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Tušek-Bunc K, Petek D. Comorbidities and characteristics of coronary heart disease patients: their impact on health-related quality of life. Health Qual Life Outcomes 2016; 14:159. [PMID: 27846850 PMCID: PMC5111348 DOI: 10.1186/s12955-016-0560-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with coronary heart disease (CHD) commonly present with more than one comorbid condition, contributing to poorer health-related quality of life (HRQoL). The aim of our study was to identify the associations between HRQoL and patient characteristics, vascular comorbidities and anxiety/depression disorders. METHODS This observational study was conducted in 36 family medicine practices selected by random stratified sampling from all regions of Slovenia. HRQoL was assessed using the European Quality of Life - 5 Dimensions (EQ-5D) questionnaire and EQ Visual Analogue Scale (EQ-VAS). The associations between HRQoL and patient characteristics stratified by demographics, vascular comorbidities, health services used, their assessment of chronic illness care, and anxiety/depression disorders were identified by ordinal logistic regression and linear regression models. RESULTS The final sample included 423 CHD patients with a mean age of 68.0 ± SD 10.8 years; 35.2% were female. Mean EQ-VAS score was 58.6 ± SD 19.9 (median: 60 with interquartile range of 45-75), and mean EQ-5D index was 0.60 ± SD 0.19 (median: 0.56 with interquartile range of 0.41-0.76). The statistically significant predictors of a lower EQ-VAS score were higher family physician visit frequency, heart failure (HF) and anxiety/depression disorders (R² 0.240; F = 17.368; p < 0.001). The statistically significant predictor of better HRQoL, according to EQ-5D was higher patient education, whereas higher family physician visit frequency, HF and peripheral artery disease (PAD) were predictors of poorer HRQoL (Nagelkerke R 2 = 0.298; χ 2 = 148.151; p < 0.001). CONCLUSIONS Results of our study reveal that comorbid conditions (HF and PAD), family physician visit frequency and years in education are significant predictors of HRQoL in Slovenian CHD patients.
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Affiliation(s)
- Ksenija Tušek-Bunc
- Faculty of Medicine, University of Maribor, Taborska ulica 8, SI 2000 Maribor, Slovenia
- Dr. Adolf Drolc Health Centre Maribor, Ul. talcev 9, SI 2000 Maribor, Slovenia
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI 1104 Ljubljana, Slovenia
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Rørth R, Wong C, Kragholm K, Fosbøl EL, Mogensen UM, Lamberts M, Petrie MC, Jhund PS, Gerds TA, Torp-Pedersen C, Gislason GH, McMurray JJ, Køber L, Kristensen SL. Return to the Workforce After First Hospitalization for Heart Failure. Circulation 2016; 134:999-1009. [DOI: 10.1161/circulationaha.116.021859] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/18/2016] [Indexed: 11/16/2022]
Abstract
Background:
Return to work is important financially, as a marker of functional status and for self-esteem in patients developing chronic illness. We examined return to work after first heart failure (HF) hospitalization.
Methods:
By individual-level linkage of nationwide Danish registries, we identified 21 455 patients of working age (18–60 years) with a first HF hospitalization in the period from 1997 to 2012. Of these patients, 11 880 (55%) were in the workforce before HF hospitalization and comprised the study population. We applied logistic regression to estimate odds ratios for associations between age, sex, length of hospital stay, level of education, income, comorbidity, and return to work.
Results:
One year after first HF hospitalization, 8040 (67.7%) returned to the workforce, 2981 (25.1%) did not, 805 (6.7%) died, and 54 (0.5%) emigrated. Predictors of return to work included younger age (18–30 versus 51–60 years; odds ratio [OR], 3.12; 95% confidence interval [CI], 2.42–4.03), male sex (OR, 1.22; 95% CI, 1.12–1.34), and level of education (long-higher versus basic school; OR, 2.06; 95% CI, 1.63–2.60). Conversely, hospital stay >7 days (OR, 0.56; 95% CI, 0.51–0.62) and comorbidity including history of stroke (OR, 0.55; 95% CI, 0.45–0.69), chronic kidney disease (OR, 0.46; 95% CI, 0.36–0.59), chronic obstructive pulmonary disease (OR, 0.62; 95% CI, 0.52–0.75), diabetes mellitus (OR 0.76; 95% CI, 0.68–0.85), and cancer (OR, 0.49; 95% CI, 0.40–0.61) were all significantly associated with lower chance of return to work.
Conclusions:
Patients in the workforce before HF hospitalization had low mortality but high risk of detachment from the workforce 1 year later. Young age, male sex, and a higher level of education were predictors of return to work.
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Affiliation(s)
- Rasmus Rørth
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Chih Wong
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Kristian Kragholm
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Emil L. Fosbøl
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Ulrik M. Mogensen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Morten Lamberts
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Mark C. Petrie
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Pardeep S. Jhund
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Thomas A. Gerds
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Christian Torp-Pedersen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Gunnar H. Gislason
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - John J.V. McMurray
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Lars Køber
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Søren L. Kristensen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
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Depuydt P, Oeyen S, De Smet S, De Raedt S, Benoit D, Decruyenaere J, Derom E. Long-term outcome and health-related quality of life in difficult-to-wean patients with and without ventilator dependency at ICU discharge: a retrospective cohort study. BMC Pulm Med 2016; 16:133. [PMID: 27677445 PMCID: PMC5039890 DOI: 10.1186/s12890-016-0295-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 06/24/2016] [Indexed: 11/16/2022] Open
Abstract
Background Long-term outcome and quality of life (QOL) in patients requiring prolonged mechanical ventilation after failure to wean in the ICU is scarcely documented. We aimed to evaluate long-term survival and QOL in patients discharged from the ICU with a tracheostomy for difficult weaning, and with or without ventilator dependency at ICU discharge. Methods We retrospectively investigated post-ICU trajectories and survival in patients requiring tracheostomy for difficult weaning admitted to the medical ICU of a tertiary center between 1999 and 2013, discriminating between patients who were ventilator dependent or were weaned at ICU discharge. In 2014, a QOL assessment was done in survivors with the use of the Short Form Health Survey (SF-36) and the Severe Respiratory Insufficiency questionnaire. Results A total of 114 patients was included, of whom 59 were ventilator dependent and 55 were weaned at ICU discharge. One-year survival rates were 73 % and 69 %, respectively. Overall QOL scores for physical functioning were low, and not significantly different between patients ventilated and those weaned at ICU discharge; scores for social functioning and mental health were less below norm and similar between both groups. Conclusions Long-term survival in patients discharged from the ICU with tracheostomy and ventilator dependency after failure to wean was not significantly different from that of patients with tracheostomy and weaned at ICU discharge. Despite the physical QOL scores being low in both groups, mental QOL was acceptable. Given the intrinsic limitations of this retrospective study, prospective and preferentially multicenter studies are required to confirm these preliminary results.
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Affiliation(s)
- P Depuydt
- Intensive Care Department, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium. .,Heymans Institute of Pharmacology, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
| | - S Oeyen
- Intensive Care Department, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - S De Smet
- Ghent University, Sint-Pietersnieuwstraat 10, Ghent, 9000, Belgium
| | - S De Raedt
- Ghent University, Sint-Pietersnieuwstraat 10, Ghent, 9000, Belgium
| | - D Benoit
- Intensive Care Department, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - J Decruyenaere
- Intensive Care Department, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - E Derom
- Department of Respiratory Diseases, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
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Sedmera D, Neckar J, Benes J, Pospisilova J, Petrak J, Sedlacek K, Melenovsky V. Changes in Myocardial Composition and Conduction Properties in Rat Heart Failure Model Induced by Chronic Volume Overload. Front Physiol 2016; 7:367. [PMID: 27610087 PMCID: PMC4997968 DOI: 10.3389/fphys.2016.00367] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/09/2016] [Indexed: 11/13/2022] Open
Abstract
Volume overload leads to development of eccentric cardiac hypertrophy and heart failure. In our previous report, we have shown myocyte hypertrophy with no fibrosis and decrease in gap junctional coupling via connexin43 in a rat model of aorto-caval fistula at 21 weeks. Here we set to analyze the electrophysiological and protein expression changes in the left ventricle and correlate them with phenotypic severity based upon ventricles to body weight ratio. ECG analysis showed increased amplitude and duration of the P wave, prolongation of PR and QRS interval, ST segment elevation and decreased T wave amplitude in the fistula group. Optical mapping showed a prolongation of action potential duration in the hypertrophied hearts. Minimal conduction velocity (CV) showed a bell-shaped curve, with a significant increase in the mild cases and there was a negative correlation of both minimal and maximal CV with heart to body weight ratio. Since the CV is influenced by gap junctional coupling as well as the autonomic nervous system, we measured the amounts of tyrosine hydroxylase (TH) and choline acetyl transferase (ChAT) as a proxy for sympathetic and parasympathetic innervation, respectively. At the protein level, we confirmed a significant decrease in total and phosphorylated connexin43 that was proportional to the level of hypertrophy, and similarly decreased levels of TH and ChAT. Even at a single time-point, severity of morphological phenotype correlates with progression of molecular and electrophysiological changes, with the most hypertrophied hearts showing the most severe changes that might be related to arrhythmogenesis.
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Affiliation(s)
- David Sedmera
- Institute of Physiology, Czech Academy of SciencesPrague, Czech Republic; First Faculty of Medicine, Institute of Anatomy, Charles University in PraguePrague, Czech Republic
| | - Jan Neckar
- Institute of Physiology, Czech Academy of SciencesPrague, Czech Republic; Institute of Clinical and Experimental MedicinePrague, Czech Republic
| | - Jiri Benes
- Institute of Physiology, Czech Academy of SciencesPrague, Czech Republic; First Faculty of Medicine, Institute of Anatomy, Charles University in PraguePrague, Czech Republic; Department of Radiology, First Faculty of Medicine, Charles University in PraguePrague, Czech Republic
| | - Jana Pospisilova
- First Faculty of Medicine, Institute of Pathological Physiology, Charles University in Prague Prague, Czech Republic
| | - Jiri Petrak
- First Faculty of Medicine, Biotechnology and Biomedicine Center of the Academy of Sciences and Charles University in Vestec Vestec, Czech Republic
| | - Kamil Sedlacek
- Institute of Clinical and Experimental Medicine Prague, Czech Republic
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van Riet EE, Hoes AW, Limburg A, Landman MA, Zuithoff PN, Rutten FH. Effect of training general practitioners in drug treatment of newly detected heart failure patients with reduced or preserved ejection fraction: A cluster randomized trial. Int J Cardiol 2016; 217:174-82. [DOI: 10.1016/j.ijcard.2016.04.171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 01/01/2023]
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106
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Johansson P, Dahlström U, Broström A. Factors and Interventions Influencing Health-Related Quality of Life in Patients with Heart Failure: A Review of the Literature. Eur J Cardiovasc Nurs 2016; 5:5-15. [PMID: 15967727 DOI: 10.1016/j.ejcnurse.2005.04.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2004] [Revised: 04/25/2005] [Accepted: 04/28/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Because of the lack of a cure for patients with chronic heart failure (HF), there has been a progressive interest in the use of health-related quality of life (Hr-QoL) as complementary end-point to mortality and morbidity. AIM The aim of this review was from a nursing perspective to describe Hr-QoL and the influencing factors of Hr-QoL, as well as to identify interventions aimed at influencing Hr-QoL in HF patients. METHOD Medline, Cinahl and PsycInfo databases were searched from 1995 to 2004. A total of 58 papers were included. RESULTS HF symptoms and activity status influence Hr-QoL negatively. However, several individual characteristics such as personality, gender and age must also be taken into consideration because different values might exist regarding what constitutes a good Hr-QoL. Nurse led interventions based on education, support and exercise can influence Hr-QoL positively. There is also a need of more studies about the effects of depression, sleep disturbances, support as well as education on Hr-QoL. There is also a need of exercise studies with larger sample sizes and older patients in higher NYHA classes. CONCLUSION Several individual factors impact Hr-QoL, therefore, must nursing interventions are individually adapted to the patient's resources.
