BACKGROUND Administrative data show that acute heart failure(HF)patients are older than those enrolled in clinical registries and frequently admitted to non-cardiological settings of care.The purpose of this study was...BACKGROUND Administrative data show that acute heart failure(HF)patients are older than those enrolled in clinical registries and frequently admitted to non-cardiological settings of care.The purpose of this study was to describe clinical characteristics of old patients hospitalised for acute HF in Cardiology,Internal Medicine or Geriatrics wards.METHODS Data came from ATHENA(AcuTe Heart failurE in advaNced Age)registry which included elderly patients(≥65 years)admitted to the above mentioned settings of care from December 1,2014 to December 1,2015.RESULTS We enrolled 396 patients,15.4%assigned to Cardiology,69.7%to Internal Medicine,and 14.9%to a Geriatrics ward.Mean age was 83.5±7.6 years(51.8%of patients≥85 years)and was higher in patients admitted to Geriatrics(P<0.001);more than half were females.Medical treatments did not differ significantly among settings of care(in a context of a low prescription rate of renin-angiotensin-aldosterone system inhibitors)whereas significant differences were observed in comorbidity patterns and management guidelines recommendation adherence for decongestion evaluation with comparison of weight and N-terminal pro-B-type natriuretic peptide levels on admission and at discharge(both P=0.035 and P<0.001),echocardiographic evaluation(P<0.001)and follow-up visits planning(P<0.001),all higher in Cardiology.Mean in-hospital length of stay was 9±5.9 days,significantly higher in Geriatrics(13.7±6.5 days)and Cardiology(9.9±6.7 days)compared to Internal Medicine(8±5.2 days),P<0.001.In-hospital mortality was 9.3%,resulting higher in Geriatrics(18.6%)and Cardiology(16.4%)than Internal Medicine(5.8%),P=0.001.CONCLUSIONS In elderly patients hospitalised for acute HF,clinical characteristics and management differ significantly according to the setting of admission.展开更多
Many patients with congestive heart failure (CHF) fail to respond to maximal CHF therapy and progress to end stage CHF with many hospitalizations, very poor quality of life, end stage renal failure, or die of cardiova...Many patients with congestive heart failure (CHF) fail to respond to maximal CHF therapy and progress to end stage CHF with many hospitalizations, very poor quality of life, end stage renal failure, or die of cardiovascular complications within a short time. One factor that has generally been ignored in many of these patients is the fact that they are often anemic. The anemia is due mainly to renal failure but also to the inhibitory effects of cytokines on the bone marrow. Anemia itself may further worsen the cardiac function and make the patients resistant to standard CHF therapies. Indeed anemia has been associated with increased severity of CHF, increased hospitalization, worse cardiac function and functional class, higher doses of diuretics, worsening of renal function and reduced quality of life. In both controlled and uncontrolled studies the correction of the anemia with erythropoietin (EPO) and oral or IV iron is associated with improvement in all these parameters. EPO itself may also play a direct role in improving the heart unrelated to the improvement of the anemia. Anemia may also play a role in the worsening of coronary heart disease even without CHF.展开更多
Increasing observational and experimental trial data have shownthat mental stress can lead toan increase in adverse clinical cardiovascular events.Mental stress affects the heart by inducing ischaemia and precipitatin...Increasing observational and experimental trial data have shownthat mental stress can lead toan increase in adverse clinical cardiovascular events.Mental stress affects the heart by inducing ischaemia and precipitating myocardial infarction(MI)or direct myocardial injury.Mental stress leads to systemic inflammation.Inflammation is known to cause rapid atheromatous plaque progression,instability and thrombosis—the classic type 1 MI.Inflammation can also lead to type 2 MI or myocarditis and injury.The published data linking systemic inflammation,mental stress and cardiovascular disease will be reviewed to establish the linkage between mind and heart,thereby highlighting the importance of holistically managing the patient,not only addressing separate organ systems.Finally,recent trial evidence showing the value of anti-inflammatory drugs in cardiovascular and mental conditions will be briefly considered.展开更多
During the last years, several pharmacological treatments have significantly improved outcome of patients with heart failure with reduced ejection fraction(HFr EF) particularly by inhibiting the renin–angiotensin–al...During the last years, several pharmacological treatments have significantly improved outcome of patients with heart failure with reduced ejection fraction(HFr EF) particularly by inhibiting the renin–angiotensin–aldosterone system(RAAS) and by blocking the sympathetic system.[1,2] More recently, it was demonstrated that a further positive neurohormonal modulation of RAAS and of the natriuretic peptides pathway with Sacubitril/Valsartan(Sa/Va).展开更多
