cardiovascular-agents and Cardiac-Output--Low

Topics: Adrenergic beta-Antagonists; Age Factors; Aged; Aged, 80 and over; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Cardiac Output, Low; Cardiovascular Agents; Digitalis Glycosides; Diuretics; Female; Germany; Guideline Adherence; Heart Failure; Humans; Male; Survival Rate

Topics: Algorithms; Cardiac Output, Low; Cardiac Resynchronization Therapy; Cardiovascular Agents; Defibrillators, Implantable; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Heart Failure; Heart Transplantation; Heart-Assist Devices; Humans; Image Processing, Computer-Assisted; Ventricular Dysfunction, Left

The treatment of progressive and terminal heart failure follows the principle of causative therapy. Therefore, etiology and pathophysiology of the underlying disease and its hemodynamic conditions are indispensable. This applies to coronary artery disease, hypertension, valvular heart disease, the cardiomyopathies with and without inflammation, and microbial persistence similarly. The classic treatment algorithms both in heart failure with and without reduced ejection fraction are based on measures onloading the heart (angiotensin-converting enzyme inhibitors, angiotensin antagonists, beta-blockers, diuretics) and on antiarrhythmics and anticoagulation, when needed. Device therapy for cardiac resynchronization in left bundle branch block and permanent stimulation therapy may contribute to the hemodynamic benefit. ICD (implantable cardioverter defibrillator) therapy prevents sudden cardiac death, which is often associated with progressive heart failure. Heart transplantation and left ventricular assist devices are final options in the treatment repertoire of terminal heart failure.

Topics: Biopsy; Cardiac Output, Low; Cardiovascular Agents; Defibrillators, Implantable; Evidence-Based Medicine; Heart Failure; Heart Transplantation; Heart-Assist Devices; Humans; Myocarditis; Myocardium; Prognosis; Randomized Controlled Trials as Topic

Acute Heart Failure Syndromes (AHFS) is a common admission diagnosis associated with high mortality and hospital readmissions. Given the mixed results of recent clinical trials, the early management of AHFS remains controversial.. To review the recent evidence regarding current and investigational therapies for the early management of AHFS.. A systematic search of peer-reviewed publications was performed on MEDLINE and EMBASE from January 1990 to August 2006. The results of unpublished or ongoing trials were obtained from presentations at national and international meetings and pharmaceutical industry releases. Bibliographies from these references were also reviewed, as were additional articles identified by content experts.. Criteria used for study selection were controlled study design, relevance to clinicians and validity based on venue of publication and power analysis.. Although all current intravenous therapies for the early management of AHFS appear to improve hemodynamics, this may not always translate into short-term clinical benefit.. The results of the trials conducted to date in AHFS have generally been disappointing. There is, therefore, an unmet need for new therapeutic approaches for the early management of AHFS that may improve the short-term and long-term outcomes.

Topics: Cardiac Output, Low; Cardiovascular Agents; Clinical Trials as Topic; Humans; Prognosis; Syndrome

Natriuretic peptides, in particular, brain or B-type, are useful for the assessment of patients presenting with dyspnea to the medical office or emergency department. Levels of natriuretic peptides are useful for assessing prognosis of heart failure or coronary syndrome patients. Less is known about serial peptide measurements for guiding treatment strategies in heart failure. The authors review the uses, pitfalls, and practical points for using natriuretic peptides clinically.

Topics: Biomarkers; Cardiac Output, Low; Cardiovascular Agents; Drug Monitoring; Female; Humans; Male; Natriuretic Peptide, Brain; Sensitivity and Specificity; Sex Factors; Ventricular Dysfunction, Left

Although the landscape of heart failure continues to rapidly evolve, and the widespread use of evidence-based pharmaceutical and device therapies has improved overall survival rates, mortality rates in heart failure patients remain high. Understanding the mode of death in heart failure is particularly important if we are to improve survival. This study reviews the evaluation of modes of death from heart failure and discusses the therapies, both pharmaceutical and device, that are useful in preventing these sequelae.

Topics: Adrenergic beta-Antagonists; Age Factors; Cardiac Output, Low; Cardiovascular Agents; Cause of Death; Death, Sudden, Cardiac; Female; Humans; Male; Randomized Controlled Trials as Topic; Survival Rate; Systole

Several systemic and cardiac diseases cause an impairment of left ventricular filling or of the ability to maintain cardiac output, without an increase in end-diastolic pressure. Prevalence of diastolic dysfunction has been found to be higher than systolic dysfunction in most studies. Many physiological conditions (age, sex and body weight), and pathological processes, such as cardiac or systemic diseases, can increase the incidence of diastolic dysfunction. Early diagnosis of left ventricular diastolic impairment has been demonstrated to have important therapeutic implications. Several invasive or non-invasive methods to investigate diastolic properties of the left ventricle have been described; a large number of studies compared different parameters of diastolic function in order to find the most accurate: this is of particular prognostic relevance since diastolic dysfunction may remain asymptomatic for a long period before resulting in overt heart failure. The purpose of this article is to provide an extensive review of the contemporary literature regarding diastolic function assessment and its role in daily practice.

