetiologies and is associated with other clinical comorbidities. Men with ED are more likely to have: cardiac disease, diabetes, hypercholesterolaemia, angina, hypertension, prostate disease and depression. Similarly, men with these conditions are more likely to have ED. It is believed that vasculogenic ED shares a common aetiology with coronary artery disease, including hyperlipidaemia, diabetes and hypertension. Taking a careful history of onset, duration and associated symptoms may reveal possible causes of ED. Past medical history, disease control, trauma and medication use can provide vital information. ED patients with a sedentary lifestyle should be encouraged to exercise. In obese men, weight loss of 10% or more can improve IIEF score. Regular exercise, healthy diet, smoking cessation, limiting alcohol intake and avoiding recreational drugs can reduce the risk of, or improve, ED. It is important to differentiate between patients suffering from nocturnal frequency, enuresis or nocturnal polyuria as the causes and treatments for each of these conditions are different. Reducing fluid intake after 6 pm and avoiding alcohol and/or caffeine at night may reduce nocturnal voiding. Anticholinergics can decrease bladder overactivity. An improvement in nocturia and nocturia bother score have been shown after administration of oral melatonin. Nocturnal enuresis can often be the only symptom of high-pressure chronic retention which is prevalent in older men. It is important to recognise this condition as treatment can prevent further renal impairment. In nocturnal polyuria the urine output at night is more than a third of the total daily urine output. If conservative measures are not successful, in the absence of heart failure, a low-dose diuretic in the afternoon can help the kidneys get rid of the fluid before bedtime.
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PMID:Diagnosing urological disorders in ageing men. 2030 27


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