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Savarese G, Lindenfeld J, Stolfo D, Adams K, Ahmad T, Desai NR, Ammirati E, Gottlieb SS, Psotka MA, Rosano GMC, Allen LA. Use of patient-reported outcomes in heart failure: from clinical trials to routine practice. Eur J Heart Fail 2023; 25:139-151. [PMID: 36644876 DOI: 10.1002/ejhf.2778] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/06/2022] [Accepted: 01/08/2023] [Indexed: 01/17/2023] Open
Abstract
Heart failure (HF) is a complex syndrome that affects mortality/morbidity and acts at different levels in the patient's life, resulting in a drastic impairment in multiple aspects of daily activities (e.g. physical, mental/emotional, and social) and leading to a reduction in quality of life. The definition of disease status and symptom severity has been traditionally based on the physician assessment, while the patient's experience of disease has been long overlooked. The active participation of patients in their own care is necessary to better understand the perception of disease and the multiple aspects of life affected, and to improve adherence to treatments. Patient-reported outcomes (PROs) aim to switch traditional care to a more patient-centred approach. Although PROs demonstrated precision in the evaluation of disease status and have a good association with prognosis in several randomized controlled trials, their implementation into clinical practice is limited. This review discusses the modalities of use of PROs in HF, summarizes the most largely adopted PROs in HF care, and provides an overview on the application of PROs in trials and the potential for their transition to clinical practice. By discussing the advantages and the disadvantages of their use, the reasons limiting their application in daily clinical routine, and the strategies that may promote their implementation, this review aims to foster the systematic integration of the patient's standpoint in HF care.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joann Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Davide Stolfo
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Kirkwood Adams
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tariq Ahmad
- Yale School of Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Nihar R Desai
- Yale School of Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Enrico Ammirati
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine and Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | | | - Giuseppe M C Rosano
- Centre for Clinical & Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Vieira MC, Mendes FDSNS, da Silva PS, da Silva GMS, Mazzoli-Rocha F, de Sousa AS, Saraiva RM, Quintana MDSB, Costa HS, Paravidino VB, Rodrigues LF, Hasslocher-Moreno AM, Americano do Brasil PEA, Mediano MFF. The association between variables of cardiopulmonary exercise test and quality of life in patients with chronic Chagas cardiomyopathy (Insights from the PEACH STUDY). PLoS One 2022; 17:e0279086. [PMID: 36520825 PMCID: PMC9754173 DOI: 10.1371/journal.pone.0279086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Studies investigating the association between functional capacity and quality of life (QoL) in individuals with chronic Chagas cardiomyopathy (CCC) usually do not include a gold-standard evaluation of functional capacity, limiting the validity and the interpretation of the results. The present study is a cross-section analysis aiming to evaluate the association between functional capacity (quantified by cardiopulmonary exercise test [CPET]) and QoL in individuals with CCC. QoL was assessed using the SF-36 questionnaire. Sociodemographic, anthropometric, clinical, cardiac function and maximal progressive CPET variables were obtained from PEACH study. Generalized linear models adjusted for age, sex, and left ventricular ejection fraction were performed to evaluate the association between CPET variables and QoL. After adjustments, VO2 peak and VO2 AT were both associated with physical functioning (β = +0.05 and β = +0.05, respectively) and physical component summary (β = +0.03 and β = +0.03, respectively). Double product was associated with physical functioning (β = +0.003), general health perceptions (β = +0.003), physical component summary (β = +0.002), and vitality (β = +0.004). HRR≤12bpm was associated with physical functioning (β = -0.32), role limitations due to physical problems (β = -0.87), bodily pain (β = -0.26), physical component summary (β = -0.21), vitality (β = -0.38), and mental health (β = -0.19). VE/VCO2 slope presented association with all mental scales of SF-36: vitality (β = -0.028), social functioning (β = -0.024), role limitations due to emotional problems (β = -0.06), mental health (β = -0.04), and mental component summary (β = -0.02). The associations between CPET variables and QoL demonstrate the importance of CPET inclusion for a more comprehensive evaluation of individuals with CCC. In this setting, intervention strategies aiming to improve functional capacity may also promote additional benefits on QoL and should be incorporated as a treatment strategy for patients with CCC.
