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1.
Arq. bras. cardiol ; 118(3): 599-604, mar. 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364357

ABSTRACT

Resumo Fundamento A evolução natural da insuficiência cardíaca é uma pior progressiva e internações hospitalares recorrentes. São necessárias estratégias para se detectar descompensações em tempo hábil. O uso do telemonitoramento da insuficiência cardíaca é inconsistente. Objetivos Este estudo tem o objetivo de avaliar o impacto desse programa de telemonitoramento (PTM) em internações hospitalares e admissões em serviços de emergência. Métodos Este é um estudo retrospectivo observacional que analisou dados de todos os pacientes que se cadastraram no PTM de janeiro a 2018 a dezembro de 2019. Foram coletados dados demográficos, clínicos e relacionados ao PTM. O número de internações hospitalares e admissões em serviços de emergência do ano anterior e posterior ao cadastro foram comparados, utilizando-se o teste de Wilcoxon. Um p-valor bilateral de <0,05 foi considerado significativo. Resultados Um total de 39 pacientes foram cadastrados, com uma média de idade de 62,1 ± 14 anos e predominância de pacientes do sexo masculino (90%). As causas mais comuns de insuficiência cardíaca foram cardiomiopatia isquêmica e dilatada. A fração de ejeção média foi de 30% e o tempo mediano da duração da doença foi de 84 meses (FIQ 33-144). Pacientes que foram cadastrados por menos de um mês foram excluídos, com um total de 34 pacientes analisados. Os pacientes foram acompanhados no PTM por um período mediano de 320 dias. O número de admissões em serviços de emergência foi reduzido em 66% (p<0,001) e o número de internações hospitalares por insuficiência cardíaca foi reduzido em 68% (p<0,001). O PTM não teve impacto no número de internações hospitalares por outras causas. Conclusões Este estudo sugere que o PTM poderia reduzir a utilização de serviços de saúde em pacientes com insuficiência cardíaca.


Abstract Background The natural history of heart failure is a progressive decline and recurrent hospital admissions. New strategies to timely detect decompensations are needed. The use of telemonitoring in heart failure is inconsistent. Objectives This study aimed to evaluate the impact of this telemonitoring program (TMP) in hospitalizations and emergency department admissions. Methods This is a retrospective observational study, that analyzed data of all the patients who enrolled in the TMP program from January 2018 to December 2019. Demographic, clinical, and TMP-related data were collected. The number of hospitalizations and emergency department admissions from the year before and after enrollment were compared, using the Wilcoxon test. A two-sided p<0.05 was considered significant. Results A total of 39 patients were enrolled, with a mean age of 62.1 ± 14 years and a male predominance (90%). The most common causes of heart failure were ischemic and dilated cardiomyopathy. The mean ejection fraction was 30% and the median time of disease duration was 84 months (IQR 33-144). Patients who were enrolled for less than one month were excluded, with a total of 34 patients analyzed. Patients were followed in the TMP for a median of 320 days. The number of emergency department admissions was reduced by 66% (p<0.001), and the number of hospitalizations for heart failure was reduced by 68% (p<0.001). The TMP had no impact on the number of hospitalizations for other causes. Conclusions This trial suggests that a TMP could reduce health service use in patients with heart failure.


Subject(s)
Humans , Male , Aged , Telemedicine , Heart Failure/diagnosis , Heart Failure/therapy , Retrospective Studies , Hospitalization , Middle Aged
2.
Arq. bras. cardiol ; 118(3): 646-654, mar. 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364346

