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Search     Simple Advanced Related Clinical Trials from ClinicalTrials.gov  Search the ESRNexus medical and societal libraries for all of the following terms: Show articles that do not have abstracts  Searching for related clinical trials... Results(1-25 of 25,000) Sort By: Publication Date Relevance Took: 4.486 seconds to search 17,750,454 articles.  Action: Copy Results to new Clipboard Build Search Link Page 1 of 1000 1 2 3 4 > Last >> (25000 articles found) Prevalence of heart failure in three general practices in north west London 1992 Parameshwar, J., Shackell, M. M., Richardson, A., Poole-Wilson, P. A., and Sutton, G. C. There is little recent information on the prevalence of heart failure in the United Kingdom. Assuming that patients with heart failure would be taking diuretic drugs all such patients were identified in three general practices in north west London. The practice records of these patients were examin... ( view more )ed to determine which patients had heart failure. Of the 30,204 patients served by the practices, 117 had heart failure, a prevalence of 3.9 per 1000 patients. The mean age of these patients was 74 years. The prevalence of heart failure among patients under 65 years of age was 0.6 per 1000 patients rising to 27.7 per 1000 among those aged 65 years and over. The aetiology of heart failure was considered to be coronary heart disease for 32% of patients, valve disease for 19%, hypertension for 6%, cor pulmonale for 4% and congenital heart disease for 2%. The aetiology for the remaining 37% of patients was unknown. Most patients were referred to hospital and only 20% had been treated solely by the general practitioner. An electrocardiogram and chest radiograph had been obtained for over 80% of patients but only 28% had an echocardiogram. Heart failure occurs primarily in elderly patients, and coronary heart disease is the dominant aetiological factor ( view less ) View Full Abstract View Article Details   Related Articles Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk 2001 Nielsen, O. W., Hilden, J., Larsen, C. T., and Hansen, J. F. Objective - To examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD). Design - Cross sectional screening study in three general practices followed by echocardiography. Setting and patients - All... ( view more ) patients >= 50 years in two general practices and >= 40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF. Main outcome measures - Prevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction <= 0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD. Results - SSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At >= 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined. Conclusion - SSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14 ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Prevalence of chronic heart failure in Southwestern Europe: the EPICA study 2002 Ceia, F., Fonseca, C., Mota, T., Morais, H., Matias, F., de, SousaA, Oliveira, A., EPICA, Investigatorso, and EPICA, Investigators AIM: To estimate the prevalence of chronic heart failure (CHF) in mainland Portugal in 1998. METHODS AND POPULATION: A community-based epidemiological survey involving subjects attending primary care centres selected by a combined two-stage sampling and stratified procedure. General practitioners (... ( view more )GPs) randomly selected in proportion to the population of the District, evaluated subjects attending primary care centres aged over 25 years, recruited consecutively and stratified by age. CHF cases were identified according to the Guidelines of the European Society of Cardiology for CHF diagnosis. RESULTS: 5434 eligible subjects were evaluated by 365 GPs; 551 patients with CHF were identified. The overall prevalence and 95% CI of CHF in mainland Portugal is 4.36% (3.69-5.02%), 4.33% in males (3.19-5.46%), and 4.38% in females (3.64-5.13%). Age-specific CHF prevalence was as follows: 1.36% in the 25-49 years-old group (0.39-2.33%), 2.93% in the 50-59 years-old group (5.58-9.37%), 7.63% in the 60-69 years-old group (5.58-9.37%), 12.67% in the 70-79 years-old group (10.73-14.6%), and 16.14% in group over 80 years old (13.81-18.47%). The prevalence of CHF due to systolic dysfunction was 1.3% and the prevalence of CHF with normal systolic function was 1.7%. CONCLUSIONS: The overall prevalence of CHF in Portugal was slightly higher than that of other European studies and increases sharply with age. The prevalence of CHF due to systolic dysfunction is very similar to that reported by other recent European studies. The differences found may correspond to differences in methodology rather than actual differences in the population ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Prevalence of chronic heart failure in Southwestern Europe: the EPICA study 2002 Ceia, F., Fonseca, C., Mota, T., Morais, H., Matias, F., de, SousaA, Oliveira, A., and EPICA, Investigators AIM: To estimate the prevalence of chronic heart failure (CHF) in mainland Portugal in 1998. METHODS AND POPULATION: A community-based epidemiological survey involving subjects attending primary care centres selected by a combined two-stage sampling and stratified procedure. General practitioners (... ( view more )GPs) randomly selected in proportion to the population of the District, evaluated subjects attending primary care centres aged over 25 years, recruited consecutively and stratified by age. CHF cases were identified according to the Guidelines of the European Society of Cardiology for CHF diagnosis. RESULTS: 5434 eligible subjects were evaluated by 365 GPs; 551 patients with CHF were identified. The overall