Heart Failure is a progressive chronic disorder that results in the inability of the heart to pump blood efficiently to the body’s tissues.
Chronic heart failure is an increasing public health problem; the growing prevalence in industrialised countries means that 1-2% of the adult population of these countries are now thought to have chronic heart failure.1-3 Estimates suggest that the prevalence in Europe, USA and Japan could increase by approximately 16.5% over the next ten years.4
The prevalence of post-myocardial infarction heart failure is less well known as it is difficult to distinguish between pre-existing and incident heart failure. However current estimates suggest that approximately 1 in 5 patients hospitalised with an acute coronary syndrome either present with heart failure or develop heart failure during their hospital stay.5
Many of the signs and symptoms of heart failure are non-specific and vary in severity depending on the disease class. The most common of these are breathlessness, fatigue, exercise intolerance, and fluid retention as evidenced by ankle swelling, peripheral oedema, and an elevated jugular venous pressure.6
Due to the non-specific nature of symptoms, the diagnosis of heart failure can be difficult. Tests can include echocardiogram, ECG, chest X-ray, laboratory tests. Following a positive diagnosis heart failure is classified into functional classes that relate to disease severity.
Management of heart failure involves lifestyle modifications, pharmacological treatment and occasionally surgery. In patients with chronic heart failure, optimal therapy involves treatment with diuretics, ACE inhibitors, certain β-blockers and a mineralocorticoid receptor antagonist.
The Heart Failure Knowledge Centre brings together current information related to chronic heart failure and post-myocardial infarction, including:
Zannad F, et al. Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL Study. Journal of the American College of Cardiology 1999; 33(3):734-742.
Cowie MR, et al. The epidemiology of heart failure. European Heart Journal 1997;18(2):208-225.
Mosterd A, Hoes A. Clinical epidemiology of heart failure. Heart 2007; 93:1137-1146.
Decision Resources. Chronic Heart Failure. Cardium Study No.4 A Pharmacor Service. 2008.
Steg PG, Dabbous OH, et al. Determinants and prognostic impact of heart failure complicating acutecoronary syndromes. Observations from the Global Registry of Acute Coronary Events (GRACE). Circulation2004;109:494-9.
NICE Clinical Guideline No 108. Chronic Heart Failure. National clinical guideline for diagnosis and management in primary and secondary care. 2010.
This educational resource contains a range of content developed for healthcare professionals based in Europe who are involved in the treatment and management of type 2 diabetes mellitus. In this section you will find:
This EACCME-accredited obesity CME series contains three CME modules, which are ideal for healthcare professionals looking to improve their understanding of obesity as a serious medical illness.
Module 1 – Understanding Obesity
Learn more about obesity as a serious and complex medical illness including comorbidities and complications, the complex factors that influence its development and the cornerstones of an effective weight-management strategy.
Module 3 – Rationale for Lifelong Behaviour Change
Explore the factors affecting maintenance of weight loss, the importance of implementing permanent behaviour changes to prevent weight regain and the components of a successful long-term weight-management strategy.
The Anti-Infectives Knowledge Network – Clostridium difficile infections (AIKN-CDI), an initiative by Astellas Pharma EMEA, shares the expertise and experience of thought leaders in the area of anti-infectives.
Opportunity to participate in the second round of the largest ever clinician consensus report through completing a questionnaire. Subsequent recommendations will be made based on the data collected from this questionnaire
Please remember to return often to read updated news, clinical insights, and essential information from the latest congresses.
Christopher D. Pfeiffer, Clinical Fellow, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA Vance Fowler, Associate Professor and Infectious Diseases, Specialist, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
Case History A 64-year-old female presented with three weeks of progressive dyspnoea, nausea and vomiting.
Decisions to start cardiopulmonary resuscitation (CPR), or to decide in advance to issue a "do not attempt (cardiopulmonary) resuscitation" (DNAR) notice have always been a hot topic in clinical medicine. It may have become even more so since a recent (June 2014) court decision. This post discusses some of the issues and legalities around DNAR decisions.
Familial hypercholesterolaemia (FH) is a common genetic cause of premature coronary heart disease..
... (CHD). Globally, one baby is born with FH every minute. If diagnosed and treated early in childhood, individuals with FH can have normal life expectancy. This consensus paper aims to improve awareness of the need for early detection and management of FH children. Familial hypercholesterolaemia is diagnosed either on phenotypic criteria, i.e. an elevated low-density lipoprotein cholesterol (LDL-C) level plus a family history of elevated LDL-C, premature coronary artery disease and/or genetic diagnosis, or positive genetic testing. Childhood is the optimal period for discrimination between FH and non-FH using LDL-C screening. An LDL-C ≥5 mmol/L (190 mg/dL), or an LDL-C ≥4 mmol/L (160 mg/dL) with family history of premature CHD and/or high baseline cholesterol in one parent, make the phenotypic diagnosis. If a parent has a genetic defect, the LDL-C cut-off for the child is ≥3.5 mmol/L (130 mg/dL). We recommend cascade screening of families using a combined phenotypic and genotypic strategy. In children, testing is recommended from age 5 years, or earlier if homozygous FH is suspected. A healthy lifestyle and statin treatment (from age 8 to 10 years) are the cornerstones of management of heterozygous FH. Target LDL-C is <3.5 mmol/L (130 mg/dL) if >10 years, or ideally 50% reduction from baseline if 8–10 years, especially with very high LDL-C, elevated lipoprotein(a), a family history of premature CHD or other cardiovascular risk factors, balanced against the long-term risk of treatment side effects. Identifying FH early and optimally lowering LDL-C over the lifespan reduces cumulative LDL-C burden and offers health and socioeconomic benefits. To drive policy change for timely detection and management, we call for further studies in the young. Increased awareness, early identification, and optimal treatment from childhood are critical to adding decades of healthy life for children and adolescents with FH.
Learn more about obesity as a serious and complex medical illness including comorbidities and complications, the complex factors that influence its development and the cornerstones of an effective weight-management strategy....
Explore the factors affecting maintenance of weight loss, the importance of implementing permanent behaviour changes to prevent weight regain and the components of a successful long-term weight-management strategy. EACCME accredited.
This is a study in patients who recently had a brain attack (stroke) and in whom no clear cause of the stroke could be identified. These strokes are likely due to a blood clot and therefore, can be ...