抗心衰标准三联疗法联合应用美托洛尔治疗老年人慢性充血性心力衰竭

目的　探讨 β 肾上腺素能受体阻滞剂美托洛尔治疗老年人慢性充血性心力衰竭 (congestiveheartfailure ,CHF)的有效性和安全性。方法　采用多中心、随机、单盲、安慰剂对照、平行组试验。入选老年CHF患者 2 36例 ,随机分为美托洛尔组 (A组 )和对照组 (B组 ) ,均予标准抗心衰治疗 (依那普利、速尿、地高辛 ) ;A组联用美托洛尔 6 .2 5～15 0mg/d ,B组联用与美托洛尔外观相同的淀粉安慰剂。观察治疗前和治疗后 1个月、6个月、12个月时的临床指标变化 ,评价其临床有效性和安全性。结果　与B组比较 ,A组心率、血压下降迅速且持久 (P <0 .0 5 ) ;无创心排量指标和临床心功能分级于 6个月时亦显著改善 (P <0 .0 5 ) ,12个月时改善更显著 ;总心脏事件的发生率于 12个月时也显著减少 (P <0 .0 5 )。结论　长期应用美托洛尔可明显改善老年人CHF患者的心脏功能 ,提高患者的生活质量和生存率 ,安全可靠     

Congestive heart failure in the elderly

CHF is a complex disease that is complicated by the normal changes that accompany the aging process. As nurses we must understand not only the medical management but also the quality-of-life issues that are critical for these patients and their caregivers.     

The meaning of living with severe chronic heart failure as narrated by elderly people

The meaning of elderly patients' experiences of living with chronic heart failure was studied. Narrative interviews were analysed using a phenomenological hermeneutic approach. 'Feeling imprisoned in illness' and 'feeling free despite illness' constituted the themes. These themes were interpreted as describing variations in awareness of the relationship between the self and the body. In theme 'feeling imprisoned in illness' the body's illness and disability hindered the subjects from being themselves. In the theme 'feeling free despite illness' the disabled body was not experienced as limiting, but rather as a part of the self. The patients' understanding of the illness must be interpreted by the caregiver, who also needs to be aware of different modes of communicating feeling about the illness.     

Chronic heart failure in the elderly

Chronic heart failure (CHF) presents the final stage of most cardiovascular diseases. The prevalence of CHF in patients with coronary artery disease grows steadily with age. CHF causes an abrupt fall in the quality of life and working ability. CHF is the main reason for hospitalization in people older than 65. The total number of hospital admission and the frequency of early secondary admission of patients with this condition tend to grow. All of this determines the necessity to search new effective ways of early diagnostics and treatment of CHF.     

Management of heart failure

Heart failure imposes a major burden on society. Primary care physicians, who care for 70% of all heart-failure patients, have opportunities to reduce the economic and mortality impact of this disease by improved outpatient management. Management tasks for these patients are discussed. Successful completion of these tasks will lead to an improvement in functional capacity, fewer hospitalizations, and longer lives for heart-failure patients.     

Nebivolol for heart failure in the elderly

Recent analyses in the temporal trends of mortality and hospitalization in patients with chronic heart failure showed marginal changes in the last 20 years, particularly in the elderly. According to the Euro Heart Survey program and other observational reports, only 37-50% of patients with heart failure are treated with beta-blockers, with a dosage that is approximately half the target dose of clinical trials. The most frequent reason for the limited use of beta-blockers and the suboptimal doses prescribed, is age greater than 70 years. Only two multicenter, double-blind, randomized, placebo-controlled, parallel group trials; the Effects of Nebivolol on Left Ventricular Function in Elderly Patients with Chronic Heart Failure (ENECA) and the Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization Seniors with Heart Failure (SENIORS), both with nebivolol, have been specifically aimed to assess the efficacy of beta-blockade in elderly heart failure patients. The results of such trials demonstrated that the drug is well tolerated and effective in reducing mortality and morbidity, and that the beneficial clinical effect is independent of the baseline ejection fraction.     

Sleep disturbances in people living with heart failure

Approximately 10% to 70% of people living with chronic heart failure (HF) experience significant sleep disturbances, which have been shown to impair their health-related quality of life and overall functional performance. Research findings, however, report inconsistent conclusions about sleep disturbances and their adverse effects on HF. The purpose of this article is to review several research studies addressing sleep disturbances in patients with HF and to highlight contradictory and inconsistent findings. Further nursing research about the phenomena related to sleep disturbances in people with HF is warranted so that evidence-based assessments and interventions can be tested in the future.     

Pharmacotherapy of congestive heart failure in elderly patients

With longer life expectancy, as well as better survival rates after myocardial infarction, the population of elderly patients with congestive heart failure steadily increases. Large, randomized, placebo-controlled studies have shown significant beneficial effects for several classes of drugs (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, aldosterone antagonists) in patients with congestive heart failure. In most of these studies, however, elderly patients were either excluded or represented only a minority of the study population. Therefore, the treatment benefit for the large population of patients aged 65 and older is still not very well documented. In this paper, we critically review the current literature with regard to outcome of heart failure therapy in this particular subpopulation.     

