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Related Concept Videos

Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Imbalances in Cardiac Output01:26

Imbalances in Cardiac Output

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The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
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Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

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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 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 Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

332
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
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Factors affecting Blood pressure01:28

Factors affecting Blood pressure

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Several physiological and lifestyle factors influence blood pressure (BP). Understanding these factors is crucial as they are significant in patient education and blood pressure management.
Physiological Factors:
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Related Experiment Video

Updated: Jun 18, 2025

Author Spotlight: Assessing Surgical Frailty with Point-of-Care Ultrasound of Quadriceps Muscles
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Author Spotlight: Assessing Surgical Frailty with Point-of-Care Ultrasound of Quadriceps Muscles

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Risk Factors for All-Cause Mortality in Patients Diagnosed with Advanced Heart Failure: A Scoping Review.

Palvinder Kaur1, Pradeep Paul George1, Sheryl Ng Hui Xian1

  • 1Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore.

Journal of Palliative Medicine
|July 31, 2024
PubMed
Summary

Identifying high-risk patients with advanced heart failure (AdHF) is crucial for timely palliative care. This review identified risk factors and prognostic models for AdHF, aiming to improve patient-centered care and survival prediction.

Keywords:
all-cause mortalityend-of-lifeend-stage heart failurepalliative careprognosticationunmet needs

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Area of Science:

  • Cardiology
  • Palliative Care
  • Health Services Research

Background:

  • Advanced heart failure (AdHF) patient needs are evolving, necessitating better risk stratification for timely palliative care referrals.
  • Limited prognostic models exist specifically for end-stage heart failure (HF) populations.
  • Accurate risk assessment facilitates individualized, patient-centered care and improves outcomes.

Purpose of the Study:

  • To identify risk factors associated with up to three-year all-cause mortality (ACM) in AdHF patients.
  • To describe prognostic models developed or validated in AdHF populations.
  • To inform timely palliative care referrals and enhance patient management strategies.

Main Methods:

  • A scoping review was conducted following the Arksey, O'Malley, and Levac framework.
  • Searched multiple databases (Medline, EMBASE, PubMed, CINAHL, Cochrane, Web of Science) and gray literature (Jan 2010-Sep 2020).
  • Included primary studies on adults (≥18 years) with AdHF (NYHA Class III/IV, AHA/ACC Stage D), assessing risk factors for ACM using multivariate analysis.

Main Results:

  • 167 risk factors for up to three-year ACM and prognostic models were identified across 65 articles (low-to-moderate bias).
  • Studies were predominantly from Western/European cohorts, in acute care settings, and derived from clinical trials.
  • Ten prognostic models showed acceptable performance (AUC: 0.71-0.81), with MELD-XI and ADHF/proBNP models demonstrating highest short-term ACM discrimination (AUC: 0.81).

Conclusions:

  • Several risk factors and prognostic models for AdHF patients are available, though research is primarily Western-centric and acute care-focused.
  • The MELD-XI and ADHF/proBNP models show promise for predicting short-term ACM in AdHF.
  • Further research is needed to develop and validate prognostic models reflecting the current AdHF management landscape for timely palliative care integration.