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Verdu-Rotellar JM, Calero E, Duran J, Navas E, Alonso S, Argemí N, Casademunt M, Furió P, Casajuana E, Vinyoles E, Muñoz MA. Impact of malnutrition on the quality of life in older patients with advanced heart failure: a cohort study. Rev Clin Esp 2024; 224:105-113. [PMID: 38280424 DOI: 10.1016/j.rceng.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
OBJECTIVES The aim of this study was to assess the prevalence of malnutrition, the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality, quality of life, self-care abilities, and activities of daily living in the older patients with advanced heart failure. METHODS A prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced HF was conducted between June 2017 and December 2019. The study was carried out in 22 primary healthcare centres, three university hospitals, one acute-care hospital, and one geriatric rehabilitation unit in the city of Barcelona (Spain). Nutritional status was assessed at baseline using the Mini Nutritional Assessment questionnaire. Patient-reported outcome measures included quality of life (EQ-5D-3L), self-care behaviour (European Heart Failure Self-care Behaviour Scale) and impact on activities of daily living (Barthel Index). RESULTS Using the MNA-SF, 126 (48.5%) patients were identified as being at risk of malnutrition and 33 (12.7%) patients as having confirmed malnutrition. Compared to HF patients with normal nutritional status, patients with confirmed malnutrition were significantly older, with a lower BMI, and with reduced haemoglobin levels. During follow-up (median 14.9 months, Interquartile Range; 4.9-26.9), 133 (51.2%) of the included participants died, and mortality was significantly higher among patients identified as having malnutrition (p < 0.001). Better Barthel index and quality of life scores were inversely related to the risk of malnutrition, [Odds Ratio (OR) 0.97 (95% Confidence interval 0.96; 0.98) and OR 0.98 (95% Confidence interval, 0.96; 0.99)], respectively. Higher scores in the European Heart Failure Self-care Behaviour Scale, which implies worse self care, were related to higher malnutrition risk, OR 1.05 (95% Confidence interval, 1.02; 1.09. Adjusted multivariate logistic model found that malnutrition was significantly associated with poor quality of life, and adverse impacts on daily activities and self-care. CONCLUSIONS In community-dwelling older patients with advanced HF, malnutrition was associated with worse patient reported outcome measures related to poor quality of life, and adverse impacts on self-care and daily activities. Nutritional status must be systematically addressed by primary care nurses and family doctors to improve survival rates in these patients. It would be helpful the incorporation of expert professionals in nutrition in the primary health care centres.
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Affiliation(s)
- J-M Verdu-Rotellar
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, School of Medicine, Universitat Pompeu Fabra, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - E Calero
- Bellvitge University Hospital, Institut Català de la Salut, Barcelona, Spain
| | - J Duran
- Clinica Sant Antoni (Institut Medic i de Rehabilitació), Barcelona, Spain
| | - E Navas
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - S Alonso
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain
| | - N Argemí
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain
| | - M Casademunt
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain
| | - P Furió
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain
| | - E Casajuana
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain
| | - E Vinyoles
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Departament de Medicina (School of Medicine, Universitat de Barcelona), Barcelona, Spain
| | - M A Muñoz
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, School of Medicine, Universitat Pompeu Fabra, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
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Forsyth P, Young S, Hughes K, James R, Oxley C, Kelly R, Jones R, Briggs S, Mackay-Thomas L, Millerick Y, Simpson M, Taylor CJ, Beggs S, Piper S, Duckett S. Multiprofessional heart failure self-development framework. Open Heart 2024; 11:e002554. [PMID: 38242561 PMCID: PMC10806483 DOI: 10.1136/openhrt-2023-002554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/25/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Heart failure remains a key public health priority across the globe. The median age of people with heart failure admitted to hospital in the UK is 81 years old. Many such patients transcend the standard interventions that are well characterised and evidenced in guidelines, into holistic aspects surrounding frailty, rehabilitation and social care. Previous published competency frameworks in heart failure have focused on the value of doctors, nurses and pharmacists. We aimed to provide an expert consensus on the minimum heart failure-specific competencies necessary for multiple different healthcare professionals, including physiotherapists, occupational therapists, dietitians and cardiac physiologists. METHODS The document has been developed focussing on four main parts, (1) establishing a project working group of expert professionals, (2) a literature review of previously existing published curricula and competency frameworks, (3) consensus building, which included developing a structure to the framework with ongoing review of the contents to adapt and be inclusive for each specialty and (4) write up and dissemination to widen the impact of the project. RESULTS The final competency framework displays competencies across seven sections; knowledge (including subheadings on heart failure syndrome, diagnosis and clinical management); general skills; heart failure-specific skills; clinical autonomy; multidisciplinary team working; teaching and education; and research and development. CONCLUSION People with heart failure can be complex and have needs that require input from a broad range of specialties. This publication focuses on the vital impact of wider multidisciplinary groups and should help define the generic core heart failure-specific competencies needed to support future pipelines of professionals, who regularly interact with and deliver care for patients with heart failure.
