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Eisele M, Boczor S, Rakebrandt A, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. General practitioners' awareness of depressive symptomatology is not associated with quality of life in heart failure patients - cross-sectional results of the observational RECODE-HF Study. BMC FAMILY PRACTICE 2017; 18:100. [PMID: 29221442 PMCID: PMC5723041 DOI: 10.1186/s12875-017-0670-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Depression is a common comorbidity in patients with chronic heart failure (HF) and linked to a wider range of symptoms which, in turn, are linked to a decreased health-related quality of life (HRQOL). Treatment of depression might improve HRQOL but detecting depression is difficult due to the symptom overlap between HF and depression. Therefore, clinical guidelines recommend to routinely screen for depression in HF patients. No studies have so far investigated the treatment after getting aware of a depressive symptomatology and its correlation with HRQOL in primary care HF patients. Therefore, we examined the factors linked to depression treatment and those linked to HRQOL in HF patients. We hypothesized that GPs' awareness of depressive symptomatology was associated with depression treatment and HRQOL in HF patients. METHODS For this observational study, HF patients were recruited in primary care practices and filled out a questionnaire including PHQ-9 and HADS. A total of 574 patients screened positive for depressive symptomatology. Their GPs were interviewed by phone regarding the patients' comorbidities and potential depression treatment. Descriptive and regression analysis were performed. RESULTS GPs reported various types of depression treatments (including dialogue/counselling by the GP him/herself in 31.8% of the patients). The reported rates differed considerably between GP-reported initiated treatment and patient-reported utilised treatment regarding psychotherapy (16.4% vs. 9.5%) and pharmacotherapy (61.2% vs. 30.3%). The GPs' awareness of depressive symptomatology was significantly associated with the likelihood of receiving pharmacotherapy (OR 2.8; p < 0.001) but not psychotherapy. The patient's HRQOL was not significantly associated with the GPs' awareness of depression. CONCLUSION GPs should be aware of the gap between GP-initiated and patient-utilised depression treatments in patients with chronic HF, which might lead to an undersupply of depression treatment. It remains to be investigated why GPs' awareness of depressive symptomatology is not linked to patients' HRQOL. We hypothesize that GPs are aware of cases with reduced HRQOL (which improves under depression treatment) and unaware of cases whose depression do not significantly impair HRQOL, resulting in comparable levels of HRQOL in both groups. This hypothesis needs to be further investigated.
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Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sigrid Boczor
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Anja Rakebrandt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Eva Blozik
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 2a, 97078 Würzburg, Germany
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center, and German Center for Cardiovascular Research, partner site Göttingen, von-Siebold-Str. 5, D-37099 Göttingen, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Effect of educational program on self-care behaviors and health outcome among patients with heart failure. INT J EVID-BASED HEA 2017; 15:178-185. [DOI: 10.1097/xeb.0000000000000108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction: 5-Year Outcomes. J Am Coll Cardiol 2017; 70:2476-2486. [PMID: 29141781 DOI: 10.1016/j.jacc.2017.08.074] [Citation(s) in RCA: 642] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with heart failure (HF) have a poor prognosis and are categorized by ejection fraction (EF). OBJECTIVES This study sought to characterize differences in outcomes in patients hospitalized with heart failure with preserved ejection fraction (HFpEF) (EF ≥50%), heart failure with borderline ejection fraction (HFbEF) (EF 41% to 49%), and heart failure with reduced ejection fraction (HFrEF) (EF ≤40%). METHODS Data from GWTG-HF (Get With The Guidelines-Heart Failure) were linked to Medicare data for longitudinal follow-up. Multivariable models were constructed to examine 5-year outcomes and to compare survival to median survival of the U.S. POPULATION RESULTS A total of 39,982 patients from 254 hospitals who were admitted for HF between 2005 and 2009 were included: 18,299 (46%) had HFpEF, 3,285 (8.2%) had HFbEF, and 18,398 (46%) had HFrEF. Overall, median survival was 2.1 years. In risk-adjusted survival analysis, all 3 groups had similar 5-year mortality (HFrEF 75.3% vs. HFpEF 75.7%; hazard ratio: 0.99 [95% confidence interval: 0.958 to 1.022]; HFbEF 75.7% vs. HFpEF 75.7%; hazard ratio: 0.99 [95% confidence interval: 0.947 to 1.046]). In risk-adjusted analyses, the composite of mortality and rehospitalization was similar for all subgroups. Cardiovascular and HF readmission rates were higher in those with HFrEF and HFbEF compared with those with HFpEF. When compared with the U.S. population, HF patients across all age and EF groups had markedly lower median survival. CONCLUSIONS Among patients hospitalized with HF, patients across the EF spectrum have a similarly poor 5-year survival with an elevated risk for cardiovascular and HF admission. These findings underscore the need to improve treatment of patients with HF.
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Jones NR, Hobbs FDR, Taylor CJ. Prognosis following a diagnosis of heart failure and the role of primary care: a review of the literature. BJGP Open 2017; 1:bjgpopen17X101013. [PMID: 30564675 PMCID: PMC6169931 DOI: 10.3399/bjgpopen17x101013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/03/2017] [Indexed: 12/26/2022] Open
Affiliation(s)
- Nicholas R Jones
- GP Trainee & Academic Clinical Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - FD Richard Hobbs
- GP & Professor of Primary Care, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare J Taylor
- GP & NIHR Academic Clinical Lecturer, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Andrews AM, Russell CL, Cheng AL. Medication Adherence Interventions for Older Adults With Heart Failure: A Systematic Review. J Gerontol Nurs 2017; 43:37-45. [DOI: 10.3928/00989134-20170523-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/18/2017] [Indexed: 11/20/2022]
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Young KA, Redfield MM, Strand JJ, Dunlay SM. End-of-Life Discussions in Patients With Heart Failure. J Card Fail 2017; 23:821-825. [PMID: 28842378 DOI: 10.1016/j.cardfail.2017.08.451] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although guidelines call on clinicians to conduct regular conversations about advance care planning and end-of-life (EOL) preferences with patients with heart failure (HF), research suggests that physicians often avoid these discussions. METHODS AND RESULTS From January 20, 2014, to January 18, 2016, Southeastern Minnesota residents hospitalized with acute decompensated HF (ADHF) at Mayo Clinic hospitals were enrolled into an observational cohort study that included the administration of face-to-face questionnaires. Risk of death (prognosis) was estimated using the Meta-analysis Global Group in Chronic Heart Failure score. Among 400 patients (mean age 77.7 years, 46% female, 48% preserved ejection fraction), only 69 (17%) reported previously discussing EOL wishes with their physician. Patients reporting EOL discussions more often had an advance directive (81% vs 66%; P = .009), recognized the term "hospice" (96% vs 87%; P = .027), and had more favorable attitudes of dying and hospice (P = .030). Resuscitation preferences and rates of completion of advance directives varied with prognosis, although patient-clinician EOL discussions did not. CONCLUSIONS The majority of patients hospitalized with ADHF did not recall discussing their preferences for EOL care with their physician. This represents an important modifiable gap in the optimal longitudinal care of HF patients.
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Affiliation(s)
| | | | - Jacob J Strand
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shannon M Dunlay
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
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Boyde M, Peters R, New N, Hwang R, Ha T, Korczyk D. Self-care educational intervention to reduce hospitalisations in heart failure: A randomised controlled trial. Eur J Cardiovasc Nurs 2017; 17:178-185. [DOI: 10.1177/1474515117727740] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: A variety of educational interventions have been implemented to assist patients with heart failure to maintain their own health, develop self-care behaviours and decrease readmissions. Aims: The purpose of this study was to determine the effectiveness of a multimedia educational intervention for patients with heart failure in reducing unplanned hospital readmissions. Methods: The study, a randomised controlled trial in a large tertiary referral hospital in Australia, recruited 200 patients. Patients diagnosed with heart failure were randomly allocated 1:1 to usual education or a multimedia educational intervention. The multimedia approach began with an individual needs assessment to develop an educational plan. The educational intervention included viewing a DVD, and verbal discussion supported by a written manual with a teach-back evaluation strategy. The primary outcome was all-cause unplanned hospital readmission at 28 days, three months and 12 months post-recruitment. The secondary outcomes were changes in knowledge and self-care behaviours at three months and 12 months post-recruitment. Results: At 12 months, data on 171 participants were analysed. There were 24 participants who had an unplanned hospital readmission in the intervention group compared to 44 participants in the control group ( p=0.005). The self-care educational intervention reduced the risk of readmission at 12 months by 30% (relative risk: 0.703; 95% confidence interval: 0.548–0.903). Conclusion: A targeted multimedia educational intervention can be effective in reducing all-cause unplanned readmissions for people with heart failure.
