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Alam SF, Gonzalez Suarez ML. Transforming Healthcare: The AI Revolution in the Comprehensive Care of Hypertension. Clin Pract 2024; 14:1357-1374. [PMID: 39051303 PMCID: PMC11270379 DOI: 10.3390/clinpract14040109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/20/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
This review explores the transformative role of artificial intelligence (AI) in hypertension care, summarizing and analyzing published works from the last three years in this field. Hypertension contributes to a significant healthcare burden both at an individual and global level. We focus on five key areas: risk prediction, diagnosis, education, monitoring, and management of hypertension, supplemented with a brief look into the works on hypertensive disease of pregnancy. For each area, we discuss the advantages and disadvantages of integrating AI. While AI, in its current rudimentary form, cannot replace sound clinical judgment, it can still enhance faster diagnosis, education, prevention, and management. The integration of AI in healthcare is poised to revolutionize hypertension care, although careful implementation and ongoing research are essential to mitigate risks.
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Affiliation(s)
- Sreyoshi F. Alam
- Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
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2
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Galhardo MM, da Cunha Chermont SLSM, de Lemos Venancio ICD, Lopes AJ, Guimaraes FS. Examining the haemodynamic repercussions of ventilator hyperinflation in elderly patients: An explanatory study. Respir Physiol Neurobiol 2023; 318:104165. [PMID: 37739150 DOI: 10.1016/j.resp.2023.104165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
This study assessed the cardiovascular repercussions of two VHI (ventilation hyperinflation) protocols using the volume-controlled mode, one with an inspiratory pause (VHI-P) and the other without an inspiratory pause (VHI-NP), in mechanically ventilated elderly patients. The patients underwent both VHI protocols in a randomized order, and impedance cardiography was used to record cardiovascular variables. During VHI-P, the diastolic blood pressure was lower than during VHI-NP (Δ = 10%; p = 0.009). VHI-NP and VHI-P demonstrated a decrease in cardiac output (CO) during the first and third sets compared to baseline (p < 0.05; ES=0.23 and 0.29, respectively). Arterial oxygen delivery decreased simultaneously with CO compared to baseline values (p < 0.05; ES=0.22 and 0.23, respectively). Five minutes after the intervention, the systolic time ratio values were lower for VHI-P than VHI-NP (Δ = 10%; p = 0.01). Left ventricular ejection time values were consistently lower in VHI-NP compared to VHI-P (Δ = 2%; p = 0.02). In conclusion, our study shows that VHI in volume-controlled mode induces hemodynamic changes in mechanically ventilated elderly patients, albeit with a small effect size and within the normal range.
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Affiliation(s)
- Manuella Melo Galhardo
- Rehabilitation Sciences Postgraduate Programme, Augusto Motta University, Rua Dona Isabel, 94, Bonsucesso, 21032-060 Rio de Janeiro, Brazil
| | | | | | - Agnaldo José Lopes
- Rehabilitation Sciences Postgraduate Programme, Augusto Motta University, Rua Dona Isabel, 94, Bonsucesso, 21032-060 Rio de Janeiro, Brazil; Medical Sciences Postgraduate Programme, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Av. Prof. Manoel de Abreu, 444, 2º andar, Vila Isabel, 20550-170 Rio de Janeiro, Brazil
| | - Fernando Silva Guimaraes
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro (UFRJ), Rua Prof. Rodolpho Paulo Rocco, 255, Cidade Universitária, 21941-590, Rio de Janeiro, Brazil.