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Affiliation(s)
- Peter Johansson
- Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden.
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107
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Pattenden JF, Roberts H, Lewin RJP. Living with Heart Failure; Patient and Carer Perspectives. Eur J Cardiovasc Nurs 2016; 6:273-9. [PMID: 17383236 DOI: 10.1016/j.ejcnurse.2007.01.097] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 01/17/2007] [Accepted: 01/29/2007] [Indexed: 11/26/2022]
Abstract
Patients with heart failure have multiple readmissions to hospital, a poor prognosis and varying quality of life. This paper explores how patients with heart failure and their family carers cope with daily life. 36 patients and 20 family caregivers were interviewed in five centres in the UK. Analysis showed that living with heart failure can be frightening, restrictive and distressing for both patients and their family carers. Patients found most difficulty coping with functional limitation and adapting to living with heart failure, but also reported particular problems due to side effects of medications, co-morbidities and a lack of psychosocial support and rehabilitation services. Those with less socio-economic resources found it harder to cope. Patients from minority ethnic groups held different beliefs about the illness and its treatment, and some had profound problems communicating with health and social care professionals that made managing the disease even more difficult. Caring for a person with heart failure often has a considerable impact on the psychological and physical health of family caregivers. Psychosocial support and rehabilitation services provided at diagnosis and after an acute episode would enable families to better manage living with this syndrome.
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Affiliation(s)
- J F Pattenden
- British Heart Foundation Care and Education Research Group, Department of Health Sciences, Seebohm Rowntree Building Area 4, University of York, York YO10 5DD, England, United Kingdom.
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108
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Franzén K, Saveman BI, Blomqvist K. Predictors for Health Related Quality of Life in Persons 65 Years or Older with Chronic Heart Failure. Eur J Cardiovasc Nurs 2016; 6:112-20. [PMID: 16859996 DOI: 10.1016/j.ejcnurse.2006.06.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 05/11/2006] [Accepted: 06/15/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND A main goal in nursing care of persons with chronic heart failure (HF) is to strengthen their health related quality of life (HRQoL). This presupposes knowledge about the relation between heart failure and HRQoL. Existing studies have shown incongruent results about whether HRQoL is affected differently depending on age or sex of elderly persons with chronic HF. AIM This study aimed to investigate if age, sex, disease severity, comorbidity and living conditions predict health related quality of life among persons 65 years or older with chronic HF. METHODS The study included a sample of 357 persons. HRQoL was measured by the Minnesota Living with Heart Failure Questionnaire and the Short Form-12 Health Survey Questionnaire. Multiple regression analyses were performed to analyse the relation between the predictors and HRQoL. RESULTS The main finding was that self-rated disease severity was strongly associated with HRQoL, but also age, sex, diabetes and respiratory diseases was associated with some of the dimensions of HRQoL. CONCLUSIONS Interventions aimed at delaying the progress of the disease, assist persons' to cope with the disease and maintain the domains of HRQoL that are still feasible could be important to improve HRQoL in elderly persons with chronic HF.
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Affiliation(s)
- Kristofer Franzén
- Department of Nursing, Faculty of Medicine, Lund University, P.O. BOX 157, SE-221 00 Lund, Sweden.
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Myocardial Viability: From Proof of Concept to Clinical Practice. Cardiol Res Pract 2016; 2016:1020818. [PMID: 27313943 PMCID: PMC4903128 DOI: 10.1155/2016/1020818] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/04/2016] [Indexed: 11/20/2022] Open
Abstract
Ischaemic left ventricular (LV) dysfunction can arise from myocardial stunning, hibernation, or necrosis. Imaging modalities have become front-line methods in the assessment of viable myocardial tissue, with the aim to stratify patients into optimal treatment pathways. Initial studies, although favorable, lacked sufficient power and sample size to provide conclusive outcomes of viability assessment. Recent trials, including the STICH and HEART studies, have failed to confer prognostic benefits of revascularisation therapy over standard medical management in ischaemic cardiomyopathy. In lieu of these recent findings, assessment of myocardial viability therefore should not be the sole factor for therapy choice. Optimization of medical therapy is paramount, and physicians should feel comfortable in deferring coronary revascularisation in patients with coronary artery disease with reduced LV systolic function. Newer trials are currently underway and will hopefully provide a more complete understanding of the pathos and management of ischaemic cardiomyopathy.
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Abstract
Advancements in paediatric heart failure management have resulted in improved survival and a focus on long-term outcomes including health-related quality of life. We compared health-related quality of life in children with heart failure with healthy patients, children with chronic conditions, and children with cardiovascular disease. Families (n=63) and children (n=73) aged 2-20 years with heart failure were enrolled and compared with data previously published for healthy patients (n=5480), those with chronic conditions (n=247), and those with cardiovascular disease (n=347). Patients and parents completed the PedsQL 4.0 and the Cardiac 3.0 Module health-related quality-of-life questionnaires. PedsQL scores including Total, Psychosocial Health Summary, and Physical were compared between groups. In general, patients with heart failure had lower scores than the healthy population (p=0.001), and comparable scores with those with chronic conditions. Parents perceived no difference in physical scores for children with heart failure when compared with healthy children, and perceived higher scores for children with heart failure when compared with those with chronic conditions (p⩽0.003). Furthermore, children with heart failure had decremental health-related quality-of-life scores as the American Heart Association stage of heart failure increased, such that patients with stage C heart failure had scores similar to children with severe cardiovascular disease. Children with heart failure reported significantly impaired health-related quality of life compared with healthy children and similar scores compared with children with chronic conditions. Parental perceptions appear to underestimate these impairments. Children with heart failure appear to have progressive impairment of health-related quality of life with advancing stage of heart failure.
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Jamil HA, Gierula J, Paton MF, Byrom R, Lowry JE, Cubbon RM, Cairns DA, Kearney MT, Witte KK. Chronotropic Incompetence Does Not Limit Exercise Capacity in Chronic Heart Failure. J Am Coll Cardiol 2016; 67:1885-96. [DOI: 10.1016/j.jacc.2016.02.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/27/2022]
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Karlström P, Johansson P, Dahlström U, Boman K, Alehagen U. Can BNP-guided therapy improve health-related quality of life, and do responders to BNP-guided heart failure treatment have improved health-related quality of life? Results from the UPSTEP study. BMC Cardiovasc Disord 2016; 16:39. [PMID: 26905220 PMCID: PMC4763442 DOI: 10.1186/s12872-016-0221-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/09/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To investigate whether B-type natriuretic peptide (NP)-guided treatment of heart failure (HF) patients improved their health related quality of life (Hr-QoL) compared to routine HF treatment, and whether changes in Hr-QoL differed depending on whether the patient was a responder to NP-guided therapy or not. METHODS A secondary analysis of the UPSTEP-study, a Scandinavian multicentre study using a prospective, randomized, open, blinded evaluation design on patients with HF with New York Heart Association (NYHA) class II-IV. NP-guiding was aimed to reduce BNP <150 ng/L if < 75 years or BNP < 300 ng/L if > 75 years. A responder was defined as a patient with a BNP < 300 ng/L and/or a decrease in BNP of at least 40% in week 16 compared to study start. Short form-36 (SF-36) was used to measure Hr-QoL. At the study start, 258 patients presented evaluable SF-36 questionnaires, 131 in the BNP group and 127 in the control group. At the study end 100 patients in the NP-guided group and 98 in the control group, presenting data from both the study start and the study end. RESULTS There were no significant differences in Hr-QoL between NP-guided HF treatment and control group; however significant improvements could be seen in four of the eight domains in the NP-guided group, whereas in the control group improvements could be seen in six of the domains. Among the responders improvements could be noted in four domains whereas in the non-responders improvements could be seen in only one domain evaluating within group changes. CONCLUSIONS Improved Hr-QoL could be demonstrated in several of the domains in both the NP-guided and the control group. In the responder group within group analyses showed more increased Hr-QoL compared to the non-responder group. However, all groups demonstrated increase in Hr-QoL.
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Affiliation(s)
- Patric Karlström
- Department of Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
| | - Peter Johansson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kurt Boman
- Research unit Skellefteå Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Urban Alehagen
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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113
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Joyce E, Chung C, Badloe S, Odutayo K, Desai A, Givertz MM, Nohria A, Lakdawala NK, Stewart GC, Young M, Weintraub J, Stevenson LW, Lewis EF. Variable Contribution of Heart Failure to Quality of Life in Ambulatory Heart Failure With Reduced, Better, or Preserved Ejection Fraction. JACC-HEART FAILURE 2016; 4:184-93. [PMID: 26874379 DOI: 10.1016/j.jchf.2015.12.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/30/2015] [Accepted: 12/09/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The relative contribution of heart failure (HF) compared with other medical and nonmedical factors on diminished quality of life (QOL) across subtypes with reduced, better, and preserved left ventricular ejection fraction (LVEF) in a large ambulatory HF population was evaluated. BACKGROUND Dominant factors influencing limited QOL in patients with HF have not been investigated. METHODS Before routine HF clinic visits, 726 patients with ambulatory HF (mean age 56 ± 15 years, 37% women) completed a 1-page questionnaire that assessed QOL and relative contributions of HF compared with other medical and nonmedical factors to their QOL limitations. Visual analogue scales were used to assess overall QOL, breathing, and energy level. Results were compared across reduced (57%), preserved (16%) and better (improvement in LVEF ≥50%) (19%) subtypes. RESULTS Just under one-half of patients (48%) rated QOL as limited dominantly by HF, 19% rated HF and medical problems as equally limiting, 18% cited medical problems as dominant, and 15% cited nonmedical factors. Patients with HF with better LVEF had the highest overall QOL score and less dyspnea burden than those with HF with preserved EF. Independent correlates of HF-dominated diminished QOL were prior cardiac surgery, worse New York Heart Association functional class, renin-angiotensin-aldosterone antagonism, use of diuretic agents, lower body mass index, lower LVEF, and lack of arthritis or history of cancer. CONCLUSIONS Fewer than one-half of patients with ambulatory HF rated HF as the greatest limitation to their QOL, suggesting that this important outcome will be difficult to affect by HF-targeted therapies alone, particularly in those with higher LVEFs and comorbidities. Patients with HF with better LVEF represent a distinct subtype with better overall QOL.