ABSTRACT

Resumo A deficiência de ferro (DF) ou ferropenia é uma importante comorbidade na insuficiência cardíaca com fração de ejeção reduzida (ICFER) estável, e muito prevalente tanto nos anêmicos como não anêmicos. A ferropenia na ICFER deve ser pesquisada por meio da coleta de saturação de transferrina e ferritina. Há dois tipos de ferropenia na IC: absoluta, em que as reservas de ferro estão depletadas; e funcional, onde o suprimento de ferro é inadequado apesar das reservas normais. A ferropenia está associada com pior classe funcional e maior risco de morte em pacientes com ICFER, e evidências científicas apontam melhora de sintomas e de qualidade de vida desses pacientes com tratamento com ferro parenteral na forma de carboximaltose férrica. O ferro exerce funções imprescindíveis como o transporte (hemoglobina) e armazenamento (mioglobina) de oxigênio, além de ser fundamental para o funcionamento das mitocôndrias, constituídas de proteínas à base de ferro, e local de geração de energia na cadeia respiratória pelo metabolismo oxidativo. A geração insuficiente e utilização anormal de ferro nas células musculares esquelética e cardíaca contribuem para a fisiopatologia da IC. A presente revisão tem o objetivo de aprofundar o conhecimento a respeito da fisiopatologia da ferropenia na ICFER, abordar as ferramentas disponíveis para o diagnóstico e discutir sobre a evidência científica existente de reposição de ferro.


Abstract Iron deficiency (ID) is an important comorbidity in heart failure with reduced ejection (HFrEF) and is highly prevalent in both anemic and non-anemic patients. In HFrEF, iron deficiency should be investigated by measurements of transferrin saturation and ferritin. There are two types of ID: absolute deficiency, with depletion of iron stores; and functional ID, where iron supply is not sufficient despite normal stores. ID is associated with worse functional class and higher risk of death in patients with HFrEF, and scientific evidence has indicated improvement of symptoms and quality of life of these patients with treatment with parenteral iron in the form of ferric carboxymaltose. Iron plays vital roles such as oxygen transportation (hemoglobin) and storage (myoblogin), and is crucial for adequate functioning of mitochondria, which are composed of iron-based proteins and the place of energy generation by oxidative metabolism at the electron transport chain. An insufficient generation and abnormal uptake of iron by skeletal and cardiac muscle cells contribute to the pathophysiology of HF. The present review aims to increase the knowledge of the pathophysiology of ID in HFrEF, and to address available tools for its diagnosis and current scientific evidence on iron replacement therapy.


Subject(s)
Humans , Iron Deficiency , Anemia, Iron-Deficiency/complications , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/therapy , Heart Failure/complications , Heart Failure/diagnosis , Heart Failure/therapy , Quality of Life , Stroke Volume , Ferritins
3.
In. Manzanares Castro, William; Aramendi Epstein, Ignacio; Pico, José Luis do. Disionías en el paciente grave: historias clínicas comentadas. Montevideo, Cuadrado, 2021. p.407-433, tab.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1344749
4.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 1684-1691, jan.-dez. 2021.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1344162

ABSTRACT

Objetivo: Identificar as evidências acerca das orientações que devem ser oferecidas à pessoa com Insuficiência Cardíaca para a continuidade do tratamento. Método: Revisão integrativa, com busca nas bases de dados Lilacs, Pubmed, Cinahl, Web of Science e Scopus. Resultados: Dos 5422 títulos identificados, 31 artigos foram incluídos para análise. Apreendeu-se que os estudos abordaram, dentre outros aspectos, a importância da orientação da doença, dos sinais e sintomas e da detecção da agudização; no entanto, constatou-se a dificuldade na utilização de linguagem adequada para facilitar a compreensão pela pessoa e/ou pelos familiares. Conclusão: Sugere-se que mais estudos sejam realizados a respeito desse tema, a fim de possibilitar aos profissionais de saúde a formulação de um plano de cuidados coerente, com fundamentação nas melhores evidências científicas


Objective: to identify the evidence on the guidance that should be offered to people with heart failure to continue treatment. Method:integrative review, searching the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), National Library of Medicine (PUBMED/MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science e Scopus. Results: of the 5422 titles identified, 32 articles were included for analysis. It was understood that the studies addressed, among other aspects, the importance of disease orientation, signs and symptoms, and acute detection; however, it was found that it was difficult to use adequate language to facilitate understanding by the person and/or family members. Conclusion: it is suggested that more studies be conducted on this topic, in order to enable health professionals to formulate a coherent care plan, based on the best scientific evidence


