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Related Concept Videos

Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

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Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
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Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
52
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

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Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
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Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response01:15

Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response

170
Circadian rhythms are cyclic changes that are crucial in plasma drug concentrations. Various standard circadian parameters, including core body temperature, heart rate, and other cardiovascular factors, directly impact disease states and the therapeutic response to drug therapy.
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
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Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

587
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Heart Failure VII: Nursing Interventions01:30

Heart Failure VII: Nursing Interventions

194
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
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Improving Diuretic Response in Heart Failure by Implementing a Patient-Tailored Variability and Chronotherapy-Guided

Ariel Kenig1, Yotam Kolben1, Rabea Asleh2

  • 1Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.

Frontiers in Cardiovascular Medicine
|August 30, 2021
PubMed
Summary

Diuretic resistance in heart failure poses challenges. A new machine learning model uses patient variability and chronotherapy to personalize diuretic dosing, aiming to improve treatment outcomes.

Keywords:
chronobiologydigital systemsdiuretic resistanceheart failurevariability

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Area of Science:

  • Cardiology
  • Pharmacology
  • Artificial Intelligence

Background:

  • Heart failure (HF) is a significant public health issue, with volume overload contributing substantially to morbidity.
  • Loop diuretics are essential for managing HF volume overload but face challenges due to variable patient response and diuretic resistance.
  • This variability impacts clinical outcomes and necessitates improved therapeutic strategies.

Purpose of the Study:

  • To review the mechanisms of diuretic resistance in heart failure.
  • To discuss the roles of the autonomic nervous system and chronobiology in HF and diuretic response.
  • To present a novel machine learning model for overcoming diuretic resistance through personalized chronotherapy.

Main Methods:

  • Review of existing literature on diuretic resistance, autonomic nervous system, and chronobiology in heart failure.
  • Development of a machine learning algorithm integrating clinical, laboratory, and sensor-derived data (including pulmonary artery measurements).
  • Algorithm incorporates inter- and intra-patient variability, biological clock alterations, and autonomic nervous system responses.

Main Results:

  • The proposed model aims to overcome diuretic resistance by tailoring diuretic dosage.
  • It utilizes a machine learning approach guided by chronotherapy and patient-specific variability.
  • The algorithm facilitates continuous, personalized dose adjustments for dynamic HF management.

Conclusions:

  • Diuretic resistance is a complex challenge in heart failure management.
  • A patient-tailored, chronotherapy-guided machine learning approach shows promise for optimizing diuretic therapy.
  • This novel model may lead to improved clinical outcomes by accommodating individual patient dynamics.