Guideline-directed medical therapy (GDMT) has the potential to reduce the risks of mortality and hospitalisation in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data indicate that many patients with HFrEF do not receive optimised GDMT, which involves several different medications, many of which require up-titration to target doses. There are many challenges to implementing GDMT, the most important being patient-related factors (comorbidities, advanced age, frailty, cognitive impairment, poor adherence, low socioeconomic status), treatment-related factors (intolerance, side-effects) and healthcare-related factors that influence availability and accessibility of HF care. Accordingly, international disparities in resources for HF management and limited public reimbursement of GDMT, coupled with clinical inertia for treatment intensification combine to hinder efforts to provide GDMT. In this review paper, authors aim to provide solutions based on available evidence, practical experience, and expert consensus on how to utilise evolving strategies, novel medications, and patient profiling to allow the more comprehensive uptake of GDMT. Authors discuss professional education, motivation, and training, as well as patient empowerment for self-care as important tools to overcome clinical inertia and boost GDMT implementation. We provide evidence on how multidisciplinary care and institutional accreditation can be successfully used to increase prescription rates and adherence to GDMT. We consider the role of modern technologies in advancing professional and patient
Association for the Study of the Liver, Almaty c., Republic of Kazakhstan At present nonalcoholic fatty liver disease (NAFLD) is one of the most common internal diseases in hospital, leading to life quality deterioration, disability and mortality both for the reason, associated with concurrent cardiovascular diseases and components of metabolic syndrome and for the reason directly associated with a liver disease itself. Provided epidemiological cross sectional study-screening is focused on examination of NAFLD prevalence and associated components of metabolic syndrome in «theoretical» healthy individuals, i.e. office employees of Almaty city.
In recent years, there has been increasing interest in the frailty as a prognostic factor of acute myocardial infarction in elderly patients.Frailty is an important prognostic marker of frequent complications, readmission to hospital, high hospital mortality and major cardiovascular events in elderly patients with acute myocardial infarction. This category of persons is often not allowed to undergo invasive interventions and are often excluded from the recommended treatment, and they tolerate cardiac surgery worse, recovery from illness is slower, functionality decreases, then disability and death develop.The present review aims to investigate the impact of frailty on management of elderly patients with acute myocardial infarction (AMI).To analyze the literature, we searched for information on this issue in PubMed / MEDLINE, PMC, Web of Science, Scopus, The Сochrane Library. The search depth was 15 years: from 2006 to 2021.One of the important factors in improving clinical outcomes, improving the quality of life in elderly patients with acute myocardial infarction is the early detection of frailty. Frailty assessment is a valuable tool for risk stratification that can be helpful to clinicians in deciding the optimal pathway for management and treatment strategies. Risk prediction is also important for deciding secondary prevention and cardiac rehabilitation measures in the elderly with acute myocardial infarction.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.