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Affiliation(s)
- M Boyde
- Princess Alexandra Hospital, Australia
- University of Queensland, Australia
| | - R Peters
- Princess Alexandra Hospital, Australia
- University of Queensland, Australia
| | - N New
- Princess Alexandra Hospital, Australia
| | - R Hwang
- Princess Alexandra Hospital, Australia
- University of Queensland, Australia
| | - T Ha
- Princess Alexandra Hospital, Australia
- University of Queensland, Australia
| | - D Korczyk
- Princess Alexandra Hospital, Australia
- University of Queensland, Australia
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Wiskar KJ, Celi LA, McDermid RC, Walley KR, Russell JA, Boyd JH, Rush B. Patterns of Palliative Care Referral in Patients Admitted With Heart Failure Requiring Mechanical Ventilation. Am J Hosp Palliat Care 2017; 35:620-626. [DOI: 10.1177/1049909117727455] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Katie J. Wiskar
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Robert C. McDermid
- Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | - Keith R. Walley
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
- Division of Critical Care Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - James A. Russell
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
- Division of Critical Care Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John H. Boyd
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
- Division of Critical Care Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Barret Rush
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, British Columbia, Canada
- Division of Critical Care Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Balmain BN, Sabapathy S, Jay O, Adsett J, Stewart GM, Jayasinghe R, Morris NR. Heart Failure and Thermoregulatory Control: Can Patients With Heart Failure Handle the Heat? J Card Fail 2017; 23:621-627. [DOI: 10.1016/j.cardfail.2017.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 12/28/2022]
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Recognition of anxiety, depression, and PTSD in patients with COPD and CHF: Who gets missed? Gen Hosp Psychiatry 2017; 47:61-67. [PMID: 28807139 DOI: 10.1016/j.genhosppsych.2017.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/09/2017] [Accepted: 05/12/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study sought to identify patient factors associated with mental health (MH) recognition and treatment in medically ill Veterans. METHOD Retrospective data from patient electronic medical records (EMR) and self-report data were reviewed for 180 Veterans with cardiopulmonary conditions who met diagnostic criteria for anxiety, depression, or posttraumatic stress disorder on the Mini-International Neuropsychiatric Interview. Multivariate logistic regression examined the association of medical record MH recognition and MH service use with patient factors, including anxiety and depression severity, self-efficacy, locus of control, coping, illness intrusiveness, and health-related quality of life (QOL). RESULTS Seventy veterans (39%) had an MH diagnosis documented in their EMR, and 101 (56%) received at least one MH service (≥1 MH encounter or psychiatric medications). Greater depression (p=0.047) and adaptive coping (p=0.012) were associated with increased likelihood of EMR documentation of MH diagnoses. EMR MH diagnosis (p<0.001), higher internal locus of control (p=0.037), and poorer physical health-related QOL (p=0.014) were associated with greater likelihood of MH service use. DISCUSSION Veterans with cardiopulmonary conditions experiencing MH problems are under-recognized. Improved MH screening is needed, particularly for patients with poor adaptive coping skills, low internal locus of control, or poor physical health-related QOL.
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Eisele M, Rakebrandt A, Boczor S, Kazek A, Pohontsch N, Okolo-Kulak M, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. Factors associated with general practitioners' awareness of depression in primary care patients with heart failure: baseline-results from the observational RECODE-HF study. BMC FAMILY PRACTICE 2017; 18:71. [PMID: 28599626 PMCID: PMC5466751 DOI: 10.1186/s12875-017-0641-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/24/2017] [Indexed: 12/30/2022]
Abstract
Background Depression is more prevalent in patients with heart failure (HF) than in those without, but its detection is complicated by the symptom overlap between the two diseases. General practitioners (GPs) are the first point of contact for patients with HF. Therefore, this study aims to investigate GPs’ awareness of depression in their HF patients and factors associated with this awareness. Methods In this cross-sectional, observational study 3224 primary care patients with HF were screened for depressive symptomatology using an algorithm based on the Hospital Anxiety and Depression Scale, the 9-item subscale on Depression of the Patient Health Questionnaire, and selected items from the PROMIS Depression and Anxiety scales. The 272 GPs of all patients involved in the study were interviewed by telephone regarding their patients’ somatic and psychological comorbidities. The awareness rates of depressive symptomatology by the patients’ GPs are analyzed using descriptive statistics. Logistic regression analyses are applied to investigate the patient- and GP-based factors associated with the GPs’ awareness of depressive symptomatology. Results GPs were aware of their patients’ depressive symptomatology in 35% of all cases. Factors associated with the awareness of depressive symptomatology were: higher patient education levels, a history of depression known to the GP, GP-consultations due to emotional distress within the last 6 months, a higher frequency of GP-contacts within the last 6 months, a higher New York Heart Association (NYHA) classification and more severe depressive symptomatology. The GPs’ characteristics, including further education in psychology/psychiatry, were not associated with GP awareness. Conclusions Many aspects, including the definition of awareness and the practical issues in primary care, may contribute to the unexpectedly low awareness rates of depressive symptomatology in HF patients in primary care. Awareness rates might increase, if GPs encouraged their patients to talk about emotional distress, held detailed medical interviews including a patient’s history of depression and payed special attention to HF patients with low education levels. However, it remains to be investigated whether GPs’ judgement of depressive symptomatology is a better or worse indicator for the future prognosis and quality of life of HF patients than psychiatry based diagnostic criteria.
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Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Anja Rakebrandt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sigrid Boczor
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Agata Kazek
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Nadine Pohontsch
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Magdalena Okolo-Kulak
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Eva Blozik
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 2a, 97078, Würzburg, Germany
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center and German Center for Cardiovascular Research, partner site Göttingen, von-Siebold-Str. 5, D-37099, Göttingen, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Ahmed SMK, Abd El-Aziz NM. Effect of medical and nursing teaching program on awareness and adherence among elderly patients with chronic heart failure in Assiut, Egypt. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2017. [DOI: 10.4103/ejim.ejim_21_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Obesity in Middle Age Increases Risk of Later Heart Failure in Women—Results From the Prospective Population Study of Women and H70 Studies in Gothenburg, Sweden. J Card Fail 2017; 23:363-369. [DOI: 10.1016/j.cardfail.2016.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 01/03/2023]
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Abstract
Heart failure is an epidemic in the United States and a major health problem worldwide. The syndrome of acute heart failure is marked by a recent onset of symptoms usually in terms of days to a few weeks of worsening fatigue, shortness of breath, orthopnea, swelling, and sudden onset of weight gain. Physicians caring for patients with heart failure must know the risk factors for this disease, pathophysiology, symptomatology, important examination findings, key diagnostic tests, and management approach so as to improve symptoms and reduce mortality.
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Affiliation(s)
- Malgorzata Mysliwiec
- Department of Medicine, Jefferson Heart Institute, Sidney Kimmel Medical College of Thomas Jefferson University, 925 Chestnut Street, Suite 323A, Philadelphia, PA 19107, USA
| | - Raphael E Bonita
- Department of Medicine, Jefferson Heart Institute, Sidney Kimmel Medical College of Thomas Jefferson University, 925 Chestnut Street, Suite 323A, Philadelphia, PA 19107, USA.
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Sargento L, Vicente Simões A, Rodrigues J, Longo S, Lousada N, Palma Dos Reis R. Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure. Nutr Metab Cardiovasc Dis 2017; 27:430-437. [PMID: 28438373 DOI: 10.1016/j.numecd.2017.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/10/2017] [Accepted: 02/09/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Malnutrition is frequent in heart failure (HF). However, the best tool for evaluating malnutrition in geriatric patients with HF with reduced ejection fraction (HFrEF) is unknown. This study aimed to evaluate the incremental prognostic value of the geriatric nutritional risk index (GNRI) in stable geriatric outpatients with HFrEF compared with a clinical/laboratory prognostic model. METHODS AND RESULTS A total of 143 outpatients with HFrEF, aged >65 years, a LVEF <40%, and who were stable and on optimal therapy were studied. Follow-up lasted 3 years. The outcome was all-cause death. The GNRI was calculated as follows: [(1.489 × serum albumin (g/L)) + (41.7 × (current body weight/ideal weight)]. The 3-year death rate was 36.4% and 16 (11.2%) patients were at risk of malnutrition (GNRI ≤98). Deceased patients had a lower GNRI (113.6 ± 9.1 vs. 105.6 ± 9.2; p < 0.001) than did survivors. Greater values of the GNRI (hazard ratio = 0.93, 95% confidence interval [CI] = 0.90-0.95; p < 0.001) and GNRI >98 (hazard ratio = 0.29, 95% CI 0.15-0.57; p < 0.001) were associated with better survival. These factors remained significant after adjustment of significant confounders. The GNRI was a better discriminator of death than weight and albumin. Adding the GNRI to the clinical/laboratory predictor survival model significantly increased the c-statistics from 0.93 to 0.95 (p < 0.001) and the chi-square likelihood ratio test from 106.15 to 119.9. CONCLUSION The risk of malnutrition, as assessed by the GNRI, in stable geriatric outpatients with HFrEF is a strong independent predictor of survival. The GNRI adds significant prognostic information to the clinical/laboratory model.