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Affiliation(s)
- Emer Joyce
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Christine Chung
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Sabrina Badloe
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Kayode Odutayo
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Akshay Desai
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Michael M Givertz
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Anju Nohria
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Neal K Lakdawala
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Garrick C Stewart
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Michelle Young
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Joanne Weintraub
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Lynne W Stevenson
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Eldrin F Lewis
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts.
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Louredo ABD, Leite ALC, Salerno GRF, Fernandes M, Blascovi-Assis S. Instruments to assess quality of life in patients with heart failure. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.004.ar03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction : Heart failure (HF) is a complex clinical syndrome representing the common final pathway of various heart diseases. It is characterized by low exercise tolerance, low survival rates and deteriorated quality of life. Several studies mention Quality of Life (QoL) as an important source of information on how disease truly affects patient's lives. In this context, the assessment of QoL is extremely important to provide data that support the choice of a therapeutic strategy and the assessment of the effectiveness of a treatment. Objectives : This study aimed to investigate and identify the most appropriate and widely used instrument for the assessment of quality of life in patients with HF. Methods : We searched the databases of Lilacs, Medline, Pubmed, Scielo and CAPES to identify relevant articles published in English and Portuguese between 2000 and 2010. Results : We found 25 papers that described, quoted or used instruments for the assessment of QoL in patients with HF. Conclusion : The MLHFQ is the most widely used instrument to assess QoL in patients with HF. Its good metric properties have been confirmed in a large number of studies. In addition, it has a simple structure and is easy to administer, which makes it the most recommended instrument for this purpose.
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115
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Benda NMM, Seeger JPH, Stevens GGCF, Hijmans-Kersten BTP, van Dijk APJ, Bellersen L, Lamfers EJP, Hopman MTE, Thijssen DHJ. Effects of High-Intensity Interval Training versus Continuous Training on Physical Fitness, Cardiovascular Function and Quality of Life in Heart Failure Patients. PLoS One 2015; 10:e0141256. [PMID: 26517867 PMCID: PMC4627811 DOI: 10.1371/journal.pone.0141256] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/05/2015] [Indexed: 01/08/2023] Open
Abstract
Introduction Physical fitness is an important prognostic factor in heart failure (HF). To improve fitness, different types of exercise have been explored, with recent focus on high-intensity interval training (HIT). We comprehensively compared effects of HIT versus continuous training (CT) in HF patients NYHA II-III on physical fitness, cardiovascular function and structure, and quality of life, and hypothesize that HIT leads to superior improvements compared to CT. Methods Twenty HF patients (male:female 19:1, 64±8 yrs, ejection fraction 38±6%) were allocated to 12-weeks of HIT (10*1-minute at 90% maximal workload—alternated by 2.5 minutes at 30% maximal workload) or CT (30 minutes at 60–75% of maximal workload). Before and after intervention, we examined physical fitness (incremental cycling test), cardiac function and structure (echocardiography), vascular function and structure (ultrasound) and quality of life (SF-36, Minnesota living with HF questionnaire (MLHFQ)). Results Training improved maximal workload, peak oxygen uptake (VO2peak) related to the predicted VO2peak, oxygen uptake at the anaerobic threshold, and maximal oxygen pulse (all P<0.05), whilst no differences were present between HIT and CT (N.S.). We found no major changes in resting cardiovascular function and structure. SF-36 physical function score improved after training (P<0.05), whilst SF-36 total score and MLHFQ did not change after training (N.S.). Conclusion Training induced significant improvements in parameters of physical fitness, although no evidence for superiority of HIT over CT was demonstrated. No major effect of training was found on cardiovascular structure and function or quality of life in HF patients NYHA II-III. Trial Registration Nederlands Trial Register NTR3671
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Affiliation(s)
- Nathalie M. M. Benda
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, the Netherlands
| | - Joost P. H. Seeger
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, the Netherlands
- Liverpool John Moores University, Research Institute for Sport and Exercise Sciences, Liverpool, United Kingdom
| | - Guus G. C. F. Stevens
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, the Netherlands
| | - Bregina T. P. Hijmans-Kersten
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, the Netherlands
| | - Arie P. J. van Dijk
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Cardiology, Nijmegen, the Netherlands
| | - Louise Bellersen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Cardiology, Nijmegen, the Netherlands
| | - Evert J. P. Lamfers
- Canisius-Wilhelmina Hospital, Department of Cardiology, Nijmegen, the Netherlands
| | - Maria T. E. Hopman
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, the Netherlands
| | - Dick H. J. Thijssen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, the Netherlands
- Liverpool John Moores University, Research Institute for Sport and Exercise Sciences, Liverpool, United Kingdom
- * E-mail:
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116
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Home telehealth uptake and continued use among heart failure and chronic obstructive pulmonary disease patients: a systematic review. Ann Behav Med 2015; 48:323-36. [PMID: 24763972 PMCID: PMC4223578 DOI: 10.1007/s12160-014-9607-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved. Purpose The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth. Methods This research performs a narrative synthesis of the results from included studies. Results Thirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or withdrawal found that almost one third of patients who were offered telehealth refused and one fifth of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of, home telehealth use were identified. Conclusions Research reports need to provide more details regarding telehealth refusal and abandonment, in order to understand the reasons why patients decide not to use telehealth. Electronic supplementary material The online version of this article (doi:10.1007/s12160-014-9607-x) contains supplementary material, which is available to authorized users.
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117
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Venkateswararao E, Son MJ, Sharma N, Manickam M, Boggu P, Kim YH, Woo SH, Jung SH. Exploration of Pharmacophore in Chrysosplenol C as Activator in Ventricular Myocyte Contraction. ACS Med Chem Lett 2015; 6:758-63. [PMID: 26191362 DOI: 10.1021/acsmedchemlett.5b00043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/20/2015] [Indexed: 11/29/2022] Open
Abstract
Chrysosplenol C (4',5,6-trihydroxy-3,3',7-trimethoxyflavone) isolated from Miliusa balansae has unique structural features as a reversible inotropic agent independent of β-adrenergic signaling and with selective activation of cardiac myosin ATPase. Hence, a series of chrysosplenol analogues were synthesized and explored for identification of pharmacophore that is essential for the increasing contractility in rat ventricular myocytes. Analogue 7-chloro-2-(3-hydroxyphenyl)-3-methoxy-4H-chromen-4-one showed highly potent contractility (54.8% at 10 μM) through activating cardiac myosin ATPase (38.7% at 10 μM). Our systematic structure-activity relationship study revealed that flavonoid nucleus of chrososplenol C appears to be an essential basic skeleton and hydrophobic substituent at position 7 of chromenone such as methoxy or chloro enhances the activity. Additionally, our ATPase study suggested that these chrysosplenol analogues have selectivity toward cardiac myosin activation. Thus, the novel flavonone with 3-/7-hydrophobic substituent and 3'-hydrogen bonding donor function is a novel scaffold for discovery of a new positive inotropic agent.
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Affiliation(s)
- Eeda Venkateswararao
- College
of Pharmacy and Institute
of Drug Research and Development, Chungnam National University, Daejeon 305-764, South Korea
| | - Min-Jeong Son
- College
of Pharmacy and Institute
of Drug Research and Development, Chungnam National University, Daejeon 305-764, South Korea
| | - Niti Sharma
- College
of Pharmacy and Institute
of Drug Research and Development, Chungnam National University, Daejeon 305-764, South Korea
| | - Manoj Manickam
- College
of Pharmacy and Institute
of Drug Research and Development, Chungnam National University, Daejeon 305-764, South Korea
| | - PullaReddy Boggu
- College
of Pharmacy and Institute
of Drug Research and Development, Chungnam National University, Daejeon 305-764, South Korea
| | - Young Ho Kim
- College
of Pharmacy and Institute
of Drug Research and Development, Chungnam National University, Daejeon 305-764, South Korea
| | - Sun-Hee Woo
- College
of Pharmacy and Institute
of Drug Research and Development, Chungnam National University, Daejeon 305-764, South Korea
| | - Sang-Hun Jung
- College
of Pharmacy and Institute
of Drug Research and Development, Chungnam National University, Daejeon 305-764, South Korea
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118
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McDonald DD, Soutar C, Chan MA, Afriyie A. A closer look: Alternative pain management practices by heart failure patients with chronic pain. Heart Lung 2015; 44:395-9. [PMID: 26088386 DOI: 10.1016/j.hrtlng.2015.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe alternative non-pharmaceutical non-nutraceutical pain self-management strategies used by people with heart failure (HF) in order to reduce chronic non-cardiac pain. BACKGROUND Little is known about alternative pain self-treatments used by HF patients with chronic pain. METHODS A cross-sectional descriptive design was used with 25 hospitalized HF patients who had chronic pain and used at least one alternative pain treatment. Pain intensity, pain interference with function, and current pain treatments were measured with the Brief Pain Inventory. RESULTS Alternative treatments included walking, stretching, use of heat and cold. Five patients used evidence-based pain treatments for their chronic pain conditions. Patients reported moderate pain intensity and pain interference with activity. CONCLUSIONS Patients with HF and chronic pain use few alternative pain treatments. Screening for chronic pain and referral to Integrative Medicine and/or Palliative care for a pain management consult might reduce the added burden of pain in people with HF.
