scholarly journals Current Therapeutic Options for Heart Failure in Elderly Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
F. Guerra ◽  
M. Brambatti ◽  
M. V. Matassini ◽  
A. Capucci
Keyword(s):  
Public Health ◽  
Heart Failure ◽  
Clinical Trial ◽  
General Population ◽  
Elderly Patients ◽  
Public Health Problem ◽  
Developed Countries ◽  
High Morbidity ◽  
Exclusion Criteria ◽  
Specific Patient

Heart failure (HF) is a major and growing public health problem with high morbidity and mortality (Ponikowski et al., 2016). It affects 1-2% of the general population in developed countries, and the average age at diagnosis is 76 years. Because of a better management of acute phase and comorbidities, HF incidence is increasing in elderly patients, with a prevalence rising to 10% among people aged 65 years or older (Mozaffarian et al., 2014). Therefore, a substantial number of elderly patients need to be treated. However, because of clinical trial exclusion criteria or coexisting comorbidities, currently recommended therapies are widely based on younger population with a much lower mean age. In this review, we will focus on available pharmacological, electrical, and mechanical therapies, underlining pros, cons, and practical considerations of their use in this specific patient population.

scholarly journals SARS-CoV-2 Seroprevalence among Healthcare Workers in General Hospitals and Clinics in Japan

2021 ◽  
Vol 18 (7) ◽  
pp. 3786
Author(s):  
Tatsuya Yoshihara ◽  
Kazuya Ito ◽  
Masayoshi Zaitsu ◽  
Eunhee Chung ◽  
Izumi Aoyagi ◽  
...  
Keyword(s):  
Public Health ◽  
Social Support ◽  
General Population ◽  
Severe Acute Respiratory Syndrome ◽  
Immunoglobulin G ◽  
Health Problem ◽  
Healthcare Workers ◽  
Public Health Problem ◽  
General Hospitals ◽  
Second Wave

Coronavirus disease 2019 (COVID-19) has become a serious public health problem worldwide. In general, healthcare workers are considered to be at higher risk of COVID-19 infection. However, the prevalence of COVID-19 among healthcare workers in Japan is not well characterized. In this study, we aimed to examine the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies among 2160 healthcare workers in hospitals and clinics that are not designated to treat COVID-19 patients in Japan. The prevalence of SARS-CoV-2 immunoglobulin G was 1.2% in August and October 2020 (during and after the second wave of the pandemic in Japan), which is relatively higher than that in the general population in Japan (0.03–0.91%). Because of the higher risk of COVID-19 infection, healthcare workers should be the top priority for further social support and vaccination against SARS-CoV-2.

Ventricular arrhythmias in seniors with heart failure: present dilemmas and therapeutic considerations: a systematic review

2021 ◽  
Vol 17 ◽  
Author(s):  
Tuoyo O Mene-Afejuku ◽  
Abayomi O Bamgboje ◽  
Modele O Ogunniyi ◽  
Ola Akinboboye ◽  
Uzoma N Ibebuogu
Keyword(s):  
Heart Failure ◽  
Ventricular Arrhythmias ◽  
Public Health Problem ◽  
Developed Countries ◽  
Cardiac Resynchronization ◽  
Cochrane Library ◽  
Global Public Health ◽  
Device Therapy ◽  
Ventricular Ejection Fraction ◽  
The Usa

Background: Heart failure (HF) is a global public health problem which affects over 23 million people worldwide. The prevalence of HF is higher among seniors in the USA and other developed countries. Ventricular arrhythmias (VAs) account for 50% of deaths among patients with HF. We aim to elucidate on the factors associated with VAs among seniors with HF, as well as therapies that may improve outcomes. Methods: PubMed, Web of Science, Scopus, Cochrane Library databases, Science Direct, and Google Scholar were searched using specific key words. The reference lists of relevant articles were searched for additional studies related to HF and VAs among seniors as well as associated outcomes. Results: The prevalence of VAs increases with worsening HF. 24-hour Holter electrocardiogram may be useful in risk stratifying patients for device therapy if they do not meet the criterion of low ventricular ejection fraction. Implantable cardiac defibrillators (ICDs) are superior to anti-arrhythmic drugs in reducing mortality in patients with HF. Guideline directed medical therapy (GDMT) together with device therapy to reduce symptoms may be required. In general, the proportion of seniors on GDMT is low. A combination of ICDs and cardiac resynchronization therapy may improve outcomes in select patients. Conclusion: Seniors with HF and VAs have a high mortality even with the use device therapy and GDMT. The holistic effect of device therapy on outcomes among seniors with HF is equivocal. More studies focused on seniors with advanced HF as well as therapeutic options is therefore required.