prevalence and 95% CI of CHF in mainland Portugal is 4.36% (3.69-5.02%), 4.33% in males (3.19-5.46%), and 4.38% in females (3.64-5.13%). Age-specific CHF prevalence was as follows: 1.36% in the 25-49 years-old group (0.39-2.33%), 2.93% in the 50-59 years-old group (5.58-9.37%), 7.63% in the 60-69 years-old group (5.58-9.37%), 12.67% in the 70-79 years-old group (10.73-14.6%), and 16.14% in group over 80 years old (13.81-18.47%). The prevalence of CHF due to systolic dysfunction was 1.3% and the prevalence of CHF with normal systolic function was 1.7%. CONCLUSIONS: The overall prevalence of CHF in Portugal was slightly higher than that of other European studies and increases sharply with age. The prevalence of CHF due to systolic dysfunction is very similar to that reported by other recent European studies. The differences found may correspond to differences in methodology rather than actual differences in the population ( view less ) View Full Abstract View Article Details   Related Articles Prevalence and aetiology of heart failure in an Arab population 2001 Agarwal, A. K., Venugopalan, P., and de, BonoD BACKGROUND: The epidemiology of heart failure in Arabia, with a population different from the West in cultural and ethnic origin, has not been studied before. AIMS: To determine the prevalence and aetiologies of symptomatic heart failure in an indigenous Arab population over a 3-year period. Method... ( view more )s: All patients with heart failure > or =13 years of age, treated at the only secondary care hospital of the Dhakliya region of Oman between 1992 and 1994 were evaluated prospectively by clinical history and physical examination. Chest radiograph and echo-Doppler studies were used to confirm the diagnosis of heart failure. Exercise stress testing and/or coronary angiography were also performed in patients >30 years of age, or earlier if ischaemic heart disease was suspected. RESULTS: A total of 1164 patients were identified giving a prevalence of 5.17/1000 population during the study period (6.04/1000 among males and 4.21/1000 among females; P<0.001). The prevalence increased with age from 1.05/1000 in age group <45 years to 15.7/1000 in 45-64 years (P<0.001) and 25.2/1000 in > or = 65 years (P<0.001). Common causes of heart failure were ischaemic heart disease (51.7%), hypertensive heart disease (24.9%) and idiopathic dilated cardiomyopathy (8.3%). Valvular heart disease and lung diseases causing heart failure were less common. CONCLUSION: The prevalence of symptomatic heart failure was appreciably significant in the population studied, showed a male preponderance and was frequent in people aged > or =45 years. Ischaemic heart disease and hypertension were the commonest aetiologies but idiopathic dilated cardiomyopathy was also present in a significant number of patients being relatively more prevalent than reported from the West ( view less ) View Full Abstract View Article Details   Related Articles Prevalence of heart failure and left ventricular dysfunction in the general population; The Rotterdam Study 1999 Mosterd, A., Hoes, A. W., de, BruyneMC, Deckers, J. W., Linker, D. T., Hofman, A., and Grobbee, D. E. AIMS: To determine the prevalence of heart failure and symptomatic as well as asymptomatic left ventricular systolic dysfunction in the general population. METHODS AND RESULTS: In 5540 participants of the Rotterdam Study (age 68.9+/-8.7 years, 2251 men) aged 55-95 years, the presence of heart failu... ( view more )re was determined by assessment of symptoms and signs (shortness of breath. ankle oedema and pulmonary crepitations) and use of heart failure medication. In 2267 subjects (age 65.7+/-7.4 years, 1028 men) fractional shortening was measured. The overall prevalence of heart failure was 3.9% (95% CI 3.0+/-4.7) and did not differ between men and women. The prevalence increased with age, with the exception of the highest age group in men. Fractional shortening was higher in women and did not decrease appreciably with age. The prevalence of left ventricular systolic dysfunction (fractional shortening <=25%) was approximately 2.5 times higher in men (5.5%, 95% CI 4.1-7.0) than in women (2.2%, 95% CI 1.4-3.2). Sixty percent of persons with left ventricular systolic dysfunction had no symptoms or signs of heart failure at all. CONCLUSIONS: The prevalence of heart failure is appreciable and does not differ between men and women. The majority of persons with left ventricular systolic dysfunction can be regarded as having asymptomatic left ventricular systolic dysfunction ( view less ) View Full Abstract View Article Details   Related Articles Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study 2004 Bleumink, G. S., Knetsch, A. M., Sturkenboom, M. C., Straus, S. M., Hofman, A., Deckers, J. W., Witteman, J. C., and Stricker, B. H. AIMS: To determine the prevalence, incidence rate, lifetime risk and prognosis of heart failure. METHODS AND RESULTS: The Rotterdam Study is a prospective population-based cohort study in 7983 participants aged > or =55. Heart failure was defined according to criteria of the European Society of Car... ( view more )diology. Prevalence was higher in men and increased with age from 0.9% in subjects aged 55-64 to 17.4% in those aged > or =85. Incidence rate of heart failure was 14.4/1000 person-years (95% CI 13.4-15.5) and was higher in men (17.6/1000 man-years, 95% CI 15.8-19.5) than in women (12.5/1000 woman-years, 95% CI 11.3-13.8). Incidence rate increased with age from 1.4/1000 person-years in those aged 55-59 to 47.4/1000 person-years in those aged > or =90. Lifetime risk was 33% for men and 29% for women at the age of 55. Survival after incident heart failure was 86% at 