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Affiliation(s)
- Deborah Dillon McDonald
- University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT 06269-2026, USA.
| | - Christina Soutar
- Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT 06105, USA
| | - Maria Agudelo Chan
- Masonicare Partners Home Health and Hospice, 111 Founders Plaza, East Hartford, CT 06108, USA
| | - Angela Afriyie
- Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT 06105, USA
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119
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Variations in patient-reported physical health between cardiac and musculoskeletal diseases: systematic review and meta-analysis of population-based studies. Health Qual Life Outcomes 2015; 13:71. [PMID: 26025136 PMCID: PMC4448727 DOI: 10.1186/s12955-015-0265-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/15/2015] [Indexed: 12/31/2022] Open
Abstract
Population-based assessments of physical health are important to evaluate healthcare resource allocation. Normative data on the level of physical impairments attributable to specific diseases and severity levels within these diseases is critical to interpreting such data. Our objective, by means of a systematic review and meta-analysis, was to test the hypothesis that specific diseases which form cardiovascular and musculoskeletal disease spectra are associated with gradients of physical impairments. We examined a cardiovascular disease spectrum which consisted of hypertension, ischaemic heart disease and heart failure, and a musculoskeletal disease spectrum of lower back pain, osteoarthritis and rheumatoid arthritis. Using Medline, EMBASE and CINAHL databases, articles which had examined these morbidities and used either the SF-12 or SF-36 in general or primary care populations were selected; data was extracted independently by three reviewers. Study characteristics were described and the mean physical component summary scores of the SF-12 or SF-36 was analysed by disease, using random-effects meta-analysis. The association between disease and physical health (mean physical component summary scores) was assessed using multilevel meta-regression analysis, adjusting for age, health setting, country, disease definition and SF-12 or 36 format. From this search, 26 articles were identified, yielding 70 separate estimates of mean physical component summary scores across the morbidities from 14 different countries. For the selected conditions, pooled unadjusted mean physical component summary scores were: 44.4 for hypertension, 38.9 for ischaemic heart disease, 35.9 for heart failure, 39.5 for lower back pain, 36.0 for osteoarthritis and 36.5 for rheumatoid arthritis. The adjusted meta-regression showed mean physical component summary score difference for ischaemic heart disease of −4.6 (95 % confidence interval −6.0 to −3.2) and heart failure −7.5 (−9.1 to −5.9) compared to the hypertension category. For osteoarthritis −4.2 (−5.3 to −3.0) and rheumatoid arthritis −3.9 (−9.5 to 1.6) compared to the lower back pain category. Our findings provide the benchmark norms for the differences in physical health within and between disease spectra. Improved characterisation of the relative impact of individual conditions on physical health will facilitate public health assessments of chronic diseases as well as assessments of interventions using functional patient-reported outcomes.
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120
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Matza LS, Stewart KD, Gandra SR, Delio PR, Fenster BE, Davies EW, Jordan JB, Lothgren M, Feeny DH. Acute and chronic impact of cardiovascular events on health state utilities. BMC Health Serv Res 2015; 15:173. [PMID: 25896804 PMCID: PMC4408571 DOI: 10.1186/s12913-015-0772-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 02/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cost-utility models are frequently used to compare treatments intended to prevent or delay the onset of cardiovascular events. Most published utilities represent post-event health states without incorporating the disutility of the event or reporting the time between the event and utility assessment. Therefore, this study estimated health state utilities representing cardiovascular conditions while distinguishing between acute impact including the cardiovascular event and the chronic post-event impact. METHODS Health states were drafted and refined based on literature review, clinician interviews, and a pilot study. Three cardiovascular conditions were described: stroke, acute coronary syndrome (ACS), and heart failure. One-year acute health states represented the event and its immediate impact, and post-event health states represented chronic impact. UK general population respondents valued the health states in time trade-off tasks with time horizons of one year for acute states and ten years for chronic states. RESULTS A total of 200 participants completed interviews (55% female; mean age = 46.6 y). Among acute health states, stroke had the lowest utility (0.33), followed by heart failure (0.60) and ACS (0.67). Utility scores for chronic health states followed the same pattern: stroke (0.52), heart failure (0.57), and ACS (0.82). For stroke and ACS, acute utilities were significantly lower than chronic post-event utilities (difference = 0.20 and 0.15, respectively; both p < 0.0001). CONCLUSIONS Results add to previously published utilities for cardiovascular events by distinguishing between chronic post-event health states and acute health states that include the event and its immediate impact. Findings suggest that acute versus chronic impact should be considered when selecting scores for use in cost-utility models. Thus, the current utilities provide a unique option that may be used to represent the acute and chronic impact of cardiovascular conditions in economic models comparing treatments that may delay or prevent the onset of cardiovascular events.
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Affiliation(s)
- Louis S Matza
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, USA.
| | - Katie D Stewart
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, USA.
| | - Shravanthi R Gandra
- Global Health Economics, Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, USA.
| | - Philip R Delio
- Neurology Associates of Santa Barbara, 219 Nogales Avenue, Suite F, Santa Barbara, CA, USA.
| | - Brett E Fenster
- Division of Cardiology, National Jewish Health, 1400 Jackson Street, Denver, CO, USA.
| | - Evan W Davies
- Outcomes Research, Evidera, Metro Building, 6th Floor, No. 1 Butterwick, London, UK.
| | - Jessica B Jordan
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, USA.
| | - Mickael Lothgren
- Global Health Economics, Amgen (Europe), Dammstrasse 23, P.O. Box 1557, CH-6301, Zug, Switzerland.
| | - David H Feeny
- Department of Economics, McMaster University, KTH 426, Hamilton, ON, Canada.
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Josefsson A, Fu M, Björnsson E, Castedal M, Kalaitzakis E. Impact of cardiac dysfunction on health-related quality of life in cirrhotic liver transplant candidates. Eur J Gastroenterol Hepatol 2015; 27:393-8. [PMID: 25874511 DOI: 10.1097/meg.0000000000000292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Cardiac dysfunction, in particular left ventricular diastolic dysfunction, is common in cirrhosis. We aimed to investigate the impact of cardiac dysfunction on health-related quality of life (QoL) in liver cirrhosis. MATERIALS AND METHODS A total of 88 cirrhotic liver transplant candidates with an available echocardiogram and ECG completed the Short form-36 (SF-36) and Fatigue Impact Scale. In a subgroup of 61 patients, levels of cardiac biomarkers, in particular serum N-terminal pro-brain natriuretic peptide, adiponectin, and high-sensitive troponin T, were also measured. RESULTS Although left ventricular systolic diameter was related to a lower SF-36 physical component summary, neither left ventricular diastolic dysfunction nor any other echocardiographic feature was found to be associated with any other SF-36 or Fatigue Impact Scale domain (P>0.05 for all). On linear regression analysis after adjustment for confounders, a prolonged QTc interval was found to be related to a lower SF-36 mental component summary score (β=-9.7, P=0.009) and increased physical fatigue (β=10.5, P=0.004). Neither serum N-terminal pro-brain natriuretic peptide, high-sensitivity troponin T, nor adiponectin levels were found to be related to QoL (P>0.05 for all). Serum adiponectin levels did not differ among patients with versus those without echocardiographic cardiac alterations (P>0.05 for all). CONCLUSION A prolonged QTc interval, but not any echocardiographic abnormalities or cardiac biomarkers, seems to be predictive of QoL in cirrhosis.
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Affiliation(s)
- Axel Josefsson
- aInstitute of Internal Medicine, Sahlgrenska Academy, University of Gothenburg bTransplant Institute, Sahlgrenska University Hospital, Gothenburg cDepartment of Gastroenterology, Skåne University Hospital, University of Lund, Lund, Sweden dDepartment of Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland
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Rahman RJ, Hudson J, Thøgersen-Ntoumani C, Doust JH. Motivational processes and well-being in cardiac rehabilitation: a self-determination theory perspective. PSYCHOL HEALTH MED 2015; 20:518-29. [PMID: 25753948 DOI: 10.1080/13548506.2015.1017509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This research examined the processes underpinning changes in psychological well-being and behavioural regulation in cardiac rehabilitation (CR) patients using self-determination theory (SDT). A repeated measures design was used to identify the longitudinal relationships between SDT variables, psychological well-being and exercise behaviour during and following a structured CR programme. Participants were 389 cardiac patients (aged 36-84 years; M(age) = 64 ± 9 years; 34.3% female) referred to a 12-week-supervised CR programme. Psychological need satisfaction, behavioural regulation, health-related quality of life, physical self-worth, anxiety and depression were measured at programme entry, exit and six month post-programme. During the programme, increases in autonomy satisfaction predicted positive changes in behavioural regulation, and improvements in competence and relatedness satisfaction predicted improvements in behavioural regulation and well-being. Competence satisfaction also positively predicted habitual physical activity. Decreases in external regulation and increases in intrinsic motivation predicted improvements in physical self-worth and physical well-being, respectively. Significant longitudinal relationships were identified whereby changes during the programme predicted changes in habitual physical activity and the mental quality of life from exit to six month follow-up. Findings provide insight into the factors explaining psychological changes seen during CR. They highlight the importance of increasing patients' perceptions of psychological need satisfaction and self-determined motivation to improve well-being during the structured component of a CR programme and longer term physical activity.
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Affiliation(s)
- Rachel Jane Rahman
- a Department of Psychology , Aberystwyth University , Penbryn 5, Penglais Campus, Aberystwyth SY23 3UX , Ceredigion , UK
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Hamo CE, Heitner JF, Pfeffer MA, Kim HY, Kenwood CT, Assmann SF, Solomon SD, Boineau R, Fleg JL, Spertus JA, Lewis EF. Baseline distribution of participants with depression and impaired quality of life in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial. Circ Heart Fail 2015; 8:268-77. [PMID: 25648577 DOI: 10.1161/circheartfailure.114.001838] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies have demonstrated the psychosocial effect of heart failure in patients with reduced ejection fraction. However, the effects on patients with preserved ejection fraction have not yet been elucidated. This study aimed to determine the baseline characteristics of participants with heart failure with preserved ejection fraction as it relates to impaired quality of life (QOL) and depression, identify predictors of poor QOL and depression, and determine the correlation between QOL and depression. METHODS AND RESULTS Among patients enrolled in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial (TOPCAT), 3400 patients completed the Kansas City Cardiomyopathy Questionnaire, 3395 patients completed European QOL 5D Visual Analog Scale, and 1431 patients in United States and Canada completed the Patient Health Questionnaire-9. The mean summary score on the Kansas City Cardiomyopathy Questionnaire was 54.8, and on European QOL 5D Visual Analog Scale, it was 60.3; 27% of patients had moderate to severe depression. Factors associated with better Kansas City Cardiomyopathy Questionnaire and European QOL 5D Visual Analog Scale via multiple logistic regression analysis were American region, older age, no history of angina pectoris or asthma, no use of hypoglycemic agent, more activity level, and lower New York Heart Association class. Factors associated with depression via multiple logistic regression analysis included younger age, female sex, comorbid angina, chronic obstructive pulmonary disease, use of a hypoglycemic agent, lower activity level, higher New York Heart Association class, and selective serotonin reuptake inhibitor use. There were significant correlations between each of the QOL scores and depression. CONCLUSIONS Patients with heart failure with preserved ejection fraction, who were younger had higher New York Heart Association class or comorbid angina pectoris, had lower activity levels, lived in Eastern Europe or were taking hypoglycemic agents, were more likely to have impaired QOL and depression. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
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Affiliation(s)
- Carine E Hamo
- From the Department of Medicine, Stony Brook University Hospital, NY (C.E.H.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P., S.D.S., E.F.L.); New England Research Institutes, Watertown, MA (H.-Y.K., C.T.K., S.F.A.); Division of Cardiology, National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F.); and St. Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.)