Objetivo: identificar la evidencia sobre las pautas que deberían ofrecerse a las personas con insuficiencia cardíaca para continuar el tratamiento. Método: revisión integrativa, búsqueda en las bases de datos Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), National Library of Medicine (PUBMED/MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science e Scopus.Resultados: de los 5422 títulos identificados, se incluyeron 32 artículos para su análisis. Se entendió que los estudios abordaron, entre otros aspectos, la importancia de la orientación de la enfermedad, los signos y síntomas, y la detección aguda; sin embargo, se descubrió que era difícil usar un lenguaje adecuada para facilitar la comprensión por parte de la persona y/o miembros de la familia. Conclusión: Se sugiere que se realicen más estudios sobre este tema, a fin de permitir a los profesionales de la salud formular un plan de atención coherente, basado en la mejor evidencia científica


Subject(s)
Humans , Male , Female , Patient Discharge/trends , Continuity of Patient Care/trends , Heart Failure/therapy , Health Education , Transitional Care/trends
5.
Rev. latinoam. enferm. (Online) ; 29: e3389, 2021. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1289777

ABSTRACT

Objective: to evaluate in the literature the effectiveness of the health education interventions in self-care and adherence to treatment of patients with Chronic Heart Failure. Method: a systematic review with meta-analysis. Studies were selected that compared health education interventions with the usual care to assess the outcomes of adherence and self-care. The quality of the methodological evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation system. Results: the educational interventions were more effective in relation to the usual care in the outcome of adherence (fixed effect=0-3841; p-value <0.001). There was no statistical difference in the outcome of self-care (fixed effect=0.0063; p-value=0.898). Conclusion: the educational interventions improved the outcome of adherence, though not self-care in the patient with Heart Failure.


Objetivo: avaliar na literatura a efetividade das intervenções de educação em saúde na adesão e autocuidado ao tratamento de pacientes com Insuficiência Cardíaca Crônica. Método: revisão sistemática com metanálise. Foram selecionados estudos que comparavam intervenções de educação em saúde com o cuidado usual para avaliar os desfechos de adesão e autocuidado. A qualidade da evidência metodológica foi avaliada pelo sistema Grading of Recommendations, Assessment, Development and Evaluation. Resultados: as intervenções educativas foram mais efetivas em relação ao cuidado usual no desfecho de adesão (efeito fixo =0,3841; p-valor <0,001). Não houve diferença estatística no desfecho de autocuidado (efeito fixo =0,0063; p-valor =0,898). Conclusão: as intervenções educativas melhoraram o desfecho de adesão, mas não o de autocuidado no paciente com Insuficiência Cardíaca.


Objetivo: evaluar en la literatura la efectividad de las intervenciones de educación en salud para la adhesión al tratamiento y el autocuidado de pacientes con Insuficiencia Cardíaca Crónica. Método: revisión sistemática con meta-análisis. Se seleccionaron estudios que comparaban intervenciones de educación en salud con el cuidado habitual para evaluar los resultados de adhesión al tratamiento y autocuidado. La calidad de la evidencia metodológica se evaluó con el sistema Grading of Recommendations, Assesment, Development and Evaluation. Resultados: las intervenciones educativas fueron más efectivas en relación al cuidado habitual en el resultado de adhesión al tratamiento (efecto fijo=0,3841; valor p <0,001). No se registró diferencia estadística en el resultado de autocuidado (efecto fijo=0,0063; valor p =0,898). Conclusión: las intervenciones educativas mejoraron el resultado de adhesión al tratamiento, aunque no el de autocuidado en el paciente con Insuficiencia Cardíaca.


Subject(s)
Humans , Self Care , Health Education , Chronic Disease , Medication Adherence , Heart Failure/therapy
6.
Rev. latinoam. enferm. (Online) ; 29: e3440, 2021. tab
Article in English | LILACS, BDENF | ID: biblio-1289767

