Heart 1998;80:432-436 ( November )
Review
Prevention of relapse in patients with congestive heart failure:
the role of precipitating factors
a Department of Epidemiology and Biostatistics,
Pharmacoepidemiology Unit, Erasmus University Medical School,
Rotterdam, Netherlands, b Department of Cardiology, Thorax
Center Dijkzigt, Erasmus University Medical School, c Inspectorate for Health Care, Drug Safety Unit,
Rijswijk, Netherlands, d Julius Center for Patient-Oriented Research, Utrecht
University Academic Hospital, Utrecht, Netherlands
Correspondence to: Dr B H Ch Stricker, Department of Epidemiology and Biostatistics, Erasmus University Medical School, Dr Molewaterplein 50 3000 DR Rotterdam, Netherlands. email: stricker{at}epib.fgg.eur.nl
Accepted for publication 2 July 1998
Relapse of congestive heart failure (CHF) frequently occurs and
has serious consequences in terms of morbidity, mortality, and health
care expenditure. Many studies have investigated the aetiological and
prognostic factors of CHF, but there are only limited data on the role
of precipitating factors that trigger relapse of CHF. Knowledge of
potential precipitating factors may help to optimise treatment and
provide guidance for patients with CHF. The literature was reviewed to
identify factors that may influence haemodynamic homeostasis in CHF.
Precipitating factors that may offer opportunities for preventing
relapse of CHF were selected. Potential precipitating factors are
discussed in relation to the pathophysiology of CHF: alcohol, smoking,
psychological stress, uncontrolled hypertension, cardiac arrhythmias,
myocardial ischaemia, poor treatment compliance, and inappropriate
medical treatment. Poor treatment compliance in particular is
frequently encountered in patients with CHF. Furthermore, studies of
medical treatment under everyday circumstances indicate that some
aspects of the management of CHF can be improved. In conclusion, the
identification of precipitating factors for relapse of CHF may strongly
contribute to optimal treatment. Improvement of treatment compliance
and optimalisation of medical treatment may offer important
possibilities to clinicians to reduce the number of relapses in
patients with CHF.
© 1998 by Heart
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