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Affiliation(s)
- Paul Forsyth
- Pharmacy, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Susan Young
- Physiotherapy, Aneurin Bevan University Health Board, Newport, UK
| | - Kirsty Hughes
- Physiotherapy, Forth Valley Royal Hospital, Larbert, UK
| | - Ruby James
- Occupational Therapy, Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Cheryl Oxley
- Cardiac Physiology Services, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ruth Kelly
- Cardiac Physiology Services, Golden Jubilee National Hospital, Clydebank, UK
| | - Rebecca Jones
- Dietetics, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Susan Piper
- Cardiology, King's College Hospital, London, UK
| | - Simon Duckett
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
- Department of Cardiology, Keele University, Keele, UK
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Liu J, Lv L, Qian HH, Sun PL, Zhang D. Role of antibiotics in Milligan-Morgan hemorrhoidectomy for Grade III to IV Hemorrhoids: A randomized clinical trial. Asian J Surg 2024; 47:169-175. [PMID: 37451888 DOI: 10.1016/j.asjsur.2023.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/28/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
PURPOSE This study was mainly to compare the safety and long-term clinical efficacy of using intravenous antibiotics in Milligan Morgan hemorrhoidectomy for Grade III to IV Prolapsing Hemorrhoids. METHODS This was a parallel group, 3-arm, randomized clinical trial to evaluate the efficacy of intravenous prophylactic antibiotics. A total of 150 consecutive patients undergoing Milligan Morgan hemorrhoidectomy (MMH) in a tertiary hospital for grade III/IV hemorrhoids from January 2020 to August 2022 were enrolled. Patients were randomly assigned to three groups using a computer-generated table. Group A did not receive any prophylactic antibiotic, group B received 2 g I/V Cefoxitin Sodium before the induction of anesthesia, and group C received 2 g I/V Cefoxitin Sodium before the induction of anesthesia and 6 h after operation. RESULTS There was no significant difference in measured VAS values on the 1st day,3rd day and 7th day after surgery (p> 0.05). Compared with VAS values on the 1st day postoperatively, these values got decreased on the 3rd day and 7th day after surgery (p< 0.05). In addition, there was no significant difference among the first defecation time, wound edema, bleeding, urinary retention after surgery (p> 0.05). There was no significant difference in the outcome comparison between all 3 groups' basal and the 3rd day postoperatively no matter in WBC, NUET% or CRP (p> 0.05). However, compared with basal, the WBC, NUET%,CRP(p< 0.05) of group A and group B on the 3rd day postoperatively got rised, the rate of recurrence of hemorrhoids follow-up for 1 year was 1.4%. CONCLUSIONS Our results suggest that there is no efficacy on intravenous prophylactic antibiotics in Milligan Morgan hemorrhoidectomy.
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Affiliation(s)
- Jiali Liu
- Department of Anorectal Surgery, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Lei Lv
- Department of Anorectal Surgery, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Hai-Hua Qian
- Department of Anorectal Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Ping-Liang Sun
- Department of Anorectal Surgery, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, 530000, China.
