RESUMEN

AIMS: Guidelines have been published for improving management of chronic heart failure (CHF). We examined the association between improved guideline adherence and risk for all-cause death in patients with stable systolic HF. METHODS: Data on ambulatory patients (2006-2010) with CHF and reduced ejection fraction (HF-REF) from the Austrian Heart Failure Registry (HIR Austria) were analysed. One-year clinical data and long-term follow-up data until all-cause death or data censoring were available for 1014 patients (age 65 [55-73], male 75%, NYHA class I 14%, NYHA II 56%, NYHA III/IV 30%). A guideline adherence indicator (GAI [0-100%]) was calculated for each patient at baseline and after 12 ± 3 months that considered indications and contraindications for ACE-I/ARB, beta blockers, and MRA. Patients were considered ΔGAI-positive if GAI improved to or remained at high levels (≥ 80%). ΔGAI50+ positivity was ascribed to patients achieving a dose of ≥ 50% of suggested target dose. RESULTS: Improvements in GAI and GAI50+ were associated with significant improvements in NYHA class and NT-proBNP (1728 [740-3636] to 970 [405-2348]) (p<0.001). Improvements in GAI50+, but not GAI, were independently predictive of lower mortality risk (HR 0.55 [95% CI 0.34-0.87; p=0.01]) after adjustment for a large variety of baseline parameters and hospitalisation for heart failure during follow-up. CONCLUSIONS: Improvement in guideline adherence with particular emphasis on dose escalation is associated with a decrease in long-term mortality in ambulatory HF-REF subjects surviving one year after registration.

Asunto(s)

RESUMEN

In 8 patients with implanted pacemaker (3 unipolar, 5 bipolar systems) the risk of interference of a regular pacemaker function and an energy source with a capacity of 110 Watt and a frequency of 434 MHz was investigated. The results show that thermotherapy in patients with prostatic hypertrophy can be used without the risk of interference with regular pacemaker function.

RESUMEN

8 of 122 patients receiving an implantable cardioverter defibrillator (ICD) in our department since 1985 for the treatment of ventricular tachyarrhythmias were considered candidates for cardiac transplantation. In 6 of 8 patients, at least one successful ICD discharge (range 1-378 discharges) was documented in the follow up time until transplantation. These therapies included cardioversions/defibrillations as well as overdrive stimulation in sustained monomorphic ventricular tachycardia. 1 patient died shortly before receiving a compatible organ. The remaining 7 patients survived successful heart transplantation undertaken 7-34 months after implantation of the cardioverter defibrillator. Cardiac transplantation was not complicated in any of these patients by the previous ICD management. Our results show the high efficacy of ICD as "bridge to transplant" therapy unit cardiac transplantation.

Asunto(s)

RESUMEN

Due to technical improvement using the transvenous-subcutaneous approach for lead fixation for cardioverter-defibrillator implantation, the incidence of device implantation has extended enormously. While a significant lower perioperative mortality in transvenously implanted systems compared to epicardially fixed implantable cardioverter-defibrillator (ICD) has been proven, perioperative as well as complications during follow-up are not analyzed systematically. In 59 patients, in whom transvenous-subcutaneous ICDs had been implanted, 3 patients showed bleeding complications in the subcutaneous patch area, 1 patient showed a bleeding in the device pocket, and in 1 patient a seroma in the subcutaneous patch region was observed necessitating surgical revisions. During follow-up of 10 +/- 7 months, lead dislocations were observed in 6 patients, in another 6 patients patch crinkling was observed. There was 1 patient with a lead fracture as well as 1 patient with a bleeding in the subcutaneous patch region. Despite the high efficacy of this therapy used in patients with life-threatening ventricular arrhythmias, these potential complications have to be considered.

Asunto(s)