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Is mortality from heart failure increasing in Australia? An analysis of official data on mortality for 1997-2003
Najafi,Farid; Dobson,Annette J; Jamrozik,Konrad;
Bulletin of the World Health Organization , 2006, DOI: 10.1590/S0042-96862006000900015
Abstract: objective: to assess whether trends in mortality from heart failure (hf) in australia are due to a change in awareness of the condition or real changes in its epidemiology. methods: we carried out a retrospective analysis of official data on national mortality data between 1997 and 2003. a death was attributed to hf if the death certificate mentioned hf as either the underlying cause of death (ucd) or among the contributory factors. findings: from a total of 907 242 deaths, heart failure was coded as the ucd for 29 341 (3.2%) and was mentioned anywhere on the death certificate in 135 268 (14.9%). between 1997 and 2003, there were decreases in the absolute numbers of deaths and in the age-specific and age-standardized mortality rates for hf either as ucd or mentioned anywhere for both sexes. hf was mentioned for 24.6% and 17.8% of deaths attributed to ischaemic heart disease and circulatory disease, respectively, and these proportions remained unchanged over the period of study. in addition, hf as ucd accounted for 8.3% of deaths attributed to circulatory disease and this did not change materially from 1997 to 2003. conclusion: the decline in mortality from hf measured as either number of deaths or rate probably reflects a real change in the epidemiology of hf. population-based studies are required to determine accurately the contributions of changes in incidence, survival and demographic factors to the evolving epidemiology of hf.
Lungs in Heart Failure  [PDF]
Anna Apostolo,Giuliano Giusti,Paola Gargiulo,Maurizio Bussotti,Piergiuseppe Agostoni
Pulmonary Medicine , 2012, DOI: 10.1155/2012/952741
Abstract: Lung function abnormalities both at rest and during exercise are frequently observed in patients with chronic heart failure, also in the absence of respiratory disease. Alterations of respiratory mechanics and of gas exchange capacity are strictly related to heart failure. Severe heart failure patients often show a restrictive respiratory pattern, secondary to heart enlargement and increased lung fluids, and impairment of alveolar-capillary gas diffusion, mainly due to an increased resistance to molecular diffusion across the alveolar capillary membrane. Reduced gas diffusion contributes to exercise intolerance and to a worse prognosis. Cardiopulmonary exercise test is considered the “gold standard” when studying the cardiovascular, pulmonary, and metabolic adaptations to exercise in cardiac patients. During exercise, hyperventilation and consequent reduction of ventilation efficiency are often observed in heart failure patients, resulting in an increased slope of ventilation/carbon dioxide (VE/VCO2) relationship. Ventilatory efficiency is as strong prognostic and an important stratification marker. This paper describes the pulmonary abnormalities at rest and during exercise in the patients with heart failure, highlighting the principal diagnostic tools for evaluation of lungs function, the possible pharmacological interventions, and the parameters that could be useful in prognostic assessment of heart failure patients. 1. Introduction Not only heart is involved in chronic heart failure but also lung, kidney, peripheral and respiratory muscles, chemo-ergoreceptors, neurohormonal mechanisms, mitochondria, all play a major role in determining the complex clinical syndrome of chronic heart failure. Indeed, energy deficit is a relevant contributor to the development of cardiac and skeletal myopathy. In heart failure several functions of muscle bioenergetics are altered such as oxygen availability, substrate oxidation, ATP production by the mitochondria, and transfer to contractile apparatus [1]. Notably, the clinical syndrome of heart failure is characterized by symptoms apparently unrelated or partially related to the heart, such as fatigue, dyspnea, anxiety, and exercise intolerance. Dyspnea, either at rest or during exercise, is one of the main symptoms in heart failure. Indeed, the most often used heart failure grading methodology, the NYHA classification, is based on dyspnea. Dyspnea is the result of a neurological reconstruction of an abnormal physiological condition characterized by hyperventilation and by high ventilation to metabolic demand ratio.