| | - John F Heitner
- From the Department of Medicine, Stony Brook University Hospital, NY (C.E.H.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P., S.D.S., E.F.L.); New England Research Institutes, Watertown, MA (H.-Y.K., C.T.K., S.F.A.); Division of Cardiology, National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F.); and St. Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.).
| | - Marc A Pfeffer
- From the Department of Medicine, Stony Brook University Hospital, NY (C.E.H.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P., S.D.S., E.F.L.); New England Research Institutes, Watertown, MA (H.-Y.K., C.T.K., S.F.A.); Division of Cardiology, National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F.); and St. Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.)
| | - Hae-Young Kim
- From the Department of Medicine, Stony Brook University Hospital, NY (C.E.H.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P., S.D.S., E.F.L.); New England Research Institutes, Watertown, MA (H.-Y.K., C.T.K., S.F.A.); Division of Cardiology, National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F.); and St. Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.)
| | - Christopher T Kenwood
- From the Department of Medicine, Stony Brook University Hospital, NY (C.E.H.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P., S.D.S., E.F.L.); New England Research Institutes, Watertown, MA (H.-Y.K., C.T.K., S.F.A.); Division of Cardiology, National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F.); and St. Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.)
| | - Susan F Assmann
- From the Department of Medicine, Stony Brook University Hospital, NY (C.E.H.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P., S.D.S., E.F.L.); New England Research Institutes, Watertown, MA (H.-Y.K., C.T.K., S.F.A.); Division of Cardiology, National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F.); and St. Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.)
| | - Scott D Solomon
- From the Department of Medicine, Stony Brook University Hospital, NY (C.E.H.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P., S.D.S., E.F.L.); New England Research Institutes, Watertown, MA (H.-Y.K., C.T.K., S.F.A.); Division of Cardiology, National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F.); and St. Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.)
| | - Robin Boineau
- From the Department of Medicine, Stony Brook University Hospital, NY (C.E.H.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P., S.D.S., E.F.L.); New England Research Institutes, Watertown, MA (H.-Y.K., C.T.K., S.F.A.); Division of Cardiology, National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F.); and St. Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.)
| | - Jerome L Fleg
- From the Department of Medicine, Stony Brook University Hospital, NY (C.E.H.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P., S.D.S., E.F.L.); New England Research Institutes, Watertown, MA (H.-Y.K., C.T.K., S.F.A.); Division of Cardiology, National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F.); and St. Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.)
| | - John A Spertus
- From the Department of Medicine, Stony Brook University Hospital, NY (C.E.H.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P., S.D.S., E.F.L.); New England Research Institutes, Watertown, MA (H.-Y.K., C.T.K., S.F.A.); Division of Cardiology, National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F.); and St. Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.)
| | - Eldrin F Lewis
- From the Department of Medicine, Stony Brook University Hospital, NY (C.E.H.); Division of Cardiology, New York Methodist Hospital, Brooklyn (J.F.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P., S.D.S., E.F.L.); New England Research Institutes, Watertown, MA (H.-Y.K., C.T.K., S.F.A.); Division of Cardiology, National Heart, Lung, and Blood Institute, Bethesda, MD (R.B., J.L.F.); and St. Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.)
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Hofmarcher T, Borg S. Cost-effectiveness analysis of ferric carboxymaltose in iron-deficient patients with chronic heart failure in Sweden. J Med Econ 2015; 18:492-501. [PMID: 25766863 DOI: 10.3111/13696998.2015.1029491] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Iron deficiency is a common but treatable comorbidity in chronic heart failure (CHF) that is associated with impaired health-related quality-of-life (HRQoL). This study evaluates the cost-effectiveness of the intravenous iron preparation ferric carboxymaltose (FCM) for the treatment of iron deficiency in CHF from a Swedish healthcare perspective. METHODS A cost-effectiveness analysis with a time horizon of 24 weeks was performed to compare FCM treatment with placebo. Data on health outcomes and medical resource use were mainly taken from the FAIR-HF trial and combined with Swedish cost data. An incremental cost-effectiveness ratio (ICER) was calculated as well as the change in per-patient costs for primary care and hospital care. RESULTS In the FCM group compared with placebo, quality-adjusted life years (QALYs) are higher (difference = 0.037 QALYs), but so are per-patient costs [(difference = SEK 2789 (€303)]. Primary care and hospital care equally share the additional costs, but within hospitals there is a major shift of costs from inpatient care to outpatient care. The ICER is SEK 75,389 (€8194) per QALY. The robustness of the result is supported by sensitivity analyses. CONCLUSIONS Treatment of iron deficiency in CHF with FCM compared with placebo is estimated to be cost-effective. The ICER in the base case scenario is twice as high as previously thought, but noticeably below SEK 500,000 (€54,300) per QALY, an informal average reference value used by the Swedish Dental and Pharmaceutical Benefits Agency. Increased HRQoL and fewer hospitalizations are the key drivers of this result.
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Affiliation(s)
- Thomas Hofmarcher
- Department of Economics, Lund University, Lund, Sweden, and IHE - The Swedish Institute for Health Economics , Lund , Sweden
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Sobajima M, Nozawa T, Fukui Y, Ihori H, Ohori T, Fujii N, Inoue H. Waon Therapy Improves Quality of Life as Well as Cardiac Function and Exercise Capacity in Patients With Chronic Heart Failure. Int Heart J 2015; 56:203-8. [DOI: 10.1536/ihj.14-266] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Mitsuo Sobajima
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Takashi Nozawa
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Yasutaka Fukui
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Hiroyuki Ihori
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Takashi Ohori
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Nozomu Fujii
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
| | - Hiroshi Inoue
- Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama
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Lelli D, Pedone C, Rossi FF, Incalzi RA. Clinical and echocardiographic characteristics of elderly hospitalized patients with high levels of NT-proBNP without clinical diagnosis of heart failure. Aging Clin Exp Res 2014; 26:607-13. [PMID: 24781829 DOI: 10.1007/s40520-014-0226-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/08/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with high NT-proBNP levels but without heart failure (HF) diagnosis have a higher risk of cardiovascular events and mortality; however, there are few data about their characteristic, especially in the elderly. AIMS To compare the clinical and echocardiographic characteristics of elderly hospitalized patients with and without increased NT-proBNP and with and without a diagnosis of HF. METHODS We reviewed 209 charts of patients admitted to an acute care ward (mean age 78.9 years, SD 10.2, 62% women). We classified the patients into four groups: no HF with or without increased (>900 pg/mL) NT-proBNP (HF-/BNP-, N = 89 and HF-/BNP+, N = 41), and HF with or without increased NT-proBNP (HF+/BNP-, N = 4 and HF+/BNP+, N = 75). The groups were compared with respect to demographic and clinical characteristics, symptoms at admission, comorbidities, echocardiographic parameters, and cardiovascular events at 180 days. RESULTS Patients in the groups HF+/BNP+ and HF-/BNP+ were older, with higher serum creatinine, blood urea nitrogen, and lower serum hemoglobin compared to patients in the HF-/BNP- group. The prevalence of ischemic heart disease, pulmonary hypertension, and atrial fibrillation progressively decreased across the HF+/BNP+, HF-/BNP+, and HF-/BNP- groups. The prevalence of abnormal echocardiographic findings in the HF-/BNP+ group was intermediate compared to the other two groups for severe aortic or mitralic regurgitation, monophasic transmitralic pattern, biatrial atriomegaly, ejection fraction, akinesia extension, and PAPs. The same pattern was observed for cardiovascular events at follow-up. DISCUSSION Elderly patients without a diagnosis of HF, but with high NT-proBNP serum concentration have intermediate clinical characteristics compared to the other two groups. CONCLUSION NT-proBNP may be a useful marker of silent cardiac damage.
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Affiliation(s)
- D Lelli
- Unit of Geriatrics, Area di Geriatria, Università Campus Biomedico di Roma, via Alvaro del Portillo 200, 00128, Rome, Italy,
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Butler J, Binney Z, Kalogeropoulos A, Owen M, Clevenger C, Gunter D, Georgiopoulou V, Quest T. Advance directives among hospitalized patients with heart failure. JACC-HEART FAILURE 2014; 3:112-21. [PMID: 25543976 DOI: 10.1016/j.jchf.2014.07.016] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/28/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the frequency and correlates of documented advance directives (ADs) among patients hospitalized for heart failure (HF). BACKGROUND Discussing ADs with patients with HF is critical for identifying treatment goals consistent with patients' values and preferences and for facilitating health care team communication. METHODS We retrospectively identified electronic medical records of adult patients admitted to 2 large tertiary care hospitals with either the primary or secondary discharge diagnosis of HF from September 2008 to August 2013 to assess the presence of ADs in electronic medical records. We performed analyses including HF as either the primary or secondary admission diagnosis and HF as the primary admission diagnosis only. Multivariable models were constructed to investigate independent predictors of documented ADs. RESULTS Data included 44,768 admissions from 24,291 individual patients over 5 years. Mean age of patients at admission was 64.8 ± 15.9 years; 47.9% of these patients were female, 51.8% were black. The median length of stay for all admissions was 5 (3 to 10) days; 12.7% of patients had documented ADs. Older age, female sex, white race, higher socioeconomic status, higher risk for adverse in-hospital outcomes, length of stay ≥5 days, hospice discharge, palliative care consultation, and a do-not-resuscitate order were all associated with a significantly higher chance of having documented ADs. A significant increase in ADs over time was noted, but more than 80% of patients did not have ADs in medical records at the end of the study period. CONCLUSIONS In a diverse population of hospitalized patients with HF, most did not have a documented AD in the medical records. Although several factors were associated with a higher probability, major opportunities exist for all subgroups of patients with HF to improve documentation of ADs.
