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Re: Article 41

Categoria: Cardiology
Autore: gfg
Remote User:
Date: 04 set 2006
Time: 13:46:30

Commenti

Numeri da record a Barcellona per l’ESC Il 5 settembre c.a. si e chiuso a Barcellona il congresso dell’ESC associato al congresso mondiale di cardiologia. Piú di 23200 i partecipanti attivi che sommati agli espositori ed accompagnatori hanno raggiunto un totale di circa 30000 persone. Con dodici sessioni scientifiche l’associazione tra le malattie cardiovascolari e l’invecchiamento e’ stato il tema fondamentale. Dei 10594 abstract discussi (con il 10% circa di contributo italiano in 2ª posizione) la funzione ventricolare in generale con il 17% e’ stata la più la trattata (scompenso, malattie valvolari, circolazione polmonare). Gli altri temi affrontati sono stati il gruppo della epidemiologia, prevenzione, farmacologia (15%), la cardiopatia ischemica (14%), le aritmie (14%) e l’ipertensione (10%). Tra le tecniche di imaging I maggiori contributi sono arrivati sulla ecocardiografia (4.9 %)e sulla cardiolologia nucleare + CMR + CT (3.4%). Ancora poco presenti, anche se in crescita, i contributi da parte degli infermieri (0.6%). Nel mondo, come in Italia, occorre certamente lavorare per allargare la partecipazione. Valentin Fuster, presidente della World Heart Federation, ha poi stressato il ruolo della prevenzione delle malattie cardiovascolari che rimangono nel mondo con 17.5 milioni di morti nel 2005, il primo killer. Il Dott. Furster si e’ lamentato della omissione nell’agenda delle Nazioni Unite di tale prioritá dicendo che “gli operatori sanitari debbono compensare tale mancanza educando i cittadini e debbono aiutarli nel controllo dei fattori di rischio conosciuti come il sovrappeso-obesità, l’inattività fisica, il fumo, l’ipertensione e le dislipidemie”. Scompenso cardiaco Abstract: Heart failure management programmes in Europe Authors: Dr Tiny T. Jaarsma, European Journal of Cardiovascular Nursing Editor-in-Chief The ESC Guidelines on Chronic Heart Failure (HF) recommend that an organised system of specialist heart failure care should be established to improve outcomes of HF patients. Only a few European countries have a large number of organised programmes for HF care and follow up. A survey conducted by UNITE research group of the WGCN of the ESC describes that half of these programmes were located in an outpatient clinic. Most programmes included physical examination, telephone consultation, patient education, drug titration and diagnostic testing. Most (89%) programmes involved nurses and physicians. Prominent differences between the countries were the degree of collaboration with home care and GP's, the role in palliative care and the funding. Reference: Authors: Jaarsma T, Strömberg A, De Geest S, Fridlund B, Heikkila J, Mårtensson J, Moons P, Scholte op Reimer W, Smith K, Stewart S, Thompson DR Cardiopatia ischemica Il gene adiponectina indicatore di coronaropatia negli uomini Secondo alcuni ricercatori austriaci condotti dal prof. H. Drexel una variante del gene adiponectina potrebbe essere usata nel futuro per predire I siggetti ad alto rischio di sviluppare cardiopatia ischemica. Il polimorfismo del gene collegato alla adiponectina e ad alter adipokine e’ allo studio del team di ricercatori. Echocardiographic measurements in Heart Failure The session ended with the presentation of Dr J E Sanderson of Stoke-on-Trent, England making some remarks on what should be measured in systolic and diastolic failure. Starting with the key message that measuring volumes is more important than measuring EF, Dr Sanderson highlighted again the pathophysiological aspects of heart failure (remodelling) that should be monitored during the examination of heart failure patients Heart failure with normal ejection fraction: Controversy continues! Diastolic heart failure (DHF) is usually defined as symptoms and signs of HF with normal ejection fraction(EF) and diastolic dysfunction (DD). It has been reported that 20 to 40% of patients with CHF and normal EF have a reduction of LV “contractility”. Dr. D. Burkhoff showed experimental and clinical data of increased plasma volume in hypertensive patients with HF and normal EF, and increased LVEDV, even in patients without HF. Dati del Dr.J.E. Sanderson hanno evidenziato decreased peak systolic velocity in tissue Doppler imaging in patients with DHF and more so in those with SHF, early diastolic velocities being similar. A mixture of abnormal systolic and DD would be present and no separate diseases would exist. . Dr. B.M. Pieske presented data suggesting that DHF and SHF are the mere extremes of a continuous spectrum of phenotypes of the same disease. They would not be a single disease and there are ultrastructural differences between the two, as well as different remodeling of the LV (concentric vs. eccentric remodeling) to support this idea. Dr. V.Melenovsky showed interesting data on the extraventricular