| 1. |
- Kristjánsdóttir, I, et al.
(författare)
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Congestion and Diuretic Resistance in Acute or Worsening Heart Failure
- 2020
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Ingår i: Cardiac failure review. - : Radcliffe Group Ltd. - 2057-7540 .- 2057-7559. ; 6, s. e25-
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Tidskriftsartikel (refereegranskat)abstract
- Hospitalisation for acute heart failure (AHF) is associated with high mortality and high rehospitalisation rates. In the absence of evidence-based therapy, treatment is aimed at stabilisation and symptom relief. The majority of AHF patients have signs and symptoms of fluid overload, and, therefore, decongestion is the number one treatment goal. Diuretics are the cornerstone of therapy in AHF, but the treatment effect is challenged by diuretic resistance and poor diuretic response throughout the spectrum of chronic to worsening to acute to post-worsening HF. Adequate dosing and monitoring and evaluation of diuretic effect are important for treatment success. Residual congestion at discharge is a strong predictor of worse outcomes. Therefore, achieving euvolaemia is crucial despite transient worsening renal function.
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| 2. |
- Rosano, GM, et al.
(författare)
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Hyperkalemia and Renin-Angiotensin-Aldosterone System Inhibitors Dose Therapy in Heart Failure With Reduced Ejection Fraction
- 2019
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Ingår i: Cardiac failure review. - : Radcliffe Group Ltd. - 2057-7540 .- 2057-7559. ; 5:3, s. 130-132
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Tidskriftsartikel (refereegranskat)abstract
- Renin–angiotensin–aldosterone system inhibitors (RAASi) are known to improve outcomes in patients who have heart failure with reduced ejection fraction (HFrEF). To reduce mortality in these patients, RAASi should be uptitrated to the maximally tolerated dose. However, RAASi may also cause hyperkalemia. As a result of this side-effect, doses of RAASi are reduced, discontinued and seldom reinstated. Thus, the therapeutic target needed in these patients is often not reached because of hyperkalemia. Also, submaximal dosing of RAASi may be a result of symptomatic hypotension, syncope, hypoperfusion, reduced kidney function and other factors. The reduction of RAASi dose leads to adverse outcomes, such as an increased risk of mortality. Management of these side-effects is pivotal to maximise the use of RAASi in HFrEF, particularly in high-risk patients.
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| 3. |
- Stolfo, D, et al.
(författare)
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Evidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection Fraction
- 2022
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Ingår i: Cardiac failure review. - : Radcliffe Media Media Ltd. - 2057-7540 .- 2057-7559. ; 8, s. e16-
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Tidskriftsartikel (refereegranskat)abstract
- Older patients are becoming prevalent among people with heart failure (HF) as the overall population ages. However, older patients are largely under-represented, or even excluded, from randomised controlled trials on HF with reduced ejection fraction, limiting the generalisability of trial results in the real world and leading to weaker evidence supporting the use and titration of guideline-directed medical therapy (GDMT) in older patients with HF with reduced ejection fraction. This, in combination with other factors limiting the application of guideline recommendations, including a fear of poor tolerability or adverse effects, the heavy burden of comorbidities and the need for multiple therapies, classically leads to lower adherence to GDMT in older patients. Although there are no data supporting the under-use and under-dosing of HF medications in older patients, large registry-based studies have confirmed age as one of the major obstacles to treatment optimisation. In this review, the authors provide an overview of the contemporary state of implementation of GDMT in older groups and the reasons for the lower use of treatments, and discuss some measures that may help improve adherence to evidence-based recommendations in older age groups.
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| 4. |
- Stolfo, D, et al.
(författare)
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Use of Renin-Angiotensin-Aldosterone System Inhibitors in Older Patients with Heart Failure and Reduced Ejection Fraction
- 2019
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Ingår i: Cardiac failure review. - : Radcliffe Media Media Ltd. - 2057-7540 .- 2057-7559. ; 5:2, s. 70-73
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Tidskriftsartikel (refereegranskat)abstract
- Patients enrolled in randomised clinical trials may not be representative of the real-world population of people with heart failure (HF). Older patients are frequently excluded and this limits the strength of evidence which supports the use of specific HF treatments in this patient group. Lack of evidence together with fear of adverse effects, drug interactions and lower tolerance may lead to the undertreatment of older patients and a less favourable outcome. Renin–angiotensin–aldosterone system (RAAS) inhibitors are the cornerstone of treatment for patients with HF with reduced ejection fraction (HFrEF), but despite the class I recommendation for all patients regardless of age in the guidelines, there are signs that RAAS inhibitors are underused among older patients. Large registry- based studies suggest that RAAS inhibitors may be at least as effective in older patients as younger ones, but these findings need to be confirmed by randomised clinical trials.
