Atrial Fibrillation

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ABSTRACT: Angiotensin-converting enzyme inhibitors and ß-blockers are the cornerstone of heart failure medical therapy; unless contraindicated, start these agents as soon as possible after volume status has been optimized. Aldosterone receptor antagonists, angiotensin-receptor blockers, and a fixed-dose combination of hydralazine and isosorbide dinitrate (the last recommended especially for African Americans) can be used as add-on therapy. Prophylactic implantable cardioverter defibrillators reduce long-term mortality in symptomatic patients with a left ventricular ejection fraction (LVEF) of 35% or less. Cardiac resynchronization therapy improves symptoms and ventricular remodeling in some patients; indications include wide (more than 20 milliseconds) QRS complex on ECG, impaired LVEF (35% or less), and advanced heart failure symptoms (NYHA classes III and IV) despite optimal drug therapy. Measurement of natriuretic peptides and impedance cardiography both show promise for monitoring patients with heart failure and for guiding therapy, but definitive data to justify their routine use are still lacking.

CHICAGO -- Medicare patients who couldn't read a physician's instructions, or who didn't understand what they read had a higher mortality rate than patients with adequate reading skills.

BOSTON -- If hospitals consistently meet quality targets, mortality rates for three common conditions are 7% to 15% lower than in less rigorous institutions, health analysts here reported.

BALTIMORE -- Older and cheaper oral drugs for type 2 diabetes may be just as effective at controlling glycemia and improving lipid profiles as newer agents, suggested a systematic literature review.

EDMONTON, Alberta -- Phosphodiesterase type 5 (PDE5) drugs, such as sildenafil (Viagra), may improve right ventricular contractility in hearts with right ventricular hypertrophy, an unexpected benefit that looks promising for treatment of right ventricular heart failure.