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Poledniczek M, Kronberger C, Willixhofer R, Ermolaev N, Cherouny B, Dachs TM, Rettl R, Binder-Rodriguez C, Camuz Ligios L, Gregshammer B, Kammerlander AA, Kastner J, Bergler-Klein J, Duca F, Badr Eslam R. Health-related quality of life is an independent predictor of mortality and hospitalisations in transthyretin amyloid cardiomyopathy: a prospective cohort study. Qual Life Res 2024; 33:2743-2753. [PMID: 39105960 PMCID: PMC11452430 DOI: 10.1007/s11136-024-03723-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE Transthyretin amyloid cardiomyopathy (ATTR-CM) is associated with severely impaired health-related quality of life (HRQL). HRQL is an independent predictor of outcome in heart failure (HF), but data on patients with ATTR-CM is scarce. This study therefore aims to evaluate the association of HRQL with outcome in ATTR-CM. METHODS Patients from our prospective ATTR-CM registry were assessed using the Kansas City cardiomyopathy questionnaire (KCCQ), the Minnesota living with HF questionnaire (MLHFQ), and the EuroQol five dimensions questionnaire (EQ-5D). Cox regression analysis was utilised to assess the impact of HRQL on all-cause mortality. RESULTS 167 patients [80 years; interquartile range (IQR): 76-84; 80.8% male] were followed for a median of 27.6 (IQR: 9.7-41.8) months. The primary endpoint of all-cause mortality was met by 43 (25.7%) patients after a median period of 16.2 (IQR: 9.1-28.1) months. In a univariate Cox regression for mortality, a 10-point change in the KCCQ implied a hazard ratio (HR) of 0.815 [95%-confidence interval (CI): 0.725-0.916; p = 0.001], in the EQ-5D VAS of 0.764 (95%-CI: 0.656-0.889; p < 0.001), and 1.163 (95%-CI: 1.114-1.433; p < 0.001) in the MLHFQ. After adjustment for established biomarkers of HF, all-cause mortality was predicted independently by the EQ-5D VAS (HR: 0.8; 95%-CI: 0.649-0.986; p = 0.037; per 10 points) and the MLHFQ (HR: 1.228; 95%-CI: 1.035-1.458; p = 0.019; per 10 points). CONCLUSION HRQL is a predictor of outcome in ATTR-CM. The EQ-5D VAS and the MLHFQ predict survival independent of biomarkers of HF.
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Affiliation(s)
- Michael Poledniczek
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Christina Kronberger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Robin Willixhofer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Nikita Ermolaev
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Bernhard Cherouny
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Theresa-Marie Dachs
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - René Rettl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Christina Binder-Rodriguez
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Luciana Camuz Ligios
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Bernhard Gregshammer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Andreas Anselm Kammerlander
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Johannes Kastner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Jutta Bergler-Klein
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Franz Duca
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Roza Badr Eslam
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
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Johnson E, Ismond K, Hyde A, Ezekowitz J, Wright G, Spiers J, Spence J, Thompson S, McNeely ML, Zheng Y, Round J, Tymchuk S, Lee-Baggley D, Isley S, Corrick S, Minckler H, Tandon P. eMPower: An online Mind-body wellness Program for adults living with chronic health conditions: A three-armed randomized controlled trial protocol. Contemp Clin Trials 2024; 145:107642. [PMID: 39079613 DOI: 10.1016/j.cct.2024.107642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/02/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Symptoms of depression and anxiety are prevalent among adults with chronic health conditions, contributing to reduced quality of life, morbidity, and mortality. Mind-body wellness interventions (i.e. psychology programming, mindful movement, breathwork, meditation) may impact mental health symptoms, with online delivery offering access and scalability. Whether online mind-body wellness interventions are effective in improving patient outcomes across a broad range of chronic conditions remains uncertain. METHODS This three-armed, pragmatic, randomized controlled trial will use a nested mixed methods approach to assess the effectiveness of an online mind-body wellness intervention (eMPower), offered at two levels of personnel support, on symptoms of anxiety and depression in adults with chronic health conditions. Inclusion criteria require a self-reported chronic condition and access to an internet-connected device. Eligible participants will be randomized 1:1:1 to [1] waitlist control; [2] eMPower; [3] eMPower + weekly 1-to-1 check-in. The primary analysis will compare the Hospital and Anxiety Depression Scale (HADS) total score between eMPower + weekly 1-to-1 check-in versus controls, with secondary and exploratory outcomes including HADS subscales, health-related quality of life, fatigue, program engagement, and frailty. CONCLUSION With online intervention delivery, a range of outcomes, mixed method evaluation, and automated intervention tracking, findings are anticipated to enhance our understanding of how individuals living with chronic health conditions engage with and are impacted by online mind-body wellness programming. Six hundred and fifty-six participants have been enrolled as of April 5, 2024, and 598 patients have completed 12-week follow-up.
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Affiliation(s)
- Emily Johnson
- Faculty of Medicine and Dentistry, Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
| | - Kathleen Ismond
- Faculty of Medicine and Dentistry, Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
| | - Ashley Hyde
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Justin Ezekowitz
- Faculty of Medicine and Dentistry, Division of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Gail Wright
- Canadian Primary Biliary Cholangitis (PBC) Society, 4936 Yonge St, North York, Ontario, Canada.
| | - Jude Spiers
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - John Spence
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - Stephanie Thompson
- Faculty of Medicine and Dentistry, Division of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Margaret L McNeely
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Yinggan Zheng
- Faculty of Medicine and Dentistry, Division of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Jeff Round
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
| | - Sarah Tymchuk
- Faculty of Medicine and Dentistry, Department of Psychiatry University of Alberta, Edmonton, Alberta, Canada.
| | - Dayna Lee-Baggley
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Serena Isley
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
| | - Shaina Corrick
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
| | - Holly Minckler
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
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3
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Miao F, Tian A, Wang B, Li J. Cognitive impairment in young and middle-aged patients with acute heart failure. ESC Heart Fail 2024; 11:2977-2985. [PMID: 38816208 PMCID: PMC11424373 DOI: 10.1002/ehf2.14885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/15/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024] Open
Abstract
AIMS This study aimed to investigate the prevalence, risk factors and prognostic implications of cognitive impairment in young and middle-aged patients with acute heart failure (HF). METHODS In a prospective cohort of patients with acute HF, we assessed cognitive function by the Mini-Cog, predictors of the cognitive impairment and its associations with 30 day and 1 year cardiovascular death or HF rehospitalization among young and middle-aged patients (<65 years old). RESULTS Among 1958 young and middle-aged patients, the prevalence of cognitive impairment was 19.6%. Predictors of cognitive impairment included older age, females, lower education levels and prior strokes. Compared with patients having normal cognitive function, cognitive impairment was associated with a higher risk of 30 day cardiovascular death or HF rehospitalization [hazard ratio (HR), 1.52, 95% confidence interval (CI), 1.07-2.17, P = 0.02], but not for 1 year cardiovascular death or HF rehospitalization (HR, 1.06, 95% CI, 0.87-1.30, P = 0.55). CONCLUSIONS Cognitive impairment is present in a notable proportion of young and middle-aged patients with acute HF and is associated with an increased risk of short-term adverse outcomes. Strategies for screening and intervention for cognitive impairment at a younger age are necessary, particularly for those at high risk.
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Affiliation(s)
- Fengyu Miao
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingPeople's Republic of China
- Fuwai Hospital, Chinese Academy of Medical SciencesShenzhenPeople's Republic of China
- Beijing Municipal Health Big Data and Policy Research CenterBeijing Institute of Hospital ManagementBeijingPeople's Republic of China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingPeople's Republic of China
- Fuwai Hospital, Chinese Academy of Medical SciencesShenzhenPeople's Republic of China
| | - Bin Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingPeople's Republic of China
- Fuwai Hospital, Chinese Academy of Medical SciencesShenzhenPeople's Republic of China
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingPeople's Republic of China
- Fuwai Hospital, Chinese Academy of Medical SciencesShenzhenPeople's Republic of China
- Central‐China Branch of National Center for Cardiovascular DiseasesCentral‐China HospitalZhengzhouPeople's Republic of China
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4
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Sauer AJ, Sherrod CF, Gosch KL, Arnold SV, Reaney M, Zhong Y, Lam J, Wyrwich KW, Spertus JA. The Psychometric Performance of the Kansas City Cardiomyopathy Questionnaire-12 in Symptomatic Obstructive Hypertrophic Cardiomyopathy. J Card Fail 2024:S1071-9164(24)00417-2. [PMID: 39349160 DOI: 10.1016/j.cardfail.2024.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 09/18/2024] [Accepted: 09/19/2024] [Indexed: 10/02/2024]
Abstract
BACKGROUND A primary goal of treating patients with obstructive hypertrophic cardiomyopathy (oHCM) is to improve their symptoms, function, and quality of life. While the psychometric properties of the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ-23) have been described in oHCM, they have not been assessed for the shorter 12-item version (KCCQ-12), which is increasingly used in clinical practice. METHODS AND RESULTS Using data from the EXPLORER-HCM trial, the psychometric properties of the KCCQ-12 were evaluated. The KCCQ-12 domain and summary scores had moderate correlations with the most relevant clinical (New York Heart Association class, exercise duration, peak oxygen consumption) and patient-reported measures (EQ-5D-5L visual analog scale, Work Productivity and Activity Impairment [WPAI] questionnaire, and Hypertrophic Cardiomyopathy Symptom Questionnaire [HCMSQ]). KCCQ-12 domain scores had strong internal consistency and test-retest reliability, demonstrated significant and proportional changes with different magnitudes of clinical change (assessed with the patient global impression of change and patient impression of severity), and demonstrated close equivalence to the KCCQ-23 scores. CONCLUSIONS The KCCQ-12 demonstrated good psychometric performance for patients with oHCM, comparable to that of the KCCQ-23, supporting its use in clinical practice to care for patients with oHCM.
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Affiliation(s)
- Andrew J Sauer
- University of Missouri Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
| | - Charles F Sherrod
- University of Missouri Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kensey L Gosch
- University of Missouri Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Suzanne V Arnold
- University of Missouri Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | | | - Yue Zhong
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Jenny Lam
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - John A Spertus
- University of Missouri Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
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Sideris K, Zhang M, Wolhfahrt P, Siu AF, Shen J, Carter S, Kyriakopoulos CP, Taleb I, Wever-Pinzon O, Shah K, Selzman CH, Rodriguez-Correa C, Kapelios C, Brinker L, Alharethi R, Hess R, Drakos SG, Steinberg BA, Fang JC, Kfoury AG, Melenovsky V, Greene T, Spertus JA, Stehlik J. Integration of Patient Reported Quality of Life Data into Risk Assessment in Heart Failure. J Card Fail 2024:S1071-9164(24)00381-6. [PMID: 39299541 DOI: 10.1016/j.cardfail.2024.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Optimal management of outpatients with heart failure (HF) requires serially updating the estimates of their risk for adverse clinical outcomes to guide treatment. Patient-reported outcomes (PROs) are becoming increasingly used in clinical care. The purpose of this study was to determine whether inclusion of PROs can improve the risk prediction for HF hospitalization and death in ambulatory HF patients. METHODS We included consecutive patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) seen in a HF clinic between 2015 and 2019 who completed PROs as part of routine care. Cox regression with a least absolute shrinkage and selection operator (LASSO) regularization and gradient boosting machine (GBM) analyses were used to estimate risk for a combined outcome of HF hospitalization, heart transplant, left ventricular assist device implantation or death. The performance of the prediction models was evaluated with the time-dependent concordance index (Cτ). RESULTS Among 1165 patients with HFrEF (mean age 59.1±16.1, 68% male) the median follow-up was 487 days and among 456 patients with HFpEF (mean age: 64.2±16.0 years, 55% male) the median follow-up was 494 days. Gradient boosting regression that included PROs had the best prediction performance - Cτ 0.73 for patients with HFrEF and 0.74 in patients with HFpEF, and showed very good stratification of risk by time to event analysis by quintile of risk. The Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-12 OSS), Visual Analogue Scale (VAS) and Patient Reported Outcomes Measurement Information System (PROMIS) dimensions of Satisfaction with social roles and Physical function had high variable importance measure in the models. CONCLUSIONS PROs improve risk prediction in both HFrEF and HFpEF, independent of traditional clinical factors. Routine assessment of PROs and leveraging the comprehensive data in the electronic health record in routine clinical care could help more accurately assess risk and support the intensification of treatment in patients with HF.