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| 5. |
- Thorvaldsen, T, et al.
(författare)
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Focusing on Referral Rather than Selection for Advanced Heart Failure Therapies
- 2019
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Ingår i: Cardiac failure review. - : Radcliffe Group Ltd. - 2057-7540 .- 2057-7559. ; 5:1, s. 24-26
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Tidskriftsartikel (refereegranskat)abstract
- Despite advances in heart failure treatment, advanced heart failure affects 5–10% of people with the condition and is associated with poor prognosis. Selection for heart transplantation and left ventricular assist device implantation is a rigorous and validated process performed by specialised heart failure teams. This entails comprehensive assessment of complex diagnostic tests and risk scores, and selecting patients with the optimal benefit-risk profile. In contrast, referral for advanced heart failure evaluation is an arbitrary and poorly studied process, performed by generalists, and patients are often referred too late or not at all. The study elaborates on the differences between selection and referral and proposes some simple strategies for optimising timely referral for advanced heart failure evaluation.
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| 6. |
- Agostoni, Pierguseppe, et al.
(författare)
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Haemodynamic Balance in Acute and Advanced Heart Failure: An Expert Perspective on the Role of Levosimendan.
- 2019
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Ingår i: Cardiac failure review. - 2057-7540. ; 5:3, s. 155-161
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Tidskriftsartikel (refereegranskat)abstract
- Acute and advanced heart failure are associated with substantial adverse short- and longer-term prognosis. Both conditions necessitate complex treatment choices to restore haemodynamic stability and organ perfusion, relieve congestion, improve symptoms and allow the patient to leave the hospital and achieve an adequate quality of life. Among the available intravenous vasoactive therapies, inotropes constitute an option when an increase in cardiac contractility is needed to reverse a low output state. Within the inotrope category, levosimendan is well suited to the needs of both sets of patients since, in contrast to conventional adrenergic inotropes, it has not been linked in clinical trials or wider clinical usage with increased mortality risk and retains its efficacy in the presence of beta-adrenergic receptor blockade; it is further believed to possess beneficial renal effects. The overall haemodynamic profile and clinical tolerability of levosimendan, combined with its extended duration of action, have encouraged its intermittent use in patients with advanced heart failure. This paper summarises the key messages derived from a series of 12 tutorials held at the Heart Failure 2019 congress organised in Athens, Greece, by the Heart Failure Association of the European Society of Cardiology.
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| 7. |
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| 8. |
- Lund, LH
(författare)
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Heart Failure with Mid-range Ejection Fraction: Lessons from CHARM
- 2018
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Ingår i: Cardiac failure review. - : Radcliffe Group Ltd. - 2057-7540. ; 4:2, s. 70-72
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Tidskriftsartikel (refereegranskat)abstract
- The newly defined category of heart failure (HF) with mid-range ejection fraction (HFmrEF; EF 40–49 %) is beginning to be characterised but little is known about the potential for treating it. Trials and observational studies suggest that standard therapy for HF with reduced ejection fraction (HFrEF; EF <40 %) may also offer some benefit to patients with EF ≥40 %; however, any difference between its effects on HFmrEF and true HF with preserved ejection fraction (HFpEF) have until now not been explored. This study summarises randomised trial data from the CHARM programme that suggest that candesartan may improve outcomes in HFmrEF
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| 9. |
- Savarese, G, et al.
(författare)
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Global Public Health Burden of Heart Failure
- 2017
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Ingår i: Cardiac failure review. - : Radcliffe Group Ltd. - 2057-7540. ; 3:1, s. 7-11
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Tidskriftsartikel (refereegranskat)abstract
- Heart failure (HF) is a global pandemic affecting at least 26 million people worldwide and is increasing in prevalence. HF health expenditures are considerable and will increase dramatically with an ageing population. Despite the significant advances in therapies and prevention, mortality and morbidity are still high and quality of life poor. The prevalence, incidence, mortality and morbidity rates reported show geographic variations, depending on the different aetiologies and clinical characteristics observed among patients with HF. In this review we focus on the global epidemiology of HF, providing data about prevalence, incidence, mortality and morbidity worldwide.
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| 10. |
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