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Affiliation(s)
- Marcelo Carvalho Vieira
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- Center for Cardiology and Exercise, Aloysio de Castro State Institute of Cardiology, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | | | - Paula Simplício da Silva
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Flavia Mazzoli-Rocha
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberto Magalhães Saraiva
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Henrique Silveira Costa
- Department of Physical Therapy, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
| | - Vitor Barreto Paravidino
- Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Physical Education and Sports, Naval Academy, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiz Fernando Rodrigues
- Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Physiological Sciences, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, Rio de Janeiro, Brazil
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Changes in Physical Performance and Their Association With Health-Related Quality of Life in a Mixed Nonischemic Cardiac Population That Participates in Rehabilitation. J Cardiopulm Rehabil Prev 2021; 40:102-107. [PMID: 31033637 DOI: 10.1097/hcr.0000000000000416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Exercise-based cardiac rehabilitation improves physical performance and health-related quality of life (HRQoL). However, whether improvements in physical performance are associated with changes in HRQoL has not been adequately investigated in a nonischemic cardiac population. METHODS Patients who were ablated for atrial fibrillation, who underwent heart valve surgery or who were treated for infective endocarditis, and who participated in 1 of 3 randomized controlled rehabilitation trials were eligible for the current study. Change in physical performance and HRQoL were measured before and after a 12-wk exercise intervention. Physical performance was assessed using a cardiopulmonary exercise test, a 6-min walk test, and a sit-to-stand test. Health-related quality of life was assessed using the generic 36-Item Short Form Health Survey and the disease-specific HeartQoL questionnaire. Spearman correlation coefficient (ρ) and linear regressions quantified the association between changes in physical outcome measures and changes in HRQoL. RESULTS A total of 344 patients were included (mean age: 60.8 ± 11.6 yr and 77% males). Associations between changes in physical outcome measures and HRQoL ranged from very weak to weak (ρ = -0.056 to 0.228). The observed associations were more dominant within physical dimensions of the HRQoL compared with mental or emotional dimensions. After adjusting for sex, age, and diagnosis, changes in physical performance explained no more than 20% of the variation in the HRQoL. CONCLUSION The findings show that the positive improvement in HRQoL from exercise-based cardiac rehabilitation cannot simply be explained by an improvement in physical performance.
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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: 125] [Impact Index Per Article: 25.0] [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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Canada JM, Van Tassell BW, Christopher S, Oddi C, Abouzaki NA, Gambill ML, Mueller G, Melchior R, Shah KB, Dinarello CA, Abbate A, Arena R. Clinical predictors of response to anakinra in patients with heart failure. Int J Cardiol 2014; 173:537-9. [PMID: 24679681 DOI: 10.1016/j.ijcard.2014.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 03/09/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Justin M Canada
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Benjamin W Van Tassell
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States; Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - Sanah Christopher
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Claudia Oddi
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Nayef A Abouzaki
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Michael L Gambill
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - George Mueller
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Ryan Melchior
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Keyur B Shah
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | | | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States.
