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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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A Structured Heart Failure Clinic: a comprehensive analysis to plan the future
Session:
CO5 - Insuficiência Cardíaca
Speaker:
Bruno M. Rocha
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Bruno M. Rocha; Gonçalo Lopes Da Cunha; Rita Gomes; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Background: </strong>Heart Failure (HF) clinics represent an opportunity to establish a structured follow-up for patients living with chronic HF. The main goals of this investigation were to (1) determine the features of stable HF with reduced (HFrEF), midrange (HFmrEF) and preserved ejection fraction (HFpEF); (2) evaluate the treatment and optimization of HFrEF as per the European Society of Cardiology (ESC) current guidelines on HF; and (3) investigate the interactive role of chronic HF appointment with the Day Hospital as a supportive structure.</p> <p><strong>Methods: </strong>This study is based on a single-center cohort enrolling consecutive patients evaluated at routine medical appointment from January to May 2018. The diagnosis and treatment rationale, i.e. optimal medical treatment (OMT), was based on the ESC recommendations on HF (2016).</p> <p><strong>Results: </strong>Of the overall cohort (n=256), most patients had HFpEF (53,1%) or HFrEF (28,1%). Those with HFpEF were found to be more often elderly (mean age 79,0 ± 13,0 years; p=0,001) with hypertensive etiology (44,0%; p<0,001) and had a higher rate of comorbidities. In contrast, those with HFrEF were significantly younger (73,0 ± 15,0 years; p=0,001) with more ischemic HF (59,7%; p<0,001). Those with HFmrEF had intermediate features. Patients with HFrEF were more often receiving angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or sacubitril-valsartan (84,5%), mineralocorticoid receptor antagonists (MRAs) (73,2%) and beta-blockers (90,1%). Furthermore, 27,5% of those with HFrEF were still on additional disease-modifying drug uptitration. Finally, at the day of the appointment, 10,5% of the overall cohort was sent to the Day Hospital, mostly referred to receive intravenous (IV) furosemide treatment (48,1%) due to decompensated HF, IV iron deficiency correction (37,1%), IV potassium or blood transfusion (14,8%). </p> <p><strong>Conclusions: </strong>In a dedicated specialized HF clinic, most patients were already on OMT or received further drug uptitration at the day of the appointment. As the expected benefit in HF is dose-dependent, additional strategies for timely uptitration can be considered. The Day Hospital could provide the means for such desirable goal. Notably, this structure is paramount for adequate HF care and allows several interventions at the day of the appointment, especially mandatory IV drugs (i.e., diuretics, iron and potassium), thus avoiding hospitalizations or emergency room visits and decreasing costs.</p>
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