Clinical Characteristics Of Heart Failure Research Articles

The nature of heart failure as a challenge to the integration of palliative care services

Despite its increasing prevalence and high mortality risk, heart failure is widely regarded as 'treatable'. Aggressive measures are employed even in its end stages. This review explores the clinical characteristics of heart failure, patterns of clinician response, and new data that may help to surmount current barriers to palliative approaches. The 'treatment imperative' that has helped to reduce overall cardiovascular mortality marginalizes palliative approaches in heart failure. The possibility of dying remains unacknowledged, and communication about palliative options tends not to occur. Both the apparently benign nature of heart failure and its inherent unpredictability discourage end-of-life considerations. Recent studies, however, provide evidence that these barriers may be surmountable, and also furnish tools to help with prognosis. A true heart failure continuum including palliative care would be desirable, although structural barriers exist. Therapeutic successes have encouraged clinicians to pursue heart failure treatment through the end stages of disease. These very successes, however, have made the course of advanced heart failure easier to predict. What is needed now is courage among clinicians to open early dialog about disease process, prognosis and palliative options with the growing number of patients with advanced disease.

Race-related differences in heart failure therapies: Simply black and white or shades of grey?

The magnitude of burden imposed by heart failure on society has necessitated the evolution of innovative strategies to identify specific avenues of treatment and the populations at highest risk. Multiple studies have demonstrated a higher burden of cardiovascular disease in black Americans. It has also been shown that the clinical characteristics of heart failure, therapeutic targets, and response to various treatment modalities, are different in blacks as compared with whites. This article explores the unique race-related differences in heart failure with particular emphasis on the currently recommended therapeutic agents in heart failure.

Clinical characteristics of nursing home residents hospitalized with heart failure.

The purpose of this retrospective study was to describe the clinical characteristics of heart failure among nursing home residents hospitalized with heart failure and determine the validity of dyspnea at rest in the diagnosis of heart failure. Subjects were nursing home residents hospitalized with a diagnosis of heart failure. Data on demographic and various admission characteristics were collected by chart abstraction. Proportions of patients presenting with various symptoms and signs of heart failure have been described. The diagnosis of heart failure was confirmed using modified Framingham criteria. The sensitivity, specificity, and positive predictive value of the symptom of dyspnea at rest in the diagnosis of heart failure in nursing home residents hospitalized with heart failure were then estimated. Patients (N = 98) were elderly, predominantly female and about one-fifth African-American. Dyspnea at rest was the presenting symptom of 85 (87%) patients. Sixty-eight (69%) patients met modified Framingham criteria for the diagnosis of heart failure. Dyspnea at rest had a sensitivity of 91%, specificity of 23%, and predictive value positive of 73% for diagnosis of heart failure. Dyspnea at rest was the most common symptom among this cohort of nursing home residents hospitalized with heart failure and has a potential to play a useful role in the diagnosis of heart failure in these patients.

Survival rates are similar between African American and white patients with heart failure

Background The clinical characteristics of heart failure differ significantly between African American patients and white patients, apparently as a result of differences in the pathobiology of the condition in the races. We investigated the hypothesis that race also influences the survival of patients with heart failure. Methods Data from the University of North Carolina Heart Failure Database were analyzed for 853 patients (44% African American, 32% women) who had symptomatic heart failure (New York Heart Association class 2.8 ± 0.02 [mean ± SEM]) with a reduced left ventricular ejection fraction of 26% ± 0.5% and a body mass index of 27 ± 0.2. Data on vital status were available in 96.4% of these patients, with a mean length of follow-up of 3.8 ± 0.1 years. Results An unadjusted univariate proportional-hazards analysis suggested similar survival rates between African American patients and white patients in the study population (relative risk, 0.90; 95% CI, 0.73-1.10; P = .293). Adjusted analysis, taking into account the characteristics shown to be of prognostic importance, demonstrated no difference in survival rate between African American patients and white patients (relative risk,1.12; 95% CI, 0.89-1.42; P = .336). The adjusted relative risk of all-cause mortality in the respective races among patients with heart failure caused by ischemic heart disease was 1.21 (95% CI, 0.80-1.84; P = .367). Conclusion African American and white patients with symptomatic heart failure had similar survival rates in our database.

