Non-pharmacological treatment of heart failure: implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy

The non-pharmacological therapy of heart failure, in particular an implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy or biventricular stimulation, improves symptoms and survival in patients with heart failure. An ICD is indicated in many patients with heart failure following cardiac arrest unless reversible causes are demonstrable. Selected patients with a left ventricular ejection fraction < or = 35% due to either ischaemic (>40 days after a myocardial infarction) or nonischaemic cardiomyopathy are candidates for ICD implantation as the primary prevention of sudden cardiac death. Patients who continue to have severe symptoms despite maximal pharmacotherapy, with a left ventricular ejection fraction < or = 35% and a wide QRS complex, are candidates for cardiac resynchronisation therapy to improve both symptoms and survival.     

Sexual activity as a trigger for ventricular tachycardia in a patient with implantable cardioverter defibrillator

Occurrence of life threatening arrhythmias and sudden death during or following sexual activity is infrequent. We describe a patient with an implantable cardioverter defibrillator who developed increased ventricular ectopic activity followed by sustained ventricular tachycardia during extramarital coitus. A review of literature and management is discussed.     

Prevalence of anxiety in patients with an implantable cardioverter defibrillator: measurement equivalence of the HADS-A and the STAI-S

Quality of Life Research - The Hospital Anxiety and Depression Scale (HADS-A) and State-Trait Anxiety Inventory (STAI-S) are popular instruments for assessing anxiety and are considered...     

Determinants of the quality of life (QoL) in patients with an implantable cardioverter/defibrillator (ICD)

OBJECTIVES: In high-risk cardiac patients the treatment of life-threatening arrhythmias with an implantable cardioverter/defibrillator (ICD) extends survival. Other important outcome criteria are treatment side effects especially the quality of life (QoL). Knowledge of the variables that influence QoL is important for therapy decisions in ICD patients. METHODS: Ninety-three ICD patients evaluated their QoL by the SF-36 after 1-6 years of ICD implantation. The QoL was studied in relation to cardiac function (severity of heart failure, ejection fraction), treatment course (number of shocks), coping styles and psychiatric syndromes. RESULTS: About 30% of the somatic QoL (physical role function, pain) is determined by the patients' somatization tendency, i.e. the extent to which they suffer from non-specific symptoms (sweating, weakness in the legs, nausea). The severity of heart failure had little influence on the physical QoL. The emotional QoL is primarily determined by phobic anxiety of ICD patients. CONCLUSIONS: Psychiatric symptoms are the most important factors to determine the QoL in ICD patients. Behavioural treatment procedures of phobic anxieties and somatization could improve QoL in ICD patients.     

A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

Objectives

Cardiac resynchronization therapy with a biventricular pacemaker (CRT-P) is an effective treatment for dyssynchronous heart failure (DHF). Adding an implantable cardioverter defibrillator (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, if the majority of patients do not require shock therapy, the cost-effectiveness ratio of CRT-D compared to CRT-P may be high. The objective of this study was to systematically review decision models evaluating the cost-effectiveness of CRT-D for patients with DHF, compare the structure and inputs of these models and identify the main factors influencing the ICERs for CRT-D.

Methods

A comprehensive search strategy of Medline (Ovid), Embase (Ovid) and EconLit identified eight cost-effectiveness models evaluating CRT-D against optimal pharmacological therapy (OPT) and/or CRT-P.

Results

The selected economic studies differed in terms of model structure, treatment path, time horizons, and sources of efficacy data. CRT-D was found cost-effective when compared to OPT but its cost-effectiveness became questionable when compared to CRT-P.

Conclusions

Cost-effectiveness of CRT-D may increase depending on improvement of all-cause mortality rates and HF mortality rates in patients who receive CRT-D, costs of the device, and battery life. In particular, future studies need to investigate longer-term mortality rates and identify CRT-P patients that will gain the most, in terms of life expectancy, from being treated with a CRT-D.

     

冠心病患者心脏康复治疗模式及依从性的研究概述

冠心病严重威胁着人类的健康,在初级和二级预防中,采取相应的措施至关重要。常规治疗存在早期缺乏预防,治疗后缺乏干预等问题,而心脏康复可使患者体力和工作能力明显增强、有助于延缓和阻止冠状动脉粥样硬化的发展。心脏康复的临床重要性虽已得到多数国家认可,但患者依从性普遍偏低。为此,国内外学者对心脏康复的治疗模式进行了大量的探索和实践,以提高患者依从性。本文就心脏康复的治疗模式及影响患者依从性的相关因素进行综述,期望为更多的冠心病患者从心脏康复中获益提供新的视角。     

心脏康复对慢性心衰患者心功能的影响

目的 探讨心脏康复对慢性心衰患者心功能的影响以及评价心功能的新指标半乳凝集素-3(galectin-3)及可溶性ST2(soluble ST2,sST2)的变化情况.方法 连续纳入成都市第五人民医院2018年7月1日-2019年6月30日收治的慢性心衰患者,根据随机数字表法把患者分为心脏康复组和对照组各123例,对照组...     

