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Precipitating factors leading to decompensation of chronic heart failure in the elderly patient in South-American community hospital

Diaz Alejandro,Ciocchini Cleto,Esperatti Mariano,Becerra Alberto,Mainardi Sabrina,Farah Alejandro,

老年心脏病学杂志(英文版) , 2011,
Abstract: Background Exacerbations of heart failure appear frequently associated with precipitating factors not directly related to the evolution of cardiac disease. There still a paucity of data on the proportional distribution of precipitating factors specifically in elderly patients. The aim of this study was to examine prospectively the precipitating factors leading to hospitalization in elderly patients with heart failure in our community hospital. Methods We evaluate elderly patients who need admissions for decompensate heart failure. All patients were reviewed daily by the study investigators at the first 24 h and closely followed-up. Decompensation was defined as the worsening in clinical NYHA class associated with the need for an increase in medical treatment (at minimum intravenously diuretics). Results We included 102 patients (mean age 79 ± 12 years). Precipitating factors were identified in 88.5%. The decompensation was sudden in 35% of the cases. Noncompliance with diet was identified in 52% of the patients, lack of adherence to the prescribed medications amounted to 30%. Others precipitating factors were infections (29%), arrhythmias (25%), acute coronary ischemia (22%), and uncontrolled hypertension (15%), miscellaneous causes were detected in 18% of the cases (progression of renal disease 60%, anemia 30% and iatrogenic factors 10%). Concomitant cause was not recognizable in 11.5%. Conclusions Large proportion heart failure hospitalizations are associated with preventable precipitating factors. Knowledge of potential precipitating factors may help to optimize treatment and provide guidance for patients with heart failure. The presence of potential precipitating factors should be routinely evaluated in patients presenting chronic heart failure.
Precipitating factors leading to decompensation of chronic heart failure in the elderly patient in South-American community hospital
Alejandro Diaz,Cleto Ciocchini,Mariano Esperatti,Alberto Becerra
老年心脏病学杂志(英文版) , 2011,
Abstract: Background Exacerbations of heart failure appear frequently associated with precipitating factors not directly related to the evolution of cardiac disease. There still a paucity of data on the proportional distribution of precipitating factors specifically in elderly patients. The aim of this study was to examine prospectively the precipitating factors leading to hospitalization in elderly patients with heart failure in our community hospital. Methods We evaluate elderly patients who need admissions for decompensate heart failure. All patients were reviewed daily by the study investigators at the first 24 h and closely followed-up. Decompensation was defined as the worsening in clinical NYHA class associated with the need for an increase in medical treatment (at minimum intravenously diuretics). Results We included 102 patients (mean age 79 ± 12 years). Precipitating factors were identified in 88.5%. The decompensation was sudden in 35% of the cases. Noncompliance with diet was identified in 52% of the patients, lack of adherence to the prescribed medications amounted to 30%. Others precipitating factors were infections (29%), arrhythmias (25%), acute coronary ischemia (22%), and uncontrolled hypertension (15%), miscellaneous causes were detected in 18% of the cases (progression of renal disease 60%, anemia 30% and iatrogenic factors 10%). Concomitant cause was not recognizable in 11.5%. Conclusions Large proportion heart failure hospitalizations are associated with preventable precipitating factors. Knowledge of potential precipitating factors may help to optimize treatment and provide guidance for patients with heart failure. The presence of potential precipitating factors should be routinely evaluated in patients presenting chronic heart failure.
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.
Heart failure in the elderly