30 days, 63% at 1 year, 51% at 2 years and 35% at 5 years of follow-up. CONCLUSION: Prevalence and incidence rates of heart failure are high. In individuals aged 55, almost 1 in 3 will develop heart failure during their remaining lifespan. Heart failure continues to be a fatal disease, with only 35% surviving 5 years after the first diagnosis ( view less ) View Full Abstract View Article Details   Related Articles Prevalence, prognostic significance, and treatment of atrial fibrillation in congestive heart failure with particular reference to the DIAMOND-CHF study. [Review] [56 refs] 2003 Pedersen, O. D., Brendorp, B., Kober, L., and Torp-Pedersen, C. Atrial fibrillation is a growing health problem and the most common cardiac arrhythmia, affecting 5% of persons above the age of 65 years. The number of hospital discharges for atrial fibrillation has more than doubled in the past decade. It occurs very often in patients with congestive heart failu... ( view more )re and the prevalence increases with the severity of the disease. These two conditions seem to be linked together, and congestive heart failure may either be the cause or the consequence of atrial fibrillation. The prognosis of atrial fibrillation is controversial, but studies indicate that atrial fibrillation is a risk factor in congestive heart failure patients. In the last 10-15 years, significant advances in the treatment of heart failure have improved survival, whereas effective management of atrial fibrillation in heart failure patients still awaits similar progress. Empirically, two strategies have evolved for treatment of atrial fibrillation: 1) rhythm control, which means conversion to sinus rhythm and maintenance of sinus rhythm; and 2) rate control, which means reduction of heart rate to an acceptable frequency. It is unknown whether one of these strategies is better than the other. In this review the authors discuss the prevalence, impact, and treatment of atrial fibrillation in heart failure patients. [References: 56] ( view less ) View Full Abstract View Article Details   Related Articles The prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in a typical regional pacemaker population 2003 Thackray, S. D. R., Witte, K. K. A., Nikitin, N. P., Clark, A. L., Kaye, G. C., and Cleland, J. G. F. Aims: To assess the prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in the chronically paced population. Methods and Results: Three hundred and seven patients were identified from attendance at routine pacemaker follow-up clinic. Subjects underwent a medical histo... ( view more )ry 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). Conclusions: 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. (C) 2003 Published by Elsevier Science Ltd on behalf of The European Society of Cardiology ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Prevalence of self-reported heart failure among US adults: results from the 1999 National Health Interview Survey.[see comment] 2003 Ni, H. OBJECTIVE: The objective of the present study was to determine the prevalence of self-reported heart failure among US adults. METHODS: Data from the 1999 National Health Interview Survey were analyzed. A total of 30,801 sampled adults aged >or=18 years were given a list of major medical conditions,... ( view more ) which included heart failure (HF), and asked if they had ever been told by a doctor or other health professional that they had any of the conditions. Analyses were conducted with the use of SUDAAN software to account for the complex sample design. RESULTS: An estimated 2.4 million adults had been told by a doctor or other health professional that they had HF. The prevalence of self-reported HF for age groups 18 to 39, 40 to 64, 65 to 74, and 75 to 105 years were 0.1%, 1.1%, 3.6%, and 5.5%, respectively. HF was most prevalent among ever-smokers, obese persons, and persons aged >or=65 years. No difference was found in the prevalence of self-reported HF between black and white persons. The most common comorbid conditions for those with HF were hypertension, coronary heart disease, and diabetes. Compared with those without HF, the elderly persons with HF were 8 times as likely to have severe mobility difficulties and 2 to 3 times as likely to have severe depression. Half of the elderly persons with HF had been hospitalized, visited an emergency room, or had >10 clinic visits in the past year. Black patients were more likely than white patients to have been unable to pay for prescription medicine and to have seen a medical specialist during the past year. CONCLUSIONS: This nationally representative survey indicates that an estimated 2.4 million adults had been told by a doctor or other health professional that they had heart failure. Black patients with HF were less likely than white patients to have received the needed care ( view less ) View Full Abstract View Article Details   Related Articles Heart failure in primary care: qualitative study of current management and perceived obstacles to evidence-based diagnosis and management by general practitioners 2002 Khunti, K., Hearnshaw, H., Baker, R., and Grimshaw, G. BACKGROUND: Chronic heart failure is a common clinical condition with high morbidity and mortality. Despite the evidence that appropriate treatment with angiotensin-converting enzyme inhibitors can improve morbidity, primary care studies show that patients with heart failure are incorrectly diagnos... ( view more )ed and inadequately treated. AIM: To explore general practitioners' accounts of their management of patients with heart failure and identify the perceived obstacles to diagnosis and management. METHODS: We conducted this qualitative study using