Background: Our objective was to determine the assessment of cardiovascular risk by family physicians. Methods: A questionnaire was sent by mail or fax regarding both awareness and use of the various CV risk scores in...Background: Our objective was to determine the assessment of cardiovascular risk by family physicians. Methods: A questionnaire was sent by mail or fax regarding both awareness and use of the various CV risk scores in southeastern Ontario. Results: Of 181 family physicians surveyed, 96% were aware of at least one CV risk score and 40% were aware of the JUPITER study. Despite this awareness, 72% simply counted risk factors to assess risk, rather than to calculate risk using established scoring methods. Only 23% used the JUPITER study criteria. This suggests an under-estimated of overall CV risk by family physician’s practicing in southeastern Ontario. Interpetation: Cardiovascular risk in primary care is being underestimated in southeastern Ontario. Additional knowledge translation strategies are required to enhance the family physician’s awareness and use of established risk scoring methods if we are to reduce the burden of CV disease.展开更多
Background: Cardiac pain arising from acute coronary syndrome (ACS) is a multi-factorial phenomenon. Historically, episodes of cardiac pain have been captured using a one-dimensional numeric pain rating scale. Lacking...Background: Cardiac pain arising from acute coronary syndrome (ACS) is a multi-factorial phenomenon. Historically, episodes of cardiac pain have been captured using a one-dimensional numeric pain rating scale. Lacking in clinical practice are acute pain assessments that employ a comprehensive evaluation of an emergent ACS episode. Aim: To examine the sensory-discriminative, motivational-affective and cognitive-evaluative dimensions of ACS-related pain. Methods: A descriptive-correlational, repeated-measure design was used to collect data on 121 ACS patients of their cardiac pain intensity. The (numeric rating scale-NRS 0-10 scale) measured chest pain “Now” and “Worst pain in the previous 2 hours over 8 hours” and the McGill Pain Questionnaire Short-Form (MPQ-SF) measured pain at 4 hours. Results: Mean age was 67.6 ± 13, 50% were male, 60% had unstable angina and 40% had Non-ST-elevation myocardial infarction. Cardiac pain intensity scores remained in the mild range from 1.1 ± 2.2 to 2.4 ± 2.7. MPQ-SF: 66% described pain as distressing and 26% reported pain was horrible or excruciating. Participants described ACS pain quality as acute injury (nociceptive pain: heavy, cramping, stabbing), as nerve damage (neuropathic: gnawing, hot-burning, shooting) and as a mixture of acute and chronic pain qualities (aching, tender and throbbing). Conclusions: Patients reported both nociceptive and neuropathic cardiac pain. It is unclear if pain perceptions are due to: i) pathophysiology of clot formation, ii) occurrence of a first or repeated ACS episode, or iii) complex co-morbidities. Pain arising from ACS requires an understanding of the interplay of ischemic, metabolic and neuropathophysiological mechanisms that contribute to complex cardiac pain experiences.展开更多
文摘BACKGROUND Administrative data show that acute heart failure(HF)patients are older than those enrolled in clinical registries and frequently admitted to non-cardiological settings of care.The purpose of this study was to describe clinical characteristics of old patients hospitalised for acute HF in Cardiology,Internal Medicine or Geriatrics wards.METHODS Data came from ATHENA(AcuTe Heart failurE in advaNced Age)registry which included elderly patients(≥65 years)admitted to the above mentioned settings of care from December 1,2014 to December 1,2015.RESULTS We enrolled 396 patients,15.4%assigned to Cardiology,69.7%to Internal Medicine,and 14.9%to a Geriatrics ward.Mean age was 83.5±7.6 years(51.8%of patients≥85 years)and was higher in patients admitted to Geriatrics(P<0.001);more than half were females.Medical treatments did not differ significantly among settings of care(in a context of a low prescription rate of renin-angiotensin-aldosterone system inhibitors)whereas significant differences were observed in comorbidity patterns and management guidelines recommendation adherence for decongestion evaluation with comparison of weight and N-terminal pro-B-type natriuretic peptide levels on admission and at discharge(both P=0.035 and P<0.001),echocardiographic evaluation(P<0.001)and follow-up visits planning(P<0.001),all higher in Cardiology.Mean in-hospital length of stay was 9±5.9 days,significantly higher in Geriatrics(13.7±6.5 days)and Cardiology(9.9±6.7 days)compared to Internal Medicine(8±5.2 days),P<0.001.In-hospital mortality was 9.3%,resulting higher in Geriatrics(18.6%)and Cardiology(16.4%)than Internal Medicine(5.8%),P=0.001.CONCLUSIONS In elderly patients hospitalised for acute HF,clinical characteristics and management differ significantly according to the setting of admission.
