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Clyde W Yancy

Publications and source records attributed to Clyde W Yancy.

At least 55 records · Page 3Linked to original sources
PubMed2003

Practical considerations for BNP use.

The evolving paradigm of heart failure has now been expanded to include the favorable neurohormonal, structural and hemodynamic profile of B-type natriuretic peptide [BNP]. As a marker of left ventricular dysfunction, BNP is a practical tool that facilitates diagnosis, contributes to prognostic evaluations and tracks disease severity. BNP elevations vary according to gender, disease states and perhaps obesity but in general elevated levels are consistent not only with left ventricular stress but likely represent the best surrogate for ongoing left ventricular remodeling. The full utility of BNP surveys has not yet been realized but emerging areas of use include clinical assessment by physician extenders, post-MI assessment, and a target of tailored therapy for heart failure. New biomarkers for heart failure similar to BNP are on the horizon but their clinical niche has yet to be determined.

Atrial Natriuretic Factor↗
PubMed2003

Heart failure in African Americans: unique etiology and pharmacologic treatment responses.

OBJECTIVES: After reading the article, "Heart Failure in African Americans: Unique Etiology and Pharmacologic Treatment Responses," the learner should be able to complete the following quiz and evaluation questions.Accredidation:NMA is accredited by the Accredidation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. NMA designates this continuing medical education activity for one credit hour in category one of the Physician's Recognition Award of the American Medical Association. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. The Journal of the National Medical Association (JNMA) has been approved by the American Academy of Family Physicians (AAFP) as having educational content acceptable for five prescribed credit hours. This article has been approved for one credit hour. Term of approval is from January 1, 2003, through December 31, 2003. Credit may be claimed for one year from date of individual use.Expiration:The quiz must be completed, postmarked and mailed by Feb. 25, 2003, for eligibility to receive continuing medical education credit for this CME activity.

Adrenergic beta-Antagonists↗
PubMed2002

The role of race in heart failure therapy.

Heart failure in blacks is a unique malady characterized by a different natural history, more worrisome prognosis, and potential variances in the response to current medical therapy for heart failure. The overwhelming burden of hypertension as a putative cause of left ventricular dysfunction identifies this illness. Although differences in the response to medical therapy have been described, angiotensin-converting enzyme inhibitors and beta-blockers remain the most appropriate therapy. Certain genetic polymorphisms may exist that explain the observed differences.

Adrenergic beta-Antagonists↗
PubMed2002

African-American Heart Failure Trial (A-HeFT): rationale, design, and methodology.

BACKGROUND: Hydralazine and isosorbide dinitrate combination (H+ISDN), angiotensin-converting enzyme inhibitors, and beta-blockers have improved outcomes in heart failure (HF). Analysis of previous trials has shown that H+ISDN appears especially beneficial in African American patients. METHODS AND RESULTS: The African-American Heart Failure Trial (A-HeFT) is double-blind, placebo-controlled, and includes African American patients with stable New York Heart Association Class III-IV HF on standard therapy. Patients must have prior HF-related events and left ventricular ejection fraction (LVEF) < or = 35% or LVEF <45% with left ventricular internal diastolic dimension >2.9 cm/m(2). Randomization to addition of placebo or BiDil (Nitro Med, Inc., Bedford, MA), a fixed combination of H+ISDN, is stratified for beta-blocker usage. All patients are treated and followed until the last patient entered completes 6 months of follow-up. The primary efficacy endpoint is a composite score including quality of life, death, and hospitalization for HF. At least 600 patients will be randomized; the first was randomized in June 2001. CONCLUSIONS: In addition to providing additional information on BiDil efficacy in HF, A-HeFT is the first HF trial aimed at a selected subgroup of patients and the first to use a new composite HF score as its primary efficacy endpoint.

Adolescent↗
PubMed2002

Potential contributing factors to noncompliance with dietary sodium restriction in patients with heart failure.

