Improving care for patients with acute heart failure: before, during and after hospitalization - Cowie - 2. ESC Heart Failure. Executive summary. For millions of people throughout the world, acute heart failure is a life- threatening medical emergency, and it is one of the most common reasons for admission to hospital. One in 1. 0 patients with acute heart failure dies in hospital, and one in three dies within the year following an episode. Despite advances in long- term care, no new treatments for acute heart failure have emerged during the past two decades. Demands on services and the need for treatment will rise as the number of people with heart failure increases in our ageing populations. It is time to address the needs of patients with acute heart failure by means of clear policy initiatives and rational redesign of patient management pathways and healthcare provision. Change at the policy level has the power to save lives and the potential for more efficient use of resources, as this report shows. The symptoms of acute heart failure are distinct from those of a heart attack. Breathlessness, fatigue, and swelling of the lower legs or ankles are surprisingly often not recognized by patients and clinicians as the life- threatening symptoms of declining heart function. The underlying causes of acute heart failure are varied, and patients exhibit different patterns and severity of symptoms. This means that many patients experience complex transitions between different healthcare providers and facilities. For patients who survive a first episode of acute heart failure, modern evidence- based treatments can reduce the risk of another episode but require careful management. These potentially life- saving treatments are often not prescribed appropriately on discharge from hospital, and about 2. Good management reduces readmission rates, improves survival rates, uses resources efficiently, and may reduce costs. It is time to ensure that excellent care becomes routine. We know that patients with heart failure are more likely to survive when treated and followed up by specialist cardiology units. Many patients with heart failure have other medical conditions, requiring treatment by a variety of specialists. Ensuring the best care in hospital involves a multidisciplinary team, supported and often led by an expert in heart failure. Excellent care involves developing and implementing guidelines and protocols for treatment and introducing a system of audits to ensure they are properly applied. When discharged from hospital, patients need a smooth and swift transition to follow- up care, as well as the right medications at the right doses. In addition, they need support and education to help them to engage actively in their own care, take the medications prescribed, and ensure that any future deterioration is identified quickly. The level of knowledge about heart failure is low among the general public, and even among patients. Surveys show that many patients who have had acute heart failure remain unable to recognize warning symptoms of future episodes. Education programmes directed at patients and the public could have a dramatic effect on improving outcomes for patients. By designing rational, evidence- based healthcare systems appropriate to each individual setting, the high standards of acute heart failure care already achieved in some hospitals and clinics could be made universal. Emerging information technology could support existing measures, by allowing remote monitoring of patients outside hospital and sharing of medical records among healthcare professionals. Where needed, access to end- of- life care and support for all patients, families, and caregivers should form part of a revitalized service. Continuing clinical research is needed to develop new medications and devices for acute heart failure in order to reduce death rates and improve patients' quality of life. However, it would be unwise merely to wait for new treatments. Much- needed changes in management, protocols, and procedures can and should be initiated now. Policy recommendations. Acute heart failure is a common and deadly disease that contributes to about 5% of all emergency hospital admissions in Europe and the USA. Numbers of admissions for heart failure are growing as its prevalence increases. Most patients with heart failure are over 7. Of patients aged under 7.
Original Article. Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer. Darby, Ph.D., Marianne Ewertz, D.M.Sc., Paul McGale, Ph.D. Treatment of dilated cardiomyopathy is essentially the same as treatment of chronic heart failure (CHF). CHF is a complex clinical syndrome for which many treatment. We therefore urge policy- makers at international, national, regional, and local levels to act on the following recommendations. Optimize care transitions. Better integration of hospital care, community care, and the emergency services will improve patient outcomes and enable more efficient use of resources. Currently, hospital admission and discharge planning are often poorly organized and inconsistently implemented, indicating a need for closer relationships among all those involved in patient care. Improve patient education and support. Better education and support for individuals with heart failure, and their families and caregivers, are essential to improve outcomes and patients' experience of care. Patients frequently lack the knowledge, confidence, and support to be actively involved in their own care, and their adherence to measures important for long- term health is often poor. Provide equity of care for all patients. All patients should have timely access to an appropriate range of diagnostic procedures, therapies, and long- term follow- up care. Currently, the quality of care varies considerably among hospitals, and across regions and countries. Appoint experts to lead heart failure care across disciplines. A multidisciplinary team led by a heart failure expert should oversee the care of patients with acute heart failure and the development of protocols, training, and local auditing to make excellent care the norm. Stimulate research into new therapies. Increased funding is needed for research into new and more effective therapies, medical devices, and care strategies for acute heart failure. New approaches are urgently required to address unmet needs. Develop and implement better measures of care quality. Performance measures based on robust, evidence- based clinical recommendations should be developed and used to improve the quality of care for patients with acute heart failure. Current performance measures are variable and lack an evidence base, and their use may have unintended consequences. Improve end- of- life care. Effective approaches to palliative and end- of- life care, addressing emotional and physical well- being, need to be made an integral part of the care of patients with heart failure, both in hospital and in the community. Promote acute heart failure prevention. Country- wide efforts to decrease risk factors for heart failure, including high blood pressure and coronary artery disease, should be intensified. Once heart failure develops, progression of the disease should be prevented or slowed by ensuring that appropriate evidence- based care is implemented promptly. Introduction and aims. This report summarizes the evidence and consensus findings from structured discussions among the author group, comprising clinicians and researchers, an advanced practice nurse, and the head of a patient action group, all with expertise and experience in the field of heart failure. The report presents the evidence base for eight policy recommendations aimed at improving care and preventing deaths of patients with acute heart failure. Heart failure is common, affecting around 1–2% of adults in developed countries. Acute heart failure is often a life- threatening event requiring urgent medical attention and can mark a transition to a more debilitating phase of the disease. Up to 1. 0% of patients with acute heart failure die in hospital, and 2. The acute episodes that typically punctuate chronic disease make increasing demands on healthcare resources. Finally, in the terminal stages of heart failure, patients may need end- of- life care. The number of people with heart failure is predicted to increase substantially over the coming decades, through a combination of an ageing population and increased survival of patients with heart problems, thanks to improved treatments. Hospitalizations for heart failure are predicted to rise substantially. In presenting the evidence, the following sections will Acute heart failure and the burden of disease. Key points. Acute heart failure is serious, requires urgent attention, and usually results in admission to hospital. Acute heart failure is characterized by breathlessness at rest or on exertion and by fluid retention, resulting in swollen ankles and legs. Heart failure is common—one in five people will develop it at some point—and it affects mainly older people, so patient numbers are increasing as the population ages. Heart failure can lead to social isolation, anxiety, and depression, as symptoms make patients less able to participate in work and in social and leisure activities. Management of acute heart failure makes extensive demands on healthcare resources, with many patients requiring repeated hospitalization. Despite continuing improvements, many patients with acute heart failure die in hospital or soon after leaving hospital, and most die within 5 years. What is acute heart failure? Acute heart failure is a life- threatening event requiring urgent medical attention. It is characterized by breathlessness (dyspnoea) at rest or on exertion and worsening fluid retention, apparent as lung congestion and/or swollen ankles and legs. Definitions of acute heart failure vary, with the European Society of Cardiology (ESC) treatment guidelines referring to the . This complexity makes heart failure difficult to define precisely. Definitions differ between the ESC, American College of Cardiology Foundation (ACCF)/American Heart Association (AHA), and National Heart Foundation of Australia treatment guidelines (Table 1), . Three of several accepted definitions of heart failure.
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