虚弱性及其对心力衰竭的影响:对预后和治疗的影响
Khawaja M Talha1, Stephen J Greene2, Javed Butler3
1Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
Cardiology clinics
|September 24, 2023
概括
虚弱影响许多心力衰竭患者,增加死亡风险. 尽管存在担忧,但证据表明,心力衰竭疗法对脆弱患者是安全的,需要多学科的护理来优化治疗和改善生活质量.
科学领域:
- 心脏病学 心脏病学
- 老年病的医生 老年病的医生
- 内部医学 内部医学
背景情况:
- 虚弱性在心力衰竭中普遍存在,减少排气分数 (HFrEF),影响大约50%的患者.
- 脆弱性显著增加死亡风险 (约2倍),并恶化HFrEF结果由于双向关系.
- 脆弱的HFrEF患者通常因药物相关不良事件的安全性担忧而未得到充分治疗.
研究的目的:
- 评估指南导向医学疗法 (GDMT) 在HFrEF的脆弱患者的安全性和有效性.
- 突出在这个高风险人群中优化治疗策略的需要.
- 强调在管理脆弱的HFrEF患者时采用多学科方法的重要性.
主要方法:
- 关于脆弱性和HFrEF管理的现有证据和临床指南的审查.
- 对心力衰竭标准药物在脆弱的老年人中的安全性数据的分析.
- 讨论多学科护理模型,以优化GDMT.
主要成果:
- 目前的证据表明,标准的心力衰竭医学疗法对老年,脆弱的HFrEF患者是安全的.
- 对不良事件的担忧不应阻止在这个人群中使用有益的疗法.
- 在脆弱的HFrEF患者中优化GDMT是可行的,并且与改善生活质量有关.
结论:
- 虚弱性是HFrEF中显著的并发症,与增加的死亡率有关.
- 尽管存在风险,但心力衰竭治疗在脆弱的HFrEF患者中是安全和有效的.
- 以目标为导向的多学科方法对于优化治疗和改善脆弱HFrEF患者的生活质量至关重要.
相关概念视频
01:17Pathophysiology of Heart Failure
1.6K
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...
1.6K
01:30Heart Failure V: Medical Management
12
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...
12
01:30Heart Failure IV: Classification and Diagnostic Evaluation
19
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
19
01:27Heart Failure I: Introduction
14
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
14
01:29Heart Failure II: Pathophysiology
14
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
14
01:30Heart Failure VII: Nursing Interventions
89
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,...
89