Assuntos
Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Neoplasias da Mama/enfermagem , Neoplasias da Mama/psicologia , Assistência Centrada no Paciente/métodos , Comunicação , Feminino , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/enfermagem , Programas de Rastreamento/psicologia , Relações Enfermeiro-PacienteAssuntos
Fibrilação Atrial/etiologia , Dispneia/etiologia , Mesotelioma/diagnóstico , Neoplasias Pleurais/diagnóstico , Síncope/etiologia , Idoso , Biópsia , Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Masculino , Mesotelioma/fisiopatologia , Neoplasias Pleurais/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: This clinical trial was performed to determine the safety and clinical impact of titrated metoprolol therapy in patients with heart failure, documented coronary artery disease and a low ejection fraction. BACKGROUND: Despite known cardiodepressant effects, long-term use of beta-adrenergic antagonists appears to be beneficial in patients with idiopathic dilated cardiomyopathy. However, this therapy has not been critically evaluated in patients with heart failure and coronary artery disease. METHODS: In 50 patients with heart failure, known coronary artery disease and an ejection fraction < or = 0.40, we examined the impact of metoprolol therapy in a 6-month double-blind, placebo-controlled randomized trial, assessing the frequency of heart failure exacerbations and changes in symptoms (New York Heart Association functional class), ejection fraction and exercise duration. Placebo-treated patients who completed 6-month follow-up studies then underwent a trial with metoprolol therapy (crossover group). RESULTS: Metoprolol was titrated to a mean maximal dose of 87 mg/day (range 25 to 100) without serious adverse reactions. During double-blind therapy, use of a beta-blocker was associated with a significant reduction in the number of hospital admissions (4% vs. 32%, p < 0.05), overall improved functional class (p = 0.02), increased ejection fraction (4 +/- 7% [mean +/- SD] compared with 0 +/- 6%, p < 0.05) and a greater increase in exercise duration (193 +/- 276 vs. 38 +/- 213 s with placebo, p < 0.01). Crossover outcome paralleled the favorable impact seen during randomized metoprolol therapy. CONCLUSIONS: Cautious use of titrated metoprolol appears to be safe and beneficial when added to standard heart failure therapy in patients with dilated cardiomyopathy associated with coronary artery disease.