semi-structured interviews in 18 general practices. The practices were stratified on the basis of size, location, and the level of practice development. The interviews were based on a schedule of open questions based on the literature on diagnosis and management of patients with heart failure. Transcriptions of the audiotaped interviews were independently analysed by two researchers and analysis was based on open coding using a constant comparative approach. Categories were reduced to major themes. RESULTS: General practitioners suspect heart failure when patients present with breathlessness or ankle oedema. Many general practitioners reported that they would diagnose heart failure after respiratory examination and a positive finding of basal crepitations. Many general practitioners arrange a chest X-ray to establish the diagnosis and some arrange an electrocardiogram. A few general practitioners mentioned that they diagnosed heart failure with a trial of diuretics. Obstacles to diagnosis were mentioned by most general practitioners and included lack of facilities for appropriate investigations (especially echocardiography) and lack of time and expertise. Obstacles to management included lack of time, high cost of drugs, difficulty with diagnosis, selection bias towards younger patients and not having the confidence to initiate angiotensin-converting enzyme inhibitors. Many general practitioners were unaware of the impact angiotensin-converting enzyme inhibitors can have on morbidity and mortality. CONCLUSIONS: Although symptoms of heart failure are not sufficiently specific for diagnosing patients with heart failure, many general practitioners in European countries treat people with suspected heart failure on the basis of symptoms and signs alone. This study has identified many obstacles to the diagnosis and management of heart failure that may explain why patients are inadequately managed in primary care. Specific implementation strategies need to be tailored to overcome these obstacles. Copyright 2002 European Society of Cardiology ( view less ) View Full Abstract View Article Details   Related Articles Prevalence of self-reported heart failure among US adults: results from the 1999 National Health Interview Survey.[see comment] 2003 Ni, H. OBJECTIVE: The objective of the present study was to determine the prevalence of self-reported heart failure among US adults. METHODS: Data from the 1999 National Health Interview Survey were analyzed. A total of 30,801 sampled adults aged >or=18 years were given a list of major medical conditions,... ( view more ) which included heart failure (HF), and asked if they had ever been told by a doctor or other health professional that they had any of the conditions. Analyses were conducted with the use of SUDAAN software to account for the complex sample design. RESULTS: An estimated 2.4 million adults had been told by a doctor or other health professional that they had HF. The prevalence of self-reported HF for age groups 18 to 39, 40 to 64, 65 to 74, and 75 to 105 years were 0.1%, 1.1%, 3.6%, and 5.5%, respectively. HF was most prevalent among ever-smokers, obese persons, and persons aged >or=65 years. No difference was found in the prevalence of self-reported HF between black and white persons. The most common comorbid conditions for those with HF were hypertension, coronary heart disease, and diabetes. Compared with those without HF, the elderly persons with HF were 8 times as likely to have severe mobility difficulties and 2 to 3 times as likely to have severe depression. Half of the elderly persons with HF had been hospitalized, visited an emergency room, or had >10 clinic visits in the past year. Black patients were more likely than white patients to have been unable to pay for prescription medicine and to have seen a medical specialist during the past year. CONCLUSIONS: This nationally representative survey indicates that an estimated 2.4 million adults had been told by a doctor or other health professional that they had heart failure. Black patients with HF were less likely than white patients to have received the needed care ( view less ) View Full Abstract View Article Details View Coded Data Related Articles The prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in a typical regional pacemaker population 2003 Thackray, S. D., Witte, K. K., Nikitin, N. P., Clark, A. L., Kaye, G. C., and Cleland, J. G. AIMS: To assess the prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in the chronically paced population. METHODS AND RESULTS: Three hundred and seven patients were identified from attendance at routine pacemaker follow-up clinic. Subjects underwent a medical histo... ( view more )ry 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). CONCLUSIONS: 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 ( view less ) View Full Abstract View Article Details   Related Articles Prevalence and predictors of heart failure with preserved systolic function: community hospital admissions of a racially and gender diverse elderly population 2004 Peyster, E., Norman, J., and Domanski, M. BACKGROUND: The reported prevalence of preserved systolic function (PSF) heart failure (HF) varies widely and has not been well-studied in nonwhite patients. To estimate the prevalence of PSF HF resulting in hospital admission, we studied admissions to a large community hospital serving a racially ... ( view more )diverse community. METHODS: The charts of 300 consecutive patients > or =65 years old with a primary discharge diagnosis of HF were reviewed. In patients who met the Framingham criteria for HF diagnosis, an assessment of left ventricular function was obtained from review of chart data. Comparison