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Affiliation(s)
- Konstantinos Sideris
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mingyuan Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Peter Wolhfahrt
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Alfonso F Siu
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jincheng Shen
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Spencer Carter
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christos P Kyriakopoulos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Iosif Taleb
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Omar Wever-Pinzon
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kevin Shah
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Carlos Rodriguez-Correa
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chris Kapelios
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lina Brinker
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rami Alharethi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Rachel Hess
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stavros G Drakos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James C Fang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Abdallah G Kfoury
- Division of Cardiovascular Medicine, Department of Internal Medicine, Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Vojtech Melenovsky
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tom Greene
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - John A Spertus
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Missouri-Kansas City, MO, USA
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Bhatt AS, Bhatt DL, Steg PG, Szarek M, Cannon CP, Leiter LA, McGuire DK, Lewis JB, Riddle MC, Voors AA, Metra M, Lund LH, Testani JM, Wilcox CS, Davies M, Pitt B, Kosiborod MN. Effects of Sotagliflozin on Health Status in Patients With Worsening Heart Failure: Results From SOLOIST-WHF. J Am Coll Cardiol 2024; 84:1078-1088. [PMID: 39260929 DOI: 10.1016/j.jacc.2024.06.036] [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: 04/01/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve health status in heart failure (HF) across the left ejection fraction ejection spectrum. However, the effects of SGLT1 and SGLT2 inhibition on health status are unknown. OBJECTIVES These prespecified analyses of the SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients with Type 2 Diabetes Post Worsening Heart Failure) trial examined the effects of sotagliflozin vs placebo on HF-related health status. METHODS SOLOIST-WHF randomized patients hospitalized or recently discharged after a worsening HF episode to receive sotagliflozin or placebo. The primary endpoint was total number of HF hospitalizations, urgent HF visits, and cardiovascular death. Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) score was a prespecified secondary endpoint. This analysis evaluated change in the KCCQ-12 score from baseline to month 4. RESULTS Of 1,222 patients randomized, 1,113 (91%) had complete KCCQ-12 data at baseline and 4 months. The baseline KCCQ-12 score was low overall (median: 41.7; Q1-Q3: 27.1-58.3) and improved by 4 months in both groups. Sotagliflozin vs placebo reduced the risk of the primary endpoint consistently across KCCQ-12 tertiles (Ptrend = 0.54). Sotagliflozin-treated patients vs those receiving placebo experienced modest improvement in KCCQ-12 at 4 months (adjusted mean change: 4.1 points; 95% CI: 1.3-7.0 points; P = 0.005). KCCQ-12 improvements were consistent across prespecified subgroups, including left ventricular ejection fraction <50% or ≥50%. More patients receiving sotagliflozin vs those receiving placebo had at least small (≥5 points) improvements in KCCQ-12 at 4 months (OR: 1.38; 95% CI: 1.06-1.80; P = 0.017). CONCLUSIONS Sotagliflozin improved symptoms, physical limitations, and quality of life within 4 months after worsening HF, with consistent benefits across baseline demographic and clinical characteristics. (Effect of Sotagliflozin on Cardiovascular Events in Participants With Type 2 Diabetes Post Worsening Heart Failure [SOLOIST-WHF]; NCT03521934).
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Affiliation(s)
- Ankeet S Bhatt
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, California, USA; Stanford University School of Medicine, Division of Cardiovascular Medicine, Palo Alto, California, USA
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Ph Gabriel Steg
- Université Paris-Cité, INSERMU1148 and AP-HP Hospital Bichat, Paris, France; French Alliance for Cardiovascular Trials, Paris, France
| | - Michael Szarek
- CPC Clinical Research and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; State University of New York Downstate School of Public Health, Brooklyn, New York, USA
| | - Christopher P Cannon
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Darren K McGuire
- University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, Texas, USA
| | - Julia B Lewis
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Adriaan A Voors
- University of Groningen-University Medical Center Groningen, Groningen, the Netherlands
| | - Marco Metra
- Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Lars H Lund
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Bertram Pitt
- Department of Internal Medicine (Emeritus), University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Mikhail N Kosiborod
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
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7
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Kolk MZH, Frodi DM, Langford J, Andersen TO, Jacobsen PK, Risum N, Tan HL, Svendsen JH, Knops RE, Diederichsen SZ, Tjong FVY. Deep behavioural representation learning reveals risk profiles for malignant ventricular arrhythmias. NPJ Digit Med 2024; 7:250. [PMID: 39284923 PMCID: PMC11405885 DOI: 10.1038/s41746-024-01247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 08/30/2024] [Indexed: 09/22/2024] Open
Abstract
We aimed to identify and characterise behavioural profiles in patients at high risk of SCD, by using deep representation learning of day-to-day behavioural recordings. We present a pipeline that employed unsupervised clustering on low-dimensional representations of behavioural time-series data learned by a convolutional residual variational neural network (ResNet-VAE). Data from the prospective, observational SafeHeart study conducted at two large tertiary university centers in the Netherlands and Denmark were used. Patients received an implantable cardioverter-defibrillator (ICD) between May 2021 and September 2022 and wore wearable devices using accelerometer technology during 180 consecutive days. A total of 272 patients (mean age of 63.1 ± 10.2 years, 81% male) were eligible with a total sampling of 37,478 days of behavioural data (138 ± 47 days per patient). Deep representation learning identified five distinct behavioural profiles: Cluster A (n = 46) had very low physical activity levels and a disturbed sleep pattern. Cluster B (n = 70) had high activity levels, mainly at light-to-moderate intensity. Cluster C (n = 63) exhibited a high-intensity activity profile. Cluster D (n = 51) showed above-average sleep efficiency. Cluster E (n = 42) had frequent waking episodes and poor sleep. Annual risks of malignant ventricular arrhythmias ranged from 30.4% in Cluster A to 9.8% and 9.5% for Clusters D-E, respectively. Compared to low-risk profiles (D-E), Cluster A demonstrated a three-to-four fold increased risk of malignant ventricular arrhythmias adjusted for clinical covariates (adjusted HR 3.63, 95% CI 1.54-8.53, p < 0.001). These behavioural profiles may guide more personalised approaches to ventricular arrhythmia and SCD prevention.
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Affiliation(s)
- Maarten Z H Kolk
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam UMC location AMC Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Diana My Frodi
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Joss Langford
- Activinsights Ltd., Unit 11, Harvard Industrial Estate, Kimbolton, Huntingdon, PE28 0NJ, United Kingdom
- College of Life and Environmental Sciences, University of Exeter, Stocker Rd, Exeter, EX4 4PY, United Kingdom
| | - Tariq O Andersen
- Department of Computer Science, University of Copenhagen, Universitetsparken 1, 2100, Copenhagen, Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Niels Risum
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands
- Netherlands Heart Institute, Moreelsepark 1, 3511 EP, Utrecht, The Netherlands
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Reinoud E Knops
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam UMC location AMC Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Søren Zöga Diederichsen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Fleur V Y Tjong
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam UMC location AMC Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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8
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Zhou Z, Wang W, Tian L, Peng Y, Lei L, Li J, Pu B, Zhang L, Zheng X. Correlation of aortic root dimensions and mortality in acute heart failure: A nationwide prospective cohort study. Heliyon 2024; 10:e37026. [PMID: 39296088 PMCID: PMC11407952 DOI: 10.1016/j.heliyon.2024.e37026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/18/2024] [Accepted: 08/26/2024] [Indexed: 09/21/2024] Open
Abstract
Background An association between increased aortic root dimensions (ARD) and elevated risk of cardiovascular mortality has been reported in the general population. However, evidence regarding the association between ARD and mortality in patients with acute heart failure (AHF) is limited. Methods In a nationwide prospective cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study, ARD was measured during diastole using echocardiography and indexed to body mass index (BMI). Cox proportional hazard models were used to validate the association between BMI-indexed ARD and mortality. Additionally, the relationship between BMI-indexed ARD and mortality was presented using restricted cubic spline in all populations, and both sexes. Results A total of 2125 participants with ARD were included in the final analysis, among of 38.4 % were women, with a median age of 67 years. Over a median follow-up period of 54.4 (interquartile range: 30.1 to 59.7) months, 895 deaths occurred, with 750 attributed to cardiovascular causes and 145 to non-cardiovascular causes. Compared to the highest tertile group of BMI-indexed ARD, the lowest tertile group had a lower risk of cardiovascular mortality (hazard ratio [HR], 0.71; 95 % confidence interval [CI], 0.58 to 0.87; P < 0.001) and all-cause mortality (HR, 0.68; 95 % CI, 0.56 to 0.81; P < 0.001). Similarly, the middle tertile group also had a lower risk of cardiovascular mortality (HR, 0.78; 95 % CI, 0.65 to 0.93; P = 0.007) and all-cause mortality (HR, 0.75; 95 % CI, 0.63 to 0.89; P < 0.001). Considering the competing risks, the lowest BMI-indexed ARD groups showed a significant mortality risk of cardiovascular mortality in all populations, and both sexes. Moreover, the relationship between BMI-indexed ARD and mortality was linear in males, while a "J" shaped relationship was observed in females. Conclusion Lower BMI-indexed ARD was associated with a decreased risk of all-cause and cardiovascular mortality than those with higher BMI-indexed ARD in AHF. Additionally, a discrepancy was observed between the sexes in the relationship between BMI-indexed ARD and mortality. These findings contribute to the prompt identification of potential mortality risks in patients with AHF.
