A Review of Prognostic Tools in Heart Failure

2017 ◽  
Vol 35 (3) ◽  
pp. 514-522 ◽  
Author(s):  
Jennifer Treece ◽  
Hrak Chemchirian ◽  
Neil Hamilton ◽  
Manar Jbara ◽  
Venkataramanan Gangadharan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Palliative Medicine ◽  
Poor Prognosis ◽  
Advanced Heart Failure ◽  
Improve Quality ◽  
Stage Disease ◽  
End Stage ◽  
Patients With Poor Prognosis

A minority of patients with end-stage disease are referred to palliative medicine for consultation in advanced heart failure. Educating stakeholders, including primary care, cardiology, and critical care of the benefits of hospice and palliative medicine for patients with poor prognosis, may increase appropriately timed referrals and improve quality of life for these patients. This article reviews multiple tools useful in prognostication in the setting of advanced heart failure.

scholarly journals Inotropes Are Not Linked to Increased Mortality in Heart Failure

2019 ◽  
Author(s):  
Maya Guglin
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Randomized Clinical Trials ◽  
Advanced Heart Failure ◽  
Current Evidence ◽  
Improve Quality ◽  
Organ Perfusion ◽  
Low Output Syndrome ◽  
Current Guidelines

How to use inotropes is one of the most controversial topics in the management of heart failure. While most clinicians use these drugs, and recognize the state of inotrope dependency, current guidelines recommend them onlu as a bridge or palliation. Thus, inotropes are considered either neutral or detrimental in terms of outcomes. Meanwhile, properly designed randomized clinical trials testing the outcomes on inotropes, have never been performed and it is unlikely that they will ever be attempted. These trials would require randomizing patients with advanced heart failure, low output syndrome, and impaired end-organ perfusion into groups that received or not received inotropes, or received inotropes or placebo. Many physicians would consider this design unethical so the trials would be challenging to implement. But if it is unethical to deny inotropes to this subset of patients, we have to admit that inotropes do not only improve quality of life, but prolong it, or decrease mortality. Otherwise, we consider it unethical to deny the medication which increases mortality. In this review, we analyze the current evidence relating to inotropes and outcomes. We demonstrate that the original trials were performed with agents that are no longer in use, or on patients without an indication for inotropes, or at a time before automatic cardio-defibrillators were recommended for primary prevention. We conclude that current guidelines for inotropes are misleading in their interpretation of outcomes in patients with advanced heart failure. The guidelines should be revised to adequately reflect the evidence.

scholarly journals THE INTREPID TRIAL – CAN MECHANCIAL CIRCULATORY SUPPORT REDUCE MORTALITY & IMPROVE QUALITY OF LIFE FOR END-STAGE HEART FAILURE PATIENTS?

ASAIO Journal ◽  
2002 ◽  
Vol 48 (2) ◽  
pp. 151
Author(s):  
Tofy Mussivand ◽  
Peer Portner ◽  
Debbie Jacobs ◽  
Michael Pasque ◽  
John Crouch ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Circulatory Support ◽  
Improve Quality ◽  
Heart Failure Patients ◽  
End Stage Heart Failure ◽  
End Stage

scholarly journals Advanced Heart Failure and End-Stage Heart Failure: Does a Difference Exist

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 170 ◽  
Author(s):  
Severino ◽  
Mather ◽  
Pucci ◽  
D’Amato ◽  
Mariani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Clinical Symptoms ◽  
Advanced Heart Failure ◽  
Correct Selection ◽  
Circulatory Support ◽  
Advanced Therapy ◽  
The Right ◽  
End Stage

Advanced heart failure (AdHF) represents a challenging aspect of heart failure patients. Because of worsening clinical symptoms, high rates of re-hospitalization and mortality, AdHF represents an unstable condition where standard treatments are inadequate and additional interventions must be applied. A heart transplant is considered the optimal therapy for AdHF, but the great problem linked to the scarcity of organs and long waiting lists have led to the use of mechanical circulatory support with ventricular-assist device (VAD) as a destination therapy. VAD placement improves the prognosis, functional status, and quality of life of AdHF patients, with high rates of survival at 1 year, similar to transplant. However, the key element is to select the right patient at the right moment. The complete assessment must include a careful clinical evaluation, but also take into account psychosocial factors that are of crucial importance in the out-of-hospital management. It is important to distinguish between AdHF and end-stage HF, for which advanced therapy interventions would be unreasonable due to severe and irreversible organ damage and, instead, palliative care should be preferred to improve quality of life and relief of suffering. The correct selection of patients represents a great issue to solve, both ethically and economically.

Virtual reality for pain management in advanced heart failure: A randomized controlled study

2021 ◽  
pp. 026921632110412
Author(s):  
Hunter Groninger ◽  
Diana Stewart ◽  
Julia M Fisher ◽  
Eshetu Tefera ◽  
James Cowgill ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Virtual Reality ◽  
Pain Management ◽  
Guided Imagery ◽  
Advanced Heart Failure ◽  
Controlled Study ◽  
Randomized Controlled ◽  
General Distress

Background: Hospitalized patients with advanced heart failure often experience acute and/or chronic pain. While virtual reality has been extensively studied across a wide range of clinical settings, no studies have yet evaluated potential impact on pain management on this patient population. Aim: To investigate the impact of a virtual reality experience on self-reported pain, quality-of-life, general distress, and satisfaction compared to a two-dimensional guided imagery active control. Design: Single-center prospective randomized controlled study. The primary outcome was the difference in pre- versus post-intervention self-reported pain scores on a numerical rating scale from 0 to 10. Secondary outcomes included changes in quality-of-life scores, general distress, and satisfaction with the intervention. Setting/participants: Between October 2018 and March 2020, 88 participants hospitalized with advanced heart failure were recruited from an urban tertiary academic medical center. Results: Participants experienced significant improvement in pain score after either 10 minutes of virtual reality (change from pre- to post −2.9 ± 2.6, p < 0.0001) or 10 minutes of guided imagery (change from pre- to post −1.3 ± 1.8, p = 0.0001); the virtual reality arm experienced a 1.5 unit comparatively greater reduction in pain score compared to guided imagery ( p = 0.0011). Total quality-of-life and general distress scores did not significantly change for either arm. Seventy-eight participants (89%) responded that they would be willing to use the assigned intervention again. Conclusion: Virtual reality may be an effective nonpharmacologic adjuvant pain management intervention in hospitalized patients with heart failure. Trial Registration: ClinicalTrials.gov database (NCT04572425).

scholarly journals CAPD to improve quality of life in patients with refractory heart failure

1998 ◽  
Vol 13 (12) ◽  
pp. 3041-3042 ◽  
Author(s):  
M. Elhalel-Dranitzki ◽  
D. Rubinger ◽  
A. Moscovici ◽  
Y. Haviv ◽  
M. Friedlaender ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Improve Quality ◽  
Refractory Heart Failure
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