6MWT in Heart Failure

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Exercise intolerance along with dyspnea fatigue are cardinal symptoms of heart failure which adversely impact quality of life of the patient. Exercise improves well being in heart failure. ESC 2016 and AHA ACC 2013 heart failure guidelines recommend exercise to improve functional capacity QOL and also to reduce the risk of hospitalization in stable HF patients Class IA . The 6 minute walk test assesses functional capacity or exercise tolerance in patients with heart failure and defines prognosis. A 6 minute walk distance less than 200 m indicates lower functional capacity and carries a poor prognosis. If the walk distance is more than 500 m the prognosis is good. If the 6 minute walk distance ranges between 200m and 500 m patient can continue to exercise with oxygen supplementation. Oxygen saturation during 6MWT also has prognostic significance. A fall in oxygen saturation SpO2 during 6MWT of more than 4 indicates significant desaturation and is a predictor of mortality. The aim should be to increase exercise tolerance even if with oxygen supplementation.

Updated guidelines for treatment for patients with ventricular arrhythmias

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The American College of Cardiology ACC American Heart Association AHA and the Heart Rhythm Society HRS have jointly published new guidelines for the management of adults who have ventricular arrhythmias or who are at risk for sudden cardiac death including diseases and syndromes associated with a risk of sudden cardiac death from ventricular arrhythmias. According to the guidelines patients considering implantation of a new ICD or replacement of an existing one should be informed of their individual risk of sudden cardiac death and nonsudden death from heart failure or noncardiac conditions and the effectiveness and potential complications of the ICD. In patients nearing the end of life from other illness clinicians should discuss ICD shock deactivation as they reassess their patients goals and preferences. Emphasizing on the role of shared decision making between patients and their doctors the guidelines say that treatment decisions should also take into consideration the health goals preferences and values of the patients. The 2017 AHA ACC HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death have been published online October 30 2017 in the Journal of the American College of Cardiology Circulation and HeartRhythm. Source ACC News Release October 30 2017

Commonly used medications and nutritional supplements may cause or worsen heart failure – American Heart Association

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The American Heart Association (AHA) has cautioned that commonly used medications and nutritional supplements may cause or worsen heart failure in its first scientific statement, which provides guidance on avoiding drug-drug or drug-condition interactions for people with heart failure. The statement provides comprehensive information about specific drugs and “natural” remedies that may have serious unintended consequences for heart failure patients.

In addition to prescription medications, over the counter drugs may also have unintended consequences for heart failure patients.

• For example, non-steroidal anti-inflammatory drugs (NSAIDs), including commonly used painkillers such as ibuprofen, can trigger or worsen heart failure by causing sodium and fluid retention and making diuretic medications less effective.

• Over-the counter heartburn medications and cold remedies may also contain significant amounts of sodium, which is usually restricted in patients with heart failure.

Heart failure patients have, on average 5 or more separate medical conditions and they take 7 or more prescription medications daily, often prescribed by different healthcare providers. And, according to the statement, medications can cause problems in several ways: being toxic to heart muscle cells or changing how the heart muscle contracts; interacting with medications used to treat heart failure so that some of their benefits are lost; and containing more sodium than advised for patients with heart failure.

Robert L. Page II, Pharm.D., M.S.P.H., chair of the writing committee for the new scientific statement said that healthcare providers should talk to patients with heart failure at every visit about all prescription and over the counter medications they may be taking, as well as nutritional supplements and herbs.

The statement suggests that patients should show each of their healthcare providers a complete list of their medications, including over-the-counter drugs and natural supplements. They should consult with a health professional before starting or stopping any medication. (Source: AHA)

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