1
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Yakut Ozdemir H, Bozdemir Ozel C, Dural M, Yalvac HE, Al A, Murat S, Mert GO, Cavusoglu Y. The 6-minute walk test and fall risk in patients with heart failure: A cross-sectional study. Heart Lung 2024; 64:80-85. [PMID: 38065041 DOI: 10.1016/j.hrtlng.2023.11.012] [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: 08/16/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 03/18/2024]
Abstract
BACKGROUND Given the increased risk of falls in patients with heart failure (HF), there is limited information in the literature about the possible relationship between fall risk and functional capacity. OBJECTIVE To investigate the relationship between functional capacity and fall risk in patients with HF and to determine whether there are differences in clinical parameters between patients with and without fall risk. METHODS The study included 64 patients with HF. The Activity-Specific Balance Confidence Scale (ABC) determined the fall risk. Functional capacity was assessed with the 6-minute walk test (6MWT). The Berg Balance Scale (BBS), the timed up-and-go test (TUG), and the five times sit-to-stand (5-STS) test were used to evaluate functional balance and mobility. Comorbidities and dyspnea perception were assessed with the Charlson Comorbidity Index (CCI) and modified Medical Research Council (mMRC), respectively. RESULTS The 6MWT was associated with fall risk in logistic regression with an odds ratio of 0.979 (0.970-0.989, p < 0.001). Furthermore, the 6MWT had a discriminative value for increased fall risk in patients with HF, with a cutoff value of 248 m. Patients with increased fall risk had lower 6MWT distance, BBS, and gait speed, and higher CCI and mMRC, number of falls, duration of TUG and 5STS compared to patients with no increased fall risk (p < 0.05). CONCLUSIONS The study results demonstrated that 6MWT may be a clinically useful tool in quickly identifying potential balance problems and increased fall risk by providing insight into fall risk/balance confidence in addition to assessing functional capacity.
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Affiliation(s)
- Hazal Yakut Ozdemir
- Izmir Democracy University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir 35140, Turkey.
| | - Cemile Bozdemir Ozel
- Eskisehir Osmangazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Eskisehir 26040, Turkey
| | - Muhammet Dural
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Cardiology, Eskisehir 26040, Turkey
| | - Halit Emre Yalvac
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Cardiology, Eskisehir 26040, Turkey
| | - Aytug Al
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Cardiology, Eskisehir 26040, Turkey
| | - Selda Murat
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Cardiology, Eskisehir 26040, Turkey
| | - Gurbet Ozge Mert
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Cardiology, Eskisehir 26040, Turkey
| | - Yuksel Cavusoglu
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Cardiology, Eskisehir 26040, Turkey
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2
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Hahn EA, Allen LA, Lee CS, Denfeld QE, Stehlik J, Cella D, Lindenfeld J, Teuteberg JJ, McIlvennan CK, Kiernan MS, Beiser DG, Walsh MN, Adler ED, Ruo B, Kirklin JK, Klein L, Bedjeti K, Cummings PD, Burns JL, Vela AM, Grady KL. PROMIS: Physical, Mental and Social Health Outcomes Improve From Before to Early After LVAD Implant: Findings From the Mechanical Circulatory Support: Measures of Adjustment and Quality of Life (MCS A-QOL) Study. J Card Fail 2023; 29:1398-1411. [PMID: 37004864 PMCID: PMC10544687 DOI: 10.1016/j.cardfail.2023.03.013] [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: 10/10/2022] [Revised: 01/28/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023]
Abstract
Study participants (n = 272) completed 12 Patient-Reported Outcomes Measurement Information System (PROMIS) physical, mental and social health measures (questionnaires) prior to implantation of a left ventricular assist device (LVAD) and again at 3 and 6 months postimplant. All but 1 PROMIS measure demonstrated significant improvement from pre-implant to 3 months; there was little change between 3 and 6 months. Because PROMIS measures were developed in the general population, patients with an LVAD, their caregivers and their clinicians can interpret the meaning of PROMIS scores in relation to the general population, helping them to monitor a return to normalcy in everyday life.
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Larry A Allen
- Department of Cardiology, University of Colorado, Aurora, CO
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA
| | - Quin E Denfeld
- Oregon Health & Science University School of Nursing, Portland, OR
| | - Josef Stehlik
- Department of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - David G Beiser
- Department of Medicine, University of Chicago, Chicago, IL
| | - Mary N Walsh
- Ascension St. Vincent Heart Center, Indianapolis, IN
| | - Eric D Adler
- Department of Medicine, University of California, San Diego, CA
| | - Bernice Ruo
- Department of Medicine, University of California, San Diego, CA
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Liviu Klein
- Department of Medicine, University of California, San Francisco, CA
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Peter D Cummings
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James L Burns
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alyssa M Vela
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathleen L Grady
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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3
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Cannata A, Savarese G. Importance of Adding Quality of Life to Years of Life in Patients With Heart Failure. JACC. ASIA 2023; 3:363-364. [PMID: 37323872 PMCID: PMC10261885 DOI: 10.1016/j.jacasi.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Antonio Cannata
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College, London, London, United Kingdom
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
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4
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Zannad F, Alikhaani J, Alikhaani S, Butler J, Gordon J, Jensen K, Khatib R, Mantovani L, Martinez R, Moore WF, Murakami M, Roessig L, Stockbridge N, Van Spall HGC, Yancy C, Spertus JA. Patient-reported outcome measures and patient engagement in heart failure clinical trials: multi-stakeholder perspectives. Eur J Heart Fail 2023; 25:478-487. [PMID: 36924142 DOI: 10.1002/ejhf.2828] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
There are many consequences of heart failure (HF), including symptoms, impaired health-related quality of life (HRQoL), and physical and social limitations (functional status). These have a substantial impact on patients' lives, yet are not routinely captured in clinical trials. Patient-reported outcomes (PROs) can quantify patients' experiences of their disease and its treatment. Steps can be taken to improve the use of PROs in HF trials, in regulatory and payer decisions, and in patient care. Importantly, PRO measures (PROMs) must be developed with involvement of patients, family members, and caregivers from diverse demographic groups and communities. PRO data collection should become more routine not only in clinical trials but also in clinical practice. This may be facilitated by the use of digital tools and interdisciplinary patient advocacy efforts. There is a need for standardization, not only of the PROM instruments, but also in procedures for analysis, interpretation and reporting PRO data. More work needs to be done to determine the degree of change that is important to patients and that is associated with increased risks of clinical events. This 'minimal clinically important difference' requires further research to determine thresholds for different PROMs, to assess consistency across trial populations, and to define standards for improvement that warrant regulatory and reimbursement approvals. PROs are a vital part of patient care and drug development, and more work should be done to ensure that these measures are both reflective of the patient experience and that they are more widely employed.
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Affiliation(s)
- Faiez Zannad
- Université de Lorraine, Inserm Clinical Investigation Center at Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy, Nancy, France
| | | | | | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jason Gordon
- HEOR- Health Economics and Outcomes Research, Ltd, Cardiff, UK
| | | | - Rani Khatib
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds; Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lorenzo Mantovani
- Value-Based Healthcare Unit, IRCCS Multimedica Hospital, Milan, Italy
| | | | - Wanda F Moore
- Sarver Heart Center Women's Heart Health Education Comm., University of Arizona, Tucson, AZ, USA
| | | | - Lothar Roessig
- Clinical Development Group, Bayer AG, Leverkusen, Germany
| | - Norman Stockbridge
- Division of Cardiology and Nephrology, Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, MD, USA
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joseph's, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Clyde Yancy
- Department of Internal Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - John A Spertus
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
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5
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Treewaree S, Kulthamrongsri N, Owattanapanich W, Krittayaphong R. Is it time for class I recommendation for sodium-glucose cotransporter-2 inhibitors in heart failure with mildly reduced or preserved ejection fraction?: An updated systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1046194. [PMID: 36824458 PMCID: PMC9941559 DOI: 10.3389/fcvm.2023.1046194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
Background In heart failure with reduced ejection fraction (HFrEF), sodium-glucose cotransporter-2 (SGLT2) inhibitors were demonstrated to lower cardiovascular mortality (CV death) and hospitalization for heart failure (HHF); however, the advantages of SGLT2 inhibitors in heart failure with mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF) are less clear. SGLT2 inhibitors were reported to enhance quality of life (QoL) in HFmrEF or HFpEF patients; however, the findings among studies are inconsistent. Objective To conduct an updated systematic review and meta-analysis of recent data to assess the effect of SGLT2 inhibitors on cardiovascular outcomes and QoL in patients with HFmrEF or HFpEF. Method Three databases were searched for studies that evaluated SGLT2 inhibitors and their effect on cardiovascular outcomes, including CV death, HHF, all-cause death, and the composite outcome of CV death, HHF, and urgent visit for heart failure (HF), and patient QoL (Kansas City Cardiomyopathy Questionnaire [KCCQ] score compared to baseline, and increase in KCCQ score ≥ 5 points) that were published during January 2000-August 2022. The meta-analysis was performed using the inverse variance method and random-effects model. INPLASY registration: INPLASY202290023. Results Sixteen studies (9 recent RCTs) were included, and a total of 16,710 HFmrEF or HFpEF patients were enrolled. SGLT2 inhibitors significantly reduced composite cardiovascular outcome (CV death/HHF/urgent visit for HF; pooled hazard ratio [HR]: 0.80, 95% confidence interval [95%CI]: 0.74-0.86) and HHF alone (HR: 0.74, 95%CI: 0.67-0.82), but there was no significant reduction in CV death alone (HR: 0.93, 95%CI: 0.82-1.05). Benefit of SGLT2 inhibitors for decreasing CV death/HHF was observed across all subgroups, including left ventricular ejection fraction (LVEF) range, diabetes status, New York Heart Association functional class, and baseline renal function. For total HHF, SGLT2 inhibitors conferred benefit in both LVEF 50-60% (HR: 0.64, 95%CI: 0.54-0.76), and LVEF >60% (HR: 0.84, 95%CI: 0.71-0.98). Significant change was observed in the KCCQ-clinical summary score compared to baseline (mean difference: 1.33, 95%CI: 1.31-1.35), and meaningful improvement in QoL was shown across all 3 types of increase in KCCQ score ≥ 5 points. Conclusion This study demonstrates the benefits of SGLT2 inhibitors for improving cardiovascular outcomes and QoL in HFmrEF or HFpEF patients.
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Affiliation(s)
- Sukrit Treewaree
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narathorn Kulthamrongsri
- Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weerapat Owattanapanich
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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6
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Younes H, Noujaim C, Mekhael M, Chouman N, Assaf A, Kreidieh O, Lim C, Marrouche N, Donnellan E. Atrial fibrillation ablation as first-line therapy for patients with heart failure with reduced ejection fraction (HFrEF): evaluating the impact on patient survival. Expert Rev Cardiovasc Ther 2023; 21:111-121. [PMID: 36680789 DOI: 10.1080/14779072.2023.2172402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Atrial fibrillation and congestive heart failure share several pathophysiological mechanisms. As a result of their association, patients have worse outcomes than if either condition were present alone. AREAS COVERED While multiple trials report no significant difference between the use of pharmacological rhythm control and the use of rate control in terms of mortality and morbidity in patients with HFrEF, there is evidence to suggest that catheter ablation is beneficial in this patient population. The present review aims to provide a comprehensive overview of catheter ablation as a treatment modality for atrial fibrillation in patients with HFrEF as well as evaluate its outcome on survival. EXPERT OPINION An appropriate patient selection strategy for patients with HFrEF could be the next step in determining which patients might benefit most from catheter ablation. Future atrial fibrillation management may incorporate digital health and pulsed-field ablation.
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Affiliation(s)
- Hadi Younes
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Charbel Noujaim
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mario Mekhael
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Nour Chouman
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ala Assaf
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Omar Kreidieh
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Chanho Lim
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Nassir Marrouche
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eoin Donnellan
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
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7
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Voorrips SN, Saucedo-Orozco H, Sánchez-Aguilera PI, De Boer RA, Van der Meer P, Westenbrink BD. Could SGLT2 Inhibitors Improve Exercise Intolerance in Chronic Heart Failure? Int J Mol Sci 2022; 23:ijms23158631. [PMID: 35955784 PMCID: PMC9369142 DOI: 10.3390/ijms23158631] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
Despite the constant improvement of therapeutical options, heart failure (HF) remains associated with high mortality and morbidity. While new developments in guideline-recommended therapies can prolong survival and postpone HF hospitalizations, impaired exercise capacity remains one of the most debilitating symptoms of HF. Exercise intolerance in HF is multifactorial in origin, as the underlying cardiovascular pathology and reactive changes in skeletal muscle composition and metabolism both contribute. Recently, sodium-related glucose transporter 2 (SGLT2) inhibitors were found to improve cardiovascular outcomes significantly. Whilst much effort has been devoted to untangling the mechanisms responsible for these cardiovascular benefits of SGLT2 inhibitors, little is known about the effect of SGLT2 inhibitors on exercise performance in HF. This review provides an overview of the pathophysiological mechanisms that are responsible for exercise intolerance in HF, elaborates on the potential SGLT2-inhibitor-mediated effects on these phenomena, and provides an up-to-date overview of existing studies on the effect of SGLT2 inhibitors on clinical outcome parameters that are relevant to the assessment of exercise capacity. Finally, current gaps in the evidence and potential future perspectives on the effects of SGLT2 inhibitors on exercise intolerance in chronic HF are discussed.
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Affiliation(s)
- Suzanne N. Voorrips
- Correspondence: (S.N.V.); (B.D.W.); Tel.: +31-50-361-2355 (S.N.V. & B.D.W.); Fax: +31-50-361-4391 (S.N.V. & B.D.W.)
| | | | | | | | | | - B. Daan Westenbrink
- Correspondence: (S.N.V.); (B.D.W.); Tel.: +31-50-361-2355 (S.N.V. & B.D.W.); Fax: +31-50-361-4391 (S.N.V. & B.D.W.)
