1,721,145 research outputs found
Training and mini-Delphi to implement heart failure treatment with mineralcorticoid receptor antagonists
No full text[Disease management system in patients with chronic heart failure]
No full textHealthcare managers are more and more interested in the role of general practitioners (GP) in the treatment of cardiovascular diseases. Continuing adjustments of the health organization are the old/new challenge in improving patient care. The European Society of Cardiology guidelines recommend a disease-management program for heart failure (HF); moreover, observational studies and randomized controlled trials have reported better patient outcomes if patients are in charge of cardiologists rather than GPs or other physicians. Patients with chronic HF are often very old and affected by multiple comorbid conditions, by themselves associated with high rates of morbidity and mortality. Furthermore, too many patients receive neither a correct diagnosis nor treatment until advanced disease occurs. New treatment approaches, some of them requiring the expertise of well-trained cardiologists, are ongoing to improve the clinical outcomes. The optimal management of patients with HF needs teamwork, i.e. GPs, cardiologists, nurses and caregivers, since a multidisciplinary program, only, can embody the best answer for outpatients with chronic HF. Currently, the Cardiovascular Center in Trieste is performing an experimental trial, so far never attempted before, in treating patients with chronic HF using a thorough approach with the full involvement of local cardiologists, GPs and nurses. Such approach is, at the same time, as well a challenge as an opportunity: a challenge because conventional clinical habits must be changed; an opportunity because patients can benefit from a proper whole care-group, aimed at prolonging life and reducing morbidity and symptoms
Correlation between histomorphometric findings and endomyocardial biopsy and clinical findings in idiopathic dilated cardiomyopathy
No full textMultivariate analysis was used to analyze the morphometric data of endomyocardial biopsies (area, perimeter and minor diameter) of myocardial cells obtained at light microscopy by a computerized approach with 16 clinical parameters and prognosis in 52 patients with idiopathic dilated cardiomyopathy. The best morphometric parameter was "area" (R2 = 0.47). A positive correlation was found with age (p less than 0.02), interval between first symptoms and diagnosis (p less than 0.02), left ventricular end-diastolic volume (p less than 0.02), cardiac index (p less than 0.05) and echocardiographic end-diastolic diameter (p less than 0.1). A negative correlation was found with prognosis (p less than 0.02), ejection fraction (p less than 0.02), shortening fraction (p less than 0.05), echocardiographic end-systolic diameter (p less than 0.06) and mitral regurgitation presence (p less than 0.1). The parameters that provided no correlation were New York Heart Association class, left ventricular end-diastolic pressure, right atrial pressure, cardiothoracic ratio, presence or absence of heart failure, fever or alcohol intake. These findings suggest that endomyocardial biopsy may provide prognostic information and confirm clinical diagnosis
Three dimensional printing of an atrial septal defect: Is it multimodality imaging?
