Heart : official journal of the British Cardiac Society
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Therapeutic hypothermia (TH) is increasingly used in patients presenting with out-of-hospital cardiac arrest (OHCA). Such strategies derive from data that suggest TH may improve survival and attenuate adverse neurological outcomes associated with the cardiac arrest. Consequently, TH has been integrated into various guidelines for the management of OHCA and has become a focussed strategy, particularly in patients with ST-segment elevation myocardial infarction. ⋯ However, even here, trial data robustness has been questioned, with ongoing debate regarding the optimum temperature for managing patients with OHCA and optimal timing of its initiation. More uniform and robust guidelines for the application of TH for patients with OHCA are required, but can only be formulated on appropriately sized robust trials. This review examines the current status of TH.
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Review
Future care planning: a first step to palliative care for all patients with advanced heart disease.
Palliative care is recommended for patients with end-stage heart failure with several recent, randomised trials showing improvements in symptoms and quality of life and more studies underway. Future care planning provides a framework for discussing a range of palliative care problems with patients and their families. ⋯ Integrating cardiology care and palliative care can benefit many patients with advanced heart disease at increased risk of death or hospitalisation. Larger, randomised trials are needed to assess the impact on patient outcomes and experiences.
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Following the first reported case of thoracic endovascular aortic repair (TEVAR) in 1987, there has been rapid technological development and widespread uptake of this approach for thoracic aortic disease. TEVAR has particular advantages for acute thoracic syndromes and there is continuing development of TEVAR for use in the elective situation. This is still a young technology and many unknowns remain, including long-term outcomes and the relative advantages and disadvantages versus both conservative treatment and open surgical repair. The current uses of TEVAR in the treatment of aortic dissection, thoracic aortic aneurysm, penetrating aortic ulcer and trauma are discussed.