Postgraduate medicine
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Postgraduate medicine · Mar 2021
ReviewHeart failure with preserved ejection fraction: strategies for disease management and emerging therapeutic approaches.
Approximately 50% of patients with heart failure (HF) have a preserved ejection fraction (HFpEF), and the incidence of HFpEF is increasing relative to HF with reduced ejection fraction (HFrEF). Both types of HF are associated with reduced survival and increased risk for hospitalization. However, in contrast to HFrEF, there are no approved treatments specifically indicated for HFpEF, and current therapy is largely focused on management of symptoms and comorbidities. ⋯ Primary care providers (PCPs) play a pivotal role in the delivery of holistic, patient-centric care from diagnosis to management and palliative care. As the prevalence of HF continues to rise in an aging population, PCPs will need to play a greater role in HFpEF care. This article will review HFpEF etiology and pathophysiology, diagnostic workup, and management of symptoms and comorbidities, with a focus on the critical role of PCPs throughout the clinical course of HFpEF.
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Postgraduate medicine · Mar 2021
Observational StudyAwareness, treatment rates, and compliance to treatment in patients with serum LDL cholesterol higher than 250 mg/dl, and possible, probable or definite familial hypercholesterolemia.
Familial hypercholesterolemia (FH) is a genetic disease characterized by increased levels of low-density lipoprotein cholesterol (LDL-C). It is underdiagnosed and undertreated despite relatively high prevalance and significant association with increased mortality. We aimed to determine treatment status and compliance in patients with LDL-C ≥ 250 mg/dL and FH. ⋯ A significant proportion of patients with LDL-C ≥ 250 mg/dL were not taking lipid-lowering drugs. Similar with many other studies, diagnosis, and treatment rates of FH patients were very low in our study. Further national studies are required to increase awareness of the disease in both physicians and patients.
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Postgraduate medicine · Mar 2021
Prevalence and associated factors of inter-arm blood pressure difference in Chinese community hypertensive population.
This study aimed to investigate the prevalence and associated factors of inter-arm blood pressure difference (IAD) in Chinese community hypertensive population. ⋯ The elevated prevalence of large IAD was shown in hypertensive population. Meanwhile, higher levels of SBP, triacylglycerol, total cholesterol, LDL-C, and lower eGFR were associated with higher sIAD.
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Postgraduate medicine · Mar 2021
Observational StudyThe long-term prognostic significance of heart failure in sarcoidosis patients ─ A cohort study.
To evaluate the proportion and the long-term prognostic significance of heart failure (HF) in sarcoidosis patients. ⋯ Sarcoidosis is independently associated with HF, and both are independently associated with all-cause mortality.
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Postgraduate medicine · Mar 2021
Clinical effectiveness of a cardiology outpatient management plan to reduce inefficiency in consultations.
Objectives: Longer delays in carrying out complementary tests in cardiology services have resulted in patients arriving for consultation without these tests being performed (inefficient consultations). To ameliorate this situation, a management-based intervention was designed, optimizing the available resources and modifying the appointment system. Therefore, our objective was to determine the effectiveness of this intervention to reduce the number of inefficient consultations and improve the clinical care process. ⋯ When the patients had all the tests completed, there was an increase in the number of new examinations (p < 0.001), outpatient discharges (p < 0.001) and new diagnoses (p = 0.004). Treatment modifications were not significant (p = 0.223). Conclusions: The intervention proved effective, clinically relevant, and statistically significant in reducing the proportion of inefficient consultations, thereby enabling continuation of the clinical care process.