Journal of cardiac failure
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Comparative Study
Comparing Perspectives of Patients, Caregivers, and Clinicians on Heart Failure Management.
Although substantial effort has been devoted to reducing readmissions among heart failure (HF) patients, little is known about factors identified by patients and caregivers that may contribute to readmissions. The goal of this study was to compare the perspectives of HF patients, their caregivers, and their care team on HF management and hospital admissions. Understanding these perspectives may lead to better strategies for improving care during the post-hospital transition and for reducing preventable readmissions. ⋯ These findings highlight that although some similarities exist, there are important differences among patients, caregivers, and clinicians in how they perceive the challenges of HF management and reasons for readmission. Understanding these differences may be critical to developing strategies to reduce readmissions.
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Right ventricular failure (RVF) is a major cause of morbidity and mortality after CF-LVAD implantation. We explored the association of pulmonary artery compliance (PAC), pulmonary artery elastance (PAE), and pulmonary artery pulsatility index (PAPi) in addition to established parameters as preoperative determinants of postoperative RVF after CF-LVAD surgery. ⋯ PAPi is a simple hemodynamic variable that may help to identify patients at high risk of developing RVF after LVAD implantation.
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Intensification of Medication Therapy for Cardiorenal Syndrome in Acute Decompensated Heart Failure.
Worsening renal function in heart failure may be related to increased venous congestion, decreased cardiac output, or both. Diuretics are universally used in acute decompensated heart failure, but they may be ineffective and may lead to azotemia. We aimed to compare the decongestive properties of a urine output-guided diuretic adjustment and standard therapy for the management of cardiorenal syndrome in acute decompensated heart failure. ⋯ Compared with SDT, patients who received an intensification of medication therapy for treating persisting congestion had greater net fluid and weight loss without being associated with renal compromise.
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Assessment of vascular endothelial function lacks consistency, and microvascular endothelial function has been only partly assessed in heart failure with preserved ejection fraction (HFpEF). ⋯ Compared with hypertensive control subjects, patients with HFpEF had a depressed endothelial function in the forearm vasculature and microvasculature.
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A >30% N-terminal pro-B-type natriuretic peptide (NT-proBNP) reduction at discharge in acute decompensated heart failure (ADHF) predicts a favorable prognosis. To study the feasibility of guiding ADHF treatment by measuring NT-proBNP well before discharge, we assessed at which moment during hospitalization patients attain a NT-proBNP reduction of >30% (target) and whether this target is still attained at discharge. ⋯ A target >30% NT-proBNP reduction is gradually attained before discharge, and rebound NT-proBNP increases to levels off-target occur in up to 33% of ADHF patients who initially attained target early during admission.