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8
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Nassif M, Fine JT, Dolan C, Reaney M, Addepalli P, Allen VD, Sehnert AJ, Gosch K, Spertus JA. Validation of the Kansas City Cardiomyopathy Questionnaire in Symptomatic Obstructive Hypertrophic Cardiomyopathy. JACC: HEART FAILURE 2022; 10:531-539. [DOI: 10.1016/j.jchf.2022.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 04/08/2023]
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9
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Aida K, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Nakamura T, Yamashita M, Uchida S, Maekawa E, Reed JL, Yamaoka-Tojo M, Matsunaga A, Ako J. Optimal cutoff values for physical function tests in elderly patients with heart failure. Sci Rep 2022; 12:6920. [PMID: 35484373 PMCID: PMC9051131 DOI: 10.1038/s41598-022-10622-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 04/11/2022] [Indexed: 11/09/2022] Open
Abstract
Six-minute walk distance (6MWD) of 300 and 400 m are important targets of functional capacity. The present study was performed to determine cutoff values of physical function associated with 6MWD < 300 m and < 400 m in elderly patients with heart failure (HF). 6MWD, handgrip strength, quadriceps isometric strength (QIS), one-leg standing time (OLST), and 5-times sit-to-stand (5STS) before hospital discharge were evaluated in 1001 patients > 65 years (median age, 75: interquartile range, 71-80, 607 men) with HF. 6MWD < 300 and < 400 m were seen in 323 patients (32.3%) and 658 patients (65.7%), respectively. Handgrip strength, QIS, OLST, and 5STS were associated with 6MWD < 300 and < 400 m, respectively (P < 0.001). The cutoff values of handgrip strength, QIS, OLST, and 5STS were 18.9 kg, 35.0% body mass (BM), 9.1 s, and 9.5 s for 6MWD < 300 m, and 21.9 kg, 40.0% BM, 12.0 s, and 8.8 s for < 400 m, respectively. The cutoff values of physical function could be used to set cardiac rehabilitation goals and limiting determinants of reduced functional capacity in a clinical setting in elderly patients with HF.
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Affiliation(s)
- Keita Aida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Physical Medicine and Rehabilitation, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takeshi Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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10
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DeVore AD, Hellkamp AS, Thomas L, Albert NM, Butler J, Patterson JH, Spertus JA, Williams FB, Shen X, Hernandez AF, Fonarow GC. The Association of Improvement in Left Ventricular Ejection Fraction with Outcomes in Patients with Heart Failure with Reduced Ejection Fraction: Data from CHAMP-HF. Eur J Heart Fail 2022; 24:762-770. [PMID: 35293088 DOI: 10.1002/ejhf.2486] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/07/2022] Open
Abstract
AIMS We assessed for an association between improvements in left ventricular ejection fraction (LVEF) and future outcomes, including health status, in routine clinical practice. METHODS AND RESULTS CHAMP-HF was a registry of outpatients with heart failure (HF) and LVEF <40%. Enrolled participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at regular intervals and were followed as part of routine care. We assessed for associations between improvements in LVEF (>10%) over time and concurrent changes in KCCQ-12, as well as the subsequent risk of poor outcomes. We included 2092 participants in the study. They had the following characteristics: median age 67 years (25th , 75th percentile 58, 75), 29% female, median duration of HF 2.7 years (0.6, 6.8), and median baseline LVEF 30% (23, 35). Of the study participants, 689 (34%) had a >10% absolute improvement in LVEF. Participants with an LVEF improvement also had an improvement in KCCQ-12 overall summary score compared with participants without an LVEF improvement (+7.6 vs +3.5, adjusted effect estimate +4.1 [95% CI 2.3 to 5.7]). Similarly, subsequent all-cause death or HF hospitalization occurred in 12% in the LVEF improvement group vs 25% in the group without an LVEF improvement (adjusted HR 0.50, 95% CI 0.41 to 0.61). CONCLUSION In a large cohort of outpatients with chronic HF, improvements in LVEF were associated with improved health status and a reduced risk for future clinical events. These data underscore the importance of improvement in LVEF as a treatment target for medical interventions for patients with chronic HF.
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Affiliation(s)
- Adam D DeVore
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Laine Thomas
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO, USA
| | | | - Xian Shen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
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11
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Alonso WW, Kupzyk KA, Norman JF, Lundgren SW, Fisher A, Lindsey ML, Keteyian SJ, Pozehl BJ. The HEART Camp Exercise Intervention Improves Exercise Adherence, Physical Function, and Patient-Reported Outcomes in Adults With Preserved Ejection Fraction Heart Failure. J Card Fail 2022; 28:431-442. [PMID: 34534664 PMCID: PMC8920955 DOI: 10.1016/j.cardfail.2021.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite exercise being one of few strategies to improve outcomes for individuals with heart failure with preserved ejection fraction (HFpEF), exercise clinical trials in HFpEF are plagued by poor interventional adherence. Over the last 2 decades, our research team has developed, tested, and refined Heart failure Exercise And Resistance Training (HEART) Camp, a multicomponent behavioral intervention to promote adherence to exercise in HF. We evaluated the effects of this intervention designed to promote adherence to exercise in HF focusing on subgroups of participants with HFpEF and heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS This randomized controlled trial included 204 adults with stable, chronic HF. Of those enrolled, 59 had HFpEF and 145 had HFrEF. We tested adherence to exercise (defined as ≥120 minutes of moderate-intensity [40%-80% of heart rate reserve] exercise per week validated with a heart rate monitor) at 6, 12, and 18 months. We also tested intervention effects on symptoms (Patient-Reported Outcomes Measurement Information System-29 and dyspnea-fatigue index), HF-related health status (Kansas City Cardiomyopathy Questionnaire), and physical function (6-minute walk test). Participants with HFpEF (n = 59) were a mean of 64.6 ± 9.3 years old, 54% male, and 46% non-White with a mean ejection fraction of 55 ± 6%. Participants with HFpEF in the HEART Camp intervention group had significantly greater adherence compared with enhanced usual care at both 12 (43% vs 14%, phi = 0.32, medium effect) and 18 months (56% vs 0%, phi = 0.67, large effect). HEART Camp significantly improved walking distance on the 6-minute walk test (η2 = 0.13, large effect) and the Kansas City Cardiomyopathy Questionnaire overall (η2 = 0.09, medium effect), clinical summary (η2 = 0.16, large effect), and total symptom (η2 = 0.14, large effect) scores. In the HFrEF subgroup, only patient-reported anxiety improved significantly in the intervention group. CONCLUSIONS A multicomponent, behavioral intervention is associated with improvements in long-term adherence to exercise, physical function, and patient-reported outcomes in adults with HFpEF and anxiety in HFrEF. Our results provide a strong rationale for a large HFpEF clinical trial to validate these findings and examine interventional mechanisms and delivery modes that may further promote adherence and improve clinical outcomes in this population. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov/. Unique identifier: NCT01658670.
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Affiliation(s)
- Windy W. Alonso
- College of Nursing,University of Nebraska Medical Center, Omaha, NE 68198,Corresponding author: Windy W. Alonso, PhD, RN, FHFSA, University of Nebraska Medical Center-College of Nursing, 985330 Nebraska Medicine, Omaha, NE 68198-5330, , Phone number: 402-559-8342, Fax number: 402-559-9666
| | - Kevin A. Kupzyk
- College of Nursing,University of Nebraska Medical Center, Omaha, NE 68198
| | - Joseph F. Norman
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE 68198
| | - Scott W. Lundgren
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68918
| | - Alfred Fisher
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198
| | - Merry L. Lindsey
- Department of Cellular and Integrative Physiology, Center for Heart and Vascular Research, University of Nebraska Medical Center, Omaha, NE 68102,Research Service, Nebraska-Western Iowa Health Care System, Omaha, NE 68198
| | | | - Bunny J. Pozehl
- College of Nursing,University of Nebraska Medical Center, Omaha, NE 68198
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12
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Zia A, Stanek J, Christian‐Rancy M, Savelli S, O'Brien SH. Iron deficiency and fatigue among adolescents with bleeding disorders. Am J Hematol 2022; 97:60-67. [PMID: 34710246 DOI: 10.1002/ajh.26389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 01/01/2023]
Abstract
Iron deficiency anemia is associated with heavy menstrual bleeding (HMB) and, by extension, a bleeding disorder (BD). It is unknown if iron deficiency without anemia is associated with a BD in adolescents. Moreover, the threshold of ferritin associated with fatigue in adolescents with HMB is unclear. In this multicenter study, we enrolled adolescents with HMB without BD. Participants underwent BD and anemia work-up in Young Women's Hematology Clinics and completed the Peds QL™ fatigue scale. BDs were defined as von Willebrand Disease, platelet function defect, clotting factor deficiencies, and hypermobility syndrome. Two hundred and fifty consecutive adolescents were enrolled, of whom 196 met eligibility criteria. Overall, 43% (95% confidence interval: 36%-50%) were diagnosed with BD. A total of 61% (n = 119) had serum ferritin levels < 15 ng/mL, 23.5% (n = 46) had iron deficiency only, and 37% (n = 73) had iron deficiency anemia. Low ferritin or ferritin dichotomized as < 15 or ≥ 15 ng/mL was not associated with BD on univariable analysis (p = .24) or when accounting for age, race, ethnicity, body mass index, and hemoglobin (p = .35). A total of 85% had total fatigue score below the population mean of 80.5, and 52% (n = 102) were > 2 SD (or < 54) below the mean, the cut-off associated with severe fatigue. A ferritin threshold of < 6 ng/mL had a specificity of 79.8% but a sensitivity of 36% for severe fatigue. In conclusion, iron deficiency without anemia is not a predictor of BD in adolescents with HMB in a specialty setting. Severe fatigue, especially sleep fatigue, is prevalent in adolescents with BD. Ferritin of < 6 ng/mL has ~80% specificity for severe fatigue in adolescents with HMB.
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Affiliation(s)
- Ayesha Zia
- Division of Pediatric Hematology/Oncology University of Texas Southwestern Medical Center Dallas Texas USA
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas Texas USA
| | - Joseph Stanek
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital Columbus Ohio USA
| | - Myra Christian‐Rancy
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital Columbus Ohio USA
| | - Stephanie Savelli
- Department of Pediatrics, Akron Children's Hospital, The Ohio State University Columbus Ohio USA
- Northeastern Ohio Universities College of Medicine Columbus Ohio USA
| | - Sarah H. O'Brien
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital Columbus Ohio USA
- Department of Pediatrics The Ohio State University, College of Medicine Columbus Ohio USA
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13
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He Z, Yang L, Nie Y, Wang Y, Wang Y, Niu X, Bai M, Yao Y, Zhang Z. Effects of SGLT-2 inhibitors on health-related quality of life and exercise capacity in heart failure patients with reduced ejection fraction: A systematic review and meta-analysis. Int J Cardiol 2021; 345:83-88. [PMID: 34653575 DOI: 10.1016/j.ijcard.2021.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/04/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Improving health-related quality of life (HRQoL) and exercise capacity is an important goal of treatment in heart failure (HF). However, evidence for the effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors on the improvement of HRQoL and exercise capacity seems to be conflicted. We performed a systematic review and meta-analysis to evaluate the effects of SGLT-2 inhibitors on HRQL and exercise capacity in patients with heart failure and reduced ejection fraction (HFrEF). METHODS All studies (up to March 20, 2021) evaluating the effects of SGLT-2 inhibitors on HRQoL and exercise capacity in patients with HFrEF were initially searched from four electronic search engines: PubMed, Web of Science, Cochrane Library, and SinoMed. All statistical analyses were performed with RevMan 5.4. RESULTS We included 9 articles describing 7 trials with 9428 patients. SGLT-2 inhibitors group exhibited significant improvement in HRQoL assessed by Kansas City Cardiomyopathy Questionnaires (KCCQ) (MD: 2.13, 95% CI: 1.11 to 3.14, p < 0.001) and the rate of KCCQ-overall summary score improvement≥5 points (RR 1.15, 95%CI 1.08 to 1.21, P < 0.001) compared with placebo. No significant difference was observed in exercise capacity assessed by 6-min walk test distance between SGLT-2 inhibitors and placebo (MD 24.45, 95%CI -22.82 to 71.72, P = 0.31). CONCLUSIONS Our meta-analysis demonstrates that SGLT-2 inhibitors significantly improve HRQoL, and supports the concept that SGLT-2 inhibitors do not significantly improve exercise capacity in patients with HFrEF. Studies with larger sample sizes and longer follow-up duration are needed to determine whether the treatment with SGLT-2 inhibitors may improve exercise ability. PROSPERO CRD42021248346.
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Affiliation(s)
- Zhiyu He
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China; the First Clinical Medical School, Lanzhou University, Lanzhou, China; Gansu Key Laboratory for Cardiovascular Diseases of Gansu Province, Lanzhou, China; Cardiovascular Clinical Research Center of Gansu Province, China
| | - Lin Yang
- Department of pathology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Yutong Nie
- the First Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Yu Wang
- the First Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Yangyang Wang
- the First Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Xiaowei Niu
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China; Gansu Key Laboratory for Cardiovascular Diseases of Gansu Province, Lanzhou, China; Cardiovascular Clinical Research Center of Gansu Province, China
| | - Ming Bai
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China; Gansu Key Laboratory for Cardiovascular Diseases of Gansu Province, Lanzhou, China; Cardiovascular Clinical Research Center of Gansu Province, China
| | - Yali Yao
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China; Gansu Key Laboratory for Cardiovascular Diseases of Gansu Province, Lanzhou, China; Cardiovascular Clinical Research Center of Gansu Province, China
| | - Zheng Zhang
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China; the First Clinical Medical School, Lanzhou University, Lanzhou, China; Gansu Key Laboratory for Cardiovascular Diseases of Gansu Province, Lanzhou, China; Cardiovascular Clinical Research Center of Gansu Province, China.