ABSTRACT

Objective: to analyze the evolution of self-care in hospitalized patients with decompensated heart failure, between the first return after hospital discharge (T0) and three months after this assessment (T1). Method: an observational, analytical and longitudinal study carried out in the cardiology outpatient clinics of two public hospitals in Ribeirão Preto, São Paulo. The sociodemographic and clinical data were collected through interviews and consultation of medical records. Self-care was assessed using the Brazilian version of the Self-Care of Heart Failure Index-SCHFI instrument. The data were analyzed by means of the Student's t test and paired distribution (McNemar) with a significance level of 0.05. Results: we verified an increase in the mean scores of the three subscales of SCHFI (Maintenance, Management and Confidence), when comparing the values of T0 and T1, these differences being statistically significant (p<0.001). When comparing the positive changes in self-care actions over these months, we found statistically significant changes in the Maintenance (6 out of 10 items), Management (5 out of 6 items) and Confidence (4 out of 6 items) subscales. Conclusion: self-care for heart failure improved in the period between the first return after discharge and the end of three months of follow-up. Further studies are needed to verify the variables associated with improved self-care after hospitalization.


Objetivo: analisar a evolução do autocuidado de pacientes internados com insuficiência cardíaca descompensada, entre o primeiro retorno após alta hospitalar (T0) e três meses após essa avaliação (T1). Método: estudo observacional, analítico e longitudinal realizado nos ambulatórios de cardiologia de dois hospitais públicos de Ribeirão Preto, São Paulo. Os dados sociodemográficos e clínicos foram coletados por entrevistas e consulta aos prontuários. O autocuidado foi avaliado pela versão brasileira do instrumento Self-Care of Heart Failure Index-SCHFI. Os dados foram analisados pelos testes de t de Student e distribuição pareada (McNemar) com nível de significância de 0,05. Resultados: constatamos aumento nas médias dos escores das três subescalas do SCHFI (Manutenção, Manejo e Confiança), quando comparados os valores de T0 e T1, sendo essas diferenças estatisticamente significantes (p<0,001). Ao compararmos as mudanças positivas nas ações de autocuidado ao longo desses meses, encontramos mudanças estatisticamente significantes nas subescalas Manutenção (6 dos 10 itens), Manejo (5 de 6 itens) e Confiança (4 de 6 itens). Conclusão: o autocuidado da insuficiência cardíaca melhorou no período entre o primeiro retorno após a alta e o final de três meses de acompanhamento. Outros estudos são necessários para verificar as variáveis associadas à melhora do autocuidado após a internação.


Objetivo: analizar la evolución del autocuidado en pacientes hospitalizados con insuficiencia cardíaca descompensada, entre el primer retorno tras el alta hospitalaria (T0) y tres meses después de esa evaluación (T1). Método: estudio observacional, analítico y longitudinal realizado en las consultas externas de cardiología de dos hospitales públicos de Ribeirão Preto, São Paulo. Se recogieron datos sociodemográficos y clínicos mediante entrevistas y consulta de historias clínicas. El autocuidado se evaluó mediante la versión brasileña del instrumento Self-Care of Heart Failure Index-SCHFI. Los datos se analizaron mediante la prueba t de Student y distribución pareada (McNemar) con un nivel de significancia de 0,05. Resultados: encontramos un aumento en las puntuaciones medias de las tres subescalas del SCHFI (Mantenimiento, Gestión y Confianza), al comparar los valores de T0 y T1, siendo estas diferencias estadísticamente significativas (p <0,001). Al comparar los cambios positivos en las acciones de autocuidado durante estos meses, encontramos cambios estadísticamente significativos en las subescalas Mantenimiento (6 de 10 ítems), Gestión (5 de 6 ítems) y Confianza (4 de 6 ítems). Conclusión: el autocuidado de la insuficiencia cardíaca mejoró en el período comprendido entre el primer retorno tras el alta y el último a los tres meses de seguimiento. Se necesitan más estudios para verificar las variables asociadas con la mejora del autocuidado después de la hospitalización.


Subject(s)
Humans , Outpatients , Patient Discharge , Self Care , Brazil , Longitudinal Studies , Heart Failure/therapy , Hospitals
7.
Clinics ; 76: e1991, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153946

ABSTRACT

OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.