Heart failure
JA Ker
South African Family Practice , 2010,
Abstract: Heart failure is a clinical syndrome that can result from any structural or functional cardiac disorder that impairs the performance of the ventricle: either to eject blood (systolic dysfunction) [or reduced ejection function] or to fill with blood (preserved ejection fraction or diastolic heart failure).
Primary Prevention of Heart Failure  [PDF]
Javed Butler
ISRN Cardiology , 2012, DOI: 10.5402/2012/982417
Abstract: Most heart failure research and quality improvement efforts are targeted at treatment and secondary prevention of patients with manifest heart failure. This is distinct from coronary disease where primary prevention has been a focus for over three decades. Given the current importance and the projected worsening of heart failure epidemiology, a more focused effort on prevention is urgently needed. 1. Epidemiology It is estimated that over 5.5 million subjects in the United States have heart failure and more than 650,000 are diagnosed for the first time each year [1]. Patients with impaired versus preserved left ventricular systolic function related heart failure each comprises about half of the overall burden of heart failure in the community [2, 3]. The proportion of heart failure with preserved ejection fraction increases with age [2]. Heart failure is the primary reason for 12–15 million office visits and 6.5 million hospital days annually. Recurrent hospitalization is a major issue with the annual number of hospitalizations now exceeding over 1 million for heart failure. These patients are particularly prone to rehospitalizations with readmission rates near 50% within six months of discharge. It has been estimated that the total direct and indirect cost of heart failure in the United States exceeds $ 30 billion [1]. The outcomes of these patients continue to remain suboptimal with only approximately 50% of the individuals surviving past five years after diagnosis [4]. Quality of life remains poor. Some improvement have been shown in individuals with systolic dysfunction, with no major advances in therapy for either patients with heart failure and preserved ejection fraction or those who are hospitalized for heart failure. Heart failure prevalence is rising and this trend will worsen. This is attributed to the increasing elderly population and the increasing prevalence of cardiovascular risk factors like diabetes and obesity. The aging of the 78 million baby boomers will result in 1 in 5 Americans to be over the age of 65 years by 2050. Heart failure incidence and prevalence are the highest amongst the elderly, and 80% of patients hospitalized with heart failure are over 65 years old. Thus the increasing age of the population is expected to significantly worsen the current heart failure epidemic. 2. Risk Factors Risk factors for heart failure range from lifestyle factors to comorbidities, medications, laboratory, and imaging characteristics to novel biomarkers and genomic markers [5]. Heart failure risk increases with age and male gender is
The Heart Failure Epidemic  [PDF]
Véronique L. Roger
International Journal of Environmental Research and Public Health , 2010, DOI: 10.3390/ijerph7041807
Abstract: Heart failure has been singled out as an emerging epidemic, which could be the result of increased incidence and/or increased survival leading to increased prevalence. Knowledge of the responsibility of each factor in the genesis of the epidemic is crucial for prevention. Population-based studies have shown that, over time, the incidence of heart failure remained overall stable, while survival improved. Therefore, the heart failure epidemic is chiefly one of hospitalizations. Data on temporal trends in the incidence and prevalence of heart failure according to ejection fraction and how it may have changed over time are needed while interventions should focus on reducing the burden of hospitalizations in hear failure.
Anemia in heart failure  [cached]
Alev K?l??gedik,Cihan Dündar,Mustafa Kür?at Tigen
Anadolu Kardiyoloji Dergisi , 2012,
Abstract: Chronic heart failure is a common problem and a major cause of death, hospital admission, poor physical function and impaired quality of life. In addition to the direct effect of heart failure on prognosis, several modifiable and non-modifiable factors contribute to the worse prognosis in heart failure. Anemia, which is common in patients with heart failure, may represent a modifiable risk factor for adverse outcome. It is also a marker for co-morbidity burden and greater disease severity. If anemia is a marker, treatment may not obviate the increased risk associated with anemia, but if it is a mediator, treatment may be helpful to reduce morbidity and mortality in heart failure. As anemia has been identified as an independent prognostic factor of both morbidity and mortality for patients with congestive heart failure, there is an increased interest in the hypothesis that the correction of anemia with erythropoietin or iron supplementation might lead to an improvement on patients’ symptoms and functional status. Large randomized trials are necessary to show the effect of anemia and the specific treatments on the outcome in these patients. This article reviews the mechanisms, impact on outcomes and therapy of anemia in patients with heart failure.
