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Post-operative patient care and hospital implications of fast track
Safe and efficient postoperative care is one of the corner stones of successful management of cardiac patients. The ever-increasing number of cardiac procedures, together with limited ICU bed availability, frequently leads to the postponement of cardiac procedures. Post-cardiac surgery fast track (FT) management is a multidisciplinary process using multimodal management techniques to improve the efficiency and safety of postoperative patient management, using available resources appropriately. The fast track concept includes the application of different pathways to fit different hospital structures. Fast track is proofed t...
Source: European Journal of Heart Failure Supplements - January 15, 2017 Category: Cardiology Authors: Zakhary, W. Z. A., Turton, E. W., Ender, J. K. Tags: Articles Source Type: research

Anaesthesia and cardiopulmonary bypass aspects of fast track
Fast track cardiac surgery involves the pre-requisite of an anaesthesia management based on short-acting agents. Many of the historical challenges have been now overcome by the availability of new-generation agents. Nevertheless, the tasks being actually asked to the cardiac anaesthesiologist for a successful fast track sequence include not only guaranteeing the adequate anaesthesia and analgesia levels but an overall intraoperative management limiting the occurrence of early post-operative complications, including an appropriate monitoring of neurologic and haemodynamic functions, as well as a careful management of haemos...
Source: European Journal of Heart Failure Supplements - January 15, 2017 Category: Cardiology Authors: Ranucci, M. Tags: Articles Source Type: research

Fast track minimally invasive aortic valve surgery: patient selection and optimizing
Fast track cardiac surgery started in the late 1980s due to a rapid growing amount of operations putting a high pressure on resources, particularly on intensive care capacity. The early fast track studies showed that this technique is feasible and safe for selected patients and procedures. Although some limitations of fast tracking such as patient age, co-morbidities and prolonged operation time were later described, this did not stop further extension of patient and procedure selection criteria. Nowadays, fast track pathways are used to improve patient care as a shorter ICU stay seems to decrease mortality. These pathways...
Source: European Journal of Heart Failure Supplements - January 15, 2017 Category: Cardiology Authors: Heijmans, J. H., Lance, M. D. Tags: Articles Source Type: research

Current evidence on fast track cardiac recovery management
This article reviews the evolution of current evidence on fast track cardiac recovery management in cardiac surgery, and particularly in minimally invasive and transcatheter aortic valve surgical procedure. The background of fast track cardiac surgery management and recovery in the 1990' with balanced anesthesia technique and early tracheal extubation is described. The safety, efficacy and cost benefits of fast track cardiac recovery are presented. The risk assessment of patients with severe aortic valve disease for minimally invasive or transcatheter surgical procedure is reviewed. The process of postoperative care togeth...
Source: European Journal of Heart Failure Supplements - January 15, 2017 Category: Cardiology Authors: Bainbridge, D., Cheng, D. Tags: Articles Source Type: research

Foreword: Fast track in aortic valve surgery
(Source: European Journal of Heart Failure Supplements)
Source: European Journal of Heart Failure Supplements - January 15, 2017 Category: Cardiology Authors: Diegeler, A. Tags: Foreword Source Type: research

What do the guidelines suggest for non-vitamin K antagonist oral anticoagulant use for stroke prevention in atrial fibrillation?
This article provides an overview of the current international guidelines with regard to NOAC use and highlights key areas by which emerging evidence may change the management of stroke prevention in patients with non-valvular AF. (Source: European Journal of Heart Failure Supplements)
Source: European Journal of Heart Failure Supplements - December 21, 2016 Category: Cardiology Authors: Shahid, F., Shantsila, E., Lip, G. Y. H. Tags: Articles Source Type: research

What are the effects of edoxaban in the general population and in the elderly?
Stroke and systemic embolism are common complications in patients with atrial fibrillation, and can be effectively prevented with oral anticoagulation. However, this strategy is associated with increased risk of major, sometimes fatal bleeding. Where vitamin K antagonists (VKAs) have been the standard of care in the past half century, new directly acting oral anticoagulants have been developed that, unlike VKA, have a fast onset and fast offset of action, and do not need monitoring either. These non-VKA oral anticoagulants (NOACs) have proven to be non-inferior to VKA with regards to stroke and systemic embolism and are at...
Source: European Journal of Heart Failure Supplements - December 21, 2016 Category: Cardiology Authors: Verheugt, F. W. A. Tags: Articles Source Type: research