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Affiliation(s)
- L Sargento
- Heart Failure Unit, Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Lisbon, Portugal.
| | - A Vicente Simões
- Internal Medicine Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Lisbon, Portugal
| | - J Rodrigues
- Internal Medicine Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Lisbon, Portugal
| | - S Longo
- Heart Failure Unit, Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Lisbon, Portugal
| | - N Lousada
- Heart Failure Unit, Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Lisbon, Portugal
| | - R Palma Dos Reis
- Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Lisbon, Portugal
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Carey SA, Bass K, Saracino G, East CA, Felius J, Grayburn PA, Vallabhan RC, Hall SA. Probability of Accurate Heart Failure Diagnosis and the Implications for Hospital Readmissions. Am J Cardiol 2017; 119:1041-1046. [PMID: 28132683 DOI: 10.1016/j.amjcard.2016.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/22/2016] [Accepted: 12/22/2016] [Indexed: 02/07/2023]
Abstract
Heart failure (HF) is a complex syndrome with inherent diagnostic challenges. We studied the scope of possibly inaccurately documented HF in a large health care system among patients assigned a primary diagnosis of HF at discharge. Through a retrospective record review and a classification schema developed from published guidelines, we assessed the probability of the documented HF diagnosis being accurate and determined factors associated with HF-related and non-HF-related hospital readmissions. An arbitration committee of 3 experts reviewed a subset of records to corroborate the results. We assigned a low probability of accurate diagnosis to 133 (19%) of the 712 patients. A subset of patients were also reviewed by an expert panel, which concluded that 13% to 35% of patients probably did not have HF (inter-rater agreement, kappa = 0.35). Low-probability HF was predictive of being readmitted more frequently for non-HF causes (p = 0.018), as well as documented arrhythmias (p = 0.023), and age >60 years (p = 0.006). Documented sleep apnea (p = 0.035), percutaneous coronary intervention (p = 0.006), non-white race (p = 0.047), and B-type natriuretic peptide >400 pg/ml (p = 0.007) were determined to be predictive of HF readmissions in this cohort. In conclusion, approximately 1 in 5 patients documented to have HF were found to have a low probability of actually having it. Moreover, the determination of low-probability HF was twice as likely to result in readmission for non-HF causes and, thus, should be considered a determinant for all-cause readmissions in this population.
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Affiliation(s)
- Sandra A Carey
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas.
| | - Kyle Bass
- Soltero Cardiovascular Research Center, Baylor University Medical Center, Dallas, Texas
| | - Giovanna Saracino
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Cara A East
- Soltero Cardiovascular Research Center, Baylor University Medical Center, Dallas, Texas
| | - Joost Felius
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Paul A Grayburn
- Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas
| | - Ravi C Vallabhan
- Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas
| | - Shelley A Hall
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas
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Flint KM, Schmiege SJ, Allen LA, Fendler TJ, Rumsfeld J, Bekelman D. Health Status Trajectories Among Outpatients With Heart Failure. J Pain Symptom Manage 2017; 53:224-231. [PMID: 27756621 DOI: 10.1016/j.jpainsymman.2016.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/11/2016] [Accepted: 08/26/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT Health status (i.e., symptoms, function, and quality of life) is an important palliative care outcome in patients with heart failure; however, patterns of health status over time (i.e., trajectories) are not well described. OBJECTIVES The objective of this study was to identify health status trajectories in outpatients with heart failure and assess whether depression, symptom burden, or sense of peace predict health status trajectory. METHODS This is an observational study utilizing data from the Patient-Centered Disease Management for Heart Failure trial. Participants completed Kansas City Cardiomyopathy Questionnaires at baseline, three, six, and 12 months. Latent class growth analysis identified health status trajectories; multinomial logistic regression models identified predictors of trajectory membership. RESULTS Patients (n = 384) were primarily men (97%) and older (mean age 67.6 ± 10.1). Three health status trajectories were identified. All three trajectories improved at three months; however, the marked improvement health status trajectory (n = 19) showed progressive improvement over one year, whereas the poor (n = 119) and moderate (n = 246) health status trajectories had little change after three months. In adjusted analyses, worse baseline depression (odds ratio 1.10; 95% confidence interval 1.01-1.20), symptom burden (1.45; 1.15-1.83), and sense of peace (0.41; 0.22-0.75) predicted membership in the poor vs. moderate health status trajectory. CONCLUSION We identified three one-year health status trajectories in patients with heart failure, with the two most common trajectories characterized by early improvement followed by limited change. Future research should assess these findings in nonveterans and women and explore whether treatment of depression, high symptom burden, and low sense of peace leads to improved long-term heart failure health status trajectory.
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Affiliation(s)
- Kelsey M Flint
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA.
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Larry A Allen
- Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA; Section of Advanced Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA
| | - Timothy J Fendler
- Division of Cardiovascular Diseases, St. Luke's Mid-American Heart Institute, University of Missouri, Kansas City, Missouri, USA
| | - John Rumsfeld
- American College of Cardiology, Washington, District of Columbia, USA
| | - David Bekelman
- Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA; VA Eastern Colorado Health Care System, Denver, Colorado, USA; Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA
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Germano G, Van Kriekinge SD. Measuring mechanical cardiac dyssynchrony in the 3-D era. J Nucl Cardiol 2017; 24:158-161. [PMID: 26719153 DOI: 10.1007/s12350-015-0379-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/11/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Guido Germano
- Cedars-Sinai Medical Center, 8700 Beverly Blvd A047 N, Los Angeles, CA, USA.
- UCLA, David Geffen School of Medicine, Los Angeles, CA, USA.
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Krishnan DK, Pawlaczyk B, McCullough PA, Enright S, Kunadi A, Vanhecke TE. Point-of-Care, Ultraportable Echocardiography Predicts Diuretic Response in Patients Admitted with Acute Decompensated Heart Failure. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:201-208. [PMID: 28008296 PMCID: PMC5170880 DOI: 10.4137/cmc.s38896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 08/11/2016] [Accepted: 08/11/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Routine management of patients with acute decompensated heart failure (ADHF) requires careful attentiveness to fluid status and diuretic treatment efficacy. New advances in ultrasound have made ultraportable echocardiography (UE) available to physicians for point-of-care use. The purpose of this study is to explore physiologic measures of intravascular fluid volume derived from UE and explore predictors of diuretic response in ADHF. METHODS Various echocardiography imaging measurements, particularly diameter and collapse of inferior vena cava (IVC), were collected from 77 patients admitted with a primary diagnosis of ADHF. Patients were divided into two groups based on whether or not they achieved a net negative fluid output of 3 L within 48 hours. The demographic information, serum laboratory markers, and physical characteristics of the subjects were obtained to correlate with daily ultrasound measurements. Univariate and multivariate analyses were used to compare diuretic “responders” to “nonresponders.” RESULTS A negative change in the IVC diameter at 48 hours was robust in prediction of diuretic response. For every 1 mm decrease in the IVC diameter at 48 hours, there was an odds ratio of 1.62 (95% CI: 1.20–2.19) for responding to diuretic therapy independent of other variables including baseline renal filtration function and blood B-type natriuretic peptide. CONCLUSION Assessment of central venous pressure as a proxy for passive renal congestion independently predicts initial diuretic response in ADHF. Future research is needed to further understand the individual variation in response to loop diuresis and to identify optimal treatment approaches that utilize anatomic and physiologic measures such as venous ultrasound.
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Affiliation(s)
- Dena K Krishnan
- Department of Internal Medicine, Genesys Regional Medical Center/Ascension Health, Grand Blanc, MI, USA.; Department of Cardiovascular Medicine, Genesys Regional Medical Center/Ascension Health, Grand Blanc, MI, USA
| | - Barbara Pawlaczyk
- Department of Internal Medicine, Genesys Regional Medical Center/Ascension Health, Grand Blanc, MI, USA
| | - Peter A McCullough
- Department of Internal Medicine and Cardiovascular Medicine, St. John Providence Health System, Providence Park Heart Institute, Novi, MI, USA
| | - Susan Enright
- Department of Internal Medicine, Genesys Regional Medical Center/Ascension Health, Grand Blanc, MI, USA
| | - Arvind Kunadi
- Department of Nephrology, Genesys Regional Medical Center/Ascension Health, Grand Blanc, MI, USA
| | - Thomas E Vanhecke
- Department of Cardiovascular Medicine, Genesys Regional Medical Center/Ascension Health, Grand Blanc, MI, USA
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Singh RK, Yeh JC, Price JF. Diagnosis and treatment strategies for children with myocarditis. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Balmain BN, Jay O, Sabapathy S, Royston D, Stewart GM, Jayasinghe R, Morris NR. Altered thermoregulatory responses in heart failure patients exercising in the heat. Physiol Rep 2016; 4:e13022. [PMID: 27905297 PMCID: PMC5112500 DOI: 10.14814/phy2.13022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/03/2016] [Accepted: 10/09/2016] [Indexed: 01/11/2023] Open
Abstract
Heart failure (HF) patients appear to exhibit impaired thermoregulatory capacity during passive heating, as evidenced by diminished vascular conductance. Although some preliminary studies have described the thermoregulatory response to passive heating in HF, responses during exercise in the heat remain to be described. Therefore, the aim of this study was to compare thermoregulatory responses in HF and controls (CON) during exercise in the heat. Ten HF (NYHA classes I-II) and eight CON were included. Core temperature (Tc), skin temperature (Tsk), and cutaneous vascular conductance (CVC) were assessed at rest and during 1 h of exercise at 60% of maximal oxygen uptake. Metabolic heat production (Hprod) and the evaporative requirements for heat balance (Ereq) were also calculated. Whole-body sweat rate was determined from pre-post nude body mass corrected for fluid intake. While Hprod (HF: 3.9 ± 0.9; CON: 6.4 ± 1.5 W/kg) and Ereq (HF: 3.3 ± 0.9; CON: 5.6 ± 1.4 W/kg) were lower (P < 0.01) for HF compared to CON, both groups demonstrated a similar rise in Tc (HF: 0.9 ± 0.4; CON: 1.0 ± 0.3°C). Despite this similar rise in Tc, Tsk (HF: 1.6 ± 0.7; CON: 2.7 ± 1.2°C), and the elevation in CVC (HF: 1.4 ± 1.0; CON: 3.0 ± 1.2 au/mmHg) was lower (P < 0.05) in HF compared to CON Additionally, whole-body sweat rate (HF: 0.36 ± 0.15; CON: 0.81 ± 0.39 L/h) was lower (P = 0.02) in HF compared to CON Patients with HF appear to be limited in their ability to manage a thermal load and distribute heat content to the body surface (i.e., skin), secondary to impaired circulation to the periphery.