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14
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DeVore AD, Hill CL, Thomas LE, Albert NM, Butler J, Patterson JH, Hernandez AF, Williams FB, Shen X, Spertus JA, Fonarow GC. Identifying patients at increased risk for poor outcomes from heart failure with reduced ejection fraction: the PROMPT-HF risk model. ESC Heart Fail 2021; 9:178-185. [PMID: 34791838 PMCID: PMC8787961 DOI: 10.1002/ehf2.13709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/04/2021] [Accepted: 10/29/2021] [Indexed: 01/14/2023] Open
Abstract
Aims We aimed to develop a risk prediction tool that incorporated both clinical events and worsening health status for patients with heart failure (HF) with reduced ejection fraction (HFrEF). Identifying patients with HFrEF at increased risk of a poor outcome may enable proactive interventions that improve outcomes. Methods and results We used data from a longitudinal HF registry, CHAMP‐HF, to develop a risk prediction tool for poor outcomes over the next 6 months. A poor outcome was defined as death, an HF hospitalization, or a ≥20‐point decrease (or decrease below 25) in 12‐item Kansas City Cardiomyopathy Questionnaire (KCCQ‐12) overall summary score. Among 4546 patients in CHAMP‐HF, 1066 (23%) experienced a poor outcome within 6 months (1.3% death, 11% HF hospitalization, and 11% change in KCCQ‐12). The model demonstrated moderate discrimination (c‐index = 0.65) and excellent calibration with observed data. The following variables were associated with a poor outcome: age, race, education, New York Heart Association class, baseline KCCQ‐12, atrial fibrillation, coronary disease, diabetes, chronic kidney disease, smoking, prior HF hospitalization, and systolic blood pressure. We also created a simplified model with a 0–10 score using six variables (New York Heart Association class, KCCQ‐12, coronary disease, chronic kidney disease, prior HF hospitalization, and systolic blood pressure) with similar discrimination (c‐index = 0.63). Patients scoring 0–3 were considered low risk (event rate <20%), 4–6 were considered intermediate risk (event rate 20–40%), and 7–10 were considered high risk (event rate >40%). Conclusions The PROMPT‐HF risk model can identify outpatients with HFrEF at increased risk of poor outcomes, including clinical events and health status deterioration. With further validation, this model may help inform therapeutic decision making.
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Affiliation(s)
- Adam D DeVore
- Duke Clinical Research Institute, 200 Morris Street, Office 6318, Durham, NC, 27701, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Claude Larry Hill
- Duke Clinical Research Institute, 200 Morris Street, Office 6318, Durham, NC, 27701, USA
| | - Laine E Thomas
- Duke Clinical Research Institute, 200 Morris Street, Office 6318, Durham, NC, 27701, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, 200 Morris Street, Office 6318, Durham, NC, 27701, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Xian Shen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
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15
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Blood Lactate AUC Is a Sensitive Test for Evaluating the Effect of Exercise Training on Functional Work Capacity in Patients with Chronic Heart Failure. Rehabil Res Pract 2021; 2021:6619747. [PMID: 34631167 PMCID: PMC8497121 DOI: 10.1155/2021/6619747] [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: 12/13/2020] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Exercise training is an essential treatment option for patients with chronic heart failure (CHF). However, it remains controversial, which surrogate measures of functional work capacity are most reliable. The purpose of this paper was to compare functional capacity work measured as capillary lactate concentrations area under the curve (AUC) with standard cardiopulmonary exercise testing (CPET) with VO2peak and the 6-minute walk test (6 MWT). Methods Twenty-three patients in New York Heart Association (NYHA) class II/III with left ventricular ejection fraction (LVEF) <35% were randomised to home-based recommendation of regular exercise (RRE) (controls), moderate continuous training (MCT) or aerobic interval training (AIT). The MCT and AIT groups underwent 12 weeks of supervised exercise training. Exercise testing was performed as standard CPET treadmill test with analysis of VO2peak, the 6 MWT and a novel 30-minute submaximal treadmill test with capillary lactate AUC. Results All patients had statistically significant improvements in VO2peak, 6 MWT and lactate AUC after 12 weeks of exercise training: 6 MWT (p =0.035), VO2peak (p =0.049) and lactate AUC (p =0.002). Lactate AUC (p =0.046) and 6MWT (p =0.035), but not VO2peak revealed difference between the exercise modalities regarding functional work capacity. Conclusion 6-MWT and lactate AUC, but not VO2peak, were able to reveal a statistically significant improvement in functional capacity between different exercise modalities.
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16
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Stubblefield WB, Jenkins CA, Liu D, Storrow AB, Spertus JA, Pang PS, Levy PD, Butler J, Chang AM, Char D, Diercks DB, Fermann GJ, Han JH, Hiestand BC, Hogan CJ, Khan Y, Lee S, Lindenfeld JM, McNaughton CD, Miller K, Peacock WF, Schrock JW, Self WH, Singer AJ, Sterling SA, Collins SP. Improvement in Kansas City Cardiomyopathy Questionnaire Scores After a Self-Care Intervention in Patients With Acute Heart Failure Discharged From the Emergency Department. Circ Cardiovasc Qual Outcomes 2021; 14:e007956. [PMID: 34555929 PMCID: PMC8628372 DOI: 10.1161/circoutcomes.121.007956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We conducted a secondary analysis of changes in the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 over 30 days in a randomized trial of self-care coaching versus structured usual care in patients with acute heart failure who were discharged from the emergency department. METHODS Patients in 15 emergency departments completed the KCCQ-12 at emergency department discharge and at 30 days. We compared change in KCCQ-12 scores between the intervention and usual care arms, adjusted for enrollment KCCQ-12 and demographic characteristics. We used linear regression to describe changes in KCCQ-12 summary scores and logistic regression to characterize clinically meaningful KCCQ-12 subdomain changes at 30 days. RESULTS There were 350 patients with both enrollment and 30-day KCCQ summary scores available; 166 allocated to usual care and 184 to the intervention arm. Median age was 64 years (interquartile range, 55-70), 37% were female participants, 63% were Black, median KCCQ-12 summary score at enrollment was 47 (interquartile range, 33-64). Self-care coaching resulted in significantly greater improvement in health status compared with structured usual care (5.4-point greater improvement, 95% CI, 1.12-9.68; P=0.01). Improvements in health status in the intervention arm were driven by improvements within the symptom frequency (adjusted odds ratio, 1.62 [95% CI, 1.01-2.59]) and quality of life (adjusted odds ratio, 2.39 [95% CI, 1.46-3.90]) subdomains. CONCLUSIONS In this secondary analysis, patients with acute heart failure who received a tailored, self-care intervention after emergency department discharge had clinically significant improvements in health status at 30 days compared with structured usual care largely due to improvements within the symptom frequency and quality of life subdomains of the KCCQ-12. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02519283.
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Affiliation(s)
- William B Stubblefield
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Cathy A Jenkins
- Department of Biostatistics (C.A.J., D.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Dandan Liu
- Department of Biostatistics (C.A.J., D.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Alan B Storrow
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - John A Spertus
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City and Saint Luke's Mid America Heart Institute, MO (J.A.S.)
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.S.P.)
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI (P.D.L.)
| | - Javed Butler
- Department of Medicine (J.B.), University of Mississippi Medical Center, Jackson
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital (A.M.C.)
| | - Douglas Char
- Division of Emergency Medicine, Department of Internal Medicine, Washington University, Seattle (D.C.)
| | - Deborah B Diercks
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX (D.B.D.)
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.)
| | - Jin H Han
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Brian C Hiestand
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (B.C.H.)
| | - Christopher J Hogan
- Division of Trauma/Critical Care, Departments of Emergency Medicine and Surgery, Virginia Commonwealth University Medical Center, Richmond (C.J.H.)
| | - Yosef Khan
- Health Informatics and Analytics, Centers for Health Metrics and Evaluation, American Heart Association (Y.K.)
| | - Sangil Lee
- Department of Emergency Medicine, University of Iowa Carver College of Medicine (S.L.)
| | - JoAnn M Lindenfeld
- Division of Cardiovascular Disease (J.M.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Candace D McNaughton
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Karen Miller
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.)
| | - Jon W Schrock
- Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (J.W.S.)
| | - Wesley H Self
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University, NY (A.J.S.)
| | - Sarah A Sterling
- Department of Emergency Medicine (S.A.S.), University of Mississippi Medical Center, Jackson
| | - Sean P Collins
- Department of Emergency Medicine (W.B.S., A.B.S., J.H.H., C.D.M., K.M., W.H.S., S.P.C.), Vanderbilt University Medical Center, Nashville, TN
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Prognostic Importance of Health Status Versus Functional Status in Heart Failure and Secondary Mitral Regurgitation. JACC-HEART FAILURE 2021; 9:684-692. [PMID: 34391740 DOI: 10.1016/j.jchf.2021.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study sought to understand the extent to which health status and exercise capacity are independently associated with long-term outcomes in patients with heart failure (HF) and secondary mitral regurgitation (MR). BACKGROUND Secondary MR in patients with HF leads to impaired health status (Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OS]) and exercise capacity (6-minute walk distance [6MWD]), both of which improve after transcatheter mitral valve repair (TMVr). METHODS The study used data from the COAPT trial (N = 604) to examine the association of baseline KCCQ-OS and 6MWD with 2-year mortality and HF hospitalization, adjusting for treatment arm and patient factors. We also examined the association of change in KCCQ-OS and 6MWD from baseline to 1 month with risk of outcomes from 1 month to 2 years. Interactions of KCCQ-OS and 6MWD with treatment assignment were explored. RESULTS Mean baseline KCCQ-OS was 53 ± 23 points, and 6MWD was 240 ± 125 meters. In models including both measures, greater baseline 6MWD (but not KCCQ-OS) was associated with reduced 2-year mortality (HR per 125 meters: 0.75, 95% CI: 0.61-0.92). When stratified by treatment group, both baseline KCCQ-OS and 6MWD were independently associated with HF hospitalization in patients treated with medical therapy, whereas only KCCQ-OS was associated with HF hospitalization in patients treated with TMVr. In separate analyses, 1-month improvements in KCCQ-OS and 6MWD were each associated with lower subsequent risk of mortality and HF hospitalization, independent of treatment group. CONCLUSIONS Among patients with HF and severe secondary MR, assessment of both health status and exercise capacity provide complementary prognostic information for patients with HF and severe secondary MR-both before and after TMVr. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial]; NCT01626079).
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LaMonte MJ, Eaton CB. Physical Activity in the Treatment and Prevention of Heart Failure: An Update. Curr Sports Med Rep 2021; 20:410-417. [PMID: 34357887 PMCID: PMC8351911 DOI: 10.1249/jsr.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Heart failure (HF) is a complex clinical syndrome hallmarked by an inability to match cardiac output with metabolic demand, resulting in exercise intolerance. HF is increasingly prevalent in an aging population and accounts for substantial burden of health care costs and morbidity. Because many of the central and peripheral mechanisms of HF respond favorably to exercise training, its role in HF treatment is becoming established. The role of habitual physical activity in the primary prevention of HF is less clear; however, available evidence is supportive. This article reviews recently published studies on exercise training and usual physical activity in HF treatment and prevention, discusses potential mechanisms, and suggests areas where further research is needed.
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Affiliation(s)
- Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Charles B. Eaton
- Departments of Family Medicine and Epidemiology, Warren Alpert Medical School, Director, Center for Primary Care and Prevention, Brown University, Providence, RI, USA
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Spertus JA, Fine JT, Elliott P, Ho CY, Olivotto I, Saberi S, Li W, Dolan C, Reaney M, Sehnert AJ, Jacoby D. Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): health status analysis of a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2021; 397:2467-2475. [PMID: 34004177 DOI: 10.1016/s0140-6736(21)00763-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Improving symptoms is a primary treatment goal in patients with obstructive hypertrophic cardiomyopathy. Currently available pharmacological options for hypertrophic cardiomyopathy are not disease-specific and are often inadequate or poorly tolerated. We aimed to assess the effect of mavacamten, a first-in-class cardiac myosin inhibitor, on patients' health status-ie, symptoms, physical and social function, and quality of life. METHODS We did a health status analysis of EXPLORER-HCM, a phase 3, double-blind, randomised, placebo-controlled trial. The study took place at 68 clinical cardiovascular centres in 13 countries. Adult patients (≥18 years) with symptomatic obstructive hypertrophic cardiomyopathy (gradient ≥50 mm Hg and New York Heart Association class II-III) were randomly assigned (1:1) to mavacamten or placebo for 30 weeks, followed by an 8-week washout period. Both patients and staff were masked to study treatment. The primary outcome for this secondary analysis was the Kansas City Cardiomyopathy Questionnaire (KCCQ), a well validated disease-specific measure of patients' health status. It was administered at baseline and weeks 6, 12, 18, 30 (end of treatment), and 38 (end of study). Changes from baseline to week 30 in KCCQ overall summary (OS) score and all subscales were analysed using mixed model repeated measures. This study is registered with ClinicalTrials.gov, NCT03470545. FINDINGS Between May 30, 2018, and July 12, 2019, 429 adults were assessed for eligibility, of whom 251 (59%) were enrolled and randomly assigned. Of 123 patients randomly assigned to mavacamten, 92 (75%) completed the KCCQ at baseline and week 30 and of the 128 patients randomly assigned to placebo 88 (69%) completed the KCCQ at baseline and week 30. At 30 weeks, the change in KCCQ-OS score was greater with mavacamten than placebo (mean score 14·9 [SD 15·8] vs 5·4 [13·7]; difference +9·1 [95% CI 5·5-12·8]; p<0·0001), with similar benefits across all KCCQ subscales. The proportion of patients with a very large change (KCCQ-OS ≥20 points) was 36% (33 of 92) in the mavacamten group versus 15% (13 of 88) in the placebo group, with an estimated absolute difference of 21% (95% CI 8·8-33·4) and number needed to treat of five (95% CI 3-11). These gains returned to baseline after treatment was stopped. INTERPRETATION Mavacamten markedly improved the health status of patients with symptomatic obstructive hypertrophic cardiomyopathy compared with placebo, with a low number needed to treat for marked improvement. Given that the primary goals of treatment are to improve symptoms, physical and social function, and quality of life, mavacamten represents a new potential strategy for achieving these goals. FUNDING MyoKardia, a Bristol Myers Squibb company.
