Article

Heart failure: diagnosis and healthcare burden.

Clinical Cardiology, National Heart & Lung Institute, Imperial College, London.
Clinical medicine (London, England) (Impact Factor: 1.69). 01/2004; 4(1):13-8. DOI: 10.7861/clinmedicine.4-1-13
Source: PubMed
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    • "almost 5 million people are affected, and 30% to 40% of all patients die within one year after diagnosis [1], [2]. The CHF is associated with major abnormalities of autonomic cardiovascular control, and this group of patients often develop breathing anomalies such as various forms of oscillatory breathing patterns characterized by rises and falls in ventilation. "
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    ABSTRACT: A correntropy-based technique is proposed for the characterization and classification of respiratory flow signals in chronic heart failure (CHF) patients with periodic or nonperiodic breathing (PB or nPB, respectively) and healthy subjects. The correntropy is a recently introduced, generalized correlation measure whose properties lend themselves to the definition of a correntropy-based spectral density (CSD). Using this technique, both respiratory and modulation frequencies can be reliably detected at their original positions in the spectrum without prior demodulation of the flow signal. Single-parameter classification of respiratory patterns is investigated for three different parameters extracted from the respiratory and modulation frequency bands of the CSD, and one parameter defined by the correntropy mean. The results show that the ratio between the powers in the modulation and respiratory frequency bands provides the best result when classifying CHF patients with either PB or nPB, yielding an accuracy of 88.9%. The correntropy mean offers excellent performance when classifying CHF patients versus healthy subjects, yielding an accuracy of 95.2% and discriminating nPB patients from healthy subjects with an accuracy of 94.4%.
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    ABSTRACT: and it can severely reduce a patient's quality of life. It consumes approximately 2% of the National Health Service budget in the United Kingdom, and in the United States, the total annual cost of treatment for heart failure is approximately $28 bil- lion. Moreover, the financial burden of heart failure will increase in coming de- cades because of the aging population and the improved treatments of its causes. Over the past 20 years, there has been considerable progress in the treatment of chronic heart failure with angiotensin-converting-enzyme (ACE) inhibitors,4,5 aldosterone antagonists,6 beta-receptor blockers,7,8 and resynchronization therapy.9,10 Even with the very best of modern therapy, however, heart failure is still associated with an annual mortality rate of 10%.10 The search for better treatments is one of the major challenges in cardiology. Chronic heart failure is multifactorial. There are many reasons why a human heart can fail,11 but the available evidence suggests that the failing heart is an engine out of fuel — that is, altered energetics play an important role in the mech- anisms of heart failure. For this reason, the modulation of cardiac metabolism has promise as a new approach to the treatment of heart failure. This review describes cardiac energy metabolism, appraises the methods used for its assessment, evaluates the role of impaired energy metabolism in heart fail- ure, and gives options for metabolic therapy.
    New England Journal of Medicine 04/2007; 356(11):1140-51. DOI:10.1056/NEJMra063052 · 54.42 Impact Factor
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    ABSTRACT: Although chronic heart failure (CHF) has a high mortality rate and symptom burden, and clinical guidance stipulates palliative care intervention, there is a lack of evidence to guide clinical practice for patients approaching the end of life. (1) To formulate guidance and recommendations for improving end-of-life care in CHF; (2) to generate data on patients' and carers' preferences regarding future treatment modalities, and to investigate communication between staff, patients and carers on end-of-life issues. Semistructured qualitative interviews were conducted with 20 patients with CHF (New York Heart Association functional classification III-IV), 11 family carers, 6 palliative care clinicians and 6 cardiology clinicians. A tertiary hospital in London, UK. Patients and families reported a wide range of end-of-life care preferences. None had discussed these with their clinicians, and none was aware of choices or alternatives in future care modalities, such as adopting a palliative approach. Patients and carers live with fear and anxiety, and are uninformed about the implications of their diagnosis. Cardiac staff confirmed that they rarely raise such issues with patients. Disease- and specialism-specific barriers to improving end-of-life care were identified. The novel, integrated data presented here provide three recommendations for improving care in line with policy directives: sensitive provision of information and discussion of end-of-life issues with patients and families; mutual education of cardiology and palliative care staff; and mutually agreed palliative care referral criteria and care pathways for patients with CHF.
    Heart (British Cardiac Society) 09/2007; 93(8):963-7. DOI:10.1136/hrt.2006.106518 · 6.02 Impact Factor
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