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Asiello JD, Kelley CM, Cannone K, McInnis L, Begin A, Dittrich M, Donovan E, Beatty K, Lam N, Taubert A, Wong J. Addressing the functional needs of left ventricular assist device candidates: Development and feasibility of an occupational therapy pre-operative evaluation. Heart Lung 2024; 64:198-207. [PMID: 38301417 DOI: 10.1016/j.hrtlng.2024.01.006] [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: 08/19/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Everyday living with a left ventricular assist device (LVAD) is complex, particularly for people with physical or cognitive impairments or limited social supports. There is a need for standardized pre-operative functional evaluations. OBJECTIVES Our objectives were to describe a pre-operative occupational therapy (OT) evaluation for LVAD candidates, assess its feasibility in routine care, and characterize functional needs. METHODS We retrospectively reviewed electronic medical records of pre-operative OT consultations for LVAD candidates over four years (n = 209). Occupational profile, vision, and sensation were operationalized from documentation narratives. Daily functioning was measured with Activity Measure for Post-Acute Care, grip strength with dynamometer, cognition with Montreal Cognitive Assessment and Allen Cognitive Level Screen-5, and LVAD self-management with a performance-based ordinal scale. RESULTS 89.5 % of consultations were completed, averaging 61.2 min (n = 187): 79.1 % (148/187) inpatient and 20.9 % (39/187) outpatient. Patients completed 87.7 % (164/187) to 100.0 % (187/187) of evaluation components. 21.9 % (41/187) of candidates lived alone. 6.4 % (12/187) and 7.0 % (13/185) had visual and sensory dysfunction. 57.4 % were independent with daily activities (104/181). 17.7 % (32/181) had impaired grip strength. 69.3 % (124/179) had impaired cognition, 29.7 % (51/172) with impaired functional cognition for everyday activities. 88.4 % (145/164) required physical or cueing assistance while practicing LVAD batteries management. OTs interpreted that 20.9 % (39/187) would likely require 24/7 post-operative support with LVAD self-care. CONCLUSION Pre-operative OT evaluations were feasible and emphasized complex functional needs. Assessing LVAD self-care abilities may inform candidacy and facilitate early interventions to optimize functioning. OT should be consulted within interprofessional teams for all LVAD candidates.
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Affiliation(s)
- Jessica D Asiello
- Department of Occupational Therapy, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA 02129, United States; Occupational Therapy Services, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Christina M Kelley
- Occupational Therapy Services, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Kellie Cannone
- Department of Occupational Therapy, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA 02129, United States
| | - Lauren McInnis
- Department of Occupational Therapy, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA 02129, United States
| | - Abigail Begin
- Occupational Therapy Services, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Marissa Dittrich
- Occupational Therapy Services, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Erin Donovan
- Occupational Therapy Services, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Kimberly Beatty
- Occupational Therapy Services, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Nicole Lam
- Occupational Therapy Services, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Alyssa Taubert
- Occupational Therapy Services, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - John Wong
- Department of Occupational Therapy, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA 02129, United States; School of Nursing, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA 02129, United States
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Horibe H, Ando K, Maekawa Y, Narisawa M, Yamase Y, Funabiki J, Ueyama C, Takemoto Y, Shigeta T, Hibino T, Kondo T, Okumura T, Murohara T. The association of serum adiponectin level with activities of daily living in hospitalized elderly patients with heart failure. J Cardiol 2024; 83:130-137. [PMID: 37591339 DOI: 10.1016/j.jjcc.