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Affiliation(s)
- John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri, Kansas City, MO, USA.
| | - Jennifer T Fine
- MyoKardia, a Bristol Myers Squibb company, Brisbane, CA, USA
| | - Perry Elliott
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Carolyn Y Ho
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Wanying Li
- MyoKardia, a Bristol Myers Squibb company, Brisbane, CA, USA
| | | | | | - Amy J Sehnert
- MyoKardia, a Bristol Myers Squibb company, Brisbane, CA, USA
| | - Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA
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20
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Hundertmark MJ, Agbaje OF, Coleman R, George JT, Grempler R, Holman RR, Lamlum H, Lee J, Milton JE, Niessen HG, Rider O, Rodgers CT, Valkovič L, Wicks E, Mahmod M, Neubauer S. Design and rationale of the EMPA-VISION trial: investigating the metabolic effects of empagliflozin in patients with heart failure. ESC Heart Fail 2021; 8:2580-2590. [PMID: 33960149 PMCID: PMC8318430 DOI: 10.1002/ehf2.13406] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/10/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022] Open
Abstract
Aims Despite substantial improvements over the last three decades, heart failure (HF) remains associated with a poor prognosis. The sodium‐glucose co‐transporter‐2 inhibitor empagliflozin demonstrated significant reductions of HF hospitalization in patients with HF independent of the presence or absence of type 2 diabetes mellitus in the EMPEROR‐Reduced trial and cardiovascular mortality in the EMPA‐REG OUTCOME trial. To further elucidate the mechanisms behind these positive outcomes, this study aims to determine the effects of empagliflozin treatment on cardiac energy metabolism and physiology using magnetic resonance spectroscopy (MRS) and cardiovascular magnetic resonance (CMR). Methods and results The EMPA‐VISION trial is a double‐blind, randomized, placebo‐controlled, mechanistic study. A maximum of 86 patients with HF with reduced ejection fraction (n = 43, Cohort A) or preserved ejection fraction (n = 43, Cohort B), with or without type 2 diabetes mellitus, will be enrolled. Participants will be randomized 1:1 to receive either 10 mg of empagliflozin or placebo for 12 weeks. Eligible patients will undergo cardiovascular magnetic resonance, resting and dobutamine stress MRS, echocardiograms, cardiopulmonary exercise tests, serum metabolomics, and quality of life questionnaires at baseline and after 12 weeks. The primary endpoint will be the change in resting phosphocreatine‐to‐adenosine triphosphate ratio, as measured by 31Phosphorus‐MRS. Conclusions EMPA‐VISION is the first clinical trial assessing the effects of empagliflozin treatment on cardiac energy metabolism in human subjects in vivo. The results will shed light on the mechanistic action of empagliflozin in patients with HF and help to explain the results of the safety and efficacy outcome trials (EMPEROR‐Reduced and EMPEROR‐Preserved).
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Affiliation(s)
- Moritz J Hundertmark
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Olorunsola F Agbaje
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ruth Coleman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Rolf Grempler
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Hanan Lamlum
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Jisoo Lee
- Boehringer Ingelheim International GmBH, Ingelheim, Germany
| | - Joanne E Milton
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Heiko G Niessen
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Oliver Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Christopher T Rodgers
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, Cambridge Biomedical Campus, Cambridge, UK
| | - Ladislav Valkovič
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Eleanor Wicks
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Masliza Mahmod
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Oxford NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
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21
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Aladin AI, Whellan D, Mentz RJ, Pastva AM, Nelson MB, Brubaker P, Duncan P, Reeves G, Rosenberg P, Kitzman DW. Relationship of physical function with quality of life in older patients with acute heart failure. J Am Geriatr Soc 2021; 69:1836-1845. [PMID: 33837953 DOI: 10.1111/jgs.17156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Older patients with acute decompensated heart failure (ADHF) have severely impaired physical function (PF) and quality of life (QOL). However, relationships between impairments in PF and QOL are unknown but are relevant to clinical practice and trial design. METHODS We assessed 202 consecutive patients hospitalized with ADHF in the multicenter Rehabilitation Therapy in Older Acute HF Patients (REHAB-HF) Trial. PF measures included Short Physical Performance Battery (SPPB) and 6-min walk distance (6MWD). Disease-specific QOL was assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ). General QOL was assessed by the Short Form-12 (SF-12) and EuroQol-5D-5L. PF was evaluated as a predictor of QOL using stepwise regression adjusted for age, sex, race, and New York Heart Association class. RESULTS Participants were 72 ± 8 years, 54% women, 55% minority race, 52% with reduced ejection fraction, and body mass index 33 ± 9 kg/m2 . Participants had severe impairments in PF (6MWD 185 ± 99 m, SPPB 6.0 ± 2.5 units) and disease-specific QOL (KCCQ Overall Score 41 ± 21 and Physical Score 47 ± 24) and general QOL (SF-12 Physical Score 28 ± 9 and EuroQol Visual Analog Scale 57 ± 23). There were modest, statistically significant correlations between 6MWD and KCCQ Overall, KCCQ Physical Limitation, and SF-12 Physical Scores (r = 0.23, p < 0.001; r = 0.30, p < 0.001; and r = 0.24, p = 0.001, respectively); and between SPPB and KCCQ Physical and SF-12 Physical Scores (r = 0.20, p = 0.004, and r = 0.19, p = 0.007, respectively). Both 6MWD and SPPB were correlated with multiple components of the EuroQol-5D-5L. 6MWD was a significant, weak predictor of KCCQ Overall Score and SF-12 Physical Score (estimate = 0.05 ± 0.01, p < 0.001 and estimate = 0.05 ± 0.02, p = 0.012, respectively). SPPB was a significant, weak predictor of KCCQ Physical Score and SF-12 Physical Score (estimate = 1.37 ± 0.66, p = 0.040 and estimate = 0.54 ± 0.25, p = 0.030, respectively). CONCLUSION In older, hospitalized ADHF patients, PF and QOL are both severely impaired but are only modestly related, suggesting that PF and QOL provide complementary information and assessment of both should be considered to fully assess clinically meaningful patient-oriented outcomes.
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Affiliation(s)
- Amer I Aladin
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - David Whellan
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, United States
| | - Amy M Pastva
- Division of Physical Therapy, Duke University School of Medicine, Durham, North Carolina, United States
| | - M Benjamin Nelson
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Peter Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, United States
| | - Pamela Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Gordon Reeves
- Novant Health Heart and Vascular Institute, Charlotte, North Carolina, United States
| | - Paul Rosenberg
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, United States
| | - Dalane W Kitzman
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
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Impact of Tafamidis on Health-Related Quality of Life in Patients With Transthyretin Amyloid Cardiomyopathy (from the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial). Am J Cardiol 2021; 141:98-105. [PMID: 33220323 DOI: 10.1016/j.amjcard.2020.10.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
Abstract
In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial, tafamidis significantly reduced all-cause mortality and cardiovascular-related hospitalizations in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). ATTR-CM is associated with a significant burden of disease; further analysis of patient-reported quality of life will provide additional data on the efficacy of tafamidis. In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial, 441 adult patients with ATTR-CM were randomized (2:1:2) to tafamidis 80 mg, tafamidis 20 mg, or placebo for 30 months, with pooled tafamidis (80 mg and 20 mg) compared with placebo. Change in Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) domain scores, EQ-5D-3L scores, and patient global assessment, were prespecified exploratory end points. A greater proportion of patients improved KCCQ-OS score at month 30 with tafamidis (41.8%) versus placebo (21.4%). Tafamidis significantly reduced the decline in all 4 KCCQ-OS domains (p <0.0001 for all), and in EQ-5D-3L utility (0.09 [confidence interval 0.05 to 0.12]; p <0.0001) and EQ visual analog scale (9.11 [confidence interval 5.39 to 12.83]; p <0.0001) scores at month 30 versus placebo. A larger proportion of tafamidis-treated patients reported their patient global assessment improved at month 30 (42.3% vs 23.8% with placebo). In conclusion, tafamidis effectively reduced the decline in patient-reported outcomes, providing further insight into its efficacy in health-related quality of life in patients with ATTR-CM.
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23
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Piña IL, Camacho A, Ibrahim NE, Felker GM, Butler J, Maisel AS, Prescott MF, Williamson KM, Claggett BL, Desai AS, Solomon SD, Januzzi JL. Improvement of Health Status Following Initiation of Sacubitril/Valsartan in Heart Failure and Reduced Ejection Fraction. JACC-HEART FAILURE 2020; 9:42-51. [PMID: 33189630 DOI: 10.1016/j.jchf.2020.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/01/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Treatment of heart failure with reduced ejection fraction (EF) may improve patient-reported health outcomes. OBJECTIVES The purpose of this study was to determine timing and magnitude of change in Kansas City Cardiomyopathy Questionnaire (KCCQ)-23 scores following initiation of sacubitril/valsartan and interaction with change in amino-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations. METHODS From a single-arm, open-label study of patients initiated on sacubitril/valsartan, KCCQ-23 scores and NT-proBNP were obtained at baseline and follow-up through 12 months. Cross-sectional and longitudinal analyses evaluated magnitude and rate of change in KCCQ-23 scores and associations with NT-proBNP. Patient-level data from the randomized EVALUATE-HF study were used as historic controls. RESULTS The analysis cohort (n = 678, age 64.7 years, 71.5% men, EF 28.9%) had a baseline KCCQ-23 overall score (OS) of 65.6. Following sacubitril/valsartan initiation, the majority (n = 412; 60.8%) of participants experienced a rise in KCCQ-23 OS ≥10 points; 26.0% increased by ≥20 points. Comparable improvement in KCCQ-23 scores was seen in various subgroups. Change in KCCQ-23 OS was inversely associated with change in circulating NT-proBNP concentrations. Among a control group of patients in EVALUATE-HF, linear rate of change in KCCQ-12 OS/14-day interval in the enalapril arm was 0.37 points (p = 0.06), whereas in the sacubitril/valsartan arm, scores increased at a rate of 1.19 points (p < 0.001), nearly identical to this dataset (1.08 points; p < 0.001). CONCLUSIONS Treatment of heart failure with reduced EF with sacubitril/valsartan is associated with rapid and significant improvement in KCCQ-23 scores which was significantly related to change in NT-proBNP. (Effects of Sacubitril/Valsartan Therapy on Biomarkers, Myocardial Remodeling and Outcomes [PROVE-HF]; NCT02887183).
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Affiliation(s)
| | - Alexander Camacho
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nasrien E Ibrahim
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - G Michael Felker
- Cardiology Division, Duke University, Durham, North Carolina, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Alan S Maisel
- Cardiology Division, University of California San Diego, San Diego, California, USA
| | | | | | | | - Akshay S Desai
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
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24
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Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care. J Am Coll Cardiol 2020; 76:2379-2390. [DOI: 10.1016/j.jacc.2020.09.542] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022]
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25
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Yeoh SE, Dewan P, Desai AS, Solomon SD, Rouleau JL, Lefkowitz M, Rizkala A, Swedberg K, Zile MR, Jhund PS, Packer M, McMurray JJV. Relationship between duration of heart failure, patient characteristics, outcomes, and effect of therapy in PARADIGM-HF. ESC Heart Fail 2020; 7:3355-3364. [PMID: 33078584 PMCID: PMC7754973 DOI: 10.1002/ehf2.12972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022] Open
Abstract
Aims Little is known about patient characteristics, outcomes, and the effect of treatment in relation to duration of heart failure (HF). We have investigated these questions in PARADIGM‐HF. The aim of the study was to compare patient characteristics, outcomes, and the effect of sacubitril/valsartan, compared with enalapril, in relation to time from HF diagnosis in PARADIGM‐HF. Methods and results HF duration was categorized as 0–1, >1–2, >2–5, and >5 years. Outcomes were adjusted for prognostic variables, including N‐terminal pro‐brain natriuretic peptide (NT‐proBNP). The primary endpoint was the composite of HF hospitalization or cardiovascular death. The number of patients in each group was as follows: 0–1 year, 2523 (30%); >1–2 years, 1178 (14%); >2–5 years, 2054 (24.5%); and >5 years, 2644 (31.5%). Patients with longer‐duration HF were older, more often male, and had worse New York Heart Association class and quality of life, more co‐morbidity, and higher troponin‐T but similar NT‐proBNP levels. The primary outcome rate (per 100 person‐years) increased with HF duration: 0–1 year, 8.4 [95% confidence interval (CI) 7.6–9.2]; >1–2 years, 11.2 (10.0–12.7); >2–5 years, 13.4 (12.4–14.6); and >5 years, 14.2 (13.2–15.2); P < 0.001. The hazard ratio was 1.26 (95% CI 1.07–1.48), 1.52 (1.33–1.74), and 1.53 (1.33–1.75), respectively, for >1–2, >2–5, and >5 years, compared with 0–1 year. The benefit of sacubitril/valsartan was consistent across HF duration for all outcomes, with the primary endpoint hazard ratio 0.80 (95% CI 0.67–0.97) for 0–1 year and 0.73 (0.63–0.84) in the >5 year group. For the primary outcome, the number needed to treat for >5 years was 18, compared with 29 for 0–1 year. Conclusions Patients with longer‐duration HF had more co‐morbidity, worse quality of life, and higher rates of HF hospitalization and death. The benefit of a neprilysin inhibitor was consistent, irrespective of HF duration. Switching to sacubitril/valsartan had substantial benefits, even in patients with long‐standing HF.