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Affiliation(s)
- Zeming Zhou
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Wei Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Lili Tian
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yue Peng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lubi Lei
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jingkuo Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Boxuan Pu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Shenzhen, Coronary Artery Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
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9
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Wettstein R, Sedaghat-Hamedani F, Heinze O, Amr A, Reich C, Betz T, Kayvanpour E, Merzweiler A, Büsch C, Mohr I, Friedmann-Bette B, Frey N, Dugas M, Meder B. A Remote Patient Monitoring System with Feedback Mechanisms using a Smartwatch: Concept, Implementation and Evaluation based on the activeDCM Randomized Controlled Trial. JMIR Mhealth Uhealth 2024. [PMID: 39365164 DOI: 10.2196/58441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Technological advances allow recording and sharing of health-related data in a patient-centric way using smartphones and wearables. Secure sharing of such patient-generated data with physicians would enable a dense management of individual health trajectories, monitoring of risk factors and asynchronous feedback. However, most Remote Patient Monitoring (RPM) systems currently available are not fully integrated into hospital IT systems or lack the patient-centric design. OBJECTIVE The objective was to conceptualize and implement a user-friendly, reusable, interoperable and secure RPM system incorporating asynchronous feedback mechanisms, using a broadly available consumer wearable (Apple Watch). Additionally, the study sought to evaluate factors influencing patient acceptance of such systems. METHODS The RPM system requirements were established through focus group sessions. Subsequently, a system concept was designed and implemented using an iterative approach, ensuring technical feasibility from the beginning. To assess clinical feasibility, the system was employed as part of the activeDCM prospective, randomized, interventional study focusing on Dilated Cardiomyopathy (DCM). Each patient used the system for at least 12 months. The System Usability Scale (SUS) was employed to measure usability from a subjective patient perspective. Additionally, an evaluation was conducted on the objective wearable interaction frequency as well as the completeness of transmitted data, classified into Sensor-based Health Data (SHD) and Patient Reported Outcome Measures (PROM). Descriptive statistics using boxplots, along bootstrapped multiple linear regression with a 95% confidence interval (CI) were utilized for evaluation, analyzing the influence of age, sex, device experience and intervention group membership. RESULTS The RPM system consists of four interoperable components: patient-devices, data-server, data-viewer and notification-service. The evaluation of the system was conducted with 95 consecutive DCM patients (female: 28 of 95 (29%), age: 50±12 years) completing the activeDCM study protocol. The wearable/ smartphone application of the system achieved a mean SUS score of 78±17, which was most influenced by device experience. 83 of 95 patients (87%) could integrate the wearable application (very) well into their daily routine and 67 of 95 (70%) saw a benefit of the RPM system for management of their health condition. Patients interacted on average with the wearable on 61%±26% of days enrolled in the study, corresponding to 239±99 of 396±39 days. SHD was available on average for 78%±23% of days and PROM data 64%±27% of weeks enrolled in the study, corresponding to 307±87 of 396±39 days and 35±15 of 56±5 weeks, respectively. Wearable interaction frequency, SHD and PROM completeness were most influenced by intervention group membership. CONCLUSIONS Our results mark a first step towards integrating RPM systems, based on a consumer wearable device for primary patient input, into standardized clinical workflows. They can serve as a blueprint for creating a user-friendly, reusable, interoperable and secure RPM system, that can be integrated into patients' daily routines. CLINICALTRIAL ClinicalTrials.gov-Identifier: NCT04359238.
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Affiliation(s)
- Reto Wettstein
- Institute for Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, DE
| | - Farbod Sedaghat-Hamedani
- Institute for Cardiomyopathies Heidelberg (ICH), Heidelberg University Hospital, Heidelberg, DE
- German Centre for Cardiovascular Research (DZHK), Heidelberg-Mannheim, DE
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, DE
| | - Oliver Heinze
- RheinMain University of Applied Sciences, Wiesbaden, DE
| | - Ali Amr
- Institute for Cardiomyopathies Heidelberg (ICH), Heidelberg University Hospital, Heidelberg, DE
- German Centre for Cardiovascular Research (DZHK), Heidelberg-Mannheim, DE
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, DE
| | - Christoph Reich
- Institute for Cardiomyopathies Heidelberg (ICH), Heidelberg University Hospital, Heidelberg, DE
- German Centre for Cardiovascular Research (DZHK), Heidelberg-Mannheim, DE
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, DE
| | - Theresa Betz
- Institute for Cardiomyopathies Heidelberg (ICH), Heidelberg University Hospital, Heidelberg, DE
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, DE
- Department of Sports Medicine, Medical Clinic, Heidelberg University Hospital, Heidelberg, DE
| | - Elham Kayvanpour
- Institute for Cardiomyopathies Heidelberg (ICH), Heidelberg University Hospital, Heidelberg, DE
- German Centre for Cardiovascular Research (DZHK), Heidelberg-Mannheim, DE
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, DE
| | - Angela Merzweiler
- Institute for Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, DE
| | - Christopher Büsch
- Institute of Medical Biometry, Heidelberg University, Heidelberg, DE
| | - Isabell Mohr
- Institute for Cardiomyopathies Heidelberg (ICH), Heidelberg University Hospital, Heidelberg, DE
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, DE
| | - Birgit Friedmann-Bette
- Department of Sports Medicine, Medical Clinic, Heidelberg University Hospital, Heidelberg, DE
| | - Norbert Frey
- Institute for Cardiomyopathies Heidelberg (ICH), Heidelberg University Hospital, Heidelberg, DE
- German Centre for Cardiovascular Research (DZHK), Heidelberg-Mannheim, DE
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, DE
| | - Martin Dugas
- Institute for Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, DE
| | - Benjamin Meder
- Institute for Cardiomyopathies Heidelberg (ICH), Heidelberg University Hospital, Heidelberg, DE
- German Centre for Cardiovascular Research (DZHK), Heidelberg-Mannheim, DE
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, DE
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10
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Kolk MZH, Frodi DM, Langford J, Meskers CJ, Andersen TO, Jacobsen PK, Risum N, Tan HL, Svendsen JH, Knops RE, Diederichsen SZ, Tjong FVY. Behavioural digital biomarkers enable real-time monitoring of patient-reported outcomes: a substudy of the multicentre, prospective observational SafeHeart study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:531-542. [PMID: 38059857 DOI: 10.1093/ehjqcco/qcad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/25/2023] [Accepted: 12/05/2023] [Indexed: 12/08/2023]
Abstract
AIMS Patient-reported outcome measures (PROMs) serve multiple purposes, including shared decision-making and patient communication, treatment monitoring, and health technology assessment. Patient monitoring using PROMs is constrained by recall and non-response bias, respondent burden, and missing data. We evaluated the potential of behavioural digital biomarkers obtained from a wearable accelerometer to achieve personalized predictions of PROMs. METHODS AND RESULTS Data from the multicentre, prospective SafeHeart study conducted at Amsterdam University Medical Center in the Netherlands and Copenhagen University Hospital, Rigshospitalet in Copenhagen, Denmark, were used. The study enrolled patients with an implantable cardioverter defibrillator between May 2021 and September 2022 who then wore wearable devices with raw acceleration output to capture digital biomarkers reflecting physical behaviour. To collect PROMs, patients received the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQoL 5-Dimensions 5-Level (EQ5D-5L) questionnaire at two instances: baseline and after six months. Multivariable Tobit regression models were used to explore associations between digital biomarkers and PROMs, specifically whether digital biomarkers could enable PROM prediction. The study population consisted of 303 patients (mean age 62.9 ± 10.9 years, 81.2% male). Digital biomarkers showed significant correlations to patient-reported physical and social limitations, severity and frequency of symptoms, and quality of life. Prospective validation of the Tobit models indicated moderate correlations between the observed and predicted scores for KCCQ [concordance correlation coefficient (CCC) = 0.49, mean difference: 1.07 points] and EQ5D-5L (CCC = 0.38, mean difference: 0.02 points). CONCLUSION Wearable digital biomarkers correlate with PROMs, and may be leveraged for real-time prediction. These findings hold promise for monitoring of PROMs through wearable accelerometers.
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Affiliation(s)
- Maarten Z H Kolk
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana M Frodi
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Joss Langford
- Activinsights Ltd, Kimbolton, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Caroline J Meskers
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tariq O Andersen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Niels Risum
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Hanno L Tan
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Jesper H Svendsen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Reinoud E Knops
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Søren Z Diederichsen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Fleur V Y Tjong
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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11
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Grady KL, Burns JL, Allen LA, Stehlik J, Teuteberg J, McIlvennan CK, Kirklin JK, Beiser DG, Lindenfeld J, Denfeld QE, Lee CS, Kiernan M, Cella D, Klein L, Walsh MN, Ruo B, Adler E, Rich J, Pham DT, Yancy C, Murks C, Bedjeti K, Hahn EA. Association of Novel Ventricular Assist Device Self-report Measures With Overall Health-Related Quality of Life. J Cardiovasc Nurs 2024:00005082-990000000-00221. [PMID: 39259580 DOI: 10.1097/jcn.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
BACKGROUND Few study authors examined factors influencing health-related quality of life (HRQOL) early after left ventricular assist device (LVAD) implantation. OBJECTIVE The purpose of this study was to determine whether 5 novel self-report measures and other variables were significantly associated with overall HRQOL at 3 months after LVAD surgery. METHODS Patients were recruited between October 26, 2016, and February 29, 2020, from 12 US sites. Data were collected before LVAD implantation and at 3 months post LVAD implantation. Overall HRQOL measures included the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) overall summary score (OSS) and EuroQol 5-dimension- 3L visual analog scale. Potential factors associated with overall HRQOL included 5 novel self-report measures (Satisfaction with Treatment, Being Bothered by VAD Self-care and Limitations, VAD Team Communication, Self-efficacy regarding VAD Self-care, and Stigma), and demographic and clinical characteristics. Statistics included regression analyses. RESULTS Of enrollees, 242 completed self-report measures at baseline, and 142 completed measures 3 months postoperatively. Patients were 55 ± 13 years old, with 21% female, 24% non-White, 39% high school or lower educated, and 47% destination therapy. Using the KCCQ-12 OSS, higher Satisfaction with Treatment was associated with a higher KCCQ-12 OSS; Being Bothered by VAD Self-care and Limitations, high school or lower education, chest incision pain, cardiac dysrhythmias within 3 postoperative months, and peripheral edema were associated with a worse KCCQ-12 OSS (R2 = 0.524). Factors associated with a worse 3-month EuroQol 5-dimension-3L visual analog scale were female sex, adverse events within 3 months post implantation (cardiac dysrhythmias, bleeding, and venous thrombosis), and chest incision pain (R2 = 0.229). No factors were associated with a higher EuroQol 5-dimension-3L visual analog scale score at 3 months. CONCLUSIONS Two novel measures, demographics, postimplantation adverse events, and symptoms were associated with post-LVAD KCCQ-12 OSS early after surgery.
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12
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El-Zein RS, Mohammed M, Nguyen DD, Hill CL, Thomas L, Nassif M, DeVore AD, Albert NM, Butler J, Patterson JH, Williams FB, Hernandez A, Fonarow GC, Spertus JA. Association of Medication Adherence and Health Status in Heart Failure With Reduced Ejection Fraction: Insights From the CHAMP-HF Registry. Circ Cardiovasc Qual Outcomes 2024; 17:e010211. [PMID: 39045701 PMCID: PMC11408112 DOI: 10.1161/circoutcomes.123.010211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/10/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND The foundation for managing heart failure with reduced ejection fraction (HFrEF) is adherence to guideline-directed medical therapy. Finding an association between medication adherence and patients' health status (their symptoms, function, and quality of life) can be used to underscore its importance to patients. METHODS The association of self-reported medication adherence in US outpatients with HFrEF enrolled in the Change the Management of Patients with Heart Failure registry from 2015 to 2017 was compared with their health status at baseline and 12 months later. A secondary analysis of changes in adherence between baseline and 6 months with 6-month health status was also performed. Medication adherence was assessed with the self-reported 4-item Morisky-Green-Levine Medication Adherence Scale, with scores ≥1 classified as nonadherent. The primary health status outcome was the disease-specific 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OS; range, 0-100; higher is better). Robust linear regression models adjusted for confounders were used. RESULTS After excluding those who died (n=316) or did not provide 12-month KCCQ (n=1285), 3495 outpatients with HFrEF were included, of whom 1108 (31.7%) reported being nonadherent. Nonadherent participants were younger, had significantly worse baseline health status (-5.83-point difference; P<0.001), and showed less improvement at 12 months (-1.7-point difference in mean change; P=0.017) than adherent participants. Among nonadherent patients at baseline, those whose adherence improved trended toward greater 6-month health status improvements than those remaining nonadherent (fully adjusted difference of 2.52 points; P=0.054). CONCLUSIONS In HFrEF, medication nonadherence was associated with worse health status and less improvement over the following year. Improvements in adherence were associated with better health status than remaining nonadherent, underscoring the importance of supporting adherence with guideline-directed medical therapy in patients with HFrEF.
