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Respiratory Care Apr 2006Congestive heart failure (CHF) is a common clinical disorder that results in pulmonary vascular congestion and reduced cardiac output. CHF should be considered in the...
Congestive heart failure (CHF) is a common clinical disorder that results in pulmonary vascular congestion and reduced cardiac output. CHF should be considered in the differential diagnosis of any adult patient who presents with dyspnea and/or respiratory failure. The diagnosis of heart failure is often determined by a careful history and physical examination and characteristic chest-radiograph findings. The measurement of serum brain natriuretic peptide and echocardiography have substantially improved the accuracy of diagnosis. Therapy for CHF is directed at restoring normal cardiopulmonary physiology and reducing the hyperadrenergic state. The cornerstone of treatment is a combination of an angiotensin-converting-enzyme inhibitor and slow titration of a beta blocker. Patients with CHF are prone to pulmonary complications, including obstructive sleep apnea, pulmonary edema, and pleural effusions. Continuous positive airway pressure and noninvasive positive-pressure ventilation benefit patients in CHF exacerbations.
Topics: Aged; Heart Failure; Humans; Respiratory Therapy; United States
PubMed: 16563194
DOI: No ID Found -
Journal of the American College of... Nov 2008The term cardiorenal syndrome (CRS) increasingly has been used without a consistent or well-accepted definition. To include the vast array of interrelated derangements,... (Review)
Review
The term cardiorenal syndrome (CRS) increasingly has been used without a consistent or well-accepted definition. To include the vast array of interrelated derangements, and to stress the bidirectional nature of heart-kidney interactions, we present a new classification of the CRS with 5 subtypes that reflect the pathophysiology, the time-frame, and the nature of concomitant cardiac and renal dysfunction. CRS can be generally defined as a pathophysiologic disorder of the heart and kidneys whereby acute or chronic dysfunction of 1 organ may induce acute or chronic dysfunction of the other. Type 1 CRS reflects an abrupt worsening of cardiac function (e.g., acute cardiogenic shock or decompensated congestive heart failure) leading to acute kidney injury. Type 2 CRS comprises chronic abnormalities in cardiac function (e.g., chronic congestive heart failure) causing progressive chronic kidney disease. Type 3 CRS consists of an abrupt worsening of renal function (e.g., acute kidney ischemia or glomerulonephritis) causing acute cardiac dysfunction (e.g., heart failure, arrhythmia, ischemia). Type 4 CRS describes a state of chronic kidney disease (e.g., chronic glomerular disease) contributing to decreased cardiac function, cardiac hypertrophy, and/or increased risk of adverse cardiovascular events. Type 5 CRS reflects a systemic condition (e.g., sepsis) causing both cardiac and renal dysfunction. Biomarkers can contribute to an early diagnosis of CRS and to a timely therapeutic intervention. The use of this classification can help physicians characterize groups of patients, provides the rationale for specific management strategies, and allows the design of future clinical trials with more accurate selection and stratification of the population under investigation.
Topics: Acute Disease; Chronic Disease; Disease Progression; Female; Heart Failure; Heart Function Tests; Humans; Kidney Function Tests; Male; Prognosis; Renal Insufficiency; Severity of Illness Index; Syndrome; Terminology as Topic
PubMed: 19007588
DOI: 10.1016/j.jacc.2008.07.051 -
Journal of the American College of... Oct 2013
2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
Topics: Adult; Disease Management; Evidence-Based Practice; Heart Failure; Humans; United States
PubMed: 23747642
DOI: 10.1016/j.jacc.2013.05.019 -
Deutsches Arzteblatt International May 2020Chronic congestive heart failure is a common condition that, if untreated, markedly impairs the quality of life and is associated with a high risk of recurrent... (Review)
Review
BACKGROUND
Chronic congestive heart failure is a common condition that, if untreated, markedly impairs the quality of life and is associated with a high risk of recurrent hospitalization and death.
METHODS
This review is based on articles retrieved by a selective search in PubMed, as well as on relevant guidelines.
RESULTS
Evidence-based treatment options are available only for congestive heart failure with a low ejection fraction. Pharma - cotherapy is based on neurohumoral inhibition of the renin-angiotensin-aldosterone system and the adrenergic system. The prognosis of patients with this condition has been further improved recently through the introduction of combined angiotensin receptor antagonists and neprilysin inhibitors. Modern implantable devices are a further component of treatment. Implantable defibrillators and special pacemakers for cardiac resynchronization are well established; the utility of alternative devices (baroreflex modulation or cardiac contractility modulation) needs to be investigated in further studies. It was recently shown that the catheter-based treatment of secondary mitral regurgitation with a MitraClip improves the outcome of selected patients.
