Fatores associados a óbito e hospitalizações em uma clínica de insuficiência cardíaca / Factors associated with death and hospitalization in a heart failure clinic

Trata-se de um estudo descritivo, retrospectivo, com abordagem quantitativa cujo objetivo geral foi descrever e analisar o perfil epidemiológico dos pacientes com Insuficiência Cardíaca atendidos pela Clinica de IC de um Hospital Universitário. Os objetivos específicos orientam-se para:(a)Caracterizar os casos de Insuficiência Cardíaca segundo variáveis demográficas, variáveis clínicas, de diagnóstico e co morbidades;(b)Comparar as características clínicas e demográficas dos pacientes conforme grupos etiológicos identificados e fração de ejeção;(c)Determinar a taxa de mortalidade e hospitalização dos pacientes acompanhados pela clínica. Os dados analisados neste estudo são oriundos de um banco de dados onde são alocadas informações dos pacientes em atendimento ambulatorial da referida clinica.Para a análise dos dados foi utilizada a estatística descritiva, freqüências e porcentagens assim como tabelas e gráficos para a demonstração dos dados levantados.Os mesmos foram analisados através do software SPSS v.18.0, no qual se utilizou a estatística multivariada e curvas de sobrevida de Kaplan-Meyer.Os resultados apontam para uma predominância masculina de 60,1%, com idade de ± 63,5 anos. Na caracterização quanto à classe funcional observa-se que a predominante é a classe funcional I e II com 73,6% do total. Os pacientes assistidos apresentam uma média de 42% da fração de ejeção do ventrículo esquerdo e 61,7% possuem etiologia não isquêmica. Em nosso estudo, descrevemos 71,8% de portadores de disfunção sistólica. Os pacientes com etiologia isquêmica tinham predomínio do sexo masculino(70,7%), e a etiologia não isquêmica com uma prevalência maior do sexo feminino(45,5%vs 29,3%;p<0,001). Além disso, os pacientes isquêmicos eram mais idosos (p<0,001), com historia familiar de DAC(p<0,041), presença de diabetes (p<0,001). A disfunção sistólica(FE<50%) era predominante no grupo de pacientes isquêmicos(77%vs 69%; p=0,048)...

It is a descriptive, retrospective, study with quantitative approach whose general objective was to describe and analyze the epidemiological profile of patients with heart failure treated in a heart failure clinic of a university hospital. The specific objectives are oriented to a) characterize the cases of heart failure according to demographic variables, clinical variables, diagnosis and comorbidities, (b) compare clinical and demographic characteristics of patients according to the main groups identified and etiologic fraction ejection, (c) Determine mortality and hospitalization rates of patients followed by the HF clinic. The data analyzed in this study come from a database which is allocated information of ambulatory patients referred to the clinic. For data analysis was used descriptive statistics with mean, median and standard deviation, frequencies and percentages ,tables and graphs to demonstrate the data collected as well multivariate statistical analysis and Kaplan-Meyer’s survival curves. They were analyzed using the software SPSS v.18.0. The results indicate a male predominance of 60.1% with an average age of 63.5 years±. The functional class observed that was the predominant class I and II, 73.6% of the total. Patients have attended an average of 42% ejection fraction of left ventricle and 61.7% had non ischemic etiology. In our study, we describe 71.8% of patients with systolic dysfunction. Patients with ischemic etiology were predominantly male (70.7%), and non ischemic etiology with a higher prevalence of females (45.5% vs 29.3%, p<0.001). In addition, ischemic patients were older (p<0.001), family history of CAD (p<0.041), diabetes (p<0.001). Systolic dysfunction (EF<50%) was predominant in the group of ischemic patients (77% vs 69%, p=0.048)...

Assessment of the clinical outcomes and cost-effectiveness of the management of systolic heart failure in Chinese patients using a home-based intervention.

This study was designed to assess the clinical effect of a home-based telephone intervention in Chinese heart failure patients. A total of 550 Chinese heart failure patients were enrolled into either (i) a group that received the usual standard of care (UC group); or (ii) a group that received a home-based heart failure centre management programme using nursing specialist-led telephone consultations (HFC group). The impact of the home-based intervention on admission rate, admission length and medical costs over 6 months was measured. Although the mean left ventricular ejection fraction in HFC patients was 29.3% compared with 34.8% in UC patients, the home-based intervention resulted in a significantly lower all-cause admission rate per person (HFC 0.60 +/- 0.77 times/person; UC 0.96 +/- 0.85 times/person), a shorter all-cause hospital stay (reduced by 8 days per person) and lower total 6-month medical costs (reduced by US$2682 per patient). These results suggest that the home-based intervention with nursing specialist-led telephone consultations may improve the clinical outcome and provide cost-savings for Chinese patients with heart failure.

Signs and symptoms of heart failure: are you asking the right questions?

BACKGROUND: Patients may not verbalize common and atypical signs and symptoms of heart failure and may not understand their association with worsening disease and treatments. OBJECTIVES: To examine prevalence of signs and symptoms relative to demographics, care setting, and functional class. METHODS: A convenience sample of 276 patients (164 ambulatory, 112 hospitalized) with systolic heart failure completed a 1-page checklist of signs and symptoms experienced in the preceding 7 days (ambulatory) or in the 7 days before hospitalization. Demographic and medical history data were collected. RESULTS: Mean age was 61.6 (SD, 14.8) years, 65% were male, 58% were white, and 45% had ischemic cardiomyopathy. Hospitalized patients reported more sudden weight gain, weight loss, severe cough, low/orthostatic blood pressure, profound fatigue, decreased exercise, restlessness/confusion, irregular pulse, and palpitations (all P < .05). Patients in functional class IV reported more atypical signs and symptoms of heart failure (severe cough, nausea/vomiting, diarrhea or loss of appetite, and restlessness, confusion, or fainting, all P

Pharmacological treatment of heart failure.

This article provides an overview of heart failure (HF) and pharmacological treatment of systolic left ventricular dysfunction. The purpose of this article is to provide nurses the knowledge of current treatment recommendations and the Five Million Lives campaign sponsored by the National Institute of Healthcare Improvement. This initiative is a national campaign to protect 5 million patients from medical harm by promoting evidence-based standards of practice to improve the healthcare of Americans. HF has become part of this national initiative and the National Institute of Healthcare Improvement in conjunction with the American College of Cardiology/American Heart Association has implemented guidelines to improve the care of HF patients. Nurses would be expected to be familiar with these guidelines, as regulatory agencies will be using these guidelines as a benchmark to evaluate the quality of care provided to patients with this diagnosis.

Current therapies in the management of systolic and diastolic dysfunction.

Heart failure, especially caused by systolic dysfunction, is the most common cause of hospitalization in the elderly population and the annual expenditure required for its management is at least $10 billion. The critical care nurse can play an active role in recognizing the differences between systolic and diastolic dysfunction, and teaching the patient and family that improper management or underuse of therapies can lead to disease progression.