Abstract：
BACKGROUND:Despite ample data from randomized clinical trials (RCTs), the management of advanced heart failure (HF) varies greatly. We examined the most common refractory questions arising in routine inpatient management of advanced HF. METHODS:From the inpatient HF service at 1 hospital, we prospectively recorded clinical questions arising for which there were no clear answers available about HF management. When possible, patients received angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and spironolactone as used in RCTs. We identified the topics and frequencies of questions and categorized them as Group 1--whether to use a therapy--or Group 2--how to use a therapy. RESULTS:During 2 separate months, 318 questions arose among 57 patients. The most common topics involved the use of diuretics, potassium, and ACE inhibitors, most often about how to titrate diuretics, what targets to use to optimize diuretic therapy, and how to select discharge doses of diuretics. Questions of whether to use a therapy occurred 73 times, and how to use a therapy, 242 times. RCT data were difficult to apply to these questions because little information exists about how to combine and titrate HF drugs and how to adjust diuretics. Questions about individual drugs arose in patients who fell outside the average RCT entry criteria for age, blood pressure, and creatinine. CONCLUSION:Most refractory questions focused on how to integrate and adjust therapies within the overall medical regimen and how to apply data to patients not represented in RCTs. Future studies should evaluate strategies of care for the advanced HF population.
journal_name
J Card Failjournal_title
Journal of cardiac failureauthors
Shah MR,Stevenson LWdoi
10.1016/j.cardfail.2003.10.006keywords:
subject
Has Abstractpub_date
2004-06-01 00:00:00pages
210-8issue
3eissn
1071-9164issn
1532-8414pii
S1071916403007462journal_volume
10pub_type
杂志文章abstract：BACKGROUND:Heart failure (HF) dramatically affects the lives of both patients and their caregivers, yet limited research exists examining the relationship between emotional well-being of HF patients and their caregivers. Therefore, we conducted a study to (1) describe and compare the emotional well-being of HF patients...
journal_title：Journal of cardiac failure
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journal_title：Journal of cardiac failure
pub_type： 更正并重新发布的文章,杂志文章,随机对照试验
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journal_title：Journal of cardiac failure
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doi：10.1054/jcaf.2000.8839
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pub_type： 杂志文章,评审
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pub_type： 杂志文章,实务指引
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journal_title：Journal of cardiac failure
pub_type： 杂志文章,多中心研究
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journal_title：Journal of cardiac failure
pub_type： 杂志文章,评审
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更新日期：2000-06-01 00:00:00
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journal_title：Journal of cardiac failure
pub_type： 杂志文章
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journal_title：Journal of cardiac failure
pub_type： 杂志文章
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更新日期：2014-01-01 00:00:00
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journal_title：Journal of cardiac failure
pub_type： 杂志文章
doi：10.1016/j.cardfail.2015.08.343
更新日期：2016-02-01 00:00:00
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journal_title：Journal of cardiac failure
pub_type： 杂志文章
doi：10.1016/j.cardfail.2016.11.006
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pub_type： 传,历史文章
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journal_title：Journal of cardiac failure
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journal_title：Journal of cardiac failure
pub_type： 杂志文章,多中心研究
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abstract：BACKGROUND:Functional electrical stimulation (FES) improves exercise capacity and quality of life in chronic heart failure (CHF) patients. However, there is no evidence regarding the effectiveness of this treatment modality according to the severity of CHF. This study compares the effectiveness of FES on exercise capac...
journal_title：Journal of cardiac failure
pub_type： 杂志文章
doi：10.1016/j.cardfail.2009.10.023
更新日期：2010-03-01 00:00:00
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journal_title：Journal of cardiac failure
pub_type： 杂志文章
doi：10.1016/j.cardfail.2007.09.009
更新日期：2008-02-01 00:00:00
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journal_title：Journal of cardiac failure
pub_type： 杂志文章
doi：10.1016/j.cardfail.2003.08.013
更新日期：2004-04-01 00:00:00
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journal_title：Journal of cardiac failure
pub_type： 杂志文章
doi：10.1016/j.cardfail.2009.03.003
更新日期：2009-09-01 00:00:00
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pub_type： 杂志文章,多中心研究
doi：10.1016/j.cardfail.2009.05.011
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pub_type： 杂志文章
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