How important it is for therapy adherence to be once a day?
New oral anticoagulants (NOACs) or non-vitamin K antagonists (VKAs) do not possess the numerous negative properties of VKAs in the therapy of atrial fibrillation patients. NOACs have a more rapid onset of action, are less dependent on interactions, food intake, age and body weight, and there are fewer gene polymorphisms. The large Phase III trials have shown that all NOACs are not inferior to VKA therapy. Nevertheless, these results are certainly based on the adherence and persistence to NOAC therapy. A once-a-day strategy has been shown to increase the adherence to therapy. Therefore, this review provides an overview over...
Source: European Journal of Heart Failure Supplements - December 21, 2016 Category: Cardiology Authors: Goette, A., Hammwöhner, M. Tags: Articles Source Type: research

How safe are non-vitamin K antagonist oral anticoagulants in atrial fibrillation?
This article expands on the concept of the ‘net clinical benefit’ and on how this may inform clinical decisions, reinforcing the perception of NOACs as better drugs than VKAs in preventing stroke in AF. (Source: European Journal of Heart Failure Supplements)
Source: European Journal of Heart Failure Supplements - December 21, 2016 Category: Cardiology Authors: De Caterina, R. Tags: Articles Source Type: research

CardioAlex 2016 Conference Proceedings Posters
(Source: European Journal of Heart Failure Supplements)
Source: European Journal of Heart Failure Supplements - December 14, 2016 Category: Cardiology Tags: Abstracts Source Type: research

CardioAlex 2016 Conference Proceedings Abstracts
(Source: European Journal of Heart Failure Supplements)
Source: European Journal of Heart Failure Supplements - December 14, 2016 Category: Cardiology Tags: Abstracts Source Type: research

Practical multidisciplinary approaches to heart failure management for improved patient outcome
This article aims to summarize the key elements necessary for high-quality multidisciplinary care to be provided for all patients, throughout the HF trajectory, from acute hospital admission to long-term follow-up. It also discusses practical approaches to improve communication between the acute hospital and community healthcare teams. These will need to be adapted depending on local needs and resources. These include HF management programmes, structured discharge planning, medicines reconciliation, nurse-led ‘in-reach’ and ‘out-reach’ approaches, and long-term follow-up and monitoring. The importan...
Source: European Journal of Heart Failure Supplements - December 5, 2016 Category: Cardiology Authors: Riley, J. P., Masters, J. Tags: Articles Source Type: research

What is on the horizon for improved treatments for acutely decompensated heart failure?
Patients hospitalized with acutely decompensated heart failure (ADHF) are often critically ill and require immediate treatment to stabilize their haemodynamic status. Despite improving the signs and symptoms of ADHF, currently available therapies have failed to demonstrate improvements in post-discharge outcomes, such as mortality and rehospitalization, and to address the impact of end-organ damage. Furthermore, attempts to develop therapies to treat patients with ADHF over the past 10 to 20 years have been largely unsuccessful, further compounding the problem. Recent evidence supporting a variety of novel therapies, such ...
Source: European Journal of Heart Failure Supplements - December 5, 2016 Category: Cardiology Authors: Diez, J., Bayes-Genis, A. Tags: Articles Source Type: research

The bumpy road to drug development for acute heart failure
The prevalence of heart failure (HF) continues to grow, in large part attributed to the aging population. Parallel to this trend is the increasing burden of hospitalization for worsening HF, which accounts for the majority of the very high societal burden of costs of care for these patients. These hospitalizations represent a change in the trajectory of the disease process and are associated with a significantly higher risk of adverse outcomes, a trend that has not changed over the past two decades. Although short-term readmissions are due to haemodynamic congestion, long-term prognosis and mortality are the result of the ...
Source: European Journal of Heart Failure Supplements - December 5, 2016 Category: Cardiology Authors: Hamo, C. E., Butler, J., Gheorghiade, M., Chioncel, O. Tags: Articles Source Type: research

Understanding acute heart failure: pathophysiology and diagnosis
Acute heart failure (AHF) is a relevant public health problem causing the majority of unplanned hospital admissions in patients aged of 65 years or more. AHF was historically described as a pump failure causing downstream hypoperfusion and upstream congestion. During the last decades a more complex network of interactions has been added to the simplistic haemodynamic model for explaining the pathophysiology of AHF. In addition, AHF is not a specific disease but the shared clinical presentation of different, heterogeneous cardiac abnormalities. Persistence of poor outcomes in AHF might be related to the paucity of improveme...
Source: European Journal of Heart Failure Supplements - December 5, 2016 Category: Cardiology Authors: Arrigo, M., Parissis, J. T., Akiyama, E., Mebazaa, A. Tags: Articles Source Type: research