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Higa H, Lennie TA, Chung ML, Tsuchihashi-Makaya M. Associations of multidimensional fatigue with the physical, psychological, and situational factors in outpatients with heart failure: a cross-sectional study. Eur J Cardiovasc Nurs 2023; 22:647-654. [PMID: 36509707 DOI: 10.1093/eurjcn/zvac117] [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: 07/18/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
AIMS Fatigue, a distressing symptom in patients with heart failure (HF), is associated with progress and health outcomes. Fatigue has been identified as having multidimensions, but a few studies have used a multidimensional fatigue scale. Many factors related to HF, including physical, psychological, and situational factors, may impact fatigue. However, there is limited knowledge about how these HF-related factors are associated with multidimensional fatigue in outpatients with HF in Japan. The aim of this study was to identify HF-related factors [physical; clinical characteristics, New York Heart Association (NYHA) functional class and physical function, psychological; depressive symptoms and anxiety, situational; health literacy and perceived control] associated with the five dimensions of fatigue in outpatients with HF. METHODS AND RESULTS Outpatients with HF (N = 165, mean age = 69.5 years, 78.8% male) completed the survey and physical assessment of gait speed. Fatigue was assessed using five dimensions of the Multidimensional Fatigue Inventory-20. Multiple linear regression analysis was conducted for each dimension of fatigue. General fatigue was predicted by age, NYHA, and perceived control. Physical fatigue was predicted by NYHA, depressive symptoms, and perceived control. Reduced activity was predicted by NYHA, gait speed, depressive symptoms, communicative health literacy, and critical health literacy. The reduced motivation was predicted by depressive symptoms and perceived control. Mental fatigue was predicted by depressive symptoms. CONCLUSION Different factors were significantly associated with each fatigue dimension. Further research is needed to alleviate fatigue in patients with HF.
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Affiliation(s)
- Hiroko Higa
- School of Nursing, Kitasato University, 2-1-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0329, Japan
| | - Terry A Lennie
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Misook L Chung
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Miyuki Tsuchihashi-Makaya
- School of Nursing, Kitasato University, 2-1-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0329, Japan
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Sharma AK, Kumar H, Razi MM, Sinha SK, Pandey U, Shukla P, Thakur R, Verma CM, Bansal RK, Krishna V. To determine the correlation between echocardiographic diastolic parameters and invasively measured left ventricular end diastolic pressure in patients with heart failure with preserved ejection fraction- an observational, descriptive study. (CEAL-HFpEF study). Indian Heart J 2021; 73:470-475. [PMID: 34474760 PMCID: PMC8424284 DOI: 10.1016/j.ihj.2021.06.012] [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: 10/09/2020] [Revised: 01/18/2021] [Accepted: 06/27/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives Though invasive monitoring is the most accurate to estimate diastolic dysfunction but it has its own risk. The purpose of this study was to find out any standardized correlation between invasive and non -invasive parameters. Methods It is an observational, descriptive study comprising of a total of 500 patients. The primary objective of the study was to determine the correlation between echocardiographic diastolic parameters and invasively measured left ventricular end diastolic pressure (LVEDP). Results On studying correlation of different invasive and non-invasive data it was reported that there was a weak correlation between peak E velocity (r = 0.14, p = 0.631), Peak A velocity (r = 0.67, p = 0.59), IVRT (r = −0.35, p = 0.178), Mitral deceleration time (DT) (r = −0.06, p = 0.842), pulmonary venous peak systolic (r = −0.02, p = 0.966) and diastolic flows (r = 0.47, p = 0.201) to LVEDP. There was a good positive correlation between elevated LVEDP and difference in duration of pulmonary venous and mitral flow at atrial contraction (A-Ard) and E/Ea at all four longitudinal segments of the left ventricle. The sensitivity and specificity for detecting an elevated LVEDP of more than 12 mm Hg, using a cut off value of E/Ea< 8, were 89% and 90%.Lateral E/Ea ≥ 12, LAVI ≥34 mL/m2, and Ard–Ad > 30 msec have the greatest diagnostic value for diagnosing diastolic dysfunction in HFpEF patients. Conclusion Lateral E/Ea ≥ 12, LAVI ≥34 mL/m2, and Ard–Ad > 30 msec have the greatest diagnostic value for diagnosing diastolic dysfunction in HFpEF patients and have good correlation with invasively measured LVEDP.
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Affiliation(s)
- Awadhesh Kumar Sharma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India.