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/24/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Several studies have reported a relationship between elevated serum adiponectin levels and poor outcomes in patients with heart failure (HF). However, data on the activities of daily living (ADL) in elderly patients with HF are limited. METHODS We evaluated 218 hospitalized elderly (≥65 years) patients with HF who underwent a comprehensive cardiac rehabilitation (CR) program during hospitalization. Serum adiponectin levels were measured before discharge. The Barthel index (BI) score was evaluated at discharge. Low ADL was defined as a BI score < 85. RESULTS Serum adiponectin levels were significantly associated with low ADL [p = 0.03; odds ratio (OR), 1.024, per 1.0 μg/mL increase]. In logistic or regression analyses adjusted for age, sex, body mass index, and estimated glomerular filtration rate, high adiponectin levels (≥16.2 μg/mL) were significantly associated with low ADL (p = 0.04; OR, 2.53), malnutrition (p < 0.01; OR, 2.88), and 6-min walk distance (p = 0.04; β = -17.5). In the multivariate analysis adjusted for conventional risk factors of low ADL, high adiponectin levels were also significantly associated with low ADL (p = 0.03; OR, 2.68). In the stepwise forward selection procedure, a high adiponectin level was an independent determinant of low ADL (p = 0.02; R2 = 0.0262). Both net reclassification improvement (0.53; p < 0.01) and integrated discrimination improvement (0.02; p = 0.01) improved significantly after the addition of high adiponectin level to conventional risk factors. In the regression analysis adjusted for age and sex, serum adiponectin levels were significantly (p < 0.0025) negatively associated with abdominal visceral and subcutaneous adipose tissue areas, body weight, body mass index, and serum triglyceride levels. CONCLUSIONS High serum adiponectin levels were not only significantly associated with an increased risk of low ADL, but also with an increased risk of malnutrition and low physical activity in elderly patients with HF after the in-hospital CR program.
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Affiliation(s)
- Hideki Horibe
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
| | - Kei Ando
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Yasutaka Maekawa
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Megumi Narisawa
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Yuichiro Yamase
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Junya Funabiki
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Chikara Ueyama
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Yoshio Takemoto
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Toshimasa Shigeta
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Takeshi Hibino
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Taizo Kondo
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yang W, Tian G, Cui Y, Li R, Zhou T, Shi Y, Shuai J, Ma Y, Yan Y. Associations between activities of daily living, leisure activities and subjective well-being in Chinese older adults. Gerodontology 2023. [PMID: 37948355 DOI: 10.1111/ger.12721] [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] [Accepted: 10/04/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The study aimed to explore the internal pathway of the association between activities of daily living and subjective well-being among Chinese older adults using a large and representative sample. BACKGROUND There is still a lack of systematic investigation into the association between activities of daily living and subjective well-being among Chinese older adults. MATERIALS AND METHODS The study included 10 578 participants from the Chinese Longitudinal Healthy Longevity Survey. We applied multiple linear regression analysis and Spearman correlation analysis to examine the association between activities of daily living and subjective well-being and PROCESS macro to determine the mediating effect of leisure activities on the relationship between them. RESULTS The mean total score of subjective well-being was 30.5 ± 4.4. The prevalence of basic activities of daily living and instrumental activities of daily living limitations was 18.0% and 60.8%, respectively. Correlation analysis showed that activities of daily living score were negatively correlated with subjective well-being. Leisure activities were positively correlated with subjective well-being. The effect of instrumental activities of daily living on subjective well-being was partially mediated by leisure activities and leisure activities completely mediated the association between basic activities of daily living and subjective well-being. CONCLUSIONS The effect of instrumental activities of daily living on subjective well-being was partially mediated by leisure activities and leisure activities completely mediated the association between basic activities of daily living and subjective well-being.