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Affiliation(s)
- Rayan S. El-Zein
- University of Missouri – Kansas City’s Healthcare Institute for Innovation in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Moghniuddin Mohammed
- University of Missouri – Kansas City’s Healthcare Institute for Innovation in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
- Department of Cardiovascular Medicine, Rochester Regional Health, Rochester, NY
| | - Daniel D. Nguyen
- University of Missouri – Kansas City’s Healthcare Institute for Innovation in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | | | | | - Michael Nassif
- University of Missouri – Kansas City’s Healthcare Institute for Innovation in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Adam D. DeVore
- Duke Clinical Research Institute, Durham, NC
- Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | | | | | - Adrian Hernandez
- Duke Clinical Research Institute, Durham, NC
- Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - John A. Spertus
- University of Missouri – Kansas City’s Healthcare Institute for Innovation in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
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13
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Sammour YM, Cohen DJ, Arnold S, Spertus JA, Stebbins A, Vekstein A, Kosinski AS, Goel SS, Kleiman NS, Vemulapalli S, Kapadia SR. Association of Baseline Tricuspid Regurgitation With Health Status and Clinical Outcomes After TAVR and Mitral TEER. JACC Cardiovasc Interv 2024; 17:1905-1915. [PMID: 39197989 DOI: 10.1016/j.jcin.2024.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is associated with worse clinical outcomes after transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (M-TEER), but little is known about its association with health status outcomes. OBJECTIVES The aims of this study were to explore, using the Society of Thoracic Surgeons and American College of Cardiology TVT (Transcatheter Valve Therapy) Registry, the association between baseline TR and health status after TAVR and M-TEER and to determine if baseline TR was associated with clinical endpoints. METHODS Health status was assessed using Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS) score in patients enrolled in the TVT Registry who underwent isolated TAVR or M-TEER between January 2019 and June 2021. The association among baseline TR and KCCQ-OS score, being alive and well, and clinical outcomes was examined. RESULTS In total, 130,097 TAVR patients (13.1% with moderate TR, 2.3% with severe TR) and 19,593 M-TEER patients (33.2% with moderate TR, 14.7% with severe TR) were included. Mean KCCQ-OS scores were lower with severe vs moderate vs none to mild TR at baseline prior to TAVR (39.4 ± 24.2 vs 45.2 ± 24.7 vs 51.3 ± 25.3; P < 0.01) or M-TEER (38.1 ± 23.9 vs 41.9 ± 24.7 vs 45.4 ± 25.2; P < 0.01) and similarly at 30 days and 1 year. The odds of being alive and well at 1 year were lower with moderate or severe TR before TAVR (adjusted OR: 0.79 [95% CI: 0.74-0.85] and adjusted OR: 0.81 [95% CI: 0.70-0.94], respectively) and severe TR before M-TEER (adjusted OR: 0.53; 95% CI: 0.40-0.71). Furthermore, moderate or severe TR before TAVR was associated with higher 1-year mortality and readmission, whereas moderate or severe TR before M-TEER was associated with higher 1-year mortality. CONCLUSIONS In a large cohort of U.S. patients who underwent TAVR or M-TEER, greater baseline TR was associated with worse health status and clinical outcomes. Understanding adverse outcomes of TR in patients with coexisting valvular abnormalities is important, especially with rapidly evolving transcatheter tricuspid valve interventions.
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Affiliation(s)
- Yasser M Sammour
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Suzanne Arnold
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Amanda Stebbins
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Andrew Vekstein
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Ingimarsdóttir IJ, Hansen JS, Bergmann HM, Einarsson H. The Icelandic Heart Failure Registry-A nationwide assessment tool for HF care and intervention in HF treatment. ESC Heart Fail 2024. [PMID: 39104306 DOI: 10.1002/ehf2.15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/13/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION The incidence of heart failure (HF) is increasing, largely because populations are both ageing and growing. Most clinical HF treatment trials are conducted on selected cohorts, only a few of which include elderly patients, among whom HF is common. HF registries can include all HF patients, independent of age or comorbidity profile, and thus reflect reality in healthcare management. METHODS The Icelandic Heart Failure Registry (IHFR) was created in the autumn of 2019 and has operated since 1 January 2020. Based on the Swedish Heart Failure Registry (SwedeHF), it quickly acquired several extensions. All patients admitted for HF to the Department of Cardiology (DC) at Landspítali - The National University Hospital of Iceland are included. Several variables are collected, including the aetiology of HF, comorbidities, clinical assessment at admission, blood tests, imaging results, treatment given and medical therapy at discharge. RESULTS During the 3 years from 2020 to 2022, the DC admitted 1890 patients. As some were readmitted during the study period, the true total was 2384 admissions. Because the IHFR 2023 edition includes 327 variables, automation of many of them is imperative for data collection. CONCLUSION HF is a heterogenous disease with numerous underlying factors. HF management differs among HF phenotypes. A registry can serve as an unbiased indicator of care quality and has the potential to be studied in the future to assess the long-term effects of HF treatment. A registry like the IHFR, therefore, can impact the treatment of all patients recorded in it, reduce the rate of readmissions and even optimize HF management costs.
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Affiliation(s)
- Inga Jóna Ingimarsdóttir
- Department of Cardiology, Landspítali - The National University Hospital of Iceland, Reykjavík, Iceland
- Department of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Johan Sindri Hansen
- Department of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hekla María Bergmann
- Department of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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15
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Piamjariyakul U, Smothers A, Wang K, Shafique S, Wen S, Petitte T, Young S, Sokos G, Smith CE. Palliative care for patients with heart failure and family caregivers in rural Appalachia: a randomized controlled trial. BMC Palliat Care 2024; 23:199. [PMID: 39097733 PMCID: PMC11297777 DOI: 10.1186/s12904-024-01531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a debilitating disease with worsening symptoms and family caregiving burden. HF affects more than 8 million Americans. West Virginia has the highest HF death rate in the U.S. and limited healthcare services. This study tested whether the family HF palliative and end-of-life care intervention (FamPALcare) improved patient and caregiver outcomes at 3- and 6-month study endpoints. METHODS This study used a randomized controlled trial design. Patients with HF and their caregivers were randomly assigned together to the intervention (n = 21) or control (n = 18) group. The intervention included five telephone coaching sessions on the HF home, palliative, and end-of-life care. The outcome data collected at baseline and at 3 and 6 months were from the patients' (a) HF-related health status and depression/anxiety scale scores; and from caregivers' (b) caregiving burden and depression/anxiety scale scores; and (c) anonymous ratings on the 11-item FamPALcare helpfulness scale, completed by the intervention participants. RESULTS The mean age of the patients was 65.66 (SD = 13.72) years, and 67% were White males. The mean age of the caregivers was 62.05 (SD = 13.14) years, and 77% were White females. Compared to the controls, patients in the intervention group had significantly greater scores for HF-related health status (p < .05) and lower depression/anxiety scores at 6 months, the study endpoint. The family caregivers in the intervention group had significantly lower scores on caregiving burden (p < .05) and depression/anxiety (p < .01) at 3 months. The mean helpfulness rating was M = 4.46 out of 5 (SD = 0.49). CONCLUSIONS The FamPALcare intervention was found to be effective at improving patient HF-related health status and reducing caregiver burden and improving both patient and caregiver depression and anxiety scores. The FamPALcare HF intervention was found feasible and consistently delivered (fidelity). The FamPALcare intervention's cost-effectiveness and helpfulness ratings information will be used to plan for subsequent clinical trials. TRIAL REGISTRATION ClinicalTrials.gov NCT04153890, Registered on 4 November 2019, https://clinicaltrials.gov/ct2/show/NCT04153890 .
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Affiliation(s)
| | - Angel Smothers
- West Virginia University School of Nursing, Morgantown, USA
| | - Kesheng Wang
- West Virginia University School of Nursing, Morgantown, USA
| | - Saima Shafique
- West Virginia University School of Nursing, Morgantown, USA
| | - Sijin Wen
- Department of Biostatistics School of Public Health, West Virginia University, Morgantown, USA
| | - Trisha Petitte
- West Virginia University School of Nursing, Morgantown, USA
| | | | - George Sokos
- West Virginia University Heart and Vascular Institute, J.W. Ruby Memorial Hospital, Morgantown, USA
| | - Carol E Smith
- School of Nursing, School of Preventive Medicine, University of Kansas Medical Center, Kansas City, USA
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16
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Grady KL, Kallen MA, Cella D, Allen LA, Lindenfeld J, McIlvennan CK, Beiser DG, Walsh MN, Denfeld QE, Lee CS, Ruo B, Murks C, Stehlik J, Kirklin JK, Teuteberg J, Adler E, Kiernan M, Rich J, Bedjeti K, Hahn EA. Efficient measurement of multiple ventricular assist device patient-reported outcomes: Creation of a 20-item profile from the MCS A-QOL study. J Heart Lung Transplant 2024; 43:1308-1317. [PMID: 38692444 DOI: 10.1016/j.healun.2024.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures of distinct concepts are often put together into patient profile assessments. When brief, profile assessments can decrease respondent burden and increase measure completion rates. In this report, we describe the creation of 5 self-reported 4-item short forms and the Mechanical Circulatory Support: Measures of Adjustment and Quality of Life (MCS A-QOL) 20-item profile to assess PROs specific to adjustment and health-related quality of life (HRQOL) among patients who undergo left ventricular assist device (LVAD) implantation. METHODS Using a cross-sectional sample of patients (n = 620) who underwent LVAD implantation at 12 U.S. sites or participated in the MyLVAD.com support group, we created 5 4-item short forms: Satisfaction with Treatment, ventricular assist device (VAD) Team Communication, Being Bothered by VAD Self-care and Limitations, Self-efficacy Regarding VAD self-care, and Stigma, which we combined into a 20-item profile. Analyses included intercorrelations among measures, Cronbach's alpha (i.e., internal consistency reliability)/score-level-specific reliability, and construct validity. RESULTS The 620 patients were mean age = 57 years, 78% male, 70% White, and 56% on destination therapy LVADs. Intercorrelations among the 5 4-item measures were low to moderate (≤0.50), indicating they are associated yet largely distinct, and correlations with calibrated measures and 6-item short forms were ≥0.76, indicating their ability to reflect full-item bank scores. Internal consistency reliability for the 5 4-item short forms ranged from acceptable (≥0.70) to good (≥0.80). Construct validity was demonstrated for these measures. CONCLUSIONS Our 5 4-item short forms are reliable and valid and may be used individually or together as a 20-item profile to assess adjustment and HRQOL in patients who undergo LVAD implantation.
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Affiliation(s)
- Kathleen L Grady
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Larry A Allen
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Colleen K McIlvennan
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David G Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois
| | | | - Quin E Denfeld
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | | | - Bernice Ruo
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Catherine Murks
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Josef Stehlik
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | | | | | - Eric Adler
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Michael Kiernan
- Department of Medicine, Tufts University, Boston, Massachusetts
| | - Jonathan Rich
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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17
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Espinosa CG, Vergez S, McDonald MV, Safford MM, Cho J, Tobin JN, Mourad O, Marcus R, Joanna Bryan Ringel J, Banerjee S, Dell N, Feldman P, Sterling MR. Leveraging home health aides to improve outcomes in heart failure: A pilot study protocol. Contemp Clin Trials 2024; 143:107570. [PMID: 38740297 PMCID: PMC11283941 DOI: 10.1016/j.cct.2024.107570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/07/2023] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
Heart failure (HF) affects six million people in the U.S., is associated with high morbidity, mortality, and healthcare utilization.(1, 2) Despite a decade of innovation, the majority of interventions aimed at reducing hospitalization and readmissions in HF have not been successful.(3-7) One reason may be that most have overlooked the role of home health aides and attendants (HHAs), who are often highly involved in HF care.(8-13) Despite their contributions, studies have found that HHAs lack specific HF training and have difficulty reaching their nursing supervisors when they need urgent help with their patients. Here we describe the protocol for a pilot randomized control trial (pRCT) assessing a novel stakeholder-engaged intervention that provides HHAs with a) HF training (enhanced usual care arm) and b) HF training plus a mobile health application that allows them to chat with a nurse in real-time (intervention arm). In collaboration with the VNS Health of New York, NY, we will conduct a single-site parallel arm pRCT with 104 participants (HHAs) to evaluate the feasibility, acceptability, and effectiveness (primary outcomes: HF knowledge; HF caregiving self-efficacy) of the intervention among HHAs caring for HF patients. We hypothesize that educating and better integrating HHAs into the care team can improve their ability to provide support for patients and outcomes for HF patients as well (exploratory outcomes include hospitalization, emergency department visits, and readmission). This study offers a novel and potentially scalable way to leverage the HHA workforce and improve the outcomes of the patients for whom they care. Clinical trial.gov registration: NCT04239911.