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Affiliation(s)
- Su E Yeoh
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Pooja Dewan
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Jean L Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, QC, Canada
| | | | | | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael R Zile
- Division of Cardiology, Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
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26
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Gary RA, Paul S, Corwin E, Butts B, Miller AH, Hepburn K, Waldrop D. Exercise and Cognitive Training Intervention Improves Self-Care, Quality of Life and Functional Capacity in Persons With Heart Failure. J Appl Gerontol 2020; 41:486-495. [PMID: 33047625 DOI: 10.1177/0733464820964338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study evaluated a 12-week, home-based combined aerobic exercise (walking) and computerized cognitive training (EX/CCT) program on heart failure (HF) self-care behaviors (Self-care of HF Index [SCHFI]), disease specific quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]), and functional capacity (6-minute walk distance) compared to exercise only (EX) or a usual care attention control (AC) stretching and flexibility program. Participants (N = 69) were older, predominately female (54%) and African American (55%). There was significant improvement in self-care management, F(2, 13) = 5.7, p < .016; KCCQ physical limitation subscale, F(2, 52) = 3.4, p < .039; and functional capacity (336 ± 18 vs 388 ± 20 m, p < .05) among the EX/CCT participants. The underlying mechanisms that EX and CCT targets and the optimal dose that leads to improved outcomes are needed to design effective interventions for this rapidly growing population.
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27
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Sepehrvand N, Savu A, Spertus JA, Dyck JRB, Anderson T, Howlett J, Paterson I, Oudit GY, Kaul P, McAlister FA, Ezekowitz JA. Change of Health-Related Quality of Life Over Time and Its Association With Patient Outcomes in Patients With Heart Failure. J Am Heart Assoc 2020; 9:e017278. [PMID: 32812460 PMCID: PMC7660771 DOI: 10.1161/jaha.120.017278] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Improving health-related quality of life is an important goal in the management of patients with heart failure (HF). Defining health-related quality of life changes over time in patients with HF with preserved (HFpEF) or reduced ejection fraction and showing their association with other important clinical events could support the use of health-related quality of life as a measure of quantifying HF care. Methods and Results In the Alberta HEART (Heart Failure Aetiology and Analysis Team) cohort (n=621), patients were categorized into 4 subgroups: healthy controls (n=98), at risk (n=163), HFpEF (n=191), and HF with reduced ejection fraction (n=169). The change of the Kansas City Cardiomyopathy Questionnaire (KCCQ), EuroQOL 5 dimensions, and Functional Assessment of Cancer Therapy-Anemia over 12 months, and its association with a composite of death or rehospitalization within 3 years were assessed. At baseline, the KCCQ overall summary score was 73 (interquartile range, 53-86) in HFpEF and 78 (interquartile range, 56-90) in HF with reduced ejection fraction (P=0.22). Overall, 30.5% of patients with HF experienced ≥5-point improvements and 32.4% had ≥5-point worsening in KCCQ overall summary score at 12 months, which did not differ between HFpEF and HF with reduced ejection fraction (P=0.23). Clinical events were higher in patients with HF who had a decline in KCCQ over 12 months as compared with those with stable KCCQ scores (70.2% versus 52.0%, P=0.012). The results were similar for the Functional Assessment of Cancer Therapy-Anemia and EuroQOL 5 dimensions. Conclusions In patients with HF, the KCCQ quantified clinically meaningful changes over time, which were associated with important clinical outcomes in patients with HFpEF. Given the observed variability and prognostication in different patient trajectories, health-related quality of life measures could be valuable for quantifying the quality of care in healthcare systems.
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Affiliation(s)
- Nariman Sepehrvand
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Anamaria Savu
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
| | - John A. Spertus
- University of Missouri–Kansas CityKansas CityMO
- Saint Luke’s Mid America Heart InstituteKansas CityMO
| | - Jason R. B. Dyck
- Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
| | - Todd Anderson
- Libin Cardiovascular Institute of AlbertaCalgaryAlbertaCanada
- Department of Cardiac SciencesUniversity of CalgaryAlbertaCanada
| | - Jonathan Howlett
- Libin Cardiovascular Institute of AlbertaCalgaryAlbertaCanada
- Department of Cardiac SciencesUniversity of CalgaryAlbertaCanada
| | - Ian Paterson
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
| | - Gavin Y Oudit
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
| | - Padma Kaul
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Finlay A. McAlister
- Patient Health Outcomes Research and Clinical Effectiveness UnitUniversity of AlbertaEdmontonAlbertaCanada
- Division of General Internal MedicineDepartment of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Justin A. Ezekowitz
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
- Division of CardiologyDepartment of MedicineUniversity of AlbertaEdmontonAlbertaCanada
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Tummalapalli SL, Zelnick LR, Andersen AH, Christenson RH, deFilippi CR, Deo R, Go AS, He J, Ky B, Lash JP, Seliger SL, Soliman EZ, Shlipak MG, Bansal N. Association of Cardiac Biomarkers With the Kansas City Cardiomyopathy Questionnaire in Patients With Chronic Kidney Disease Without Heart Failure. J Am Heart Assoc 2020; 9:e014385. [PMID: 32578483 PMCID: PMC7670503 DOI: 10.1161/jaha.119.014385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a measure of heart failure (HF) health status. Worse KCCQ scores are common in patients with chronic kidney disease (CKD), even without diagnosed heart failure (HF). Elevations in the cardiac biomarkers GDF-15 (growth differentiation factor-15), galectin-3, sST2 (soluble suppression of tumorigenesis-2), hsTnT (high-sensitivity troponin T), and NT-proBNP (N-terminal pro-B-type natriuretic peptide) likely reflect subclinical HF in CKD. Whether cardiac biomarkers are associated with low KCCQ scores is not known. Methods and Results We studied participants with CKD without HF in the multicenter prospective CRIC (Chronic Renal Insufficiency Cohort) Study. Outcomes included (1) low KCCQ score <75 at year 1 and (2) incident decline in KCCQ score to <75. We used multivariable logistic regression and Cox regression models to evaluate the associations between baseline cardiac biomarkers and cross-sectional and longitudinal KCCQ scores. Among 2873 participants, GDF-15 (adjusted odds ratio 1.42 per SD; 99% CI, 1.19-1.68) and galectin-3 (1.28; 1.12-1.48) were significantly associated with KCCQ scores <75, whereas sST2, hsTnT, and NT-proBNP were not significantly associated with KCCQ scores <75 after multivariable adjustment. Of the 2132 participants with KCCQ ≥75 at year 1, GDF-15 (adjusted hazard ratio, 1.36 per SD; 99% CI, 1.12-1.65), hsTnT (1.20; 1.01-1.44), and NT-proBNP (1.30; 1.08-1.56) were associated with incident decline in KCCQ to <75 after multivariable adjustment, whereas galectin-3 and sST2 did not have significant associations with KCCQ decline. Conclusions Among participants with CKD without clinical HF, GDF-15, galectin-3, NT-proBNP, and hsTnT were associated with low KCCQ either at baseline or during follow-up. Our findings show that elevations in cardiac biomarkers reflect early symptomatic changes in HF health status in CKD patients.
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Affiliation(s)
| | - Leila R Zelnick
- Kidney Research Institute University of Washington Seattle WA.,Division of Nephrology Department of Medicine University of Washington Seattle WA
| | - Amanda H Andersen
- Biostatistics and Epidemiology and Informatics Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
| | | | | | - Rajat Deo
- Division of Cardiovascular Medicine University of Pennsylvania Philadelphia PA
| | - Alan S Go
- Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco San Francisco CA.,Department of Medicine University of California San Francisco CA.,Division of Research Kaiser Permanente Northern California Oakland CA
| | - Jiang He
- Tulane University New Orleans LA
| | - Bonnie Ky
- Division of Cardiology Department of Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Biostatistics, Epidemiology & Informatics Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - James P Lash
- Department of Medicine University of Illinois at Chicago IL
| | - Stephen L Seliger
- Division of Nephrology University of Maryland School of Medicine Baltimore MD
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention Epidemiological Cardiology Research Center Wake Forest University School of Medicine Winston-Salem NC
| | - Michael G Shlipak
- Kidney Health Research Collaborative University of California San Francisco CA.,San Francisco Veterans Affairs Medical Center San Francisco CA
| | - Nisha Bansal
- Kidney Research Institute University of Washington Seattle WA.,Division of Nephrology Department of Medicine University of Washington Seattle WA
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Damluji AA, Rodriguez G, Noel T, Davis L, Dahya V, Tehrani B, Epps K, Sherwood M, Sarin E, Walston J, Bandeen-Roche K, Resar JR, Brown TT, Gerstenblith G, O'Connor CM, Batchelor W. Sarcopenia and health-related quality of life in older adults after transcatheter aortic valve replacement. Am Heart J 2020; 224:171-181. [PMID: 32416332 DOI: 10.1016/j.ahj.2020.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Skeletal muscle wasting, or sarcopenia, affects a significant proportion of patients undergoing transcatheter aortic valve replacement (TAVR). However, its influence on post-TAVR recovery and 1-year health-related quality of life (HR-QOL) remains unknown. We examined the relationship between skeletal muscle index (SMI), post-TAVR length of hospital stay (LOS), and 1-year QOL. METHODS The study sample consisted of 300 consecutive patients undergoing TAVR from 2012 to 2018 who had pre-TAVR computed tomographic scans suitable for analysis of body composition. Skeletal muscle mass was quantified as cm2 of skeletal mass per m2 of body surface area from the cross-sectional computed tomographic image at the third lumbar vertebra. Sarcopenia was defined using established sex-specific cutoffs (women: SMI < 39 cm2/m2; men: < 55 cm2/m2). Multivariable linear regression analysis was used to determine the relationship between SMI, LOS, and HR-QOL using the Kansas City Cardiomyopathy Questionnaire. RESULTS Sarcopenia was present in most (59%) patients and associated with older age (82 vs 76 years; P < .001) and lower body mass index (27 vs 33 kg/m2; P < .001). There were no other differences in baseline clinical or echocardiographic characteristics among the 4 quartiles of SMI. SMI was positively correlated with LOS and 1-year QOL. After adjusting for age, gender, race, and body mass index, SMI remained a significant predictor of both LOS (P = .01) and 1-year QOL (P = .012). For every 10 cm2/m2 higher SMI, there was an 8-point increase in Kansas City Cardiomyopathy Questionnaire score, a difference that is clinically meaningful. CONCLUSIONS Sarcopenia is prevalent in TAVR patients. Higher SMI is associated with shorter LOS and better 1-year HR-QOL. To achieve optimal TAVR benefits, further study into how body composition influences post-TAVR recovery and durable improvement in QOL is warranted.
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30
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Wachter R, Shah SJ, Cowie MR, Szecsödy P, Shi V, Ibram G, Zhao Z, Gong J, Klebs S, Pieske B. Angiotensin receptor neprilysin inhibition versus individualized RAAS blockade: design and rationale of the PARALLAX trial. ESC Heart Fail 2020; 7:856-864. [PMID: 32297449 PMCID: PMC7261527 DOI: 10.1002/ehf2.12694] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
Aims Although the effect of the angiotensin receptor blocker neprilysin inhibitor (ARNI) sacubitril/valsartan on heart failure (HF) hospitalizations and cardiovascular death has been evaluated, its effects on functional capacity in patients with HF and ejection fraction (EF) >40% has yet to be determined. In addition, no prior studies have compared sacubitril/valsartan with angiotensin‐converting enzyme inhibitor therapy. We sought to compare the effect of ARNI to background‐medication‐based individualized comparators (BMICs) on N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), functional capacity [6 min walk distance (6MWD)], symptoms, and quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ)] in patients with HF and EF >40% in a randomized clinical trial. Methods PARALLAX is a prospective, randomized, controlled, double‐blind multicentre clinical trial in patients with chronic symptomatic HF with EF >40%, New York Heart Association (NYHA) class II–IV symptoms, elevated natriuretic peptides, and evidence of structural heart disease. Eligible patients are randomized to sacubitril/valsartan vs. BMIC for cardiovascular and related co‐morbidities. BMIC includes (i) enalapril, (ii) valsartan, and (iii) placebo depending on the type of medical therapy prior to enrolment. The primary endpoints are the change in plasma NT‐proBNP concentration from baseline to 12 weeks and the change from baseline in 6MWD distance at 24 weeks. The secondary endpoints assess quality of life and symptom burden. Conclusions PARALLAX will determine if sacubitril/valsartan compared with standard medical therapy for co‐morbidities improves NT‐proBNP levels, exercise capacity, quality of life, and symptom burden in HF patients with EF >40%.
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Affiliation(s)
- Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany.,Clinic for Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Martin R Cowie
- Faculty of Medicine, National Heart & Lung Institute, Imperial College, London, UK
| | | | - Victor Shi
- Novartis, East Hanover EastHanover NJ, USA
| | | | | | | | - Sven Klebs
- Novartis Pharma GmbH, Nuremberg, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Center, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Clinical Research Unit Cardiology, Berlin Institute of Health, Berlin, Germany
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31
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Bouabdallaoui N, O'Meara E, Bernier V, Komajda M, Swedberg K, Tavazzi L, Borer JS, Bohm M, Ford I, Tardif J. Beneficial effects of ivabradine in patients with heart failure, low ejection fraction, and heart rate above 77 b.p.m. ESC Heart Fail 2019; 6:1199-1207. [PMID: 31591826 PMCID: PMC6989297 DOI: 10.1002/ehf2.12513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/01/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Ivabradine has been approved in heart failure with reduced ejection fraction (HFrEF) and elevated heart rate despite guideline-directed medical therapy (GDMT) to reduce cardiovascular (CV) death and hospitalization for worsening HF. The median value of 77 b.p.m. is the lower bound selected for the regulatory approval in Canada, South Africa, and Australia. Patient-reported outcomes (PROs) including symptoms, quality of life, and global assessment are considered of major interest in the global plan of care of patients with HF. However, the specific impact of GDMT, and specifically ivabradine, on PRO remains poorly studied. In the subgroup of patients from the Systolic Heart failure treatment with the If inhibitor ivabradine Trial (SHIFT) who had heart rate above the median of 77 b.p.m. (pre-specified analysis) and for whom the potential for improvement was expected to be larger, we aimed (i) to evaluate the effects of ivabradine on PRO (symptoms, quality of life, and global assessment); (ii) to consolidate the effects of ivabradine on the primary composite endpoint of CV death and hospitalization for HF; and (iii) to reassess the effects of ivabradine on left ventricular (LV) remodelling. METHODS AND RESULTS Comparisons were made according to therapy, and proportional hazards models (adjusted for baseline beta-blocker therapy) were used to estimate the association between ivabradine and various outcomes. In SHIFT, n = 3357 (51.6%) patients had a baseline heart rate > 77 b.p.m. After a median follow-up of 22.9 months (inter-quartile range 18-28 months), ivabradine on top of GDMT improved symptoms (28% vs. 23% improvement in New York Heart Association functional class, P = 0.0003), quality of life (5.3 vs. 2.2 improvement in Kansas City Cardiomyopathy Questionnaire overall summary score, P = 0.005), and global assessment [from both patient (improved in 72.3%) and physician (improved in 61.0%) perspectives] significantly more than did placebo (both P < 0.0001). Ivabradine induced a 25% reduction in the combined endpoint of CV death and hospitalization for HF (hazard ratio 0.75; P < 0.0001), which translates into a number of patients needed to be treated for 1 year of 17. Patients under ivabradine treatment demonstrated a significant reduction in LV dimensions when reassessed at 8 months (P < 0.05). CONCLUSIONS In patients with chronic HFrEF, sinus rhythm, and a heart rate > 77 b.p.m. while on GDMT, the present analysis brings novel insights into the role of ivabradine in improving the management of HFrEF, particularly with regard to PRO (ISRCTN70429960).
