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

WORLD EMERGENCY MEDICINE SOCIETIES

HEMORRHAGIC SHOCK THE THOR WAY

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miércoles, 10 de octubre de 2018

Chronic heart failure in adults

Resultado de imagen de british medical journal
BMJ 2018;362:k3646 doi: https://doi.org/10.1136/bmj.k3646 
(Published 24 September 2018)
"What you need to know
  • Refer people with suspected heart failure and N-terminal pro B-type natriuretic peptide (NT-proBNP) greater than 400 ng/L for specialist assessment and transthoracic echocardiography within 6 weeks.
  • Offer angiotensin converting enzyme (ACE) inhibitors and beta blockers as first line treatment for heart failure with reduced ejection fraction, and add mineralocorticoid receptor antagonist (MRA) if symptoms continue.
  • Offer exercise based cardiac rehabilitation therapy to people with stable heart failure in a format and setting that is easily accessible.
  • Provide management in primary care once the person’s condition is stable, with advice from specialist heart failure teams (MDTs).
  • People with heart failure do not routinely need to restrict their sodium or fluid consumption.
What’s new in this guidance
  • Clearer advice on managing the care of people with heart failure, including a greater emphasis on multidisciplinary working, shared decision making, care planning, lifestyle advice and interventions, co-morbidities, and end-of-life care.
  • N-terminal pro-B-type natriuretic peptide (NT-proBNP) specified as the biomarker to be used in the diagnosis (and, if relevant, the monitoring) of people with heart failure.
  • Mineralocorticoid receptor antagonist (MRA) to be offered (in addition to an ACE inhibitor (or angiotensin receptor blocker, ARB) and beta blocker) in people with heart failure with reduced ejection fraction who remain symptomatic."