Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey

Cleland, John G.F.; Cohen‐Solal, Alain; Aguilar, Juan Cosín; Dietz, Rainer; Eastaugh, Joanne; Folláth, Ferenc; Freemantle, Nick; Gavazzi, Antonello; Gilst, Wiek H. van; Hobbs, FD Richard; Korewicki, J; Madeira, Hugo; Préda, István; Swedberg, Karl; Widimský, Jiří

doi:10.1016/s0140-6736(02)11601-1

Cited by 487 publications

(383 citation statements)

References 29 publications

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“…While recent evidence suggests modest improvements in HF-related outcomes (150), the care provided to many HF patients, particularly those who are elderly, still fails to meet the standards set out in the CCS recommendations on HF (151)(152)(153)(154)(155). Applying quality assurance methods to chronic HF requires consideration of the often unpredictable illness trajectory, characterized by periods of relative stability that are punctuated by episodes of acute decompensation (156).…”

Section: Quality Assurance Considerations For Hf Carementioning

confidence: 99%

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Howlett¹,

McKelvie²,

Costigan³

et al. 2010

Canadian Journal of Cardiology

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Section: Quality Assurance Considerations For Hf Carementioning

confidence: 99%

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Howlett¹,

McKelvie²,

Costigan³

et al. 2010

Canadian Journal of Cardiology

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“…3 It is now widely accepted that DHF is also a major cardiovascular disorder with poor prognosis, accounting for approximately half of the patients with a heart failure symptom. 4,5 It has been reported that nearly 30% of patients with DHF also have diabetes mellitus (DM). 6,7 DM is a major risk factor for heart failure, 6,8 because the disorder causes functional, biochemical and morphological abnormalities of cardiomyocytes, independent of coronary artery disease or hypertension (HT).…”

Section: Introductionmentioning

confidence: 99%

Diabetes mellitus accelerates left ventricular diastolic dysfunction through activation of the renin–angiotensin system in hypertensive rats

et al. 2009

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Diabetes mellitus (DM) is a major risk factor for heart failure, independent of coronary artery disease or hypertension (HT). Therefore, our study was designed to examine the mechanisms of DM-induced left ventricular (LV) diastolic dysfunction. In this study, we made five different 10-week treatment groups of Dahl salt-sensitive rats as follows: Control; a low-salt (0.5% NaCl) diet, HT; a high-salt (5% NaCl) diet, DM; a low-salt diet with streptozotocin (STZ) injection (30 mg kg À1 i.p.), HT+DM; a highsalt diet with STZ injection, and the Olmesartan group; a high-salt diet with STZ treated with an angiotensin receptor blocker, olmesartan (1 mg kg À1 day À1 ). Cardiac diastolic dysfunction with a preserved systolic function was noted in the HT group, and was most prominently noted in the HT+DM group, characterized by enhanced cardiac fibrosis, whereas the extent of HT and myocardial hypertrophy was comparable between the two groups. Myocardial expressions of collagen III, transforming growth factor-b2, angiotensin-converting enzyme (ACE), angiotensin II type-1 receptor and myocardial oxidative stress (evaluated by 4-hydroxy-2-nonenal-modified protein) were mostly enhanced in the HT+DM group. Importantly, there was a positive correlation between the extent of diastolic dysfunction and that of myocardial ACE expression. All these cardiac abnormalities induced by DM and HT were ameliorated in the olmesartan group. These results indicate that DM accelerates diastolic dysfunction in hypertensive heart disease through activation of the renin-angiotensin system, with subsequent inflammatory and oxidative stresses and myocardial fibrosis, suggesting that an inhibition of the system is effective for the treatment of diastolic dysfunction in this combined disorder.

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“…An average blood pressure of 140/81 mmHg in the 6337 patients in primary care with heart failure in the IMPROVEMENT of Heart Failure study points to a considerably higher mean pressure before the onset of heart failure and administration of drug therapy, and quite possibly a higher prevalence of predisposing hypertension than the 48% quoted. 35 In the report by Kitzman et al, 36 patients aged 60 years and greater with systolic or diastolic heart failure had, despite anti-heart failure treatment, higher levels of systolic arterial pressure than agematched healthy controls (136, 147 and 128 mmHg respectively). Perhaps, in this particular case, the prevalence of hypertension prior to heart failure was in the order of 62-85%, as quoted.…”

Section: Measurements Of Arterial Pressurementioning

confidence: 95%

Hypertension — still an important cause of heart failure?

et al. 2005

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Hypertension has been the single most important risk factor for heart failure until the last few decades. Now, it is frequently claimed that atherosclerotic coronary artery disease dominates as the major underlying cause, and hypertension is of lesser importance. We here review evidence regarding the contribution of hypertension to heart failure in the recent decades. It is not possible, in our view, to be confident of the relative importance of hypertension and coronary artery disease since there are significant limitations in the available data. The often-questionable diagnostic criteria used in defining heart failure is one such limitation. The absence or inadequacy of blood pressure recordings over the years prior to a diagnosis of heart failure seriously hinders the reaching of firm conclusions in many reports. Extrapolations from aetiological observations in one racial group to those in other racial groups, and from highly selected study groups in tertiary referral centres to patients with heart failure in primary and secondary care, may not be justified. Finally, the situation of heart failure primarily due to impaired left ventricular diastolic function, where hypertension is a frequent precursor, is often ignored in discussions of aetiology. Our view is that hypertension remains and probably is the single most, important modifiable risk factor for cardiac failure in some races and countries, where the dominant cardiac abnormality is left ventricular diastolic dysfunction. The situation is less clear for patients with heart failure primarily due to left ventricular systolic dysfunction.

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Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey

Cited by 487 publications

References 29 publications

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Diabetes mellitus accelerates left ventricular diastolic dysfunction through activation of the renin–angiotensin system in hypertensive rats

Hypertension — still an important cause of heart failure?

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