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Affiliation(s)
| | - Sasha Vergez
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | | | | | - Jacklyn Cho
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Jonathan N Tobin
- Clinical Directors Network (CDN) and The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
| | - Omar Mourad
- Weill Cornell Medicine- Qatar, Qatar Foundation - Education City, Doha, Qatar
| | - Rosa Marcus
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | | | | | | | - Penny Feldman
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
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18
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Leone AM, Di Giusto F, Lucarelli K, Vicerè A, Anastasia G, Galante D, Petrolati E, Bianchini F, Burzotta F, Aurigemma C, Lombardo A, Locorotondo G, Graziani F, Casamassima V, Grimaldi M, Trani C. A Novel Hemodynamic Index Characterizing Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair: The MPF. JACC. ADVANCES 2024; 3:101099. [PMID: 39105121 PMCID: PMC11299577 DOI: 10.1016/j.jacadv.2024.101099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 08/07/2024]
Abstract
Background Hemodynamic impact of residual mitral regurgitation (MR) after transcatheter edge-to-edge repair (TEER) is not always univocally measured by transesophageal echocardiographic (TEE) assessment alone. When analyzing TEER procedure result, operators often encounter discrepancy between TEE guidance and invasive hemodynamic monitoring. Objectives This study sought to investigate the role of invasive hemodynamic monitoring during mitral valve TEER procedure on top of TEE guidance. Methods We analyzed 78 patients with moderate-to-severe or severe MR who underwent TEER. Mitral pulse pressure fraction (MPF) was extracted from intraprocedural continuous left atrial pressure monitoring. Twenty-three patients with the same grade of MR not undergoing TEER were included as a control group. At follow-up, clinical and functional status in the majority of patients undergoing TEER were reassessed by NYHA classification and the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ). Results TEER significantly reduced MR burden on both TEE guidance and invasive hemodynamic monitoring. Post-TEER MPF was significantly reduced compared to both pre-TEER setting (P < 0.001) and control group (P < 0.001). At follow-up, while MR reduction assessed by TEE was associated with an improved functional status in terms of the 12-item KCCQ but not of NYHA classification, a greater reduction in MPF was associated with a significant amelioration of both NYHA classification (P = 0.036) and 12-item KCCQ (P = 0.032). Conclusions MPF could provide an immediate estimate of the real hemodynamic impact of MR and a prompt prediction of the functional improvement after TEER.
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Affiliation(s)
- Antonio Maria Leone
- Unità Operativa Complessa di Cardiologia Diagnostica ed Interventistica - UTIC, Ospedale Isola Tiberina-Gemelli Isola, Roma, Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Federico Di Giusto
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Katya Lucarelli
- Unità Operativa Complessa di Cardiologia, Ospedale Generale Regionale F. Miulli Acquaviva delle Fonti, Acquaviva delle Fonti, Bari, Italy
| | - Andrea Vicerè
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Gianluca Anastasia
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Domenico Galante
- Unità Operativa Complessa di Cardiologia Diagnostica ed Interventistica - UTIC, Ospedale Isola Tiberina-Gemelli Isola, Roma, Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Edoardo Petrolati
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Francesco Bianchini
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Cristina Aurigemma
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Antonella Lombardo
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Gabriella Locorotondo
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Francesca Graziani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Vito Casamassima
- Unità Operativa Complessa di Cardiologia, Ospedale Generale Regionale F. Miulli Acquaviva delle Fonti, Acquaviva delle Fonti, Bari, Italy
| | - Massimo Grimaldi
- Unità Operativa Complessa di Cardiologia, Ospedale Generale Regionale F. Miulli Acquaviva delle Fonti, Acquaviva delle Fonti, Bari, Italy
| | - Carlo Trani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
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19
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Pu B, Wang W, Yu Y, Peng Y, Lei L, Li J, Zhang L, Li J. Characteristics and Factors of 30-Day Readmissions after Hospitalization for Acute Heart Failure in China. Rev Cardiovasc Med 2024; 25:279. [PMID: 39228489 PMCID: PMC11366993 DOI: 10.31083/j.rcm2508279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 09/05/2024] Open
Abstract
Background Patients with acute heart failure (HF) are at high risk of 30-day readmission. Little is known about the characteristics and associated factors of 30-day readmissions among patients with acute HF in China. Methods We enrolled consecutive patients hospitalized for acute HF and discharged from 52 hospitals in China from August 2016 to May 2018. We describe the rate of 30-day readmission, the time interval from discharge to readmission, and the causes of readmission. We also analyzed the factors associated with readmission risk by fitting multivariate Cox proportional hazards models. Results We included 4875 patients with a median age of 67 years (interquartile range, 57-75), 3045 (62.5%) of whom were male. Within 30 days after discharge, 613 (12.6%) patients were readmitted for all causes, with a median from discharge to readmission of 12 (6-21) days. Most readmissions were attributed to cardiovascular causes (71.1%) and 60.0% to HF-related causes. Readmission occurred within 14 days of discharge in more than half of the patients (56.4%). Diabetes (hazard ratio [HR]: 1.25, 95% confidence interval [95% CI]: 1.06-1.50), anemia (HR: 1.26, 95% CI: 1.03-1.53), high New York Heart Association classification (HR: 1.48, 95% CI: 1.08-2.01), elevated N-terminal pro-B type natriuretic peptide (HR: 1.67, 95% CI: 1.24-2.25), and high-sensitivity cardiac troponin T (HR: 1.26, 95% CI: 1.01-1.58) were associated with increased risks of readmission. High systolic blood pressure (HR: 0.56, 95% CI: 0.38-0.81) and Kansas City Cardiomyopathy Questionnaire-12 scores (HR: 0.64, 95% CI: 0.44-0.94) were associated with decreased risk of readmission. Conclusions In China, almost one in eight patients with acute HF were readmitted within 30 days after discharge, mainly due to cardiovascular reasons, and approximately three-fifths of the readmissions occurred in the first 14 days. Both clinical and patient-centered characteristics were associated with readmission.
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Affiliation(s)
- Boxuan Pu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 100037 Beijing, China
| | - Wei Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 100037 Beijing, China
| | - Yanwu Yu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 100037 Beijing, China
| | - Yue Peng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 100037 Beijing, China
| | - Lubi Lei
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 100037 Beijing, China
| | - Jingkuo Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 100037 Beijing, China
| | - Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 100037 Beijing, China
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 100037 Beijing, China
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20
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Agorrody G, Begun I, Verma S, Mazer CD, Garagiola ML, Fernandez-Campos B, Acuña R, Kearney K, Buckley A, Dhingra NK, Ghamarian E, Roche SL, Alonso-Gonzalez R, Wald RM. Patient Reported Outcome Measures in Adults with Fontan Circulatory Failure. J Clin Med 2024; 13:4175. [PMID: 39064214 PMCID: PMC11277569 DOI: 10.3390/jcm13144175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Patient reported outcomes (PROs) are important measures in acquired heart disease but have not been well defined in Adult Congenital Heart Disease (ACHD). Our aim was to explore the discriminatory capacity of PRO survey tools in Fontan circulatory failure (FCF). Methods: Consecutive adults were enrolled from our ambulatory clinics. Inclusion criteria were age ≥18 years, a Fontan circulation or a hemodynamically insignificant shunt lesion, and sufficient cognitive/language abilities to complete PROs. A comprehensive package of PRO measures, designed to assess perceived health-related quality of life (HRQOL) was administered (including the Kansas City Cardiomyopathy Questionnaire [KCCQ-12], EuroQol-5-dimension [EQ5D], Short Form Health Status Survey [SF-12], self-reported New York Heart Association [NYHA] Functional Class, and Specific Activity Scale [SAS]). Results: We compared 54 Fontan patients (35 ± 10 years) to 25 simple shunt lesion patients (34 ± 11 years). The KCCQ-12 score was lower in Fontan versus shunt lesion patients (87 [IQR 79, 95] versus 100 [IQR 97, 100], p-value < 0.001). The FCF subgroup was associated with lower KCCQ-12 scores as compared with the non-FCF subgroup (82 [IQR 56, 89] versus 93 [IQR 81, 98], p-value = 0.002). Although the KCCQ-12 had the best discriminatory capacity for determination of FCF of all PRO tools studied (c-statistic 0.75 [CI 0.62, 0.88]), superior FCF discrimination was achieved when the KCCQ-12 was combined with all PRO tools (c-statistic 0.82 [CI 0.71, 0.93]). Conclusions: The KCCQ-12 questionnaire demonstrated good discriminatory capacity for the identification of FCF, which was further improved through the addition of complementary PRO tools. Further research will establish the value of PRO tools to guide management strategies in ACHD.
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Affiliation(s)
- Guillermo Agorrody
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Isaac Begun
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Unity Health, St. Michael’s Hospital, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada (N.K.D.)
| | - C. David Mazer
- Department of Anaesthesia, Unity Health, St. Michael’s Hospital, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Maria Luz Garagiola
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Beatriz Fernandez-Campos
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Ronald Acuña
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Katherine Kearney
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Alvan Buckley
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Nitish K. Dhingra
- Division of Cardiac Surgery, Unity Health, St. Michael’s Hospital, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada (N.K.D.)
| | - Ehsan Ghamarian
- Applied Health Research Centre, Unity Health, St. Michael’s Hospital, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - S. Lucy Roche
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Rafael Alonso-Gonzalez
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Rachel M. Wald
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, Division of Cardiology, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
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21
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Januzzi JL, Butler J, Del Prato S, Ezekowitz JA, Ibrahim NE, Lam CSP, Lewis GD, Marwick TH, Perfetti R, Rosenstock J, Solomon SD, Tang WHW, Zannad F. Randomized Trial of a Selective Aldose Reductase Inhibitor in Patients With Diabetic Cardiomyopathy. J Am Coll Cardiol 2024; 84:137-148. [PMID: 38597864 DOI: 10.1016/j.jacc.2024.03.380] [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: 03/08/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Progression to symptomatic heart failure is a complication of type 2 diabetes; heart failure onset in this setting is commonly preceded by deterioration in exercise capacity. OBJECTIVES This study sought to determine whether AT-001, a highly selective aldose reductase inhibitor, can stabilize exercise capacity among individuals with diabetic cardiomyopathy (DbCM) and reduced peak oxygen uptake (Vo2). METHODS A total of 691 individuals with DbCM meeting inclusion and exclusion criteria were randomized to receive placebo or ascending doses of AT-001 twice daily. Stratification at inclusion included region of enrollment, cardiopulmonary exercise test results, and use of sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists. The primary endpoint was proportional change in peak Vo2 from baseline to 15 months. Subgroup analyses included measures of disease severity and stratification variables. RESULTS The mean age was 67.5 ± 7.2 years, and 50.4% of participants were women. By 15 months, peak Vo2 fell in the placebo-treated patients by -0.31 mL/kg/min (P = 0.005 compared to baseline), whereas in those receiving high-dose AT-001, peak Vo2 fell by -0.01 mL/kg/min (P = 0.21); the difference in peak Vo2 between placebo and high-dose AT-001 was 0.30 (P = 0.19). In prespecified subgroup analyses among those not receiving sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists at baseline, the difference between peak Vo2 in placebo vs high-dose AT-001 at 15 months was 0.62 mL/kg/min (P = 0.04; interaction P = 0.10). CONCLUSIONS Among individuals with DbCM and impaired exercise capacity, treatment with AT-001 for 15 months did not result in significantly better exercise capacity compared with placebo. (Safety and Efficacy of AT-001 in Patients With Diabetic Cardiomyopathy [ARISE-HF]; NCT04083339).