Clinical Characteristics of Nursing Home Residents Hospitalized with Heart Failure

Objective The purpose of this retrospective study was to describe the clinical characteristics of heart failure among nursing home residents hospitalized with heart failure and determine the validity of dyspnea at rest in the diagnosis of heart failure. Methods Subjects were nursing home residents hospitalized with a diagnosis of heart failure. Data on demographic and various admission characteristics were collected by chart abstraction. Proportions of patients presenting with various symptoms and signs of heart failure have been described. The diagnosis of heart failure was confirmed using modified Framingham criteria. The sensitivity, specificity, and positive predictive value of the symptom of dyspnea at rest in the diagnosis of heart failure in nursing home residents hospitalized with heart failure were then estimated. Results Patients (N = 98) were elderly, predominantly female and about one-fifth African-American. Dyspnea at rest was the presenting symptom of 85 (87%) patients. Sixty-eight (69%) patients met modified Framingham criteria for the diagnosis of heart failure. Dyspnea at rest had a sensitivity of 91%, specificity of 23%, and predictive value positive of 73% for diagnosis of heart failure. Conclusion Dyspnea at rest was the most common symptom among this cohort of nursing home residents hospitalized with heart failure and has a potential to play a useful role in the diagnosis of heart failure in these patients. The purpose of this retrospective study was to describe the clinical characteristics of heart failure among nursing home residents hospitalized with heart failure and determine the validity of dyspnea at rest in the diagnosis of heart failure. Subjects were nursing home residents hospitalized with a diagnosis of heart failure. Data on demographic and various admission characteristics were collected by chart abstraction. Proportions of patients presenting with various symptoms and signs of heart failure have been described. The diagnosis of heart failure was confirmed using modified Framingham criteria. The sensitivity, specificity, and positive predictive value of the symptom of dyspnea at rest in the diagnosis of heart failure in nursing home residents hospitalized with heart failure were then estimated. Patients (N = 98) were elderly, predominantly female and about one-fifth African-American. Dyspnea at rest was the presenting symptom of 85 (87%) patients. Sixty-eight (69%) patients met modified Framingham criteria for the diagnosis of heart failure. Dyspnea at rest had a sensitivity of 91%, specificity of 23%, and predictive value positive of 73% for diagnosis of heart failure. Dyspnea at rest was the most common symptom among this cohort of nursing home residents hospitalized with heart failure and has a potential to play a useful role in the diagnosis of heart failure in these patients.

Clinical Characteristics of Nursing Home Residents Hospitalized with Heart Failure

<h3>Objective</h3> The purpose of this retrospective study was to describe the clinical characteristics of heart failure among nursing home residents hospitalized with heart failure and determine the validity of dyspnea at rest in the diagnosis of heart failure. <h3>Methods</h3> Subjects were nursing home residents hospitalized with a diagnosis of heart failure. Data on demographic and various admission characteristics were collected by chart abstraction. Proportions of patients presenting with various symptoms and signs of heart failure have been described. The diagnosis of heart failure was confirmed using modified Framingham criteria. The sensitivity, specificity, and positive predictive value of the symptom of dyspnea at rest in the diagnosis of heart failure in nursing home residents hospitalized with heart failure were then estimated. <h3>Results</h3> Patients (N = 98) were elderly, predominantly female and about one-fifth African-American. Dyspnea at rest was the presenting symptom of 85 (87%) patients. Sixty-eight (69%) patients met modified Framingham criteria for the diagnosis of heart failure. Dyspnea at rest had a sensitivity of 91%, specificity of 23%, and predictive value positive of 73% for diagnosis of heart failure. <h3>Conclusion</h3> Dyspnea at rest was the most common symptom among this cohort of nursing home residents hospitalized with heart failure and has a potential to play a useful role in the diagnosis of heart failure in these patients.

Failure of Platelet Parameters and Biomarkers to Correlate Platelet Function to Severity and Etiology of Heart Failure in Patients Enrolled in the EPCOT Trial

Data from small studies have suggested the presence of platelet abnormalities in patients with congestive heart failure (CHF). We sought to characterize the diagnostic utility of different platelet parameters and platelet-endothelial biomarkers in a random outpatient CHF population investigated in the EPCOT (‘Whole Blood Impedance Aggregometry for the Assessment of Platelet Function in Patients with Congestive Heart Failure’) Trial. Blood samples were obtained for measurement of platelet contractile force (PCF), whole blood aggregation, shear-induced closure time, expression of glycoprotein (GP) IIb/IIIa, and P-selectin in 100 consecutive patients with CHF. Substantial interindividual variability of platelet characteristics exists in patients with CHF. There were no statistically significant differences when patients were grouped according to incidence of vascular events, emergency revascularization needs, survival, or etiology of heart failure. Aspirin use did not affect instrument readings either. PCF correlates very poorly with whole blood aggregometry (r² = 0.023), closure time (r² = 0.028), platelet GP IIb/IIIa (r² = 0.0028), and P-selectin (r² = 0.002) expression. Furthermore, there was no correlation with brain natriuretic peptide concentrations, a marker of severity and prognosis in heart failure reflecting the neurohumoral status. Patients with heart failure enrolled in the EPCOT Trial exhibited a marginal, sometimes oppositely directed change in platelet function, challenging the diagnostic utility of these platelet parameters and biomarkers to serve as useful tools for the identification of platelet abnormalities, for predicting clinical outcomes, or for monitoring antiplatelet strategies in this population. The usefulness of these measurements for assessing platelets in the different clinical settings remains to be explored. Taken together, opposite to our expectations, major clinical characteristics of heart failure did not correlate well with the platelet characteristics investigated in this study.