Devices in heart failure: potential methods for device-based monitoring of congestive heart failure.
Shahzeb M. MunirRoberta C. BogaevEd SobashK.J. ShankarSreedevi GondiIgor StupinJillian RobertsonM. Alan BrewerS. Ward CasscellsReynolds M. DelgadoAmany Ahmed
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Abstract:
Congestive heart failure has long been one of the most serious medical conditions in the United States; in fact, in the United States alone, heart failure accounts for 6.5 million days of hospitalization each year. One important goal of heart-failure therapy is to inhibit the progression of congestive heart failure through pharmacologic and device-based therapies. Therefore, there have been efforts to develop device-based therapies aimed at improving cardiac reserve and optimizing pump function to meet metabolic requirements. The course of congestive heart failure is often worsened by other conditions, including new-onset arrhythmias, ischemia and infarction, valvulopathy, decompensation, end-organ damage, and therapeutic refractoriness, that have an impact on outcomes. The onset of such conditions is sometimes heralded by subtle pathophysiologic changes, and the timely identification of these changes may promote the use of preventive measures. Consequently, device-based methods could in the future have an important role in the timely identification of the subtle pathophysiologic changes associated with congestive heart failure.Keywords:
Decompensation
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The clinical and economic importance of heart failure is widely recognized. The incidence of heart failure is on the increase, particularly with the aging of the population around the world. It is time for a paradigm shift in heart failure management. Alternative non-pharmacological strategies to remodel the failing ventricle will shape a major portion of heart failure therapy in the decade ahead. Exposure to heat is widely used as a traditional therapy in many cultures. In this paper, we will review recent data that suggest thermal therapy may be helpful as an adjunctive non-pharmacological treatment for heart failure. J Teh Univ Heart Ctr 3 (2009) 149-158
Adjunct
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Cardiac decompensation
Decompensation
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Etiology
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This chapter contains sections titled: Introduction Therapeutic devices as monitors Heart rate Arrhythmia burden Proportion of atrial or ventricular pacing Heart rate variability Future monitoring systems Clinical practice Conclusions References
Clinical Practice
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The global burden of heart failure has continued to increase dramatically with 26 million people affected and an estimated health expenditure of $31 billion worldwide. Several practice-influencing studies were reported recently, bringing advances along many frontiers in heart failure, particularly heart failure with reduced ejection fraction. In this article, we discuss nine distinct therapeutic areas that were significantly influenced by this scientific progress. These distinct areas include the emergence of sodium-glucose cotransporter-2 inhibitors, broadening the application of angiotensin-neprilysin inhibition, clinical considerations in therapy withdrawal in those patients with heart failure that ‘recover’ myocardial function, benefits of low-dose direct oral anticoagulants in sinus rhythm, targeted therapy for treating cardiac amyloidosis, usefulness of mitral valve repair in heart failure, the advent of newer left ventricular assist devices for advanced heart failure, the role of ablation in atrial fibrillation in heart failure, and finally the use of wearable defibrillators to address sudden death.
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Contents: Molecular and Biochemical Aspects.- Pathophysiological Aspects of Heart Failure.- Ventricular Function in Heart Failure.- Non-Invasive Imaging Techniques in the Assessment of Patients with Heart Failure.- Heart Failure in Acute Ischemic Syndromes and Acute Myocardial Infarction.- Rheumatic Heart Disease and Valvular Heart Disease.- Cardiomyopathies.- Pharmacotherapy of Heart Failure.- Cardiac Arrhythmias in Heart Failure.- Exercise Physiology and Exercise Therapy in Heart Failure.- Neurohumoral Mechanisms.- Newer Interventional Techniques.- Newer Surgical Techniques in the Patient with Heart Failure.- Cardiac Assist Devices, Heart Transplantation.
valvular heart disease
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Acute heart failure is life threatening in adults and in the pediatric population. It represents the final pathway of complex physiological mechanisms that vary with age and underlying diseases. Strategies for treatment of heart failure should integrate to an concept of stepwise approach to heart failure. Evolving therapies, that are changing standard of care, are discussed. This paper gives an overview on principles for treatment of congestive heart failure, like diuretics, ss-beta-blockade, and angiotensin-converting enzyme blockers and discusses the approach to acute heart failure, including new and well known inotropic agents. Mechanical circulatory support and finally heart transplantation are focused as options in the last line.
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