Tag Archives: quality of life

Introduction ST-elevation myocardial infarction (STEMI) is an acute ischaemic event associated with an increased risk of clinical complications, poor recovery, and adverse cardiovascular events.1 Owing to the recent development and advancements in management, outcomes of STEMI patients have improved significantly.2 Primary percutaneous coronary intervention (PCI) remains the recommended treatment option by both European and American clinical practice guidelines.3,4 In addition to improvements in the management strategy, risk stratification of patients with STEMI improved extensively with the introduction of various risk-stratification modali

Introduction It is important to consider quality of life (QoL) when managing the health and wellbeing of patients as it assists in the interpretation of symptoms, functional status, perceptions, experiences and patient expectations.1 Atrial fibrillation (AF) and diabetes are both long-term conditions that are increasing in prevalence. Both AF and diabetes can influence physical and psychological health and reduce QoL.1 Evidence has shown that in up to 40% of patients with diabetes, AF can co-exist,2 and little is known about how diabetes can further worsen QoL in AF. This comparison study, therefore, explores the QoL in these often co-existin

Introduction Refractory angina (RA) is an increasingly common clinical problem due to improved survival from coronary artery disease (CAD) and an ageing population. It is defined as chronic angina-type chest pain (≥3 months in duration) due to myocardial ischaemia in the setting of CAD that persists despite optimal medical therapy, angioplasty or bypass surgery. In the US, between 600,000 and 1.8 million people are living with RA.1,2 Annually, it is estimated that 75,000 new cases are diagnosed in the US and 30,000 to 50,000 in Europe. Long-term outcomes are better than previously estimated (nine-year life expectancy is 71.6%).3 With persis

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In the USA, in 2008 the total inflation-adjusted cost of heart failure admissions was US$10.7 billion, compared with US$6.9 billion in 1997.2 So heart failure admissions are expensive and there is considerable interest in how we might reduce admissions, thereby reducing costs and leading to an improved quality of life (QoL) for patients with heart failure.3  One solution might be the Observation Unit (OU) proposed by Collins et al.4 as an alternative to hospital admission for patients needing a brief period (under 24 hours) of intravenous diuretic therapy. Observation, by definition, is the use of appropriate monitoring, diagnostic testing,

Introduction Acute heart failure (AHF) has been defined by the European Society of Cardiology (ESC) as the rapid onset of, or change in, symptoms and signs of heart failure, and is a life-threatening condition that requires immediate medical attention.1 These symptoms and signs include shortness of breath at rest or during exertion, fatigue, pulmonary or peripheral fluid retention, a cough, and evidence of an abnormality of the structure or function of the heart at rest.2-4 This change in cardiac function results in an urgent need for therapy, and AHF is among the most common causes of hospitalisation.5 AHF can, therefore, be seen to represen

Prevalence In published reports of patients with heart failure, the prevalence of anaemia varies markedly, reflecting the very varied characteristics of the studied populations. In reports based upon clinical trials, the reported prevalence ranges from 10–25% (figure 1), while in cohorts of patients in observational or registry-based studies, it appears to be higher, from 15–50% (figure 2). This variation is unsurprising given the relatively selected nature of patients recruited to clinical trials in CHF. A reasonable overall estimate can be gleaned from a large systematic review of 34 studies, including more than 150,000 patients, in wh

Introduction Atrial fibrillation (AF) is a common cardiac arrhythmia affecting approximately six million patients in Europe and 2.3 million in the USA.1 Estimates in the general population suggest a prevalence rate of 0.4–1.0%, with marked increase in prevalence with age, increasing to approximately 10% by the age of 80 years.2 AF can precipitate heart failure, ventricular arrhythmias, and it is associated with a four- to five-fold increase in chance of stroke.3,4 In addition, although AF is frequently asymptomatic, it can reduce quality of life causing fatigue, palpitations, anxiety and dizziness.3 AF is classified in three ways:5 Paroxy

Choice of surgery The mainstay of cardiac surgery is CABG, which is performed for both symptomatic and prognostic reasons. In elderly asymptomatic patients, the prognostic value of the operation has to be thought through carefully and in the context of the patient’s general health and lifestyle. The overall risk following CABG in patients older than 80 years is approximately 8%.2 Recently, there has been an increase in the number of elderly patients referred for cardiac surgery. One of the reasons is the emergence of minimally invasive techniques like transcatheter aortic valve implantation (TAVI) and off-pump CABG (beating heart). It was

Lessons Both patients and doctors can learn from this study. Patients need to be better informed about the natural history of coronary heart disease and what can be done to try to alter it – that is control not cure. Patients also need to understand the limitations of pharmaceutical agents and what revascularisation strategies can realistically achieve in the short and long term. In particular, over-optimistic pre-operative expectations1 need to be tempered with a dose of reality – the TV soaps and tabloid newspapers and magazines may be partly responsible – but more detailed explanation prior to intervention would not go amiss. Doctors