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排序方式: 共有73条查询结果,搜索用时 15 毫秒
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Sean P. Collins MD MSc Phillip D. Levy MD MPH Gregory J. Fermann MD Michael M. Givertz MD Jennifer M. Martindale MD MSc Peter S. Pang MD MSc Alan B. Storrow MD Deborah D. Diercks MD MSc G. Michael Felker MD Gregg C. Fonarow MD David J. Lanfear MD MSc Daniel J. Lenihan MD JoAnn M. Lindenfeld MD W. Frank Peacock MD Douglas M. Sawyer MD PhD John R. Teerlink MD Javed Butler MD MPH MBA 《Academic emergency medicine》2018,25(1):85-93
Each year over one million patients with acute heart failure (AHF) present to a United States emergency department (ED). The vast majority are hospitalized for further management. The length of stay and high postdischarge event rate in this cohort have changed little over the past decade. Therapeutic trials have failed to yield substantive improvement in postdischarge outcomes; subsequently, AHF care has changed little in the past 40 years. Prior research studies have been fragmented as either “inpatient” or “ED‐based.” Recognizing the challenges in identification and enrollment of ED patients with AHF, and the lack of robust evidence to guide management, an AHF clinical trials network was developed. This network has demonstrated, through organized collaboration between cardiology and emergency medicine, that many of the hurdles in AHF research can be overcome. The development of a network that supports the collaboration of acute care and HF researchers, combined with the availability of federally funded infrastructure, will facilitate more efficient conduct of both explanatory and pragmatic trials in AHF. Yet many important questions remain, and in this document our group of emergency medicine and cardiology investigators have identified four high‐priority research areas. 相似文献
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Waleed Al-Darzi Lindsey Aurora Alexander Michaels Jennifer Cowger Gillian Grafton Yelena Selektor Cristina Tita Bashar Hannawi David Lanfear Hassan W. Nemeh Celeste T. Williams 《Clinical transplantation》2020,34(12):e14091
A chronic immunosuppressed state as in solid organ transplant recipients is a reported risk factor for the novel 2019 coronavirus infection. Patients with a history of orthotopic heart transplant (OHT) at a tertiary care transplant center in Detroit, Michigan were retrospectively reviewed from March until May 2020. Clinical parameters and outcomes of 5 OHT recipients and one combined heart–lung recipient with confirmed SARS-CoV-2 were obtained. The cohort was predominately African American males with median age of 59 years (interquartile range, 48.25-73.25). All patients were classified as having mild–moderate disease; none required intubation or ICU admission with no deaths. The most common presenting symptoms were fever and shortness of breath 83% (n = 5), followed by cough and chills 67% (n = 4). All admitted patients (n = 5) received hydroxychloroquine and 3 received high-dose steroids. Antimetabolites were held for 2 patients (33.3%). The calcineurin inhibitor trough goal was decreased in only 1 patient; 3 other patients, without change in goal, required calcineurin inhibitor dosage reduction. Two patients requiring readmission presented 7 and 23 days after initial symptoms onset. In conclusion, our experience with OHT patients infected by the SARS-CoV-2 virus did not have an elevated risk of severe infection. Impact of modifying immunosuppression remains unclear. 相似文献
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Clinical and Research Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society for Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group
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Sean P. Collins MD MSc Phillip D. Levy MD MPH Jennifer L. Martindale MD Mark E. Dunlap MD Alan B. Storrow MD Peter S. Pang MD MSc Nancy M. Albert RN PhD G. Michael Felker MD MS Gregory J. Fermann MD Gregg C. Fonarow MD Michael M. Givertz MD Judd E. Hollander MD David E. Lanfear MD Daniel J. Lenihan MD JoAnn M. Lindenfeld MD W. Frank Peacock MD Douglas B. Sawyer MD PhD John R. Teerlink MD Javed Butler MD MPH MBA 《Academic emergency medicine》2016,23(8):922-931
Management approaches for patients in the emergency department (ED) who present with acute heart failure (AHF) have largely focused on intravenous diuretics. Yet, the primary pathophysiologic derangement underlying AHF in many patients is not solely volume overload. Patients with hypertensive AHF (H‐AHF) represent a clinical phenotype with distinct pathophysiologic mechanisms that result in elevated ventricular filling pressures. To optimize treatment response and minimize adverse events in this subgroup, we propose that clinical management be tailored to a conceptual model of disease that is based on these mechanisms. This consensus statement reviews the relevant pathophysiology, clinical characteristics, approach to therapy, and considerations for clinical trials in ED patients with H‐AHF. 相似文献
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Lanfear DE 《Heart failure reviews》2010,15(3):219-228
Heart failure (HF) is a modern epidemic and is one of the few cardiovascular diseases which is increasing in prevalence. The
growing importance of the Natriuretic Peptide (NP) system in HF is well recognized. Laboratory tests for B-type Natriuretic
Peptide (BNP) have proven value as diagnostic and prognostic tools in HF and are now part of routine clinical care. Furthermore,
recombinant atrial natriuretic peptide (ANP) (carperitide) and BNP (nesiritide) and are approved HF therapies in Japan and
the US, respectively and additional natriuretic peptides (e.g., CNP, urodilatin, and designer NPs) are under investigation
for use in HF. Common genetic sequence variants are increasingly being recognized as determinants of disease risk or drug
response and may help explain a portion of the inter-individual variation in the human NP system. This review describes current
knowledge of NP system genetic variation as it pertains to HF as well as ongoing studies and where the field is expected to
progress in the near future. To briefly summarize, NP system genetic variants have been associated with alterations in gene
expression, NP levels, and cardiovascular disease. The next step forward will include specific investigations into how this
genetic variation can advance ‘Personalized Medicine’, such as whether they impact the utility of diagnostic BNP testing or
effectiveness of therapeutic NP infusion. This is already in progress, with pharmacogenetic studies of nesiritide currently
underway. We expect that within 5 years there should be a reasonable idea of whether NP system genetic variation will have
important clinical implications. 相似文献
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Early Management of Patients With Acute Heart Failure: State of the Art and Future Directions—A Consensus Document from the SAEM/HFSA Acute Heart Failure Working Group
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Sean P. Collins MD MSc Alan B. Storrow MD Phillip D. Levy MD MPH Nancy Albert PhD Javed Butler MD Justin A. Ezekowitz MD G. Michael Felker MD Gregory J. Fermann MD Gregg C. Fonarow MD Michael M. Givertz MD Brian Hiestand MD MPH Judd E. Hollander MD David E. Lanfear MD Peter S. Pang MD MSc W. Frank Peacock MD Douglas B. Sawyer MD PhD John R. Teerlink MD Daniel J. Lenihan MD 《Academic emergency medicine》2015,22(1):94-112
Heart failure (HF) afflicts nearly 6 million Americans, resulting in 1 million emergency department (ED) visits and over 1 million annual hospital discharges. The majority of inpatient admissions originate in the ED; thus, it is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics, and alternatives to hospitalization. This article discusses contemporary ED management as well as the necessary next steps for ED‐based acute HF research. 相似文献