Outpatient Management of Stable Heart Failure with Reduced Ejection Fraction
Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler in Heart Failure, 2022
The epidemic of heart failure is a major public health issue. Heart failure accounts for substantial morbidity and mortality in the world. In the United States, approximately 5 million people suffer from and 400,000 people are newly diagnosed with heart failure each year. The overall prevalence of heart failure is thought to be increasing due to aging of the population, improved management of other cardiovascular problems such as myocardial infarction, valvular heart disease, and arrhythmias. Fortunately, there are many therapies available to patients with heart failure with reduced ejection fraction, regardless of symptomatology. Careful consideration should be taken at every encounter to evaluate not only volume status but also optimize guideline directed medical therapy as well as device therapy. In this chapter we outline the indications, mechanism of action, dosing, and evidence behind the benefit of the currently available therapy for the management of outpatient heart failure with reduced ejection fraction.
Peripartum Cardiomyopathy and Heart Failure in Pregnancy
Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler in Heart Failure, 2022
Cardiovascular disease is a leading cause of pregnancy related deaths in the United States as well as the rest of the world. Peripartum cardiomyopathy and heart failure in pregnancy contribute to this mortality significantly, but can be difficult to diagnose, as the associated symptoms overlap with normal signs in pregnancy. Increased awareness and education can help discern between pathologic heart failure and physiologic symptoms of pregnancy. Continued advancement in diagnostic modalities, identifying risk factors, and exploring biological triggers that can be modified with therapy are integral to improving outcomes in this population of patients. Furthermore, awareness about a possible recurrence of heart failure with additional pregnancies is essential in providing comprehensive understanding of the disease.
Heart Failure with Recovered Ejection Fraction (HFrecEF) and Heart Failure with Midrange Ejection Fraction (HFmrEF)
Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler in Heart Failure, 2022
Heart failure (HF) research and guidelines have primarily focused on two major groups defined by left ventricular ejection fraction (LVEF)—HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). This chapter discusses two groups of patients with HF that have not been clearly addressed in the existing evidence base. HF with recovered ejection fraction (HFrecEF) refers to the subset of HF patients with low LVEF that subsequently improved to normal or near-normal LVEF. Heart failure with midrange EF (HFmrEF) refers to the subset of patients with HF and an LVEF in the border zone between HFpEF and HFrEF, currently defined as LVEF between 40% and 49%. This chapter reviews the characteristics, clinical course, and treatments of HFrecEF and HFmrEF. The topics discussed include the reliability of LVEF measurements, predictors of LVEF recovery, transitions in LVEF across categories including HFmrEF, and the heterogeneity of phenotypes within HFrecEF and within HFmrEF.
Current treatment of heart failure with reduction of left ventricular ejection fraction
Published in Expert Review of Clinical Pharmacology, 2016
ABSTRACT Introduction: Heart failure is the commonest cause of hospitalization and of rehospitalization This review paper is a comprehensive review of current treatment of heart failure in 2016. The target of this review is all health care professionals who treat patients with heart failure. Areas covered: This article discusses stages of heart failure, treatment of heart failure with general measures, and drug therapy with diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, aldosterone antagonists, isosorbide dinitrate plus hydralazine, digoxin, other neurohormonal antagonists, sacubitril/valsartan, calcium channel blockers, and ivabradine. This article also discusses treatment of heart failure with use of cardiac resynchronization therapy, implantable cardioverter-defibrillators, and surgical therapy, and management of end-stage heart failure. This paper was written after an extensive Medline search reviewing articles written from 1970 through May, 2016. Expert commentary: Our approach as physicians must emphasize prevention of heart failure as well as treating it. Risk factors for developing heart failure, especially hypertension, must be better controlled starting in childhood. I concur with the current heart failure treatment guidelines (Tables 1 and 2 in this paper).
Recognising heart failure in the dog and cat
Published in Veterinary Nursing Journal, 2010
A patient with heart failure can be a challenge to the veterinary nurse and clinician. Heart failure can be caused by venous congestion (congestive heart failure), arterial under-filling (low output heart failure), or a combination of both.
Growth hormone and testosterone in heart failure therapy
Published in Expert Opinion on Pharmacotherapy, 2010
Megha Agarwal, Jesse Naghi, Kiran Philip, Anita Phan, Robert D Willix Jr, Ernst R Schwarz
Importance of the field: Heart failure is a progressive disease affecting millions of people worldwide. The disease carries a significantly high morbidity and mortality risk. There are multiple pharmaceutical options to decrease this risk and prolong survival; however, despite optimization of medical management, several patients still await heart transplant, the only definitive cure for heart failure. To slow the progression of disease preventing need for transplantation, improve clinical symptoms, and improve heart failure outcomes, there is a persistent need to discover new therapeutic strategies. Of interest, low growth hormone and testosterone levels have been associated with a worsening degree of heart failure. Many studies have begun to show a clinical improvement in heart failure symptoms when these levels are corrected with hormonal therapy. These findings, although mixed, are promising and indicate that both testosterone and growth hormone therapy should be considered as adjunctive therapy in advanced heart failure patients. Areas covered in this review: This review discusses the physiology of both of these natural hormones, their therapeutic effects in heart failure and data from the published literature on studies using growth hormone or testosterone in patients with chronic heart failure. An extensive search of PubMed was conducted for topics on heart failure, growth hormone, insulin-like growth factor, testosterone, their physiology and pathophysiology, and trials in which they have been used as therapeutic interventions between 1989 and 2009. What the reader will gain: The reader will gain an understanding of the intricate balance of both of these hormones in the disease state of heart failure. In addition, the trials conducted using these hormones in pharmacotherapy for heart failure are discussed along with proposed theories for interstudy variability. Take home message: Testosterone deficiency and growth hormone resistance are positively associated with a poor state of heart failure. Treatment of deficiency improves outcomes in heart failure; however, there is a significant paucity of data with regard to testosterone and heart failure as well as a significant amount of study variability with growth hormone and heart failure.
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