CONCLUSION
The treatment of chronic systolic heart failure as recommended in the relevant guidelines, with drugs and implanted devices if indicated, can significantly improve the clinical outcome.
Topics: Heart Failure; Humans; Practice Guidelines as Topic; Stroke Volume; Treatment Outcome
PubMed: 32843138
DOI: 10.3238/arztebl.2020.0376 -
Folia Medica Cracoviensia 2018Congestive heart failure (CHF) is the final stage in several heart diseases. The diagnosis of CHF in older patients is a challenge. Preserved left ventricular systolic...
Congestive heart failure (CHF) is the final stage in several heart diseases. The diagnosis of CHF in older patients is a challenge. Preserved left ventricular systolic function is a characteristic type of CHF in seniors. The purpose of the study was to characterize elderly patients with CHF and to highlight specific features of the conditions in seniors. e most common etiology of HF in this group of patients is hypertension and coronary heart disease. In seniors atypical presentations of chronic heart failure is much more common than in younger patients. Malnutrition, limitations of exercise and sedentary lifestyles or comorbid diseases have an influence on asymptomatic, early stage of HF. There are better outcomes of treatment in obese individuals. It is called the obesity paradox. Open communication with a patient and his/her family may improve their response to therapy. When heart failure becomes an incurable disease and aggressive treatment is ineffective, palliative care should be considered in end-of-life heart failure patients. The goal of treatment in the remaining moments of life last moments of life should be maximizing the patient's comfort.
Topics: Aged; Aged, 80 and over; Chronic Disease; Female; Heart Failure; Humans; Male; Risk Factors
PubMed: 30745601
DOI: No ID Found -
Critical Care Clinics Jul 2015Congestive heart failure (CHF) is among the most common causes of admission to hospitals in the United States, especially in those over age 65. Few data exist regarding... (Review)
Review
Congestive heart failure (CHF) is among the most common causes of admission to hospitals in the United States, especially in those over age 65. Few data exist regarding the prevalence CHF of Cheyne-Stokes respiration (CSR) owing to congestive heart failure in the intensive care unit (ICU). Nevertheless, CSR is expected to be highly prevalent among those with CHF. Treatment should focus on the underlying mechanisms by which CHF increases loop gain and promotes unstable breathing. Few data are available to determine prevalence of CSR in the ICU, or how CSR might affect clinical management and weaning from mechanical ventilation.
Topics: Cheyne-Stokes Respiration; Heart Failure; Humans; Intensive Care Units; Prevalence; Respiration, Artificial; Sleep Apnea, Central
PubMed: 26118916
DOI: 10.1016/j.ccc.2015.03.005 -
The Israel Medical Association Journal... Sep 2023Congestive heart failure (CHF) with reduced ejection fraction (HFrEF) or with preserved ejection fraction (HFpEF) is a common diagnosis in patients hospitalized in the...
BACKGROUND
Congestive heart failure (CHF) with reduced ejection fraction (HFrEF) or with preserved ejection fraction (HFpEF) is a common diagnosis in patients hospitalized in the department of internal medicine. Recently, the therapeutic regimens were updated, as the sodium-glucose cotransporter-2 (SGLT2) inhibitors became an integral part of the therapeutic regimen for either HFrEF or HFpEF.
OBJECTIVES
To define the demographic and clinical characteristics of CHF patients hospitalized in the department of medicine.
METHODS
We conducted a retrospective cohort study that included all patients hospitalized in the departments of medicine at the Rabin Medical Center, Israel, between 2016 and 2019. Demographic and clinical background, in-hospital procedures, discharge regimens, and outcome parameters were evaluated according to HFrEF/HFpEF.
RESULTS
The cohort included 4458 patients. The majority (97%) presented with a preexisting diagnosis, whereas HF was an active condition in only half of them. The rates of HFrEF/HFpEF were equal. In most cases, the trigger of the exacerbation could not be determined; however, infection was the most common cause. There were basic differences in the demography, clinical aspects, and therapeutic regimens at discharge between HFrEF and HFpEF. Both conditions were associated with high in hospital mortality (8%) and re-admissions rates (30 days [20%], 90 days [35%]) without any difference between them.
CONCLUSIONS
HFrEF/HFpEF patients differed by demographics and co-morbidities. They were equally represented among patients admitted to medical wards and had similar prognosis. For both diagnoses, hospitalization should be considered for updating therapeutic regimens, especially with SGLT2 inhibitors.
