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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Sunday, September 16, 2012

Diagnóstico y tratamiento de la insuficiencia cardíaca (ACCF/AHA)

2009 Focused Updatei:dACCF/AHAsGuidelines for the Diagnosis and Management of Heart Failure in Adults
A Report of the American College of Cardiology Foundation/AmericanHeart Association Task Force on Practice Guidelines
Diuretic Dosing Key to HF Length of Stay.
By Todd Neale, Senior Staff Writer, MedPage Today. Published: July 03,2012. 
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania
..."To look at the relationship between the adequacy of diuretic dosing and outcomes, Fearon-Clarke performed a retrospective chart review of 250 consecutive patients who presented to the emergency department at Overlook with acute decompensated heart failure from October 2008 to July 2010.
The initial IV diuretic dose administered in the emergency department was considered adequate if it was 1.5 times the outpatient oral loop diuretic dose given as an IV bolus or was IV furosemide 80 mg or the equivalent for diuretic-naive patients.
Adequate dosing and male sex were associated with significantly shorter lengths of stay, and systolic blood pressure less than 110 mm Hg, higher serum creatinine levels, and higher body weight at admission were associated with longer lengths of stay (P<0.05 for all).
Both low blood pressure and high serum creatinine levels were associated with the underdosing of diuretics because, Fearon-Clarke said, the clinicians were afraid of making the patients with these characteristics worse.
"The clinicians aren't realizing that a blood pressure of 90 mm Hg is actually normal for these patients on really good heart failure meds," she said..."