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Aims: This study aimed to analyse community management of patients during the symptomatic period prior to admission with acute decompensated heart failure (ADHF). Methods and results: We conducted a prospective, two‐centre, two‐country observational study evaluating care pathways and patient experience in patients admitted to hospital with ADHF. Quantitative and qualitative data were gathered from patients, carers, and general practitioners (GPs). From the Irish centre, 114 patients enrolled, and from the English centre, 50 patients. Symptom duration longer than 72 h prior to hospitalization was noted among 70.4% (76) Irish and 80% (40) English patients, with no significant difference between those with a new diagnosis of HF [de novo HF (dnHF)] and those with known HF [established HF (eHF)] in either cohort. For the majority, dyspnoea was the dominant symptom; however, 63.3% (31) of these Irish patients and 47.2% (17) of these English patients did not recognize this as an HF symptom, with no significant difference between dnHF and eHF patients. Of the 46.5% (53) of Irish and 38% (19) of English patients reviewed exclusively by GPs before hospitalization, numbers prescribed diuretics were low (11.3%, six; and 15.8%, three, respectively); eHF patients were no more likely to receive diuretics than dnHF patients. Barriers to care highlighted by GPs included inadequate access to basic diagnostics, specialist support and up‐to‐date patient information, and lack of GP comfort in managing HF. Conclusion: The aforementioned findings, consistent across both health care jurisdictions, show a clear potential to intervene earlier and more effectively in ADHF or to prevent the need for hospitalization. [ABSTRACT FROM AUTHOR]

How should we design a research study that enables us to best answer our clinical question? How do we choose a method that combines our need for speed of answer, with both accuracy and usefulness? How can we design a study that enables all of this but at a cost that we can afford? This article draws upon key points raised in the previous articles in the series to discuss important issues in research design, and consider how they influence the design of a study that best answers the clinical research question. [ABSTRACT FROM AUTHOR]

Recent advances in care and management of heart failure have improved outcome, largely as a result of the developing evidence basis for medications, implantable devices and the organization of heart failure follow-up. Such developments have also increased the complexity of delivering and coordinating care. This has led to a change to the way in which heart failure services are organized and to the traditional role of the heart failure nurse. Nurses in many countries now provide a range of services that include providing care for patients with acute and with chronic heart failure, working in and across different sectors of care (inpatient, outpatient, community care, the home and remotely), organising care services around the face-to-face and the remote collection of patient data, and liaising with a wide variety of health-care providers and professionals. To support such advances the nurse requires a skill set that goes beyond that of their initial education and training. The range of nurses' roles across Europe is varied. So too is the nature of their educational preparation. This heart failure nurse curriculum aims to provide a framework for use in countries of the European Society of Cardiology. Its modular approach enables the key knowledge, skills, and behaviours for the nurse working in different care settings to be outlined and so facilitate nursing staff to play a fuller role within the heart failure team. [ABSTRACT FROM AUTHOR]

Background: Despite the high prevalence of heart failure in low- and middle-income countries, evidence concerning patient-reported burden of disease in advanced heart failure is lacking. Objective: The aim of this study is to measure patient-reported symptom prevalence and correlates of symptom burden in patients with advanced heart failure. Methods: Adult patients diagnosed with New York heart Association (NYHA) stage III or IV heart failure were recruited from the emergency unit, emergency ward, cardiology ward, general medicine wards, and outpatient cardiology clinic of a public hospital in South Africa. Patients were interviewed by researchers using the Memorial Symptom Assessment Scale--Short Form, a well-validated multidimensional instrument that assesses presence and distress of 32 symptoms. Results: A total of 230 patients (response, 99.1 %), 90% NYHA III and 10% NYHA IV (12% newly diagnosed), with a mean age of 58 years, were included. Forty-five percent were women, 14% had completed high school, and 26% reported having no income. Mean Karnofsky Performance Status Score was 50%. Patients reported a mean of 19 symptoms. Physical symptoms with a high prevalence were shortness of breath (95.2%), feeling drowsy/tired (93.0%), and pain (91.3%). Psychological symptoms with a high prevalence were worrying (94.3%), feeling irritable (93.5%), and feeling sad (93.0%). Multivariate linear regression analyses, with total number of symptoms as dependent variable, showed no association between number of symptoms and gender, education, number of healthcare contacts in the last 3 months, years since diagnosis, or comorbidities. Increased number of symptoms was significantly associated with higher age (b = 0.054, P = .042), no income (b = -2.457, P = .013), and fewer hospitalizations in the last 12 months (b = -1.032, P= .017). Conclusions: Patients with advanced heart failure attending a medical center in South Africa experience high prevalence of symptoms and report high levels of burden associated with these symptoms. Improved compliance with national and global treatment recommendations could contribute to reduced symptom burden. Healthcare professionals should consider incorporating palliative care into the care for these patients. [ABSTRACT FROM AUTHOR]

Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches. [ABSTRACT FROM AUTHOR]

Acute heart failure is a fatal syndrome. Emergency physicians, cardiologists, intensivists, nurses and other health care providers have to cooperate to provide optimal benefit. However, many treatment decisions are opinion-based and few are evidenced-based. This consensus paper provides guidance to practicing physicians and nurses to manage acute heart failure in the pre-hospital and hospital setting. Criteria of hospitalization and of discharge are described. Gaps in knowledge and perspectives in the management of acute heart failure are also detailed. This consensus paper on acute heart failure might help enable contiguous practice. [ABSTRACT FROM AUTHOR]

All major manufacturers of implantable pacing or defibrillator technologies support remote monitoring of their devices. Integration of signals from several monitored variables can facilitate earlier detection of arrhythmia or technical problems, and can also identify patients at risk of deterioration. Meta-analyses of randomized studies of remote monitoring of heart failure using standalone systems suggest considerable clinical benefit when compared with usual care. However, there may be little to be gained by frequently monitoring patients with well-treated stable disease. Trials of implantable monitoring-only devices suggest that there is a subgroup of patients that may benefit from such remote monitoring. Remote monitoring is still not widely adopted due to a number of social, technological and reimbursement issues, but this is likely to change rapidly. Remote monitoring will not replace face-to-face clinical review, but it will be part of the solution to ever increasing numbers of patients with heart failure and/or an implantable device requiring expert input to their care. [ABSTRACT FROM AUTHOR]

The article presents various topics presented in the Conference of the European Society of Cardiology held in Munich on August 2004. Over 25,000 delegates from around the world attended the conference. It offered the opportunity to hear about the latest developments in cardiac care, debate newer models of treatment and discuss the results from large European surveys of the care and management of the person with heart disease. Members of Harefield Hospital have developed a follow-up service for patients who have undergone Percutanerous Transluminal Coronary Angioplasty (PTCA) to relieve their symptoms of angina. A study undertaken in the Netherlands looked at enabling patients following PTCA to mobilise earlier and so leave hospital sooner.