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Escalona O, Cullen N, Weli I, McCallan N, Ng KY, Finlay D. Robust Arm Impedocardiography Signal Quality Enhancement Using Recursive Signal Averaging and Multi-Stage Wavelet Denoising Methods for Long-Term Cardiac Contractility Monitoring Armbands. SENSORS (BASEL, SWITZERLAND) 2023; 23:5892. [PMID: 37447749 DOI: 10.3390/s23135892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
Impedance cardiography (ICG) is a low-cost, non-invasive technique that enables the clinical assessment of haemodynamic parameters, such as cardiac output and stroke volume (SV). Conventional ICG recordings are taken from the patient's thorax. However, access to ICG vital signs from the upper-arm brachial artery (as an associated surrogate) can enable user-convenient wearable armband sensor devices to provide an attractive option for gathering ICG trend-based indicators of general health, which offers particular advantages in ambulatory long-term monitoring settings. This study considered the upper arm ICG and control Thorax-ICG recordings data from 15 healthy subject cases. A prefiltering stage included a third-order Savitzky-Golay finite impulse response (FIR) filter, which was applied to the raw ICG signals. Then, a multi-stage wavelet-based denoising strategy on a beat-by-beat (BbyB) basis, which was supported by a recursive signal-averaging optimal thresholding adaptation algorithm for Arm-ICG signals, was investigated for robust signal quality enhancement. The performance of the BbyB ICG denoising was evaluated for each case using a 700 ms frame centred on the heartbeat ICG pulse. This frame was extracted from a 600-beat ensemble signal-averaged ICG and was used as the noiseless signal reference vector (gold standard frame). Furthermore, in each subject case, enhanced Arm-ICG and Thorax-ICG above a threshold of correlation of 0.95 with the noiseless vector enabled the analysis of beat inclusion rate (BIR%), yielding an average of 80.9% for Arm-ICG and 100% for Thorax-ICG, and BbyB values of the ICG waveform feature metrics A, B, C and VET accuracy and precision, yielding respective error rates (ER%) of 0.83%, 11.1%, 3.99% and 5.2% for Arm-IG, and 0.41%, 3.82%, 1.66% and 1.25% for Thorax-ICG, respectively. Hence, the functional relationship between ICG metrics within and between the arm and thorax recording modes could be characterised and the linear regression (Arm-ICG vs. Thorax-ICG) trends could be analysed. Overall, it was found in this study that recursive averaging, set with a 36 ICG beats buffer size, was the best Arm-ICG BbyB denoising process, with an average of less than 3.3% in the Arm-ICG time metrics error rate. It was also found that the arm SV versus thorax SV had a linear regression coefficient of determination (R2) of 0.84.
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Affiliation(s)
- Omar Escalona
- School of Engineering, Ulster University, Belfast BT15 1AP, UK
| | - Nicole Cullen
- School of Engineering, Ulster University, Belfast BT15 1AP, UK
| | - Idongesit Weli
- School of Engineering, Ulster University, Belfast BT15 1AP, UK
| | - Niamh McCallan
- School of Engineering, Ulster University, Belfast BT15 1AP, UK
| | - Kok Yew Ng
- School of Engineering, Ulster University, Belfast BT15 1AP, UK
| | - Dewar Finlay
- School of Engineering, Ulster University, Belfast BT15 1AP, UK
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Pharmacotherapy Decision Aids for the American Heart Association 2021 Statement on Management of Stage 1 Hypertension. Curr Hypertens Rep 2023; 25:71-75. [PMID: 36930450 DOI: 10.1007/s11906-023-01239-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE OF REVIEW This is a pragmatic decision aid for initiating pharmacotherapy for stage 1 hypertension. RECENT FINDINGS If a stage 1 patient presents with clinical signs of fluid retention, then a diuretic should be the primary agent. However, if the patient is normovolemic, then a vasodilator should be the primary agent. If targeted blood pressure is not achieved with the primary agent, then the choices are dose escalation or the addition of a second drug. For stage 1, the addition of secondary agents is preferred. This approach includes the polypill (a single pill with multiple low-dose antihypertensive agents). The positives are the polypill lessens the need to make decisions associated with up-titration and the low doses mitigate adverse side effects. The polypill targets several concurrent mechanisms to counteract hypertension. For stage 1, the goal should be to lower blood pressure with a simple regiment which minimizes adverse side affects.
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Pilz N, Patzak A, Bothe TL. Continuous cuffless and non-invasive measurement of arterial blood pressure—concepts and future perspectives. Blood Press 2022; 31:254-269. [DOI: 10.1080/08037051.2022.2128716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Niklas Pilz
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Translational Physiology, Berlin, Germany
| | - Andreas Patzak
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Translational Physiology, Berlin, Germany
| | - Tomas L. Bothe
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Translational Physiology, Berlin, Germany
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Sheikh SAA, Gurel NZ, Gupta S, Chukwu IV, Levantsevych O, Alkhalaf M, Soudan M, Abdulbaki R, Haffar A, Clifford GD, Inan OT, Shah AJ. Validation of a new impedance cardiography analysis algorithm for clinical classification of stress states. Psychophysiology 2022; 59:e14013. [PMID: 35150459 PMCID: PMC9177512 DOI: 10.1111/psyp.14013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 01/01/2023]
Abstract
Pre-ejection period (PEP) is an index of sympathetic nervous system activity that can be computed from electrocardiogram (ECG) and impedance cardiogram (ICG) signals, but sensitive to speech/motion artifact. We sought to validate an ICG noise removal method, three-stage ensemble-average algorithm (TEA), in data acquired from a clinical trial comparing active versus sham non-invasive vagal nerve stimulation (tcVNS) after standardized speech stress. We first compared TEA's performance versus the standard conventional ensemble-average algorithm (CEA) approach to classify noisy ICG segments. We then analyzed ECG and ICG data to measure PEP and compared group-level differences in stress states with each approach. We evaluated 45 individuals, of whom 23 had post-traumatic stress disorder (PTSD). We found that the TEA approach identified artifact-corrupted beats with intraclass correlation coefficient > 0.99 compared to expert adjudication. TEA also resulted in higher group-level differences in PEP between stress states than CEA. PEP values were lower in the speech stress (vs. baseline rest) group using both techniques, but the differences were greater using TEA (12.1 ms) than CEA (8.0 ms). PEP differences in groups divided by PTSD status and tcVNS (active vs. sham) were also greater when using the TEA versus CEA method, although the magnitude of the differences was lower. In conclusion, TEA helps to accurately identify noisy ICG beats during speaking stress, and this increased accuracy improves sensitivity to group-level differences in stress states compared to CEA, suggesting greater clinical utility.