Subject(s)
Humans , Disease Management , Heart Failure/therapy , Brazil , Cross-Sectional Studies , Surveys and Questionnaires
8.
Clinics ; 76: 2550, 2021. graf, tab
Article in English | SES-SP, LILACS, SES-SP, CONASS, SESSP-IDPCPROD, SES-SP | ID: biblio-1278931

ABSTRACT

OBJECTIVES: We aimed to compare the effects of home-and center-based exercise training programs on functional capacity, inspiratory muscle strength, daily physical activity level, and quality of life (QoL) in patients with chronic heart failure (CHF) over a 12-week period. METHODS: This study included 23 patients with CHF (left ventricular ejection fraction 31±6%) randomized to a home-based (n=11) or center-based (n=12) program. Patients underwent 12 weeks of aerobic training (60%-70% heart rate reserve): walking for the home-based and supervised cycling for the center-based group, both combined with resistance training (50% of 1 maximum repetition). At baseline and after 12 weeks of training, we assessed cardiopulmonary test variables, 6-min walk test distance (6 MWD), steps/day with accelerometry, and QoL (Minnesota Living with Heart Failure questionnaire). Maximal inspiratory pressure and handgrip strength were measured at baseline and after 4, 8, and 12 weeks of training. ClinicalTrials.gov: NCT03615157. RESULTS: There were no adverse events during training in either group. The home- and center-based training groups obtained similar improvements in peak oxygen uptake, maximal ventilation, and 6 MWD. However, there were significant between-group differences: center-based training was more effective in improving maximal inspiratory pressure (p=0.042), number of steps/day (p=0.001), and QoL (p=0.039). CONCLUSIONS: Home-based training is safe and can be an alternative to improve the exercise capacity of patients with stable CHF. However, center-based training was superior in improving inspiratory muscle strength, QoL, and daily physical activity.


Subject(s)
Humans , Quality of Life , Heart Failure/therapy , Stroke Volume , Pilot Projects , Ventricular Function, Left , Exercise Tolerance , Hand Strength , Exercise Therapy
9.
Chinese Acupuncture & Moxibustion ; (12): 1029-1035, 2021.
Article in Chinese | WPRIM | ID: wpr-921004

ABSTRACT

OBJECTIVE@#To investigate the mechanism of electroacupuncture (EA) with the involvement of sarcoplasmic reticulum Ca@*METHODS@#Thirty SPF-ranked SD rats were randomly divided into a control group, a model group, an EA group, an aconitine group and an EA plus aconitine group, with 6 rats in each group. The rat model of acute heart failure was established by infusion of high-dose propranolol hydrochloride solution into the right femoral vein. After stabilized for 10 min in the modeled rats, EA was exerted at "Neiguan" (PC 6), with disperse-dense wave, 2 Hz/15 Hz in frequency, 3 mA in intensity, for 30 min in the EA group and the EA plus aconitine group; aconitine solution (10 μg/kg) was injected from the left femoral veins in the rats in the aconitine group and the EA plus aconitine group. Hemodynamic indexes such as the left ventricular systolic pressure (LVSP) and the maximum rate of increase/decrease of left ventricular pressure (±dp/dt@*RESULTS@#Compared with the control group, LVSP and ±dp/dt@*CONCLUSION@#The intervention with electroacupuncture achieves the synergism/ attenuation effect of aconitine for the improvements in heart failure probably by up-regulating the expression of SERCA2a and down-regulating the expression of PLB in myocardial tissue.


Subject(s)
Aconitine , Animals , Calcium-Binding Proteins , Electroacupuncture , Heart Failure/therapy , Rats , Rats, Sprague-Dawley
10.
Article in Chinese | WPRIM | ID: wpr-879251

ABSTRACT

Right ventricular (RV) failure has become a deadly complication of left ventricular assist device (LVAD) implantation, for which desynchrony in bi-ventricular pulse resulting from a LVAD is among the important factor. This paper investigated how different control modes affect the synchronization of pulse between LV (left ventricular) and RV by numerical method. The numerical results showed that the systolic duration between LV and RV did not significantly differ at baseline (LVAD off and cannula clamped) (48.52%


Subject(s)
Heart Failure/therapy , Heart-Assist Devices , Humans , Systole , Ventricular Dysfunction, Right , Ventricular Function, Right
13.
Rev. Assoc. Med. Bras. (1992) ; 66(12): 1750-1756, Dec. 2020. graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143664

