GPC: Insuficiencia Cardíaca actualizada en Circulation

ACCF/AHA Guidelines on Diagnosing and Treating Heart Failure

The American College of Cardiology Foundation and the American Heart Association have jointly issued updated guidelines for the management of heart failure. The guidelines, which replace those from 2005, appear online in Circulation.

 

The revised guidelines:

• emphasize the role of natriuretic peptides in stratifying risk;
• slightly downgrade the benefit (relative to risk) of exercise testing in designing rehab programs;
• recommend use of hydralazine and nitrates in combination for African Americans on optimal therapy having moderate-to-severe symptoms;
• recommend either controlling ventricular rate or maintaining sinus rhythm in patients with atrial fibrillation and heart failure;
• offer advice on eligibility for implantable cardioverter-defibrillators and cardiac resynchronization therapy; and
• provide recommendations for patients hospitalized with heart failure.

 

Circulation article with updated guidelines (Free PDF)

Circulation article with full guidelines (Free PDF)

Atención Ambulatoria por especialistas en los EEUU

Adjunto el link y las conclusiones de un estudio realizado por Jose M. Valderas, Barbara Starfield, Christopher B. Forrest, Bonnie Sibbald, y Martin Roland, publicado en el  último número de la revista de “Annals of family Medicine”.

Ambulatory Care Provided by Office-Based Specialists in the United States

In the United States, nearly one-half of patient visits to specialists are for routine and preventive services that might be provided in primary care.

CONCLUSIONS:

Ambulatory offi ce-based activity of specialists includes a large share of routine and preventive care for patients already known, not referred, to

the physician. It is likely that many of these services could be managed in primary care settings, lessening demand for specialists and improving coordination of care.

http://www.annfammed.org/cgi/content/full/7/2/104

 

Diabetes tipo 2: nuevo algoritmo de predicción de riesgo de desarrollar la enfermedad

Simple Algorithm for Predicting 10-Year Risk for Type 2 Diabetes

A clinical algorithm using “routinely collected data” rather than laboratory measurements can help determine a patient’s 10-year risk for developing type 2 diabetes, researchers report online in BMJ. 

 The final algorithm included age, BMI, family history of diabetes, smoking status, treated hypertension, corticosteroid use, presence of cardiovascular disease, socioeconomic status, and self-reported ethnicity. Overall, it performed well, with close correspondence between predicted and observed risk. (The risk calculator is available online; see link.) 

 The authors conclude that their tool “might be used to identify and proactively intervene in [high-risk individuals].”

Link:al artículo de  BMJ: www.bmj.com/cgi/content/full/338/mar17_2/b880

 

 

Alerta FDA: Metoclopramida y discinesia

La FDA advierte sobre metoclopramida Todos los productos que contengan metoclopramida deben incluir una advertencia sobre el riesgo de discinesia tardía, de acuerdo con un anuncio de la FDA. La metoclopramida, utilizada para agilizar el vaciamiento gástrico y como antiemético, puede poner a los pacientes en riesgo cuando es utilizada de manera crónica, y el tratamiento por más de tres meses no está recomendado. De acuerdo con la FDA, el uso crónico debe evitarse siempre a menos que el beneficio supere al riesgo. Los individuos de la tercera edad y especialmente las mujeres tienen mayor riesgo.