Topics: Acute Disease; Angiotensin-Converting Enzyme Inhibitors; Cardiac Output, Low; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Diabetes Complications; Diastole; Echocardiography; Humans; Hypertension; Myocardial Ischemia; Pericarditis; Renin-Angiotensin System; Ventricular Dysfunction, Left; Ventricular Function, Left

Maintaining adequate cardiac output in postoperative cardiac surgery patients is a complex and challenging feat for health care teams. Alterations in preload, afterload, contractility, heart rate, and rhythm can be devastating to these patients and lead to lethal consequences. An array of pharmacologic therapies is available in the critical care setting to help prevent and treat such complications and ensure satisfactory cardiac performance.

Topics: Arrhythmias, Cardiac; Cardiac Output, Low; Cardiac Surgical Procedures; Cardiovascular Agents; Humans; Postoperative Care; Ventricular Dysfunction, Left

Toll-like receptors (TLRs) form a family of pattern recognition receptors that have emerged as key mediators of innate immunity. These receptors sense invading microbes and initiate the immune response. TLR-mediated inflammation is an important pathogenic link between innate immunity and a diverse panel of clinical disorders. Among the processes in which TLRs play a role are cardiovascular disorders such as cardiac ischaemia, coronary artery disease, ventricular remodelling, cancer angiogenesis or transplant rejection. From these, many important opportunities for disease modification through TLR signalling manipulation can be imagined. Their role as potential targets for therapeutic intervention is just beginning to be appreciated and this article reviews the current status of these treatment strategies for cardiovascular disease.

Topics: Animals; Anti-Inflammatory Agents; Atherosclerosis; Cardiac Output, Low; Cardiovascular Agents; Cardiovascular Diseases; Clinical Trials as Topic; Genetic Predisposition to Disease; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Inflammation; Ligands; Polymorphism, Genetic; Signal Transduction; Toll-Like Receptor 2; Toll-Like Receptor 4; Toll-Like Receptor 5

Despite advances in treatment, chronic heart failure is still associated with significant morbidity and a poor prognosis. The scope for further advances based on additional neurohumoral blockade is small. Effective adjunctive therapies acting via a different cellular mechanism would, therefore, be attractive. Energetic impairment seems to contribute to the pathogenesis of heart failure. The findings from several studies have shown that the so-called metabolic agents could have potential as adjunctive therapies in heart failure. These agents cause a shift in the substrate used by the heart away from free fatty acids, the oxidation of which normally provides around 70% of the energy needed, towards glucose. The oxygen cost of energy generation is lessened when glucose is used as the substrate. In this review we aim to draw attention to the metabolic alteration in heart failure and we present evidence supporting the use of metabolic therapy in heart failure.

Topics: Acetanilides; Adrenergic beta-Antagonists; Animals; Cardiac Output, Low; Cardiovascular Agents; Energy Metabolism; Epoxy Compounds; Fatty Acids, Nonesterified; Glycine; Heart; Humans; Myocardium; Oxygen; Perhexiline; Piperazines; Ranolazine; Trimetazidine

There is growing evidence that the altered production and/or spatiotemporal distribution of reactive oxygen and nitrogen species creates oxidative and/or nitrosative stresses in the failing heart and vascular tree, which contribute to the abnormal cardiac and vascular phenotypes that characterize the failing cardiovascular system. These derangements at the integrated system level can be interpreted at the cellular and molecular levels in terms of adverse effects on signaling elements in the heart, vasculature, and blood that subserve cardiac and vascular homeostasis.

Topics: Animals; Cardiac Output, Low; Cardiovascular Agents; Cardiovascular System; Humans; Myocardium; Nitric Oxide; Oxidation-Reduction; Reactive Nitrogen Species; Reactive Oxygen Species; Signal Transduction

The main goal of current antihypertensive therapy is to achieve a lowering of intra-arterial pressure by various mechanisms. A plethora of data suggests that this reduces cardiovascular morbidity and mortality due to stroke, heart failure and to a lesser extent, ischemic heart disease. Early cardiac manifestations of chronic hypertension, left ventricular hypertrophy (LVH) and diastolic dysfunction (CHF-D) confer additional risk of cardiovascular morbidity and mortality in patients with hypertension. Regression of left ventricular (LV) mass with antihypertensive therapy is associated with improved diastolic function and overall reduction in cardiovascular events, and this benefit may be independent of actual lowering of arterial pressure. Antihypertensive therapy should therefore be geared to both lower arterial blood pressure and specifically reverse pathophysiologic processes that promote LVH and CHF-D. Emerging therapies accomplish this without specifically affecting blood pressure. Therefore, future treatments for hypertension may require a combination of drugs performing complimentary tasks in lowering arterial pressure and reversing maladaptive physiologic and genetic processes causing hypertensive heart disease. This review summarizes the current and emerging approaches to the treatment of individuals with hypertensive heart disease.