aspects in DHF, namely increased arterial stiffness, increased left atrial (LA) volume and decreased LA contractile reserve, as well as decreased augmentation of CO due to blunted HR response because of autonomic dysfunction, and inadequate vasodilatation. They suggested that we should talk of HF without mention of EF. A multi-country randomized trial on the role of a new telemonitoring system in CHF: the HHH Study (Home or Hospital Heart Failure). By Dr. Andrea Mortara HHH study is a randomized controlled trial conducted in Italy, Poland and UK enrolling patients with chronic heart failure (CHF; LVEF <35%, NYHA class II-IV) in 2 arms (usual clinical practice and home-care strategy). ‘Home care strategy’ patients have been randomized into: 1) normal clinical practice supplemented by monitoring using conventional telephone contacts, 2) as strategy 1 plus periodic telemonitoring of vital signs 3) as 2° strategy plus periodic 24h ECG, respiration and physical activity (NICRAM) recording which is used in care plan. Enrolment in the 11 Centers (5 in Italy, 3 in UK and 3 in Poland) has been over 12 months with a further 12 months follow-up. Objectives are: 1) To determine if different strategies of home-care telemonitoring: (i) simple voice contact by telephone plus routine hospital care: (ii) as (i) plus intermittent monitoring of vital signs: (iii) as (ii) plus periodic continuous monitoring of ECG, respiration and activity, affect hospital admissions, improve patient sense of well-being, and reduce overall costs of medical care. 2) To define the prevalence and the clinical impact of breathing disorders, arrhythmias and abnormalities of HRV in the occurrence of acute periods of instability when on optimal therapy. 3) To evaluate in the home setting a new system for continuous monitoring of cardio-respiratory signals plus physical activity with tele-transmission of recorded data embedded in an interactive voice response based telehealth system. The primary end-point will be total bed-days occupancy for heart failure in acute medical / surgical beds. Secondary end-points will be bed-days occupancy for all cause and for cardiovascular events (death, HF, arrhythmias, unstable angina, myocardial infarction, stroke and cardiovascular procedures), measures of patient well-being (death, hospital bed days, symptom score and QoL), change in therapy, costs of care and cost-effectiveness. Exploratory end-points will include: frequency of Cheyne-Stokes respiration (apnoea/ hypopnoea index and total time during night and day) and predicting role of heart rate variability parameters. A separate analysis on the value of pre-discharge NICRAM in predicting early (<1 month) unplanned readmission and cardiac events will also be performed in patients of both groups. From July 2002 to July 2004, 461 HF patients were enrolled in 11 centers (age 60±11 yrs, NYHA class 2.4±0.6, LVEF 29±7%) and follow-up was completed in July 2005. In Italy, Poland and UK 82%, 75% and 93% respectively, of practicable vital signs transmissions have successfully been carried out by the patients, for a total of 50217 parameters and 686 voice messages received. In the three countries, 96%, 85% and 99% of NICRAM recordings, have been correctly transmitted, and 77% were eligible for the study (i.e. >2.5 hours of good quality data during the night), for a total of 1296 home recordings. We hypothesise that long-term telemonitoring of NICRAM will allow early identification of clinical deterioration, earlier optimisation of treatment, better survival, improve QoL and encourage self care in HF patients. Such a tele-monitoring system, if proven to be effective and practical will then be applicable to several other clinical situations (e.g. rehabilitation post-MI and stroke, obstructive sleep apnoea, chronic lung disease. What role should nurses have in research? Building databases Compliance with medication Communication with patients What role should nurses have in research? Building databases 35 % Compliance with medication 22 % Communication with patients 43 % Marcella Ferrada, Cardiology Nurse Santiago, Chile: Elderly patients need more nurses’ time, more counselling, and more follow-up by telephone. When they are discharged, they may lack understanding and you may need to explain their treatment many times. They often take a large number of different pills and may need help to organise their treatment. In Chile, government health insurance may not cover treatment so we also have to tell them how to buy their medication. Congenital heart disease caused by diabetes TYPE II diabetes and gestational diabetes in pregnant women can result in their babies being born with congenital heart disease (CHD) and hypertrophic cardiomyopathy (HCM), according to a Swiss abstract By E.and collegues. He suggested that preconception glycaemic control might also be improved with the placement of a subcutaneous insulin pump.


Updated on (Aggiornato il): 04-09-06