scholarly journals Smoking in Latin America: a major public health problem

1998 ◽  
Vol 14 (suppl 3) ◽  
pp. S109-S115 ◽  
Author(s):  
Vera Luiza da Costa e Silva ◽  
Sergio Koifman
Keyword(s):  
Public Health ◽  
Latin America ◽  
Latin American ◽  
Health Problem ◽  
Public Health Problem ◽  
Lung Cancer Mortality ◽  
Developed Countries ◽  
Major Public Health Problem ◽  
Tobacco Epidemic ◽  
Latin American Countries

Smoking has become a major public health problem in Latin America, and its scope varies from country to country. Despite difficulties in obtaining methodologically consistent data for the region, we analyzed the results from prevalence surveys in 14 Latin American countries. Smoking prevalence among men varied from 24.1% (Paraguay) to 66.3% (Dominican Republic) and among women from 5.5% (Paraguay) to 26,6% (Uruguay). By applying point prevalence data to the stage model of the tobacco epidemic in developed countries, we concluded that the Latin American countries are in stage 2, i.e., with a clearly rising prevalence among men, a prevalence for women that is beginning to increase, and mortality attributable to smoking among men still not reflecting peak prevalence. None of the countries analyzed appeared to have reached stage 3, in which one observes a downward trend in prevalence of smoking among men and peak prevalence among women, with broad impact on tobacco-related mortality. The only exception appears to be Paraguay, which is still emerging from stage 1, i.e., with low prevalence rates among men, too. Nevertheless, high lung cancer mortality rates in Uruguay and Argentina are comparable to those of the developed countries.

P6321Therapeutic optimization and inclusion in rehabilitation and education programs depend on age in chronic heart failure. A report of the French survey OFICSel

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Broussier ◽  
E Berthelot ◽  
M Kharoubi ◽  
G Barnabas ◽  
L Bonnefous ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cardiovascular Risk ◽  
Elderly Patients ◽  
Cardiovascular Risk Factors ◽  
De Novo ◽  
Public Health Problem ◽  
Therapeutic Education ◽  
Major Public Health Problem ◽  
Education Programs

Abstract Background Heart Failure (HF) is a major public health problem resulting in high rates of hospitalization and mortality. Frequency of HF increase due to the aging of population and improvement of treatments. Therefore, we hypothetized that elderly is a factor that might limit access to appropriate HF Care. Purpose and methods Our aim was to analyzed the optimization therapy and participation in rehabilitation and education programs depending according to classes of age (<40 years, 40–50; 50–60; 60–70; 70–80 and >80) in a large French HF population (out and in-patients, de novo/chronique/acute; consultation/hospitalization/rehabilitation; all LVEF classes and any type of cardiologist practice). Data were analized according to age groups Results A total of 2729 HF patients from 79 French departments were included of whom 36% were out patients, 53% were in-patients and 11% were in rehabilitation center. 16% were de novo Chronic HF and 31% were in Acute HF. Elderly patients were more frequently included in acute HF. Main data according on classes of age are presented in the table. Ischemic etiology and valvular diseases increased with age (p<0.0001). Cardiovascular risk factors (HTA, hypercholesterolemia) and atrial fibrillation were more frequent with ageing (p<0.0001). Beta-blockers, angiotensin converting enzyme inhibitors, and anti-aldosterone, were less prescribed after 60 years old (p<0.0001) as therapeutic education or rehabilitation programs (p<0.0001). Modern means of communication (e-mail, smartphone and internet) were less used by elderly patients.(p<0.0001). Main data according on classes of age Characteristics All (n=2729) <40 (n=91) 40–50 (n=197) 50–60 (n=447) 60–70 (n=706) 70–80 (n=715) >80 (n=573) p SBP 120±21 107±15 117±21 117±21 118±21 122±20 126±22 <0.0001 NYHA Class <0.0001   I 339 (13.8) 16 (19.3) 42 (23.5) 87 (21.4) 103 (16.1) 57 (8.8) 34 (6.7)   II 1187 (48.2) 45 (54.2) 95 (53.1) 213 (52.3) 311 (48.5) 314 (48.4) 209 (41.3)   III 763 (31.0) 20 (24.1) 34 (19.0) 97 (23.8) 199 (31.0) 206 (31.7) 207 (40.9)   IV 176 (7.1) 2 (2.4) 8 (4.5) 10 (2.5) 28 (4.4) 72 (11.1) 56 (11.1) LVEF 36 (29–50) 33 (26–44) 35 (25–45) 35 (25–42) 35 (25–45) 40 (30–50) 44 (32–55) <0.0001 NTproBNP 1808 (690–4323) 1176 (569–2434) 737 (294–1945) 1072 (346–2611) 1480 (619–3597) 2287 (1015–5689) 3275 (1500–6240) <0.0001 Plus-minus values are means ± SD, n (%) median (IQR). Origin of patients according on classes Conclusion Elderly patients receive less Chronic HF treatment, and are less included in patient education and rehabilitation program despite having more comorbidities and cardiovascular risk factors. Thus, to improve outcome, the health care system needs to be adapt to the patients'age. Acknowledgement/Funding SFC, CNCF, CNCH, FFC, Alliance du coeur, GERS, SNSMCV