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Affiliation(s)
- Javed Butler
- Cardiology Division, Stony Brook University, Stony Brook, New York.
| | - Zachary Binney
- Emory Cardiovascular Clinical Research Institute, Emory University, Atlanta, Georgia
| | | | - Melissa Owen
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Carolyn Clevenger
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Debbie Gunter
- Emory Cardiovascular Clinical Research Institute, Emory University, Atlanta, Georgia
| | | | - Tammie Quest
- Emory Cardiovascular Clinical Research Institute, Emory University, Atlanta, Georgia; Atlanta Veterans Administration Medical Center, Department of Veterans Affairs, Atlanta, Georgia
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Min L, Mazzurco L, Gure TR, Cigolle CT, Lee P, Bloem C, Chan CL, Romano MA, Nallamothu BK, Langa KM, Prager RL, Malani PN. Longitudinal functional recovery after geriatric cardiac surgery. J Surg Res 2014; 194:25-33. [PMID: 25483736 DOI: 10.1016/j.jss.2014.10.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/21/2014] [Accepted: 10/23/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Impaired functional and cognitive status is an important outcome for older adults undergoing major cardiac surgery. We conducted this pilot study to gauge feasibility of assessing these outcomes longitudinally, from preoperatively up to two time points postoperatively to assess for recovery. METHODS We interviewed patients aged ≥ 65 y preoperatively and repeated functional and cognitive assessments at 4-6 wk and 4-6 mo postoperatively. Simple unadjusted linear regression was used to test whether baseline measures changed at each follow-up time point. Then we used a longitudinal model to predict postoperative recovery overall, adjusting for comorbidity. RESULTS A total of 62 patients (age 74.7 ± 5.9) underwent scheduled cardiac surgery. Preoperative activities of daily living (ADL) impairment was associated with poorer functional recovery at 4-6 wk postoperatively with each baseline ADL impairment conferring recovery of 0.5 fewer ADLs (P < 0.05). By 4-6 mo, we could no longer detect a difference in recovery. Preoperative cognition and physical activity were not associated with postoperative changes in these domains. CONCLUSIONS A preoperative and postoperative evaluation of function and cognition was integrated into the surgical care of older patients. Preoperative impairments in ADLs may be a means to identify patients who might benefit from careful postoperative planning, especially in terms of assistance with self-care during the first 4-6 wk after cardiac surgery.
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Affiliation(s)
- Lillian Min
- Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan.
| | - Lauren Mazzurco
- Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan
| | - Tanya R Gure
- Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christine T Cigolle
- Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan
| | - Pearl Lee
- Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan
| | - Cathie Bloem
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Chiao-Li Chan
- Divisions of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Matthew A Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kenneth M Langa
- Division of General Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Preeti N Malani
- Divisions of Infectious Disease, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan
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Cedars AM, Spertus JA. Call for a Disease-Specific Patient-Reported Outcome Tool in Adult Congenital Heart Disease. Circ Cardiovasc Qual Outcomes 2014; 7:971-4. [DOI: 10.1161/circoutcomes.114.001406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Park JES, Lyon AR, Shao D, Hector LR, Xu H, O'Gara P, Pinhu L, Chambers RC, Wort SJ, Griffiths MJD. Pulmonary venous hypertension and mechanical strain stimulate monocyte chemoattractant protein-1 release and structural remodelling of the lung in human and rodent chronic heart failure models. Thorax 2014; 69:1120-7. [DOI: 10.1136/thoraxjnl-2013-204190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nesbitt T, Doctorvaladan S, Southard JA, Singh S, Fekete A, Marie K, Moser DK, Pelter MM, Robinson S, Wilson MD, Cooper L, Dracup K. Correlates of quality of life in rural patients with heart failure. Circ Heart Fail 2014; 7:882-7. [PMID: 25146960 DOI: 10.1161/circheartfailure.113.000577] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is abundant research indicating poor physical, psychological, and social functioning of patients with chronic heart failure (HF), a reality that can lead to poor health-related quality of life (QoL). Little is known about the experience of rural patients with HF. METHODS AND RESULTS This study was part of a randomized clinical trial titled Rural Education to Improve Outcomes in Heart Failure (REMOTE-HF) designed to test an education and counseling intervention to improve self-care in patients with HF. We evaluated 612 rural patients. Multiple validated questionnaires were administered to assess patient perceptions of health and health literacy. Baseline factors were collected and compared with baseline QoL measures only. Patients' health-related QoL was assessed using the Minnesota Living with Heart Failure scale. The data were analyzed using a general linear model to test the association of various patient characteristics with QoL in rural patients with HF. Patients were 65.8 (+12.9) years of age. The majority were men (58.7%), married (56.4%), and had completed a high-school education (80.9%). Factors associated with reduced QoL among this population include geographic location, younger age, male sex, higher New York Heart Association class, worse HF knowledge, poorer perceived control, and symptoms of depression or anxiety. The data provided no evidence of an association between left ventricular ejection fraction and QoL. CONCLUSIONS This study of rural patients with HF confirms previously identified factors associated with perceptions of QoL. However, further study is warranted with an urban control group. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00415545.
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Affiliation(s)
- Thomas Nesbitt
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Sahar Doctorvaladan
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Jeffrey A Southard
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.).
| | - Satinder Singh
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Anne Fekete
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Kate Marie
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Debra K Moser
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Michelle M Pelter
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Susan Robinson
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Machelle D Wilson
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Lawton Cooper
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Kathleen Dracup
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
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Ladwig KH, Lederbogen F, Albus C, Angermann C, Borggrefe M, Fischer D, Fritzsche K, Haass M, Jordan J, Jünger J, Kindermann I, Köllner V, Kuhn B, Scherer M, Seyfarth M, Völler H, Waller C, Herrmann-Lingen C. Position paper on the importance of psychosocial factors in cardiology: Update 2013. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2014; 12:Doc09. [PMID: 24808816 PMCID: PMC4012565 DOI: 10.3205/000194] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Indexed: 12/30/2022]
Abstract
Background: The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008. Methods: The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated to coronary heart diseases (CHD), heart rhythm diseases and heart failure because to date the evidence-based clinical knowledge is most advanced in these particular areas. Differences between men and women and over the life span were considered in the recommendations as were influences of cognitive capability and the interactive and synergistic impact of classical somatic risk factors on the affective comorbidity in heart disease patients. Results: A IA recommendation (recommendation grade I and evidence grade A) was given for the need to consider psychosocial risk factors in the estimation of coronary risks as etiological and prognostic risk factors. Furthermore, for the recommendation to routinely integrate psychosocial patient management into the care of heart surgery patients because in these patients, comorbid affective disorders (e.g. depression, anxiety and post-traumatic stress disorder) are highly prevalent and often have a malignant prognosis. A IB recommendation was given for the treatment of psychosocial risk factors aiming to prevent the onset of CHD, particularly if the psychosocial risk factor is harmful in itself (e.g. depression) or constrains the treatment of the somatic risk factors. Patients with acute and chronic CHD should be offered anti-depressive medication if these patients suffer from medium to severe states of depression and in this case medication with selective reuptake inhibitors should be given. In the long-term course of treatment with implanted cardioverter defibrillators (ICDs) a subjective health technology assessment is warranted. In particular, the likelihood of affective comorbidities and the onset of psychological crises should be carefully considered. Conclusions: The present state of the art paper presents an update of current empirical evidence in psychocardiology. The paper provides evidence-based recommendations for the integration of psychosocial factors into cardiological practice and highlights areas of high priority. The evidence for estimating the efficiency for psychotherapeutic and psychopharmacological interventions has increased substantially since the first release of the policy document but is, however, still weak. There remains an urgent need to establish curricula for physician competence in psychodiagnosis, communication and referral to ensure that current psychocardiac knowledge is translated into the daily routine.
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Affiliation(s)
- Karl-Heinz Ladwig
- Deutsches Forschungszentrum für Gesundheit und Umwelt, Institut für Epidemiologie-2, Helmholtz-Zentrum München, Neuherberg, Germany ; Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum Rechts der Isar der TU München, Germany
| | - Florian Lederbogen
- Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Medizinische Fakultät Mannheim, Germany
| | - Christian Albus
- Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln, Germany
| | | | - Martin Borggrefe
- I. Medizinische Klinik für Kardiologie, Angiologie, Pneumologie, Internistische Intensivmedizin und Hämostaseologie, Universitätsmedizin Mannheim, Germany
| | - Denise Fischer
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Kurt Fritzsche
- Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Germany
| | - Markus Haass
- Innere Medizin II: Kardiologie, Angiologie und Internistische Intensivmedizin, Theresienkrankenhaus und St. Hedwig-Klinik, Mannheim, Germany
| | - Jochen Jordan
- Herz-, Thorax- und Rheumazentrum, Abteilung für Psychokardiologie, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Jana Jünger
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Universität Heidelberg, Germany
| | - Ingrid Kindermann
- Innere Medizin III (Kardiologie/Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Volker Köllner
- Medizinische Fakultät, Universität des Saarlandes, Blieskastel, Germany
| | - Bernhard Kuhn
- Fachpraxis für Innere Medizin, Kardiologie, Angiologie und Notfallmedizin, Heidelberg, Germany
| | - Martin Scherer
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Melchior Seyfarth
- Medizinische Klinik 3 (Kardiologie), Helios-Klinikum Wuppertal-Herzzentrum, Universität Witten/Herdecke, Wuppertal, Germany
| | - Heinz Völler
- Fachklinik für Innere Medizin, Abteilung Kardiologie, Klinik am See, Rüdersdorf, Germany
| | - Christiane Waller
- Abteilung Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Germany
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Whittaker BD, Soine LA, Errico KM. Patient and process factors associated with all-cause 30-day readmission among patients with heart failure. J Am Assoc Nurse Pract 2014; 27:105-13. [PMID: 24687697 DOI: 10.1002/2327-6924.12123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 05/19/2013] [Indexed: 11/09/2022]
Abstract
PURPOSE To explore the patient and process factors associated with all-cause 30-day readmission after heart failure (HF) hospitalization and develop recommendations to reduce readmissions of patients with HF. DATA SOURCES A retrospective, cohort study of 239 patients ages 18 years and older was performed using electronic medical chart review. All patients were discharged from the medical center between July 1, 2009 and June 30, 2010 with a principal diagnosis of HF. Patient and process factors were compared in readmitted and non-readmitted groups. CONCLUSIONS Renal failure/insufficiency was the only factor significantly associated with all-cause 30-day readmission among patients with HF. IMPLICATIONS FOR PRACTICE Assessment of renal function during hospitalization will help identify patients with HF at high risk for all-cause 30-day readmission. Give careful consideration to the timing of discharge of patients who appear otherwise ready for discharge but still have creatinine levels above their baseline. Careful follow-up is needed for patients with impaired renal function.
