Lege Artis Medicinae

[NON-PHARMACOLOGICAL TREATMENT OF CHRONIC HEART FAILURE]

MERKELY Béla, RÓKA Attila

JULY 14, 2007

Lege Artis Medicinae - 2007;17(06-07)

[Heart failure has a poor prognosis despite the advances in pharmacological treatment. The utilization of non-pharmacological treatment with appropriate indications significantly improves the quality of life and life expectancy of these patients. Cardiac resynchronization therapy with biventricular pacemaker has a clinically proven efficacy in the treatment of heart failure associated with intraventricular dyssynchrony. Implantable cardioverter- defibrillators decrease the mortality from sudden cardiac death. Heart transplantation is needed in cases refractory to therapy. There are several other non-pharmacological treatment approaches, including mechanical circulatory assist devices, total artificial heart and ultrafiltration, whose routine application is not recommended due to limited clinical experience, but the initial results are promising.]

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[INTRODUCTION - Adverse effects of treatment for chronic C virus hepatitis present an important problem both for the patient and the clinician. The reduction of drug doses or the suspension of therapy lessen the likelihood of recovery. PATIENTS, METHODS - Between 2001 and 2004, 66 patients with chronic hepatitis C received 180 μg pegylated interferon-alpha-2a per week and 800-1200 mg ribavirin per day, 6 of whom for 24 weeks and 60 patients for 48 weeks. During treatment, patients were closely followed in order to recognize any adverse effects early. RESULTS - Of the patients treated for 48 weeks, 48.3% developed adverse effects, with changes in the differential in 41.7%, and anaemia, low platelet count, neutropenia in similar rates. Further side effects included cardiac complications, skin symptoms, persisting high fever, autoimmune thyroiditis and liver failure, altogether in 9 cases. Dose reduction or temporary suspension of pegylated interferon-alpha-2a was necessary in 21 cases (31.7%), while complete cessation of this treatment was decided in 7 cases, most of them because of blood count changes. The 1000 to 1200 mg per day ribavirin had to be reduced in 30.8% of patients, while treatment was stopped in 3 cases. Long-term virological remission occurred in 48% of patients who received treatment for 48 weeks, whereas no such result was observed among any of those treated for 24 weeks. CONCLUSION - Adverse effects of variable severity developed in nearly half of the patients with chronic hepatitis C infection who received antiviral treatment for 48 weeks, but treatment had to be stopped in only a small proportion of this group. Early treatment of adverse effects can prevent the need to cease therapy and may improve its efficiency.]

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