心脏康复运动疗法对慢性心力衰竭患者影响

目的心脏康复在许多国家已经是心血管病治疗的重要组成部分。我国心脏康复虽然发展很快,但仍相对滞后。心脏康复能改善疾病的相关症状、生活质量和临床结果。本研究旨在评估心脏康复对慢性心力衰竭患者心血管危险因素、心功能和生活质量的影响。方法选取2016-03-31-2018-12-31齐齐哈尔市第一医院收治的80例慢性稳定性心力衰竭患者为研究对象,检测项目包括血压、心率、体质量指数、腰围、糖化血红蛋白、血脂谱和超声心动图等。经过2个月规定的运动康复训练,在康复计划开始及结束后均采用6min步行试验(6-minutewalk test,6MWT)评价心功能,采用明尼苏达州心功能不全生命质量量表(Minnesota living with heart failure questionnaire,MLHFQ)评价生活质量。结果心脏康复结束时,患者体质量指数(t=6.271,P0.001)、腰围(t=8.472,P0.001)、收缩压(t=10.400,P0.001)、舒张压(t=8.793,P0.001)和糖化血红蛋白(t=5.601,P0.001)下降,与干预前比较,差异均有统计学意义;NYHA分级改善,χ2=31.8,P0.001。心脏康复运动前后心率分别为(78.75±9.45)和(71.70±7.23)次/分,t=5.621,P0.001;呼吸困难指数分别为(0.58±0.78)和(0.33±0.47)分,t=3.204,P=0.003;疲劳指数分别为(0.53±0.78)和(0.45±0.71)分,t=1.778,P=0.083;MLHFQ评分分别为(42.63±7.58)和(32.60±5.19)分,t=18.130,P0.001;躯体功能评分分别为(20.58±4.68)和(15.38±3.48)分,t=12.354,P0.001;心理功能评分分别为(4.33±2.73)和(1.10±1.22)分,t=12.315,P0.001。结论心脏康复运动疗法可改善慢性心力衰竭患者的心血管危险因素,提高其心功能及生活质量。     

Successful treatment with an implantable cardioverter defibrillator for spontaneous ventricular fibrillation in dilated cardiomyopathy with very high defibrillation thresholds.

A 72-year-old male patient with idiopathic dilated cardiomyopathy who had shown recurrent episodes of drug refractory ventricular fibrillation underwent implantation of a transvenous implantable cardioverter defibrillator (ICD). Ventricular fibrillation (VF) was induced by a T wave shock at the implantation. However, the ICD device with a maximum energy of 30 J failed to terminate the VF. Reversing defibrillation polarity and/or adding a defibrillation electrode lead at the site of a high superior vena cava were also ineffective. The ICD was programmed to a maximum energy of 30 J when the device sensed spontaneous VF. During the follow-up period of 5 months, two episodes of spontaneous VF were recorded from ICD telemetry, and the ICD device terminated VF successfully with the first therapy shock in both episodes. No previous reports have shown failure to terminate induced VF at implantation of the ICD with successful termination of spontaneous VF during follow-up. Careful follow-up is needed in ICD patients, especially those with very high defibrillation thresholds.     

Exercise based cardiac rehabilitation in chronic heart failure

People with chronic heart failure often present to their general practitioner with questions about their participation in cardiac rehabilitation programs. This article outlines the risks and benefits of such programs.     

美托洛尔治疗风湿性心脏病慢性心力衰竭效果研究

目的 探讨美托洛尔对风湿性心脏病慢性心力衰竭患者血压水平及心功能的影响.方法 选取本院2016年3月-2018年4月收治的70例风湿性心脏病慢性心力衰竭患者,随机分为对照组与观察组,各35例.对照组采用常规治疗,在对照组基础上,观察组予以美托洛尔治疗.比较两组临床疗效、血压水平、心功能.结果 对照组治疗总效率为65.7...     

