Heart failure


 

The management of chronic in Italy: focus on the heart failure.

Chest pain is one of the most common and complicated symptoms for which patients rush to emergency sectors; on the basis of any spread project this is cause of the 5-7% of admissions. The chest pain includes a great variety ofsensations, starting from the less serious arriving to those with high risk for patient's life, but only a low percentage of patients who present this symptom, has an acute coronary syndrome. So, it's obvious the importance of defining the clinical methods appropriate to the identification of associated situations with a high morbidity and mortality.  This process must be typical of efficacy in the stratification of patients at risk and speed of execution, to steer the patient with acute coronary syndrome towards the most appropriate reperfusion treatment in Instensive Cardiological Care Unit that is to exclude the coronary origin of the pain and to steer them towards other diagnostic itineraries or to dismiss them in moderated periods (12-24 hours).

 

Cardial deficiency update.

The cardial deficiency in Europe has a prevalence on general population of the 2-3% while in the age group 70-80 years-old: 10-20%. But, in younger age brackets the biggest prevalence is found in male (because of a greater effect of ischemic heart disease) and for the 50% during the old age.

In general population we can observe an increasing of prevalence and bearing of cardial deficiency because of ageing, a growth of survival after an acute coronary syndrome, success of secondary prevalence.

The innovations that can be found in the field of care of cardial deficiency are surely in assessment, the pharmacological therapy (stage C) with ACE-I, antagonistic of angiotensin II's receptor, diuretics, beta-blockers, digoxin and hydralanzine-isosorbide diethylene.

As regards the non-pharmacological therapy (stage C) we can observe cardiac resynchronization, physiotherapy, telemonitoring, while, as regards the acute cardiac decompensation we have mechanical non-invasive ventilation,NESIRITIDE, antagonistics of vasopressin's receptor and phosphodiesterase's inhibitors.

Finally, in cases of  terminal cardial deficiency (stage D), ultrafiltration, supportive mechanical circulatory,  heart transplant and stem cell transplant.

 

Cardiovascular continuum: from hypertensive patients to patients with cardial deficiency.

The growth of incidence and prevalence of cardiovascular and metabolic diseases and relating mortality outlines a public health problem, with an economic impact in the field of the use of diagnostic-therapeutic treatments, in a background characterized by a lack of resources. We need an implementation of  disease management process, turned to pertinence of care, efficacy, harmony, continuity of the care and cost-effectiveness. Primary care and general medicine assume a crucial role in cardiovascular prevention and in the improvement of public health.

 

Cardial deficiency's epidemiology

In this field, during the third millennium these characteristic have been noticed:

• Increasing prevalence and effect;

• Difficult limitation of working aptitude;

• Heavy helpful charge in terms of diagnostic, medicines and hospitalization;

• High morbidity and mortality;

• High economic and social cost.

But above all:

• Prevalence: about 5.000.000 individuals; 0.4/2.7%; 6/10% (aged 65-90);

• Effect: 400/700.000 new cases every year;

• Hospitalization prevalence: 1 million/ year (about 250.000 in the 90's)

• Mortality: 80% men, 65% women after 6 years from the diagnosis.

 

Non-pharmacological therapy for cardial deficiency

In addition to pharmacological, surgical and invasive treatment, an alternative exists and it's represented by the substitution of the renal system (ultrafiltration, haemofiltration, haemodiafiltration and dialysis), which should be taken into account only in selected patients and in specific clinical condition; now the European guidelines consider these treatments laid down respectively, acute cardial deficiency patients with severe renal impairment and immune salt retention to the therapy and in the chronic forms to treat fluid overload  (pulmonary or external oedema) immune to the diuretic therapy.

The other non-pharmacological treatment used, is the non-invasive ventilator support (NIV) indicated by the guidelines 

that is to exclude the coronary origin of the pain and to steer them towards other diagnostic itineraries or to dismiss them in moderated periods (12-24 hours).

 

Cardial deficiency update.

The cardial deficiency in Europe has a prevalence on general population of the 2-3% while in the age group 70-80 years-old: 10-20%. But, in younger age brackets the biggest prevalence is found in male (because of a greater effect of ischemic heart disease) and for the 50% during the old age.

In general population we can observe an increasing of prevalence and bearing of cardial deficiency because of ageing, a growth of survival after an acute coronary syndrome, success of secondary prevalence.

The innovations that can be found in the field of care of cardial deficiency are surely in assessment, the pharmacological therapy (stage C) with ACE-I, antagonistic of angiotensin II's receptor, diuretics, beta-blockers, digoxin and hydralanzine-isosorbide diethylene.

As regards the non-pharmacological therapy (stage C) we can observe cardiac resynchronization, physiotherapy, telemonitoring, while, as regards the acute cardiac decompensation we have mechanical non-invasive ventilation,NESIRITIDE, antagonistics of vasopressin's receptor and phosphodiesterase's inhibitors.

Finally, in cases of  terminal cardial deficiency (stage D), ultrafiltration, supportive mechanical circulatory,  heart transplant and stem cell transplant.

 

Cardiovascular continuum: from hypertensive patients to patients with cardial deficiency.

The growth of incidence and prevalence of cardiovascular and metabolic diseases and relating mortality outlines a public health problem, with an economic impact in the field of the use of diagnostic-therapeutic treatments, in a background characterized by a lack of resources. We need an implementation of  disease management process, turned to pertinence of care, efficacy, harmony, continuity of the care and cost-effectiveness. Primary care and general medicine assume a crucial role in cardiovascular prevention and in the improvement of public health.

 

Cardial deficiency's epidemiology

In this field, during the third millennium these characteristic have been noticed:

• Increasing prevalence and effect;

• Difficult limitation of working aptitude;

• Heavy helpful charge in terms of diagnostic, medicines and hospitalization;

• High morbidity and mortality;

• High economic and social cost.

But above all:

• Prevalence: about 5.000.000 individuals; 0.4/2.7%; 6/10% (aged 65-90);

• Effect: 400/700.000 new cases every year;

• Hospitalization prevalence: 1 million/ year (about 250.000 in the 90's)

• Mortality: 80% men, 65% women after 6 years from the diagnosis.

 

Non-pharmacological therapy for cardial deficiency

In addition to pharmacological, surgical and invasive treatment, an alternative exists and it's represented by the substitution of the renal system (ultrafiltration, haemofiltration, haemodiafiltration and dialysis), which should be taken into account only in selected patients and in specific clinical condition; now the European guidelines consider these treatments laid down respectively, acute cardial deficiency patients with severe renal impairment and immune salt retention to the therapy and in the chronic forms to treat fluid overload  (pulmonary or external oedema) immune to the diuretic therapy.

The other non-pharmacological treatment used, is the non-invasive ventilator support (NIV) indicated by the guidelines like a protection which has to be actualized at an early stage in case of  stabilization of the cardial deficiency with an acute pulmonary oedema, as well as in treatments for the sleep and obstructive apnoea, that often are associated with cardial deficiency's chronic phases.

Last but not least, we must remember that between non-pharmacological therapies the management strategies,  that, over the years, have acquired significance, since the majority of the studies have demostrated the efficacy in reducingthe number of rehospitalisations because of cardial deficiency, provided that the continuing assistance and a correct patient's education are made. In this regard the strategies which want the operation made by the nursing profession,  prove to be particularly efficient.