Important Aspects of the Treatment of Chronic Heart Failure

Italian heart journal : official journal of the Italian Federation of Cardiology, 2003

In the past 20 years, enormous progress has been made in the understanding of the pathophysiology and treatment of the complex clinical syndrome of heart failure. It has been a bidirectional process, with improvements in the understanding of the pathophysiology suggesting new therapeutic approaches and the success and failures of clinical trials refining our hypotheses or even suggesting the involvement of new pathophysiological mechanisms. In the past, heart failure was interpreted on the basis of a pathophysiological model according to which the hemodynamic abnormalities played a key role in determining the clinical presentation and the evolution of the disease. Therefore, the objective of pharmacological treatment was to improve these hemodynamic abnormalities. At the beginning of the '90s it became clear that the activation of the reninangiotensin-aldosterone system and of the sympathetic system caused by the abnormality in cardiac function had deleterious clinical effects i...

Education (ACCME) to provide continuing medical education for physicians.

Clinical Medicine Insights: Cardiology, 2015

Medicine, 2010

Heart failure (HF) is a clinical syndrome characterized by dyspnoea, fatigue and fluid retention accompanied by objective evidence of cardiac dysfunction. The syndrome affects around 2% of the general population, affecting men more commonly than women (under the age of 80), with incidence and prevalence rising steeply with age. HF causes substantial morbidity and reduced life expectancy, and coronary artery disease accounts for two-thirds of cases in developed countries. Investigation is important to ascertain the diagnosis, identify the aetiology (which might be reversible) and give some indication of prognosis. Currently, more than 40% of people die within 18 months of a new diagnosis of HF. Treatment has been revolutionized by large randomized-controlled clinical trials studying the effects of antagonism of the renineangiotensinealdosterone and sympathetic nervous systems, and, more recently, the effects of device therapy. Cardiac transplantation remains an option for patients who are severely symptomatic (and at high risk) despite optimal medical and appropriate device therapy.

2021

Background: HF heart failure is a serious cardiovascular disease with its increased incidence, serious illness, high mortality and rapidly increasing medical costs. HF patients are increasing worldwide and South Korea is no exception. Over the past 40 years, there have been significant improvements in the definition, diagnosis, and treatment of HF. There are ongoing efforts to improve HF risk classification using biomarkers, imaging and genetic testing. Newly developed drugs and HF devices are widely accepted in clinical practice. In addition, specific treatments for end-stage renal disease, including left ventricular defense devices and heart transplants, will soon emerge. This review summarizes recent HF management and new diagnostic and therapeutic approaches to improve outcomes in HF patients. Conclusion: Heart failure is a public health burden that has far-reaching consequences for the future of health care and human health.

ESC HEART FAILURE, 2019

Aims Heart failure (HF) is a clinical syndrome with significant social and economic burden. We aimed to estimate the burden of HF in mainland Portugal over a 22-year time horizon, between 2014 and 2036. Methods and results Heart failure burden was measured in disability adjusted life years (DALYs), resulting from the sum of years of life lost (YLL) due to premature death and years lost due to disability (YLD). YLL were estimated based on the Portuguese mortality rates reported by the European Detailed Mortality Database. For YLD, disease duration and the overall incidence were estimated using an epidemiological model developed by the World Health Organization (DISMOD II). Disability weights were retrieved from published literature. The impact of ageing was estimated with a shift-share analysis using official demographic projections. In 2014, 4688 deaths were attributed to HF, corresponding to 4.7% of the total deaths in mainland Portugal. DALYs totalled 21 162, 53.9% due to premature death (YLL: 11 398) and 46.1% due to disability (YLD: 9765). Considering only population ageing over a 22-year horizon, the deaths and burden of HF are expected to increase by 73.0% and 27.9%, respectively, reaching 8112 deaths and 27 059 DALYs lost due to HF in 2036. DALY’s growth is mainly driven by the increase of YLL, whose contribution to overall burden will increase to 62.0%. Conclusions Heart failure is an emerging and growing health problem where significant health gains may be obtained. The projected significant increase of HF burden highlights the need to set HF as a priority for healthcare system.

Journal of Cardiovascular Medicine and Cardiology, 2022

Background and objectives: Heart failure is a pathological condition characterized by the inability of the heart to pump (cardiac output) an adequate amount of blood to meet the metabolic needs of the body or, at any rate, to be able to do so only at the expense of increased filling pressures in one or more cardiac chambers and the upstream venous circulation. The research group states here the primary objective of expanding the indications contained in the ESC 2021 with the results of the last year on the subject of treatment profiles, to facilitate a better understanding of the overall clinical picture and contribute to the next edition of the guidelines.

Circulation Research, 2012

RNA-Protein Interaction Protocols, 2008

2010

Chronic heart failure (CHF) is a common condition, particularly among older patients, and is associated with a high rate of mortality and morbidity. In the first part of this article, we reviewed the diagnostic tools and medical therapies used in the management of CHF. In part two, we provide guidance on when patients should be referred for more intensive management and focus on device therapies.

Australian Journal of General Practice

2020

Heart failure (HF), the inability of the heart to achieve adequate blood supply to meet the metabolic needs of the organs, is classified based on the left ventricular ejection fraction (LVEF) into HF with reduced LVEF (HFrEF) and HF with preserved LVEF (HFpEF). The pharmacological treatment of HF mainly consists of medications that suppress the maladaptive mechanisms leading to myocardial dysfunction. In HFrEF the treatment mainly focusses on the inhibition of the sympathetic nervous system and renin-angiotensin-aldosterone system, whereas in HFpEF the main goal is to control the comorbidities. The backbone of treatment of HFrEF is neurohormonal consisting of an angiotensin converting enzyme inhibitor, a beta blocker and a mineralocorticoid receptor antagonist. Randomised controlled clinical trials have shown this approach to be effective in improving both mortality and quality of life and these drugs have been included in current guidelines. Relatively newer drugs, such as ivabradi...

Italian Journal of Medicine, 2013

The heart failure (HF) is one of the greatest problems of public health with increasing epidemiological importance. In the present study we analyzed a population of 299 patients, consecutively admitted to hospital, whose diagnosis of HF was verified retrospectively. In our analysis we considered underlying heart diseases, comorbidities, ejection fraction, presence of atrial fibrillation and pleural effusion, values of NT pro-BNP and causes of destabilization precipitating HF. The mean age of our population was 81 years. Patients with preserved systolic function were 145 (61% of the total, 59 male and 86 female). 166 patients (69% of the total) had hypertensive heart disease and 211 had hypertension (88% of the total). Patients with pleural effusion were 108 (46% of total). In the total population 102 patients (43%) had from 3 to 5 comorbidities, 169 patients (71%) had at least 2 comorbidities and only 4 patients (1.7%) had no comorbidities. The collected data highlight the complexit...