Topics: Antihypertensive Agents; Cardiac Output, Low; Cardiovascular Agents; Heart Failure; Humans; Hypertension; Hypertrophy, Left Ventricular; Ventricular Dysfunction, Left

Heart failure is a common condition, associated with both poor prognosis and poor quality of life. In contrast to all other cardiovascular diseases, the prevalence of heart failure is increasing in the western world, and is likely to continue to do so as the population ages. In the UK, a significant proportion of patients with heart failure come from South Asian and African Caribbean ethnic groups. A large body of evidence exists that there may be epidemiological and pathophysiological differences between patients with heart failure from different ethnic groups. Treatments such as ACE inhibitors, which are now part of standard heart failure therapy, have an evidence base consisting of trials in patients of almost exclusively white ethnicity. Such treatments may not be equally effective in patients from other ethnic groups. This review will discuss the current evidence for heart failure management with respect to ethnicity, and consider the implications for future drug development and implications for antihypertensive therapy.

Topics: Cardiac Output, Low; Cardiovascular Agents; Drug Design; Humans; Hypertension

Topics: Cardiac Output, Low; Cardiovascular Agents; Chronic Disease; Humans; Pharmacists

Both the prevention and attenuation of chronic heart failure (CHF) are important issues for cardiologists. There are three different strategies to prevent patients from deleterious sequels. The first strategy is to remove the causes of CHF if possible; the second is to attenuate the events that may lead to CHF, such as myocardial ischaemia and reperfusion injury, cardiomyopathy and myocarditis, cardiac hypertrophy and ventricular remodelling; the third is to prevent or attenuate the progression of CHF. Adenosine has a number of actions which merit it as a possible cardioprotective and therapeutic agent for CHF. Firstly, adenosine induces collateral circulation via inducing growth factors and triggering ischaemic preconditioning, both of which induce ischaemic tolerance in advance. Adenosine is also known to reduce the release of noradrenaline, production of endothelin and attenuate the activation of renin-angiotensin system all of which are believed to cause cardiac hypertrophy and remodelling. Secondly, exogenous adenosine is known to reduce the severity of ischaemia and reperfusion injury. Thirdly, adenosine is reported to counteract neurohumoral factors, i.e., cytokine systems, known to be related to the pathophysiology of CHF. Recently, we revealed that adenosine metabolism is changed in patients with CHF and increases in adenosine levels may aid to reduce the severity of CHF. Thus, there are many potential mechanisms for cardioprotection attributable to adenosine and we postulate the use of adenosine therapy will be beneficial in patients with CHF.

Topics: Adenosine; Animals; Cardiac Output, Low; Cardiovascular Agents; Chronic Disease; Heart Failure; Humans; Myocardium; Receptors, Purinergic P1

Respiratory muscle dysfunction has been demonstrated in several clinical situations including chronic respiratory disease, such as chronic obstructive pulmonary disease, as well as cardiac insufficiency. In the latter case, respiratory muscle dysfunction has been demonstrated in acute situation (cardiogenic shock) and in chronic cardiac insufficiency. In the former case, it has been shown in an animal model that respiratory muscle dysfunction could influence markedly the outcome of cardiogenic shock. In chronic cardiac insufficiency histologic, biochemical and contractile abnormalities of the respiratory muscles have been demonstrated in an animal model as well as in humans. These alterations may account, at least in part, for the sensation of dyspnea that these patients encountered. Finally, several pharmacological agents such as angiotensin-converting enzyme inhibitors have been shown to restore muscle abnormalities observed during chronic cardiac insufficiency.

Topics: Animals; Cardiac Output, Low; Cardiovascular Agents; Chronic Disease; Diaphragm; Humans; Intercostal Muscles; Shock, Cardiogenic

The treatment of heart failure has advanced greatly over the past two decades. Angiotensin-converting enzyme inhibitors have become standard therapy, not only in symptomatic patients but also in those with asymptomatic left ventricular dysfunction. Diuretic regimens have become increasingly potent and sophisticated. Much of the controversy over the efficacy of digoxin has been resolved, although its effect on survival is still uncertain. Most symptomatic patients, therefore, should be treated with what has become "standard" triple therapy, but practices vary as to when and at what dose to use these medications. More problematic is how to treat the patient who remains symptomatic on a three-drug regimen, and how to manage ancillary but important issues such as arrhythmias and thromboembolic risk. This article reflects the author's personal approach to managing the patient with left ventricular systolic dysfunction in 1994.