de Freitas Elizabete Viana,Batlouni Michel,Gamarsky Roberto,

老年心脏病学杂志(英文版) , 2012,
Abstract: The aging of the population is, currently, a major phenomenon, drawing the attention of a number of investigators. The significant increase of life expectancies over the past few decades, in addition to social and economic consequences, has lead to a major change in the morbidity and mortality profile of elders. Heart failure (HF) is a condition in which the heart can not pump enough blood to meet the body's needs. HF is predominantly a disorder of the elderly with rates increasing exponentially. The prevalence of HF approximately doubles with each decade of life. As people live longer, the occurrence of HF rises, as well as other conditions that complicate its treatment. Impaired heart function implies a reduced duration of survival. Fortunately, many factors that can prevent HF and improve outcome are known and can be applied at any stage. This review emphasizes the importance of factors inherent in aging itself. Focusing on heart disease, particularly as a disease of aging, can help critically refine management of this acute and chronic disease, as well as foster preventive strategies to reduce the incidence of this common malady.
Heart failure in the elderly
Elizabete Viana de Freitas,Michel Batlouni,Roberto Gamarsky
老年心脏病学杂志(英文版) , 2012,
Abstract: The aging of the population is, currently, a major phenomenon, drawing the attention of a number of investigators. The significant increase of life expectancies over the past few decades, in addition to social and economic consequences, has lead to a major change in the morbidity and mortality profile of elders. Heart failure (HF) is a condition in which the heart can not pump enough blood to meet the body's needs. HF is predominantly a disorder of the elderly with rates increasing exponentially. The prevalence of HF approximately doubles with each decade of life. As people live longer, the occurrence of HF rises, as well as other conditions that complicate its treatment. Impaired heart function implies a reduced duration of survival. Fortunately, many factors that can prevent HF and improve outcome are known and can be applied at any stage. This review emphasizes the importance of factors inherent in aging itself, focusing on heart disease, particularly as a disease of aging, can help critically refine management of this acute and chronic disease, as well as foster preventive strategies to reduce the incidence of this common malady.
Markers of severity of heart failure in the elderly  [PDF]
Antonia Macarie,Valer Donca,?tefan C. Vesa
Human & Veterinary Medicine , 2009,
Abstract: Objective: To determine the possible correlation of NYHA classification with clinical andparaclinical parameters in elderly diagnosed with heart failure. Material and methods: Patients agedover 65 years, diagnosed with heart failure, were included in study. Clinical data, biochemical markersand imagistic parameters were determined, and the presence or absence of comorbidities was noted.Results: A number of 178 patients were included in study. In univariate analysis, NYHA classificationwas associated with: orthopnea, jugular venous distention, rales, bilateral ankle edema, pleuraleffusion, hepatomegaly, atrial fibrillation, estimated glomerular filtration rate (eGFR), blood ureanitrogen (BUN), C-reactive protein (CRP), high-density lipoprotein cholesterol (HDL-cholesterol), andleft ventricle ejection fraction (LVEF). The multivariate analysis showed the independent markerslinked to NYHA classification: presence of orthopnea (p<0.001), bilateral ankle edema (p=0.05),chronic kidney disease (p=0.05), high levels of CRP (p=0.04) and altered LVEF (p=0.02). Conclusion:Orthopnea, bilateral ankle edema, renal dysfunction, inflammation and low LVEF are correlated withNYHA classification.
Quality of life in elderly heart failure patients
Kathleen L Grady,Kathleen Halvey,
Kathleen L. Grady
,Kathleen Halvey

老年心脏病学杂志(英文版) , 2006,
Abstract: Quality of life(QOL),as a relevant area of research in the understanding of heart failure(HF)patient outcomes,has been increasingly studied during the last two decades.The purposes of this review article are to (1)describe QOL in older adults with HF,(2) identify and critique research designed to test interventions to improve QOL,(3)identify gaps in the literature,and (4)provide recommendations for future research.Seventeen studies describing QOL in older adults with HF were identified.Elderly HF patient QOL has been reported to be fair to poor and is worse as compared to a healthy control group.Furthermore,there is some evidence that suggests that QOL is better in older adults than younger adults and worse in women(both older and younger)than in men,although these findings are not consistent across studies.Predictors of QOL and its dimensions in older HF patients included demographic,clinical,and psychosocial variables.Sixteen interventional studies were identified that reported QOL as an outcome in older adults.Findings among randomized clinical trials(RCTs)to improve QOL outcomes in elderly HF patients do not allow strong conclusions about the benefits of the interventions.It must be noted,though,that while not all studies reported improvements in QOL(either significant or as a trend), no studies reported deterioration in QOL with randomization to an intervention versus control.These studies were limited by several methodological issues.While there has been some research of QOL in this elderly cohort,it is paramount that we address methodological issues and thereby improve the scientific rigor of our research,continue to explore QOL in elderly HF patients,and design intervention trials for elders at risk for poor QOL.
Hope in elderly adults with chronic heart failure. Concept analysis
Caboral,Meriam F.; Evangelista,Lorraine S.; Whetsell,Martha V.;
Investigación y Educación en Enfermería , 2012,
Abstract: this topic review employed walker and avant's method of concept analysis to explore the construct of hope in elderly adults with chronic heart failure. the articles analyzed revealed that hope, as the belief of the occurrence of a positive result without any guarantee that it will be produced, is necessary for the survival and wellbeing of the elderly adults enduring this disease.
Heart failure in very elderly population - a profile of heart failure in patients over the age of eighty
Heart failure in very elderly population-a profile of heart failure in patients over the age of eighty