BACKGROUND: Although sodium restriction is considered essential in the management of patients with chronic heart failure (CHF), there are no data available regarding patients awareness of and ability to comply with the sodium restriction guideline. METHODS: Between May 1999 and August 2000, 50 patients referred to the Parkland Memorial Hospital CHF clinic were assessed by a registered dietitian for (1) awareness of the sodium restriction guideline, (2) ability to read the sodium content from a Nutrition Facts label, and (3) ability to sort 12 food containers, all bearing a Nutrition Facts label, into high- and low-sodium groups. A global measure of dietary sodium knowledge was calculated ("sodium knowledge score," range 0-10). These tests were repeated after the patient completed one or more educational sessions (mean 2.8 +/- 1.5) with the dietitian. RESULTS: The proportion of patients aware of the sodium restriction guideline was 14% at baseline and 42% at follow-up (P <.01). The proportion of patients able to read the sodium content from the Nutrition Facts label was 58% at baseline and 92% at follow-up (P <.01). The sodium knowledge score was 3.8 +/- 3.4 at baseline and 5.8 +/- 3.2 at follow-up (P <.01). The proportion of subjects who achieved a perfect sodium knowledge score of 10 was 8% at baseline and 26% at follow-up (P <.05). The number of food containers sorted accurately was 10.6 +/- 1.5 at baseline and 11.3 +/- 1.1 at follow-up, P =.09. CONCLUSIONS: On referral to a specialty CHF clinic, many patients had severe deficiencies in their knowledge base regarding dietary sodium intake that would preclude compliance with the sodium restriction guideline. Directed education focusing on sodium intake corrected many of these deficiencies.

Female↗
PubMed2002

Special clinical considerations of beta-blocker treatment.

Outcomes for heart failure have improved considerably with the implementation of neurohormonal antagonism that includes angiotensin-converting enzyme inhibitors and beta-blockers. Despite the robust benefit of beta-blockers for heart failure, it is not clear that the benefit can be extended to all patient groups. Special clinical consideration thus needs to be given to the elderly, women, and African Americans. A retrospective review of available data suggests that despite differences in the natural history of heart failure for these groups, significant benefit can still be expected from the use of beta-blockers for heart failure. Future trials will address these groups in a prospective manner.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Advances in the management of acute and chronic decompensated heart failure.

Congestive heart failure (CHF) is a pervasive and insidious disease that affects almost 5 million, mostly elderly, Americans. Significant therapeutic advances in the management of heart failure (HF) have resulted in striking decrements in mortality rates, but hospitalization use is ever increasing, now at over 1 million hospitalizations per year with a cost of >15 billion dollars-a cost that is largely borne by Medicare and Medicaid. One of the most historically challenging factors facing case managers who work with the CHF population is how to minimize treatment costs while enhancing clinical outcomes for those with this highly prevalent and clinically challenging chronic disease. To date the typical treatment of acute decompensation has been based in the hospital and woefully inadequate in promoting any long-term medical stability.

Acute Disease↗
PubMedDate not supplied

Advances in the management of acute and chronic decompensated heart failure.

Congestive heart failure (CHF) is a pervasive and insidious disease that affects almost 5 million, mostly elderly, Americans. Significant therapeutic advances in the management of heart failure (HF) have resulted in striking decrements in mortality rates, but hospitalization use is ever increasing, now at over 1 million hospitalizations per year with a cost of > $15 billion--a cost that is largely borne by Medicare and Medicaid. One of the most historically challenging factors facing case managers who work with the CHF population is how to minimize treatment costs while enhancing clinical outcomes for those with this highly prevalent and clinically challenging chronic disease. To date the typical treatment of acute decompensation has been based in the hospital and woefully inadequate in promoting any long-term medical stability.

Acute Disease↗
PubMedDate not supplied

Racial response to angiotensin-converting enzyme therapy in systolic heart failure.

The treatment of heart failure with angiotensin-converting enzyme inhibitors has resulted in substantial improvements in morbidity and mortality due to heart failure. Varying reports in the literature have suggested that African Americans respond less well to angiotensin-converting enzyme inhibitors, but careful reanalysis of major clinical trials in heart failure, especially the Studies of Left Ventricular Dysfunction (SOLVD), demonstrates a similar mortality benefit for African Americans as for whites. Morbidity, measured as hospitalizations, may not be as favorably impacted. African Americans do respond to angiotensin-converting enzyme inhibitors as a preemptive strategy to prevent heart failure, but the incidence of heart failure is still higher in this population. Mechanisms for these potential nuances in the response to angiotensin-converting enzyme inhibitors are not yet clear. The exaggerated benefit of nitrates and hydralazine implicates alterations in nitric oxide homeostasis. Race is an inadequate model to explain the observed differences. Careful translational research focusing on genetic patterns of disease may help resolve these outstanding questions.