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Affiliation(s)
- James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA; Baylor Scott and White Institute, Dallas, Texas, USA
| | - Stefano Del Prato
- Interdisciplinary Center "Health Sciences," Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Justin A Ezekowitz
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Nasrien E Ibrahim
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolyn S P Lam
- Baim Institute for Clinical Research, Boston, Massachusetts, USA; National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | - Gregory D Lewis
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Julio Rosenstock
- Velocity Clinical Research Center at Medical City, Dallas, Texas, USA
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - W H Wilson Tang
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Faiez Zannad
- Université de Lorraine, Inserm CIC and CHRU, Nancy, France
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22
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Gard EK, Noaman S, Stub D, Vriesendorp P, Htun N, Johnston R, Gartner E, Dick R, Walton A, Kaye D, Nanayakkara S. The Role of Comorbidities in Predicting Functional Improvement After Transcatheter Aortic Valve Implantation. Heart Lung Circ 2024; 33:1018-1026. [PMID: 38582702 DOI: 10.1016/j.hlc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Patients undergoing transcatheter aortic valve implantation (TAVI) have a high comorbidity burden. We sought to stratify patients into functional outcomes using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12), a patient-reported outcome with benefits over both the New York Heart Association (NYHA) classification and the original 23-item KCCQ, and to evaluate the importance of comorbidities in predicting failure of functional improvement post-TAVI in a contemporary cohort. METHODS In total, 366 patients with severe aortic stenosis undergoing TAVI with baseline KCCQ-12 were retrospectively analysed and divided into two groups. Failure to improve was defined as a score <60 and a change in score <10 at 1 year in either overall score (KCCQ-OS) or clinical summary score (KCCQ-CSS). RESULTS Failure to improve was noted in 13% of patients, who were more likely to have lower KCCQ-OS at baseline (47 [35-59] vs 56 [42-74]), chronic obstructive pulmonary disease (COPD) (19% vs 8%), severe chronic kidney disease (CKD) (13% vs 2%), a clinical frailty score (CFS) ≥5 (41% vs 14%), and lower serum albumin (36 g/L [34-38] vs 38 g/L [35-40]). On multivariate analysis, with an area under the curve of 0.71 (0.63-0.78), baseline KCCQ-OS (adjusted odds ratio [aOR] 0.3 [0.1-0.6], p=0.04), COPD (aOR 2.8 [1.2-6.5], p=0.02), and severe CKD (aOR 5.7 [1.7-18.5], p=0.004) remained independent predictors. CFS alone had a similar predictive value as the multivariable model (OR 2.0 [1.3-3.4], area under the curve 0.69 [0.59-0.80], p<0.001). CONCLUSIONS KCCQ scores were effective in delineating functional outcomes, with most patients in our relatively lower surgical risk cohort showing significant functional improvements post-TAVI. Low baseline KCCQ, moderate or worse COPD, and severe CKD were associated with failure of improvement post-TAVI. Baseline CFS appears to be a good screening tool to predict poor improvement. These factors should be evaluated and weighted accordingly in pre-TAVI assessments and decision-making.
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Affiliation(s)
- Emma K Gard
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Samer Noaman
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia
| | - Pieter Vriesendorp
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Nay Htun
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia
| | - Rozanne Johnston
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Elisha Gartner
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Ronald Dick
- Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - David Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Vic, Australia
| | - Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia; Baker Heart & Diabetes Institute, Melbourne, Vic, Australia.
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23
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Mendes JL, Dos Santos CM, Sousa-Pinto B. Assessment of patient-reported outcomes measures in heart failure: a systematic review. Heart Fail Rev 2024; 29:853-867. [PMID: 38630207 DOI: 10.1007/s10741-024-10404-y] [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] [Accepted: 04/03/2024] [Indexed: 06/19/2024]
Abstract
Heart failure (HF) is a prevalent global disease, particularly impacting developed countries. With the world's aging population, HF's impact on the quantity and quality of life is expected to grow. This review aims to ascertain the frequency, characteristics, and properties of all patient-reported outcomes measures (PROMs) studied in HF patients. We searched Ovid/Medline and Web of Science for original articles about PROMs performed in adults with HF. Using pre-established quality criteria for measurement properties, an overall rating was assigned to evaluate and compare different instruments. The quality of evidence was assessed with the COSMIN risk of bias checklist. Of 4283 records identified, we reviewed 296 full-text documents and included 64 papers, involving 30,185 participants. Thirty different PROMs were identified, with 14 specifically designed for HF being the most commonly used. Minnesota Living with Heart Failure (MLHF) and Kansas City Cardiomyopathy Questionnaire (KCCQ) were evaluated 16 and 13 times, respectively, demonstrating good psychometric properties. The MacNew Heart Disease Health-Related Quality of Life Questionnaire, a common heart disease-specific instrument, exhibited negative performances across various psychometric measures. Evidence for generic instruments was scant and unremarkable and they proved to be less responsive in HF populations. MLHF and KCCQ emerged as the most commonly used and well-supported PROMs, with robust overall evidence. They are comprehensive and accurate instruments, particularly suitable for application in clinical practice and research. Future research should explore how computer-adapted instruments can enhance precision, reduce respondent burden, and improve communication between clinicians and patients, thereby promoting more efficient and patient-centered services.
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Affiliation(s)
- João Lázaro Mendes
- Internal Medicine Department, Unidade Local de Saúde de Viseu Dão-Lafões, Viseu, Portugal.
| | | | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal
- Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Center for Health Technology and Services Research, Porto, Portugal
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24
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Wang W, Peng Y, He G, Li Y, Liu Y, Lei L, Li J, Pu B, Yu Y, Zhang L, Guo Y. Effects of Cumulative Cognitive Function Within 1 Year of Discharge on Subsequent Mortality Among Patients Hospitalized for Acute Heart Failure: A Nationwide Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad288. [PMID: 38170569 PMCID: PMC11157964 DOI: 10.1093/gerona/glad288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To examine the association between cumulative cognitive function and subsequent mortality among patients hospitalized for acute heart failure (AHF). METHODS Based on a prospective cohort of patients hospitalized for AHF, cognitive function was measured using Mini-Cog test at admission, 1- and 12-month following discharge. Cumulative cognitive function was interpreted by cumulative Mini-Cog score and cumulative times of cognitive impairment. Outcomes included subsequent all-cause and cardiovascular mortality. RESULTS 1 454 patients hospitalized for AHF with median follow-up of 4.76 (interquartile range [IQR]: 4.18-5.07) years were included. Tertile 1 of cumulative Mini-Cog score had the highest risk of all-cause (hazard ratio [HR]: 1.52, 95% confidence interval [CI]: 1.14-2.03) and cardiovascular mortality (HR: 1.40, 95% CI: 1.02-1.93) compared with Tertile 3; patients with ≥2 times of cognitive impairment had the highest risk of all-cause (HR: 1.34, 95% CI: 1.03-1.73) and cardiovascular mortality (HR: 1.25, 95% CI: 0.93-1.67) compared with patients without any cognitive impairment. Cumulative Mini-Cog score provided the highest incremental prognostic ability in predicting all-cause (C-statistics: 0.64, 95% CI: 0.61-0.66) and cardiovascular mortality (C-statistics: 0.63, 95% CI: 0.60-0.67) risk on the basis of Get With The Guidelines-Heart Failure score. CONCLUSIONS Poor cumulative cognitive function was associated with increased risk of subsequent mortality and provided incremental prognostic ability for the outcomes among patients with AHF. Longitudinal assessment and monitoring of cognitive function among patients with AHF would be of great importance in identifying patients at greater risk of self-care absence for optimizing personal disease management in clinical practice.
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Affiliation(s)
- Wei Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Peng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangda He
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanchen Liu
- National Clinical Research Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
| | - Lubi Lei
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingkuo Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Boxuan Pu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanwu Yu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanlin Guo
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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25
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Bachmann JM, Shiflet MA, Palacios JR, Turer RW, Wallace GH, Rosenbloom ST, Rice TW. Patient-Reported Outcome Measures in Routine Clinical Practice: Practical Guidance for Institutional Review Boards. Ethics Hum Res 2024; 46:27-37. [PMID: 38944884 DOI: 10.1002/eahr.500216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
The use of patient-reported outcome measures (PROMs) is increasingly common in routine clinical practice. As tools to quantify symptoms and health status, PROMs play an important role in focusing health care on outcomes that matter to patients. The uses of PROM data are myriad, ranging from clinical care to survey-based research and quality improvement. Discerning the boundaries between these use cases can be challenging for institutional review boards (IRBs). In this article, we provide a framework for classifying the three primary PROM use cases (clinical care, human subjects research, and quality improvement) and discuss the level of IRB oversight (if any) necessary for each. One of the most important considerations for IRB staff is whether PROMs are being used primarily for clinical care and thus do not constitute human subjects research. We discuss characteristics of PROMs implemented primarily for clinical care, focusing on: data platform; survey location; questionnaire length; patient interface; and clinician interface. We also discuss IRB oversight of projects involving the secondary use of PROM data that were collected during the course of clinical care, which span human subjects research and quality improvement. This framework provides practical guidance for IRB staff as well as clinicians who use PROMs as communication aids in routine clinical practice.
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Affiliation(s)
- Justin M Bachmann
- Assistant professor of medicine and biomedical informatics and medical director for patient-reported outcomes measurement at Vanderbilt University Medical Center. He is also a staff physician and research scientist at the Veterans Affairs Tennessee Valley Healthcare System
| | - Molly A Shiflet
- Operations manager for the human research protections program at Vanderbilt University Medical Center
| | | | - Robert W Turer
- Assistant professor of emergency medicine at University of Texas-Southwestern Medical Center
| | - Grace H Wallace
- Clinical/translational research coordinator at Vanderbilt University Medical Center
| | - S Trent Rosenbloom
- Professor of biomedical informatics, medicine, pediatrics, and nursing, and is a vice chair of faculty affairs in the Department of Biomedical Informatics at Vanderbilt University Medical Center. He also directs My Health at Vanderbilt, Vanderbilt's patient portal
| | - Todd W Rice
- Professor of medicine and vice president for clinical trial innovation and operations as well as medical director of the human research protections program at Vanderbilt University Medical Center
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26
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Fishkin T, Wang A, Frishman WH, Aronow WS. Healthcare Disparities in Cardiovascular Medicine. Cardiol Rev 2024; 32:328-333. [PMID: 36511638 DOI: 10.1097/crd.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There are significant healthcare disparities in cardiovascular medicine that represent a challenge for cardiologists and healthcare policy-makers who wish to provide equitable care. Disparities exist in both the management and outcomes of hypertension, coronary artery disease and its sequelae, and heart failure. These disparities are present along the lines of race, gender, and socioeconomic status. Despite recent efforts to reduce disparity, there are knowledge and research gaps among cardiologists with regards to both the scope of the problem and how to solve it. Solutions include increasing awareness of disparities in cardiovascular health, increasing research for optimal treatment of underserved communities, and public policy changes that reduce disparities in social determinants of health.