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Affiliation(s)
- Bryce N Balmain
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Surendran Sabapathy
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Danielle Royston
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Glenn M Stewart
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Rohan Jayasinghe
- Menzies Health Institute, Gold Coast, Queensland, Australia
- Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Norman R Morris
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
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Mittal MK, Katta N, Alpert MA. Role of isolated ultrafiltration in the management of chronic refractory and acute decompensated heart failure. Hemodial Int 2016; 20 Suppl 1:S30-S39. [PMID: 27669547 DOI: 10.1111/hdi.12464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic congestive heart failure (CHF) and acute decompensated heart failure (ADHF) refractory to medical therapy represent therapeutic challenges. In such patients, attempts to reduce pulmonary and systemic congestion frequently produce deterioration of renal function. In studies of patients with chronic severe CHF refractory to medical therapy (including loop diuretics), isolated ultrafiltration was frequently able to relieve congestive symptoms by precise removal of extracellular water and sodium, and in some cases was able to restore responsiveness to loop diuretics. Randomized controlled trials comparing isolated ultrafiltration and medical therapy (mainly loop diuretics) in patients with ADHF failed to demonstrate the superiority of isolated ultrafiltration over diuretic therapy with respect to renal function and mortality. Isolated ultrafiltration reduced length of hospital stay in several studies. At this time, there is insufficient evidence to support the use of isolated ultrafiltration as initial therapy of ADHF.
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Affiliation(s)
- Mayank K Mittal
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Natraj Katta
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Martin A Alpert
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA.
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Kwekkeboom KL, Bratzke LC. A Systematic Review of Relaxation, Meditation, and Guided Imagery Strategies for Symptom Management in Heart Failure. J Cardiovasc Nurs 2016; 31:457-68. [PMID: 26065388 PMCID: PMC4675700 DOI: 10.1097/jcn.0000000000000274] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pain, dyspnea, fatigue, and sleep disturbance are prevalent and distressing symptoms in persons with advanced heart failure. Although many lifestyle and self-care interventions have been developed to control heart failure progression, very few studies have explored treatments exclusively for symptom palliation. Cognitive-behavioral strategies may be effective treatment for these symptoms in advanced heart failure. OBJECTIVE A systemic review was conducted to describe the effect of cognitive-behavioral strategies on pain, dyspnea, fatigue, and sleep disturbance in patients with heart failure. METHODS CINAHL, Medline, and PsychINFO were searched from inception through December 2014. Articles were selected for inclusion if they tested a cognitive-behavioral strategy using a quasi-experimental or experimental design, involved a sample of adults with heart failure, and measured pain, dyspnea, fatigue, sleep disturbance, or symptom-related quality of life. The 2 authors evaluated study quality, abstracted data elements from each study, and synthesized findings. RESULTS Thirteen articles describing 9 unique studies met criteria and were included in the review. Five studies tested relaxation strategies, 3 tested meditation strategies, and 1 tested a guided imagery strategy. Of the 9 studies, 7 demonstrated some improvement in symptom outcomes. Relaxation, meditation, guided imagery, or combinations of these strategies resulted in less dyspnea and better sleep compared with attention control or usual care conditions and reduced pain, dyspnea, fatigue, and sleep disturbance within treatment groups (pretreatment to posttreatment). Symptom-related quality of life was improved with meditation compared with attention control and usual care conditions and improved pre- to post-guided imagery. CONCLUSIONS Studies exploring cognitive-behavioral symptom management strategies in heart failure vary in quality and report mixed findings but indicate potential beneficial effects of relaxation, meditation, and guided imagery on heart failure-related symptoms. Future research should test cognitive-behavioral strategies in rigorously designed efficacy trials, using samples selected for their symptom experience, and measure pain, dyspnea, fatigue, and sleep disturbance outcomes with targeted symptom measures.
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Affiliation(s)
- Kristine L Kwekkeboom
- Kristine L. Kwekkeboom, PhD, RN Professor, School of Nursing, University of Wisconsin-Madison. Lisa C. Bratzke, PhD, RN, ANP-BC Assistant Professor, School of Nursing, University of Wisconsin-Madison
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Cossette S, Belaid H, Heppell S, Mailhot T, Guertin MC. Feasibility and acceptability of a nursing intervention with family caregiver on self-care among heart failure patients: a randomized pilot trial. Pilot Feasibility Stud 2016; 2:34. [PMID: 27965853 PMCID: PMC5154064 DOI: 10.1186/s40814-016-0077-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/23/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Self-care practices in heart failure (HF) contribute to quality of life, symptom stabilization, and extended life expectancy. However, adherence to practices such as liquid and salt restriction or symptom monitoring require high motivation on a daily basis. The aim was to assess the feasibility, acceptability, and potential effectiveness of a nursing intervention with family caregivers, aimed at improving self-care practice of HF patients. METHODS This pilot study involved 32 HF patient-caregiver dyads (16/group) randomized to an experimental (EG) or control group (CG). The intervention, based on the Self-Determination Theory, was designed to enhance patients' autonomy and motivation in self-care practices, by involving their caregivers' support. Five encounters were planned with the EG dyads-two face-to-face during hospitalization and three by telephone after discharge. The feasibility of delivering the protocol was evaluated as well as the acceptability of the intervention. The potential effectiveness of the intervention was assessed based on patient outcomes, including general self-care management and self-care specific to HF, perceived competence to manage HF, autonomous motivation (A-motivation, external extrinsic motivation, internal extrinsic motivation, and intrinsic motivation), and perceived support from the caregiver. Caregiver outcomes included level of support provided to the patient. RESULTS Despite recruitment challenges, the intervention was feasible, with 12 of the 16 dyads receiving all 5 encounters delivered per protocol. The 4 other dyads received the two hospital encounters, but at least 1 of the 3 post-discharge planned telephone encounters was not feasible because the patients had been re-hospitalized or was deceased. Participant's satisfaction with the intervention was high. Outcomes favoring the EG include self-care specific to HF, internal extrinsic motivation, intrinsic motivation, and caregiver's feeling that they provide a higher level of support. CONCLUSIONS Caregiver involvement was found to be both a feasible and acceptable means of supporting self-care practice in HF patients. This approach presents a potential avenue for enhancing patients' efforts in this regard. However, this pilot study offers preliminary findings only, which need to be replicated in a phase 3 clinical trial.
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Affiliation(s)
- Sylvie Cossette
- Faculty of Nursing, University of Montreal, Montreal Heart Institute Research Center S-2510, 5000 Belanger Street, Montreal, Quebec H1T 1C8 Canada
| | - Hayet Belaid
- Heart Failure Clinic, Montreal Heart Institute Research Center S-2490, 5000 Belanger Street, Montreal, Quebec H1T 1C8 Canada
| | - Sonia Heppell
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8 Canada
| | - Tanya Mailhot
- Heart Failure Clinic, Montreal Heart Institute Research Center S-2490, 5000 Belanger Street, Montreal, Quebec H1T 1C8 Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Suite 400, 4100 Rue Molson, Montréal, Québec H1Y 3N1 Canada
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Chan WW, Waltman Johnson K, Friedman HS, Navaratnam P. Association between cardiac, renal, and hepatic biomarkers and outcomes in patients with acute heart failure. Hosp Pract (1995) 2016; 44:138-45. [PMID: 27292609 DOI: 10.1080/21548331.2016.1197760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Myocardial injury, worsening renal function, and hepatic impairment are independent risk factors for poor patient acute heart failure (AHF) outcomes. Biomarkers of organ damage may be useful in identifying patients at risk for poor outcomes. The objective of this analysis was to assess the relationship between abnormal AHF biomarkers and outcomes in AHF patients. METHODS AHF admissions (N = 104,794) data from the Cerner Health Facts® inpatient database were analyzed retrospectively. Multivariate predictive models determined the impact of biomarkers on mortality, readmission, length of stay (LOS), and cost from index admission through 180 days post discharge. Thirty and 60 day time windows are reported but 180 day results were consistent with 60 day outcomes. Biomarkers evaluated were aspartate transaminase (AST), estimated glomerular filtration rate (eGFR), high sensitivity cardiac troponin, bilirubin, alanine transaminase (ALT), sodium, high sensitivity C-reactive protein (hs-CRP), uric acid, B-type natriuretic peptide (BNP), NT-ProBNP, blood urea nitrogen (BUN), serum creatinine (SCr), and hemoglobin. RESULTS All biomarkers evaluated except hs-CRP, uric acid, and NT-ProBNP were significant (p < 0.0001) predictors of mortality at all timepoints; non-significance for these 3 biomarkers is likely due to low patient counts (1%-2%). Odds ratios for significant biomarkers of mortality ranged from 1.168-2.076 at index admission, 1.205-1.946 at 30 days post-discharge, and 1.233-1.991 at 60 days post-discharge. AST, eGFR, troponin, ALT, BNP, BUN, SCr, and hemoglobin were significant (p < 0.0001) predictors of readmission risk at all timepoints. AST, eGFR, troponin, bilirubin, BUN, SCr, and hemoglobin were significant (p < 0.0001) predictors of cumulative LOS at all timepoints. AST, eGFR, troponin, ALT, sodium, BUN, and hemoglogin were significant (p < 0.0001) cost predictors at 30 and 60 days post-discharge. CONCLUSIONS Renal function measures were associated with outcomes in patients hospitalized for AHF. Increased vigilance of renal biomarkers may be warranted to assess risk and promote proactive clinical management to improve outcomes.