ABSTRACT

SUMMARY Cardiovascular diseases are important causes of morbidity and mortality in the course of chronic kidney disease (CKD). Diastolic dysfunction (DD) may progress with the clinical manifestation of heart failure, known as heart failure with preserved ejection fraction, a condition that precedes systolic dysfunction. The early identification of DD by echocardiography at the point-of-care before the appearance of symptoms and signs of pulmonary congestion and the implementation of appropriate treatment can improve the prognosis of CKD. This review article briefly addresses DD in kidney disease and presents a practical approach to the echocardiographic diagnosis of DD at the point of care.


SUMÁRIO As doenças cardiovasculares são causa importante de morbidade e mortalidade no curso da doença renal crônica (DRC). A disfunção diastólica (DD) pode evoluir com insuficiência cardíaca manifesta clinicamente, denominada insuficiência cardíaca com fração de ejeção preservada, e precede a disfunção sistólica. A identificação precoce da DD pela ecocardiografia "point of care", antes do aparecimento dos sintomas e sinais de congestão pulmonar, e a implementação de tratamento adequado podem melhorar o prognóstico da DRC. Este artigo de revisão aborda brevemente a DD na doença renal e apresenta uma abordagem prática para o diagnóstico ecocardiográfico da DD à beira do leito


Subject(s)
Humans , Ventricular Dysfunction, Left/diagnostic imaging , Heart Failure/therapy , Heart Failure/diagnostic imaging , Stroke Volume , Point-of-Care Systems , Diastole , Nephrologists
16.
Rev. Méd. Clín. Condes ; 31(1): 21-27, ene.-feb. 2020.
Article in Spanish | LILACS | ID: biblio-1223317

ABSTRACT

Las enfermedades cardiovasculares son muy frecuentes en la población anciana (pacientes mayores de 75 años). El enfrentamiento y manejo de ellas es distinto al indicado en pacientes jóvenes. Son escasos los estudios que incluyen población mayor de 75 años, con evidencia acerca de las diferencias que existen en la respuesta terapéutica en comparación al paciente joven. El anciano tiene mayor fragilidad y múltiples comorbilidades, con reserva cardiaca disminuida, lo que obliga a un manejo integral y acucioso. Los cambios propios de la edad repercuten tanto en riñón, cerebro, hígado, musculatura y corazón, lo que los hace pacientes más proclives a presentar complicaciones de la terapia farmacológica o intervencional. El objetivo de este artículo es resumir las recomendaciones sobre el manejo de las cardiopatías más frecuentes en el anciano, incluyendo insuficiencia cardiaca crónica, cardiopatía coronaria, hipertensión arterial, estenosis aórtica valvular y fibrilación auricular no valvular.


Cardiovascular diseases are very common in the elderly population, and their management is different. There are few studies that include population older than 75 years, with little evidence about the differences in the therapeutic response compared to the young patient. The elderly have greater fragility and multiple comorbidities, with diminished cardiac reserve, which requires a comprehensive and careful management. Changes due to advanced age, in kidney, brain, liver and musculature (among others), make them more vulnerable to complications of the pharmacological or interventional treatment. The objective of this article is to summarize the recommendations on the management of the most frequent heart diseases in the elderly, including chronic heart failure, coronary heart disease, arterial hypertension, valvular aortic stenosis, and non-valvular atrial fibrillation.


Subject(s)
Humans , Aged , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Aortic Valve Stenosis , Pacemaker, Artificial , Arrhythmias, Cardiac , Atrial Fibrillation , Death, Sudden, Cardiac , Coronary Disease/diagnosis , Coronary Disease/therapy , Defibrillators , Heart Failure/diagnosis , Heart Failure/therapy , Hypertension/diagnosis , Hypertension/therapy
18.
Arch. cardiol. Méx ; 90(supl.1): 26-32, may. 2020. tab
Article in Spanish | LILACS | ID: biblio-1152839