Topics: Cardiac Output, Low; Cardiovascular Agents; Forecasting; Heart Failure; Hemodynamics; Humans; Ventricular Function, Left

Low cardiac output syndrome (LCOS) is a severe condition which can occur after cardiac surgery, especially among patients with pre-existing left ventricular dysfunction. Dobutamine, its first-line treatment, is associated with sinus tachycardia. This study aims to assess the ability of intravenous ivabradine to decrease sinus tachycardia associated with dobutamine infused for LCOS after coronary artery bypass graft (CABG) surgery.. In a phase 2, multi-center, single-blind, randomized controlled trial, patients with left ventricular ejection fraction below 40% presenting sinus tachycardia of at least 100 beats per minute (bpm) following dobutamine infusion for LCOS after CABG surgery received either intravenous ivabradine or placebo (three ivabradine for one placebo). Treatment lasted until dobutamine weaning or up to 48 h. The primary endpoint was the proportion of patients achieving a heart rate (HR) in the 80- to 90-bpm range. Secondary endpoints were invasive and non-invasive hemodynamic parameters and arrhythmia events.. Nineteen patients were included. More patients reached the primary endpoint in the ivabradine than in the placebo group (13 (93%) versus 2 (40%); P = 0.04). Median times to reach target HR were 1.0 h in the ivabradine group and 5.7 h in the placebo group. Ivabradine decreased HR (112 to 86 bpm, P <0.001) while increasing cardiac index (P = 0.02), stroke volume (P <0.001), and systolic blood pressure (P = 0.03). In the placebo group, these parameters remained unchanged from baseline. In the ivabradine group, five patients (36%) developed atrial fibrillation (AF) and one (7%) was discontinued for sustained AF; two (14%) were discontinued for bradycardia.. Intravenous ivabradine achieved effective and rapid correction of sinus tachycardia in patients who received dobutamine for LCOS after CABG surgery. Simultaneously, stroke volume and systolic blood pressure increased, suggesting a beneficial effect of this treatment on tissue perfusion.. European Clinical Trials Database: EudraCT 2009-018175-14 . Registered February 2, 2010.

Topics: Administration, Intravenous; Aged; Cardiac Output, Low; Cardiotonic Agents; Cardiovascular Agents; Coronary Artery Bypass; Dobutamine; Elective Surgical Procedures; Female; Humans; Ivabradine; Male; Middle Aged; Placebos; Single-Blind Method

Defective endothelial function has been shown in dilated cardiomyopathy. Therefore, improvement in endothelial function after low-molecular-weight heparin (LMWH) therapy may be clinically beneficial. Consequently, the effect of adjunct enoxaparin, a LMWH, on standard treatment of dilated cardiomyopathy was investigated.. This was a randomized, standard treatment-controlled, 2-center pilot trial of 102 patients (52 receiving adjunctive therapy with enoxaparin at a dosage of 1.5 mg/kg daily for 3 months and 50 receiving standard therapy with angiotensin-converting enzyme inhibitors, beta-blockers, and diuretics alone) with stable chronic heart failure secondary to dilated cardiomyopathy (New York Heart Association [NYHA] class II and III; left ventricular [LV] ejection fraction, < or = 40%). All patients underwent coronary angiography and endomyocardial biopsy and were clinically stable for at least 6 months before enrollment. The combined primary end point included mortality, urgent heart transplantation, and readmission to hospital due to heart failure progression. The secondary end point was to determine the severity of heart failure (serum level of N-terminal brain natriuretic peptide), cardiac function (LV ejection fraction by radionuclide ventriculography), LV diameters by echocardiography, exercise capacity (changes in NYHA class, changes in peak oxygen consumption), and changes in quality of life (Minnesota Living with Heart Failure questionnaire). The clinical outcome was assessed after 6 and 12 months of therapy.. Baseline characteristics were comparable in both groups. Five patients dropped out during 12 months of the study. Twelve patients achieved primary end point (8 in the control group and 4 in the LMWH group). The free survival rate was 94% for the LMWH group and 90% for the controls (not statistically significant). After the 12-month period, in the LMWH group, N-terminal brain natriuretic peptide level and LV diameters decreased significantly (P < .001 and P = .006, respectively), whereas LV systolic function increased (P < .001). Changes in exercise capacity and subjective improvement did not differentiate the groups (nonsignificant). Adverse reactions to the enoxaparin therapy were minor and transient.. In patients with chronic heart failure due to dilated cardiomyopathy, adjunct long-term enoxaparin therapy may offer additional clinical benefit without deleterious effects on major cardiac events.