Black or African American↗
PubMedDate not supplied

The use of beta-adrenergic receptor antagonists in the treatment of African Americans with heart failure.

The addition of beta-adrenergic antagonists to the treatment regimen for heart failure has validated the neurohormonal hypothesis and provided much-improved outcomes. This benefit had been in question for African Americans based on past experiences in the field of hypertension and worrisome data reported from the Beta Blocker Evaluation of Survival Trial. However, the totality of data now demonstrate that African Americans respond favorably to beta blockers and are capable of having the same outcomes in response to medical therapy for heart failure. There should be no reluctance, nor is there an appropriate rationale, to withhold beta-blocker therapy for heart failure to any patient with left ventricular dysfunction without an overt contraindication. The first prospective trial in African Americans with heart failure, the African American Heart Failure Trial (A-HeFT), is ongoing and provides additional insight into the best treatment strategies for this patient population.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

The natural history, epidemiology, and prognosis of heart failure in African Americans.

Heart failure is more common in African Americans and appears to be of worse severity. At the time of diagnosis, left ventricular function is more severely impaired and the clinical class is more advanced. The strongest risk factor for heart failure in African Americans appears to be hypertension, which is both more prevalent and more pathologic in African Americans. It is likely that heart failure represents an important end organ effect of hypertension. When affected by heart failure, African Americans experience a greater rate of hospitalization and may be exposed to a higher mortality risk as well. Genomic medicine has yielded a number of candidate single nucleotide polymorphisms that might contribute to the excess pathogenicity of heart failure in African Americans, but much more work needs to be done in larger cohorts. Effective therapy of heart failure must start with the recognition of the different manifestations of heart failure in African Americans. An increased awareness of the risk of hypertension followed by early and effective intervention may reduce the risk of heart failure in this population.

Black or African American↗
PubMedDate not supplied

BNP Consensus Panel 2004: A clinical approach for the diagnostic, prognostic, screening, treatment monitoring, and therapeutic roles of natriuretic peptides in cardiovascular diseases.

Among the most exciting developments in the field of heart failure in recent times has been the rediscovery of the natriuretic peptide system and its pleuripotent effects on cardiac structure and function. This is particularly true of its natriuretic and hemodynamic effects. There has been an explosion of the knowledge base seeking to understand the wide range of homeostatic, regulatory, and counter-regulatory functions in which the natriuretic peptide system participates. Additional interest has been stimulated by advances in technology such as point-of-care and core laboratory BNP assays and the use of the recombinant B-type natriuretic peptide nesiritide as a treatment option. Despite this recent interest, the available literature lacks a comprehensive expert review of the current science and roles of natriuretic peptides for diagnostic, prognostic, screening, treatment monitoring, and therapeutic purposes. More importantly, a summary updating and guiding the clinician on most of these advances was lacking. An expert Consensus Panel with basic, methodological, and clinical expertise was convened to summarize current knowledge in these areas and the findings and consensus statements are contained herein.

Atrial Natriuretic Factor↗
PubMedDate not supplied

Decompensated heart failure: is there a role for the outpatient use of nesiritide?

Heart failure (HF) management has seen enormous advances in the past two decades, including publication of HF management guidelines targeted at further reduction of morbidity and mortality. Nonetheless, the morbidity of HF has steadily increased and now represents one of the largest health care expenditures in this country. Because hospitalization for HF is most likely for patients with more advanced HF, they share a disproportionate burden of the hospitalization costs and will require treatment regimens beyond the current guidelines, if this burden is to be alleviated. In June 2004, a group of investigators who helped establish the natriuretic peptide treatment paradigm, met to discuss the potential role of nesiritide as an outpatient treatment option for patients with symptomatic HF who were at high risk for repeated admissions, a syndrome now described as "chronic decompensated HF." This report presents their considerations on the contribution of natriuretic peptide physiology to the amelioration of progressive left ventricular dysfunction, the therapeutic use of B-type natriuretic peptide, and its potential application to the outpatient management of acute and chronic decompensated HF. The use of outpatient IV nesiritide was considered a promising treatment option for symptomatic chronic decompensated HF patients that merits further investigation. Such an approach, once validated, should be integrated into an evidence-based HF disease management program.

Acute Disease↗