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Van Tassell BW, Arena R, Biondi-Zoccai G, Canada JM, Oddi C, Abouzaki NA, Jahangiri A, Falcao RA, Kontos MC, Shah KB, Voelkel NF, Dinarello CA, Abbate A. Effects of interleukin-1 blockade with anakinra on aerobic exercise capacity in patients with heart failure and preserved ejection fraction (from the D-HART pilot study). Am J Cardiol 2014; 113:321-327. [PMID: 24262762 PMCID: PMC4899612 DOI: 10.1016/j.amjcard.2013.08.047] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 02/08/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome of exercise intolerance due to impaired myocardial relaxation and/or increased stiffness. Patients with HFpEF often show signs of chronic systemic inflammation, and experimental studies have shown that interleukin-1 (IL-1), a key proinflammatory cytokine, impairs myocardial relaxation. The aim of the present study was to determine the effects of IL-1 blockade with anakinra on aerobic exercise capacity in patients with HFpEF and plasma C-reactive protein (CRP) >2 mg/L (reflecting increased IL-1 activity). A total of 12 patients were enrolled in a double-blind, randomized, placebo-controlled, crossover trial and assigned 1:1 to receive 1 of the 2 treatments (anakinra 100 mg or placebo) for 14 days and an additional 14 days of the alternate treatment (placebo or anakinra). The cardiopulmonary exercise test was performed at baseline, after the first 14 days, and after the second 14 days of treatment. The placebo-corrected interval change in peak oxygen consumption was chosen as the primary end point. All 12 patients enrolled in the present study and receiving treatment completed both phases and experienced no major adverse events. Anakinra led to a statistically significant improvement in peak oxygen consumption (+1.2 ml/kg/min, p = 0.009) and a significant reduction in plasma CRP levels (-74%, p = 0.006). The reduction in CRP levels correlated with the improvement in peak oxygen consumption (R = -0.60, p = 0.002). Three patients (25%) had mild and self-limiting injection site reactions. In conclusion, IL-1 blockade with anakinra for 14 days significantly reduced the systemic inflammatory response and improved the aerobic exercise capacity of patients with HFpEF and elevated plasma CRP levels.
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Affiliation(s)
- Benjamin Wallace Van Tassell
- Virginia Commonwealth University, VCU Pauley Heart Center and Victoria Johnson Research Laboratories, Richmond, VA, USA
| | | | | | - Justin McNair Canada
- Virginia Commonwealth University, VCU Pauley Heart Center and Victoria Johnson Research Laboratories, Richmond, VA, USA
| | - Claudia Oddi
- Virginia Commonwealth University, VCU Pauley Heart Center and Victoria Johnson Research Laboratories, Richmond, VA, USA
| | - Nayef Antar Abouzaki
- Virginia Commonwealth University, VCU Pauley Heart Center and Victoria Johnson Research Laboratories, Richmond, VA, USA
| | - Arehzo Jahangiri
- Virginia Commonwealth University, VCU Pauley Heart Center and Victoria Johnson Research Laboratories, Richmond, VA, USA
| | - Raquel Appa Falcao
- Virginia Commonwealth University, VCU Pauley Heart Center and Victoria Johnson Research Laboratories, Richmond, VA, USA
| | - Michael Christopher Kontos
- Virginia Commonwealth University, VCU Pauley Heart Center and Victoria Johnson Research Laboratories, Richmond, VA, USA
| | - Keyur Bharat Shah
- Virginia Commonwealth University, VCU Pauley Heart Center and Victoria Johnson Research Laboratories, Richmond, VA, USA
| | - Norbert Felix Voelkel
- Virginia Commonwealth University, VCU Pauley Heart Center and Victoria Johnson Research Laboratories, Richmond, VA, USA
| | | | - Antonio Abbate
- Virginia Commonwealth University, VCU Pauley Heart Center and Victoria Johnson Research Laboratories, Richmond, VA, USA