Topics: Adult; Anticoagulants; Cardiac Output, Low; Cardiomyopathy, Dilated; Cardiovascular Agents; Chronic Disease; Drug Administration Schedule; Drug Therapy, Combination; Echocardiography; Enoxaparin; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pilot Projects; Survival Analysis; Systole; Treatment Outcome; Ventricular Function, Left

To assess the prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in the chronically paced population.. Three hundred and seven patients were identified from attendance at routine pacemaker follow-up clinic. Subjects underwent a medical history and examination, 6-minute walk test and echocardiography. 94 (31%) had a left ventricular ejection fraction (LVEF) <40%, of whom 83 had symptoms of heart failure (70% NYHA II, 26% NYHA III and 4% NYHA IV). Heart failure was more prevalent in patients with single chamber compared to dual chamber pacemakers, (DDD(R) 18% vs 35% VVI(R), p<0.008), and those with chronic atrial fibrillation (AF) compared to those with sinus rhythm (42% vs 21%, p=0.003). Decreasing 6-minute walk distance, history of ischaemic heart disease and years of pacing were independently associated with the presence of heart failure (combined R=0.572, p<0.001).. Heart failure due to left ventricular systolic dysfunction is common in the paced population. Only a minority of these had a pre-existing diagnosis and a smaller proportion were on 'optimal' therapy. Echocardiographic screening of this high-risk population is justified to improve rates of diagnosis and treatment of heart failure.

Topics: Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Blood Flow Velocity; Cardiac Output, Low; Cardiac Pacing, Artificial; Cardiovascular Agents; Diabetic Angiopathies; Double-Blind Method; Dyspnea; Echocardiography; Exercise Tolerance; Fatigue; Female; Humans; Male; Middle Aged; Risk Factors; Stroke Volume; Ventricular Dysfunction, Left

To investigate effects of trimetazidine and perindopril on myocardial function and metabolism in patients with cardiac failure after myocardial infarction.. A comparative study was mode of the effects of 6-month therapy with perindopril, trimetazidine alone and in combination on clinical symptoms, left ventricular function and perfusion, glucose utilization, excretion and utilization of fatty acids in the zones of postinfarction scar, periinfarction ischemia and in without infarction changes.. Combined treatment with the ACE inhibitor and trimetazidine produced positive clinical and functional-metabolic shifts in postmyocardial infarction patients with cardiac failure.. The addition to the program of mild cardiac failure treatment early after myocardial infarction of an ACE inhibitor and a cytoprotective drug (trimetazidine) promotes more complete clinical compensation of the patients.

Topics: Adult; Aged; Blood Pressure; Cardiac Output, Low; Cardiovascular Agents; Drug Therapy, Combination; Electrocardiography; Energy Metabolism; Fatty Acids, Nonesterified; Glucose; Humans; Infarction; Male; Middle Aged; Myocardial Contraction; Myocardium; Perindopril; Trimetazidine

Topics: Cardiac Output, Low; Cardiovascular Agents; Humans; Shock, Cardiogenic; Vasodilator Agents

To evaluate the effectiveness of mild hypothermia on low cardiac output in patients after cardiac surgery.. Twelve patients manifesting low cardiac output after cardiac surgery despite of the use of massive doses of catecholamine and intra-aortic balloon pump (IABP) underwent mild hypothermia during May 2009 to February 2011. Changes in hemodynamic parameters of the patients were measured, including cardiac index (CI),mixed venous oxygen saturation [SvO(2)] and urine volume.. In the process of mild hypothermia treatment, bladder temperature of patients was lowered to 33-35 centigrade in order to reduce the body oxygen demand. The CI [ml·s(-1)·m(-2)]of patients after mild hypothermia treatment was increased obviously (38.34 ± 5.00 vs. 30.01 ± 5.00), the same as SvO(2) (0.64 ± 0.07 vs. 0.54 ± 0.08) and urine output [ml·kg(-1)·h(-1): 3.0 ± 2.1 vs. 1.5 ± 1.1, all P < 0.05]. However, there was no significant change in heart rate, mean arterial pressure and blood oxygen pressure.. Mild hypothermia is an effective and simple procedure to improve the cardiac function in patients after cardiac surgery complicated with low cardiac output.

Topics: Aged; Blood Pressure; Cardiac Output, Low; Cardiac Surgical Procedures; Cardiovascular Agents; Female; Heart Rate; Humans; Hypothermia, Induced; Intra-Aortic Balloon Pumping; Male; Middle Aged; Prospective Studies; Treatment Outcome

We examined factors affecting the choice of surgical versus medical treatment of severe aortic stenosis and evaluated associated patient survival.. We retrospectively reviewed data from all patients diagnosed with severe aortic stenosis at a Veterans Affairs medical facility between January 1997 and April 2008.. Of 345 patients with severe aortic stenosis, 260 (75%) underwent surgical evaluation, and 205 (59%) underwent aortic valve replacement (AVR). The patient's decision to decline surgical referral or AVR (n = 47) and severe comorbidities (n = 34) were the top two reasons for medical treatment rather than AVR. The AVR group was younger (69.5 +/- 9.6 years versus 75.7 +/- 8.6 years; p < 0.001) and had a higher prevalence of symptoms (96% versus 71%; p < 0.001) than the medical group. The medical group had a lower cardiac ejection fraction (0.42 +/- 0.15 versus 0.50 +/- 0.12; p < 0.001) and was less likely to be independent in activities of daily living (64% versus 74%). The AVR group had higher survival rates than the medical patients at 1 year (92% versus 65%), 3 years (85% versus 29%), and 5 years (73% versus 16%; log-rank test p < 0.0001). Valve replacement was independently associated with decreased mortality (hazard ratio, 0.17; 95% confidence interval, 0.10 to 0.27; p < 0.0001).. The management of severe aortic stenosis in veterans is sometimes limited to medical evaluation and treatment. Surgeons should be involved in the complex process of risk assessment, to select patients with severe aortic stenosis who would benefit from the survival advantage associated with AVR.