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Affiliation(s)
- Nadia Bouabdallaoui
- Montreal Heart InstituteUniversité de Montréal5000 Belanger StreetMontrealH1T 1C8QuebecCanada
| | - Eileen O'Meara
- Montreal Heart InstituteUniversité de Montréal5000 Belanger StreetMontrealH1T 1C8QuebecCanada
| | - Virginie Bernier
- Scientific and Medical AffairsServier Canada Inc.LavalQuebecCanada
| | - Michel Komajda
- Department of CardiologyParis Saint Joseph HospitalParisFrance
| | - Karl Swedberg
- Department of Molecular and Clinical MedicineSahlgrenska Academy, University of GothenburgGothenburgSweden
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
| | - Jeffrey S. Borer
- Howard Gilman and Schiavone InstitutesState University of New York Downstate Medical CenterNew YorkNYUSA
| | - Michael Bohm
- Internal Medicine Clinic III, Saarland University ClinicSaarland UniversityHomburgSaarGermany
| | - Ian Ford
- Robertson Centre for BiostatisticsUniversity of GlasgowGlasgowUK
| | - Jean‐Claude Tardif
- Montreal Heart InstituteUniversité de Montréal5000 Belanger StreetMontrealH1T 1C8QuebecCanada
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32
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Nassif ME, Windsor SL, Tang F, Khariton Y, Husain M, Inzucchi SE, McGuire DK, Pitt B, Scirica BM, Austin B, Drazner MH, Fong MW, Givertz MM, Gordon RA, Jermyn R, Katz SD, Lamba S, Lanfear DE, LaRue SJ, Lindenfeld J, Malone M, Margulies K, Mentz RJ, Mutharasan RK, Pursley M, Umpierrez G, Kosiborod M. Dapagliflozin Effects on Biomarkers, Symptoms, and Functional Status in Patients With Heart Failure With Reduced Ejection Fraction: The DEFINE-HF Trial. Circulation 2019; 140:1463-1476. [PMID: 31524498 DOI: 10.1161/circulationaha.119.042929] [Citation(s) in RCA: 264] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Outcome trials in patients with type 2 diabetes mellitus have demonstrated reduced hospitalizations for heart failure (HF) with sodium-glucose co-transporter-2 inhibitors. However, few of these patients had HF, and those that did were not well-characterized. Thus, the effects of sodium-glucose co-transporter-2 inhibitors in patients with established HF with reduced ejection fraction, including those with and without type 2 diabetes mellitus, remain unknown. METHODS DEFINE-HF (Dapagliflozin Effects on Biomarkers, Symptoms and Functional Status in Patients with HF with Reduced Ejection Fraction) was an investigator-initiated, multi-center, randomized controlled trial of HF patients with left ventricular ejection fraction ≤40%, New York Heart Association (NYHA) class II-III, estimated glomerular filtration rate ≥30 mL/min/1.73m2, and elevated natriuretic peptides. In total, 263 patients were randomized to dapagliflozin 10 mg daily or placebo for 12 weeks. Dual primary outcomes were (1) mean NT-proBNP (N-terminal pro b-type natriuretic peptide) and (2) proportion of patients with ≥5-point increase in HF disease-specific health status on the Kansas City Cardiomyopathy Questionnaire overall summary score, or a ≥20% decrease in NT-proBNP. RESULTS Patient characteristics reflected stable, chronic HF with reduced ejection fraction with high use of optimal medical therapy. There was no significant difference in average 6- and 12-week adjusted NT-proBNP with dapagliflozin versus placebo (1133 pg/dL (95% CI 1036-1238) vs 1191 pg/dL (95% CI 1089-1304), P=0.43). For the second dual-primary outcome of a meaningful improvement in Kansas City Cardiomyopathy Questionnaire overall summary score or NT-proBNP, 61.5% of dapagliflozin-treated patients met this end point versus 50.4% with placebo (adjusted OR 1.8, 95% CI 1.03-3.06, nominal P=0.039). This was attributable to both higher proportions of patients with ≥5-point improvement in Kansas City Cardiomyopathy Questionnaire overall summary score (42.9 vs 32.5%, adjusted OR 1.73, 95% CI 0.98-3.05), and ≥20% reduction in NT-proBNP (44.0 vs 29.4%, adjusted OR 1.9, 95% CI 1.1-3.3) by 12 weeks. Results were consistent among patients with or without type 2 diabetes mellitus, and other prespecified subgroups (all P values for interaction=NS). CONCLUSIONS In patients with heart failure and reduced ejection fraction, use of dapagliflozin over 12 weeks did not affect mean NT-proBNP but increased the proportion of patients experiencing clinically meaningful improvements in HF-related health status or natriuretic peptides. Benefits of dapagliflozin on clinically meaningful HF measures appear to extend to patients without type 2 diabetes mellitus. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02653482.
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Affiliation(s)
- Michael E Nassif
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.).,University of Missouri-Kansas City, MO (M.E.N., Y.K., B.A., M.K.)
| | - Sheryl L Windsor
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.)
| | - Fengming Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.)
| | - Yevgeniy Khariton
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.).,University of Missouri-Kansas City, MO (M.E.N., Y.K., B.A., M.K.)
| | - Mansoor Husain
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada (M.H.).,Ted Rogers Centre for Heart Research, Toronto, Canada (M.H.).,University of Toronto, Canada (M.H.).,Peter Munk Cardiac Centre, Toronto, Canada (M.H)
| | | | - Darren K McGuire
- University of Texas Southwestern Medical Center, Dallas (D.K.M., M.H.D.)
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Benjamin M Scirica
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.M.S., M.M.G.)
| | - Bethany Austin
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.).,University of Missouri-Kansas City, MO (M.E.N., Y.K., B.A., M.K.)
| | - Mark H Drazner
- University of Texas Southwestern Medical Center, Dallas (D.K.M., M.H.D.)
| | - Michael W Fong
- Keck School of Medicine of USC, University of Southern California, Los Angeles (M.W.F.)
| | - Michael M Givertz
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.M.S., M.M.G.)
| | | | | | - Stuart D Katz
- New York University Langone Health, New York (S.D.K.)
| | - Sumant Lamba
- First Coast Cardiovascular Institute, Jacksonville, FL (S.L.)
| | | | - Shane J LaRue
- Washington University School of Medicine, St. Louis, MO (S.J.L.)
| | | | - Michael Malone
- Charlotte Heart Group Research Center, Port Charlotte, FL (M.M.)
| | | | | | | | | | | | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, MO (M.E.N., S.L.W., F.T., Y.K., B.A., M.K.).,University of Missouri-Kansas City, MO (M.E.N., Y.K., B.A., M.K.).,The George Institute for Global Health, Sydney, Australia (M.K.).,University of New South Wales, Sydney, Australia (M.K.)
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Khariton Y, Fonarow GC, Arnold SV, Hellkamp A, Nassif ME, Sharma PP, Butler J, Thomas L, Duffy CI, DeVore AD, Albert NM, Patterson JH, Williams FB, McCague K, Spertus JA. Association Between Sacubitril/Valsartan Initiation and Health Status Outcomes in Heart Failure With Reduced Ejection Fraction. JACC-HEART FAILURE 2019; 7:933-941. [PMID: 31521679 DOI: 10.1016/j.jchf.2019.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study sought to describe the short-term health status benefits of angiotensin-neprilysin inhibitor (ARNI) therapy in patients with heart failure and reduced ejection fraction (HFrEF). BACKGROUND Although therapy with sacubitril/valsartan, a neprilysin inhibitor, improved patients' health status (compared with enalapril) at 8 months in the PARADIGM-HF (Prospective Comparison of ARNI with ACE inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) study, the early impact of ARNI on patients' symptoms, functions, and quality of life is unknown. METHODS Health status was assessed by using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ) in 3,918 outpatients with HFrEF and left ventricular ejection fraction ≤40% across 140 U.S. centers in the CHAMP-HF (Change the Management of Patients with Heart Failure) registry. ARNI therapy was initiated in 508 patients who were matched 1:2 to 1,016 patients who were not initiated on ARNI (no-ARNI), using a nonparsimonious time-dependent propensity score (6 sociodemographic factors, 23 clinical characteristics), prior KCCQ overall summary (KCCQ-OS) score, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker status. RESULTS Multivariate linear regression demonstrated a greater mean improvement in KCCQ-OS in patients initiated on ARNI therapy (5.3 ± 19 vs. 2.5 ± 17.4, respectively; p < 0.001) over a median (interquartile range [IQR]) of 57 (32 to 104) days. The proportions of ARNI versus no-ARNI groups with ≥10-point (large) and ≥20-point (very large) improvements in KCCQ-OS were 32.7% versus 26.9%, respectively, and 20.5% versus 12.1%, respectively, consistent with numbers needed to treat of 18 and 12, respectively. CONCLUSIONS In routine clinical care, ARNI therapy was associated with early improvements in health status, with 20% experiencing a very large health status benefit compared with 12% who were not started on ARNI therapy. These findings support the use of ARNI to improve patients' symptoms, functions, and quality of life.
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Affiliation(s)
- Yevgeniy Khariton
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri.
| | - Gregg C Fonarow
- Department of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, California
| | - Suzanne V Arnold
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Ann Hellkamp
- Duke Clinical Research Institute, Durham, North Carolina
| | - Michael E Nassif
- Department of Cardiology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri
| | - Puza P Sharma
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Laine Thomas
- Duke Clinical Research Institute, Durham, North Carolina
| | - Carol I Duffy
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - Adam D DeVore
- Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | | | - Kevin McCague
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey
| | - John A Spertus
- Departments of Cardiology and Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
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Van Tassell BW, Trankle CR, Canada JM, Carbone S, Buckley L, Kadariya D, Del Buono MG, Billingsley H, Wohlford G, Viscusi M, Oddi-Erdle C, Abouzaki NA, Dixon D, Biondi-Zoccai G, Arena R, Abbate A. IL-1 Blockade in Patients With Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2019; 11:e005036. [PMID: 30354558 DOI: 10.1161/circheartfailure.118.005036] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Enhanced inflammation may lead to exercise intolerance in heart failure with preserved ejection fraction. The aim of the current study was to determine whether IL (interleukin)-1 blockade with anakinra improved cardiorespiratory fitness in heart failure with preserved ejection fraction. Methods and Results Thirty-one patients with heart failure with preserved ejection fraction and CRP (C-reactive protein) >2 mg/L were randomized to anakinra (100 mg subcutaneously daily, N=21) or placebo (N=10) for 12 weeks. We measured peak oxygen consumption (Vo2), ventilatory efficiency (VE/Vco2 slope), and high-sensitivity CRP and NT-proBNP (N-terminal pro-B-type natriuretic peptide) at 4, 12, and 24 weeks. Twenty-eight patients completed ≥2 visits, 18 women (64%), 27 (96%) obese. There were no differences in peak Vo2 or VE/Vco2 slope between groups at baseline. Peak Vo2 was not changed after 12 weeks of anakinra (from 13.6 [11.8-18.0] to 14.2 [11.2-18.5] mL·kg-1·min-1, P=0.89), or placebo (14.9 [11.7-17.2] to 15.0 [13.8-16.9] mL·kg-1·min-1, P=0.40), without significant between-group differences in changes at 12 weeks (-0.4 [95% CI, -2.2 to +1.4], P=0.64). VE/Vco2 slope was also unchanged with anakinra (from 28.3 [27.2-33.0] to 30.5 [26.3-32.8], P=0.97) or placebo (from 31.6 [27.3-36.9] to 31.2 [27.8-33.4], P=0.78), without significant between-group differences in changes at 12 weeks (+1.2 [95% CI, -1.8 to +4.3], P=0.97). Within the anakinra-treated patients, high-sensitivity CRP and NT-proBNP levels were lower at 4 weeks compared with baseline ( P=0.026 and P=0.022 versus placebo [between-group analysis], respectively). Conclusions Treatment with anakinra for 12 weeks failed to improve peak Vo2 and VE/Vco2 slope in a group of obese heart failure with preserved ejection fraction patients. The favorable trends in high-sensitivity CRP and NT-proBNP with anakinra deserve exploration in future studies. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02173548.
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Affiliation(s)
- Benjamin W Van Tassell
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.).,Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond (B.W.V.T., L.B., G.W., D.D.)
| | - Cory R Trankle
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.)
| | - Justin M Canada
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.)
| | - Salvatore Carbone
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.)
| | - Leo Buckley
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond (B.W.V.T., L.B., G.W., D.D.)
| | - Dinesh Kadariya
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.)
| | - Marco G Del Buono
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.)
| | - Hayley Billingsley
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.)
| | - George Wohlford
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.).,Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond (B.W.V.T., L.B., G.W., D.D.)
| | - Michele Viscusi
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.)
| | - Claudia Oddi-Erdle
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.)
| | - Nayef A Abouzaki
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.)
| | - Dave Dixon
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.).,Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond (B.W.V.T., L.B., G.W., D.D.)