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Feldman DE, Huynh T, Lauriers JD, Giannetti N, Frenette M, Grondin F, Michel C, Sheppard R, Montigny M, Lepage S, Nguyen V, Behlouli H, Pilote L. Access to heart failure care post emergency department visit: do we meet established benchmarks and does it matter? Am Heart J 2013; 165:725-32. [PMID: 23622909 DOI: 10.1016/j.ahj.2013.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 02/16/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Canadian Cardiology Society recommends that patients should be seen within 2 weeks after an emergency department (ED) visit for heart failure (HF). We sought to investigate whether patients who had an ED visit for HF subsequently consult a physician within the current established benchmark, to explore factors related to physician consultation, and to examine whether delay in consultation is associated with adverse events (AEs) (death, hospitalization, or repeat ED visit). METHODS Patients were recruited by nurses at 8 hospital EDs in Québec, Canada, and interviewed by telephone within 6 weeks of discharge and subsequently at 3 and 6 months. Clinical variables were extracted from medical charts by nurses. We used Cox regression in the analysis. RESULTS We enrolled 410 patients (mean age 74.9 ± 11.1 years, 53% males) with a confirmed primary diagnosis of HF. Only 30% consulted with a physician within 2 weeks post-ED visit. By 4 weeks, 51% consulted a physician. Over the 6-month follow-up, 26% returned to the ED, 25% were hospitalized, and 9% died. Patients who were followed up within 4 weeks were more likely to be older and have higher education and a worse quality of life. Patients who consulted a physician within 4 weeks of ED discharge had a lower risk of AEs (hazard ratio 0.59, 95% CI 0.35-0.99). CONCLUSION Prompt follow-up post-ED visit for HF is associated with lower risk for major AEs. Therefore, adherence to current HF guideline benchmarks for timely follow-up post-ED visit is crucial.
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Exercise oscillatory ventilation reflects diminished quality of life and perceived functional capacity in patients with heart failure. Int J Cardiol 2011; 153:213-4. [PMID: 21993226 DOI: 10.1016/j.ijcard.2011.09.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 09/17/2011] [Indexed: 11/21/2022]
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9
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Feldman DE, Ducharme A, Giannetti N, Frenette M, Michel C, Grondin F, Sheppard R, Lauriers JD, Behlouli H, Pilote L. Outcomes for Women and Men Who Attend a Heart Failure Clinic: Results of a 12-Month Longitudinal Study. J Card Fail 2011; 17:540-6. [DOI: 10.1016/j.cardfail.2011.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/01/2011] [Accepted: 03/03/2011] [Indexed: 11/26/2022]
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Feldman DE, Ducharme A, Giannetti N, Frenette M, Michel C, Grondin F, Sheppard R, Lauriers JD, Behlouli H, Pilote L. Outcomes for Women and Men Who Attend a Heart Failure Clinic: Results of a 12-Month Longitudinal Study. J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.03.001
https://www.sciencedirect.com/science/article/pii/s1071916411001023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Comparative value of NYHA functional class and quality-of-life questionnaire scores in assessing heart failure. J Cardiopulm Rehabil Prev 2011; 30:101-5. [PMID: 19952769 DOI: 10.1097/hcr.0b013e3181be7e47] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To assess the relationships between New York Heart Association (NYHA) functional class, quality of life, aerobic capacity (peak oxygen uptake, (.)VO2), ventilatory efficiency (minute ventilation/carbon dioxide production slope, VE/(.)VCO2 slope), and brain natriuretic peptide (BNP) in creating a model for predicting peak (.)VO2). METHODS Cardiopulmonary exercise testing was performed in 62 patients. A baseline blood sample was taken to measure the N-terminal prohormone BNP (NT-proBNP). Patients also completed the Minnesota Living with Heart Failure Questionnaire (MLHF) and the Specific Activity Questionnaire (SAQ), and NYHA functional class was determined. RESULTS NYHA functional class correlated more strongly with SAQ score than with MLHF score. Peak (.)VO2 and VE/(.)VCO2 slope had stronger associations with NYHA functional class and SAQ score than with MLHF score. NT-proBNP plasma levels correlated more significantly with NYHA functional class and SAQ score (both P < .001) than with MLHF score. Using multiple linear regression analysis adjusted for age and sex, SAQ score, NT-proBNP, and etiology of heart failure had significant independent relationships with peak (.)VO2, explaining 63% of its variability (adjusted R(2) = 0.596). CONCLUSIONS Cardiopulmonary exercise variables and plasma NT-proBNP are associated more with NYHA functional class and SAQ score than with MLHF score. When combined, SAQ score, NT-proBNP, and etiology of heart failure can satisfactorily predict peak oxygen uptake.