Topics: Humans; Heart Failure; Retrospective Studies; Stroke Volume; Internal Medicine; Hospital Mortality
PubMed: 37698314
DOI: No ID Found -
Cardiology Journal 2022The United States healthcare system currently faces an economic challenge related to frequent hospital readmission rates. As such, hospitals have begun implementing...
The United States healthcare system currently faces an economic challenge related to frequent hospital readmission rates. As such, hospitals have begun implementing strategies to reduce readmission rates for specific medical conditions such as congestive heart failure, which had a 30-day readmission rate of 23.2% in 2014. Patient education and frequent monitoring of symptoms have since allowed patients to work together with doctors and nurses to take charge of their healthcare management. Due to heart failure clinics and the rise of telemedicine and telemonitoring, heart failure readmission rates have since decreased.
Topics: Humans; United States; Patient Readmission; Telemedicine; Hospitals; Heart Failure
PubMed: 34308538
DOI: 10.5603/CJ.a2021.0073 -
Journal of Biomedical Informatics Jan 2022Congestive Heart Failure (CHF) is among the most prevalent chronic diseases worldwide, and is commonly associated with comorbidities and complex health conditions....
Congestive Heart Failure (CHF) is among the most prevalent chronic diseases worldwide, and is commonly associated with comorbidities and complex health conditions. Consequently, CHF patients are typically hospitalized frequently, and are at a high risk of premature death. Early detection of an envisaged patient disease trajectory is crucial for precision medicine. However, despite the abundance of patient-level data, cardiologists currently struggle to identify disease trajectories and track the evolution patterns of the disease over time, especially in small groups of patients with specific disease subtypes. The present study proposed a five-step method that allows clustering CHF patients, detecting cluster similarity, and identifying disease trajectories, and promises to overcome the existing difficulties. This work is based on a rich dataset of patients' records spanning ten years of hospital visits. The dataset contains all the health information documented in the hospital during each visit, including diagnoses, lab results, clinical data, and demographics. It utilizes an innovative Cluster Evolution Analysis (CEA) method to analyze the complex CHF population where each subject is potentially associated with numerous variables. We have defined sub-groups for mortality risk levels, which we used to characterize patients' disease evolution by refined data clustering in three points in time over ten years, and generating patients' migration patterns across periods. The results elicited 18, 23, and 25 clusters respective to the first, second, and third visits, uncovering clinically interesting small sub-groups of patients. In the following post-processing stage, we identified meaningful patterns. The analysis yielded fine-grained patient clusters divided into several finite risk levels, including several small-sized groups of high-risk patients. Significantly, the analysis also yielded longitudinal patterns where patients' risk levels changed over time. Four types of disease trajectories were identified: decline, preserved state, improvement, and mixed-progress. This stage is a unique contribution of the work. The resulting fine partitioning and longitudinal insights promise to significantly assist cardiologists in tailoring personalized interventions to improve care quality. Cardiologists could utilize these results to glean previously undetected relationships between symptoms and disease evolution that would allow a more informed clinical decision-making and effective interventions.
Topics: Chronic Disease; Clinical Decision-Making; Cluster Analysis; Comorbidity; Heart Failure; Humans
PubMed: 34875386
DOI: 10.1016/j.jbi.2021.103949 -
Journal of the American College of... Nov 2001Congestive heart failure (CHF) is the most devastating cardiac sequella of long-standing hypertension. Recent data from the Antihypertensive and Lipid Lowering Treatment... (Review)
Review
Congestive heart failure (CHF) is the most devastating cardiac sequella of long-standing hypertension. Recent data from the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) have shown the risk of CHF to be twice as high with doxazosin than with chlorthalidone. Although some questions remain regarding the diagnosis and mortality of CHF in the doxazosin arm and regarding the risk of dying from malignancy in the diuretic arm of ALLHAT, drugs used to treat hypertension should lower the CHF risk. Therefore, until ironclad safety data are provided, doxazosin, and probably all alpha-blockers, should no longer be used as first-line antihypertensive therapy.
Topics: Adrenergic alpha-Antagonists; Adverse Drug Reaction Reporting Systems; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cause of Death; Diuretics; Doxazosin; Drug Therapy, Combination; Heart Failure; Humans; Hypertension; Morbidity; Neoplasms; Patient Selection; Prognosis; Research Design; Risk Factors; Safety; Survival Analysis
PubMed: 11691497
DOI: 10.1016/s0735-1097(01)01534-0