No full textNoninvasive imaging plays a pivotal role in the diagnosis and management of congenital heart disease (CHD). Despite cardiac magnetic resonance (MRI) and computed tomography (CT) have gained particular importance, 2D transthoracic echocardiogram (TEE) and 3D trans- esophageal echocardiogram (TOE) still remain the work- houses of imaging routinely used in all and CHD patients; however 3D images could be challenging in some CHD patients and not being so informative. 3D printing tech- nology improvements have been tremendous over the last few years and several different 3D printing processes have
been invented in Medicin
Wavelet‐Mixed Landmark Survival Models for the Effect of Short‐Term Changes of Potassium in Heart Failure Patients
Full text linkStatistical methods to study the association between a longitudinal biomarker and the risk of death are very relevant for the long-term care of subjects affected by chronic illnesses, such as potassium in heart failure patients. Particularly in the presence of comorbidities or pharmacological treatments, sudden crises can cause potassium to undergo very abrupt yet transient changes. In the context of the monitoring of potassium, there is a need for a dynamic model that can be used in clinical practice to assess the risk of death related to an observed patient's potassium trajectory. We considered different landmark survival approaches, starting from the simple approach considering the most recent measurement. We then propose a novel method based on wavelet filtering and landmarking to retrieve the prognostic role of past short-term potassium shifts. We argue that while taking into account the smooth changes in the biomarker, short-term changes cannot be overlooked. State-of-the-art dynamic survival models are prone to give more importance to the smooth component of the potassium profiles. However, our findings suggest that it is essential to also take into account recent potassium instability to capture all the relevant prognostic information. The data used comes from over 2000 subjects, with a total of over 80,000 repeated potassium measurements collected through administrative health records. The proposed wavelet landmark method revealed the prognostic role of past short-term changes in potassium. We also performed a simulation study to assess how and when to apply the proposed wavelet-mixed landmark model
Continuità assistenziale ospedale-territorio per il paziente con scompenso cardiaco cronico: Una rivoluzione e una sfida nella cura ambulatoriale
No full textHealthcare managers are more and more interested in the role of general practitioners (GP) in the
treatment of cardiovascular diseases. Continuing adjustments of the health organization are the
old/new challenge in improving patient care. The European Society of Cardiology guidelines recommend
a disease-management program for heart failure (HF); moreover, observational studies and
randomized controlled trials have reported better patient outcomes if patients are in charge of cardiologists
rather than GPs or other physicians.
Patients with chronic HF are often very old and affected by multiple comorbid conditions, by
themselves associated with high rates of morbidity and mortality. Furthermore, too many patients receive
neither a correct diagnosis nor treatment until advanced disease occurs. New treatment approaches,
some of them requiring the expertise of well-trained cardiologists, are ongoing to improve
the clinical outcomes.
The optimal management of patients with HF needs teamwork, i.e. GPs, cardiologists, nurses and
caregivers, since a multidisciplinary program, only, can embody the best answer for outpatients with
chronic HF.
Currently, the Cardiovascular Center in Trieste is performing an experimental trial, so far never
attempted before, in treating patients with chronic HF using a thorough approach with the full involvement
of local cardiologists, GPs and nurses. Such approach is, at the same time, as well a challenge
as an opportunity: a challenge because conventional clinical habits must be changed; an opportunity
because patients can benefit from a proper whole care-group, aimed at prolonging life and
reducing morbidity and symptoms
Response to: “Direct oral anticoagulants, vitamin K antagonists and simple single tooth extraction”
No full textN/
Early Improvement of Functional Mitral Regurgitation in Patients With Idiopathic Dilated Cardiomyopathy
No full textThe aim of the study was to assess the clinical and prognostic impact of early functional mitral regurgitation (FMR) improvement on the outcome of patients with idiopathic dilated cardiomyopathy (IDC). The prevalence and prognostic role of FMR improvement, particularly at early follow-up, in patients with IDC are still unclear. From 1988 to 2009, we enrolled 470 patients with IDC with available FMR data at baseline and after 6 ± 2 months. According to the evolution of FMR, patients were classified into 3 groups: stable absent-mild FMR, early FMR improvement (downgrading from moderate-severe to absent-mild), and persistence/early development of moderate-severe FMR. At baseline, 177 of 470 patients (38%) had moderate-severe FMR. Patients with early FMR improvement had significantly better survival rate-free from heart transplant with respect to those with persistence/early development of moderate-severe FMR (93%, 81%, and 66% vs 91%, 64%, and 52% at 1, 6, and 12 years, respectively; p = 0.044). At 6-month follow-up multivariate analysis, FMR improvement was associated with better prognosis (hazard ratio 0.78, 95% confidence interval [CI] 0.64 to 0.96, p = 0.02); the other independent predictors were male gender, heart failure duration, and early re-evaluation of the New York Heart Association class and left ventricle systolic function. This model provided more accurate risk stratification compared with the baseline model (Net Reclassification Index 80% at 12 months and 41% at 72 months). In conclusion, in a large cohort of patients with IDC receiving optimal medical treatment, early improvement of FMR was frequent (53%) and emerged as a favorable independent prognostic factor with an incremental short- and long-term power compared with the baseline evaluation
- …