| | - Hitender Kumar
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - M M Razi
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Praveen Shukla
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - C M Verma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - R K Bansal
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Vinay Krishna
- Department of Cardiothoracic Surgury, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
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Anchouche K, Elharram M, Oulousian E, Razaghizad A, Avram R, Marquis-Gravel G, Randhawa VK, Nkulikiyinka R, Ni W, Fiuzat M, O'Connor C, Psotka MA, Fox J, Tyl B, Kao D, Sharma A. Use of Actigraphy (Wearable Digital Sensors to Monitor Activity) in Heart Failure Randomized Clinical Trials: A Scoping Review. Can J Cardiol 2021; 37:1438-1449. [PMID: 34256087 DOI: 10.1016/j.cjca.2021.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Actigraphy-based measurements of physiologic parameters may enable design of patient-centric heart failure (HF) clinical trials. Recently, the Heart Failure Collaboratory focused on recommendations for meaningful change and use of actigraphy as an end point in HF clinical trials. We aimed to evaluate randomized controlled trials (RCTs) that have quantified the impact of HF interventions using actigraphy. METHODS Using a scoping review strategy, we evaluated the use of actigraphy in HF RCTs. Studies were identified through electronic searches of Embase, OVID Medline, PubMed, and Cochrane Review. Data on trial characteristics and results were collected. RESULTS We identified 11 RCTs with a total of 1,455 participants. The risk of bias across the included trials was high overall. All trials had the primary outcomes reflecting measures of either physical activity (n = 8), sleep (n = 2), or both (n = 1). Five trials evaluated response to pharmacologic therapies compared with placebo, 3 evaluated physical activity interventions, 2 evaluated group or cognitive therapy, and 1 evaluated sleep-ventilation strategy. Sample sizes ranged from 30 to 619 participants. There was significant heterogeneity relating to device type, body placement site, and handling of missing actigraphy data. Duration of monitoring ranged from 48 hours to 12 weeks. None of the studies evaluating pharmacologic therapies (n = 5) demonstrated a significant improvement of actigraphy-based primary end point measurements. CONCLUSIONS There is significant heterogeneity in the use, methodology, and results of actigraphy-based HF RCTs. Our results highlight the need to develop, standardize, and validate actigraphy-specific outcomes for use in HF clinical trials.
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Affiliation(s)
- Khalil Anchouche
- Division of Cardiology, McGill University Health Centre, McGill University, Montréal, Québec, Canada; DREAM-CV Lab, McGill University Health Centre, McGill University, Montréal, Québec, Canada
| | - Malik Elharram
- Division of Cardiology, McGill University Health Centre, McGill University, Montréal, Québec, Canada; DREAM-CV Lab, McGill University Health Centre, McGill University, Montréal, Québec, Canada
| | - Emily Oulousian
- Division of Cardiology, McGill University Health Centre, McGill University, Montréal, Québec, Canada; DREAM-CV Lab, McGill University Health Centre, McGill University, Montréal, Québec, Canada
| | - Amir Razaghizad
- Division of Cardiology, McGill University Health Centre, McGill University, Montréal, Québec, Canada; DREAM-CV Lab, McGill University Health Centre, McGill University, Montréal, Québec, Canada
| | - Robert Avram
- Division of Cardiology, Department of Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of California San Francisco, San Francisco, California, USA; Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Varinder Kaur Randhawa
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, Heart, Vascular and Thoracic Institute, Cleveland, Ohio, USA
| | | | - Wei Ni
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Mona Fiuzat
- Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Christopher O'Connor
- Division of Cardiology, Duke University, Durham, North Carolina, USA; Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | | | - Jonathan Fox
- Eidos Therapeutics, San Francisco, California, USA
| | - Benoit Tyl
- Center for Therapeutic Innovation Cardiovascular and Metabolic diseases, Institut de Recherches Internationales Servier, Suresnes, France
| | - David Kao
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Abhinav Sharma
- Division of Cardiology, McGill University Health Centre, McGill University, Montréal, Québec, Canada; DREAM-CV Lab, McGill University Health Centre, McGill University, Montréal, Québec, Canada.
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Khandwalla RM, Grant D, Birkeland K, Heywood JT, Fombu E, Owens RL, Steinhubl SR. The AWAKE-HF Study: Sacubitril/Valsartan Impact on Daily Physical Activity and Sleep in Heart Failure. Am J Cardiovasc Drugs 2021; 21:241-254. [PMID: 32978755 DOI: 10.1007/s40256-020-00440-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AWAKE-HF evaluated the effect of the initiation of sacubitril/valsartan versus enalapril on activity and sleep using actigraphy in patients who have heart failure with reduced ejection fraction (HFrEF). METHODS In this randomized, double-blind study, patients with HFrEF (n = 140) were randomly assigned to sacubitril/valsartan or enalapril for 8 weeks, followed by an 8-week open-label phase with sacubitril/valsartan. Primary endpoint was change from baseline in mean activity counts during the most active 30 min/day at week 8. The key secondary endpoint was change in mean nightly activity counts/minute from baseline to week 8. Kansas City Cardiomyopathy Questionnaire-23 (KCCQ-23) was an exploratory endpoint. RESULTS There were no detectable differences between groups in geometric mean ratio of activity counts during the most active 30 min/day at week 8 compared with baseline (0.9456 [sacubitril/valsartan:enalapril]; 95% confidence interval [CI] 0.8863-1.0088; P = 0.0895) or in mean change from baseline in activity during sleep (difference: 2.038 counts/min; 95% CI - 0.062 to 4.138; P = 0.0570). Change from baseline to week 8 in KCCQ-23 was 2.89 for sacubitril/valsartan and 4.19 for enalapril, both nonsignificant. CONCLUSIONS In AWAKE-HF, no detectable differences in activity and sleep were observed when comparing sacubitril/valsartan with enalapril in patients with HFrEF using a wearable biosensor. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02970669.