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Aortic Valve Stenosis; Blood Vessel Prosthesis Implantation; Cardiac Output, Low; Cardiovascular Agents; Comorbidity; Echocardiography; Female; Health Status Indicators; Hospitals, Veterans; Humans; Male; Middle Aged; Postoperative Complications; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Survival Rate; Treatment Refusal; Veterans

To assess differences in clinical characteristics, treatment and outcome between men and women with heart failure (HF) treated at a multidisciplinary HF unit. All patients had their first unit visit between August 2001 and April 2004.. We studied 350 patients, 256 men, with a mean age of 65 +/- 10.6 years. In order to assess the pharmacological intervention more homogeneously, the analysis was made at one year of follow-up.. Women were significantly older than men (69 +/- 8.8 years vs. 63.6 +/- 10.9 years, p < 0.001). Significant differences were found in the HF etiology and in co-morbidities. A higher proportion of men were treated with ACEI (83% vs. 68%, p < 0.001) while more women received ARB (18% vs. 8%, p = 0.006), resulting in a similar percentage of patients receiving either of these two drugs (men 91% vs. women 87%). No significant differences were observed in the percentage of patients receiving beta-blockers, loop diuretics, spironolactone, anticoagulants, amiodarone, nitrates or statins. More women received digoxin (39% vs. 22%, p = 0.001) and more men aspirin (41% vs. 31%, p = 0.004). Carvedilol doses were higher in men (29.4 +/- 18.6 vs. 23.8 +/- 16.4, p = 0.03), ACEI doses were similar between sexes, and furosemide doses were higher in women (66 mg +/- 26.2 vs. 56 mg +/- 26.2, p < 0.05). Mortality at 1 year after treatment analysis was similar between sexes (10.4% men vs. 10.5% women).. Despite significant differences in age, etiology and co-morbidities, differences in treatment between men and women treated at a multidisciplinary HF unit were small. Mortality at 1 year after treatment analysis was similar for both sexes.

Topics: Age Factors; Aged; Cardiac Output, Low; Cardiovascular Agents; Comorbidity; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Patient Selection; Sex Factors; Time Factors; Treatment Outcome

Heart failure (HF) affects approximately 5 million persons in the United States each year. HF is predominantly a disease of the elderly: Approximately 80% of patients hospitalized with HF are older than age 65. Approximately one-half of older adult patients with CHF have a decreased ejection fraction. Elderly patients with HF and a reduced LVEF have a higher mortality than elderly patients with HF with a normal LVEF. Despite numerous excellent studies showing the efficacy of appropriate drugs in reducing mortality in patients with HF and a reduced LVEF, these medications are underutilized in the treatment of HF. This article discusses the latest guidelines from the American College of Cardiology/American Heart Association for the treatment of patients with HF and a reduced LVEF.

Topics: Aged; Cardiac Output, Low; Cardiovascular Agents; Combined Modality Therapy; Death, Sudden, Cardiac; Exercise; Heart Failure; Humans; Risk Factors; Secondary Prevention; Treatment Outcome; Ventricular Dysfunction, Left

National surveys suggest that treatment of heart failure in daily practice differs from guidelines and is characterized by underuse of recommended medications. Accordingly, the Euro Heart Failure Survey was conducted to ascertain how patients hospitalized for heart failure are managed in Europe and if national variations occur in the treatment of this condition.. The survey screened discharge summaries of 11304 patients over a 6-week period in 115 hospitals from 24 countries belonging to the ESC to study their medical treatment.. Diuretics (mainly loop diuretics) were prescribed in 86.9% followed by ACE inhibitors (61.8%), beta-blockers (36.9%), cardiac glycosides (35.7%), nitrates (32.1%), calcium channel blockers (21.2%) and spironolactone (20.5%). 44.6% of the population used four or more different drugs. Only 17.2% were under the combination of diuretic, ACE inhibitors and beta-blockers. Important local variations were found in the rate of prescription of ACE inhibitors and particularly beta-blockers. Daily dosage of ACE inhibitors and particularly of beta-blockers was on average below the recommended target dose. Modelling-analysis of the prescription of treatments indicated that the aetiology of heart failure, age, co-morbid factors and type of hospital ward influenced the rate of prescription. Age <70 years, male gender and ischaemic aetiology were associated with an increased odds ratio for receiving an ACE inhibitor. Prescription of ACE inhibitors was also greater in diabetic patients and in patients with low ejection fraction (<40%) and lower in patients with renal dysfunction. The odds ratio for receiving a beta-blocker was reduced in patients >70 years, in patients with respiratory disease and increased in cardiology wards, in ischaemic heart failure and in male subjects. Prescription of cardiac glycosides was significantly increased in patients with supraventricular tachycardia/atrial fibrillation. Finally, the rate of prescription of antithrombotic agents was increased in the presence of supraventricular arrhythmia, ischaemic heart disease, male subjects but was decreased in patients over 70.. Our results suggest that the prescription of recommended medications including ACE inhibitors and beta-blockers remains limited and that the daily dosage remains low, particularly for beta-blockers. The survey also identifies several important factors including age, gender, type of hospital ward, co morbid factors which influence the prescription of heart failure medication at discharge.