ABSTRACT

Resumen La pandemia por COVID-19 decretada por la Organización Mundial de la Salud (OMS) desde el 12 de marzo de 2020 está produciendo estragos a nivel mundial y es un verdadero reto económico, social y sanitario. Aunque las manifestaciones clínicas del COVID-19 son síntomas respiratorios, algunos pacientes también tienen síntomas cardiológicos. Dentro de los pacientes con afecciones cardiológicas2 suponen un grupo de mayor riesgo y que de hecho son un grupo especialmente vulnerable, por su mayor riesgo de contagio y mayor gravedad en caso de adquirir la enfermedad1 aquellos con insuficiencia cardiaca (IC), incluyendo al trasplante cardiaco (TC) y las asistencias ventriculares, así como los pacientes con hipertensión arterial pulmonar (HAP). La IC es la principal patología cardiovascular crónica y los pacientes en este grupo son los más vulnerables para el desarrollo de cuadros clínicos más graves tras sufrir la infección, y en mayor medida los casos con IC avanzada3. De hecho, la IC es unas de las complicaciones más frecuentes en los pacientes con COVID-194. De igual forma, los pacientes trasplantados que requieren de los inmunosupresores para evitar el rechazo del injerto, constituyen una población especialmente susceptible a la infección y a desarrollar procesos más graves. Esta situación ha hecho que la Asociación Nacional de Cardiólogos de México (ANCAM) y la Sociedad Mexicana de Cardiología (SMC) junto con sus respectivos capítulos, hayan elaborado las siguientes recomendaciones para el personal médico, que participa en la atención de este grupo especial de pacientes en los diferentes escenarios clínicos, que padezcan o no, COVID-19.


Abstract The COVID-19 pandemic decreed by the World Health Organization (WHO) since March 12, 2020 is wreaking havoc globally and it is a true economic, social and health challenge. Although the clinical manifestations of COVID-19 are respiratory symptoms, some patients also have cardiological symptoms. Among patients with cardiological conditions2 they represent a group of higher risk and, in fact, they are a particularly vulnerable group, due to their higher risk of contagion and greater severity in case of acquiring the disease1 those with heart failure (HF), including heart transplant (CT) and ventricular assists, as well as patients with pulmonary arterial hypertension (PAH). HF is the main chronic cardiovascular disease and patients in this group are the most vulnerable for the development of more serious clinical symptoms after suffering the infection, and to a greater extent cases with advanced HF3. In fact, HF is one of the most frequent complications in patients with COVID-194. Likewise, transplant patients who require immunosuppressants to avoid graft rejection, constitute a population especially susceptible to infection and to develop more serious processes. This situation has made the National Association of Cardiologists of Mexico (ANCAM) and the Mexican Society of Cardiology (SMC) together with their respective chapters, have prepared the following recommendations for medical personnel, who participate in the care of this special group of patients in the different clinical settings, who suffer or not, of COVID-19.


Subject(s)
Humans , Pneumonia, Viral/complications , Cardiovascular Diseases/virology , Coronavirus Infections/complications , Heart Failure/virology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Severity of Illness Index , Cardiovascular Diseases/physiopathology , Cardiovascular Diseases/therapy , Risk Factors , Coronavirus Infections/epidemiology , Pandemics , COVID-19 , Heart Failure/physiopathology , Heart Failure/therapy , Mexico
19.
Medwave ; 20(7): e8008, 2020.
Article in English, Spanish | LILACS | ID: biblio-1122676

