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dc.contributor.authorTsuyuki, R. T.
dc.contributor.authorMcKelvie, R. S.
dc.contributor.authorArnold, JMO
dc.contributor.authorAvezum, A.
dc.contributor.authorBarretto, ACP
dc.contributor.authorCarvalho, ACC
dc.contributor.authorIsaac, D. L.
dc.contributor.authorKitching, A. D.
dc.contributor.authorPiegas, L. S.
dc.contributor.authorTeo, K. K.
dc.contributor.authorYusuf, S.
dc.identifier.citationArchives of Internal Medicine. Chicago: Amer Medical Assoc, v. 161, n. 19, p. 2337-2342, 2001.
dc.description.abstractBackground: Few studies have prospectively and systematically explored the factors that acutely precipitate exacerbation of congestive heart failure (CHF) in patients with left ventricular dysfunction. Knowledge of such factors is important in designing measures to prevent deterioration of clinical status. the objective of this study was to prospectively describe the precipitants associated with exacerbation of CHF status in patients enrolled in the Randomized Evaluation of Strategies for Left Ventricular Dysfunction Pilot Study.Methods: We conducted a 2-stage, multicenter, randomized trial in 768 patients with CHF who had an ejection fraction of less than 40%. Patients were randomly assigned to receive enalapril maleate, candesartan cilexetil, or both for 17 weeks, followed by randomization to receive metoprolol succinate or placebo for 26 weeks. Investigators systematically documented information on clinical presentation, management, and factors associated with the exacerbation for any episode of acute CHF during follow-up.Results: A total of 323 episodes of worsening of CHF occurred in 180 patients during 43 weeks of follow-up; 143 patients required hospitalization, and 5 died. Factors implicated in worsening of CHF status included noncompliance with salt restriction (22%); other noncardiac causes (20%), notably pulmonary infectious processes; study medications (15%); use of antiarrhythmic agents in the past 48 hours (15%); arrhythmias (13%); calcium channel blockers (13%); and inappropriate reductions in CHF therapy (10%).Conclusions: A variety of factors, many of which are avoidable, are associated with exacerbation of CHF. Attention to these factors and patient education are important in the prevention of CHF deterioration.en
dc.publisherAmer Medical Assoc
dc.relation.ispartofArchives of Internal Medicine
dc.rightsAcesso restrito
dc.titleAcute precipitants of congestive heart failure exacerbationsen
dc.contributor.institutionUniv Alberta
dc.contributor.institutionMcMaster Univ
dc.contributor.institutionDante Pazzanese Cardiol Inst
dc.contributor.institutionUniversidade de São Paulo (USP)
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionUniv Calgary
dc.description.affiliationUniv Alberta, Epidemiol Coordinating & Res Ctr EPICORE, Div Cardiol, Edmonton, AB T6G 2S2, Canada
dc.description.affiliationMcMaster Univ, Div Cardiol, Hamilton, ON, Canada
dc.description.affiliationDante Pazzanese Cardiol Inst, São Paulo, Brazil
dc.description.affiliationUniv São Paulo, Med Sch Hosp, Inst Heart, São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Paulista Sch Med, São Paulo, Brazil
dc.description.affiliationUniv Calgary, Div Cardiol, Calgary, AB, Canada
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Paulista Sch Med, São Paulo, Brazil
dc.description.sourceWeb of Science
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