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Piepoli MF, Hussain RI, Comin-Colet J, Dosantos R, Ferber P, Jaarsma T, Edelmann F. OUTSTEP-HF: randomised controlled trial comparing short-term effects of sacubitril/valsartan versus enalapril on daily physical activity in patients with chronic heart failure with reduced ejection fraction. Eur J Heart Fail 2020; 23:127-135. [PMID: 33314487 DOI: 10.1002/ejhf.2076] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS OUTSTEP-HF compared the effect of sacubitril/valsartan vs. enalapril on 6-min walk test (6MWT) distance, non-sedentary daytime physical activity and heart failure (HF) symptoms in patients with HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS Ambulatory patients (n = 621) with stable symptomatic HFrEF were randomised 1:1 to sacubitril/valsartan (n = 310) or enalapril (n = 311). Changes in physical activity and mean daily non-sedentary daytime activity from baseline to Week 12 were measured using 6MWT and a wrist-worn accelerometer device, respectively. After 12 weeks, 6MWT improved by 35.09 m with sacubitril/valsartan [97.5% confidence interval (CI) 27.85, 42.32] and by 26.11 m with enalapril (97.5% CI 18.78, 33.43); however, there was no significant difference between groups [least squares means treatment difference: 8.98 m (97.5% CI -1.31, 19.27); P = 0.0503]. Mean daily non-sedentary daytime activity decreased by 27 min with sacubitril/valsartan and by 21 min with enalapril [least squares means treatment difference: -6 min (97.5% CI -25.7, 13.4), P = 0.4769] after 12 weeks. 6MWT improved by ≥30 m in 51% of patients in the sacubitril/valsartan group vs. 44% of patients treated with enalapril (odds ratio 1.251, 95% CI 0.895, 1.748). At Week 4, non-sedentary daytime activity increased by ≥10% in 58% of patients treated with sacubitril/valsartan vs. 64% with enalapril; 58% of patients treated with sacubitril/valsartan reported improved HF symptoms as assessed by patient global assessment vs. 43% with enalapril. However, these differences did not persist at Week 12. CONCLUSION After 12 weeks of treatment, there was no significant benefit of sacubitril/valsartan on either 6MWT or daytime physical activity measured by actigraphy compared with enalapril.
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Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, Cardiology Department, G. da Saliceto Polichirurgico Hospital, Piacenza, Italy, and Scuola Superiore S. Anna, Piacenza, Italy
| | | | - Josep Comin-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Tiny Jaarsma
- Division of Nursing Science, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
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6
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Edelmann F, Jaarsma T, Comin‐Colet J, Schorr J, Ecochard L, Hussain RI, Piepoli MF. Rationale and study design of
OUTSTEP‐HF
: a randomised controlled study to assess the effect of sacubitril/valsartan and enalapril on physical activity measured by accelerometry in patients with heart failure with reduced ejection fraction. Eur J Heart Fail 2020; 22:1724-1733. [DOI: 10.1002/ejhf.1919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/15/2020] [Accepted: 05/23/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Frank Edelmann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin Berlin Germany
| | - Tiny Jaarsma
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht UNiversity Utrecht The Netherlands
- Division of Nursing Science, Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | - Josep Comin‐Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Biomedical Research Institute (IDIBELL) University of Barcelona, Hospitalet de Llobregat Barcelona Spain
| | | | | | | | - Massimo F. Piepoli
- Heart Failure Unit, Cardiology Department, G. da Saliceto Hospital Piacenza Italy
- Institute of Life Sciences Sant'Anna School of Advanced Studies Pisa Italy
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Khandwalla RM, Birkeland K, Heywood JT, Steinhubl S, McCague K, Fombu E, Grant D, Riebman JB, Owens RL. Activity Sensors to Evaluate the Effect of Sacubitril/Valsartan on Quality-of-Life in Heart Failure: rational and design of the AWAKE-HF study. ESC Heart Fail 2019; 6:1313-1321. [PMID: 31638338 PMCID: PMC6989284 DOI: 10.1002/ehf2.12514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/02/2019] [Accepted: 08/16/2019] [Indexed: 12/31/2022] Open
Abstract
Aims Limited data are available regarding the ability of sacubitril/valsartan to provide clinically meaningful health‐related quality of life (HRQoL) improvements among individuals with heart failure (HF). Objective measurement of physical activity and sleep using actigraphy can provide insight into daily functioning and HRQoL. Methods and results We designed an 18 week, multicenter, randomized, double‐blind, double‐dummy, parallel‐group study to objectively assess changes in function and HRQoL directly after initiating sacubitril/valsartan vs. enalapril in participants with HF in their home environments. A total of 136 outpatient, ambulatory participants with New York Heart Association Class II or III HF with reduced ejection fraction (HFrEF) will be included in the study. Patients will undergo a 2 week baseline observational phase (continuing current HF treatment); data from the second week of this phase will be the baseline value for comparison with those of subsequent periods. Patients will then enter an 8 week blinded‐treatment phase (randomly assigned 1:1 to sacubitril/valsartan or enalapril), followed by an 8 week open‐label extension phase (treatment with only sacubitril/valsartan). The primary efficacy endpoint is the change in mean activity counts during the most active 30 min of the participant's day between baseline and the final randomized treatment phase measurement. Secondary endpoints include the change in mean sleep activity during the randomized and open‐label phases; questionnaires will also assess HRQoL measures. Rather than analysing pooled actigraphy data, the researchers are considering each participant to be acting as his or her own control. Conclusions This will be the first study to assess the effects of sacubitril/valsartan on objective measures of sleep and activity in individuals with HFrEF within the context of their daily lives. Wearable accelerometer devices will be used to gain insight into how the medication affects physical activity and sleep.