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Affiliation(s)
- Wing W Chan
- a Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | | | - Howard S Friedman
- b DataMed Solutions LLC , New York , NY , USA.,c School of International and Public Affairs , Columbia University , New York , NY , USA
| | - Prakash Navaratnam
- b DataMed Solutions LLC , New York , NY , USA.,d College of Pharmacy , The Ohio State University , Columbus , OH , USA
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Abstract
Multiple studies have been conducted assessing strategies for managing heart failure with the goal of decreasing admissions and readmissions, decreasing mortality, increasing self-management, and improving quality of life. Telemonitoring has been explored as an intervention to support and monitor adherence to all aspects of the heart failure management plan, including medication and appointment adherence, diet, exercise, and self-care. This article addresses the findings of studies and provides recommendations for future consideration. The need to apply the right interventions, to the right patient, at the right time, based on self-efficacy and readiness to change is also addressed.
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Affiliation(s)
- Josie Dimengo
- Healthways, Inc., Employer Market, 701 Cool Springs Boulevard, Franklin, TN 37067, USA.
| | - Gerrye Stegall
- Healthways International, 701 Cool Springs Boulevard, Franklin, TN 37067, USA
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Ansara AJ, Kolanczyk DM, Koehler JM. Neprilysin inhibition with sacubitril/valsartan in the treatment of heart failure: mortality bang for your buck. J Clin Pharm Ther 2016; 41:119-27. [DOI: 10.1111/jcpt.12363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/21/2016] [Indexed: 01/05/2023]
Affiliation(s)
- A. J. Ansara
- Department of Pharmacy; Indiana University Health Methodist Hospital; Indianapolis IN USA
- Department of Pharmacy Practice; Butler University College of Pharmacy and Health Sciences; Indianapolis IN USA
| | - D. M. Kolanczyk
- Department of Pharmacy; Loyola University Medical Center; Maywood IL USA
- Department of Pharmacy Practice; Midwestern University Chicago College of Pharmacy; Downers Grove IL USA
| | - J. M. Koehler
- Department of Pharmacy Practice; Butler University College of Pharmacy and Health Sciences; Indianapolis IN USA
- Pulmonary Rehabilitation and Transitional Care; Indiana University Health; Indianapolis IN USA
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Colin-Ramirez E, McAlister FA, Zheng Y, Sharma S, Ezekowitz JA. Changes in dietary intake and nutritional status associated with a significant reduction in sodium intake in patients with heart failure. A sub-analysis of the SODIUM-HF pilot study. Clin Nutr ESPEN 2015; 11:e26-e32. [PMID: 28531423 DOI: 10.1016/j.clnesp.2015.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/22/2015] [Accepted: 11/02/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND & AIMS Concerns have been raised about the impact of dietary sodium restriction on the overall dietary intake and nutritional status in patients with heart failure (HF). The objective of this study was to evaluate the association between a significant reduction in sodium intake and dietary changes and nutritional status in patients with chronic HF. METHODS This is a secondary analysis of 38 patients enrolled in a pilot study of dietary sodium reduction. Patients were classified into two groups according to a level of sodium reduction achieved (≥25% [n = 21 patients] and <25% [n = 14 patients]) at 6 months. Between group changes in energy, nutrient intake, weight loss, and hand grip strength from baseline to 6 months were compared. RESULTS Patients had a median age of 65 years, 51% were male, median body mass index was 30.7 kg/m2 and median ejection fraction was 39%. Over 6 months, the group with ≥25% sodium reduction exhibited a greater increase in folate intake [median change 50 mcg/day (25th-75th percentiles: -101, 167) vs. -31 mcg/day (25th-75th percentiles: -221, 51), p = 0.04 between groups] and a larger reduction in calcium intake [median change -262 (25th-75th percentiles: -585, -9) vs. 91 (25th-75th percentiles: -114, 210), p = 0.01 between groups], and were more likely to meet the parameters of the DASH diet compared to the <25% sodium reduction group. No significant differences between groups were seen for caloric intake and other relevant nutrients and no significant weight loss was found in either group. CONCLUSIONS Dietary sodium reduction may be achieved without compromising overall dietary intake and nutritional status in patients with HF when an individualized and comprehensive dietary approached is used. CLINICAL TRIAL IDENTIFIER Clinicaltrials.gov identifier: NCT01480401.
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Affiliation(s)
| | - Finlay A McAlister
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
| | - Yinggan Zheng
- Canadian VIGOUR Centre at the University of Alberta, Edmonton, Canada
| | - Sangita Sharma
- Medicine Department, University of Alberta, Edmonton, Canada
| | - Justin A Ezekowitz
- Medicine Department, University of Alberta, Edmonton, Canada; Canadian VIGOUR Centre at the University of Alberta, Edmonton, Canada; Heart Function Clinic, Division of Cardiology, University of Alberta, Edmonton, Canada.
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Abstract
Hypertension affects 80 million people in the United States. It remains poorly controlled, with only 54% of diagnosed patients treated to blood pressure targets. Hypertension management is complex in part due to the volume of antihypertensive agents, variable patient needs and responses, and inconsistent design and outcomes from clinical trials. Therefore, trustworthy clinical practice guidelines have a key role in hypertension management. The United States experienced a 10-year gap in publication of hypertension guidelines, followed by multiple guideline publications in 2013. These guidelines led to more controversy than clarity, as there was discordance among them. This review summarizes the guidelines and clinical statements influencing the current debate in order to facilitate appropriate application.
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Affiliation(s)
- Toni L. Ripley
- Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Mary Baumert
- Siouxland Community Health Center, University of Nebraska Medical Center, Omaha, NE, USA
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Andrade DC, Lucero C, Toledo C, Madrid C, Marcus NJ, Schultz HD, Del Rio R. Relevance of the Carotid Body Chemoreflex in the Progression of Heart Failure. BIOMED RESEARCH INTERNATIONAL 2015; 2015:467597. [PMID: 26779536 PMCID: PMC4686619 DOI: 10.1155/2015/467597] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/08/2015] [Indexed: 12/18/2022]
Abstract
Chronic heart failure (CHF) is a global health problem affecting millions of people. Autonomic dysfunction and disordered breathing patterns are commonly observed in patients with CHF, and both are strongly related to poor prognosis and high mortality risk. Tonic activation of carotid body (CB) chemoreceptors contributes to sympathoexcitation and disordered breathing patterns in experimental models of CHF. Recent studies show that ablation of the CB chemoreceptors improves autonomic function and breathing control in CHF and improves survival. These exciting findings indicate that alterations in CB function are critical to the progression of CHF. Therefore, better understanding of the physiology of the CB chemoreflex in CHF could lead to improvements in current treatments and clinical management of patients with CHF characterized by high chemosensitivity. Accordingly, the main focus of this brief review is to summarize current knowledge of CB chemoreflex function in different experimental models of CHF and to comment on their potential translation to treatment of human CHF.
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Affiliation(s)
- David C. Andrade
- Laboratory of Cardiorespiratory Control, Center of Biomedical Research, Universidad Autónoma de Chile, 8900000 Santiago, Chile
| | - Claudia Lucero
- Laboratory of Cardiorespiratory Control, Center of Biomedical Research, Universidad Autónoma de Chile, 8900000 Santiago, Chile
| | - Camilo Toledo
- Laboratory of Cardiorespiratory Control, Center of Biomedical Research, Universidad Autónoma de Chile, 8900000 Santiago, Chile
| | - Carlos Madrid
- Centro de Fisiología Celular e Integrativa, Clínica Alemana-Universidad del Desarrollo, 7500000 Santiago, Chile
| | - Noah J. Marcus
- Department of Physiology and Pharmacology, Des Moines University, Des Moines, IA 50312, USA
| | - Harold D. Schultz
- Department of Cellular & Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Center of Biomedical Research, Universidad Autónoma de Chile, 8900000 Santiago, Chile
- Dirección de Investigación, Universidad Científica del Sur, Lima 15067, Peru
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Colin-Ramirez E, Arcand J, Ezekowitz JA. Estimates of Dietary Sodium Consumption in Patients With Chronic Heart Failure. J Card Fail 2015; 21:981-8. [DOI: 10.1016/j.cardfail.2015.08.345] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 07/27/2015] [Accepted: 08/31/2015] [Indexed: 11/25/2022]
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Sriram K, Ramasubramanian V, Meguid MM. Special postoperative diet orders: Irrational, obsolete, and imprudent. Nutrition 2015; 32:498-502. [PMID: 26746678 DOI: 10.1016/j.nut.2015.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 02/08/2023]
Abstract
There are no indications to prescribed special diets for postoperative patients. Low-sodium and low-fat or low-cholesterol diets are examples of restricted diets, especially in patients with heart disease and atherosclerosis. These restricted diets are unpalatable. Postoperative nausea, paralytic ileus, and vomiting caused by residual anesthetic effects and opioids used for pain control further contribute to the problem. Long-term adherence to these diets is necessary to derive benefits. Prescribing regular and palatable diets in the immediate postoperative period to meet protein and energy goals is important for wound healing and is commensurate with best clinical practices. In the following, we review the pertinent literature and offer clinical evidence that routine special diet orders for postoperative patients are not necessary.