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Feldman DE, Ducharme A, Giannetti N, Frenette M, Michel C, Grondin F, Sheppard R, Lauriers JD, Behlouli H, Pilote L. Severity at entry to specialized heart failure clinics: discrepancies between health-related quality of life and function in men and women. Can J Cardiol 2011; 27:382-7. [PMID: 21514784 DOI: 10.1016/j.cjca.2010.12.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 12/02/2009] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We compared severity of heart failure (HF) between men and women at entry to the multidisciplinary HF clinic based on 3 measures: New York Heart Association functional class, norm-referenced 6-minute walk distance, and health-related quality of life. METHODS Newly admitted patients to 1 of 6 HF clinics were enrolled. Data were collected from a clinical database, questionnaires were administered to patients, and tests were administered by clinic nurses. We compared men and women with respect to the 3 severity indicators at entry to the clinic. RESULTS In adjusted analyses, women had a lower health-related quality of life (P = 0.04) but did not have lower norm-referenced 6-minute walk distance or lower New York Heart Association functional class on entry to the clinic. Having more comorbid conditions, being on medication, and having visited the emergency department or been admitted to hospital in the past 6 months were associated with higher severity at entry according to all 3 indicators. CONCLUSIONS Women report a lower health-related quality of life at entry to the clinic, although functional capacity does not seem to differ between women and men. Reasons for these discrepancies will need to be elucidated to better address women's health needs.
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Affiliation(s)
- Debbie Ehrmann Feldman
- University of Montreal, Faculty of Medicine, School of Rehabilitation, and Public Health Department of Montreal, Montreal, Québec, Canada.
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Explanation of the variance in quality of life and activity capacity of patients with heart failure by laboratory data. ACTA ACUST UNITED AC 2010; 17:375-9. [PMID: 19940776 DOI: 10.1097/hjr.0b013e328333e962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was conducted to explain the variance in quality of life (QoL) and activity capacity of patients with congestive heart failure from pathophysiological changes as estimated by laboratory data. METHODS Peak oxygen consumption (peak VO2) and ventilation (VE)/carbon dioxide output (VCO2) slope derived from cardiopulmonary exercise testing, plasma N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and echocardiographic markers [left atrium (LA), left ventricular ejection fraction (LVEF)] were measured in 62 patients with congestive heart failure, who also completed the Minnesota Living with Heart Failure Questionnaire and the Specific Activity Questionnaire. All regression models were adjusted for age and sex. RESULTS On linear regression analysis, peak VO2 with P value less than 0.001, VE/VCO2 slope with P value less than 0.01, LVEF with P value less than 0.001, LA with P=0.001, and logNT-proBNP with P value less than 0.01 were found to be associated with QoL. On stepwise multiple linear regression, peak VO2 and LVEF continued to be predictive, accounting for 40% of the variability in Minnesota Living with Heart Failure Questionnaire score. On linear regression analysis, peak VO2 with P value less than 0.001, VE/VCO2 slope with P value less than 0.001, LVEF with P value less than 0.05, LA with P value less than 0.001, and logNT-proBNP with P value less than 0.001 were found to be associated with activity capacity. On stepwise multiple linear regression, peak VO2 and LA continued to be predictive, accounting for 53% of the variability in Specific Activity Questionnaire score. CONCLUSION Peak VO2 is independently associated both with QoL and activity capacity. In addition to peak VO2, LVEF is independently associated with QoL, and LA with activity capacity.
