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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
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
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L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
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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
36. Basic Science
37. Miscellanea
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Early reevaluation after acute heart failure: Experience from a dedicated clinic
Session:
Posters 5 - Écran 6 - Insuficiência Cardíaca
Speaker:
Gonçalo José Lopes Da Cunha
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.6 Acute Heart Failure - Clinical
Session Type:
Posters
FP Number:
---
Authors:
Gonçalo Lopes Da Cunha; Bruno Rocha; Rita Ventura Gomes; Rui Morais; Luis Campos; Susana Quintão; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Background:</strong></p> <p>Heart failure (HF) is an increasingly prevalent syndrome, with high morbidity, mortality and burdening costs. About half of the direct costs are due to hospitalizations. According to the European registries, 30-day hospitalization rate is approximately 25%. Patients are at increased risk for readmission within this period, the so-called vulnerable phase. The European Society of Cardiology guidelines recommend early reevaluation in order to reduce HF readmissions. However, evidence supporting the benefits of such strategy is yet scarce. Therefore, we aimed to study the usefulness of post-discharge early reevaluation of our HF management program.</p> <p><strong>Methods:</strong></p> <p>This was a single-center retrospective cohort study enrolling consecutive patients admitted to an acute HF unit due to decompensated HF from May to August 2018.</p> <p><strong>Results:</strong></p> <p>A total of 53 patients were admitted to the HF unit with acute decompensation. Thirty-one (58%) were male, mean age was 77 ± 11 years and most had ischemic (35,8%) or hypertensive (26,4%) HF. Reduced, mid-range and preserved ejection fraction was observed in 55,7%, 7,7% and 36,5% of the cases, respectively. Acute phenotypes were as follows: wet and warm in 89%, wet and cold in 9% and dry and cold in 2%. During hospital stay, 2 patients were transferred and 5 died. Of the remaining 46 patients, 86,9% were referred to our early reevaluation HF management program. Two patients missed this appointment, thus being excluded from further analysis. When assessing the remaining 44 patients, mean time to day Hospital re-evaluation was 11,7 ± 4,6 days. On the first appointment, 18 (41%) were congestive, of which 50% received intravenous furosemide. Their mean weight gain from discharge to evaluation was 3,0 ± 2,0Kg. Patients were again compensated after a median time of 7 ± 17 days and 2,0 ± 2,0 appointments, with a 51,0 ± 40,7% increase of mean oral dose of furosemide, i.e., 43 ± 31,6mg compared to the previous dose. The rate of HF readmissions at 30-days was 0%.</p> <p><strong>Conclusions:</strong></p> <p>Almost half of the patients were congestive at early reevaluation, of which roughly half needed IV diuretics for compensation before definite oral dose readjustment. These findings emphasize the importance of early post discharge reevaluation for adequate stabilization of HF during the vulnerable phase, thus reducing re-hospitalizations.</p>
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