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Affiliation(s)
- Tzvi Fishkin
- From the Departments of Medicine, and Cardiology, Westchester Medical Center and New York Medical College, Vaslhalla, NY
| | - Andy Wang
- From the Departments of Medicine, and Cardiology, Westchester Medical Center and New York Medical College, Vaslhalla, NY
| | - William H Frishman
- From the Departments of Medicine, and Cardiology, Westchester Medical Center and New York Medical College, Vaslhalla, NY
| | - Wilbert S Aronow
- From the Departments of Medicine, and Cardiology, Westchester Medical Center and New York Medical College, Vaslhalla, NY
- Westchester Medical Center and New York Medical College, Vaslhalla, NY
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27
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Akita K, Kageyama S, Suzuki S, Ohno K, Kamakura M, Nawada R, Takanaka C, Wakabayashi Y, Kanda T, Tawarahara K, Mutoh M, Matsunaga M, Suwa S, Takeuchi Y, Sakamoto H, Saito H, Hayashi K, Wakahara N, Unno K, Ikoma T, Sato R, Iguchi K, Satoh T, Sano M, Suwa K, Naruse Y, Ohtani H, Saotome M, Maekawa Y. Machine learning-based detection of sleep-disordered breathing in hypertrophic cardiomyopathy. Heart 2024; 110:954-962. [PMID: 38589224 DOI: 10.1136/heartjnl-2023-323856] [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: 12/28/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is often concomitant with sleep-disordered breathing (SDB), which can cause adverse cardiovascular events. Although an appropriate approach to SDB prevents cardiac remodelling, detection of concomitant SDB in patients with HCM remains suboptimal. Thus, we aimed to develop a machine learning-based discriminant model for SDB in HCM. METHODS In the present multicentre study, we consecutively registered patients with HCM and performed nocturnal oximetry. The outcome was a high Oxygen Desaturation Index (ODI), defined as 3% ODI >10, which significantly correlated with the presence of moderate or severe SDB. We randomly divided the whole participants into a training set (80%) and a test set (20%). With data from the training set, we developed a random forest discriminant model for high ODI based on clinical parameters. We tested the ability of the discriminant model on the test set and compared it with a previous logistic regression model for distinguishing SDB in patients with HCM. RESULTS Among 369 patients with HCM, 228 (61.8%) had high ODI. In the test set, the area under the receiver operating characteristic curve of the discriminant model was 0.86 (95% CI 0.77 to 0.94). The sensitivity was 0.91 (95% CI 0.79 to 0.98) and specificity was 0.68 (95% CI 0.48 to 0.84). When the test set was divided into low-probability and high-probability groups, the high-probability group had a higher prevalence of high ODI than the low-probability group (82.4% vs 17.4%, OR 20.9 (95% CI 5.3 to 105.8), Fisher's exact test p<0.001). The discriminant model significantly outperformed the previous logistic regression model (DeLong test p=0.03). CONCLUSIONS Our study serves as the first to develop a machine learning-based discriminant model for the concomitance of SDB in patients with HCM. The discriminant model may facilitate cost-effective screening tests and treatments for SDB in the population with HCM.
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Affiliation(s)
- Keitaro Akita
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Shigetaka Kageyama
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Sayumi Suzuki
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kazuto Ohno
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masamitsu Kamakura
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Ryuzo Nawada
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | | | - Yasushi Wakabayashi
- Department of Cardiology, Seirei Mikatahara Hospital, Hamamatsu, Shizuoka, Japan
| | - Takahiro Kanda
- Department of Cardiology, Hamamatsu Red Cross Hospital, Hamamatsu, Shizuoka, Japan
| | - Kei Tawarahara
- Department of Cardiology, Hamamatsu Red Cross Hospital, Hamamatsu, Shizuoka, Japan
| | - Masahiro Mutoh
- Department of Cardiology, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Masaki Matsunaga
- Department of Cardiology, Iwata City Hospital, Iwata, Shizuoka, Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Yasuyo Takeuchi
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Hideki Saito
- Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Kazusa Hayashi
- Department of Internal Medicine, JA Shizuoka Kohseiren Enshu Hospital, Hamamatsu, Shizuoka, Japan
| | - Nobuyuki Wakahara
- Department of Cardiology, Fujinomiya City General Hospital, Fujinomiya, Shizuoka, Japan
| | - Kyoko Unno
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takenori Ikoma
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ryota Sato
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Keisuke Iguchi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Terumori Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hayato Ohtani
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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28
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Micovic S, Nobre A, Choi JW, Solinas M, Shehada SE, Torella M, Baeza C, Parrino E, Pollari F, Troise G, Kappert U, Mellert F, Je HG, Argano V, Lam KY, Rinaldi M, Gutermann H, Meuris B. Early outcomes of aortic valve replacement with Perceval PLUS sutureless valve: results of the prospective multicentric MANTRA study. J Cardiothorac Surg 2024; 19:340. [PMID: 38902742 PMCID: PMC11191267 DOI: 10.1186/s13019-024-02861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND The aim of this study is to report the preliminary real-word clinical and hemodynamic performance from the MANTRA study in patients undergoing aortic valve replacement with Perceval PLUS sutureless valve. METHODS MANTRA is an ongoing "umbrella" prospective, multi-center, international post-market study to collect real-life safety and performance data on Corcym devices (Corcym S.r.l, Saluggia, Italy). Clinical and echocardiographic outcomes were collected preoperatively, at discharge and at each follow up. KCCQ-12 and EQ-5D-5L quality of life questionnaires were collected preoperatively and at 30-days. RESULTS A total of 328 patients underwent aortic valve replacement with Perceval PLUS in 29 International institutions. Patients were enrolled from July 2021 to October 2023 and enrollment is still ongoing. Mean age was 71.9 ± 6.4 years, mean EuroSCORE II was 2.9 ± 3.9. Minimally invasive approach was performed in 44.2% (145/328) of patients; concomitant procedures were done in 40.8% (134/328) of cases. Thirty-day mortality was 1.8% (6/328) and no re-interventions were reported. Pacemaker implant was required in 4.0% (13/328) of the patients. The assessment of the functional status demonstrated marked and stable improvement in NYHA class in most patients at 30-day follow-up, with significant increase of KCCQ-12 summary score (from 58.8 ± 23.0 to 71.8 ± 22.1, p < 0.0001) and EQ-5D-5L VAS score (from 64.5 ± 20.4 to 72.6 ± 17.5, p < 0.0001). Mean pressure gradient decreased from 46.2 ± 17.3 mmHg to 10.1 ± 4.7 mmHg at 30-day follow-up. Low or no incidence of moderate-to-severe paravalvular or central leak was reported. CONCLUSIONS Preliminary results demonstrate good clinical outcomes and significant improvement of Quality of Life at 30-days, excellent early hemodynamic performance within patient implanted with Perceval PLUS. TRIAL REGISTRATION The MANTRA study has been registered in ClinicalTrials.gov (NCT05002543, Initial release 26 July 2021).
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Affiliation(s)
- Slobodan Micovic
- Dedinje Cardiovascular Institute, Milana Tepica 1, Belgrade, 11000, Serbia.
| | - Angelo Nobre
- Hospital de Santa Maria Lisbon, Lisbon, Portugal
| | | | | | | | - Michele Torella
- University of Campania "L. Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Cristian Baeza
- University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | | | - Giovanni Troise
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Utz Kappert
- Herzzentrum Dresden GmbH Universitätsklinik, Dresden, Germany
| | | | - Hyung Gon Je
- Pusan National University Yangsan Hospital, Yangsan, South Korea
| | | | - Ka Yan Lam
- Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Mauro Rinaldi
- A.O.U. Città Della Salute E Della Scienza Di Torino - Ospedale Molinette, Turin, Italy
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29
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Sandhu AT, Calma J, Skye M, Kalwani N, Zheng J, Schirmer J, Din N, Brown Johnson C, Gupta A, Lan R, Yu B, Spertus JA, Heidenreich PA. Clinical Impact of Routine Assessment of Patient-Reported Health Status in Heart Failure Clinic: The PRO-HF Trial. Circulation 2024; 149:1717-1728. [PMID: 38583147 DOI: 10.1161/circulationaha.124.069624] [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: 03/13/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The impact of routine clinic use of patient-reported outcome (PRO) measures on clinical outcomes in patients with heart failure (HF) has not been well-characterized. We tested if clinic-based use of a disease-specific PRO improves patient-reported quality of life at 1 year. METHODS The PRO-HF trial (Patient-Reported Outcome Measurement in Heart Failure Clinic) was an open-label, parallel, patient-level randomized clinical trial of routine PRO assessment or usual care at an academic HF clinic between August 30, 2021, and June 30, 2022, with 1 year of follow-up. In the PRO assessment arm, participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at each HF clinic visit, and results were shared with their treating clinician. The usual care arm completed the KCCQ-12 at randomization and 1 year later, which was not shared with the treating clinician. The primary outcome was the KCCQ-12 overall summary score (OSS) between 12 and 15 months after randomization. Secondary outcomes included domains of the KCCQ-12, hospitalization and emergency department visit rates, HF medication therapy, clinic visit frequency, and testing rates. RESULTS Across 17 clinicians, 1248 participants were enrolled and randomized to PRO assessment (n=624) or usual care (n=624). The median age was 63.9 years (interquartile range [IQR], 51.8-72.8), 38.9% were women, and the median baseline KCCQ-12 OSS was 82.3 (IQR, 58.3-94.8). Final KCCQ-12 (available in 87.9% of the PRO arm and 85.1% in usual care; P=0.16) median OSS were 87.5 (IQR, 68.8-96.9) in the PRO arm and 87.6 (IQR, 69.7-96.9) in the usual care arm with a baseline-adjusted mean difference of 0.2 ([95% CI, -1.7 to 2.0]; P=0.85). The results were consistent across prespecified subgroups. A post hoc analysis demonstrated a significant interaction with greater benefit among participants with a baseline KCCQ-12 OSS of 60 to 80 but not in less or more symptomatic participants. No significant differences were found in 1-year mortality, hospitalizations, emergency department visits, medication therapy, clinic follow-up, or testing rates between arms. CONCLUSIONS Routine PRO assessment in HF clinic visits did not impact patient-reported quality of life or other clinical outcomes. Alternate strategies and settings for embedding PROs into routine clinical care should be tested. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04164004.
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Affiliation(s)
- Alexander T Sandhu
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Stanford Prevention Research Center (A.T.S.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Jamie Calma
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
| | - Megan Skye
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Neil Kalwani
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Jimmy Zheng
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Jessica Schirmer
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
| | - Natasha Din
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Cati Brown Johnson
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Anshal Gupta
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Roy Lan
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Brian Yu
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - John A Spertus
- University of Missouri-Kansas City Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.)
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
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Juarez-Casso FM, Singh M, Lewis BR, Sandhu GS, Arghami A, Rowse PG, Bagameri G, Crestanello JA, Greason KL. Long-term Stroke and Mortality Risk in Nonagenarians After Transcatheter Aortic Valve Insertion. Ann Thorac Surg 2024:S0003-4975(24)00372-2. [PMID: 38763221 DOI: 10.1016/j.athoracsur.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 03/05/2024] [Accepted: 04/22/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Limited data exist on the long-term outcomes of transcatheter aortic valve insertion (TAVI) in nonagenarian patients. This study investigated the relationship between patient baseline comorbidity and frailty on the long-term outcome of the nonagenarian population. METHODS A retrospective analysis was conducted of 187 consecutive nonagenarian patients who underwent TAVI from 2009 to 2020. Multivariable models were used to analyze the association between baseline patient and frailty variables and mortality, stroke, and repeat hospitalization. Long-term survival was compared with an age- and sex-matched United States population. RESULTS The median Society of Thoracic Surgeons predicted risk of mortality was 10% (interquartile range, 7%-17%). Frailty was met in 72% of patients based on the 5-meter walk test, 13% based on the Kansas City Cardiomyopathy Questionnaire 12-item instrument score, 12% based on Katz Index of Independence in Activities of Daily Living, and 8% based on serum albumin levels. Procedure-related death occurred in 3 patients (2%) and stroke in 8 (4%). The median duration of follow-up was 3.4 years. Outcomes included death in 150 patients (80%), stroke in 15, and repeat hospitalization in 114. Multivariable analysis identified no association between any of the baseline patient variables with mortality, stroke, repeat hospitalization, or the combined outcomes (all P > .05). The 1- and 5-year survival rates in TAVI-treated nonagenarians were similar to age- and sex-matched controls (P = .27). CONCLUSIONS Long-term death or stroke is independent of The Society of Thoracic Surgeons predicted risk of mortality and frailty risk variables in this nonagenarian patient population who received TAVI. Furthermore, survival is similar to age- and sex-matched controls.