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Affiliation(s)
- Krishnan Sriram
- Adult Critical Care and eICU, Advocate Health Care, Oakbrook, IL; Division of Surgical Critical Care, Stroger Hospital of Cook County, Chicago, IL.
| | | | - Michael M Meguid
- Professor Emeritus, Surgery, Neuroscience and Nutrition, Department of Surgery, Upstate Medical University, University Hospital, Syracuse, NY
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Wassilew K, Terziev D, Wassilew G, Fitzl G, Frölich K, Kandolf R, Fried A. Ultrastructural morphometric findings of cardiomyocytes in patients with impaired ventricular function--a comparative clinicopathological study. Cardiovasc Pathol 2015; 25:25-32. [PMID: 26472277 DOI: 10.1016/j.carpath.2015.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/01/2015] [Accepted: 09/20/2015] [Indexed: 11/24/2022] Open
Abstract
AIM The present study aims to analyze the differences in ultrastructural changes between right ventricular myocardium in clinically determined grades of heart failure (HF) [New York Heart Association (NYHA) classes I-IV] and their value in the routine diagnostic setting. METHODS We investigated consecutive right ventricular endomyocardial biopsies of 12 patients presenting with HF (49±11.2years; male=10) by light microscopy and ultrastructural morphometric analysis. The patients were divided into four groups according to their NYHA classes (NYHA I: n=1, II: n=2, III: n=8, IV: n=1). We used a stereological point counting method on electron micrographs to determine the volume, surface, and numerical density of cardiomyocyte myofibrils; z-lines; mitochondria; and cristae as required. Further, secondary parameters were calculated. RESULTS Myofibrillar parameters increased between NYHA class I and II (P<.01), which matched with more pronounced cardiomyocyte hypertrophy on the light microscopic level. In NYHA classes III and IV, the myofibrillar parameters dropped, while parameters concerning the mitochondria and their cristae rose (P<.01). This resulted in an elevated mitochondria to myofibril ratio (P<.05) and correlated with histologically evident atrophic cardiomyocytes, perinuclear loss of myofibrils and dot-like perinuclear staining positive on peroxide acid shift. CONCLUSION In this present study, right ventricular myocardial ultrastructure differed between patients diagnosed with HF of different degrees in distinct subcellular changes. These findings suggest that ultrastructural analysis, while correlated with histopathological features, adds to the diagnosis in the routine diagnostic setting, specifically in lower NYHA grades, in which only minor changes are observed histologically.
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Affiliation(s)
- Katharina Wassilew
- Cardiac Pathology Unit, Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
| | - Denis Terziev
- Institute of Anatomy, Medical University Leipzig, Leipzig, Germany
| | | | - Günther Fitzl
- Institute of Anatomy, Medical University Leipzig, Leipzig, Germany
| | | | - Reinhard Kandolf
- Department of Molecular Pathology, Institute of Pathology and Neuropathology, Tübingen, Germany
| | - Andreas Fried
- Department of Cardiology, Hospital Havelhoehe, Berlin, Germany
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Abstract
The newly available clinical guidelines in heart failure (HF) from Europe (2012), the United States (2010 and 2013), and Canada (2015) were compared, focusing on the systems for grading the evidence and classifying the recommendations, HF definitions, pharmacologic treatment, and devices used in HF. Some gaps were evident in the methodology for assessing evidence or in HF definitions. Pharmacologic treatments and recommendations for cardiac resynchronization therapy and implantable cardioverter-defibrillators are similar but some differences need to be considered by the practicing clinician. Guideline recommendations regarding new emergent treatments are becoming available.
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Affiliation(s)
- Juan F Bulnes
- Division of Internal Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 367, Santiago 8320000, Chile
| | - Jorge E Jalil
- Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 367, 8th Floor, Santiago 8320000, Chile.
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86
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Harkness K, Buck HG, Arthur H, Carroll S, Cosman T, McGillion M, Kaasalainen S, Kryworuchko J, O'Keefe-McCarthy S, Sherifali D, Strachan PH. Caregiver Contribution to Heart Failure Self-Care (CACHS). Nurs Open 2015; 3:51-60. [PMID: 27708815 PMCID: PMC5047331 DOI: 10.1002/nop2.35] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 09/01/2015] [Indexed: 12/26/2022] Open
Abstract
Aim While caregivers (CGs) make an important contribution to the self‐care of heart failure (HF) patients, there are no reliable and valid tools for measuring such contributions. Current interventions that strive to optimize patient outcomes through self‐care strategies neglect to account for CG contributions, a potential confounder on outcomes. The aim of the study was to develop an instrument that measures CG contributions to HF patients’ self‐care. Design The study design follows an established process for instrument development. Methods A systematic literature review and semi‐structured interviews of CGs were conducted to identify measureable CG activities. Items were derived from thematic analysis of CG narratives. A content validity index was computed for each item (I‐CVI). Items with an I‐CVI of >0·70 were retained. Items with an I‐CVI of 0·50–0·70 were revised for clarification and items with an I‐CVI <0·5 were discarded, except in instances where fulsome theoretical or empirical evidence supported their retention. Results 14 CGs completed interviews and 10 CGs with 4 expert nurses completed I‐CVI testing. Major interview themes included arranging appointments, medication adherence, monitoring, coordinating care, encouraging independence and taking action. A total of 36 items were constructed and underwent I‐CVI testing. Following I‐CVI testing, 27 items were retained, seven items were retained after revision based on CG feedback and two items were removed. This newly developed 34‐item questionnaire represents current literature, CGs’ experiences, excellent I‐CVI scores and ready for further psychometric testing.
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Affiliation(s)
- Karen Harkness
- School of Nursing McMaster University Hamilton ON Canada; Hamilton Health Sciences Hamilton ON Canada
| | - Harleah G Buck
- Schreyer Honors College Hartford Center of Geriatric Nursing Excellence College of Nursing The Pennsylvania State University PA USA
| | | | - Sandra Carroll
- School of Nursing McMaster University Hamilton ON Canada; Population Health Research Institute Hamilton ON Canada
| | - Tammy Cosman
- School of Nursing McMaster University Hamilton ON Canada; Hamilton Health Sciences Hamilton ON Canada
| | - Michael McGillion
- School of Nursing McMaster University Hamilton ON Canada; Population Health Research Institute Hamilton ON Canada; Cardiovascular Nursing Research Hamilton ON Canada
| | | | | | | | - Diana Sherifali
- School of Nursing McMaster University Hamilton ON Canada; Diabetes Care and Research Program Hamilton Health Sciences Hamilton ON Canada
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Sinnige J, Korevaar JC, Westert GP, Spreeuwenberg P, Schellevis FG, Braspenning JC. Multimorbidity patterns in a primary care population aged 55 years and over. Fam Pract 2015; 32:505-13. [PMID: 26040310 PMCID: PMC4576758 DOI: 10.1093/fampra/cmv037] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To support the management of multimorbid patients in primary care, evidence is needed on prevalent multimorbidity patterns. OBJECTIVE To identify the common and distinctive multimorbidity patterns. METHODS Clinical data of 120480 patients (≥55 years) were extracted from 158 general practices in 2002-11. Prevalence rates of multimorbidity were analyzed (overall, and for 24 chronic diseases), adjusted for practice, number of diseases and patients' registration period; differentiated between patients 55-69 and ≥70 years. To investigate multimorbidity patterns, prevalence ratios (prevalence rate index-disease group divided by that in the non-index-disease group) were calculated for patients with heart failure, diabetes mellitus, migraine or dementia. RESULTS Multiple membership multilevel models showed that the overall adjusted multimorbidity rate was 86% in patients with ≥1 chronic condition, varying from 70% (migraine) to 98% (heart failure), 38% had ≥4 chronic diseases. In patients 55-69 years, 83% had multimorbidity. Numerous significant prevalence ratios were found for disease patterns in heart failure patients, ranging from 1.2 to 7.7, highest ratio for chronic obstructive pulmonary disease-cardiac dysrhythmia. For diabetes mellitus, dementia or migraine patients highest ratios were for heart failure-visual disorder (2.1), heart failure-depression (3.9) and depression-back/neck disorder (2.1), respectively (all P-values<0.001). CONCLUSIONS Multimorbidity management in general practice can be reinforced by knowledge on the clinical implications of the presence of the comprehensive disease patterns among the elderly patients, and those between 55 and 69 years. Guideline developers should be aware of the complexity of multimorbidity. As a consequence of this complexity, it is even more important to focus on what matters to a patient with multimorbidity in general practice.