of baseline characteristics and multivariate analysis of potential predictors of PSF HF was undertaken. RESULTS: Of the 300 patients, 247 (82%) met the Framingham criteria for diagnosis of HF. Ninety-seven patients (39%) of these had PSF. Twenty (8%) of the diagnosed HF patients had a diagnosis of severe aortic or mitral valvular disease, 9 of whom had preserved systolic functions. Thus 88 (36%) of the HF patients had PSF HF likely resulting from diastolic dysfunction. On multivariate analysis, age, hypertension at presentation, peripheral edema, normal sinus rhythm and a history of coronary artery bypass grafting or coronary angioplasty were significantly associated with PSF HF rather than HF with reduced systolic function. Left bundle branch block or other intraventricular conduction delay was independently associated with reduced systolic function HF. However, because these findings occurred in patients with and without systolic dysfunction, none were pathognomonic of PSF HF. CONCLUSION: In this racially diverse, majority nonwhite, cohort of older patients admitted for HF, the Framingham criteria for the diagnosis of HF were met in 82% of the patients. Of these, 39% had PSF HF and 36% had PSF HF in the absence of severe aortic or mitral valve disease, suggesting that diastolic dysfunction was etiologic. Although there was an independent association of PSF HF with a number of clinical characteristics, none of these characteristics was pathognomonic of preserved, versus reduced, systolic function HF ( view less ) View Full Abstract View Article Details   Related Articles The relevance of heart failure severity for treatment with evidence-based pharmacotherapy in general practice 2003 Pont, L. G., van Gilst, W. H., Lok, D. J. A., Kragten, H. J. A., and Haaijer-Ruskamp, F. M. Aims: Internationally, research indicates that pharmacotherapy for chronic heart failure (CHF) is sub-optimal. Traditionally, assessment of drug use in heart failure has focused on the use of individual agents irrespective of CHF severity. This study investigates drug use for CHF patients in genera... ( view more )l practice with respect to the available evidence, incorporating both disease severity and the use of combination drug regimes. Methods and results: A cross-sectional survey of 769 Dutch CHF patients was performed as part of IMPROVEMENT of HF study. For each New York Heart Association severity classification the minimum treatment appropriate for the heart failure severity according to the scientific evidence available at the time of the study (1999) was defined. The proportion of patients treated with each drug increased with increasing severity, with the exception of the [beta]-blockers. Patients with less severe heart failure were approximately four to eight times more likely to receive evidence-based treatment than those with more severe heart failure. Discussion: To assess pharmacological treatment of heart failure, in relation to the available evidence, it is important to take severity into account. While the number of drugs prescribed increased with increasing severity, the use of evidence-based regimes was lower in patients with more severe heart failure. (C) 2002 European Society of Cardiology. Published by Elsevier Science B.V. All rights reserved ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: The Weight Monitoring in Heart Failure (WHARF) trial 2003 Goldberg, L. R., Piette, J. D., Walsh, M. N., Frank, T. A., Jaski, B. E., Smith, A. L., Rodriguez, R., Mancini, D. M., Hopton, L. A., Orav, E. J., and Loh, E. Background: Heart failure treatment guidelines emphasize daily weight monitoring for patients with heart failure, but data to support this practice are lacking. Using a technology-based heart failure monitoring system, we determined whether daily reporting of weight and symptoms in patients with ad... ( view more )vanced heart failure would reduce rehospitalization and mortality rates despite aggressive guideline-driven heart failure care. Methods: This was a randomized, controlled trial. Patients hospitalized with New York Heart Association class III or IV heart failure, with a left ventricular ejection fraction <=35% were randomized to receive heart failure program care or heart failure program care plus the AlereNet system (Alere Medical, Reno, Nev) and followed-up for 6 months. The primary end point was 6-month hospital readmission rate. Secondary end points included mortality, heart failure hospitalization readmission rate, emergency room visitation rate, and quality of life. Results: Two hundred eighty patients from 16 heart failure centers across the United States were randomized: 138 received the AlereNet system and 142 received standard care. Mean age was 59 +/- 15 years and 68% were male. The population had very advanced heart failure, New York Heart Association class III (75%) or IV (25%), as evidenced by serum norepinepherine levels, 6-minute walk distance and outcomes. No differences in hospitalization rates were observed. There was a 56.2% reduction in mortality (P < .003) for patients randomized to the AlereNet group. Conclusions: This is the largest multicenter, randomized trial of a technology-based daily weight and symptom-monitoring system for patients with advanced heart failure. Despite no difference in the primary end point of rehospitalization rates, mortality was significantly reduced for patients randomized to the AlereNet system without an increase in utilization, despite specialized and aggressive heart failure care in both groups ( view less ) View Full Abstract View Article Details View Coded Data Related Articles The effect of an integrated care approach for heart failure on general