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Exercise and heart failure.

Abstract

Chronic heart failure (CHF) is a common condition with a poor prognosis, commonly associated with poor exercise tolerance and debilitation symptoms despite optimal modern therapy. Recent investigations have shown that the degree of exercise limitation may be related to pathophysiological changes that occur systemically in the patient with CHF. Exercise training in carefully selected stable patients with heart failure has been shown to be safe to correct many of these pathophysiological changes in the periphery and to lead to worthwhile improvements in exercise capacity. Recent studies have suggested a possible improvement in mortality and morbidity with exercise training in this patient group. This article discusses the factors limiting exercise capacity in CHF and reviews the controlled clinical trial of exercise testing in this condition.

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BibTeXRIS

A J Coats. 2001. Exercise and heart failure.. https://doi.org/10.1016/s0733-8651(05)70233-2

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The development and implementation of the Chronic Care Management Programme in Counties Manukau.

AIMS: To develop an effective and efficient process for the seamless delivery of care for targeted patients with specific chronic diseases. To reduce inexplicable variation and maximise use of available resources by implementing evidence-based care processes. To develop a programme that is acceptable and applicable to the Counties Manukau region. METHODS: A model for the management of people with chronic diseases was developed. Model components and potential interventions were piloted. For each disease project, a return on investment was calculated and external evaluation was undertaken. The initial model was subsequently modified and individual disease projects aligned to it. RESULTS: The final Chronic Care Management model, agreed in September 2001, described a single common process. Key components were the targeting of high risk patients, organisation of cost effective interventions into a system of care, and an integrated care server acting as a data warehouse with a rules engine, providing flags and reminders. Return on investment analysis suggested potential savings for each disease component from $277 to $980 per person per annum. CONCLUSIONS: For selected chronic diseases, introduction of an integrated chronic care management programme, based on internationally accepted best practice processes and interventions can make significant savings, reducing morbidity and improving the efficiency of health delivery in the Counties Manukau region.

Chronic Disease↗