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Affiliation(s)
- Judith Sinnige
- NIVEL, Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, 6500 HB Nijmegen, The Netherlands, and
| | - Joke C Korevaar
- NIVEL, Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands
| | - Gert P Westert
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, 6500 HB Nijmegen, The Netherlands, and
| | - Peter Spreeuwenberg
- NIVEL, Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands
| | - François G Schellevis
- NIVEL, Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands, Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT Amsterdam, The Netherlands
| | - Jozé C Braspenning
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, 6500 HB Nijmegen, The Netherlands, and
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Jackevicius CA, de Leon NK, Lu L, Chang DS, Warner AL, Mody FV. Impact of a Multidisciplinary Heart Failure Post-hospitalization Program on Heart Failure Readmission Rates. Ann Pharmacother 2015; 49:1189-96. [PMID: 26259774 DOI: 10.1177/1060028015599637] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Specialized chronic heart failure (HF) clinics have demonstrated significant reductions in readmissions. Limited evidence is available regarding HF clinics in the immediate post-discharge period. OBJECTIVE To evaluate the effect of a multidisciplinary HF clinic on 90-day readmission rates and all-cause mortality in those recently discharged from a HF hospitalization. METHODS In this retrospective cohort study, patients discharged with a primary HF diagnosis who attended the HF postdischarge clinic in 2010-2012 were compared with controls from 2009. During 6 clinic visits, patients were seen by a physician assistant, clinical pharmacist specialist, and case manager, with care overseen by a cardiologist. The program focused on optimizing therapy, identifying HF etiology/precipitating factors, medication titration, education, and medication adherence. The primary outcome was 90-day HF readmission. A multivariate Cox proportional hazards model was used to compare outcomes. RESULTS Among the 277 patients (144 clinic, 133 control) in the study, 7.6% of patients in the clinic and 23.3% of patients in the control group were readmitted for HF within 90 days (aHR (adjusted hazard ratio) = 0.17; 95% CI = 0.07-0.41; P < 0.001; ARR (absolute risk reduction) = 15.7%; NNT (number needed to treat) = 7). Clinic patients had lower 90-day time-to-first HF readmission or all-cause mortality (9.0% vs 28.6%; aHR = 0.28; 95% CI = 0.06-0.31; P < 0.001; ARR = 19.6%; NNT = 6). CONCLUSIONS The multidisciplinary HF posthospitalization outpatient program was associated with a significant reduction in 90-day HF readmissions in patients who were recently discharged from a HF hospitalization.
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Affiliation(s)
- Cynthia A Jackevicius
- Western University of Health Sciences, Pomona, CA, USA VA Greater Los Angeles Healthcare System, CA, USA Institute for Clinical Evaluative Sciences, Toronto, ON, Canada University of Toronto, ON, Canada University Health Network, Toronto, ON, Canada
| | - Noelle K de Leon
- University of California, San Francisco Medical Center and School of Pharmacy, San Francisco, CA
| | - Lingyun Lu
- VA Greater Los Angeles Healthcare System, CA, USA California Northstate University College of Pharmacy, Elk Grove, CA
| | - Donald S Chang
- VA Greater Los Angeles Healthcare System, CA, USA University of California, Los Angeles, CA, USA
| | - Alberta L Warner
- VA Greater Los Angeles Healthcare System, CA, USA University of California, Los Angeles, CA, USA
| | - Freny Vaghaiwalla Mody
- VA Greater Los Angeles Healthcare System, CA, USA University of California, Los Angeles, CA, USA
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90
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Mishra A, Swati D. The recursive combination filter approach of pre-processing for the estimation of standard deviation of RR series. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2015; 38:413-23. [PMID: 26104469 DOI: 10.1007/s13246-015-0357-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/15/2015] [Indexed: 11/25/2022]
Abstract
Variation in the interval between the R-R peaks of the electrocardiogram represents the modulation of the cardiac oscillations by the autonomic nervous system. This variation is contaminated by anomalous signals called ectopic beats, artefacts or noise which mask the true behaviour of heart rate variability. In this paper, we have proposed a combination filter of recursive impulse rejection filter and recursive 20% filter, with recursive application and preference of replacement over removal of abnormal beats to improve the pre-processing of the inter-beat intervals. We have tested this novel recursive combinational method with median method replacement to estimate the standard deviation of normal to normal (SDNN) beat intervals of congestive heart failure (CHF) and normal sinus rhythm subjects. This work discusses the improvement in pre-processing over single use of impulse rejection filter and removal of abnormal beats for heart rate variability for the estimation of SDNN and Poncaré plot descriptors (SD1, SD2, and SD1/SD2) in detail. We have found the 22 ms value of SDNN and 36 ms value of SD2 descriptor of Poincaré plot as clinical indicators in discriminating the normal cases from CHF cases. The pre-processing is also useful in calculation of Lyapunov exponent which is a nonlinear index as Lyapunov exponents calculated after proposed pre-processing modified in a way that it start following the notion of less complex behaviour of diseased states.
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Affiliation(s)
- Alok Mishra
- Department of Physics, Faculty of Science, Banaras Hindu University, Varanasi, 221 005, India.
| | - D Swati
- Department of Physics and Bioinformatics, MMV, Banaras Hindu University, Varanasi, 221 005, India.
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91
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Liu C, Hou Y, Wang X, Zhao Z, Liu Z, Zhai J, Mao J, Shang H. Clinical assessment of Shenfu injection loading in the treatment of patients with exacerbation of chronic heart failure due to coronary heart disease: study protocol for a randomized controlled trial. Trials 2015; 16:222. [PMID: 25994188 PMCID: PMC4446800 DOI: 10.1186/s13063-015-0729-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/23/2015] [Indexed: 11/16/2022] Open
Abstract
Background Acute exacerbation is a common cause of hospitalization in patients with chronic heart failure, and coronary heart disease is the most common cause. Shenfu injection, a Traditional Chinese Medicine injection, widely used in the adjuvant treatment of patients with acute exacerbation of chronic heart failure, shows some treatment effect in improving the symptoms and the quality of life, but it lacks the rigorous clinical evaluation of research reports. This paper describes the protocol for the clinical assessment of Shenfu injection loading in the treatment of patients with acute exacerbation of chronic heart failure. Methods This protocol adopts the design of a prospective, randomized, multicenter, blind imitation, placebo-controlled trial to assess the efficacy and safety of Shenfu injection loading in the treatment of patients with acute exacerbation of chronic heart failure due to coronary heart disease. The research will be carried out in 12 hospitals in China and is expected to enroll 160 inpatients with acute exacerbation of chronic heart failure due to coronary heart disease (yang and qi deficiency syndrome). On the basis of the conventional therapy of western medicine, patients will be randomized to either the treatment group (100 ml 5% glucose injection + 50 ml Shenfu injection) or the control group (150 ml 5% glucose injection) for 7 ± 1 days and follow-up for 28 ± 3 days. The primary outcomes are New York Heart Association cardiac function classification and Traditional Chinese Medicine syndromes. The secondary outcomes are left ventricular ejection fraction, brain natriuretic peptide level, Lee’s heart failure score, 6-minute walking distance, and the incidence and readmission rate of cardiovascular events (including the emergency rate due to acute exacerbation of chronic heart failure). Discussion This trial will assess the effect of loading Shenfu injection in the treatment of patients with acute exacerbation of chronic heart failure caused by coronary heart disease (yang-qi deficiency syndrome) on the symptoms and signs of heart failure, exercise tolerance, and other aspects, and observe its influence on the short-term prognosis with follow-up. The results of the study will provide clinical research evidence for application of Shenfu injection in the treatment. Trial registration This trial was registered on 26 December 2012 at the Chinese Clinical Trials Register (Identifier: ChiCTR-TRC-12002857). Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0729-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chunxiang Liu
- Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine, 312 Anshan Western Road, Nankai District, Tianjin, 300193, China.
| | - Yazhu Hou
- Cardiovascular Department of The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 314 Anshan Western Road, Tianjin, Nankai District, Tianjin, 300193, China. .,Tianjin University of Traditional Chinese Medicine, 312 Anshan Western Road, Nankai District, Tianjin, 300193, China.
| | - Xianliang Wang
- Cardiovascular Department of The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 314 Anshan Western Road, Tianjin, Nankai District, Tianjin, 300193, China.
| | - Zhiqiang Zhao
- Cardiovascular Department of The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 314 Anshan Western Road, Tianjin, Nankai District, Tianjin, 300193, China.
| | - Zhi Liu
- Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine, 312 Anshan Western Road, Nankai District, Tianjin, 300193, China.
| | - Jingbo Zhai
- Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine, 312 Anshan Western Road, Nankai District, Tianjin, 300193, China.
| | - Jingyuan Mao
- Cardiovascular Department of The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 314 Anshan Western Road, Tianjin, Nankai District, Tianjin, 300193, China.
| | - Hongcai Shang
- Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine, 312 Anshan Western Road, Nankai District, Tianjin, 300193, China. .,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
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92
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Nurse-Enhanced Computerized Cognitive Training Increases Serum Brain-Derived Neurotropic Factor Levels and Improves Working Memory in Heart Failure. J Card Fail 2015; 21:630-41. [PMID: 25982826 DOI: 10.1016/j.cardfail.2015.05.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/27/2015] [Accepted: 05/07/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Memory loss is common in heart failure (HF) patients, but few interventions have been tested to treat it. The objective of this study was to evaluate efficacy of a cognitive training intervention, Brain Fitness, to improve memory, serum brain-derived neurotropic factor (BDNF) levels, working memory, processing speed, executive function, instrumental activities of daily living, mobility, depressive symptoms, and health-related quality of life. METHODS AND RESULTS Twenty-seven HF patients were randomly assigned to Brain Fitness and health education active control interventions. Data were collected at baseline and 8 and 12 weeks. Linear mixed models analyses were completed. Patients in the Brain Fitness group were older with lower ejection fraction. At 12 weeks, a group by time interaction effect was found for serum BDNF levels (P = .011): serum BDNF levels increased among patients who completed Brain Fitness and decreased among patients who completed health education. No differences were found in memory, but a group by time interaction (P = .046) effect was found for working memory. CONCLUSIONS Findings support efficacy of Brain Fitness in improving working memory and serum BDNF levels as a biomarker of intervention response. A randomized controlled study is needed among a larger more diverse group of HF patients.
