摘要:

As the final common pathway in many forms of cardiovascular disease, heart failure is a major public health problem in the United States. It is the only cardiovascular condition that is increasing in incidence, prevalence, and mortality. The economic impact of heart failure is staggering and is likely to escalate as increasing numbers of people are saved from premature death attributable to coronary heart disease. This article reviews the incidence, prevalence, prognosis, risk factors, and economic impact of this common and usually lethal condition.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The physiologic changes that accompany heart failure are complex and evolve over time. Adaptations to an initial insult include both central (myocardial) and peripheral mechanisms that attempt to maintain adequate cardiac output at rest, as well as during increased metabolic demands such as exercise. Physiologic models provide insight into these complex changes and are necessary to design and evaluate the efficacy of pharmacologic and nonpharmacologic interventions. Recent advances in ventricular remodeling and changes in myocardial adrenergic receptors are presented as are alterations in vasodilatory response, skeletal muscle structure, function, and metabolism.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Heart failure is a common clinical syndrome in which left ventricular dysfunction results in vasoconstriction, volume overload, activity intolerance, reduced quality of life, and high mortality. Recognition of the role of neurohormonal activation in the progression of heart failure has led to more effective treatment. Integral to optimal treatment of heart failure is maximization of both pharmacologic and nonpharmacologic therapy. This article presents information important to maximizing both types of therapy in the advanced heart failure patient. The importance of effective patient and family education is emphasized.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Chronic heart failure represents a significant challenge to caregivers because these patients are fragile, care is complex, and the numbers of patients are increasing dramatically. The anticipated illness trajectory is also rapidly changing due to the advent of pharmacologic interventions that offer greatly improved outcomes and quality of life for these patients. Despite such advances, mortality and morbidity remain high. Therefore, an important goal is to develop and evaluate nonpharmacologic interventions as adjuvant therapy to the traditional pharmacologic approach. Although relatively few studies have examined nonpharmacologic treatment strategies, it appears that many patients with heart failure may benefit significantly from participation in long-term aerobic exercise conditioning programs. Psychological and biobehavioral interventions also have the potential to substantially enhance treatment outcomes and quality of life for patients with chronic heart failure. This article reviews the available literature about nonpharmacologic strategies in the treatment of heart failure along with specific recommendations for practice.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Heart transplantation is an accepted therapeutic alternative for patients with end-stage heart failure. The most common diagnoses of patients who require heart transplantation are ischemic and nonischemic cardiomyopathy. Evaluation for heart transplantation involves an examination of the patient's heart disease including left ventricle ejection fraction, hemodynamic status, presence of ventricular ectopy, New York Heart Association functional class, symptoms, exercise tolerance, and sympathetic nervous system activation. In addition, absolute and relative contraindications must be identified to determine their influence on a patient's candidacy. Care must be taken to determine the best use of a donor heart, a scarce resource, with regard to posttransplant morbidity, mortality, and quality of life.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Despite an increased incidence of congestive heart failure and frequency of hospital admissions for the Medicare population, there is little information available on improving outcomes for these patients. As changes in health care lead toward capitation, efficient care with limited use of expensive inpatient hospital resources is a necessity. The coordination of three critical components— inpatient, outpatient, and home care—can lead to positive outcomes in terms of functional capacity changes, length of stay, readmission rates, patient self-care knowledge, and patient satisfaction.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The Agency for Health Care Policy and Research (AHCPR) and Rand Corporation convened a panel of experts to review published studies on care of the patient with heart failure. The outcome was the Clinical Practice Guideline for the evaluation and care of patients with left ventricular systolic dysfunction, published in June 1994. This article reviews key points in the clinical practice guideline and summarizes important areas for future research to improve patient outcomes.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The Agency for Health Care Policy and Research Clinical Practice Guideline on heart failure recommends that providers assess patients' health-related quality of life (HRQOL) and recommends using HRQOL information to modify treatment and guide patient and family teaching to facilitate adaptation to heart failure. This research column reviews eight studies that measured HRQOL as an outcome for patients with medically managed heart failure.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID