Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association.

Heart failure is a common, costly, and debilitating syndrome that is associated with a highly complex drug regimen, a large number of comorbidities, and a large and often disparate number of healthcare providers. All of these factors conspire to increase the risk of heart failure exacerbation by direct myocardial toxicity, drug-drug interactions, or both. This scientific statement is designed to serve as a comprehensive and accessible source of drugs that may cause or exacerbate heart failure to assist healthcare providers in improving the quality of care for these patients.

Sleep and Heart Failure.

Sleep deprivation occurs for many reasons but, when chronic in nature, has many consequences for optimal health and performance. Despite its high prevalence, sleep-disordered breathing is underrecognized and undertreated. This is especially true in the setting of heart failure, where sleep-disordered breathing affects more than 50% of patients.

Society of chest pain centers: building better value into health care.

With initiation of VBP, acute care hospitals are rewarded based on how closely clinical guidelines and practices are followed and how well hospitals enhance patients' experiences. Thus, the VBP program requires reengineering of acute care processes. Patient-centered care must remain the focus of a rigorous curriculum of goals and metrics for acute care hospitals.

Innovative approach to improving the care of acute decompensated heart failure.

The care of patients presenting to hospitals with acute decompensated heart failure remains a challenging and multifaceted dilemma across the continuum of care. The combination of improved survival rates for and rising incidence of heart failure has created both a clinical and economic burden for hospitals of epidemic proportion. With limited clinical resources, hospitals are expected to provide efficient, comprehensive, and quality care to a population laden with multiple comorbidities and social constraints.

Continuous hemodynamic monitoring in patients with mild to moderate heart failure: results of The Reducing Decompensation Events Utilizing Intracardiac Pressures in Patients With Chronic Heart Failure (REDUCEhf) trial.

Clinical trial results support the hypothesis that implantable hemodynamic monitoring (IHM) systems may reduce hospitalizations among patients with chronic heart failure (HF). The Reducing Decompensation Events Utilizing Intracardiac Pressures in Patients With Chronic Heart Failure (REDUCE hf  ) study was a prospective, randomized, multicenter, single-blinded trial that enrolled patients with New York Heart Association class II or III symptoms, an indication for an implantable cardioverter-defibrillator (ICD), and a previous HF hospitalization. A combination IHM-ICD was implanted and patients were randomly assigned to a treatment group in which hemodynamic information was used or a control group in which hemodynamic information was not available.

The impact of educational message framing on adherence to continuous positive airway pressure therapy.

Although of proven health benefit to persons with obstructive sleep apnea (OSA), adherence to continuous positive airway pressure (CPAP) therapy is suboptimal, with patterns of use that are established early and that are not easily altered after the initial experience. In a randomized controlled trial, 70 participants with OSA and cardiovascular disease were assigned to receive either positively or negatively framed education about CPAP. Objective adherence was measured following 30 days of home CPAP therapy.

Cardiorenal dysfunction.

Left ventricular dysfunction and renal dysfunction are common chronic conditions that frequently coexist in the same individual, and both are associated with significant morbidity and mortality. Disorders in 1 organ generally lead to dysfunction in the other, and this bidirectional interaction serves as the pathophysiological basis for cardiorenal syndrome (CRS). Until recently, CRS has been neither well defined nor well understood, making its diagnosis and treatment challenging for clinicians.

Nesiritide in acute decompensated heart failure: a pooled analysis of randomized controlled trials.

Background: Previous randomized controlled trials (RCTs) evaluating nesiritide for the treatment of acute decompensated heart failure (ADHF) have reported wide variances in mortality hazard ratios for nesiritide vs controls, but these individual trials were neither designed nor powered to evaluate mortality. This study used relevant data from all RCTs of nesiritide in ADHF completed as of June 2006 to independently estimate the effect of nesiritide on 30- and 180-day mortality.

Hypothesis: Administration of nesiritide to treat patients with ADHF does not significantly increase mortality at 30 or 180 days.

Hemodynamic monitoring in heart failure: a nursing perspective.

Managing patients who have heart failure is challenging and requires the integration of inpatient and outpatient care. Until evidence from clinical trials of implantable hemodynamic monitors (IHMs) is available and approval from the Food and Drug Administration is received, the best available model seems to be telemonitoring in conjunction with a comprehensive heart failure disease management program. A number of issues, including established processes for data review and interpretation, must be addressed before IHMs are widely adopted and accepted.

Heart failure: a call to action.

A recent survey commissioned by The American Association of Heart Failure Nurses, The Preventive Cardiovascular Nurses Association, and The Society for Chest Pain Centers found that respondents had a striking lack of awareness and knowledge about heart failure. This article reviews the confusion and misperceptions surrounding heart failure, discusses implications of the survey findings, and offers suggestions for patients at risk for heart failure as well as professionals who work with these patients-including clinicians, researchers, and those in larger groups such as institutions and government bodies.

An integrated approach to managing sleep disordered breathing and cardiovascular disease.

Despite its prevalence, most cases of sleep disordered breathing (SDB) go unrecognized by the medical community, creating a mismatch between disease pervasiveness and medical appreciation of its impact. Of particular importance is that 30% of those with cardiovascular disease (CVD) have some type of sleep disorder. One explanation for this lack of recognition and under-appreciation is that common symptoms seen with SDB are non-specific and are present in many acute and chronic conditions.

Nursing considerations for the management of heart failure in the emergency department.

Despite a lack of trials examining the impact of educational interventions in the emergency department and observation unit, there is ample evidence in other health care settings supporting its use in the management of patients with heart failure. The challenge for the emergency department and observation unit nurse is to adapt these interventions to fit realistically within the fast-paced environment. This article addresses nursing considerations for the management of heart failure in the emergency department setting.

Effect of treatment with continuous positive airway pressure or oxygen on sleep-disordered breathing in patients with heart failure: results of the Sleep Events, Arrhythmias, and Respiratory Analysis in Chronic Heart Failure (SEARCH) study.

The response to sleep-disordered breathing (SDB)-directed therapy was evaluated using the Clear Path home-based monitoring system. There were 26 patients with heart failure enrolled in the Sleep Events, Arrhythmias, and Respiratory Analysis in Chronic Heart Failure (SEARCH) study with SDB requiring treatment (apnea-hypopnea index [AHI] >or=15 events/h). Patients were monitored using both standard polysomnography and the Clear Path system to determine the change in SDB parameters before and after initiation of therapy.

Using devices for physiologic monitoring in heart failure.

Heart failure (HF) is a complex and costly disease process associated with high morbidity and mortality. Implanted cardiac rhythm management devices are increasingly used in the HF population to provide therapies such as protection from sudden death and cardiac resynchronization therapy. Device-based diagnostic monitoring provides clinicians with information that can assist in identifying patients at risk for HF decompensation and subsequent hospitalization.

Relationship of heart failure patients' knowledge, perceived barriers, and attitudes regarding low-sodium diet recommendations to adherence.

The purposes of this study were to describe heart failure patient perceptions regarding instructions received for following a low-sodium diet and the benefits, barriers, and ease and frequency of following the diet. A total of 246 patients with heart failure referred from academic medical centers in the United States and Australia participated in the study. A subset of 145 patients provided 24-hour urine samples for sodium excretion assessment.

Sleep-disordered breathing, cognitive functioning, and adherence in heart failure: linked through pathology?

Heart failure (HF) is well recognized as a condition resulting from chronic neurohormonal activation. Sleep-disordered breathing (SDB) as a neurohormonal disorder is less recognized. In SDB, whether obstructive or central in nature, nightly repetitive cycles of hypoxia-reoxygenation produce intense sympathetic activation and deprive the body of much needed sleep.