practice 2003 A. Pearl, S. P. Wright, G. D. Gamble, S. Muncaster, H. J. Walsh, N. Sharpe and R. N. Doughty BACKGROUND: Recent studies have investigated specific strategies for heart failure management. None has involved collaboration between primary and secondary care. Potential gains for patients may result from collaborative strategies. OBJECTIVE: To assess the effect of an integrated management appr... ( view more )oach for patients with heart failure on general practice. METHODS: The study design was a cluster randomized controlled trial of integrated primary/ secondary care compared with usual care for heart failure patients. The study took place at Auckland Hospital, New Zealand and involved 197 patients admitted with an episode of heart failure. Patients were randomized to management group or control group (who received "usual" care). Management group patients received early clinical review, education sessions, a personal diary for medications and weight, and regular clinical follow-up alternating between GP and hospital clinic. Follow-up was for 12 months. RESULTS: Patients visited GPs frequently (median 14 visits, range 0-40), with no statistical difference between the two groups. Heart failure was the most common reason for consulting the GP. There was no relationship between GP consultations and patients' attendance at the study clinic, or hospital admissions. Management group GPs and patients expressed a high level of satisfaction. CONCLUSION: GP consultation rates were not affected by the programme. Further research will determine if general practice based programmes result in further gains. ( view less ) View Full Abstract View Article Details   Related Articles The effect of an integrated care approach for heart failure on general practice 2003 Pearl, A., Wright, S. P., Gamble, G. D., Muncaster, S., Walsh, H. J., Sharpe, N., and Doughty, R. N. Background. Recent studies have investigated specific strategies for heart failure management. None has involved collaboration between primary and secondary care. Potential gains for patients may result from collaborative strategies. Objective. To assess the effect of an integrated management appro... ( view more )ach for patients with heart failure on general practice. Methods. The study design was a cluster randomized controlled trial of integrated primary/secondary care compared with usual care for heart failure patients. The study took place at Auckland Hospital, New Zealand and involved 197 patients admitted with an episode of heart failure. Patients were randomized to management group or control group (who received 'usual' care). Management group patients received early clinical review, education sessions, a personal diary for medications and weight, and regular clinical follow-up alternating between GP and hospital clinic. Follow-up was for 12 months. Results. Patients visited GPs frequently (median 14 visits, range 0-40), with no statistical difference between the two groups. Heart failure was the most common reason for consulting the GP. There was no relationship between GP consultations and patients' attendance at the study clinic, or hospital admissions. Management group GPs and patients expressed a high level of satisfaction. Conclusion. GP consultation rates were not affected by the programme. Further research will determine if general practice based programmes result in further gains ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Bedside B-type natriuretic peptide and functional capacity in chronic heart failure 2003 Jourdain, P., Funck, F., Bellorini, M., Guillard, N., Loiret, J., Thebault, B., Desnos, M., and Duboc, D. Objectives: To determine if B-type natriuretic peptide (BNP) measurement could be useful in determination of functional capacity in patients suffering from chronic heart failure. Background: Evaluating functional capacity is a crucial factor in the follow-up of patients with chronic heart failure. ... ( view more )There are numerous methods for measuring functional capacity and their relative merits remain under discussion. Clinical classifications are very subjective and other methods are difficult to use in clinical practice. Methods: We evaluated functional capacity in 151 consecutive patients using the 6-min walk test. All patients were clinically classified using the New York Heart Association (NYHA) classification. We measured BNP plasma levels using a bedside BNP test. Results: Six minute walk test performance decreased through NYHA classes 1 to 4 (469 +/- 87, 411 +/- 82, 325+/-83 and 196+/-63 m, respectively, P<0.01) and BNP levels increased through NYHA classes 1 to 4 (26.3+/-7.2, 73+/-13, 401+/-74 and 924+/-84 pg/ml, respectively, P < 0.001). There was a significant correlation between 6-min walk test performance and BNP plasma levels (R = 0.69 P < 0.001) and a weaker correlation between BNP and left ventricular ejection fraction (R = 0.45 P < 0.04). In some patients there was a mismatch between NYHA classification and 6-min walk test performance. In all cases BNP could correct the clinical estimation of functional capacity. When we divided the patients into three sub-groups within each NYHA class, we showed that using BNP could better define functional capacity in patients suffering from chronic heart failure in NYHA classes I to III. Conclusion: The measurement of BNP levels thus usefully supplements the clinical examination. The existence of bedside BNP testing methods facilitates its use in routine clinical practice. It also permits easier follow-up of patients with chronic heart failure. (C) 2002 European Society of Cardiology. Published by Elsevier Science B.V. All rights reserved ( view less ) View Full Abstract View