Christopher VChien,Dani Hackner,Ernst R Schwarz,
Christopher V. Chien
,Dani Hackner,Ernst R. Schwarz

老年心脏病学杂志(英文版) , 2007,
Abstract: Objective Heart failure is an epidemic in the elderly, but there is a striking lack of data in this clinically important patient population. We investigated the demographics, cardiac performance, and medication management of a segment of the hospital popula-tion in at least their eighth decade of life. Methods We retrospectively reviewed 75 records of heart failure patients who were 80 years of age or older. Records were reviewed for demographic information, presence or absence of diastolic dysfunction, evaluation of ejection fraction, and medication usage including angiotensin-concerting enzyme (ACE) inhibitors, angiotensin receptor antagonists (ARBs), beta-adrenergic blockers, digoxin, and aldosterone antagonists. Assessment for contra-indications to ACE inhibitor or ARBs use was also performed to assess co-morbidities that limit treatment of heart failure. Results The population of very elderly with heart failure is heterogeneous. We found a higher proportion of females as well as higher rates of diastolic dysfunction in patients aged > 90 years compared to patients between the ages of 80-89 years. Usage of ACE inhibitors, ARBs and beta-adrenergic blockers was strikingly low throughout the very elderly population. While co-morbid conditions limited use of agents in many cases, there was a lack of explicit centra-indication in most patients not on an ACE inhibitor or an ARB. Conclusions Heart failure is not a single disease processes, but a continuum of disease processes that vary with age. The elderly with heart failure are an undertreated population, in part due to the multitude of co-morbidities that affect them. Further prospective studies are needed to better understand the physiology and ideal treatment regiment in this growing population.
Comparative study of quality of life after hospital-at-home or in-patient admission for acute decompensation of chronic heart failure  [PDF]
Angel García-Soleto, Naiara Parraza-Diez, Felipe Aizpuru-Barandiaran, Fernando Aros-Borau, Humberto Mendoza-Ruiz de Zuazu, María Jesús Martin-Gudino, Jose Regalado de los Cobos
World Journal of Cardiovascular Diseases (WJCD) , 2013, DOI: 10.4236/wjcd.2013.31A025
Abstract:

AIMS: Hospitalisation at home (HaH) achieves comparable health outcomes to conventional in-patient care, in terms of cost-effectiveness and quality of life. Our objective was to assess the impact of episodes of acute decompensation of heart failure (ADCHF) on functional status and quality of life, in patients under HaH care compared with a matched group receiving conventional in-patient care at a Cardiology ward (CW). Methods: Randomised clinical trial in 71 patients with ADCHF attending the Emergency Department. Patients were either admitted to the hospital’s CW or to the HaH service. The functional status and health related quality of life (HRQOL) were assessed using the Barthel Index (BI) and the EQ-5D, Short Form-36 (SF-36) and Minnessota Living with Heart Failure (MLHFQ) questionnaires, administered at admission and, depending on the test, at discharge and 1, 3, 6 and 12 months after discharge. Results: MLHFQ and SF-36 experienced significant improvement in most domains with respect to the initial values at discharge and 6 months after only in the HaH group; though by 12-months there were no significant differences. Barthel Index and EQ-5D value scores showed improvement with respect to initial values in both arms. The improvement could be appreciated in more components and for longer among the HaH patients. Conclusions: Functional independence and quality of life improve at discharge compared to admission, after both home-based and in-patient hospitalisation, outcomes being better in various respects over the first year of follow-up after hospital-at-home care.

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