Articles: treatment.
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Dtsch. Med. Wochenschr. · Feb 2025
[Unstable heart failure: practical guidelines for avoiding frequent hospital admissions].
Heart failure is the leading cause of hospital admissions in Germany. The prevention of hospitalizations due to heart failure has recently improved, encompassing guideline-based basic therapy, targeted medication escalation options, and structured outpatient care incorporating telemedicine. An early identification of parameters that precede or indicate acute heart failure is crucial. ⋯ It is recommended to start or up-titrate guideline-recommended medical therapy and additionally initiate treatment with the soluble guanylate cyclase stimulator Vericiguat in patients with heart failure with a reduced ejection fraction. Initiation and up-titration should begin during hospitalization and should be completed during careful follow-up within the first 6 weeks after discharge. This guide provides recommendations for the comprehensive and coordinated treatment of worsening heart failure, considering all these aspects which are crucial for improving patient outcomes.
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Whether the large effect size of endovascular thrombectomy (EVT) for stroke due to large-vessel occlusion applies to stroke due to medium-vessel occlusion is unclear. ⋯ Endovascular treatment for acute ischemic stroke due to medium-vessel occlusion within 12 hours did not lead to better outcomes at 90 days than usual care. (Funded by the Canadian Institutes for Health Research and Medtronic; ESCAPE-MeVO ClinicalTrials.gov number, NCT05151172.).
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There are no useful treatments to prevent the development of severe complications of liver cirrhosis. Simvastatin and rifaximin have shown beneficial effects in liver cirrhosis. ⋯ The addition of simvastatin plus rifaximin to standard therapy does not improve outcomes in patients with decompensated liver cirrhosis.
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Endovascular treatment (EVT) of stroke with large-vessel occlusion is known to be safe and effective. The effect of EVT for occlusion of medium or distal vessels is unclear. ⋯ In persons with stroke with occlusion of medium or distal vessels, EVT did not result in a lower level of disability or a lower incidence of death than best medical treatment alone. (Funded by the Swiss National Science Foundation and others; DISTAL ClinicalTrials.gov number, NCT05029414.).