Heart failure: pathophysiologic mechanisms

A Telehealth Program to Reduce Readmission Rates Among Heart Failure Patients: One Agency’s Experience

Posthospital management of congestive heart failure (CHF), a chronic disease with frequent hospital readmissions, continues to challenge the already financially burdened health care system and growing nursing shortage. A promising approach to the multidisciplinary management of this and other chronic diseases is Telehealth, defined as the delivery of health care and sharing of medical knowledge over a distance using telecommunication systems. One home health agencycompared CHF patients’ hospital readmissions with patients who received routine home care skilled nursing visits and those who also received remote video telehealth contacts.

The comparison of the effects of education provided by nurses on the quality of life in patients with congestive heart failure (CHF) in usual and home-visit cares in Iran

Aim:

Quality of life (QOL) can be considered as a quality indicator of health care systems and nurses can play an important role to improve QOL in patients with congestive heart failure (CHF). The aim of this study was to determine the effects of education provided by nurses on the QOL in patients with CHF in home-visit care compared to usual care.

Method:

In a single-blind randomized controlled trial conducted from September 2011 to June 2012, 110 patients with CHF were randomly assigned into two groups. While patients in group I were received usual education at the time of hospital discharge, patients in Group II, in addition to usual education, were received special education regards to their illness by nurses who visited patients in their homes. The 36-item short-form (SF-36) questionnaire was used to evaluate the patient’s QOL at the time of discharge and also six months after hospital discharge.

Results:

At the time of hospital discharge, mean score of all 8 sub-score of SF-36 questionnaire was 63.4±7.8 in patients of group II and 61.1±6.4 in patients of group I, respectively (P> 0.05). QOL was decreased in group I and increased in group II compared to the time of hospital discharge. After six months, mean score of QOL was higher in group II than in group I.

Conclusions:

QOL of patients with CHF were decreased after hospital discharge. Education provided by nurses in home-visit care could improve the QOL in patients with CHF, based on the findings of this study.

The effectiveness of telehealth care on caregiver burden, mastery of stress, and family function among family caregivers of heart failure patients: a quasi-experimental study

BACKGROUND

Telehealth care was developed to provide home-based monitoring and support for patients with chronic disease. The positive effects on physical outcome have been reported; however, more evidence is required concerning the effects on family caregivers and family function for heart failure patients transitioning from the hospital to home.

OBJECTIVE

To evaluate the effectiveness of nursing-led transitional care combining discharge plans and telehealth care on family caregiver burden, stress mastery and family function in family caregivers of heart failure patients compared to those receiving traditional discharge planning only.

DESIGN

This is a quasi-experimental study design.

METHODS

Sixty-three patients with heart failure were assessed for eligibility and invited to participate in either telehealth care or standard care in a medical centre from May to October 2010. Three families refused to participate in data collection. Thirty families who chose telehealth care after discharge from the hospital to home comprised the experimental group; the others families receiving discharge planning only comprised the comparison group. Telenursing specialist provided the necessary family nursing interventions by 24-h remote monitoring of patients' health condition and counselling by telephone, helping the family caregivers successfully transition from hospital to home. Data on caregiver burden, stress mastery and family function were collected before discharge from the hospital and one month later at home. Effects of group, time, and group×time interaction were analysed using Mixed Model in SPSS (17.0).

RESULTS

Family caregivers in both groups had significantly lower burden, higher stress mastery, and better family function at one-month follow-up compared to before discharge. The total score of caregiver burden, stress mastery and family function was significantly improved for the family caregivers in the experimental group compared to the comparison group at posttest. Two subscales of family function-Relationships between family and subsystems and Relationships between family and society were improved in the experimental group compared to the comparison group, but Relationships between family and family members was not different.

CONCLUSIONS

The results provide evidence that telehealth care combined with discharge planning could reduce family caregiver burden, improve stress mastery, and improve family function during the first 30 days at home after heart failure patients are discharged from the hospital. Telenursing specialists cared caregivers with the concepts of providing transitional care to help them successful cross the critical transition stage.

Chronic oral administration of Ocimum sanctum Linn. augments cardiac endogenous antioxidants and prevents isoproterenol-induced myocardial necrosis in rats

