Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al, American College of Cardiology Foundation; American Heart Association. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation

Journal of the American College of Cardiology (Impact Factor: 15.34). 05/2009; 53(15):e1-e90. DOI: 10.1016/j.jacc.2008.11.013
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    • "Early feasibility studies have successfully tested the possibility of sending data such as blood pressure, body weight (BW), and electrocardiogram from the patient's home (De Lusignan, Wells, Johnson, Meredith, & Leatham, 2001; Jenkins & McSweneney, 2001; Nanewicz et al., 2000). TM in addition with symptom questions have been the focus in several randomized controlled trials (RCTs), and even though the results in meta-analyses showed significant decreases in hospitalization and death, the findings in large multicentre RCTs have been neutral, and thus, TM is mentioned as an alternative in HF care in the current guidelines (Chaudhry et al., 2010; Hunt et al., 2009; Inglis et al., 2008; McMurray et al., 2012). Another issue that raises important questions is the rather low compliance rate with TM that is reported in RCTs (Chaudhry et al., 2010; Cleland et al., 2005). "
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    ABSTRACT: Chronic heart failure (HF) is associated with a high burden of morbidity and mortality and with reduced quality of life. New techniques such as telemonitoring (TM) have recently been introduced in the care of patients with HF in order to improve outcomes. TM is defined as sending data from the patients' home to healthcare professionals. Most studies have focussed on endpoints such as morbidity and mortality, and relatively little attention has been paid to patients' perceptions of TM. Therefore, the aim of this study was to explore and describe patients' perceptions of transmission of body weight (BW) and TM, regularly accomplished from patients' homes to an HF clinic. An explorative design with a phenomenographic approach was used, and semi-structured interviews were conducted with a maximum variation sampling of 20 participants. The findings are described in five metaphoric categories that were assigned and used as a description: the habitual patient, the concerned patient, the technical patient, the secure patient, and the self-caring patient. The conclusions were that the transmission of BW made the patients active in their own care and increased self-care activities. In clinical care, concerns for deterioration in HF as well as the reliability of the TM system should be considered. Future research may focus on healthcare professionals and their perceptions of transmission of BW and TM in the care of patients with HF.
    International Journal of Qualitative Studies on Health and Well-Being 12/2013; 8:21524. DOI:10.3402/qhw.v8i0.21524 · 0.93 Impact Factor
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    • "The incidence of HF is destined to increase substantially over the next decade [4]. Recent updates of AHA/ACC guidelines about HF focus on diagnosis and management of HF in adults [5]. The current methods for clinical assessment of HF subdivide patients with HF or with high risk for HF in four classes or stages. "
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    ABSTRACT: Heart Failure (HF) is an acute or chronic syndrome, that causes a lot of damaging effects to every system. The involvement of different systems is variably related to age and others comorbidities. The severity of organ damage is often proportional to the duration of heart failure. The typology of HF and the duration determine which organs will be affected and vice versa the severity of organ damage supplies precious information about prognosis and outcome of patients with heart failure. Moreover, a classification based not only on symptomatic and syndromic typical features of heart failure, but also on functional data of each system, could allow us to apply the most appropriate therapies, to obtain a more accurate prognosis, and to employ necessary and not redundant human and financial resources. With an eye on the TNM staging used in oncology, we drawn up a classification that will consider the different involvement of organs such as lungs, kidneys, and liver in addition to psychological pattern and quality of life in HF patients. For all these reasons, it is our intention to propose a valid and more specific classification available for the clinical staging of HF that takes into account pathophysiological and structural changes that can remark prognosis and management of HF.
    The Scientific World Journal 11/2013; 2013:175925. DOI:10.1155/2013/175925 · 1.73 Impact Factor
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    • "Our study points to a small yet significant increase in MRA use among eligible post-MI patients without prior HF, which was still significantly lower than prescription to patients with the more conventional indication of chronic HF symptoms. These findings may be influenced by past guidelines that considered only moderately symptomatic HF patients on optimal dosage of ACE-I/ARB and β-blockers with NYHA 3–4 eligible for MRA therapy [3] [20]. "
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    ABSTRACT: Following the EPHESUS trial in 2003, mineralocorticoid receptor antagonist (MRA) therapy received a class I indication for the management of eligible high-risk post-MI patients. Our goal was to examine temporal trends in MRA use in eligible post-myocardial infarction (MI) patients. We investigated temporal trends and factors associated with MRA utilization among eligible patients enrolled in the biannual Acute Coronary Syndrome Israeli Surveys (ACSIS) 2004-2010. Among 7696 patients enrolled in the ACSIS surveys from 2004, 955 (12%) were eligible for MRA therapy. In this population, prescription of MRAs at discharge from the index event showed a modest increase from 21% to 25% over the six-year period, whereas utilization of other guideline recommended drugs, including angiotensin converting enzyme inhibitors/receptor blockers and β-blockers was >2-fold higher. Multivariate logistic regression analysis showed that independent predictors of MRA prescription at discharge included a higher degree of left ventricular dysfunction (LVEF ≤30% vs. 31-40%: OR=2.19; p=0.02), history of heart failure prior to admission (OR=1.92; p<0.004), admission Killip≥II (OR=1.78; p=0.004), and an anterior location of the index MI (OR=1.54; p=0.03). MRA utilization was not associated with an increased risk for adverse events or rehospitalization at 30days of follow-up. In a real world setting, approximately one quarter of eligible post-MI patients are treated with an MRA following the index event, without a significant time-dependent change in this management strategy. MRAs are more likely to be underutilized in eligible lower-risk patients.
    International journal of cardiology 07/2013; 168(4). DOI:10.1016/j.ijcard.2013.06.091 · 6.18 Impact Factor
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