文摘Many patients with congestive heart failure (CHF) fail to respond to maximal CHF therapy and progress to end stage CHF with many hospitalizations, very poor quality of life, end stage renal failure, or die of cardiovascular complications within a short time. One factor that has generally been ignored in many of these patients is the fact that they are often anemic. The anemia is due mainly to renal failure but also to the inhibitory effects of cytokines on the bone marrow. Anemia itself may further worsen the cardiac function and make the patients resistant to standard CHF therapies. Indeed anemia has been associated with increased severity of CHF, increased hospitalization, worse cardiac function and functional class, higher doses of diuretics, worsening of renal function and reduced quality of life. In both controlled and uncontrolled studies the correction of the anemia with erythropoietin (EPO) and oral or IV iron is associated with improvement in all these parameters. EPO itself may also play a direct role in improving the heart unrelated to the improvement of the anemia. Anemia may also play a role in the worsening of coronary heart disease even without CHF.
文摘Increasing observational and experimental trial data have shownthat mental stress can lead toan increase in adverse clinical cardiovascular events.Mental stress affects the heart by inducing ischaemia and precipitating myocardial infarction(MI)or direct myocardial injury.Mental stress leads to systemic inflammation.Inflammation is known to cause rapid atheromatous plaque progression,instability and thrombosis—the classic type 1 MI.Inflammation can also lead to type 2 MI or myocarditis and injury.The published data linking systemic inflammation,mental stress and cardiovascular disease will be reviewed to establish the linkage between mind and heart,thereby highlighting the importance of holistically managing the patient,not only addressing separate organ systems.Finally,recent trial evidence showing the value of anti-inflammatory drugs in cardiovascular and mental conditions will be briefly considered.
文摘During the last years, several pharmacological treatments have significantly improved outcome of patients with heart failure with reduced ejection fraction(HFr EF) particularly by inhibiting the renin–angiotensin–aldosterone system(RAAS) and by blocking the sympathetic system.[1,2] More recently, it was demonstrated that a further positive neurohormonal modulation of RAAS and of the natriuretic peptides pathway with Sacubitril/Valsartan(Sa/Va).
文摘Background: Our objective was to determine the assessment of cardiovascular risk by family physicians. Methods: A questionnaire was sent by mail or fax regarding both awareness and use of the various CV risk scores in southeastern Ontario. Results: Of 181 family physicians surveyed, 96% were aware of at least one CV risk score and 40% were aware of the JUPITER study. Despite this awareness, 72% simply counted risk factors to assess risk, rather than to calculate risk using established scoring methods. Only 23% used the JUPITER study criteria. This suggests an under-estimated of overall CV risk by family physician’s practicing in southeastern Ontario. Interpetation: Cardiovascular risk in primary care is being underestimated in southeastern Ontario. Additional knowledge translation strategies are required to enhance the family physician’s awareness and use of established risk scoring methods if we are to reduce the burden of CV disease.
文摘Background: Cardiac pain arising from acute coronary syndrome (ACS) is a multi-factorial phenomenon. Historically, episodes of cardiac pain have been captured using a one-dimensional numeric pain rating scale. Lacking in clinical practice are acute pain assessments that employ a comprehensive evaluation of an emergent ACS episode. Aim: To examine the sensory-discriminative, motivational-affective and cognitive-evaluative dimensions of ACS-related pain. Methods: A descriptive-correlational, repeated-measure design was used to collect data on 121 ACS patients of their cardiac pain intensity. The (numeric rating scale-NRS 0-10 scale) measured chest pain “Now” and “Worst pain in the previous 2 hours over 8 hours” and the McGill Pain Questionnaire Short-Form (MPQ-SF) measured pain at 4 hours. Results: Mean age was 67.6 ± 13, 50% were male, 60% had unstable angina and 40% had Non-ST-elevation myocardial infarction. Cardiac pain intensity scores remained in the mild range from 1.1 ± 2.2 to 2.4 ± 2.7. MPQ-SF: 66% described pain as distressing and 26% reported pain was horrible or excruciating. Participants described ACS pain quality as acute injury (nociceptive pain: heavy, cramping, stabbing), as nerve damage (neuropathic: gnawing, hot-burning, shooting) and as a mixture of acute and chronic pain qualities (aching, tender and throbbing). Conclusions: Patients reported both nociceptive and neuropathic cardiac pain. It is unclear if pain perceptions are due to: i) pathophysiology of clot formation, ii) occurrence of a first or repeated ACS episode, or iii) complex co-morbidities. Pain arising from ACS requires an understanding of the interplay of ischemic, metabolic and neuropathophysiological mechanisms that contribute to complex cardiac pain experiences.