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Relation of heart rate recovery to psychological distress and quality of life in patients with chronic heart failure. ACTA ACUST UNITED AC 2010; 16:645-50. [PMID: 19801939 DOI: 10.1097/hjr.0b013e3283299542] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Psychological distress, poor disease-specific quality of life (QoL), and reduction in vagally mediated early heart rate recovery (HRR) after exercise, all previously predicted morbidity and mortality in patients with chronic heart failure (CHF). We hypothesized lower HRR with greater psychological distress and poorer QoL in CHF. DESIGN All assessments were made at the beginning of a comprehensive cardiac outpatient rehabilitation intervention program. METHODS Fifty-six CHF patients (mean 58+/-12 years, 84% men) completed the Hospital Anxiety and Depression Scale and the Minnesota Living With Heart Failure Questionnaire. HRR was determined as the difference between HR at the end of exercise and 1 min after exercise termination (HRR-1). RESULTS Elevated levels of anxiety symptoms (P=0.005) as well as decreased levels of the Minnesota Living With Heart Failure Questionnaire total (P = 0.025), physical (P=0.026), and emotional (P=0.017) QoL were independently associated with blunted HRR-1. Anxiety, total, physical, and emotional QoL explained 11.4, 8, 7.8, and 9.0%, respectively, of the variance after controlling for covariates. Depressed mood was not associated with HRR-1 (P=0.20). CONCLUSION Increased psychological distress with regard to elevated anxiety symptoms and impaired QoL were independent correlates of reduced HRR-1 in patients with CHF. Reduced vagal tone might explain part of the adverse clinical outcome previously observed in CHF patients in relation to psychological distress and poor disease-specific QoL.
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Ehrmann Feldman D, Ducharme A, Frenette M, Giannetti N, Michel C, Grondin F, Sheppard R, Behlouli H, Pilote L. Factors related to time to admission to specialized multidisciplinary clinics in patients with congestive heart failure. Can J Cardiol 2009; 25:e347-52. [PMID: 19812808 DOI: 10.1016/s0828-282x(09)70720-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Congestive heart failure (CHF) is a common cause of hospitalization and has a poor prognosis. Specialized multidisciplinary clinics are effective in the management of CHF. OBJECTIVES To measure time of admission to the specialized clinics and explore factors related to the time of admission to these clinics. METHODS Patients who were newly admitted to one of six CHF multidisciplinary clinics in the province of Quebec were enrolled in the study. Data were collected from the common clinical database used at these clinics as well as from questionnaires administered to the patients. RESULTS A total of 531 patients with a mean age of 65.9 years were enrolled. Only 26% were women. The median duration of disease before admission to the CHF clinic was 1.2 years. The majority of patients (62%) were referred by a cardiologist or an internist, while 24% were referred by other specialists, and 14% by general practitioners. One-fifth of patients did not have regular follow-up for their CHF before being admitted to the clinic. Factors associated with shorter disease duration at admission to the clinic were referral by a specialist, not having regular medical follow-up for CHF, having a higher income and having visited the emergency room for CHF. CONCLUSION There may be a need to improve dissemination of information regarding availability and benefits of CHF clinics and criteria for referral.
