Utilization of biomarkers to characterize patients with acute decompensated heart failure at UNC Hospitals
Public Deposited- Last Modified
- February 26, 2019
- Creator
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Patel, Rashmi
- Affiliation: Eshelman School of Pharmacy
- Abstract
- Heart failure (HF) is a complex clinical syndrome that results in the impairment of the heart’s ability to fill or to pump out blood. As of 2013, an estimated 5.8 million people in the United States were living with HF. Patients with HF have varying signs and symptoms that are often nonspecific and have a wide differential diagnosis, making diagnosis by presentation very challenging. Some of the symptoms are due to congestion such as dyspnea on exertion (DOE), orthopnea, paroxysmal nocturnal dyspnea (PND), and fluid retention while other symptoms are due to lack of adequate cardiac output that include fatigue, exercise intolerance, and weakness. This diversity of presentation often results in delays in definitive diagnosis and treatment, and such delays are linked with poor prognosis. Cardiac function may be assessed by echocardiography or radionuclide ventriculography however, there is no specific diagnostic test for HF. Cardiovascular physical examination is used commonly as a basis for diagnosis and therapy in congestive heart failure. Patients diagnosed with HF require constant observation to identify hemodynamic deterioration that might warrant adjustments to their therapy. There are two basic pathophysiologic mechanisms that cause reduced cardiac output and HF: heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). HFrEF and HFpEF may be due to a variety of etiologies and effective management is often dependent upon establishing the etiology. The most common causes of HFrEF are coronary (ischemic) heart disease, idiopathic dilated cardiomyopathy, hypertension, and valvular disease. While HFpEF can be induced by many of the same conditions, the most common causes are uncontrolled hypertension, ischemic heart disease, hypertrophic obstructive cardiomyopathy, and restrictive cardiomyopathy. Clinical trials of HF therapies have typical inclusion criteria with the majority of patients being younger males of HFrEF with no other lifethreatening comorbidities such as unstable angina or heart failure due to valvular heart disease. Consequently, few data are available in patients with HFpEF that describe outcomes or guide management strategies; this lack of evidence is problematic because these patients are frequently hospitalized for HF. We have proposed a single center (UNC), pilot study to take a contemporary snapshot of the acute HF patient population with a retrospective and prospective chart review to characterize patients hospitalized for heart failure. We proposed to focus on specific biomarkers as described below.
- Date of publication
- spring 2016
- Keyword
- DOI
- Resource type
- Rights statement
- In Copyright
- Note
- Funding: None
- Advisor
- Patterson, J.Herbert
- Degree
- Doctor of Pharmacy
- Honors level
- Highest Honors
- Degree granting institution
- University of North Carolina at Chapel Hill
- Extent
- 7
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