1,721,343 research outputs found
Do pharmacological differences among beta-blockers affect their clinical efficacy in heart failure?
No full textMedical training and mini-Delphi approach to implement heart failure treatment with mineralocorticoid receptor antagonists
No full textBackground. Mineralocorticoid receptor antagonists (MRAs) are a class of drugs still underused in heart failure with reduced ejection fraction. Hyperkalemia, worsening of renal function and gynecomastia are the main causes of the MRA missed prescription but also an inadequate knowledge of this class of drugs may represent a reason for their underuse. The aim of this project was to evaluate the possible usefulness of a unique and innovative web-based platform in order to identify the main issues related to the underuse of MRAs and to discuss shared strategies of interventions to overcome the obstacles to MRA prescription. Methods. The “HF Clinical Practice project” enrolled 55 hospital cardiologists. It was based on the development and production of the eCaseTrack platform which was capable of activating a content-sharing system between professionals and specialists, using a mixed-methods study consisting of a survey, shared clinical experiences, training and consensus mini-Delphi method. Results. The results of the survey showed that the respondents substantially agreed about the criteria for MRA prescription (NYHA class, left ventricular ejection fraction, glomerular filtration rate and serum potassium). This agreement was confirmed by mini-Delphi, by which the use of MRAs in patients with hypotension, hyperkalemia and gynecomastia emerged as the most controversial issue. Conclusions. A web-based system of sharing clinical experiences and discussing controversial issues, is useful to implement the introduction of a proven efficacious therapeutic strategy which is still underused in current clinical practice
La ridefinizione e management dello scompenso cardiaco: le nuove Linee Guida, differenze tra Europa ed USA
No full textInfestazione da Toxoplasmosi gondii e malattia coronarica: approccio sieroepidemiologico.
No full textThe evolving care of the elderly with heart failure: from the 'high-tech' to the 'high-touch' approach.
No full textRelationship between exercise tolerance and spirometric data in a group of patients affected by idiopathic cardiomyopathy
No full textTriple/quadruple therapy in heart failure: integrating scientific evidence with clinical reasoning
No full textAnti-neurohormonal pharmacological agents successfully tested in randomized controlled trials over the last two decades - firstly angiotensin-converting enzyme inhibitors (ACE-I), then beta-blockers (BB) and more recently aldosterone receptor-antagonists (ARA) and angiotensin II receptor blockers (ARB) - have significantly contributed to increase the chance of favorable outcomes in patients with chronic heart failure. An ACE-I and a BB, usually combined with diuretics and often with digoxin, continue to represent the cornerstones for the treatment of heart failure; moreover, most patients who are taking these drugs are now expected to receive as add-on therapies also an ARA and/or an ARB. However, as the number of available drugs increases coupled with the hope of greater clinical benefits, these more complicated pharmacological options are destined to generate even more controversy. Now, much debate is over to which triple (ACE-I + BB + ARA or ARB) and quadruple (ACE-I + BB + ARA + ARB) therapies may be offered. Current guidelines do not fully address the aim of providing straightforward guidance about what should be the third drug of the triple therapy and as to whether or not quadruple therapy may have any role in the present-day heart failure management. Adapting any pharmacological strategy--based upon both scientific evidence and clinical reasoning--to the specific profile of the individual patient can be helpful to circumvent uncertainties and errors in daily practice of medicine and make the best use of currently available drugs
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