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Affiliation(s)
- Shafa-at Ali Sheikh
- Department of Biomedical Informatics, Emory University, Atlanta, USA
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, USA
| | - Nil Z. Gurel
- Neurocardiology Research Center of Excellence and Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Shishir Gupta
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Ikenna V. Chukwu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Oleksiy Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Mhmtjamil Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Majd Soudan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Rami Abdulbaki
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Ammer Haffar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, USA
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, USA
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, USA
- Atlanta Veterans Affairs Health Care System, Atlanta, USA
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Dong H. RELATIONSHIP BETWEEN THE ECHOCARDIOGRAPHIC RESPONSE OF DIASTOLIC FUNCTION AND LOAD EXERCISE. REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228022021_0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction: This article studies the echocardiographic images of patients and observes the changes in diastolic cardiac function after exercise. Objective: This article tries to find the relationship between cardiac images during exercise and the diagnosis of myocardial ischemia. Methods: Samples of people with equal fitness for the same exercise area were selected with specific equipment to measure the sample ventricular strain curve before and after 5 minutes to exercise with a load. The diastolic strain index (SDI) ratio before and after exercise assesses the relationship between myocardial ischemia and exercise load. Results: The test results showed no significant difference in the range of motion of the cardiac atrioventricular annulus both before and after subjects were subjected to intense exertion exercise. A significant change in slope was noted in the ECG data curve about the exercise index, in addition to a reduction in the diastolic period. Conclusion: When the exercise load increases, it can easily cause changes in the ventricular wall. This can make local myocardial dysfunction more prone. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Mansouri S, Alharbi Y, Alshrouf A, Alqahtani A. Cardiovascular Diseases Diagnosis by Impedance Cardiography. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2022; 13:88-95. [PMID: 36694881 PMCID: PMC9837870 DOI: 10.2478/joeb-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Indexed: 06/17/2023]
Abstract
Cardiovascular disease (CVD) represents the leading cause of mortality worldwide. In order to diagnose CVDs, there are a range of detection methods, among them, the impedance cardiography technique (ICG). It is a non-invasive and low-cost method. In this paper, we highlight recent advances and developments of the CDVs diagnosis mainly by the ICG method. We considered papers published during the last five years (from 2017 until 2022). Based on this study, we expressed the need for an ICG database for the different CDVs.
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Affiliation(s)
- Sofiene Mansouri
- Department of Biomedical Technology, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Laboratory of Biophysics and Medical Technologies, Higher Institute of Medical Technologies of Tunis, University of Tunis El Manar, TunisTunisia
| | - Yousef Alharbi
- Department of Biomedical Technology, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Anwar Alshrouf
- Department of Biomedical Technology, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Abdulrahman Alqahtani
- Department of Biomedical Technology, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Medical Equipment Technology, College of Applied Medical Science, Majmaah University, Majmaah City, Saudi Arabia
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Zhang J, Liang J, Zhang X, Su C, He J, Qiu Y, Zhou Z, Wang Z, Dong B, Tu Q, Xu S, Xia W, Tao J. Non-invasive Systemic Hemodynamic Index in Vascular Risk Stratification Tailored for Hypertensives. Front Cardiovasc Med 2021; 8:744349. [PMID: 34881303 PMCID: PMC8645861 DOI: 10.3389/fcvm.2021.744349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
Vascular dysfunction is a key hallmark of hypertension and related cardiovascular outcomes. As a well-known hemodynamic disease, hypertension is characterized by abnormal ventricular-vascular interactions. Complementing non-invasive systemic hemodynamics in hypertensive vascular risk assessment is of promising significance. We aimed to investigate the effects of abnormal hemodynamic states other than elevated blood pressure on vascular damage and establish a united index of systemic hemodynamics for generalized vascular risk evaluation. Non-invasive systemic hemodynamics, assessed by impedance cardiography, was compared among blood pressure stages. Vascular function was evaluated by flow-mediated dilation (FMD) and brachial-ankle pulse wave velocity (baPWV). Systemic hemodynamics was obtained from a total of 88 enrollees with a mean (±SD) systolic blood pressure 140 (±17) mm Hg, and aged 17 to 91 years. Both stroke systemic vascular resistance index and left stroke work index exhibited a significant alteration among blood pressure stages (p < 0.001; p = 0.01, respectively), whereas heterogeneous hemodynamic and vascular function subsets existed within similar blood pressure. In addition, blood pressure categories failed to recognize between-group differences in endothelial dysfunction (p = 0.88) and arterial stiffness (p = 0.26). An increase in myocardial contractility and a parallel decrease in afterload was associated with the decline of vascular dysfunction. Systemic Hemodynamic Index (SHI), as a surrogate marker, demonstrated a significantly negative correlation with vascular damage index (VDI, r = −0.49, p < 0.001). These findings illustrate that systemic hemodynamics underlying hypertensives provides more vascular information. The SHI/VDI score may be a feasible tool for cardiovascular function assessment.
