Heart failure, chronic diagnosis

Total estimated direct and indirect costs for managing both chronic and acute HF in the United States for 2005 was approximately 27.9 billion. Medications account for approximately 10% of that cost.3 Heart failure is the most common hospital discharge diagnosis for Medicare patients and is the most costly diagnosis in this population. 

CLINICAL PRESENTATION AND DIAGNOSIS OF CHRONIC HEART FAILURE... 

From ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult. Circulation 2005 112 el54. 

Hunt SA et al ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult Summary article A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2005 46 1116. 

Swedberg et al Guidelines for the diagnosis and treatment of chronic heart failure. Task Force for the Diagnosis and Treatment of Chronic Heart Failure. Eur Heart J 2005 26 1115. [PMID 15901669]... 

The development of a bedside assay for plasma BNP has focused considerable attention on the use of BNP as an aid in the diagnosis of suspected heart failure. Plasma BNP concentration is positively correlated with the degree of left ventricular dysfunction and heart failure, and this assay is now used frequently in acute care settings to assist in the differential diagnosis of dyspnea [heart failure versus asthma, chronic obstructive pulmonary disease (COPD), or infection]. Recent studies found that an elevated BNP concentration is an independent predictor of heart failure as the cause of dyspnea and that in patients with decompensated heart failure, an elevated pre-hospital discharge BNP concentration is associated with an increased risk of death or readmission. Additional research is ongoing to better characterize the role of BNP measurement in the diagnosis and treatment of heart failure. 

Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJV, Ponikowski P, Poole-Wilson PA, Stromberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur Heart J 2008 29(19) 2388-442. 

In its more severe forms thiamine deficiency can present as (1) wet beri-beri with generalized oedema 2md tendency to heart failure, (2) dry beri-beri, a chronic polyneuropathy with degenerative changes in the peripheral nerves, (3) infantile beri-beri, a chronic marasmic state also frequently associated with sudden heart failure, and (4) Wernicke s encephalopathy, which may be seen in chronic alcoholics and may be regarded as a cerebral beri-beri . Less severe states of thiamine deficiency usually manifest themselves as a chronic polyneuropathy. Problems of differential diagnosis from other forms of peripheral neuritis therefore arise, and it is in this connection that studies of pyruvate metabolism may be of help. 

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