Article Details View Coded Data Related Articles The diagnosis of heart failure in general practice: implications for the UK National Service Framework 2003 Sparrow, N., Adlam, D., Cowley, A., and Hampton, J. R. BACKGROUND: The UK National Service Framework recommends patients with suspected heart failure undergo echocardiography. Selection of patients for this investigation in primary care is difficult. It is not clear which clinical features best identify patients with left ventricular systolic dysfuncti... ( view more )on. AIM: Using echocardiography, to establish the accuracy of primary care diagnosis of left ventricular systolic dysfunction. To investigate the sensitivity, specificity and predictive values of clinical features in the diagnosis of left ventricular systolic dysfunction. STUDY: A cross-sectional study of 621 patients from a population prescribed loop diuretics in 7 general practices. METHOD: Clinical diagnoses were extracted from general practice records. Symptoms, clinical signs, ECG features, brain natriuretic peptide levels and echocardiographic findings were studied in a research clinic. RESULTS: Left ventricular systolic dysfunction (ejection fraction <40%) was present in 50% of 621 patients prescribed loop diuretics in primary care. General practice diagnoses showed high false positive rates. Individual or combinations of clinical features did not accurately predict left ventricular systolic dysfunction. CONCLUSION: These results suggest the clinical diagnosis of left ventricular systolic dysfunction is inaccurate in this population. General practitioners should have a low threshold for referring patients prescribed loop diuretics for echocardiography. Increased open access echocardiography facilities will be needed ( view less ) View Full Abstract View Article Details   Related Articles Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom 3-5-1916 de, GiuliF, Khaw, K. T., Cowie, M. R., Sutton, G. C., Ferrari, R., and Poole-Wilson, P. A. BACKGROUND: There are few large population-based studies of the incidence and outcome of heart failure where the diagnosis of heart failure (HF) has been made by a General Practitioner (GP) in the community. METHODS: From the General Practice Research Database in the UK, we selected a population of... ( view more ) 686,884 people 45 years or older. Incident cases of HF in 1991 were classified definite HF, possible HF, or a first prescription of diuretics without a diagnosis of HF. The population was followed for 3-year mortality. RESULTS: A total of 6478 patients had definite HF (mean age 77.2 years, 55.5% women), 14,050 had possible HF and 6076 persons were prescribed diuretics without a definite or possible diagnosis of HF. The overall incidence of definite HF was 9.3/1000 persons/year and of possible HF 20.2/1000 persons/year. Diuretics were prescribed for the first time for other reasons for 8.7 persons/1000/year. The incidence of HF was higher in men. The incidence of definite HF increased with age. Survival curves showed higher mortality rates in the first 3 months after the diagnosis of HF. One-year cumulative probability of death for patients with definite HF was 15.9 times higher in men and 14.7 times higher in women in comparison with the UK population. CONCLUSION: The diagnosis of HF by a GP successfully identifies patients at high risk of death, comparable to patients with HF identified by cardiologists on the basis of defined diagnostic criteria. HF is common in the general population, increases sharply with age, and has a poor prognosis ( view less ) View Full Abstract View Article Details   Related Articles Specialist care of heart failure improves appropriate pharmacotherapy at the expense of greater polypharmacy and drug-interactions 2004 Ledwidge, M., Travers, B., Ryder, M., Ryan, E., and McDonald, K. Background: There is growing concern at the nature and extent of polypharmacy in heart failure (HF), which may be associated with increased drug interactions, adverse drug effects and a poor understanding of and compliance with therapy. Aims: This study evaluates polypharmacy in a relatively unsele... ( view more )cted community heart failure population following emergency admission and determines the impact of an in-hospital, specialist heart failure care programme on appropriate pharmacotherapy, polypharmacy and drug interactions. Methods: We analysed the medication profiles of 91 consecutive patients with an emergency admission for HF to our institution on admission and discharge. The numbers of inappropriate medicines, inappropriate dosages and omitted medicines according to guidelines were recorded. Medication profiles were analysed for potential drug-drug, drug-liver and drug-kidney interactions using standard criteria. Results: In the study population, average age 71.1+/-10.4 years, 65.9% were male, 68.1% had left ventricular systolic dysfunction and the average ejection fraction on transfer to the specialist HF service was 38+/-13%. A total of 66 inappropriate medicines, 107 omitted medicines and 37 inappropriate dosage regimens were identified in the cohort on admission. These figures had dropped to 31, 33 and 19, respectively, on discharge, with per patient averages decreasing significantly (all P<0.0001). However, polypharmacy and potential drug interactions increased by 33% and 62%, respectively, from admission to discharge (P<0.0001) as did drug-kidney interactions and drug-liver interactions. Only ischemic aetiology and hypercholesterolaemia predicted polypharmacy in this cohort on discharge, whereas age, sex, renal function and heart failure type did not. Conclusions: Specialist care of heart failure following emergency admission