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Affiliation(s)
- Jianning Zhang
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiawen Liang
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyu Zhang
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chen Su
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiang He
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yumin Qiu
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhe Zhou
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhichao Wang
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bing Dong
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiang Tu
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shiyue Xu
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenhao Xia
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jun Tao
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation of Ministry of Health, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Krzesiński P, Siebert J, Jankowska EA, Galas A, Piotrowicz K, Stańczyk A, Siwołowski P, Gutknecht P, Chrom P, Murawski P, Walczak A, Szalewska D, Banasiak W, Ponikowski P, Gielerak G. Nurse-led ambulatory care supported by non-invasive haemodynamic assessment after acute heart failure decompensation. ESC Heart Fail 2021; 8:1018-1026. [PMID: 33463072 PMCID: PMC8006602 DOI: 10.1002/ehf2.13207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 12/28/2022] Open
Abstract
Heart failure (HF) is characterized by frequent decompensation and an unpredictable trajectory. To prevent early hospital readmission, coordinated discharge planning and individual therapeutic approach are recommended. Aims We aimed to assess the effect of 1 month of ambulatory care, led by nurses and supported by non‐invasive haemodynamic assessment, on the functional status, well‐being, and haemodynamic status of patients post‐acute HF decompensation. Methods and results This study had a multicentre, prospective, and observational design and included patients with at least one hospitalization due to acute HF decompensation within 6 months prior to enrolment. The 1 month ambulatory care included three visits led by a nurse when the haemodynamic state of each patient was assessed non‐invasively by impedance cardiography, including thoracic fluid content assessment. The pharmacotherapy was modified basing on haemodynamic assessment. Sixty eight of 73 recruited patients (median age = 67 years; median left ventricular ejection fraction = 30%) finished 1 month follow‐up. A significant improvement was observed in both the patients' functional status as defined by New York Heart Association class (P = 0.013) and sense of well‐being as evaluated by a visual analogue score (P = 0.002). The detailed patients' assessment on subsequent visits resulted in changes of pharmacotherapy in a significant percentage of patients (Visit 2 = 39% and Visit 3 = 44%). Conclusions The proposed model of nurse‐led ambulatory care for patients after acute HF decompensation, with consequent assessment of the haemodynamic profile, resulted in: (i) improvement in the functional status, (ii) improvement in the well‐being, and (iii) high rate of pharmacotherapy modifications.
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Affiliation(s)
- Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Szaserow Street 128, Warsaw, 04-141, Poland
| | - Janusz Siebert
- University Center for Cardiology, Medical University of Gdansk, Gdansk, Poland.,Department of Family Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Anita Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, Wroclaw University Hospital, Wroclaw, Poland
| | - Agata Galas
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Szaserow Street 128, Warsaw, 04-141, Poland
| | - Katarzyna Piotrowicz
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Szaserow Street 128, Warsaw, 04-141, Poland
| | - Adam Stańczyk
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Szaserow Street 128, Warsaw, 04-141, Poland
| | - Paweł Siwołowski
- Department of Cardiology, Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland
| | - Piotr Gutknecht
- University Center for Cardiology, Medical University of Gdansk, Gdansk, Poland.,Department of Family Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Paweł Chrom
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Szaserow Street 128, Warsaw, 04-141, Poland
| | - Piotr Murawski
- Department of Informatics, Military Institute of Medicine, Warsaw, Poland
| | - Andrzej Walczak
- Software Engineering Department, Cybernetics Faculty, Military University of Technology, Warsaw, Poland
| | - Dominika Szalewska
- Department and Clinic of Rehabilitation Medicine, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Waldemar Banasiak
- Department of Cardiology, Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, Wroclaw University Hospital, Wroclaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Szaserow Street 128, Warsaw, 04-141, Poland
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