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134
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Total Artificial Heart Implantation: Clinical Indications, Expected Postoperative Imaging Findings, and Recognition of Complications. AJR Am J Roentgenol 2014; 202:W191-201. [DOI: 10.2214/ajr.13.11066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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135
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Lee KS, Lennie TA, Wu JR, Biddle MJ, Moser DK. Depressive symptoms, health-related quality of life, and cardiac event-free survival in patients with heart failure: a mediation analysis. Qual Life Res 2014; 23:1869-76. [PMID: 24488573 DOI: 10.1007/s11136-014-0636-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Health-related quality of life (HRQOL) and depressive symptoms both are associated with an adverse prognosis in heart failure (HF), although their associations with outcomes have been examined only in isolation. Therefore, it is unknown how HRQOL and depressive symptoms might interact in their associations with outcomes. The present study was conducted to determine whether the association between HRQOL and cardiac event-free survival is mediated by depressive symptoms in HF patients given that depressive symptoms are associated strongly with HRQOL. METHODS A total of 209 HF patients (61 ± 11 years, 24 % female, 49 % NYHA III/IV) participated. The Minnesota Living with HF Questionnaire and the Patient Health Questionnaire-9 were used to measure HRQOL and depressive symptoms, respectively. Patients were followed for a median of 357 days to determine cardiac event-free survival. RESULTS In Cox regression analysis, HRQOL [hazard ratio (HR) 1.013; 95 % confidence interval (CI) 1.001-1.026] and depressive symptoms (HR 1.075; 95 % CI 1.025-1.127) predicted cardiac event-free survival separately, controlling for demographic and clinical variables. HRQOL independently explained 38.7 % of the variance in depressive symptoms (p < 0.05; standardized β = 0.695) in a multiple regression. When HRQOL and depressive symptoms were entered in the model simultaneously, only depressive symptoms independently predicted cardiac event-free survival (HR 1.068; 95 % CI 1.001-1.139), demonstrating a mediation effect of depressive symptoms. CONCLUSIONS Depressive symptoms mediated the relationship between HRQOL and cardiac event-free survival. Interventions targeting HRQOL to enhance patient outcomes must also address patient depressive symptoms to be fully efficacious.
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Affiliation(s)
- Kyoung Suk Lee
- School of Nursing, K6/342 Clinical Sciences Center, University of Wisconsin-Madison, 600 Highland Ave., Madison, WI, 53792-2455, USA,
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136
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Pan L, Yan J, Guo Y, Yan J. Effects of Tai Chi training on exercise capacity and quality of life in patients with chronic heart failure: a meta-analysis. Eur J Heart Fail 2014; 15:316-23. [PMID: 23099355 DOI: 10.1093/eurjhf/hfs170] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lei Pan
- State Key Laboratory of Respiratory Disease, First Affiliated Hospital, Guangzhou Medical College; 151 Yanjiang Road 510120 Guangzhou PR China
| | - JunHong Yan
- Affiliated Hospital of Binzhou Medical College; Binzhou PR China
| | - YongZhong Guo
- State Key Laboratory of Respiratory Disease, First Affiliated Hospital, Guangzhou Medical College; 151 Yanjiang Road 510120 Guangzhou PR China
| | - JunHe Yan
- People's Hospital of Yangxin County; Yangxin PR China
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Hole T, Grundtvig M, Gullestad L, Flønaes B, Westheim A. Improved quality of life in Norwegian heart failure patients after follow-up in outpatient heart failure clinics: results from the Norwegian heart failure registry. Eur J Heart Fail 2014; 12:1247-52. [DOI: 10.1093/eurjhf/hfq156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Torstein Hole
- Department of Medicine; Ålesund Hospital, Sunnmøre Hospital Trust; N-6026 Ålesund Norway
- Norwegian University of Science and Technology; Trondheim Norway
| | - Morten Grundtvig
- Department of Medicine; Innlandet Hospital Trust, Division Lillehammer; Lillehammer Norway
| | - Lars Gullestad
- Department of Cardiology, Rikshospitalet Medical Centre; Oslo University Hospital; Oslo Norway
| | - Berit Flønaes
- Department of Medicine; Vestre Viken Hospital Trust, Division Asker and Baerum Hospital; Asker Norway
| | - Arne Westheim
- Department of Cardiology, Ullevaal Medical Center; Oslo University Hospital; Oslo Norway
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Iqbal J, Francis L, Reid J, Murray S, Denvir M. Quality of life in patients with chronic heart failure and their carers: a 3-year follow-up study assessing hospitalization and mortality. Eur J Heart Fail 2014; 12:1002-8. [DOI: 10.1093/eurjhf/hfq114] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Javaid Iqbal
- Centre for Cardiovascular Science, Queens Medical Research Institute; University of Edinburgh; EH16 4TJ Edinburgh UK
| | | | - Janet Reid
- Lothian Heart Failure Network; NHS Lothian; Edinburgh UK
| | - Scott Murray
- Primary Palliative Care Research Group; University of Edinburgh; Edinburgh UK
| | - Martin Denvir
- Centre for Cardiovascular Science, Queens Medical Research Institute; University of Edinburgh; EH16 4TJ Edinburgh UK
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139
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Bhatia G, Sosin M, Leahy JF, Connolly DL, Davis RC, Lip GYH. Hibernating myocardium in heart failure. Expert Rev Cardiovasc Ther 2014; 3:111-22. [PMID: 15723580 DOI: 10.1586/14779072.3.1.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ischemic left ventricular systolic dysfunction may result from myocardial necrosis or from hypocontractile areas of viable myocardium. In some cases, recovery of contractility may occur on revascularization--this reversibly dysfunctional tissue is commonly referred to as hibernating myocardium. Observational data suggest that revascularization of patients with ischemic left ventricular systolic dysfunction and known viable myocardium provides a survival benefit over medical therapy. Identification of viable, dysfunctional myocardium may be especially worthwhile in deciding which patients with ischemic left ventricular systolic dysfunction will benefit from revascularization procedures. Randomized, prospective trials evaluating this are currently ongoing. This review will provide an overview of the complex pathophysiology of viable, dysfunctional myocardium, and will discuss outcomes after revascularization. Of the techniques used to determine the presence of hibernating myocardium, functional methods such as stress echocardiography and cardiac magnetic resonance appear more specific, but less sensitive, than the nuclear modalities, which assess perfusion and metabolic activity. Currently, the availability of all methods is variable.
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Affiliation(s)
- Gurbir Bhatia
- Sandwell Hospital, Department of Cardiology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK
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140
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Psychosocial Functioning and Quality of Life in Adults with Congenital Heart Disease and Heart Failure. Heart Fail Clin 2014; 10:35-42. [DOI: 10.1016/j.hfc.2013.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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141
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Raj P, Lieben Louis X, Thandapilly SJ, Movahed A, Zieroth S, Netticadan T. Potential of resveratrol in the treatment of heart failure. Life Sci 2014; 95:63-71. [DOI: 10.1016/j.lfs.2013.12.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/04/2013] [Accepted: 12/09/2013] [Indexed: 01/11/2023]
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142
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Lyngå P, Fridlund B, Langius-Eklöf A, Bohm K. Perceptions of transmission of body weight and telemonitoring in patients with heart failure? Int J Qual Stud Health Well-being 2013; 8:21524. [PMID: 24345687 PMCID: PMC3866836 DOI: 10.3402/qhw.v8i0.21524] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2013] [Indexed: 01/28/2023] Open
Abstract
Chronic heart failure (HF) is associated with a high burden of morbidity and mortality and with reduced quality of life. New techniques such as telemonitoring (TM) have recently been introduced in the care of patients with HF in order to improve outcomes. TM is defined as sending data from the patients' home to healthcare professionals. Most studies have focussed on endpoints such as morbidity and mortality, and relatively little attention has been paid to patients' perceptions of TM. Therefore, the aim of this study was to explore and describe patients' perceptions of transmission of body weight (BW) and TM, regularly accomplished from patients' homes to an HF clinic. An explorative design with a phenomenographic approach was used, and semi-structured interviews were conducted with a maximum variation sampling of 20 participants. The findings are described in five metaphoric categories that were assigned and used as a description: the habitual patient, the concerned patient, the technical patient, the secure patient, and the self-caring patient. The conclusions were that the transmission of BW made the patients active in their own care and increased self-care activities. In clinical care, concerns for deterioration in HF as well as the reliability of the TM system should be considered. Future research may focus on healthcare professionals and their perceptions of transmission of BW and TM in the care of patients with HF.
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Affiliation(s)
- Patrik Lyngå
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden;
| | - Bengt Fridlund
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
| | - Katarina Bohm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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143
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Cerne A, Svab I, Kersnik J, Selic P. Did past economic prosperity affect the health related quality of life predictors? A longitudinal study on a representative sample of Slovenian family medicine patients. BMC Public Health 2013; 13:1160. [PMID: 24325279 PMCID: PMC4029188 DOI: 10.1186/1471-2458-13-1160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 11/26/2013] [Indexed: 01/20/2023] Open
Abstract
Background Health related quality of life (HRQOL) as an important measure of medical outcomes has been shown to be associated with demographic factors and the most common mental and chronic somatic diseases. This study’s aim was to identify factors predicting changes in HRQOL over a follow-up period in a representative sample of Slovenian family medicine patients. Methods In a longitudinal multi-centred study between 2003 and 2005, data were collected from 1118 consecutive attendees from 60 family medicine practices in Slovenia on quality of life, socio-demographic factors and the presence of mental disorders, with follow-up after 6 and 24 months. Retrospective information on chronic diseases was obtained from patients` health records. In three time-sequential multiple linear regression models, data on 601 patients (53.8%) was analysed to determine factors associated with each component score of quality of life. Results At baseline the patients were 48.58 (SE = 0.58) years of age, over half were women (386 (64.2%)) and most were Slovenian (548 (91.2%)). Quality of life was seen to improve over the two-year period. Factors significantly and consistently associated with a better mental component score of quality of life were social support, satisfactory circumstances in patients` household and absence of anxiety. Major life events in the past year and depression were shown to be risk factors for mental and physical components, while level of education, absence of long-term disability and chronic pain were identified as predictors of the physical component. Conclusions Detection and successful treatment of depression and anxiety has a potential to lead to improved quality of life in family medicine attendees; family physicians should be alert for the early onset of these conditions, knowing that symptoms of chronic pain, depression and anxiety often overlap in patients. Poorly educated patients and those lacking social support and/or satisfactory household circumstances should be recognised and empowered, and appropriate coping mechanisms should be introduced.
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Affiliation(s)
| | | | | | - Polona Selic
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana, Slovenia.