Cardiomyocytic apoptosis and heart failure
Quanzhou Feng,
Quanzhou Feng
,Shiwen Wang

老年心脏病学杂志(英文版) , 2008,
Abstract: Heart failure is a major disease seriously threatening human health.Once left ventricular dysfunction develops,cardiac function usually deteriorates and progresses to congestive heart failure in several months or years even if no factors which accelerate the deterioration repeatedly exist.Mechanism through which cardiac function continually deteriorates is still unclear.Cardiomyocytic apoptosis can occur in acute stage of ischemic heart diseases and the compensated stage of cardiac dysfunction.In this review,we summarize recent advances in understanding the role of cardiomyocytic apoptosis in heart failure.
Cardiorenal biomarkers in acute heart failure
Rajiv Choudhary,Dipika Gopal,Ben A. Kipper,Alejandro De La Parra Landa
老年心脏病学杂志(英文版) , 2012,
Abstract: Managing patients with heart failure (HF) is a challenging task within itself, but the presence of associated worsening renal function can greatly increase mortality and morbidity. Early diagnosis and treatment is the key to prevent re-hospitalizations and reduce healthcare costs. Biomarkers have long been established as highly sensitive and specific tools in diagnosing and prognosticating patients with HF. Reflecting distinct pathophysiological events and ongoing cellular insult, biomarkers have been proven superior to conventional laboratory tests. Availability of better assays and rapid analysis has allowed the use of biomarkers as point-of-care tests in the emergency department and at the patient’s bed-side. Acute HF patients often go on to develop worsening renal function, termed as acute cardiorenal syndrome. The growing breadth of studies has shown the implications of combining multiple biomarkers to better chart outcomes and produce desirable results in such patients.
Childhood heart failure in Ibadan
IA Lagunju, SI Omokhodion
West African Journal of Medicine , 2003,
Abstract: One hundred consecutive admissions of children with a diagnosis of congestive cardiac failure to the paediatric department of the University College Hospital, Ibadan were evaluated during a 10-month period. They were aged 8 days to 12 years. They constituted 5.8% of the total paediatric admissions during the study period. The most frequent underlying causes of heart failure were acute lower respiratory tract infections (36%), intrinsic heart disease (31%) and severe anaemia (28%). Other less common causes of heart failure were renal disorders (3%) and septiceamia (2%). Heart failure remains a common problem encountered in emergency paediatric practice in Nigeria, with the majority of cases resulting from preventable causes.
Diastolic heart failure in the elderly
Jeffrey H Barsuk,William G Cotts,
Jeffrey H. Barsuk
,William G. Cotts

老年心脏病学杂志(英文版) , 2006,
Abstract: Heart failure with preserved left ventricular function is a common problem among elderly patients.Given that diastolic heart failure(DHF)occurs in up to 50% of all heart failure admissions,and that incidence increases with age,knowledge of current recommendations for its diagnosis and treatment are extremely important for the elderly population.Causes of DHF include the aging process itself,hypertension,left ventricular hypertrophy,aortic stenosis,and hypertrophic obstructive cardiomyopathy.The patient with DHF may present with signs and symptoms similar to those observed in systolic heart failure.Treatment goals for the patient with DHF include achieving normal volume status,improving relaxation of the left ventricle,regression of hypertrophy if possible,and management of any co-morbidities that may aggravate the clinical status of patients with DHF.Hopefully,in the future,further data from randomized clinical trials will allow a more defined approach to care in these patients.
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