综合干预对慢性心力衰竭患者疾病进展的影响

目的观察慢性心力衰竭(chronic heart failure,CHF)患者给予综合干预对疾病进展的影响。方法选择2014年6月—2015年5月收治的80例慢性CHF患者作为研究对象,随机分为对照组和干预组各40例。对照组给予常规药物治疗,干预组制定针对性干预计划,按计划进行早期干预。分别于入组时及干预后12个月观察两组左室射血分数(left ventricular ejection fraction,LVEF)、左室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)等心功能指标、生活质量评分及急性发作需治疗次数等指标的变化情况。计量资料组间比较采用t检验,组内比较采用配对t检验,P0.05为差异有统计学意义。结果干预后12个月,干预组LVEF、LVEDD、发作次数、生活质量评分分别为(56.78±8.12)%、(48.90±4.09)mm、(0.79±1.12)次、(9.34±3.12)分,与入组时的(41.67±6.78)%、(55.78±5.45)mm、(1.32±1.10)次、(19.98±4.12)分比较差异均有统计学意义(均P0.05)。干预后12个月,干预组LVEF、LVEDD、发作次数、生活质量评分与对照组的(43.89±5.56)%、(55.78±5.07)mm、(1.56±1.23)次、(19.89±6.12)分比较差异均有统计学意义(均P0.05)。结论早期行为干预可明显减缓慢性CHF患者疾病发展,提高生活质量。     

螺内酯治疗冠心病慢性心力衰竭的临床疗效

目的:观察螺内酯对冠心病慢性心力衰竭的临床疗效.方法:冠心病慢性心力衰竭患者80例,随机分为治疗组40例,对照组 40例,对照组选用利尿剂氢氯噻嗪及氨苯喋啶、血管紧张素转换酶( ACE)抑制剂卡托普利、β-受体拮抗 剂倍他乐克,洋地黄制剂地高辛为主要治疗药物.治疗组以螺内酯替代上述氨苯喋啶,其他治疗同对照组,治疗 3个 月后评判疗效.结果:治疗组总有效率达 92.5%,对照组总有效率为 75.0%,两组比较有显著性差异( P<0.05).结 论:螺内酯治疗冠心病慢性心力衰竭可明显提高临床疗效.     

慢性阻塞性肺病合并左心衰竭患者的临床分析

目的探讨了慢性阻塞性肺病（COPD）合并左心衰竭的诊治情况。方法对笔者所在医院在2009年1月～2010年3月收治的95例COPD合并左心衰竭患者的临床资料进行回顾分析。结果本组治疗的总有效率为87．4％，Ⅰ级、Ⅱ级、Ⅲ级的治疗总有效率分别为100％、92．8％和74．3％，统计后发现Ⅲ级患者总有效率与Ⅰ级、Ⅱ级比较，差异均有统计学意义（P〈0．05）。结论若能及早诊断出左心衰竭的发生，必能改善患者的预后情况。     

美托洛尔治疗老年冠心病慢性心力衰竭52例疗效观察

目的评价β-受体阻滞剂治疗老年冠心病慢性心力衰竭的疗效及安全性.方法 105例老年冠心病慢性心力衰竭患者按就诊顺序随机分为两组,美托洛尔组52例在常规抗心力衰竭治疗基础上加用美托洛尔12.5～25 mg,2/d;对照组53例采用常规抗心力衰竭治疗,未用美托洛尔.定期来诊随访,观察临床表现,监测治疗前后心率、血压、心功能参数变化.结果美托洛尔组显效率53.8%,总有效率88.5%;对照组显效率30.2%,总有效率67.9%,两者比较有显著性差异(P<0.05).美托洛尔组患者心率减慢、血压降低较对照组明显,超声心动图复查显示治疗6个月后左室舒张末期内径缩小,左室射血分数增高较对照组显著.结论美托洛尔为老年冠心病慢性心力衰竭提供一种较为安全有效的药物治疗手段.     

The adolescent with simple or corrected congenital heart disease

An ever-increasing number of congenital heart disease patients are surviving into and beyond adolescence. Despite the encouraging cardiac results, with the vast majority asymptomatic and requiring no medication and having few, if any, limitations, there are many challenges for this patient population. They are likely to find obstacles to attaining education, social development, health and life insurance, and employment. Most of these obstacles are attributable to the stresses upon children with congenital heart disease and their families, and the prejudices of a society that knows little about congenital heart disease. Practitioners caring for these young people must be familiar with these issues and knowledgeable about the facts of individual cases, so that they may anticipate needs and offer support to their patients in their progress toward adulthood.