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Affiliation(s)
- Raj M Khandwalla
- Cedars-Sinai Heart Institute, 250 N Robertson Blvd, Suite #403, Beverly Hills, Los Angeles, CA, USA
| | - Kade Birkeland
- Cedars-Sinai Heart Institute, 250 N Robertson Blvd, Suite #403, Beverly Hills, Los Angeles, CA, USA
| | | | | | - Kevin McCague
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Emmanuel Fombu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Daniel Grant
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Robert L Owens
- University of California, San Diego School of Medicine, San Diego, CA, USA
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8
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Floegel TA, Dickinson JM, DerAnanian C, McCarthy M, Hooker SP, Buman MP. Association of Posture and Ambulation With Function 30 Days After Hospital Discharge in Older Adults with Heart Failure. J Card Fail 2018; 24:126-130. [PMID: 29325794 DOI: 10.1016/j.cardfail.2018.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/21/2017] [Accepted: 12/28/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this work was to investigate the predictive value of in-hospital posture and ambulatory activity for 30 days following discharge on functional status in older patients with heart failure. METHODS AND RESULTS We undertook a prospective observational pilot study of 27 patients (78 ± 9.8 y, 51.8% female) admitted with heart failure. Participants wore 2 inclinometric accelerometers to record posture in-hospital and an ankle accelerometer to record ambulatory activity in-hospital and 30 days after discharge. Function was assessed on the day after discharge (Timed Up and Go [TUG], Short Physical Performance Battery [SPPB], hand grip strength) and 30 days after discharge. Length of stay was 5.1 ± 3.9 days. Participants spent 63.0 ± 19.2% of their hospital time lying down, 30.2 ± 18.7% sitting, 5.3 ± 4.2% standing, and 1.9 ± 8.6% ambulating. Thirty-day mean post-discharge stepping was 4890 ± 2285 steps/day. Each 10% increase in hospital lying time was associated with 0.7 s longer TUG time (95% confidence interval [CI] 0.2-1.9) at 30 days. Each 1000 additional daily steps in the post-discharge period was associated with a 0.8-point higher SPPB score (95% CI 0.1-1.0) at 30 days. Handgrip strength was unchanged. CONCLUSIONS Older patients with heart failure were sedentary during hospitalization, which may contribute to decreased functional performance. Physical activity after discharge may minimize this negative effect.
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Affiliation(s)
- Theresa A Floegel
- College of Nursing, East Carolina University, Greenville, North Carolina; College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Jared M Dickinson
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Cheryl DerAnanian
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Marianne McCarthy
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Steven P Hooker
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, Arizona
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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. Eur Heart J 2017; 39:1224-1245. [DOI: 10.1093/eurheartj/ehx211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/15/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Carlos E Ruiz
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | - Rebecca T Hahn
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
| | | | - Jeffrey S Borer
- State University of New York Downstate Medical Center and College of Medicine, New York, New York
| | | | - Greg Fontana
- Cedars Sinai Medical Center, Los Angeles, California
| | | | - Reda Ibrahim
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Vladimir Jelnin
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | | | | | - Chad Kliger
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Itzhak Kronzon
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Patrick Nataf
- AP-HP Hôpital Bichat Service de Cardiologie, Paris, France
| | | | | | | | | | | | - Paul Sorajja
- Minneapolis Heart Institute and Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | - Zoltan G Turi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | | | | | - Martin B Leon
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
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10
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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. J Am Coll Cardiol 2017; 69:2067-2087. [DOI: 10.1016/j.jacc.2017.02.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/09/2017] [Accepted: 02/15/2017] [Indexed: 01/05/2023]
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11
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Health-Related Quality of Life, Functional Status, and Cardiac Event-Free Survival in Patients With Heart Failure. J Cardiovasc Nurs 2017; 31:236-44. [PMID: 25774841 DOI: 10.1097/jcn.0000000000000248] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL), functional status, and cardiac event-free survival are outcomes used to assess the effectiveness of interventions in patients with heart failure (HF). However, the nature of the relationships among HRQOL, functional status, and cardiac event-free survival remains unclear. OBJECTIVE The purpose of this study is to examine the nature of the relationships among HRQOL, functional status, and cardiac event-free survival in patients with HF. METHODS This was a prospective, observational study of 313 patients with HF that was a secondary analysis from a registry. At baseline, patient demographic and clinical data were collected. Health-related quality of life was assessed using the Minnesota Living With Heart Failure Questionnaire and functional status was measured using the Duke Activity Status Index. Cardiac event-free survival data were obtained by patient interview, hospital database, and death certificate review. Multiple linear and Cox regressions were used to explore the relationships among HRQOL, functional status, and cardiac event-free survival while adjusting for demographic and clinical factors. RESULTS Participants (n = 313) were men (69%), white (79%), and aged 62 ± 11 years. Mean left ventricular ejection fraction was 35% ± 14%. The mean HRQOL score of 32.3 ± 20.6 indicated poor HRQOL. The mean Duke Activity Status Index score of 16.2 ± 12.9 indicated poor functional status. Cardiac event-free survival was significantly worse in patients who had worse HRQOL or poorer functional status. Patients who had better functional status had better HRQOL (P < .001). Health-related quality of life was not a significant predictor of cardiac event-free survival after entering functional status in the model (P = .54), demonstrating that it was a mediator of the relationship between HRQOL and outcome. CONCLUSION Functional status was a mediator between HRQOL and cardiac event-free survival. These data suggest that intervention studies to improve functional status are needed.
