EARLY DIAGNOSIS OF FRAILTY SYNDROME CAN REDUCE THE COST OF TREATING OLDER ADULTS WITH HEART FAILURE
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Frailty syndrome
Decompensation
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Canadian Cardiovascular Society
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To the Editor:— In their paper, Congestive Heart Failure—Acute Pulmonary Edema ( 208 :1895, 1969), Burch and De Pasquale made several therapeutic recommendations which merit additional comment, I believe. The use of intermittent positive-pressure breathing (IPPB) devices may often be life saving in the patient rendered hypoxic by the pulmonary congestion. But pulmonary obstruction may be intensified by the froth of the edema, and in this situation, the addition of 90% ethyl alcohol by nebulization greatly reduces the foaming. 1 It must be remembered, however, that the administration of high concentrations of oxygen by any means can be lethal for patients with underlying pulmonary insufficiency and must be used with great caution. In the majority of patients digoxin might be preferable to deslanoside. The onset of action of digoxin is comparable to deslanoside, and later, the need to change to another digitalis preparation for maintenance is obviated with digoxin. Deslanoside and
Acute pulmonary edema
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Carvedilol
Disease management
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The management of heart failure is complex. Initiating and maintaining drug therapy in patients with heart failure can be challenging. Many factors influence the heart failure syndrome and are important to account for when evaluating these patients. Concomitant diseases such as ischemic heart disease and hypertension may contribute to worsening heart failure, and treatment strategies addressing these conditions should be implemented in affected patients. Concomitant drugs also must be considered. The heart failure population is at risk for drug interactions, both pharmacokinetic and pharmacodynamic, because these patients often take many drugs at the same time. Proactively recognizing potential interactions and modifying a patient's regimen to minimize or avoid adverse effects are important. Many agents are contraindicated in heart failure; thus, avoiding such therapies may significantly affect a patient's outcome. The successful treatment of a patient with heart failure requires careful consideration of many factors, including other diseases, drugs, and social issues. Addressing these factors when treating patients translates into improved pharmaceutical care.
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Heart failure is highly prevalent in patients with chronic kidney disease (CKD) and a leading cause of morbidity and mortality in this population. Heart failure therapies proven to benefit the general population may have different risk-benefit profiles in patients with concurrent CKD, plausibly because of the unique pathophysiology of heart failure in this population. The present review highlights recent advances in heart failure treatment as they apply to patients with CKD.Several recent publications have shown possible benefits of established heart failure therapies to improve clinical outcomes in patients with CKD; while others conclude neutral or even harmful effects of heart failure therapies in CKD patients. Novel heart failure therapies show promise to improve outcomes in the general population and should be evaluated in future studies to further elucidate the efficacy and safety of these novel therapies specifically in patients with CKD.Knowledge of heart failure treatment to improve clinical outcomes in the CKD population remains limited. Future studies should focus on patients with CKD to evaluate the generalizability of heart failure therapies to this patient population.
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Disease management
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