Iyngkaran Pupalan, Liew Danny, Neil Christopher, Driscoll Andrea, Marwick Thomas H, Hare David L
Northern Territory Medical Program, Flinders University, Darwin, NT, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Clin Med Insights Cardiol. 2018 Dec 4;12:1179546818809358. doi: 10.1177/1179546818809358. eCollection 2018.
This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.
这篇关于充血性心力衰竭（CHF）再入院专题系列的特写文章旨在概述针对患有多种合并症的患者和老年人的指南中存在的重要差距。充血性心力衰竭的诊断表现为在医院和社区之间的三个阶段，即急性、慢性稳定和生命末期（姑息）阶段。这个过程在不同强度上需要三级医院内的多学科护理，或来自医院门诊或初级卫生服务机构的门诊护理，并结合普通社区的护理。管理目标是一致的，即在充血性心力衰竭项目中提供金标准治疗，以尽可能达到最低的纽约心脏协会分级，并提高射血分数。合并症是影响治疗结果的一个重要共同因素。合并症包括糖尿病、慢性阻塞性气道疾病、慢性肾功能损害、高血压、肥胖、睡眠呼吸暂停以及年龄增长。老年护理包括上述因素以及诸如虚弱、跌倒、失禁和意识模糊等综合征。许多系统仍然未能全面实现此类项目的所有方面。本综述探讨了这些因素。
