• 2018-07
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  • The primary tool in the pharmacological management of


    The primary tool in the pharmacological management of PTSD is the use of selective serotonin reuptake inhibitors [55,56], but positive response rates are generally limited. In addition, non-pharmacological treatment such as CBT has been shown to be effective for PTSD [57].
    Psychological distress in partners of ICD patients Recently, attention has been focused on psychological distress in the partners of ICD patients. Studies have reported that the distress level in partners of ICD patients was as high as that in the patients themselves [58]. In most partners, this distress level seems to decrease in the first year after implantation of an ICD [58]. The predictive factors of psychological distress in partners of ICD patients considered in the literature are age, secondary indication for ICD implantation, and personality traits such as type D, although the causal relationships are unclear [33,59]. Moreover, the influence of ICD shocks on the distress in partners of ICD patients is also complex and ranges from some to no impact on distress levels. However, it is not possible to draw conclusions on these issues because of the small number of studies examining psychological distress in partners of patients with an ICD.
    Conflicts of interests
    Introduction With the aging of the world\'s population and the consequent increasing prevalence of major cardiovascular risk factors, polo like kinase failure (HF) has become an important medical problem, one that imposes a great economic burden on healthcare [1]. The worldwide prevalence of HF has been estimated at 2–3% of the adult population [2]. With a mortality rate as high as 50% in 4 years [2], the long-term prognosis for patients with symptomatic HF appears to be even worse than for those with certain major types of cancer. Patients with HF have a poor quality of life, and suffer from high mortality resulting from progressive HF or sudden death associated with arrhythmias [3]. In 2010, the estimated direct cost of care for HF in the United States alone was $39.2 billion, while in-patient treatment costs accounted for more than half of this total cost [4]. Improvements in the outpatient management of patients with HF are needed in order to reduce the burden of hospital admissions. First introduced approximately 30 years ago, cardiac resynchronization therapy (CRT) has emerged as an attractive therapeutic intervention for patients with medically-refractory New York Heart Association (NYHA) classes III–IV HF and wide QRS duration [5]. Various studies have shown that, through synchronization of right ventricular (RV)–left ventricular (LV) (interventricular) or intraventricular contraction and optimization of atrioventricular (AV) timing, CRT facilitates reverse modeling of the LV, resulting in an increased LV ejection fraction (LVEF), reduced mitral regurgitation, and reduced heart size [6–9]. This translates to a clinical improvement in the patient\'s functional status, as determined by NYHA class, peak oxygen uptake, and exercise tolerance, better quality of life scores, and reduced all-cause mortality [10–13]. The concept of CRT is a simple yet elegant one. The reality, however, has exposed uncertainties in the efficacy of CRT, as several studies have reported that up to 25–30% of patients show no benefit from it [14–16]. Much emphasis in CRT-related research has been focused on the identification of suitable candidates with ventricular dyssynchrony. In contrast, guidelines for device follow up and troubleshooting in the event of a suboptimal response after implantation have been lacking. To maximize the potential of resynchronization therapy, CRT settings need to be monitored and titrated accordingly [17]. This involves addressing issues such as device optimization, management of arrhythmia and comorbidities, and, importantly, HF monitoring and treatment. It has been shown that a multi-disciplinary care plan involving frequent follow up and HF monitoring at pre-discharge, 1 month, 3 months, and 6 months after implantation leads to a significant improvement in event-free survival in comparison to conventional care, up to 2 years after implantation [18]. By this rationale, the ideal minimum frequency of follow up of CRT is every 1–3 months [19]. However, in view of the exponential growth in CRT implantations over the past decade, the benefits of frequent in-office follow ups are limited by the immense healthcare cost.