This is an important database for assessing the effectiveness of HF therapies. The findings suggest that ACE inhibitors and angiotensin receptor blockers may be effective in improving blood pressure and preventing worsening kidney function. ACE inhibitors may also reduce risk of stroke and mortality. Beta-blockers may improve survival by reducing the amount of fluid retained by the kidneys and therefore lowering blood pressure.
Clinical trials must be designed with special consideration given to the physiologic consequences of trial therapies. The initiation of clinical trials requires a careful assessment of which populations may benefit from intervention. Patients with chronic heart failure deserve aggressive investigation of promising therapies.
In contemporary practice, few patients are identified as having CHF based on clinical presentation alone; however, CHF can be diagnosed confidently via echocardiographic and electrocardiographic findings suggestive of impaired left ventricular filling or systolic dysfunction.
CHF incidence rates are increasing in U.S. population; however, this increase appears to be driven largely by older women, who are more likely to develop CHF with advancing age. Hospitals should implement CHF screening programs to improve the detection of CHF.
In a recent study, findings does not support claims for the cure of CHF. The small number of patients who had improvement may suggest an ongoing clinical response to treatment.
The heart failure pattern in the UK is different from the US pattern. There appears to be a higher proportion of cases where cardiac pathology is predominantly non-ischaemic in origin. This should assist clinicians in deciding which therapies might be more appropriate for those patients.
With the current state of knowledge, we have seen no compelling evidence that has succeeded in improving the prognosis of CHF patients. The drugs used have all shown disappointing results, except for ACE inhibitors in particular. However, despite the absence of any convincing evidence of benefit in our patients, the use of these drugs has become widespread worldwide.
CRT may improve cardiac performance in CHF patients with LBBB; however, the effect may be related to the degree of left ventricular dysfunction rather than the presence of LBBB per se.
Patients with CHF were at significantly higher risk of postoperative morbidity and mortality compared with patients without CHF. These data highlight the need for prospective studies to identify modifiable patient-specific factors and strategies to improve prognosis in CHF patients undergoing cardiac surgical procedures.
Older adults demonstrated greater neural activation during a visuospatial working memory task compared to their young counterparts. These differences were associated with depressive symptoms. Results from a recent paper suggest that older adults may represent a vulnerable group because of their heightened vulnerability to depression and cognitive dysfunction.
Low LVEF is associated with poor outcomes after CRT implantation and improved response to CRT is obtained in patients with LVEF<35%. Among patients with LVEF>35%, the improvement in QRS duration was associated with better outcomes.