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Carmona-Bernal C, Ruiz-García A, Villa-Gil M, Sánchez-Armengol A, Quintana-Gallego E, Ortega-Ruiz F, Barón-Esquivias G, Capote F. Quality of life in patients with congestive heart failure and central sleep apnea. Sleep Med 2008; 9:646-51. [DOI: 10.1016/j.sleep.2007.11.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 09/26/2007] [Accepted: 11/13/2007] [Indexed: 11/17/2022]
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Myers J, Zaheer N, Quaglietti S, Madhavan R, Froelicher V, Heidenreich P. Association of functional and health status measures in heart failure. J Card Fail 2006; 12:439-45. [PMID: 16911910 DOI: 10.1016/j.cardfail.2006.04.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Revised: 04/10/2006] [Accepted: 04/17/2006] [Indexed: 12/30/2022]
Abstract
BACKGROUND A wide variety of instruments have been used to assess the functional capabilities and health status of patients with chronic heart failure (HF), but it is not known how well these tests are correlated with one another, nor which one has the best association with measured exercise capacity. METHODS AND RESULTS Forty-one patients with HF were assessed with commonly used functional, health status, and quality of life measures, including maximal cardiopulmonary exercise testing, the Duke Activity Status Index (DASI), the Veterans Specific Activity Questionnaire (VSAQ), the Kansas City Cardiomyopathy Questionnaire (KCCQ), and 6-minute walk distance. Pretest clinical variables, including age, resting pulmonary function tests (forced expiratory volume in 1 s and forced vital capacity), and ejection fraction (EF) were also considered. The association between performance on these functional tools, clinical variables, and exercise test responses including peak VO2 and the VO2 at the ventilatory threshold, was determined. Peak oxygen uptake (VO2) was significantly related to VO2 at the ventilatory threshold (r = 0.76, P < .001) and estimated METs from treadmill speed and grade (r = 0.72, P < .001), but had only a modest association with 6-minute walk performance (r = 0.49, P < .01). The functional questionnaires had modest associations with peak VO2 (r = 0.37, P < .05 and r = 0.26, NS for the VSAQ and DASI, respectively). Of the components of the KCCQ, peak VO2 was significantly related only to quality of life score (r = 0.46, P < .05). Six-minute walk performance was significantly related to KCCQ physical limitation (r = 0.53, P < .01) and clinical summary (r = 0.44, P < .05) scores. Among pretest variables, only age and EF were significantly related to peak VO2 (r = -0.58, and 0.46, respectively, P < .01). Multivariately, age and KCCQ quality of life score were the only significant predictors of peak VO2, accounting for 72% of the variance in peak VO2. CONCLUSION Commonly used functional measures, symptom tools, and quality of life assessments for patients with HF are poorly correlated with one another and are only modestly associated with exercise test responses. These findings suggest that exercise test responses, non-exercise test estimates of physical function, and quality of life indices reflect different facets of health status in HF and one should not be considered a surrogate for another.
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Affiliation(s)
- Jonathan Myers
- Cardiovascular Division, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, California 94304, USA
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van Tol BAF, Huijsmans RJ, Kroon DW, Schothorst M, Kwakkel G. Effects of exercise training on cardiac performance, exercise capacity and quality of life in patients with heart failure: a meta-analysis. Eur J Heart Fail 2006; 8:841-50. [PMID: 16713337 DOI: 10.1016/j.ejheart.2006.02.013] [Citation(s) in RCA: 195] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 01/04/2006] [Accepted: 02/27/2006] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite major advances in pharmacological treatment of chronic heart failure (CHF), a number of patients still suffer from dyspnoea, fatigue, diminished exercise capacity and poor quality of life. It is in this context that exercise training is being intensively evaluated for any additional benefit in the treatment of CHF. AIMS To determine the effect of exercise training in patients with CHF on cardiac performance, exercise capacity and health-related quality of life. A meta-analysis was performed to obtain this goal. METHODS AND RESULTS After including 35 randomised controlled trials, the methodological quality of each study was assessed, summary effect sizes (SESs) and the concomitant 95% confidence intervals (95% CI) were calculated for each outcome. Quantitative analysis showed statistically significant SESs, at rest, for diastolic blood pressure and end-diastolic volume. During maximal exercise, significant SESs were found for systolic blood pressure, heart rate, cardiac output, peak oxygen uptake, anaerobic threshold and 6-min walking test. The Minnesota Living with Heart Failure Questionnaire improved by an average of 9.7 points. CONCLUSIONS Exercise training has clinically important effects on exercise capacity and HRQL, and may have small positive effects on cardiac performance during exercise.
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Affiliation(s)
- Benno A F van Tol
- Department of Physical Therapy, VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
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