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Concurrent Validity of Daily Activity Data From Medtronic ICD/CRT Devices and the Actigraph GT3X Triaxial Accelerometer: A Pilot Study. Cardiopulm Phys Ther J 2017. [DOI: 10.1097/cpt.0000000000000042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The purpose of this investigation is to examine differences in rest-activity patterns and sleep characteristics in older adults with heart failure (HF) and healthy older adults. The sample included older adults with HF (n = 20) and a reference group of healthy older adults (n = 20). Traditional cosinor analysis was used to assess three parameters of rest-activity from wrist actigraphy data: amplitude (range of activity), mesor (mean activity), and acrophase (time of peak activity). Traditional sleep characteristics were also determined from actigraphy data: total sleep time (TST), sleep latency (SL), sleep efficiency (SE), and wake after sleep onset (WASO). The HF group demonstrated significantly lower mesor and amplitude than the reference group (p < .01). The HF group had significantly greater TST (p < .01), but the groups had similar SE, SL, and WASO. Despite similar sleep characteristics to healthy older adults, overall rest-activity patterns were significantly dampened in those with HF.
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Zengarini E, Hoogendijk EO, Pérez-Zepeda MU, Ruggiero C, Mecocci P, Vellas B, Cesari M. Lack of Energy and Negative Health-Related Outcomes in Nursing Home Residents: Results From the INCUR Study. J Am Med Dir Assoc 2016; 17:525-9. [PMID: 26969535 DOI: 10.1016/j.jamda.2016.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE "Lack of energy" or anergia is a common complaint associated with adverse outcomes in older people. There is a lack of knowledge on this symptom in the nursing home (NH) setting. The aim of this study was to investigate whether lack of energy was associated with hospitalization and mortality in NH residents. DESIGN Longitudinal observational cohort study. SETTING AND PARTICIPANTS A total of 575 NH residents (72% women) in 13 French NHs from the Incidence of pNeumonia and related ConseqUences in nursing home Residents (INCUR) study cohort. MEASUREMENTS Lack of energy was measured at the baseline visit as part of the 10-item Geriatric Depression Scale. Unadjusted and adjusted Cox proportional hazard regression models were performed to test the association of lack of energy with hospitalization events and mortality over 12 months of follow-up. RESULTS The mean age of the study sample was 86.3 (SD = 7.5) years. At the baseline, 250 (43.5%) residents complained about lack of energy. Overall, 192 (33.4%) individuals experienced at least 1 hospitalization event and 98 (17.0%) died during the 12-month follow-up. Lack of energy was significantly associated with a higher risk of hospitalization (HR 1.35; 95% CI 1.02-1.80; P = .03), even after adjustment for potential confounders (HR 1.41; 95% CI 1.04-1.91; P = .02). No statistically significant association was found between lack of energy and 12-month mortality. CONCLUSION Lack of energy is a predictor of hospitalization in older people living in NHs. It may be considered a relevant clinical feature for identifying individuals at risk of adverse health outcomes, thus potentially serving as a screening tool for subsequently conducting a comprehensive geriatric assessment in this highly vulnerable and complex population.
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Affiliation(s)
- Elisa Zengarini
- Department of Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy; Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
| | - Emiel O Hoogendijk
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Mario U Pérez-Zepeda
- Clinical and Epidemiological Research Department, National Geriatric Institute, Mexico City, Mexico
| | - Carmelinda Ruggiero
- Department of Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Patrizia Mecocci
- Department of Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR1027, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Matteo Cesari
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR1027, Université Toulouse III - Paul Sabatier, Toulouse, France
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Relationship Between Accelerometer-Measured Activity and Self-Reported or Performance-Based Function in Older Adults with Severe Aortic Stenosis. CURRENT GERIATRICS REPORTS 2015; 4:377-384. [PMID: 27668146 DOI: 10.1007/s13670-015-0152-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In older adults with aortic stenosis, we evaluated whether accelerometer-measured physical activity provides distinct clinical information apart from self-reported surveys or performance-based function tests. We employed wrist-mounted accelerometry in 52 subjects with severe aortic stenosis prior to transcatheter aortic valve replacement (TAVR). Daily daytime activity was estimated using the maximum 10 h of daily accelerometer-measured activity (M10) reported in activity counts. Subjects completed baseline surveys (New York Heart Association (NYHA), Short Form 12 (SF12), Kansas City Cardiomyopathy Questionnaire (KCCQ), EuroQol-5D (EQ-5D), Revised Life Orientation Test (LOT-R), Life Space, Detailed Activity Form) and performance-based function tests (Short Physical Performance Battery, 6-min walk test distance, grip strength) to estimate functional status. Simple and multiple linear regression models were used to evaluate the relationship between accelerometer-measured activity and survey data and performance-based function tests. Among all baseline surveys and performance-based function tests, the only statistically significant univariable relationships identified were weak, negative associations between M10 and SF-12 Mental Composite Score (R2=0.1970, P=0.04) and between M10 and grip strength (R2=0.1568, P=0.004). Neither multiple linear regression of overall survey data (R2=0.6159, P=0.23) nor performance-based function tests (R2=0.1743, P=0.10) correlated with M10. Self-reported surveys and performance-based function tests are not meaningfully correlated with daytime accelerometer-measured activity. The results of our study suggest that accelerometer-measured physical activity provides distinct clinical information apart from self-reported surveys or performance-based function tests.
