![]() ![]() ![]() The strongest and most extensive research is on in-person treatment, but CBT-I is also conducted in groups, in briefer formats, via telephone and Skype, by internet programs and with self-help books. While studies are underway to determine if one of the components of CBT-I is more potent than others, experts hold that the behavioral interventions produce the most rapid and largest clinical effects. (For major depression, the ACP recommends selecting between either CBT or second-generation antidepressants, while for mild to moderate depression, the United Kingdom's medical system recommends CBT with behavioral activation and problem-solving as the go-to treatment.)ĬBT-I is a combination of treatments that includes behavioral therapy interventions, such as sleep restriction and stimulus control cognitive interventions, including restructuring dysfunctional beliefs and decastrophizing negative thoughts about sleep and sleep hygiene to address factors that may augment treatment outcomes. It's the first time a psychological treatment has been given the thumbs up as the preferred treatment by a medical organization, at least in the United States. Collaborative networks and registries, including ACTION (Advanced Cardiac Therapies Improving Outcomes Network), will have an important role in understanding the natural history, enhancing quality of care, and providing platforms for research of these relatively rare disease processes.In July, the organization that represents the internal medicine community in the United States - the American College of Physicians, or ACP - officially endorsed what many meta-analyses have found: Cognitive behavioral therapy for insomnia, or CBT-I, is the best treatment for chronic insomnia disorder and should be the first line of treatment for the approximately 24 million adults suffering from the condition.While some studies have shown this as a therapy to delay or avoid heart transplantation, further prospective study is required. Pulmonary artery banding has emerged as a potential therapy for infants with DCM and preserved ventricular function. The majority of children enrolled in the study were on ACE inhibitors or angiotensin-receptor blockers, mineralocorticoid receptor antagonists, and beta blockade.įor pediatric patients with hypertrophic cardiomyopathy, cause-specific diagnosis is increasingly important given the increasing availability of disease-specific therapies. In patients with a first-degree relative with dilated cardiomyopathy (DCM), annual screening is recommended for children 0-5 years of age, every 1-2 years for children 6-12 years of age, every 2-3 years for children 13-19 years of age, every 2-3 years for adults 20-50 years of age, and every 5 years for adults >50 years of age.Ī recent study showed improvement in left ventricular ejection fraction and reduced natriuretic peptide concentrations in children receiving ivabradine. Novel therapies such as single exon skipping, adeno-associated virus gene therapy, and gene-editing techniques hold promise in the treatment of patients with dystrophinopathies.Ĭurrent evidence does not support using standard oral HF therapies to prevent treatment-related cardiotoxicity in asymptomatic children who have received cardiotoxic cancer therapies.Ĭardioprotective medications such as the iron chelator dexrazoxane may prevent or reduce anthracycline-related cardiotoxicity when given concurrently with chemotherapy agents. Current treatment guidelines recommend initiation of angiotensin-converting enzyme (ACE) inhibition therapy in adolescence. Patients with muscular dystrophies are often stage A and at risk of HF. While extrapolating results of studies from adults may be reasonable in certain diseases or age groups, it is not uniformly appropriate.Stage D (refractory patients): Refractory HF requiring specialized interventions.Stage C (symptomatic patients): Cardiomyopathic heart disease with current or past.Stage B (asymptomatic patients): Structural heart disease but without signs or symptoms of HF.Stage A (at risk patients): The patient is at risk for HF but has no structural heart disease or.A 4-stage system has been proposed for therapeutic interventions in heart failure (HF):. ![]() The following are key points to remember from an American Heart Association Scientific Statement on treatment strategies for cardiomyopathy in children:
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