ABSTRACT

En diciembre de 2019 se reportó en Wuhan, China, la aparición de una nueva cepa de coronavirus SARS-CoV-2 que producía un compromiso pulmonar severo y progresaba a estrés respiratorio agudo. A la fecha, son más de diecisiete millones los casos confirmados y más de medio millón los fallecidos en todo el mundo a causa de COVID-19. Los estudios reportan que los pacientes con enfermedad cardiovascular son más susceptibles a contraer esta enfermedad y a presentar más complicaciones. El propósito de esta revisión es proporcionar información actualizada para los profesionales de la salud que atienden a pacientes con COVID-19 y que tienen además enfermedad cardiovascular y por ende un riesgo elevado de complicaciones y mortalidad. Realizamos una búsqueda de bibliografía científica acerca de la asociación de enfermedad cardiovascular y COVID-19 en diferentes bases de datos como Scopus, MEDLINE vía PubMed y Cochrane Library. El tratamiento con inhibidores de la enzima convertidora de angiotensina y bloqueadores del receptor de angiotensina ha sido motivo de discusión y no hay evidencia sólida para contraindicarlo en pacientes con COVID-19. Respecto al tratamiento con hidroxicloroquina asociado o no con azitromicina, hay evidencia que demuestra un mayor riesgo con su utilización, que beneficio clínico y/o disminución de mortalidad. En este contexto, los pacientes con insuficiencia cardíaca representan un grupo importante de riesgo por su condición per se y por el dilema diagnóstico generado al evaluar un paciente con COVID-19, en el que los signos de insuficiencia cardíaca aguda podrían enmascararse. Por otro lado, en los pacientes con síndrome coronario agudo, el enfoque terapéutico inicial podría cambiar en el contexto de la pandemia, aunque sólo sobre la base de opiniones de expertos. Quedan, sin embargo, muchos temas en controversia que serán motivo de investigaciones futuras.


In December 2019, a new strain of the SARS-CoV-2 coronavirus was reported in Wuhan, China, which produced severe lung involvement and progressed to respiratory distress. To date, more than seventeen million confirmed cases and more than half a million died worldwide from COVID-19. Patients with cardiovascular disease are more susceptible to contracting this disease and presenting more complications. We did a literature search on the association of cardiovascular disease and COVID-19 in databases such as Scopus, PubMed/MEDLINE, and the Cochrane Library. The purpose of this review is to provide updated information for health professionals who care for patients with COVID-19 and cardiovascular disease, given that they have a high risk of complications and mortality. Treatment with angiotensin-converting enzyme inhibitors and receptor blockers is controversial, and there is no evidence not to use these medications in patients with COVID-19. Regarding treatment with hydroxychloroquine associated or not with azithromycin, there is evidence of a higher risk with its use than clinical benefit and decreased mortality. Likewise, patients with heart failure are an important risk group due to their condition per se. Patients with heart failure and COVID-19 are a diagnostic dilemma because the signs of acute heart failure could be masked. On the other hand, in patients with acute coronary syndrome, the initial therapeutic approach could change in the context of the pandemic, although only based on expert opinions. Nonetheless, many controversial issues will be the subject of future research.


Subject(s)
Humans , Cardiovascular Diseases/complications , SARS-CoV-2 , COVID-19/complications , Antiviral Agents/adverse effects , Prognosis , Renin-Angiotensin System/physiology , Algorithms , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Azithromycin/adverse effects , Peptidyl-Dipeptidase A/metabolism , Drug Therapy, Combination , Electrocardiography/drug effects , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/therapy , Pandemics , COVID-19/drug therapy , Heart Failure/etiology , Heart Failure/therapy , Hydroxychloroquine/adverse effects , Hypertension/complications , Hypertension/drug therapy
20.
Braz. j. med. biol. res ; 53(7): e9646, 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1132528

ABSTRACT

Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have symptoms and signs of HF with normal or near-normal left ventricular ejection fraction (LVEF ≥50%). Roughly half of all patients with HF worldwide have an LVEF ≥50% and nearly half have an LVEF <50%. Thanks to the increased scientific attention about the condition and improved characterization and diagnostic tools, the incidence of HF with reduced ejection fraction (HFrEF) dropped while that of HFpEF has increased by 45%. HFpEF has no single guideline for diagnosis or treatment, the patient population is heterogeneously and inconsistently described, and longitudinal studies are lacking. To better understand and overcome the disease, in this review, we updated the latest knowledge of HFpEF pathophysiology, introduced the existing promising diagnostic methods and treatments, and summarized its prognosis by reviewing the most recent cohort studies.


Subject(s)
Humans , Stroke Volume/physiology , Ventricular Function, Left/physiology , Heart Failure/diagnosis , Heart Failure/physiopathology , Heart Failure/therapy , Prognosis
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