Use of Guideline-Recommended Medical Therapy in Patients with Heart Failure

By Connor Emdin
September 26, 2018

Over the past thirty years, survival after the diagnosis of heart failure has improved, with five-year mortality falling from 57% in 1979 to 1984 to 48% in 1996 to 2000.1 Much of this reduction in mortality has been due to the development of novel therapeutics for treatment of heart failure.2 Large randomized clinical trials have demonstrated that angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor neprilysin inhibitors (ARNIs), beta-blockers (BBs) and mineralcorticoid receptor antagonists (MRAs) all reduce the risk of death and re-hospitalization among patients with heart failure with reduced ejection fraction (HFrEF).2 Current guidelines strongly recommend that all eligible patients with HFrEF be treated with a combination of these agents.2 Continue reading “Use of Guideline-Recommended Medical Therapy in Patients with Heart Failure”

Restrictive versus Liberal Fluid Therapy in Abdominal Surgery

By Connor Emdin
August 28, 2018

Abdominal surgery can result in significant fluid loss, arising from multiple sources, including fasting prior to surgery, evaporation during surgery, from blood loss and from other sources.1 Traditionally, individuals undergoing abdominal surgery received liberal fluid resuscitation (up to 7L on the day of surgery) which frequently exceeded their losses and led to weight gain of 3-6kg.2 Excessive fluid loading can lead to elevated rates of postoperative heart failure, arrhythmias, and wound infection due to local tissue edema, and in small clinical trials, restrictive hydration strategies (targeting net zero fluid balance) have been associated with fewer complications than liberal fluid replacement.3 Consequently, clinical guidelines now recommend more restrictive fluid therapy for abdominal surgery.4,5 Continue reading “Restrictive versus Liberal Fluid Therapy in Abdominal Surgery”

Epinephrine in Out-Of-Hospital Cardiac Arrest: Increased Survival but at What Cost?

By Martina McGrath, MD
August 8, 2018

It is estimated that 1 in every 7.5 people in the US will die of sudden cardiac death.1 Survival following out-of-hospital cardiac arrest has increased in recent years, from 10.2% in 2006, to 12.4% in 2015.1 However, only 9% of those surviving to hospital discharge were classified as having good functional status. Therefore, significant long-term neurologic impairment is a common outcome of cardiac arrest. Continue reading “Epinephrine in Out-Of-Hospital Cardiac Arrest: Increased Survival but at What Cost?”

Palliative Care in Advanced Heart Failure

By Connor Emdin
September 20, 2017

Heart failure (HF) is the leading cause of hospitalization for adults over the age of 65 in the United States and is associated with poor short-term survival, with an estimated median survival of 1.5-3 years after diagnosis.1,2 In addition to causing significant morbidity and mortality, HF is associated with reduced quality of life, spiritual distress, depression, and anxiety.3
Continue reading “Palliative Care in Advanced Heart Failure”

Declining Risk of Sudden Death in Heart Failure with Reduced Ejection Fraction

By Connor Emdin
August 1, 2017

Heart failure is the cause of more than one million hospital admissions in the United States annually1 and is a leading cause of death worldwide.2 Heart failure with reduced ejection fraction (HFrEF), characterized by EF typically <40%, is observed in approximately 50% of individuals with heart failure1 and is associated with an elevated risk of sudden cardiac death due to ventricular arrhythmia.3 While implantable cardioverter-defibrillators (ICD) can reduce the risk of sudden death, substantial risk remains and implantation itself is expensive and associated with risks including infection, and device misfiring.1,4 Therefore identifying the patient population who will gain most benefit from ICD implantation is of considerable interest. Continue reading “Declining Risk of Sudden Death in Heart Failure with Reduced Ejection Fraction”