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.-Z.).,Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy (G.B.-Z.)
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (R.A.)
| | - Antonio Abbate
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Richmond (B.W.V.T., C.R.T., J.C., S.C., D.K., M.G.D.B., H.B., G.W., M.V., C.O.-E., N.A.A., D.D., A.A.)
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Norman JF, Kupzyk KA, Artinian NT, Keteyian SJ, Alonso WS, Bills SE, Pozehl BJ. The influence of the HEART Camp intervention on physical function, health-related quality of life, depression, anxiety and fatigue in patients with heart failure. Eur J Cardiovasc Nurs 2019; 19:64-73. [PMID: 31373222 DOI: 10.1177/1474515119867444] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Regular exercise training has beneficial effects on quality of life, physical function, depression and anxiety in individuals with heart failure. Unfortunately, individuals with heart failure have low levels of adherence to exercise. Thus, studies are needed to assess intervention strategies which may enhance clinical outcomes. AIM The aim of this study was to identify the components of the HEART Camp intervention, which contributed to optimizing clinical outcomes. METHODS The Heart Failure Exercise and Resistance Training Camp (HEART Camp) was a randomized controlled trial to evaluate the effect of a multicomponent intervention on adherence to exercise (6, 12 and 18 months) compared to an enhanced usual care group. This study assessed various components of the intervention on the secondary outcomes of physical function, health-related quality of life, depression, anxiety, and fatigue. RESULTS Individuals participating (n=204) in this study were 55.4% men and the average age was 60.4 (11.5) years. A combination of individualized and group-based strategies demonstrated clinical improvements, HEART Camp versus enhanced usual care groups, in physical function, positive trends in health-related quality of life and positive changes in the minimally important differences for depression, anxiety, and fatigue. CONCLUSIONS Individualized coaching by an exercise professional and group-based educational sessions were identified as important components of patient management contributing to improvements in the secondary outcomes of physical function, health-related quality of life, depression, anxiety and fatigue.
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Affiliation(s)
- Joseph F Norman
- College of Allied Health Professions, University of Nebraska Medical Center, USA
| | - Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, USA
| | | | | | - Windy S Alonso
- College of Nursing, University of Nebraska Medical Center, USA
| | - Sara E Bills
- College of Allied Health Professions, University of Nebraska Medical Center, USA
| | - Bunny J Pozehl
- College of Nursing, University of Nebraska Medical Center, USA
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Endrighi R, Dimond AJ, Waters AJ, Dimond CC, Harris KM, Gottlieb SS, Krantz DS. Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure. Psychol Health 2019; 34:1250-1266. [PMID: 31111738 DOI: 10.1080/08870446.2019.1609676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms. Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5 ± 11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant. Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.
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Affiliation(s)
- Romano Endrighi
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA.,Center for Behavioral Science Research, Department of Health Policy, Health Services Research, Boston University Henry M. Goldman School of Dental Medicine , Boston , MA , USA
| | - Andrew J Dimond
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | | | - Kristie M Harris
- Section on Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven , CT , USA
| | - Stephen S Gottlieb
- Department of Medicine, University of Maryland School of Medicine , Baltimore , MD , USA
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
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37
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Mack MJ, Abraham WT, Lindenfeld J, Bolling SF, Feldman TE, Grayburn PA, Kapadia SR, McCarthy PM, Lim DS, Udelson JE, Zile MR, Gammie JS, Gillinov AM, Glower DD, Heimansohn DA, Suri RM, Ellis JT, Shu Y, Kar S, Weissman NJ, Stone GW. Cardiovascular Outcomes Assessment of the MitraClip in Patients with Heart Failure and Secondary Mitral Regurgitation: Design and rationale of the COAPT trial. Am Heart J 2018; 205:1-11. [PMID: 30134187 DOI: 10.1016/j.ahj.2018.07.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/25/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with heart failure (HF) and symptomatic secondary mitral regurgitation (SMR) have a poor prognosis, with morbidity and mortality directly correlated with MR severity. Correction of isolated SMR with surgery is not well established in this population, and medical management remains the preferred approach in most patients. The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial was designed to determine whether transcatheter mitral valve (MV) repair with the MitraClip device is safe and effective in patients with symptomatic HF and clinically significant SMR. STUDY DESIGN The COAPT trial is a prospective, randomized, parallel-controlled, open-label multicenter study of the MitraClip device for the treatment of moderate-to-severe (3+) or severe (4+) SMR (as verified by an independent echocardiographic core laboratory) in patients with New York Heart Association class II-IVa HF despite treatment with maximally tolerated guideline-directed medical therapy (GDMT) who have been determined by the site's local heart team as not appropriate for MV surgery. A total of 614 eligible subjects were randomized in a 1:1 ratio to MV repair with the MitraClip plus GDMT versus GDMT alone. The primary effectiveness end point is recurrent HF hospitalizations through 24 months, analyzed when the last subject completes 12-month follow-up, powered to demonstrate superiority of MitraClip therapy. The primary safety end point is a composite of device-related complications at 12 months compared to a performance goal. Follow-up is ongoing, and the principal results are expected in late 2018. CONCLUSIONS HF patients with clinically significant SMR who continue to be symptomatic despite optimal GDMT have limited treatment options and a poor prognosis. The randomized COAPT trial was designed to determine the safety and effectiveness of transcatheter MV repair with the MitraClip in symptomatic HF patients with moderate-to-severe or severe SMR.
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Affiliation(s)
- Michael J Mack
- Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas, TX.
| | - William T Abraham
- Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart & Lung Research Institute, The Ohio State University, Columbus, OH
| | - JoAnn Lindenfeld
- Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville, TN
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Ted E Feldman
- Evanston Hospital Cardiology Division, Northshore University Health System, Evanston, IL
| | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, VA
| | - James E Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Donald D Glower
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | - David A Heimansohn
- Department of Cardiothoracic Surgery, St Vincent Heart Center, Indianapolis, IN
| | - Rakesh M Suri
- Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | | | - Saibal Kar
- Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | | | - Gregg W Stone
- New York Presbyterian Hospital, Columbia University Medical Center, and The Cardiovascular Research Foundation, New York, NY
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38
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Luo N, O'Connor CM, Cooper LB, Sun JL, Coles A, Reed SD, Whellan DJ, Piña IL, Kraus WE, Mentz RJ. Relationship between changing patient-reported outcomes and subsequent clinical events in patients with chronic heart failure: insights from HF-ACTION. Eur J Heart Fail 2018; 21:63-70. [PMID: 30168635 DOI: 10.1002/ejhf.1299] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/20/2018] [Accepted: 07/08/2018] [Indexed: 12/11/2022] Open
Abstract
AIMS A 5-point change in the Kansas City Cardiomyopathy Questionnaire (KCCQ) is commonly considered to be a clinically significant difference in health status in patients with heart failure. We evaluated how the magnitude of change relates to subsequent clinical outcomes. METHODS AND RESULTS Using data from the HF-ACTION trial of exercise training in chronic heart failure (n = 2331), we used multivariable Cox regression with piecewise linear splines to examine the relationship between change in KCCQ overall summary score from baseline to 3 months (range 0-100; higher scores reflect better health status) and subsequent all-cause mortality/hospitalization. Among 2038 patients with KCCQ data at the 3-month visit, KCCQ scores increased from baseline by ≥5 points for 45%, scores decreased by ≥5 points for 23%, and scores changed by <5 points for the remaining 32% of patients. There was a non-linear relationship between change in KCCQ and outcomes. Worsening health status was associated with increased all-cause mortality/hospitalization (adjusted hazard ratio 1.07 per 5-point KCCQ decline; 95% confidence interval 1.03-1.12; P < 0.001). In contrast, improving health status, up to an 8-point increase in KCCQ, was associated with decreased all-cause mortality/hospitalization (adjusted hazard ratio 0.93 per 5-point increase; 95% confidence interval 0.90-0.97; P < 0.001). Additional improvements in health status beyond an 8-point increase in KCCQ was not associated with all-cause death or hospitalization (P = 0.42). CONCLUSION In patients with heart failure, small changes in KCCQ are associated with changing future risk, but more research will be necessary to understand how different magnitudes of improving health status affect outcomes.
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Affiliation(s)
- Nancy Luo
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Christopher M O'Connor
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Lauren B Cooper
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Jie-Lena Sun
- Duke Clinical Research Institute, Durham, NC, USA
| | - Adrian Coles
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Ileana L Piña
- Montefiore-Einstein Medical Center, New York, NY, USA
| | - William E Kraus
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
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39
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Dose-Response Relationship Between Exercise Intensity, Mood States, and Quality of Life in Patients With Heart Failure. J Cardiovasc Nurs 2018; 32:530-537. [PMID: 28353541 DOI: 10.1097/jcn.0000000000000407] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND We conducted a secondary analysis to (1) compare changes in mood disorders and quality of life (QOL) among 4 groups of patients with heart failure in a home-based exercise program who had varying degrees of change in their exercise capacity and (2) determine whether there was an association between exercise capacity, mood disorders, and QOL. METHODS Seventy-one patients were divided into 4 groups based on changes in exercise capacity from baseline to 6 months: group 1showed improvements of greater than 10% (n = 19), group 2 showed improvements of 10% or less (n = 16), group 3 showed reductions of 10% or less (n = 9), and group 4 showed reductions of greater than 10% (n = 27). RESULTS Over time, patients in all 4 groups demonstrated significantly lower levels of depression and hostility (P < .001) and higher levels of physical and overall quality of life (P = .046). Group differences over time were noted in anxiety (P = .009), depression (P = .015), physical quality of life (P < .001), and overall quality of life (P = .002). Greater improvement in exercise capacity was strongly associated with lower depression scores (r = -0.49, P = .01). CONCLUSIONS An improvement in exercise capacity with exercise training was associated with a decrease in depression and anxiety and an increase in QOL in patients with heart failure.
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Abstract
Background: Complementary and alternative medicine is a rapidly growing area of biomedical inquiry. Yoga has emerged in the forefront of holistic medical care due to its long history of linking physical, mental, and spiritual well-being. Research in yoga therapy (YT) has associated improved cardiovascular and quality of life (QoL) outcomes for the special needs of heart failure (HF) patients. Aim: The aim of this study is to review yoga intervention studies on HF patients, discuss proposed mechanisms, and examine yoga's effect on physiological systems that have potential benefits for HF patients. Second, to recommend future research directions to find the most effective delivery methods of yoga to medically stable HF patients. Methods: The authors conducted a systematic review of the medical literature for RCTs involving HF patients as participants in yoga interventions and for studies utilizing mechanistic theories of stretch and new technologies. We examined physical intensity, mechanistic theories, and the use of the latest technologies. Conclusions: Based on the review, there is a need to further explore yoga mechanisms and research options for the delivery of YT. Software apps as exergames developed for use at home and community activity centers may minimize health disparities and increase QoL for HF patients.
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Affiliation(s)
- Paula R Pullen
- Department of Kinesiology, University of North Georgia, Oakwood, GA, USA
| | | | - Walter R Thompson
- College of Education and Human Development at Georgia State University, Atlanta, GA, USA
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41
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Atwater BD, Friedman DJ. Are We Approaching Chronotropy (In)competently? JACC-HEART FAILURE 2017; 6:114-116. [PMID: 29226813 DOI: 10.1016/j.jchf.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Brett D Atwater
- Electrophysiology Section, Division of Cardiology, Duke University Hospital System, Durham, North Carolina.
| | - Daniel J Friedman
- Electrophysiology Section, Division of Cardiology, Duke University Hospital System, Durham, North Carolina
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42
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Xu Y, Deforest M, Grabell J, Hopman W, James P. Relative contributions of bleeding scores and iron status on health-related quality of life in von Willebrand disease: a cross-sectional study. Haemophilia 2016; 23:115-121. [DOI: 10.1111/hae.13062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Y. Xu
- School of Medicine; Queen's University; Kingston Canada
| | - M. Deforest
- NCIC Clinical Trials Group; Queen's University; Kingston Canada
| | - J. Grabell
- Department of Pathology and Molecular Medicine; Queen's University; Kingston Canada
| | - W. Hopman
- Clinical Research Centre, Kingston General Hospital; Queen's University; Kingston Canada
- Department of Public Health Sciences; Queen's University; Kingston Canada
| | - P. James
- Department of Pathology and Molecular Medicine; Queen's University; Kingston Canada
- Department of Medicine; Queen's University; Kingston Canada
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43
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Psotka MA, von Maltzahn R, Anatchkova M, Agodoa I, Chau D, Malik FI, Patrick DL, Spertus JA, Wiklund I, Teerlink JR. Patient-Reported Outcomes in Chronic Heart Failure: Applicability for Regulatory Approval. JACC-HEART FAILURE 2016; 4:791-804. [PMID: 27395351 DOI: 10.1016/j.jchf.2016.04.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/14/2016] [Accepted: 04/27/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The study sought to review the characteristics of existing patient-reported outcome (PRO) instruments used with chronic heart failure (HF) patients and evaluate their potential to support an approved U.S. Food and Drug Administration (FDA) product label claim. BACKGROUND PROs, including symptoms and their associated functional limitations, contribute substantially to HF patient morbidity. PRO measurements capture the patient perspective and can be systematically assessed with structured questionnaires, however rigorous recommendations have been set by the FDA regarding the acceptability of PRO measures as a basis for product label claims. METHODS Extensive searches of databases and specialty guidelines identified PRO instruments used in patients with chronic HF. Information on critical properties recommended by the FDA guidance were systematically extracted and used to evaluate the selected PRO instruments. RESULTS Nineteen PRO instruments used with chronic HF patients were identified. The Kansas City Cardiomyopathy Questionnaire and Minnesota Living with Heart Failure Questionnaire were the most extensively evaluated and validated in studies of this population. However, judged by criteria listed in the FDA PRO guidance, no existing PRO measure met all of the criteria to support a product label claim in the United States. CONCLUSIONS Currently available chronic HF PRO measures do not fulfill all the recommendations provided in the FDA PRO guidance and therefore may not support an FDA-approved product label claim. Future investigations are merited to develop a PRO measure for use in patients with chronic HF in accordance with the FDA guidance.