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Conley S, Feder S, Redeker NS. The relationship between pain, fatigue, depression and functional performance in stable heart failure. Heart Lung 2015; 44:107-12. [PMID: 25576085 PMCID: PMC4352387 DOI: 10.1016/j.hrtlng.2014.07.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 06/26/2014] [Accepted: 07/02/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evaluate the relationship between pain, fatigue, depression, demographic, clinical, and functional variables in stable heart failure (HF). BACKGROUND Pain, fatigue and depression are common in HF. Little is known about the relationship between pain, fatigue and depression and functional measures in this population. METHODS Secondary data analysis of a cross sectional study of 173 stable HF patients. Associations between clinical and demographic factors, pain (SF-36), depression (CES-D), and fatigue (MAF) to functional performance and capacity (SF-36 role limitations due to physical functioning and 6-Minute Walk Test) were evaluated using hierarchical multiple regressions. RESULTS The sample was 65% male with a mean age of 60. Fifty-seven percent (n = 100) had pain, 54% (n = 94) had fatigue, and 46% (n = 79) had depression. Pain, depression and fatigue were negatively associated with functional performance but not functional capacity when controlling for demographic and clinical covariates. CONCLUSIONS Pain, fatigue and depression were associated with decreased functional performance in stable HF. Symptom management interventions are needed in HF.
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Affiliation(s)
- Samantha Conley
- Yale School of Nursing, Yale University West Campus, PO Box 27399, West Haven, CT 06516-7399
| | - Shelli Feder
- Yale School of Nursing, Yale University West Campus, PO Box 27399, West Haven, CT 06516-7399
| | - Nancy S. Redeker
- Yale School of Nursing, Yale University West Campus, PO Box 27399, West Haven, CT 06516-7399
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Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, Popma JJ, Ferrucci L, Forman DE. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2013; 63:747-62. [PMID: 24291279 DOI: 10.1016/j.jacc.2013.09.070] [Citation(s) in RCA: 747] [Impact Index Per Article: 67.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 09/25/2013] [Accepted: 09/30/2013] [Indexed: 12/16/2022]
Abstract
Due to the aging and increasingly complex nature of our patients, frailty has become a high-priority theme in cardiovascular medicine. Despite the recognition of frailty as a pivotal element in the evaluation of older adults with cardiovascular disease (CVD), there has yet to be a road map to facilitate its adoption in routine clinical practice. Thus, we sought to synthesize the existing body of evidence and offer a perspective on how to integrate frailty into clinical practice. Frailty is a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors. Upward of 20 frailty assessment tools have been developed, with most tools revolving around the core phenotypic domains of frailty-slow walking speed, weakness, inactivity, exhaustion, and shrinking-as measured by physical performance tests and questionnaires. The prevalence of frailty ranges from 10% to 60%, depending on the CVD burden, as well as the tool and cutoff chosen to define frailty. Epidemiological studies have consistently demonstrated that frailty carries a relative risk of >2 for mortality and morbidity across a spectrum of stable CVD, acute coronary syndromes, heart failure, and surgical and transcatheter interventions. Frailty contributes valuable prognostic insights incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients. Interventions designed to improve outcomes in frail elders with CVD such as multidisciplinary cardiac rehabilitation are being actively tested. Ultimately, frailty should not be viewed as a reason to withhold care but rather as a means of delivering it in a more patient-centered fashion.
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Affiliation(s)
- Jonathan Afilalo
- Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Karen P Alexander
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Michael J Mack
- Division of Cardiothoracic Surgery, Baylor Health Care System, The Heart Hospital Baylor Plano, Plano, Texas
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Philip Green
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeffrey J Popma
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Daniel E Forman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, VA Boston Healthcare Center, Boston, Massachusetts
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Brimah P, Oulds F, Olafiranye O, Ceide M, Dillon S, Awoniyi O, Nunes J, Jean-Louis G. Sleep duration and reported functional capacity among black and white US adults. J Clin Sleep Med 2013; 9:605-9. [PMID: 23772195 DOI: 10.5664/jcsm.2762] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Evidence suggests that individuals reporting sleeping below or above the population's modal sleep duration are at risk for diabetes, hypertension, and other cardiovascular diseases. Evidence also indicates that individuals with these conditions have reduced functional capacity. We assessed whether reported sleep duration and functional capacity are independently associated and whether individuals' race/ethnicity has an effect on this association. METHOD Data were obtained from 29,818 black and white Americans (age range: 18-85 years) who participated in the 2005 National Health Interview Survey (NHIS). The NHIS uses a multistage area probability design sampling of non-institutionalized representatives of the US civilian population. Of the sample, 85% were white and 56% were women. RESULTS Univariate logistic regression analysis showed that individuals sleeping < 6 h were 3.55 times more likely than those sleeping 6-8 h to be functionally impaired (34% vs 13%; p < 0.001). Likewise, those sleeping > 8 h were 3.77 times more likely to be functionally impaired (36% vs 13%; p < 0.001). Individuals of the black race/ethnicity were more likely to be functionally impaired than their white counterparts (23% vs 19%; p < 0.001). Multivariate-adjusted regression analyses showed significant interactions between individuals' race/ethnicity and short sleep with respect to functional capacity (black: OR = 2.78, p < 0.0001; white: OR = 2.30, p < 0.0001). Significant interactions between race/ethnicity and long sleep were also observed (black: OR = 2.43, p < 0.001; white: OR = 2.63, p < 0.001). CONCLUSION Our findings suggest that individuals' habitual sleep duration and their race/ethnicity are significant predictors of their functional capacity.