Topics: Adrenergic beta-Antagonists; Age Factors; Aged; Angiotensin-Converting Enzyme Inhibitors; Aspirin; Calcium Channel Blockers; Cardiac Glycosides; Cardiac Output, Low; Cardiovascular Agents; Europe; Female; Fibrinolytic Agents; Health Surveys; Hospitalization; Humans; Male; Multivariate Analysis; Platelet Aggregation Inhibitors; Quality of Health Care; Spironolactone

We report the case of a 77-year-old male who developed a florid photosensitive eruption while taking thiazide diuretics for heart failure. The lesions were lichenoid in appearance and this was confirmed histologically. The eruption cleared on withdrawal of the drug. Although thiazide-induced photosensitivity is a well-documented phenomenon, there have been no histologically proven cases of a lichenoid eruption in light exposed areas in the recent literature.

Topics: Aged; Cardiac Output, Low; Cardiovascular Agents; Dermatitis, Photoallergic; Drug Combinations; Drug Eruptions; Humans; Hydrochlorothiazide; Lichenoid Eruptions; Male; Triamterene

We assessed gender differences in the risk of mortality in heart failure (HF) patients and evaluated the association between HF drug treatment and mortality.. We identified a cohort of 820 patients with newly diagnosed HF in 1996 in UK general practices. The diagnosis of HF was confirmed by the general practitioner. Fifty per cent were females and 27% were less than 70 years old. During a mean follow-up of 2 years, 172 patients died. We used computerized records to assess risk factors and drugs prescribed as treatment. The information on severity was assessed through a questionnaire. We performed a nested case-control analysis, and observed that men had twice the risk of dying than females, however the effect of age on mortality was stronger in females than males. We found a similar interaction between HF severity and sex. Data on use of some cardiovascular drugs such as diuretics, beta-blockers ACE-inhibitors and calcium channel blockers were suggestive of a reduced mortality risk. Current use of nitrates and glycosides carried an increased risk.. Older age, male sex and severity of HF were the main predictors of mortality among HF patients. Long-term use of beta-blockers was associated with a significantly reduced risk of mortality.

Topics: Adult; Aged; Cardiac Output, Low; Cardiovascular Agents; Cohort Studies; Female; Humans; Male; Middle Aged; Risk Factors; Sex Factors

Topics: Age Factors; Aged; Cardiac Output, Low; Cardiovascular Agents; Clinical Trials as Topic; Female; Humans; Male; Risk Assessment; Sex Factors; Statistics as Topic; Treatment Outcome

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiac Output, Low; Cardiovascular Agents; Diabetes Complications; Diuretics; Drug Prescriptions; Forecasting; Humans; Pharmacogenetics; Risk Factors; Survival Rate

Despite the deleterious and sometimes catastrophic consequences of proximal left anterior descending (LAD) artery occlusion, there is a paucity of data to guide the treatment of patients with such disease. Our aim was to describe outcomes with medical therapy, angioplasty, or left internal mammary artery (LIMA) bypass grafting in patients with 1-vessel, proximal LAD disease. We retrospectively analyzed prospectively collected data from 1,188 patients first presenting only with proximal LAD disease at 1 center over 9 years. We assessed the rates of death, acute myocardial infarction, and repeat intervention by initial treatment over a median 5.7 years of follow-up. Patients undergoing angioplasty or LIMA bypass were more often men and had progressive or unstable angina; those receiving medical therapy had a lower median ejection fraction. Both revascularization procedures offered slightly better adjusted survival versus medicine (hazard ratio for angioplasty, 0.82; 95% confidence interval, 0.60 to 1.11; hazard ratio for bypass, 0.74; 95% confidence interval, 0.44 to 1.23). Bypass, but not angioplasty, was associated with significantly fewer composite end point events (death, infarction, or reintervention, p <0.0001), and angioplasty was associated with a higher composite event rate than bypass or medical therapy (p <0.0001 and p = 0.0003, respectively). The initial advantages of bypass and medicine over angioplasty diminished over time; angioplasty became more advantageous than medicine after 1 year (p = 0.05) and not significantly different from bypass. Treatment of 1-vessel, proximal LAD disease with medicine, angioplasty, or UMA bypass resulted in comparable adjusted survival. However, LIMA bypass alone reduced the long-term incidence of infarctions and repeat procedures.