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Affiliation(s)
- Mitchell A Psotka
- School of Medicine, University of California San Francisco and Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | | | | | - Dina Chau
- Amgen Inc., Thousand Oaks, California
| | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, California
| | - Donald L Patrick
- Department of Health Services, University of Washington, Seattle, Washington
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and Department of Biomedical and Health Informatics, University of Missouri, Kansas City, Missouri
| | | | - John R Teerlink
- School of Medicine, University of California San Francisco and Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California.
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44
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Cooper TJ, Anker SD, Comin-Colet J, Filippatos G, Lainscak M, Lüscher TF, Mori C, Johnson P, Ponikowski P, Dickstein K. Relation of Longitudinal Changes in Quality of Life Assessments to Changes in Functional Capacity in Patients With Heart Failure With and Without Anemia. Am J Cardiol 2016; 117:1482-7. [PMID: 27015889 DOI: 10.1016/j.amjcard.2016.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
Clinical status in heart failure is conventionally assessed by the physician's evaluation, patients' own perception of their symptoms, quality of life (QoL) tools, and a measure of functional capacity. These aspects can be measured with tools such as the New York Heart Association functional class, QoL tools such as the EuropeanQoL-5 dimension, the Kansas City Cardiomyopathy Questionnaire, patient global assessment (PGA), and by 6-minute walk test (6MWT), respectively. The ferric carboxymaltose in patients with heart failure and iron deficiency (FAIR-HF) trial demonstrated that treatment with intravenous ferric carboxymaltose in iron-deficient patients with symptomatic heart failure with reduced left ventricular function, significantly improved all 5 outcome measures. This analysis assessed the correlations between the longitudinal changes in the measures of clinical status, as measured by QoL tools and the changes in the measures of functional capacity as measured by the 6MWT. This analysis used the database from the FAIR-HF trial, which randomized 459 patients with chronic heart failure (reduced left ventricular ejection fraction) and iron deficiency, with or without anemia to ferrous carboxymaltose or placebo. The degree of correlation between QoL tools and the 6MWT was assessed at 4, 12, and 24 weeks. The data demonstrate highly significant correlations between QoL and functional capacity, as measured by the 6MWT, at all time points (p <0.001). Changes in PGA, Kansas City Cardiomyopathy Questionnaire, and EuroQoL-5D correlated increasingly over time with changes in 6MWT performance. Interestingly, the strongest correlation at 24 weeks is for the PGA, which is a simple numerical scale (r = -0.57, p <0.001). This analysis provides evidence that QoL assessment show a significant correlation with functional capacity, as measured by the 6MWT. The strength of these correlations increased over time.
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45
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Mastenbroek MH, Van't Sant J, Versteeg H, Cramer MJ, Doevendans PA, Pedersen SS, Meine M. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy. J Card Fail 2015; 22:385-94. [PMID: 26363091 DOI: 10.1016/j.cardfail.2015.08.342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/30/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS Eighty-four patients with a 1st-time CRT-defibrillator (mean age 65 ± 11; 73% male) underwent echocardiography and cardiopulmonary exercise testing (CPX) before implantation (baseline) and 6 months after implantation. At baseline, patients also completed a set of questionnaires measuring mental and physical health. The association between echocardiographic response (left ventricular end-systolic volume decrease ≥15%) and a comprehensive set of CPX results was examined. Echocardiographic responders (54%) demonstrated higher peak oxygen consumption and better exercise performance than nonresponders at baseline and at 6-month follow-up. Furthermore, only echocardiographic responders showed improvements in ventilatory efficiency during follow-up. Multivariable repeated measures analyses revealed that, besides reverse remodeling, New York Heart Association functional class II and good patient-reported health status before implantation were the most important correlates of higher average oxygen consumption during exercise, and that nonischemic etiology and smaller pre-implantation QRS width were associated with better ventilatory efficiency over time. CONCLUSIONS During the first 6 months of CRT there was a significant positive association between reverse remodeling and cardiopulmonary exercise capacity.
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Affiliation(s)
- Mirjam H Mastenbroek
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands; Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
| | - Jetske Van't Sant
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Henneke Versteeg
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands; Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Susanne S Pedersen
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mathias Meine
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
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Al Halabi S, Qintar M, Hussein A, Alraies MC, Jones DG, Wong T, MacDonald MR, Petrie MC, Cantillon D, Tarakji KG, Kanj M, Bhargava M, Varma N, Baranowski B, Wilkoff BL, Wazni O, Callahan T, Saliba W, Chung MK. Catheter Ablation for Atrial Fibrillation in Heart Failure Patients: A Meta-Analysis of Randomized Controlled Trials. JACC Clin Electrophysiol 2015; 1:200-209. [PMID: 26258174 DOI: 10.1016/j.jacep.2015.02.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rhythm control with antiarrhythmic drugs (AADs) is not superior to rate control in patients with heart failure (HF) and atrial fibrillation (AF), but AF ablation may be more successful at achieving rhythm control than AADs. However, risks for both ablation and AADs are likely higher and success rates lower in patients with HF. OBJECTIVE To compare rate control versus AF catheter ablation strategies in patients with AF and HF. METHODS We conducted a meta-analysis of trials which randomized HF patients (LVEF<50%) with AF to a rate control or AF catheter ablation strategy and reported change in LVEF, quality of life, 6-minute walk test, or peak oxygen consumption. Study quality and heterogenity were assessed using Jadad scores and Cochran's Q statistics, respectively. Mantel Haenszel relative risks and mean differences were calculated using random effect models. RESULTS Four trials (N=224) met inclusion criteria; 82.5% (n=185) had persistent AF. AF ablation was associated with an increase in LVEF (mean difference 8.5%; 95%CI 6.4,10.7%; P<0.001) compared to rate control. AF ablation was superior in improving quality of life by Minnesota Living with Heart Failure (MLWHF) questionnaire scores (mean difference -11.9; 95%CI -17.1, -6.6; P<0.001). Peak oxygen consumption and 6-minute walk distance increased in AF ablation compared to rate control patients (mean difference 3.2; 95%CI 1.1,5.2; P=0.003; mean difference 34.8; 95%CI 2.9, 66.7; P = 0.03, respectively). In the persistent AF subgroup LVEF and MLWHF were significantly improved with AF ablation. Major adverse event rates (RR 1.3; 95% CI, 0.4, 3.9; p=0.64) were not significantly different. No significant heterogeneity was evident. CONCLUSIONS In patients with HF and AF, AF catheter ablation is superior to rate control in improving LVEF, quality of life and functional capacity. Prior to accepting a rate control strategy in HF patients with persistent or drug refractory AF, consideration should be given to AF ablation.
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Affiliation(s)
- Shadi Al Halabi
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Mohammed Qintar
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Ayman Hussein
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - M Chadi Alraies
- The Department of Cardiology, University of Minnesota, Minneapolis, MN
| | - David G Jones
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom ; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Tom Wong
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom ; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Mark C Petrie
- Golden Jubilee National Hospital, Glasgow, Scotland, United Kingdom
| | - Daniel Cantillon
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Khaldoun G Tarakji
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Mohamed Kanj
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Mandeep Bhargava
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Niraj Varma
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Bryan Baranowski
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Bruce L Wilkoff
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Oussama Wazni
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Thomas Callahan
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Walid Saliba
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Mina K Chung
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
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Thompson LE, Bekelman DB, Allen LA, Peterson PN. Patient-Reported Outcomes in Heart Failure: Existing Measures and Future Uses. Curr Heart Fail Rep 2015; 12:236-46. [DOI: 10.1007/s11897-015-0253-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Zakeri R, Levine JA, Koepp GA, Borlaug BA, Chirinos JA, LeWinter M, VanBuren P, Dávila-Román VG, de Las Fuentes L, Khazanie P, Hernandez A, Anstrom K, Redfield MM. Nitrate's effect on activity tolerance in heart failure with preserved ejection fraction trial: rationale and design. Circ Heart Fail 2015; 8:221-8. [PMID: 25605640 PMCID: PMC4304404 DOI: 10.1161/circheartfailure.114.001598] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/03/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Rosita Zakeri
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - James A Levine
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Gabriel A Koepp
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Barry A Borlaug
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Julio A Chirinos
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Martin LeWinter
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Peter VanBuren
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Victor G Dávila-Román
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Lisa de Las Fuentes
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Prateeti Khazanie
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Adrian Hernandez
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Kevin Anstrom
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.)
| | - Margaret M Redfield
- From the Mayo Clinic, Rochester, MN (R.Z., B.A.B., M.M.R.); Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Pennsylvania, Philadelphia (J.A.C.); University of Vermont College of Medicine, Burlington (M.L., P.V.); Washington University School of Medicine, St Louis, MO (V.G.D.-R., L.d.l.F.); and Duke Clinical Research Institute, Durham, NC (P.K., A.H., K.A.).
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Kerrigan DJ, Williams CT, Ehrman JK, Saval MA, Bronsteen K, Schairer JR, Swaffer M, Brawner CA, Lanfear DE, Selektor Y, Velez M, Tita C, Keteyian SJ. Cardiac rehabilitation improves functional capacity and patient-reported health status in patients with continuous-flow left ventricular assist devices: the Rehab-VAD randomized controlled trial. JACC-HEART FAILURE 2014; 2:653-9. [PMID: 25447348 DOI: 10.1016/j.jchf.2014.06.011] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/13/2014] [Accepted: 06/13/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study examined the effects of a cardiac rehabilitation (CR) program on functional capacity and health status (HS) in patients with newly implanted left ventricular assist devices (LVADs). BACKGROUND Reduced functional capacity and HS are independent predictors of mortality in patients with heart failure. CR improves both, and is related to improved outcomes in patients with heart failure; however, there is a paucity of data that describe the effects of CR in patients with LVADs. METHODS Enrolled subjects (n = 26; 7 women; age 55 ± 13 years; ejection fraction 21 ± 8%) completed a symptom-limited cardiopulmonary exercise test, the Kansas City Cardiomyopathy Questionnaire (KCCQ), a 6-min walk test (6MW), and single-leg isokinetic strength test before 2:1 randomization to CR versus usual care. Subjects in the CR group underwent 18 visits of aerobic exercise at 60% to 80% of heart rate reserve. Within-group changes from baseline to follow-up were analyzed with a paired t-test, whereas an independent t-test was used to determine differences in the change between groups. RESULTS Within-group improvements were observed in the CR group for peak oxygen uptake (10%), treadmill time (3.1 min), KCCQ score (14.4 points), 6MW distance (52.3 m), and leg strength (17%). Significant differences among groups were observed for KCCQ, leg strength, and total treadmill time. CONCLUSIONS Indicators of functional capacity and HS are improved in patients with continuous-flow LVADs who attend CR. Future trials should examine the mechanisms responsible for these improvements, and if such improvements translate into improved clinical outcomes. (Cardiac Rehabilitation in Patients With Continuous Flow Left Ventricular Assist Devices:Rehab VAD Trial [RehabVAD]; NCT01584895).
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Affiliation(s)
- Dennis J Kerrigan
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan.
| | - Celeste T Williams
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Jonathan K Ehrman
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Matthew A Saval
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Kyle Bronsteen
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - John R Schairer
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Meghan Swaffer
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - David E Lanfear
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Yelena Selektor
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Mauricio Velez
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Cristina Tita
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
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50
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Tang WHW, Topol EJ, Fan Y, Wu Y, Cho L, Stevenson C, Ellis SG, Hazen SL. Prognostic value of estimated functional capacity incremental to cardiac biomarkers in stable cardiac patients. J Am Heart Assoc 2014; 3:e000960. [PMID: 25332177 PMCID: PMC4323823 DOI: 10.1161/jaha.114.000960] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Few studies have investigated functional capacity self‐assessment tools in either prediction of future major adverse cardiac outcomes beyond all‐cause mortality or direct comparisons with clinically available biomarkers. Methods and Results We estimated functional capacity using the Duke Activity Status Index (DASI) questionnaire in 8987 sequential stable patients without acute coronary syndrome who were undergoing elective diagnostic coronary angiography with 3‐year follow‐up of major adverse cardiac events (death, nonfatal myocardial infarction, or stroke). A low DASI score provided independent prediction of a 4.8‐fold increase in future risk of incident major adverse cardiac events at 3 years (quartiles 1 versus 4 hazard ratio [95% CI] 4.76 [4.03 to 5.61], P<0.001), and a 3.8‐fold increased risk after adjusting for traditional risk factors (3.77 [3.15 to 4.51], P<0.001). The prognostic value of the DASI score was evident in both primary and secondary prevention cohorts, with and without heart failure, as well as high and low C‐reactive protein and B‐type natriuretic peptide levels. The DASI score reclassified 15% of patients (P<0.001) beyond traditional risk factors in predicting future MACE. Conclusion A simple self‐assessment tool of functional capacity in stable patients undergoing elective diagnostic cardiac evaluation provides independent and incremental prognostic value for prediction of both significant coronary angiographic disease and long‐term adverse clinical events.
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Affiliation(s)
- W H Wilson Tang
- Department of Cellular and Molecular Medicine, Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute, Cleveland, OH (W.T., S.L.H.) Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (W.T., L.C., C.S., S.G.E., S.L.H.)
| | | | - Yiying Fan
- Department of Mathematics, Cleveland State University, Cleveland, OH (Y.F., Y.W.)
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, Cleveland, OH (Y.F., Y.W.)
| | - Leslie Cho
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (W.T., L.C., C.S., S.G.E., S.L.H.)
| | - Cindy Stevenson
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (W.T., L.C., C.S., S.G.E., S.L.H.)
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (W.T., L.C., C.S., S.G.E., S.L.H.)
| | - Stanley L Hazen
- Department of Cellular and Molecular Medicine, Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute, Cleveland, OH (W.T., S.L.H.) Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (W.T., L.C., C.S., S.G.E., S.L.H.)
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