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Affiliation(s)
- Perry Brimah
- Brooklyn Health Disparities Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Green P, Newman JD, Shaffer JA, Davidson KW, Maurer MS, Schwartz JE. Relation of patients living without a partner or spouse to being physically active after acute coronary syndromes (from the PULSE accelerometry substudy). Am J Cardiol 2013; 111:1264-9. [PMID: 23411104 PMCID: PMC3640672 DOI: 10.1016/j.amjcard.2013.01.272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 12/22/2022]
Abstract
Living alone is associated with adverse outcomes after acute coronary syndromes (ACS). One potential mediator of the relation between partner status and outcomes after ACS is physical activity. To evaluate the association of partner status with physical activity after ACS, data from 107 participants enrolled in the Prescription Use, Lifestyle, and Stress Evaluation (PULSE) study, a prospective observational study of post-ACS patients, were analyzed. Accelerometers were used to measure physical activity after hospital discharge. The primary outcome measure was a maximum 10 hours of daytime activity 1 month after discharge. One month after discharge from ACS hospitalizations, participants without a partner or spouse exhibited 24.4% lower daytime activity than those with a partner or spouse (p = 0.003). After controlling for age, gender, body mass index, Charlson co-morbidity index, and traditional psychosocial and clinical cardiovascular correlates of post-ACS physical activity, partner status remained an independent predictor of post-ACS physical activity (20.5% lower daytime activity among those without a partner or spouse, p = 0.008). In conclusion, in this study of accelerometer-measured physical activity after an ACS hospitalization, those without a partner or spouse exhibit significantly less physical activity than those with a partner or spouse 1 month after discharge from the hospital. Low physical activity may be an important mediator of the prognosis associated with partner status after ACS.
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Affiliation(s)
- Philip Green
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
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Shaffer JA, Davidson KW, Schwartz JE, Shimbo D, Newman JD, Gurland BJ, Maurer MS. Prevalence and characteristics of anergia (lack of energy) in patients with acute coronary syndrome. Am J Cardiol 2012; 110:1213-8. [PMID: 22835409 PMCID: PMC3470778 DOI: 10.1016/j.amjcard.2012.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 12/22/2022]
Abstract
Anergia, a commonly occurring syndrome in older adults and patients with cardiovascular diseases, is associated with functional and clinical limitations. To date, the prevalence and clinical-demographic characteristics of anergia in patients with acute coronary syndrome (ACS) have not been elucidated. We examined the prevalence and clinical-demographic characteristics of anergia in a multiethnic sample of patients with ACS. Hospitalized patients with ACS (n = 472), enrolled in the Prescription Usage, Lifestyle, and Stress Evaluation (PULSE) prospective cohort study, completed assessments of demographic, behavioral, and clinical characteristics within 7 days of hospitalization for an ACS event. Current depressive disorder was ascertained using a structured psychiatric interview 3 to 7 days after discharge. Anergia was assessed at baseline and defined using patients' binary responses (yes/no) to 7 items related to energy level. At least 1 complaint of anergia was reported by 79.9% of patients (n = 377) and 32% of patients (n = 153) met criteria for anergia. In a multivariable logistic regression model, anergia was independently associated with being a woman, being white (compared to black), having bodily pain, participating in exercise, having current depressive disorder, and having higher values on the Charlson Co-morbidity Index. In conclusion, anergia is a highly prevalent syndrome in patients with ACS. It is distinct from depression and is associated with modifiable clinical factors such as participation in exercise and bodily pain that may be appropriate targets for intervention.
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Affiliation(s)
- Jonathan A. Shaffer
- Center for Cardiovascular Behavioral Health, Columbia University Medical Center, New York, NY
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Karina W. Davidson
- Center for Cardiovascular Behavioral Health, Columbia University Medical Center, New York, NY
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Joseph E. Schwartz
- Center for Cardiovascular Behavioral Health, Columbia University Medical Center, New York, NY
- Department of Medicine, Columbia University Medical Center, New York, NY
- Department of Psychiatry, Stony Brook University, New York, NY
| | - Daichi Shimbo
- Center for Cardiovascular Behavioral Health, Columbia University Medical Center, New York, NY
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Jonathan D. Newman
- Center for Cardiovascular Behavioral Health, Columbia University Medical Center, New York, NY
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Barry J. Gurland
- Stroud Center for the Studies of Quality of Life, Columbia University, New York, NY
| | - Mathew S. Maurer
- Department of Medicine, Columbia University Medical Center, New York, NY
- Stroud Center for the Studies of Quality of Life, Columbia University, New York, NY
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Bernard S, Maurer MS. Heart Failure With a Normal Ejection Fraction: Treatments for a Complex Syndrome? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:305-18. [DOI: 10.1007/s11936-012-0187-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
BACKGROUND Physical symptoms are likely to occur in clusters that may be associated with adverse outcome in patients with heart failure (HF). Despite the importance of early recognition of worsening symptoms in HF management, the impact of physical symptoms on adverse outcome has not been explored in the context of symptom clusters. PURPOSE The purposes of this study were to explore which physical symptom clusters occur in HF patients and to determine the impact of symptom clusters on event-free survival. METHODS A total of 421 patients (60% male; 62 [SD, 14] years; 72% New York Heart Association class II/III) completed the modified Memorial Symptom Assessment Scale-Heart Failure to measure physical symptoms during an index hospitalization in Seoul, Korea. Times to first event of cardiac rehospitalization and cardiac death were collected for 12 months after discharge and confirmed by review of hospital records. An agglomerative hierarchical clustering approach with Ward's method was used to identify symptom clusters. Hierarchical Cox hazard regression was used to determine the impact of symptom clusters on cardiac rehospitalization and cardiac mortality. RESULTS Two distinct symptom clusters, the dyspneic and the weary symptom clusters, occurred in patients with HF. Shortness of breath, difficulty breathing when lying flat, and waking up breathless at night comprised the dyspneic symptom cluster. Lack of energy, lack of appetite, and difficulty sleeping comprised the weary symptom cluster. In hierarchical Cox hazard regression, elevated distress from the weary symptom cluster independently predicted cardiac rehospitalization (hazard ratio, 1.45; 95% confidence interval, 1.09-1.93), and increased distress from the dyspneic symptom cluster independently predicted cardiac mortality (hazard ratio, 2.00; 95% confidence interval, 1.16-3.34). CONCLUSION The weary and the dyspneic symptom clusters predicted cardiac rehospitalization and cardiac mortality, respectively. Patient education for self-monitoring of symptoms should focus on symptom clusters rather than single symptom.