Wistar rats (200–250 g) of either sex were fed with fresh leaf homogenate of Ocimum sanctum by oral gavage in two different doses, 50 mg kg−1 (Os 50) and 100 mg kg−1 (Os 100), daily for 30 days. This was followed by isoproterenol administration (85 mg kg−1 s.c. two doses at 24 h intervals) in both control and O. sanctum-fed rats to induce myocardial necrosis. Hearts were isolated for estimation of endogenous myocardial antioxidants (superoxide dismutase (SOD), catalase, reduced glutathione (GSH) and glutathione peroxidase (GPx) and myocardial lipid peroxidation) and light microscopic study. Increased basal myocardial antioxidant SOD (9.3 ± 1.2 vs 3.7 ± 0.7 units mg−1 protein; P < 0.05) and catalase activities (34.3 ± 5.4 vs 17.9 ± 5.1 units mg−1 protein; P < 0.05) were observed in the Os 50 group only without any evidence of cellular injury in both the groups. In control rats, isoproterenol administration caused significant depletion of myocardial SOD (1.7 ± 0.2 units mg−1 protein) and GPx (104 ± 2 mU mg−1 protein) activities and increase in GSH (551.7 ± 30.9 μg g−1 wet weight of tissue) level, with evidence of myocardial necrosis. Isoproterenol-induced changes in myocardial SOD, GPx and GSH were prevented by both the doses of O. sanctum, however cellular injury was minimal only with 50 mg kg−1. The results indicate that long-term feeding of O. sanctum offered significant protection against isoproterenol-induced myocardial necrosis through a unique property of enhancement of endogenous antioxidants.

The effect of biofeedback on function in patients with heart failure

Decreased HRV has been consistently associated with increased cardiac mortality and morbidity in HF patients. The aim of this study is to determine if a 6-week course of heart rate variability (HRV) biofeedback and breathing retraining could increase exercise tolerance, HRV, and quality of life in patients with New York Heart Association Class I-III heart failure (HF). Participants (N = 29) were randomly assigned to either the treatment group consisting of six sessions of breathing retraining, HRV biofeedback and daily practice, or the comparison group consisting of six sessions of quasi-false alpha-theta biofeedback and daily practice. Exercise tolerance, measured by the 6-min walk test (6MWT), HRV, measured by the standard deviation of normal of normal beats (SDNN), and quality of life, measured by the Minnesota Living with Congestive Heart Failure Questionnaire, were measured baseline (week 0), post (week 6), and follow-up (week 18). Cardiorespiratory biofeedback significantly increased exercise tolerance (p = .05) for the treatment group in the high (>or=31%) left ventricular ejection fraction (LVEF) category between baseline and follow-up. Neither a significant difference in SDNN (p = .09) nor quality of life (p = .08), was found between baseline and follow-up. A combination of HRV biofeedback and breathing retraining may improve exercise tolerance in patients with HF with an LVEF of 31% or higher. Because exercise tolerance is considered a strong prognostic indicator, cardiorespiratory biofeedback has the potential to improve cardiac mortality and morbidity in HF patients.

Effects of Thalidomide on Isoprenaline-Induced Acute Myocardial Injury: A Haemodynamic, Histopathological and Ultrastructural Study

In the present study, we investigated the cardioprotective effects of thalidomide in a rat model of acute myocardial injury, induced by subcutaneous injection of isoprenaline hemisulphate (85 mg/kg per day for 2 days). Thalidomide (75/150/300 mg/kg) or vehicle (dimethylsulphoxide) or saline (0.9% NaCl) was administered orally for 14 days and isoprenaline injection on the 12th and 13th days. Cardiovascular responses (arterial and left ventricular haemodynamic parameters and heart rate) were obtained in anaesthetized rats on the 14th day. Histopathological and electronmicroscopical analysis of myocardial injury was done. The results showed that thalidomide 300 mg/kg per day orally caused significant improvement in isoprenaline-induced reduction of cardiac function with increases in maximum rate of pressure development (+LVdP/dt, P < 0.001) and maximum rate of pressure decline (-LVdP/dt, P < 0.001) and decreases in left ventricular end-diastolic pressure (P < 0.01), systolic arterial pressure (P < 0.001), diastolic arterial pressure (P < 0.001), mean arterial pressure (P < 0.001) and heart rate (P < 0.001). The myocardial injury caused by isoprenaline was significantly reduced by thalidomide treatment as judged by the reduction of myocardial necrosis, ultrastructural changes such as mitochondria and myofibril damage, 300 mg/kg being the most effective dose. In conclusion, oral administration of thalidomide is able to ameliorate isoprenaline-induced myocardial injury and impaired myocardial function in spite of decreases in systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, which may be due to its depressant effect on the sino-atrial node and sedative action.

Emerging Trends in the Management of Heart Failure: Beta Blocker Therapy

There is overwhelming evidence that beta blocker therapy in the form of metoprolol, bisoprolol, and carvedilol can have positive outcomes on morbidity, mortality, and quality of life in patients who have been diagnosed with mild to severe heart failure. Barring contraindications, beta blockers should be considered a cornerstone of therapy for these patients along with ACE inhibitors and diuretics. Beta blocking drugs are effective in modifying the cascade of events that occur as a result of the neurohormonal response that leads to the devastating effects evident during heart failure. Long-term effects of beta blockade include an increase in cardiac output, an increase in exercise tolerance, a decrease in the number of hospitalizations, and an overall improvement in symptoms.