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93
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Development and Testing of the Feasibility and Acceptability of a Tailored Dietary Intervention in Patients With Heart Failure. J Cardiovasc Nurs 2015; 30:213-21. [DOI: 10.1097/jcn.0000000000000148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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94
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Berezin AE, Kremzer AA, Samura TA, Martovitskaya YV, Malinovskiy YV, Oleshko SV, Berezina TA. Predictive value of apoptotic microparticles to mononuclear progenitor cells ratio in advanced chronic heart failure patients. J Cardiol 2015; 65:403-11. [PMID: 25123603 DOI: 10.1016/j.jjcc.2014.06.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 10/24/2022]
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95
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Basuray A, Dolansky M, Josephson R, Sattar A, Grady EM, Vehovec A, Gunstad J, Redle J, Fang J, Hughes JW. Dietary sodium adherence is poor in chronic heart failure patients. J Card Fail 2015; 21:323-9. [PMID: 25576680 PMCID: PMC4395528 DOI: 10.1016/j.cardfail.2014.12.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 12/11/2014] [Accepted: 12/29/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND We sought to determine the rates and predictors of dietary sodium restriction and to evaluate the reliability of 24-hour urine collection as a tool to estimate dietary sodium intake in heart failure (HF) patients. METHODS AND RESULTS We evaluated the 24-hour urinary sodium excretion of 305 outpatients with HF and reduced ejection fraction who were educated on following a <2 g sodium diet. The mean sodium excretion according to a single sample from each participant was 3.15 ± 1.58 g, and 23% were adherent to the <2 g recommendation. One hundred sixty-eight participants provided 2 samples with urinary creatinine excretion within normative range. Averaging both resulted in a mean sodium excretion of 3.21 ± 1.20 g and lower adherence rates to the <2-gram diet: 14% versus 23% (P = .019). Multivariate logistic regression showed only male sex and higher body mass index (BMI) to be associated with nonadherence (male: odds ratio [OR] 2.20, 95% confidence interval [CI] 1.25-3.88; 1 unit BMI: OR 1.05, 95% CI 1.01-1.10). Bland-Altman plots of urinary sodium and creatinine showed poor reproducibility between samples. CONCLUSIONS In this chronic HF population, sodium consumption probably exceeds recommended amounts, particularly in men and those with higher BMI. Urine analyses were not highly reproducible, suggesting variation in both diet and urine collection.
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Affiliation(s)
- Anupam Basuray
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio.
| | - Mary Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Richard Josephson
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Abdus Sattar
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ellen M Grady
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Anton Vehovec
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, Ohio
| | - Joseph Redle
- Summa Health System, Akron City Hospital, Akron, Ohio
| | - James Fang
- Division of Cardiology, Department of Internal Medicine, University Hospital, Salt Lake City, Utah
| | - Joel W Hughes
- Department of Psychology, Kent State University, Kent, Ohio
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Fleg JL, Cooper LS, Borlaug BA, Haykowsky MJ, Kraus WE, Levine BD, Pfeffer MA, Piña IL, Poole DC, Reeves GR, Whellan DJ, Kitzman DW. Exercise training as therapy for heart failure: current status and future directions. Circ Heart Fail 2015; 8:209-20. [PMID: 25605639 DOI: 10.1161/circheartfailure.113.001420] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jerome L Fleg
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
| | - Lawton S Cooper
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Barry A Borlaug
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Mark J Haykowsky
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - William E Kraus
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Benjamin D Levine
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Marc A Pfeffer
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Ileana L Piña
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - David C Poole
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Gordon R Reeves
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - David J Whellan
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Dalane W Kitzman
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
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Heo S, Moser DK, Pressler SJ, Dunbar SB, Mudd-Martin G, Lennie TA. Psychometric properties of the Symptom Status Questionnaire-Heart Failure. J Cardiovasc Nurs 2015; 30:136-44. [PMID: 24598550 PMCID: PMC4391745 DOI: 10.1097/jcn.0000000000000102] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Many patients with heart failure (HF) experience physical symptoms, poor health-related quality of life (HRQOL), and high rates of hospitalization. Physical symptoms are associated with HRQOL and are major antecedents of hospitalization. However, reliable and valid physical symptom instruments have not been established. Therefore, this study examined the psychometric properties of the Symptom Status Questionnaire-Heart Failure (SSQ-HF) in patients with HF. METHOD Data on symptoms using the SSQ-HF were collected from 249 patients (aged 61 years, 67% male, 45% in New York Heart Association functional class III/IV). Internal consistency reliability was assessed using Cronbach's α. Item homogeneity was assessed using item-total and interitem correlations. Construct validity was assessed using factor analysis and testing hypotheses on known relationships. Data on depressive symptoms (Beck Depression Inventory II), HRQOL (Minnesota Living With Heart Failure Questionnaire), and event-free survival were collected to test known relationships. RESULTS Internal consistency reliability was supported: Cronbach's α was .80. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Factor analysis supported the construct validity of the instrument. More severe symptoms were associated with more depressive symptoms, poorer HRQOL, and more risk for hospitalization, emergency department visit, or death, controlling for covariates. CONCLUSIONS The findings of this study support the reliability and validity of the SSQ-HF. Clinicians and researchers can use this instrument to assess physical symptoms in patients with HF.
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Affiliation(s)
- Seongkum Heo
- Seongkum Heo, PhD, RN Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences, Little Rock Debra K. Moser, DNSc, RN, FAAN Professor and Gill Chair of Nursing, College of Nursing, University of Kentucky, Lexington. Susan J. Pressler, PhD, RN Professor, School of Nursing, University of Michigan, Ann Arbor Sandra B. Dunbar, DSN, RN Professor, School of Nursing, Emory University, Atlanta, Georgia Gia Mudd-Martin, PhD, RN Assistant Professor, College of Nursing, University of Kentucky, Lexington Terry A. Lennie, PhD, RN Professor, University of Kentucky, College of Nursing, Lexington
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Leung AW, Chan CY, Yan BP, Yu CM, Lam YY, Lee VW. Management of heart failure with preserved ejection fraction in a local public hospital in Hong Kong. BMC Cardiovasc Disord 2015; 15:12. [PMID: 25887230 PMCID: PMC4364510 DOI: 10.1186/s12872-015-0002-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/05/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Heart failure (HF) is one of the most debilitating chronic illnesses. The prevalence is expected to increase due to aging population. The current study aimed to examine the management of heart failure with preserved ejection fraction (HFpEF) including drug use pattern, direct medical cost and humanistic outcome in a local public hospital in Hong Kong. METHODS The current study adopted the retrospective observational study design. Subjects were recruited from the Heart Failure Registry of the Prince of Wales Hospital in Hong Kong between 2006 and 2008 and completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at 3 designated time-points conferred eligibility. Patients with significant valvular disorder were excluded. Each patient's medical record was reviewed for 12 months after the date of admission. Heart failure related admissions, clinic visits, cardiovascular drugs, laboratory tests and diagnostic tests were documented. Costs and MLHFQ scores in patients with or without hypertension, diabetes and renal impairment were compared. RESULTS A total of 73 HFpEF patients were included. It was found that loop diuretics (93.1%, 78.1%) was the most frequently used agent for HFpEF management in both in-patient and out-patient settings. The mean 1-year direct medical cost was USD$ 19969 (1 US $ = 7.8 HK$), with in-patient ward care contributing to the largest proportion (72.2%) of the total cost. Patients with diabetes or renal impairment were associated with a higher cost of HFpEF management. Significant difference was found in the renal impairment group (median cost: USD$ 24604.2 versus USD$ 12706.8 in no impairment group, p = 0.023). The MLHFQ scores of the subjects improved significantly during the study period (p < 0.0005). CONCLUSIONS The cost of management of HFpEF was enormous and further increased in the presence of comorbidities.
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Affiliation(s)
- Angel W Leung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Cherise Y Chan
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Cheuk Man Yu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Yat Yin Lam
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Vivian W Lee
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Marcuccilli L, Casida JJ, Bakas T, Pagani FD. Family caregivers' inside perspectives: caring for an adult with a left ventricular assist device as a destination therapy. Prog Transplant 2015; 24:332-40. [PMID: 25488555 DOI: 10.7182/pit2014684] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Understanding the experience of caring for an adult with a left-ventricular assist device as a destination therapy (LVAD-DT) remains in its infancy. OBJECTIVE/DESIGN A hermeneutic-phenomenological inquiry guided by van Manen's methods was used to explore the LVAD-DT family caregiving experience.Participants/Setting-Seven family caregivers (1 man and 6 women) 50 to 74 years old who cared for an adult with an LVAD-DT in home settings. Recruitment and data collection occurred in an outpatient mechanical circulatory support center in the Midwest. METHODS Data were collected by means of face-to-face interviews using open-ended questions and 1 follow-up interview. Interviews were audio recorded and transcribed verbatim. Thematic analysis consisted of writing, rewriting, and reflecting across participants' data, which produced themes illustrating the experience and meaning of caring for an adult with an LVAD-DT. Themes were consensually validated. Procedures for trustworthiness are described. RESULTS Five main themes were identified from participants' experiences: (1) advanced heart failure is a life-changing event, (2) self-doubt about LVAD caregiving improves over time, (3) lifestyle adjustments come with time, (4) persistent worry and stress, and (5) caregiving is not a burden-it's a part of life. These main themes were elucidated by 8 subthemes in which participants described a process of adjustment despite persistent worry and stress and eventually accepted caregiving as part of their lives. Future studies are needed to explore caregiver burden, adaptation, and the effects of caregiving outcomes, such as emotional and physical health and overall quality of life.
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