scholarly journals Short-Term Therapies for Treatment of Acute and Advanced Heart Failure—Why so Few Drugs Available in Clinical Use, Why Even Fewer in the Pipeline?

2019 ◽  
Vol 8 (11) ◽  
pp. 1834 ◽  
Author(s):  
Piero Pollesello ◽  
Tuvia Ben Gal ◽  
Dominique Bettex ◽  
Vladimir Cerny ◽  
Josep Comin-Colet ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Elderly Population ◽  
The Elderly ◽  
Development Project ◽  
Advanced Heart Failure ◽  
Clinical Use ◽  
New Agents ◽  
The Moment

Both acute and advanced heart failure are an increasing threat in term of survival, quality of life and socio-economical burdens. Paradoxically, the use of successful treatments for chronic heart failure can prolong life but—per definition—causes the rise in age of patients experiencing acute decompensations, since nothing at the moment helps avoiding an acute or final stage in the elderly population. To complicate the picture, acute heart failure syndromes are a collection of symptoms, signs and markers, with different aetiologies and different courses, also due to overlapping morbidities and to the plethora of chronic medications. The palette of cardio- and vasoactive drugs used in the hospitalization phase to stabilize the patient’s hemodynamic is scarce and even scarcer is the evidence for the agents commonly used in the practice (e.g. catecholamines). The pipeline in this field is poor and the clinical development chronically unsuccessful. Recent set backs in expected clinical trials for new agents in acute heart failure (AHF) (omecamtiv, serelaxine, ularitide) left a field desolately empty, where only few drugs have been approved for clinical use, for example, levosimendan and nesiritide. In this consensus opinion paper, experts from 26 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, The Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, Turkey, U.K. and Ukraine) analyse the situation in details also by help of artificial intelligence applied to bibliographic searches, try to distil some lesson-learned to avoid that future projects would make the same mistakes as in the past and recommend how to lead a successful development project in this field in dire need of new agents.

scholarly journals Management of Advanced Heart Failure in the Elderly: Ethics, Economics, and Resource Allocation in the Technological Era

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Keith M. Swetz ◽  
John M. Stulak ◽  
Shannon M. Dunlay ◽  
Ellin F. Gafford
Keyword(s):  
Heart Failure ◽  
Ethical Issues ◽  
The Elderly ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
Future Directions ◽  
Goods And Services ◽  
Mechanical Circulatory Support Devices ◽  
Made In

Significant strides have been made in the durability, portability, and safety of mechanical circulatory support devices (MCS). Although transplant is considered the standard treatment for advanced heart failure, limits in organ availability leave a much larger pool of recipients in need versus donors. MCS is used as bridge to transplantation and as destination therapy (DT) for patients who will have MCS as their final invasive therapy with transplant not being an option. Despite improvements in quality of life (QOL) and survival, defining the optimal candidate for DT may raise questions regarding the economics of this approach as well as ethical concerns regarding just distribution of goods and services. This paper highlights some of the key ethical issues related to justice and the costs of life-prolonging therapies with respect to resource allocations. Available literature, current debates, and future directions are discussed herein.

scholarly journals A comparative study of the voice-related quality of life among Egyptian elderly with and without voice complaints

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Nesreen Fathi Mahmoud ◽  
Huda Zahran ◽  
Sherif Abdelmonam
Keyword(s):  
Quality Of Life ◽  
Elderly Population ◽  
Life Quality ◽  
Voice Disorders ◽  
The Elderly ◽  
Different Types ◽  
Related Quality ◽  
The Impact ◽  
The Voice

Abstract Background This study focuses on the self-perception of the voice in the elderly as assessed by the Voice-Related Quality of Life (V-RQOL) questionnaire. This work aimed to compare differences in the voice-related quality of life outcomes between (1) elderly with and without voice disorders, (2) female and male elderly with voice disorders, and (3) different types of voice disorders, and to explore the correlation between the V-RQOL and perceptual analysis done by the clinician. Forty-three dysphonic and 44 non-dysphonic elderly filled out the Voice-Related Quality of Life (V-RQOL) protocol that analyzes the impact of dysphonia on life quality. Vocal perceptual assessment of each subject with dysphonia was made by three voice therapists, followed by a flexible nasofibrolaryngoscope. Results A significant statistical difference was found between the means of total V-RQOL scores and its subdomains for each group (dysphonic and non-dysphonic). No significant differences were found between male and female elderly with dysphonia. The statistical analysis showed a significant correlation with the vocal assessment made by the clinicians and the V-RQOL self-assessment made by the subjects. Conclusions This study provides valuable information regarding the risk factors that contribute to vocal quality in the elderly population. Our results revealed that different types of voice disorders are common among the elderly population with significant negative effects on quality of life. It was observed that the poorest score on the V-RQOL was for functional voice disorders, followed by neoplastic lesions, whereas MAPLs had the best score on the V-RQOL.

scholarly journals Monitoring Health Parameters of Elders to Support Independent Living and Improve Their Quality of Life

Sensors ◽  
2021 ◽  
Vol 21 (2) ◽  
pp. 517
Author(s):  
Ilia Adami ◽  
Michalis Foukarakis ◽  
Stavroula Ntoa ◽  
Nikolaos Partarakis ◽  
Nikolaos Stefanakis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Independent Living ◽  
Elderly Population ◽  
Well Being ◽  
The Elderly ◽  
Chronic Illnesses ◽  
Age Related ◽  
Self Sufficiency ◽  
Health And Well Being

