Heart Failure Issues and Management: A European Perspective

Abstract

Heart failure poses an increasing problem for global health care systems. The epidemiological data which have been accrued over the last 30 years have predominantly been accumulated from experience within North America and Europe. The European experience in heart failure, although similar to that in North America, has recently demonstrated differences in hospitalization which may underlie the differences between health care system configurations. Despite the predicted increase in the number of patients affected by heart failure, over the last 30 years a clear management algorithm has evolved for the use of pharmacotherapies, device-based therapies, and mechanical therapies, including left ventricular assist devices and cardiac transplantation. Although the treatment of such patients has been clearly delineated in national and international guidelines, the underuse of all available and appropriate therapies remains a significant problem. The purpose of this review is to provide a European perspective on management of heart failure.

Comparison of the clinical characteristics and prognosis of primary versus secondary acute gastrointestinal injury in critically ill patients

“…The S group patients showed a higher prevalence of comorbidities, such as CHF, CVD, and COPD. Indeed, such comorbidities may potentially provoke AGI development: CHF reduces bowel perfusion and impairs function of the intestinal barrier [ 11 ], CVD results in GI stress and complications following stroke [ 12 ], and COPD patients often suffer hypoxia [ 13 ] which impairs gut mucosa perfusion and GI function [ 14 ]. In addition, the S-AGI patients were older and had decreased GI reserve, which made them highly sensitive to minor insults, and decompensation could rapidly occur [ 15 ].…”

A critical appraisal of the morphine in the acute pulmonary edema: real or real uncertain?

“…Interestingly, despite the tremendous burden of AHF on the medical system, few prospective randomized trials have been conducted to establish best care. Given the lack of good evidence to guide their practice, it is not surprising that many clinicians base their treatment decisions on their own experience, as well as the anecdotal reports provided by colleagues and instructors during their training (4). Often treatment must be administered in parallel with the diagnostic work-up.…”

“…Systolic blood pressure, heart rhythm and rate, saturation of peripheral oxygen using a pulse oximeter, and urine output should be monitored on a regular and frequent basis until the patient is stabilized. Although not 'evidence based' in the same way as treatments for chronic heart failure, the key drugs are oxygen, diuretics (furosemide, torasemide, hydrochlorothiazide, indapamide, spironolactone, eplerenone, amiloride and triamterene), and vasodilators (nitroglycerine and nitroprusside) (1,4).…”