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Affiliation(s)
- Wenyan Yang
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Gang Tian
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yiran Cui
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Rui Li
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Tong Zhou
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yan Shi
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jingliang Shuai
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yulan Ma
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yan Yan
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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Ahmad F, Karim A, Khan J, Qaisar R. Statin Therapy Induces Gut Leakage and Neuromuscular Disjunction in Patients With Chronic Heart Failure. J Cardiovasc Pharmacol 2023; 82:189-195. [PMID: 37381157 DOI: 10.1097/fjc.0000000000001445] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
ABSTRACT Statins are commonly used to limit the risk of cardiovascular diseases, including ischemic heart attack and stroke. However, treatment often leads to myopathy and muscle weakness. Therefore, a better understanding of underlying pathomechanism is needed to improve the clinical outcomes. Here, we assessed the physical performance, including handgrip strength (HGS), gait speed (GS), and short physical performance battery, in 172 patients diagnosed with chronic heart failure (CHF) treated with (n = 50) or without (n = 122) statin and 59 controls. The plasma biomarkers, including sarcopenia marker C-terminal agrin fragment-22 (CAF22), intestinal barrier integrity marker zonulin, and C-reactive protein (CRP), were measured and correlated with the physical performance of patients. The HGS, short physical performance battery scores, and GS were significantly compromised in patients with CHF versus controls. Irrespective of etiology, significant elevation of plasma CAF22, zonulin, and CRP was observed in patients with CHF. There were strong inverse correlations of CAF22 with HGS (r 2 = 0.34, P < 0.0001), short physical performance battery scores (r 2 = 0.08, P = 0.0001), and GS (r 2 = 0.143, P < 0.0001). Strikingly, CAF22 and zonulin were positively correlated with each other (r 2 = 0.10, P = 0.0002) and with the level of CRP in patients with CHF. Further investigations revealed a significant induction of CAF22, zonulin, and CRP in patients with CHF taking statin versus nonstatin group. Consistently, HGS and GS were significantly lower in the statin versus nonstatin CHF patients' group. Collectively, statin therapy adversely affects the neuromuscular junction and intestinal barrier, which potentially induces systemic inflammation and physical disability in patients with CHF. Further prospective confirmation of the findings is required in a well-controlled study.
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Affiliation(s)
- Firdos Ahmad
- Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Biomedical Sciences, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Asima Karim
- Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Javaidullah Khan
- Department of Cardiology, Post Graduate Medical Institute, Hayatabad Medical Complex, Peshawar, Pakistan; and
| | - Rizwan Qaisar
- Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Blum M, McKendrick K, Gelfman LP, Pinney SP, Goldstein NE. Using Latent Class Analysis to Identify Different Clinical Profiles Among Patients With Advanced Heart Failure. J Pain Symptom Manage 2023; 65:111-119. [PMID: 36911500 PMCID: PMC9994448 DOI: 10.1016/j.jpainsymman.2022.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Context Although palliative care is guideline-indicated for patients with advanced heart failure (HF), the scarcity of a specialty-trained palliative care workforce demands better identification of patients who are most burdened by the disease. Objectives We sought to identify latent subgroups with variations regarding symptom burden, functional status, and multimorbidity in an advanced HF population. Methods We performed a latent class analysis (LCA) of baseline data from a trial enrolling advanced HF patients. As LCA input variables, we chose indicators of HF severity, physical and psychological symptom burden, functional status, and the number of comorbidities. Results Among 563 patients, two subgroups emerged from LCA, Class A (352 [62.5%]) and Class B (211 [37.5%]). Patients in Class A were less often classified as NYHA class III or IV (88.0% vs. 97.5%, P < 0.001), as compared to Class B patients. Class A patients had fewer symptoms, fewer comorbidities, only 25.9% had impairments in activities of daily living (ADL), and virtually none suffered from clinically significant anxiety (0.4%) or depression (0.9%). In Class B, every patient reported more than three symptoms, almost all patients (92.6%) had some impairment in ADL, and nearly a third had anxiety (30.2%) or depression (28.3%). All-cause mortality after 12 months was higher in Class B, as compared to Class A (18.5% vs. 12.5%, P = 0.047). Conclusion Among advanced HF patients, we identified a distinct subgroup characterized by a conjunction of high symptom burden, anxiety, depression, multimorbidity, and functional status impairment, which might profit particularly from palliative care interventions. J Pain Symptom Manage 2022;000:1-9.
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Affiliation(s)
- Moritz Blum
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Internal Medicine/Cardiology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Karen McKendrick
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura P. Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), Bronx, New York, USA
| | | | - Nathan E. Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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