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Howell J, Strong BM, Weisenberg J, Kakade A, Gao Q, Cuddihy P, Delisle S, Kachnowski S, Maurer MS. Maximum daily 6 minutes of activity: an index of functional capacity derived from actigraphy and its application to older adults with heart failure. J Am Geriatr Soc 2010; 58:931-6. [PMID: 20374397 DOI: 10.1111/j.1532-5415.2010.02805.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare the correlation between the maximum 6 minutes of daily activity (M6min) and standard measures of functional capacity in older adults with heart failure (HF) with that in younger subjects and its prognostic utility. DESIGN Prospective, cohort study. SETTING Tertiary care, academic HF center. PARTICIPANTS Sixty, ambulatory, adults, New York Heart Association (NYHA) Class I to III, stratified into young (50.9 +/- 9.4) and older cohorts (76.8 +/- 8.0). MEASUREMENTS Correlation between M6min and measures of functional capacity (6-minute walk test; 6MWT) and peak oxygen consumption (VO(2)) according to cardiopulmonary exercise testing in a subset of subjects. Survival analysis was employed to evaluate the association between M6min and adverse events. RESULTS Adherence to actigraphy was high (90%) and did not differ according to age. The correlation between M6min and 6MWT was higher in subjects aged 65 and older than in those younger than 65 (correlation coefficient (r=0.702, P<.001 vs r=0.490, P=.002). M6min was also significantly associated with peak VO(2) (r=0.612, P=.006). During the study, 26 events occurred (2 deaths, 10 hospitalizations, 8 emergency department visits, and 6 intercurrent illnesses). The M6min was significantly associated with subsequent events (hazard ratio=2.728, 95% confidence interval=1.10-6.77, P=.03), independent of age, sex, ejection fraction, NYHA class, brain natriuretic peptide, and 6MWT. CONCLUSION The high adherence to actigraphy and association with standard measures of functional capacity and independent association with subsequent morbid events suggest that it may be useful for monitoring older adults with HF.
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Affiliation(s)
- Jason Howell
- Healthcare Innovation and Technology Laboratory, New York, New York, USA
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The comparative palliative care needs of those with heart failure and cancer patients. Curr Opin Support Palliat Care 2009; 3:241-6. [DOI: 10.1097/spc.0b013e328332e808] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Allen JG, Weiss ES, Schaffer JM, Patel ND, Ullrich SL, Russell SD, Shah AS, Conte JV. Quality of life and functional status in patients surviving 12 months after left ventricular assist device implantation. J Heart Lung Transplant 2009; 29:278-85. [PMID: 19837607 DOI: 10.1016/j.healun.2009.07.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 07/28/2009] [Accepted: 07/29/2009] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND As left ventricular assist device (LVAD) support duration increases, quality of life (QoL) becomes a concern. We reviewed the QoL in patients on LVAD support for >or=1 year. METHODS We retrospectively reviewed our prospective database for patients supported >or=1 year by HeartMate pulsatile- (HM1) or continuous-flow (HM2) LVADs from 2000 to 2009. Transplant or death before 1 year merited exclusion. Metabolic equivalents of tasks (METs), the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the 6-minute walk distance (6MWD), and New York Heart Association (NYHA) class were reviewed. Complications and re-admissions were assessed. RESULTS Thirty patients were supported for >or=1 year (7 HM1s, 23 HM2s). Mean support duration was 594 +/- 173 days. Mean QoL metrics/functional status indicators at 12 months were: 6MWD, 393 +/- 290 m; MET tolerance, 3.3 +/- 1; MLHFQ, 35 +/- 31; and NYHA, 1.4 +/- 0.6. Mean re-admissions/year was 2.9 +/- 2, with a duration of 13.8 +/- 21 days. Three patients were never re-admitted. Mean out-of-hospital time was 471 +/- 172 days (87.3% of days). Infectious complications led to 43% of re-admissions and occurred in the: drive-line (47%) at 442 +/- 236 days; blood (37%) at 472 +/- 257 days; and LVAD pocket (20%) at 550 +/- 202 days. Twenty-three patients (77%) required additional operations (1.7 +/- 1.8/year). The most common indication was drive-line infection, but ranged from ischemic bowel to defibrillator exchange. Eight required LVAD exchanges for mechanical (n = 4), electrical (n = 3), and thrombotic (n = 1) issues. CONCLUSIONS Although LVAD support is not without complications, patients spend the majority of time outside the hospital enjoying a good quality of life.
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Affiliation(s)
- Jeremiah G Allen
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University Medical Institutions, Baltimore, Maryland 21287, USA
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