American heart journal
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American heart journal · Oct 1996
Intermittent inotropic therapy in an outpatient setting: a cost-effective therapeutic modality in patients with refractory heart failure.
Patients with intractable heart failure (New York Heart Association [NYHA] class III and IV) who were receiving maximal conventional treatment were enrolled in an outpatient program that included inotropic infusions, intensive patient education, and close follow-up. The effects of this approach to therapy were evaluated on (1) the number of hospital admissions, (2) length of stay, and (3) number of emergency room visits during the ensuing year. These data were compared with similar data from the year before entry in the program for each patient. ⋯ After enrollment, patients had 10 emergency room visits, 34 admissions, and 150 days spent in the hospital. In conclusion, this therapeutic regimen reduced the number of hospital admissions, days spent in the hospital, and emergency room visits. Our study supports the concept that the use of intermittent inotropic therapy in the outpatient setting plays an important role in managing this severely ill group of patients.
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American heart journal · Sep 1996
Comparative StudyCardiac complications in noncardiac surgery: relative value of resting two-dimensional echocardiography and dipyridamole thallium imaging.
Although perfusion imaging studies are extensively used as a preoperative screening test for risk stratification of patients undergoing noncardiac surgery, no single cardiac noninvasive test has been shown to be ideal for risk stratification. We investigated the relative impact of transthoracic two-dimensional echocardiography (ECHO) compared with dipyridamole thallium scintigraphy (DT) in predicting major cardiac complications in patients undergoing non-cardiac surgery. Eighty-seven consecutive patients undergoing 96 procedures (56 vascular, 40 general) underwent preoperative evaluation first with DT and then with ECHO before surgery. ⋯ The results were not significantly different when the 4 patients who underwent revascularization were excluded. In conclusion, (1) in spite of similar sensitivity of ECHO and DT, ECHO appears to be relatively more specific in predicting major CC, and (2) when ECHO and DT are both abnormal, the risk of CC related to noncardiac surgery is significantly increased. Use of the combination of DT and ECHO before major noncardiac surgery can improve the identification of patients at risk for complications.