results in more appropriate pharmacotherapy of heart failure. However, increased polypharmacy and drug-interactions are an inevitable consequence independent of age, sex and renal function. We advocate a practice of systematic evaluation of polypharmacy in all heart failure patients to identify potential problems and modify therapy where appropriate. (C) 2003 European Society of Cardiology. Published by Elsevier B.V. All rights reserved ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Incidence and risk factors of asymptomatic first-dose hypotension with angiotensin-converting enzyme inhibitors in chronic heart failure due to systolic dysfunction 2003 Thanikachalam, S. and Manchanda, S. C. Background: In practice, chronic heart failure is often not treated with angiotensin-converting enzyme inhibitors. One reason is the fear of first-dose hypotension. In the majority of patients, this condition is asymptomatic and the consequences are unexpected. Presently, little is known of its epi... ( view more )demiology. Methods and Results: This was a prospective, 48-hour observational study of 160 patients with chronic heart failure due to systolic dysfunction, previously untreated with angiotensin-converting enzyme inhibitors, randomly drawn from the clinical practice of selected cardiologists across India. The primary outcome was a change in the mean arterial pressure during the first 24-hours after the first dose of an angiotensin-converting enzyme inhibitor. In 131/160 patients (81.9%) with no hypotensive symptoms, the incidence of first-dose hypotension (maximum 24-hour fall in mean arterial pressure greater than 10% from baseline) was 56/131 (42.7%). Pre-treatment diastolic pressure had a negative, independent association with 24-hour change in mean arterial, pressure, accounting for 29% (R2=0.29, p<0.01) of its variability, and its predictive value was greater with pro-drug angiotensin-converting enzyme inhibitors. The incidence of first-dose hypotension increased from 1 patient (4.8%) at a pre-treatment diastolic pressure of 50-70 mmHg to 35 patients (42.7%) at 71-90 mmHg, p<0.01. Conclusions: The incidence of first-dose hypotension with angiotensin-converting enzyme inhibitors in outpatients with chronic heart failure due to systolic dysfunction is high. Pre-treatment diastolic pressure is an independent risk factor, and its predictive value increases with pro-drug angiotensin-converting enzyme inhibitors. This could help physicians to anticipate asymptomatic first-dose hypotension and increase the utilization of these agents in heart failure ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Management of heart failure in the elderly 2002 Rich, M. W. The management of chronic heart failure in elderly patients is often complicated by the presence of multiple comorbid conditions, polypharmacy, psychosocial and financial concerns, and difficulties with adherence to complex medication and dietary regimens. In addition, few patients over 80 years of... ( view more ) age have been enrolled in clinical trials, so that the efficacy of current heart failure therapies remains uncertain in this age group. Taken together, these factors contribute to the persistently high hospitalization and mortality rates as well as the poor quality of life associated with chronic heart failure in the elderly. In this article, nonpharmacologic aspects of care and the pharmacotherapy of systolic heart failure in elderly patients are reviewed. Optimal management requires a systematic approach comprising 5 key elements: coordination of care across disciplines, patient and caregiver education, enhancement of self-management skills, effective followup, and the judicious use of medications. However, it must be recognized that even with 'best practice' interventions, the prognosis for established heart failure remains poor. Future research must therefore be directed at developing more effective strategies for the prevention of heart failure in our aging population ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Ambulatory heart failure management in private practice in France 2001 Komajda, M., Bouhour, J. B., Amouyel, P., Delahaye, F., Vicaut, E., Croce, I., Rougemond, E., Vuittenez, F., and Leutenegger, E. Management of ambulatory heart failure was assessed in a group of 600 patients, mean age 73, 64% males, NYHA I: 9%; II: 52%; III: 33%; IV: 6%; followed up by a representative sample of private cardiologists. Fifty-two percent of patients had been previously hospitalised for worsening heart failure ... ( view more )with a mean duration of stay of 13.1 days, for those hospitalised in the year preceding the survey (26%). First diagnosis of heart failure had been performed by a cardiologist (57%), a general practitioner (37%) or another category of physician (6%). Seventy percent of patients received three or more different classes of heart failure medications. Diuretics were prescribed to 71%, angiotensin converting enzyme inhibitors to 54% and digitalis to 35% of the population. Beta-blockers were given to only 14% of the patients. In patients aged over 80 years, only 45% received angiotensin converting enzyme inhibitors. CONCLUSION: This survey of ambulatory heart failure patients confirms that the disease is predominantly observed in elderly patients, and associated with prolonged and recurrent hospitalisations. The underuse of recommended therapeutic classes including angiotensin converting enzyme inhibitors and beta-blockers deserves further investigation ( view less ) View Full Abstract View Article Details   Related Articles Page 1 of 1000 1 2 3 4 > Last >> (25000 articles found)

      
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