The management of heart failure has changed significantly over the last 30 years, leading to improvements in the quality of life and outcomes, at least for patients with a substantially reduced left ventricular ejection fraction (HFrEF). This has been made possible by the identification of various pathways leading to the development and progression of heart failure, which have been successfully targeted with effective therapies. Meanwhile, many other potential targets of treatment have been identified, and the list is constantly expanding. In this review, we summarise planned and ongoing trials exploring the potential benefit, or harm, of old and new pharmacological interventions that might offer further improvements in treatment for those with HFrEF and extend success to the treatment of patients with heart failure with preserved left ventricular ejection fraction (HFpEF) and other heart failure phenotypes.
Clearly defining heart failure (HF) in clinical practice and for the purposes of clinical research can be elusive and hard to standardize. Most definitions focus on diagnostic features of HF as a clinical syndrome, but there is significant heterogeneity regarding specific diagnostic criteria. In an effort to provide more specificity, some early definitions proposed the incorporation of hemodynamic and metabolic concepts.1,2 However, assessment and application of such parameters can be difficult in routine clinical practice. Further, the criteria used to define HF in clinical trials have been highly variable, posing limitations on the collection of related endpoints of interest, especially HF-related hospitalizations. As the burden of HF continues to increase and growing evidence suggests deficiencies in the implementation of guideline-directed medical therapy (GDMT),3 the need for a universal definition of HF that is clinically relevant, simple, comprehensive, globally applicable, and allows all stakeholders to stage, prognosticate and guide available therapies, was urgently needed.
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Classifying HF by stage grants clinicians the opportunity to communicate with patients in a more practical manner and provide key terms to allow for more effective shared decision-making and care. Clinicians and patients can appreciate HF as a continuum along cardiovascular health with indications to focus on treatment and/or prevention depending on the stage. The pre-HF phase affords opportunities for education, addressing key risk factors, and preventing transition to symptomatic phases wherein heart failure is "active".
Lastly, the Universal Definition and Classification of HF offers recognition of the fact that language matters. As we aim to sway away from the traditionally accepted term "heart failure" and transition to "heart function", there are also other key terms introduced by this committee that are worth highlighting. First, clinicians should opt for the term "persistent HF" instead of "stable HF" because even in the setting of stable HF, there are opportunities to optimize therapies that prevent further worsening and/or deterioration or adverse outcomes. Along these same lines, "HF in remission" is defined as an important substitution for the conventionally used term "recovered HF", for patients who experience resolution of their symptoms and/or systolic function, as HF is known to frequently relapse. As heart function cardiologists, it also is important that we convey to patients that improvement does not mean the HF is cured. The semantic changes and classification scheme in the new definition offer opportunities for better communication and patient engagement, wherein clinicians can focus on the implementation of GDMT across a continuum to improve outcomes (Figure 1).
Critical congenital heart defects (also called critical CHDs or critical congenital heart disease) are the most serious congenital heart defects. Babies with critical CHDs need surgery or other treatment within the first year of life. Without treatment, critical CHDs can cause serious health problems and death.
Coarctation of the aorta (also called COA). In this condition, part of the aorta is too narrow. This can reduce or block the flow of blood to the body. The heart muscles need to work harder to get blood out of the heart. This extra stress on the heart can weaken the heart muscle and cause other heart problems. Babies with COA are treated with surgery or a procedure called balloon angioplasty. In this procedure, a provider uses a catheter (a thin, flexible tube) with a tiny balloon that he expands to stretch open the aorta. He may put in a stent, which is a small mesh-covered tube used to keep the blood vessel open. Many children with COA need to take medicine to lower their blood pressure. Blood pressure is the force of blood against the walls of the arteries.
Septal defects. These conditions leave a hole in the septum. This can cause blood to go in the wrong direction or to the wrong place, or it can cause extra blood to be pumped to the lungs. Types of septal defects include:
Your baby is tested for critical CHDs as part of newborn screening before she leaves the hospital after birth. Newborn screening checks for serious but rare and mostly treatable conditions. It includes blood, hearing and heart screening. All states require newborn screening, and all states except California require screening for critical CHDs. California requires that providers offer screening for critical CHDs.
In heart valve disease, one or more of the valves in the heart doesn't work properly. There are four heart valves. They keep blood flowing through the heart in the correct direction. Sometimes a valve doesn't open or close all the way. This can change how blood flows through the heart to the rest of the body.
A typical heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of the heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.
Each valve has flaps, called leaflets or cusps. The flaps open and close once during each heartbeat. If a valve flap doesn't open or close properly, less blood moves out of the heart to the rest of the body.
Some people are born with heart valve disease. This is called congenital heart valve disease. But adults can get heart valve disease too. Causes of heart valve disease in adults may include infections, age-related changes and other heart conditions.
You can walk into any pharmacy, grocery or convenience store and buy aspirin without a prescription. The Drug Facts label on medication products, will help you choose aspirin for relieving headache, pain, swelling, or fever. The Drug Facts label also gives directions that will help you use the aspirin so that it is safe and effective.
But what about using aspirin for a different use, time period, or in a manner that is not listed on the label? For example, using aspirin to lower the risk of heart attack and clot-related strokes. In these cases, the labeling information is not there to help you with how to choose and how to use the medicine safely. Since you don't have the labeling directions to help you, you need the medical knowledge of your doctor, nurse practitioner or other health professional.
You can increase the chance of getting the good effects and decrease the chance of getting the bad effects of any medicine by choosing and using it wisely. When it comes to using aspirin to lower the risk of heart attack and stroke, choosing and using wisely means: Know the facts and work with your health professional.
Aspirin has been shown to be helpful when used daily to lower the risk of heart attack, clot-related strokes and other blood flow problems in patients who have cardiovascular disease or who have already had a heart attack or stroke. Many medical professionals prescribe aspirin for these uses. There may be a benefit to daily aspirin use for you if you have some kind of heart or blood vessel disease, or if you have evidence of poor blood flow to the brain. However, the risks of long-term aspirin use may be greater than the benefits if there are no signs of, or risk factors for heart or blood vessel disease.
There are no directions on the label for using aspirin to reduce the risk of heart attack or clot-related stroke. You may rely on your health professional to provide the correct information on dose and directions for use. Using aspirin correctly gives you the best chance of getting the greatest benefits with the fewest unwanted side effects. Discuss with your health professional the different forms of aspirin products that might be best suited for you.
Aspirin has been shown to lower the risk of heart attack and stroke in patients who have cardiovascular disease or who have already had a heart attack or stroke, but not all over-the-counter pain and fever reducers do that. Even though the directions on the aspirin label do not apply to this use of aspirin, you still need to read the label to confirm that the product you buy and use contains aspirin at the correct dose. Check the Drug Facts label for "active ingredients: aspirin" or "acetylsalicylic acid" at the dose that your health professional has prescribed.
As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back, throat, neck or jaw pain. These symptoms are not always recognized as a symptom of a heart condition in women. As a result, treatment for women can be delayed.
Arteries and veins link your heart to the rest of the circulatory system. Veins bring blood to your heart. Arteries take blood away from your heart. Your heart valves help control the direction the blood flows. 0852c4b9a8
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