Management of decompensated heart failure

Much has been written about the management of chronic heart failure (HF) and there is strong evidence from many controlled, multicenter trials to support a specific strategy for management of compensated HF. There is little evidence and limited guidance for the management of patients during a period of decompensation. The use of diuretics, inodilators, and vasodilators is based primarily on anecdotal observation. This article reviews selected current literature in three areas (diuretics, vasodilators, and inotropes) to examine objective evidence and expert opinion that are available to guide the advanced practitioner who manages the care of patients with decompensated HF.     

Management of advanced heart failure

Congestive heart failure (CHF) due to progressive systolic dysfunction has become a modern-day epidemic. Despite the increased incidence and prevalence, significant progress has been made in the past 10 to 15 years in the treatment of CHF at all stages. The current outlook for patients with newly diagnosed, mild heart failure is encouraging. It should be noted, however, that most of the morbidity and health care expenditure is incurred by a minority of patients diagnosed with CHF who are in the advanced stages of their disease. The thrust of this article will be to provide practical advice beyond current guidelines on the management of advanced CHF.     

Management of end-stage heart failure

The prevalence of heart failure (HF) is increasing and morbidity and mortality remain high. There is a clear need for palliative care for the growing population of chronically ill patients with HF. Because HF-specific therapy modifies disease and palliates symptoms, recommended treatments for chronic and acute decompensated HF are reviewed. This article discusses symptom burden in advanced HF and specific considerations for patients with HF regarding advance care planning and symptom-directed therapy. Options for care at the end of life, including hospice, chronic inotropic support, and deactivation of an internal cardiac defibrillator, are also discussed.     

Management of decompensated heart failure

Hospitalizations for heart failure have increased threefold during the past 3 decades, and this trend is expected to continue for the next 25 years. Heart failure now is the largest single expense for Medicare, and hospitalizations account for more than half of these costs. Most hospitals sustain financial losses with heart failure management because expenses exceed reimbursement. The hospital emergency department often is the initial encounter site for patients with new-onset heart failure, but most heart failure emergency department visits are for recurrent decompensation. The majority of these patients will be admitted to the hospital. Although accurate diagnosis and effective treatment are important for improving outcomes and lowering costs, there are no published guidelines for managing acutely decompensated heart failure. This review describes new diagnostic and management strategies, utilizing the emergency department observational unit as a triage area, that may decrease hospital length of stay, reduce hospital costs, and prevent readmissions.     

Management of advanced heart failure

Congestive heart failure (CHF) due to progressive systolic dysfunction has become a modern-day epidemic. Despite the increased incidence and prevalence, significant progress has been made in the past 10 to 15 years in the treatment of CHF at all stages. The current outlook for patients with newly diagnosed, mild heart failure is encouraging. It should be noted, however, that most of the morbidity and health care expenditure is incurred by a minority of patients diagnosed with CHF who are in the advanced stages of their disease. The thrust of this article will be to provide practical advice beyond current guidelines on the management of advanced CHF.     

老年多病因心力衰竭构成分析

目的对老年多病因心力衰竭（MHFE）的多病因性构成及多病因特点进行探讨,以期为MHFE的防治提供临床依据。方法回顾性分析95例MHFE的病因构成特点与心力衰竭类型。结果构成MHFE的主要基础病因前3位为冠心病40例（42.1%）、高血压20例（21.1%）及肺源性心脏病12例（12.6%）。MHFE患者基础疾病以冠心病、高血压、肺源性心脏病为主,合并疾病以糖尿病、慢性阻塞性肺疾病为主。老年人心力衰竭主要以舒张性心力衰竭为主,占67.4%（64/95）。结论 MHFE患者的主要基础病因为冠心病、高血压和肺源性心脏病,且心力衰竭主要以舒张性心力衰竭为主。     

老年人多病因心力衰竭524例临床分析

目的对不同年龄段老年人多病因慢性心力衰竭（CHF）住院病例,进行病因、诱因、伴随疾病和病死率的对比分析,以期为临床老年CHF防治提供参考。方法从住院病例中选出2007年1至12月住院的老年CHF患者524例,以60-69岁、70-79岁和≥80岁分为3个年龄段,比较分析不同的临床特征。结果70-79岁和≥80岁年龄段与60-69岁年龄段相比,病因中冠心病、高血压病、肺心病随增龄增多;诱因中肺炎随增龄明显增多;伴随疾病中糖尿病、慢性肾功能不全、贫血随增龄增多;心律失常无显著差异;病死率随增龄显著增高。结论老年CHF患者的病因、诱因、伴随疾病构成比中,冠心病、高血压病、糖尿病和肺炎随增龄增多。病死率随增龄增高。