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By Russell C. Davis

A realistic advisor to educating in drugs geared toward medical professionals who sooner or later of their occupation need to train, no matter if in a school room or in a scientific surroundings. invaluable articles on idea with a better emphasis on 'how to do it'.

Authors comprise essentially the most authoritative clinical educationalists on the planet; therefore readers gets the advantage of writers who've nice educating event subsidized up by way of wide academic learn.

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The combination of atrial fibrillation and heart failure (or evidence of left ventricular systolic dysfunction on echocardiography) is associated with a particularly high risk of thromboembolism, which is reduced by long term treatment with warfarin. Aspirin seems to have little effect on the risk of thromboembolism and overall mortality in such patients. Antiarrhythmic treatment Chronic heart failure and atrial fibrillation Restoration and long term maintenance of sinus rhythm is less successful in the presence of severe structural heart disease, particularly when the atrial fibrillation is longstanding.

Com on 1 October 2006 The graph showing cardiac transplantations worldwide is adapted with permission from Hosenpud et al (J Heart Lung Transplant 1998;17:656-8). The table showing survival rates is adapted from Hobbs (Heart 1999; 82(suppl IV):IV8-10). 562 Indications x End stage heart failure—for example, ischaemic heart disease and dilated cardiomyopathy x Rarely, restrictive cardiomyopathy and peripartum cardiomyopathy x Congenital heart disease (often combined heart-lung transplantation required) Absolute contraindications x Recent malignancy (other than basal cell and squamous cell carcinoma of the skin) x Active infection (including HIV, Hepatitis B, Hepatitis C with liver disease) x Systemic disease which is likely to affect life expectancy x Significant pulmonary vascular resistance Relative contraindications x Recent pulmonary embolism x Symptomatic peripheral vascular disease x Obesity x Severe renal impairment x Psychosocial problems—for example, lack of social support, poor compliance, psychiatric illness x Age (over 60-65 years) 4500 4000 31 Transplantations 30 Age of donors 3500 29 3000 28 2500 27 2000 26 1500 25 1000 24 500 23 0 22 Mean age of donors (years) Cardiac transplantation The outcome in cardiac transplantation is now good, with long term improvements in survival and quality of life in patients with severe heart failure.

Relevance to hospital practice In our survey of acute hospital admissions of patients with heart failure to a city centre hospital, the median duration of stay was 8 (range 1-96) days, with 20% inpatient mortality. Clinical variables associated with an adverse prognosis include the presence of atrial fibrillation, poor exercise tolerance, electrolyte abnormalities, and the presence of coronary artery disease. 0 general practice consultations per patient. 74 visits per patient). These figures represent the collective burden of heart failure on hospital practice.

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