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Lowrie R, Johansson L, Forsyth P, Bryce SL, McKellar S, Fitzgerald N. Experiences of a community pharmacy service to support adherence and self-management in chronic heart failure. Int J Clin Pharm 2013; 36:154-62. [PMID: 24293306 DOI: 10.1007/s11096-013-9889-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Heart failure (HF) is common, disabling and deadly. Patients with HF often have poor self-care and medicines non-adherence, which contributes to poor outcomes. Community pharmacy based cognitive services have the potential to help, but we do not know how patients view community-pharmacist-led services for patients with HF. OBJECTIVE We aimed to explore and portray in detail, the perspectives of patients receiving, and pharmacists delivering an enhanced, pay for performance community pharmacy HF service. SETTING Community pharmacies and community-based patients in Greater Glasgow and Clyde, Scotland. METHODS Focus groups with pharmacists and semi-structured interviews with individual patients by telephone. Cross sectional thematic analysis of qualitative data used Normalization Process Theory to understand and describe patient's reports. MAIN OUTCOME MEASURE Experiences of receiving and delivering an enhanced HF service. RESULTS Pharmacists voiced their confidence in delivering the service and highlighted valued aspects including the structured consultation and repeated contacts with patients enabling the opportunity to improve self care and medicines adherence. Discussing co-morbidities other than HF was difficult and persuading patients to modify behaviour was challenging. Patients were comfortable discussing symptoms and medicines with pharmacists; they identified pharmacists as fulfilling roles that were needed but not currently addressed. Patients reported the service helped them to enact HF medicines and HF self care management strategies. CONCLUSION Both patients receiving and pharmacists delivering a cognitive HF service felt that it addressed a shortfall in current care. There may be a clearly defined role for pharmacists in supporting patients to address the burden of understanding and managing their condition and treatment, leading to better self management and medicines adherence. This study may inform the development of strategies or policies to improve the process of care for patients with HF and has implications for the development of other extended role services.
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Affiliation(s)
- Richard Lowrie
- Research and Development, Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, Victoria Infirmary, Langside Road, Glasgow, G42 9TT, UK,
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López Castro J, Cid Conde L, Fernández Rodríguez V, Failde Garrido J, Almazán Ortega R. Análisis de la calidad de vida en pacientes con insuficiencia cardíaca mediante el cuestionario genérico SF-36. ACTA ACUST UNITED AC 2013; 28:355-60. [DOI: 10.1016/j.cali.2013.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 05/15/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
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146
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Bello VD, Carrubba SL, Antonini-Canterin F, Salvo GD, Caso P, Canna GL, Erlicher A, Badano L, Romano MF, Zito C, Vriz O, Conte L, Carerj S. Role of electrocardiography and echocardiography in prevention and predicting outcome of subjects at increased risk of heart failure. Eur J Prev Cardiol 2013; 22:249-62. [DOI: 10.1177/2047487313508343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Megari K. Quality of Life in Chronic Disease Patients. Health Psychol Res 2013; 1:e27. [PMID: 26973912 PMCID: PMC4768563 DOI: 10.4081/hpr.2013.e27] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/01/2013] [Accepted: 03/02/2013] [Indexed: 12/04/2022] Open
Abstract
During the past decades there was an increasing predominance of chronic disorders, with a large number of people living with chronic diseases that can adversely affect their quality of life. The aim of the present paper is to study quality of life and especially Health-related quality of life (HRQoL) in chronic diseases. HRQOL is a multidimensional construct that consists of at least three broad domains – physical, psychological, and social functioning – that are affected by one’s disease and/or treatment. HRQoL is usually measured in chronic conditions and is frequently impaired to a great extent. In addition, factors that are associated with good and poor HRQoL, as well as HRQoL assessment will be discussed. The estimation of the relative impact of chronic diseases on HRQoL is necessary in order to better plan and distribute health care resources aiming at a better HRQoL. [«All the people perceive the concept of living good or being well, that is the same as being happy». (Aristotle. 384-322 BC. Ethica Nichomachea)]
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Affiliation(s)
- Kalliopi Megari
- School of Psychology, Aristotle University of Thessaloniki , Greece
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148
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Moser DK, Heo S, Lee KS, Hammash M, Riegel B, Lennie TA, Arslanian-Engoren C, Mudd-Martin G, Albert N, Watkins J. 'It could be worse ... lot's worse!' Why health-related quality of life is better in older compared with younger individuals with heart failure. Age Ageing 2013; 42:626-32. [PMID: 23832262 DOI: 10.1093/ageing/aft078] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND health-related quality of life (HRQOL) is markedly impaired in patients with heart failure (HF). Despite worse prognosis and physical status, older patients have better HRQOL than younger patients. OBJECTIVE to determine reasons for differences in HRQOL in older compared with younger HF patients. METHODS a mixed methods approach was used. HRQOL was assessed using the Minnesota Living with HF Questionnaire and compared among HF patients (n = 603) in four age groups (≤ 53, 54-62, 63-70 and ≥ 71 years). Socio-demographic/clinical and psychological factors related to HRQOL were determined in four groups using multiple regressions. Patients (n = 20) described their views of HRQOL during semi-structured interviews. RESULTS HRQOL was worse in the youngest group, and best in the two oldest groups. The youngest group reported higher levels of depression and anxiety than the oldest group. Anxiety, depression and functional capacity predicted HRQOL in all age groups. Qualitatively, patients in all age groups acknowledged the negative impact of HF on HRQOL; nonetheless older patients reported that their HRQOL exceeded their expectations for their age. Younger patients bemoaned the loss of activities and roles, and reported their HRQOL as poor. CONCLUSIONS better HRQOL among older HF patients is the result, in part, of better psychosocial status. The major factor driving better HRQOL among older patients is a change with advancing age in expectations about what constitutes good HRQOL.
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Affiliation(s)
- Debra K Moser
- College of Nursing, University of Kentucky, 527 CON Rose Street, Lexington, Kentucky 40515, USA.
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149
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Spivak MY, Bubnov RV, Yemets IM, Lazarenko LM, Tymoshok NO, Ulberg ZR. Development and testing of gold nanoparticles for drug delivery and treatment of heart failure: a theranostic potential for PPP cardiology. EPMA J 2013; 4:20. [PMID: 23889805 PMCID: PMC3751918 DOI: 10.1186/1878-5085-4-20] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/01/2013] [Indexed: 01/04/2023]
Abstract
Introduction Nanoscale gold particles (AuNPs) have wide perspectives for biomedical applications because of their unique biological properties, as antioxidative activity and potentials for drug delivery. Aims and objectives The aim was to test effects of AuNPs using suggested heart failure rat model to compare with proved medication Simdax, to test gold nanoparticle for drug delivery, and to test sonoporation effect to increase nanoparticles delivery into myocardial cells. Material and methods We performed biosafety and biocompatibility tests for AuNPs and conjugate with Simdax. For in vivo tests, we included Wistar rats weighing 180–200 g (n = 54), received doxorubicin in cumulative dose of 12.0 mg/kg to model advance heart failure, registered by ultrasonography. We formed six groups: the first three groups of animals received, respectively, 0.06 ml Simdax, AuNPs, and conjugate (AuNPs-Simdax), intrapleurally, and the second three received them intravenously. The seventh group was control (saline). We performed dynamic assessment of heart failure regression in vivo measuring hydrothorax. Sonoporation of gold nanoparticles to cardiomyocytes was tested. Results We designed and constructed colloidal, spherical gold nanoparticles, AuNPs-Simdax conjugate, both founded biosafety (in cytotoxicity, genotoxicity, and immunoreactivity). In all animals of the six groups after the third day post-medication injection, no ascites and liver enlargement were registered (P < 0.001 vs controls). Conjugate injection showed significantly higher hydrothorax reduction than Simdax injection only (P < 0.01); gold nanoparticle injection showed significantly higher results than Simdax injection (P < 0.05). AuNPs and conjugate showed no significant difference for rat recovery. Difference in rat life continuity was significant between Simdax vs AuNPs (P < 0.05) and Simdax vs conjugate (P < 0.05). Sonoporation enhances AuNP transfer into the cell and mitochondria that were highly localized, superior to controls (P < 0.01 for both). Conclusions Gold nanoparticles of 30 nm and its AuNPs-Simdax conjugate gave positive results in biosafety and biocompatibility in vitro and in vivo. AuNPs-Simdax and AuNPs have similar significant cardioprotective effects in rats with doxorubicin-induced heart failure, higher than that of Simdax. Intrapleural (local) delivery is preferred over intravenous (systemic) delivery according to all tested parameters. Sonoporation is able to enhance gold nanoparticle delivery to myocardial cells in vivo.
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Affiliation(s)
- Mykola Ya Spivak
- Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Zabolotny str,, 154, Kyiv 03680, Ukraine.
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150
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Spivak MY, Bubnov RV, Yemets IM, Lazarenko LM, Tymoshok NO, Ulberg ZR. Gold nanoparticles - the theranostic challenge for PPPM: nanocardiology application. EPMA J 2013; 4:18. [PMID: 23800174 PMCID: PMC3702527 DOI: 10.1186/1878-5085-4-18] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/13/2013] [Indexed: 12/18/2022]
Abstract
The article overviews the potential biomedical applications of nanoscale gold particles for predictive, preventive and personalised nanomedicine in cardiology. The review demonstrates the wide opportunities for gold nanoparticles due to their unique biological properties. The use of gold nanoparticles in cardiology is promising to develop fundamentally new methods of diagnosis and treatment. The nanotheranostics in cardiovascular diseases allows the non-invasive imaging associated with simultaneous therapeutic intervention and predicting treatment outcomes. Imaging may reflect the effectiveness of treatment and has become a fundamental optimisation setting for therapeutic protocol. Combining the application of biomolecular and cellular therapies with nanotechnologies foresees the development of complex integrated nanodevices. Nanocardiology may challenge existing healthcare system and economic benefits as cardiovascular diseases are the leading cause of morbidity and mortality at present.
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Affiliation(s)
- Mykola Ya Spivak
- Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Zabolotny Str., 154, Kyiv 03680, Ukraine
- LCL “DIAPROF”, Svitlycky Str., 35, Kyiv 04123, Ukraine
| | - Rostyslav V Bubnov
- Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Zabolotny Str., 154, Kyiv 03680, Ukraine
- Clinical Hospital “Pheophania” of State Affairs Department, Zabolotny Str., 21, Kyiv 03680, Ukraine
| | - Ilya M Yemets
- Scientific-Practical Centre of Pediatric Cardiology and Cardiac Health of Ukraine, Chornovil Str., 28/1, Kyiv 01135, Ukraine
| | - Liudmyla M Lazarenko
- Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Zabolotny Str., 154, Kyiv 03680, Ukraine
| | - Natalia O Tymoshok
- Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Zabolotny Str., 154, Kyiv 03680, Ukraine
| | - Zoia R Ulberg
- Ovcharenko Institute of Biocolloidal Chemistry, National Academy of Sciences of Ukraine, Acad. Vernadsky Blvd, 42, Kyiv 03142, Ukraine
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