Topics: Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiac Output, Low; Cardiovascular Agents; Cohort Studies; Confidence Intervals; Coronary Disease; Disease Progression; Female; Follow-Up Studies; Humans; Incidence; Internal Mammary-Coronary Artery Anastomosis; Male; Middle Aged; Myocardial Infarction; Odds Ratio; Proportional Hazards Models; Prospective Studies; Reoperation; Retreatment; Retrospective Studies; Sex Factors; Stroke Volume; Survival Rate; Treatment Outcome

Atrial fibrillation is a frequent disorder in the elderly and a known risk factor for cerebrovascular stroke. We investigated the association of atrial fibrillation with dementia and cognitive impairment in a large cross-sectional, population-based study in the elderly.. Of the 6584 participants in the Rotterdam Study aged 55 to 106 years, detailed information on dementia status and ECG abnormalities was available. Dementia was diagnosed in three phases. First, participants were screened. Screen-positive subjects were tested further. Those with possible dementia underwent an extensive diagnostic workup. Dementia and dementia subtypes were diagnosed according to prevailing criteria. Cognitive impairment was defined as a Mini-Mental State Examination test score of < 26 points for a nondemented subject.. Atrial fibrillation was diagnosed in 195, dementia in 276, and cognitive impairment in 635 subjects. We found significant positive associations of atrial fibrillation with both dementia and impaired cognitive function (age- and sex-adjusted odds ratios, 2.3 [95% confidence interval, 1.4 to 3.7] and 1.7 [95% confidence interval, 1.2 to 2.5]), respectively). The strongest association was found not for vascular dementia but rather for Alzheimer's disease with cerebrovascular disease. The associations were stronger in women, and the relation with dementia was more pronounced in the relatively younger elderly. A history of stroke in subjects with atrial fibrillation could not account for these associations.. Dementia and subtypes Alzheimer's disease and vascular dementia may be related to atrial fibrillation even if no clinical stokes have occurred.

Topics: Age Factors; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiac Output, Low; Cardiovascular Agents; Cerebrovascular Circulation; Cognition Disorders; Comorbidity; Cross-Sectional Studies; Dementia; Dementia, Vascular; Electrocardiography; Female; Humans; Male; Middle Aged; Netherlands; Prevalence; Risk Factors

Topics: Cardiac Output, Low; Cardiovascular Agents; Cerebrovascular Circulation; Coronary Circulation; Education, Nursing, Continuing; Female; Hemodynamics; Humans; Male; Monitoring, Physiologic; Myocardial Contraction; Neurologic Examination; Nursing Assessment; Nursing Diagnosis; Pulse; Renal Circulation

Topics: Cardiac Output, Low; Cardiovascular Agents; Education, Nursing, Continuing; Humans; Nursing Assessment; Pulmonary Wedge Pressure; Shock, Cardiogenic

Over the past six years there has been a 15-fold increase in the number of patients requiring reoperation coronary artery bypass grafting (RCABG) surgery at the University of Alabama in Birmingham. To determine the perioperative risk, a retrospective chart survey of one calendar year's (1981) experience was made comparing the 58 RCABG patients with 59 cohorts undergoing primary operation. All patients were anaesthetized with diazepam, fentanyl and halothane or enflurane anaesthesia. Preoperative evaluation revealed by history that the incidence of unstable angina and digoxin use were greater (p = 0.05) in the RCABG patients. Cardiac catheterization revealed a higher incidence (26 vs 89 percent) of left main coronary disease in controls and similar indices of left ventricular function (wall abnormalities, ejection fraction and LVEDP). Operating and bypass times were longer (p less than 0.01) for RCABG patients and there was a trend for greater (p = 0.08) use of dopamine in the RCABG patients. CK-MB release was significantly (p less than 0.05) greater in RCABG patients. Serious postoperative complications (CK-MB greater than or equal to 15 IU/L, low cardiac output, and death) were significantly (p = 0.02) greater in the RCABG group. It is concluded that RCABG patients represent a greater risk of complications and that new strategies for improving myocardial protection need to be developed to reduce the risk.

Topics: Adult; Aged; Anesthesia, Endotracheal; Cardiac Output, Low; Cardiovascular Agents; Coronary Artery Bypass; Dopamine; Humans; Hypotension; Middle Aged; Nitroglycerin; Nitroprusside; Postoperative Period; Reoperation; Retrospective Studies; Risk

Topics: Cardiac Output, Low; Cardiovascular Agents; Drug Therapy, Combination; Humans