Improving the well-being and quality of life of the elderly population is closely related to assisting them to effectively manage age-related conditions such as chronic illnesses and anxiety, and to maintain their independence and self-sufficiency as much as possible. This paper presents the design, architecture and implementation structure of an adaptive system for monitoring the health and well-being of the elderly. The system was designed following best practices of the Human-Centred Design approach involving representative end-users from the early stages.

scholarly journals Elderly and drugs: risks and necessity of rational use

2010 ◽  
Vol 46 (4) ◽  
pp. 617-632 ◽  
Author(s):  
André de Oliveira Baldoni ◽  
Farah Maria Drumond Chequer ◽  
Elisa Raquel Anastácio Ferraz ◽  
Danielle Palma de Oliveira ◽  
Leonardo Régis Leira Pereira ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Effects ◽  
Elderly Population ◽  
Adverse Drug Events ◽  
The Elderly ◽  
External Factors ◽  
Access To Information ◽  
Inappropriate Use ◽  
The World

In recent decades, the world has undergone a demographic transformation with a rapid growth of the elderly population, resulting in an increased demand for funds to maintain their health and drug consumption. Pharmacokinetic and pharmacodynamic changes occurring in the elderly can interfere directly in the adverse effects of drugs and increase the risk of intoxication. In addition, there are external factors interfering with the pharmacotherapy of the elderly, such as inappropriate use and the lack of access to information. Many therapeutic classes of drugs should be used with caution or avoided in the elderly population, such as anti-inflammatory and some anti-hypertensive drugs, diuretics and digitalis. If not managed carefully, these medicines can affect the safety and quality of life in the elderly. Thus, the aim of this review was to identify drugs that should be used with caution in elderly patients in order to avoid intoxication and/or adverse drug events.

Surgical methods of treatment of chronic heart failure and their place in modern clinical recommendations

2020 ◽  
Vol 22 (4) ◽  
pp. 183-191
Author(s):  
O. T. Kotsoeva ◽  
A. V. Koltsov ◽  
V. V. Tyrenko ◽  
A. A. Ialovets
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Heart Transplantation ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Surgical Methods ◽  
The Moment

This review discusses a number of aspects of surgical methods for treating severe chronic heart failure: resynchronizing therapy, mechanical circulatory support systems, and heart transplantation. Surgical methods for the treatment of heart failure are a rapidly developing field of modern cardiology and cardiac surgery. The main surgical method of treatment was and remains orthotopic transplantation of a donor heart. The advent of implantable systems has affected the problem of heart transplantation. Over the past decade, the use of mechanical circulatory support systems has grown significantly. At the moment, there are 3 main directions: creating devices for auxiliary blood circulation, various modes and methods of electrical stimulation of the myocardium, creating devices that mechanically remodel the heart chambers (left ventricle). All of these directions to some extent (depending on the evidence base) have found their place in modern recommendations for the treatment of chronic heart failure. The use of mechanical left ventricular remodeling shows good results in patients suffering from symptomatic heart failure, which leads to a significant and persistent decrease in the volume of the left ventricle and improvement of its function, symptoms and quality of life. Despite the fact that at the moment the geography and prevalence of their use is small, the number of implanted devices will only grow. Thus, given the need for frequent hospitalizations and high treatment costs, it is necessary to improve modern methods of surgical treatment of severe and terminal heart failure, make them more accessible, which will affect the duration and quality of life of these patients.

scholarly journals Quality of life of the elderly population during the virus Covid-19 pandemic with special reference to agriculturists

2020 ◽  
Vol 67 (4) ◽  
pp. 1155-1167
Author(s):  
Pavle Radanov ◽  
Ivana Lešević ◽  
Pavle Brzaković ◽  
Dragan Pajić
Keyword(s):  
Quality Of Life ◽  
Rural Areas ◽  
Urban Areas ◽  
Elderly Population ◽  
The Elderly ◽  
Special Importance ◽  
Negative Consequences ◽  
State Of Emergency ◽  
The Republic

In the Republic of Serbia, on March 15 th , 2020 Government decided to declare a state of emergency due to the Covid-19 pandemic. One of the measures was a movement ban for people over 65 in urban areas and those over 70 in rural areas. This research should indicate how people over 65 in urban areas have endured this situation, especially in relation to the same population in rural areas, as well as implications of the movement ban on the quality of life of the elderly population. Special importance is given to the rural population engaged in agriculture. A tool of data collection in this research was anonymous survey. Respondents' answers were statistically processed, which led to clear conclusions about the large negative consequences for the elderly population, including the agricultural activities in rural areas. Covid-19 is still present, which opens further questions related to the quality of life of the elderly population, if necessity for similar measures recurs in the future.

scholarly journals ANMCO POSITION PAPER: Role of intra-aortic balloon pump in patients with acute advanced heart failure and cardiogenic shock

2021 ◽  
Vol 23 (Supplement_C) ◽  
pp. C204-C220
Author(s):  
Roberta Rossini ◽  
Serafina Valente ◽  
Furio Colivicchi ◽  
Cesare Baldi ◽  
Pasquale Caldarola ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Acute Heart Failure ◽  
Advanced Heart Failure ◽  
Position Paper ◽  
Present Position ◽  
Intra Aortic Balloon Pump ◽  
All Cause Mortality ◽  
Practical Recommendations

Abstract The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists, reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure.

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