| | - Dan Zhang
- Department of Anorectal Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
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Liu L, Qian J, Li Y, Ni Y, Zhao Y, Che L. Effects of obesity on short-term mortality in patients with acute heart failure under different nutritional status. BMC Cardiovasc Disord 2023; 23:221. [PMID: 37120589 PMCID: PMC10149014 DOI: 10.1186/s12872-023-03206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/26/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Increased body mass index (BMI) is associated with better survival in patients with acute heart failure (AHF), which is a paradoxical phenomenon. However, it is unclear whether different nutritional status affects this association. METHODS 1325 patients with AHF from the Medical Information Mart for Intensive Care III database were retrospectively included. Nutritional status was assessed by serum albumin (SA) and prognostic nutritional index (PNI). Patients were divided into High-SA (≥ 3.5 g/dL) and Low-SA groups (< 3.5 g/dL), and they also were divided into High-PNI (≥ 38) and Low-PNI groups (< 38). Propensity-score matching (PSM) was used to control for the effect of baseline confounding factors, multifactor regression model was adopted to assess the association of nutritional status, BMI, and outcomes in AHF patients. RESULTS Of the 1325 patients (mean age 72.4 ± 13.1 years), 52.1% (n = 690) were male, 13.1% (n = 173) died in hospital and 23.5% (n = 311) died within 90 days. Before PSM, after adjusting for potential confounders, in the High-SA population, compared with the under/normal BMI group, overweight and obesity were negatively correlated with 90-day mortality, with adjusted hazard ratios (HR) of 0.47, 95% confidence interval (CI) (0.30-0.74), P = 0.001; HR 0.45, 95%CI (0.28-0.72), P = 0.001, respectively. However, this correlation was much attenuated in the Low-SA group (overweight BMI: HR 1.06, 95%CI 0.75-1.50, P = 0.744; obese BMI: HR 0.86, 95%CI 0.59-1.24, P = 0.413). After PSM, those who were overweight or obese in the High-SA group had a 50-58% reduction in 90-day risk of death, while the protective effect disappeared in the Low-SA group (HR 1.09, 95% CI 0.70-1.71; HR 1.02, 95%CI 0.66 - 0.59). Similarly, results were similar in analyses using PNI as a nutritional assessment criterion. CONCLUSION Overweight or Obesity was associated with lower short-term mortality in well-nourished AHF patients, whereas this association was significantly attenuated or even disappeared in malnourished patients. Therefore, further research is needed for weight loss recommendations for malnourished obese patients with AHF.
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Affiliation(s)
- Linlin Liu
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200092, China
| | - Jun Qian
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200092, China
| | - Yuanyuan Li
- Department of Cardiology, Kong Jiang Hospital Of Yangpu District, Shanghai, 200093, China
| | - Ye Ni
- Department of Cardiology, Kong Jiang Hospital Of Yangpu District, Shanghai, 200093, China
| | - Ya Zhao
- Department of Cardiology, Kong Jiang Hospital Of Yangpu District, Shanghai, 200093, China.
| | - Lin Che
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200092, China.
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Chen MY, Wen JX, Lu MT, Jian XY, Wan XL, Xu ZW, Liang JQ, Wu JD. Association Between Prognostic Nutritional Index and Prognosis in Patients With Heart Failure: A Meta-Analysis. Front Cardiovasc Med 2022; 9:918566. [PMID: 35757355 PMCID: PMC9226429 DOI: 10.3389/fcvm.2022.918566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background The prognostic nutritional index (PNI) has been proposed as a marker of malnutrition and associated with the prognosis of cardiovascular disease. However, whether PNI can serve as a potential biomarker for the prognosis of heart failure (HF) upon those established risk factors were still controversial. This meta-analysis aimed to generate comprehensive evidence on the prognostic value of PNI in patients with HF. Methods Multiple databases (PubMed, Embase, the Cochrane Library, and Google Scholar) were searched for related studies up to January 31, 2022. Observational studies accessed associations between PNI levels and the prognosis in patients with HF were included for meta-analysis. The hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. Results Fourteen studies, comprising 19,605 patients with HF were included for meta-analysis. The median follow-up duration was 18.5 months. Compared with those with higher PNI (normal nutritional status), patients with HF with lower PNI (malnourished) were associated with a higher risk of all-cause mortality (HR 1.53, 95% CI 1.27–1.85) and composite major adverse cardiac outcomes (MACEs; HR 2.26, 95% CI 1.54–3.31) in the multivariable-adjusted model. Furthermore, when PNI was defined as per 1 increment as a continuous metric, higher PNI was associated with a decrease in all-cause mortality (per 1 increment of PNI: HR 0.94, 95% CI 0.88–0.96) and MACEs (per 1 increment of PNI: HR 0.97, 95% CI 0.95–0.98). Conclusions The PNI can serve as an easily calculated bedside “malnutrition-inflammation” biomarker in HF. Lower PNI was associated with a worse prognosis in patients with HF.
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Affiliation(s)
- Mei-Yu Chen
- Department of General Medicine, The Second People's Hospital of Foshan, Foshan, China
| | - Jiang-Xiong Wen
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
| | - Mei-Ting Lu
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
| | - Xiang-Yu Jian
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
| | - Xiao-Liang Wan
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
| | - Zhi-Wen Xu
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
| | - Jian-Qiu Liang
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
- Jian-Qiu Liang
| | - Jian-Di Wu
- Department of Cardiology, The Second People's Hospital of Foshan, Foshan, China
- *Correspondence: Jian-Di Wu
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