Bleeding and Other Presentations in Thai Patients with Dengue Infection

2004 ◽  
Vol 10 (4) ◽  
pp. 397-398 ◽  
Author(s):  
Viroj Wiwanitkit
Keyword(s):  
Public Health ◽  
Gastrointestinal Tract ◽  
General Population ◽  
Health Problem ◽  
Clinical Presentation ◽  
Dengue Infection ◽  
Public Health Problem ◽  
Chief Complaint ◽  
Major Public Health Problem ◽  
Bleeding Manifestation

Dengue infection is a major public health problem, affecting the general population in Southeast Asia. Hematologic aberrations in dengue infection include atypical lymphocytosis, coagulopathy, and predominant thrombocytopenia. Bleeding and other presentations in 30 Thai patients with dengue infection during an endemic season (2003) are presented. A review of the clinical presentation of these patients was performed. All had fever as a chief complaint. The three most common complaints were fever (100%), vomiting (90%), and cough (90%), respectively. Concerning bleeding, only eight cases (26.6%) had signs of bleeding. Those manifestations included petechiae (seven cases, 23.3%) and melena (one case, 3.3%). Skin bleeding (petechiae) due to thrombocytopenia is the most common bleeding manifestation in dengue infection. However, physicians should not overlook bleeding from other less common sites such as the gastrointestinal tract and genitourinary tract.

scholarly journals Exclusion Criteria of Breast Cancer Clinical Trial Protocols: A Descriptive Analysis

2021 ◽  
Author(s):  
Clara Wan ◽  
Nicole E. Caston ◽  
Stacey A. Ingram ◽  
Gabrielle B. Rocque
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Clinical Trial ◽  
Congestive Heart Failure ◽  
Descriptive Analysis ◽  
Comorbid Conditions ◽  
Cns Metastases ◽  
Exclusion Criteria ◽  
Eligibility Criteria ◽  
Laboratory Values

Abstract Purpose3% of US adults with cancer are enrolled in a clinical trial due to various barriers to enrollment. The purpose of this study is to evaluate the variability of eligibility criteria, which currently have no standard guidelines. MethodsThis descriptive analysis utilized all therapeutic breast protocols offered at the University of Alabama at Birmingham between 2004-2020. Exclusion criteria were abstracted using OnCore and ClinicalTrials.gov. Laboratory values included liver function tests and hematologic labs. Comorbid conditions included congestive heart failure, cardiovascular disease, central nervous system (CNS) metastases, and prior cancer history. Comorbid conditions were further analyzed by amount of time protocols required participants to be from diagnosis or exacerbation-free. Results102 protocols were eligible. Among liver laboratory values, bilirubin (78%) was included in most protocols ranging from institutional upper limit of normal (ULN) (9%) to 3xULN (2%), with 1.5xULN (56%) being most common. Similar variability was observed in alanine transaminase and aspartate transaminase. Among hematological labs, 82% of protocols defined a lower limit of acceptable absolute neutrophil count ranging from 500μL (1%) to 1,800μL (1%), with 1,500μL (64%) being most common. Of the comorbid conditions, exclusion criteria varied for congestive heart failure (49%), an acute exacerbation of cardiovascular disease (80%), CNS metastases (59%) and a prior cancer (66%). The allowable timeframe varied between protocols for cardiovascular disease and prior cancer. ConclusionSubstantial heterogeneity was observed across laboratory values and comorbid variables among protocols. Future research should focus on defining standardized eligibility criteria while allowing for deviation based on drug specificity.

scholarly journals Diuretic treatment in chronic heart failure

2016 ◽  
Vol 11 (2) ◽  
pp. 155-159
Author(s):  
Camelia C. DIACONU ◽  
◽  
Alice BĂLĂCEANU ◽  
Mihaela Adela IANCU ◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Diuretic Therapy ◽  
Medical Science ◽  
Clinical Manifestations ◽  
Public Health Problem ◽  
Developed Countries ◽  
The Body ◽  
Major Public Health Problem ◽  
Important Place ◽  
Central Pillar

Heart failure is a major public health problem in developed countries. Many of the clinical manifestations of heart failure are due to congestion and fluid retention, therefore diuretic therapy occupied for a long time an important place in the management of these patients. All diuretics increase the excretion of water from the body, each of the classes of diuretics achieving this effect in a distinct manner. Given the magnitude of their effect, loop diuretics are the central pillar of diuretic therapy in many patients with heart failure. Resistance to diuretic therapy is one of the management issues for medical science, which is looking for solutions.

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