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Affiliation(s)
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bradley R Lewis
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Gurpreet S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Phillip G Rowse
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
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31
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Mukherjee M, Strom JB, Afilalo J, Hu M, Beussink-Nelson L, Kim J, Addetia K, Bertoni A, Gottdiener J, Michos ED, Gardin JM, Shah SJ, Freed BH. Normative Values of Echocardiographic Chamber Size and Function in Older Healthy Adults: The Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2024; 17:e016420. [PMID: 38716661 PMCID: PMC11108741 DOI: 10.1161/circimaging.123.016420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/26/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Echocardiographic (2-dimensional echocardiography) thresholds indicating disease or impaired functional status compared with normal physiological aging in individuals aged ≥65 years are not clearly defined. In the present study, we sought to establish standard values for 2-dimensional echocardiography parameters related to chamber size and function in older adults without cardiopulmonary or cardiometabolic conditions. METHODS In this cross-sectional study of 3032 individuals who underwent 2-dimensional echocardiography at exam 6 in the MESA (Multi-Ethnic Study of Atherosclerosis), 608 participants fulfilled our inclusion criteria of healthy aging, with normative values defined as the mean ± 1.96 standard deviation and compared across sex and race and ethnicity. Functional status measures included NT-proBNP (N-terminal pro-B-type natriuretic peptide), 6-minute walk distance, and Kansas City Cardiomyopathy Questionnaire. Prognostic performance using MESA cutoffs was compared with established guideline cutoffs using time-to-event analysis. RESULTS The normative aging cohort (69.5±7.0 years, 46.2% male, 47.5% White) had lower NT-proBNP, higher 6-minute walk distance, and higher (better) Kansas City Cardiomyopathy Questionnaire summary values. Women had significantly smaller chamber sizes and better biventricular systolic function. White participants had the largest chamber dimensions, whereas Chinese participants had the smallest, even after adjustment for body size. Current guidelines identified 81.6% of healthy older adults in MESA as having cardiac abnormalities. CONCLUSIONS Among a large, diverse group of healthy older adults, we found significant differences in cardiac structure and function by sex and race/ethnicity, which may signal sex-specific cardiac remodeling with advancing age. It is crucial for existing guidelines to consider the observed and clinically significant differences in cardiac structure and function associated with healthy aging. Our study highlights that existing guidelines, which grade abnormalities in echocardiographic cardiac chamber size and function based on younger individuals, may not adequately address the anticipated changes associated with normal aging.
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Affiliation(s)
| | | | | | - Mo Hu
- Northwestern University Feinberg School of Medicine,
Chicago, IL
| | | | - Jiwon Kim
- Weill Cornell Medicine, New York, NY
| | - Karima Addetia
- University of Chicago Pritzker School of Medicine, Chicago,
IL
| | | | | | - Erin D. Michos
- Johns Hopkins University School of Medicine, Baltimore,
MD
| | | | - Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine,
Chicago, IL
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32
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Zhang X, Ho GWK, Mak YW. Effectiveness of a videoconferencing group-based dyad acceptance and commitment therapy on the quality of life of chronic heart failure patients and their family caregivers: A study protocol for a randomized controlled trial. PLoS One 2024; 19:e0298178. [PMID: 38635558 PMCID: PMC11025806 DOI: 10.1371/journal.pone.0298178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/03/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Chronic heart failure (CHF) poses a significant burden on both patients and their family caregivers (FCs), as it is associated with psychological distress and impaired quality of life (QOL). Acceptance and Commitment Therapy (ACT) supports QOL by focusing on value living and facilitates acceptance of psychological difficulties by cultivating psychological flexibility. A protocol is presented that evaluates the effectiveness of a dyad ACT-based intervention delivered via smartphone on QOL and other related health outcomes compared with CHF education only. METHODS This is a single-center, two-armed, single-blinded (rater), randomized controlled trial (RCT). One hundred and sixty dyads of CHF patients and their primary FCs will be recruited from the Cardiology Department of a hospital in China. The dyads will be stratified block randomized to either the intervention group experiencing the ACT-based intervention or the control group receiving CHF education only. Both groups will meet two hours per week for four consecutive weeks in videoconferencing sessions over smartphone. The primary outcomes are the QOL of patients and their FCs. Secondary outcomes include psychological flexibility, psychological symptoms, self-care behavior, and other related outcomes. All outcomes will be measured by blinded outcome assessors at baseline, immediately post-intervention, and at the three-month follow-up. Multilevel modeling will be conducted to assess the effects of the intervention. DISCUSSION This study is the first to adopt an ACT-based intervention for CHF patient-caregiver dyads delivered in groups via smartphone. If effective and feasible, the intervention strategy and deliverable approach could be incorporated into clinical policies and guidelines to support families with CHF without geographic and time constraints. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04917159. Registered on 08 June 2021.
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Affiliation(s)
- Xuelin Zhang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Grace W. K. Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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DeGroot L, Pavlovic N, Perrin N, Gilotra NA, Miller H, Denfeld QE, McIlvennan CK, Dy SM, Davidson PM, Szanton SL, Abshire Saylor M. The Association of Unmet Palliative Care Needs and Physical Frailty With Clinical Outcomes: A Prospective Study of Adults With Heart Failure. J Cardiovasc Nurs 2024:00005082-990000000-00185. [PMID: 38635901 DOI: 10.1097/jcn.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND People with heart failure, particularly those who are physically frail, experience complex needs that can be addressed by palliative care (PC). However, we have a limited understanding of how the intersection of unmet PC needs and physical frailty contributes to health-related quality of life (HRQOL) and risk for hospitalization or mortality. OBJECTIVE In this study, we sought to examine the association of unmet PC needs and physical frailty with clinical outcomes (baseline HRQOL and hospitalizations or mortality at 6 months). METHODS We recruited a convenience sample of community-dwelling persons with heart failure from an urban hospital system who were older than 50 years and hospitalized in the last year. We measured physical frailty using the FRAIL scale (nonfrail, 0-2; frail, 3-5), PC needs using the Integrated Palliative Outcome Scale (range, 0-58; higher scores indicating higher needs), and HRQOL using the Kansas City Cardiomyopathy Questionnaire (range, 0-100; higher scores indicate higher HRQOL). We performed multivariable linear regression to test the relationships between physical frailty, PC needs, and HRQOL, and multivariable logistic regression for associations with all-cause 6-month hospitalization or mortality. We also performed an exploratory analysis of 4 PC needs/frailty groups (high PC needs/frail, high PC needs/nonfrail, low PC needs/frail, low PC needs/nonfrail) with outcomes. RESULTS In our overall sample (n = 298), mean (SD) age was 68 (9.8) years, 37% were women (n = 108), 28% identified as Black/African American (n = 84), and 65% had heart failure with preserved ejection fraction (n = 194). Mean PC needs score was 19.7, and frail participants (n = 130, 44%) had a significantly higher mean PC needs score than nonfrail participants (P < .001). Those with higher PC needs (Integrated Palliative Care Outcome Scale ≥ 20) had significantly worse HRQOL (P < .001) and increased odds of hospitalization or mortality (odds ratio, 2.5; P < .01) compared with those with lower PC needs, adjusting for covariates. Physically frail participants had significantly worse HRQOL (P < .001) and higher odds of hospitalization or mortality at 6 months (odds ratio, 2.6; P < .01) than nonfrail participants, adjusting for covariates. In an exploratory analysis, physically frail participants with high PC needs had the lowest HRQOL score, with an average score of 28.6 points lower (P < .001) and 4.6 times higher odds of hospitalization or mortality (95% confidence interval, 2.03-10.43; P < .001) than low-needs/nonfrail participants. CONCLUSION Higher unmet PC needs and physical frailty, separately and in combination, were associated with lower HRQOL and higher odds of hospitalization or mortality. Self-reported PC needs and physical frailty assessment in clinical settings may improve identification of patients at the highest risk for poor HRQOL and hospitalization or mortality amenable to PC intervention.
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Derendorf L, Stock S, Simic D, Shukri A, Zelenak C, Nagel J, Friede T, Herbeck Belnap B, Herrmann-Lingen C, Pedersen SS, Sørensen J, Müller And On Behalf Of The Escape Consortium D. Health economic evaluation of blended collaborative care for older multimorbid heart failure patients: study protocol. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:29. [PMID: 38615050 PMCID: PMC11015692 DOI: 10.1186/s12962-024-00535-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/21/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Integrated care, in particular the 'Blended Collaborative Care (BCC)' strategy, may have the potential to improve health-related quality of life (HRQoL) in multimorbid patients with heart failure (HF) and psychosocial burden at no or low additional cost. The ESCAPE trial is a randomised controlled trial for the evaluation of a BCC approach in five European countries. For the economic evaluation of alongside this trial, the four main objectives were: (i) to document the costs of delivering the intervention, (ii) to assess the running costs across study sites, (iii) to evaluate short-term cost-effectiveness and cost-utility compared to providers' usual care, and (iv) to examine the budgetary implications. METHODS The trial-based economic analyses will include cross-country cost-effectiveness and cost-utility assessments from a payer perspective. The cost-utility analysis will calculate quality-adjusted life years (QALYs) using the EQ-5D-5L and national value sets. Cost-effectiveness will include the cost per hospital admission avoided and the cost per depression-free days (DFD). Resource use will be measured from different sources, including electronic medical health records, standardised questionnaires, patient receipts and a care manager survey. Uncertainty will be addressed using bootstrapping. DISCUSSION The various methods and approaches used for data acquisition should provide insights into the potential benefits and cost-effectiveness of a BCC intervention. Providing the economic evaluation of ESCAPE will contribute to a country-based structural and organisational planning of BCC (e.g., the number of patients that may benefit, how many care managers are needed). Improved care is expected to enhance health-related quality of life at little or no extra cost. TRIAL REGISTRATION The study follows CHEERS2022 and is registered at the German Clinical Trials Register (DRKS00025120).
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Affiliation(s)
- Lisa Derendorf
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany.
| | - Stephanie Stock
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Dusan Simic
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Arim Shukri
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Christine Zelenak
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Jonas Nagel
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Tim Friede
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Birgit Herbeck Belnap
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
- Center for Behavioral Health, Media, and Technology, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jan Sørensen
- Healthcare Outcomes Research Centre, Dublin, Ireland
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Metra M, Radulescu CI, Cersosimo A, Massussi M, Laurito A, Chioncel O, Adamo M. Quality of life in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: tools and evidence. J Cardiovasc Med (Hagerstown) 2024; 25:259-270. [PMID: 38488063 DOI: 10.2459/jcm.0000000000001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Aortic stenosis is the most prevalent valvular heart disease requiring intervention, especially in the elderly population. Surgical aortic valve replacement and transcatheter aortic valve implantation (TAVI) are well established treatment options for symptomatic patients with severe aortic stenosis, as they provide a significant survival benefit. Aortic stenosis may have an important impact on patients' quality of life (QoL). However, advanced age, comorbidities and frailty may limit the beneficial effect of aortic stenosis interventions in terms of QoL. Current guidelines mention the importance of frailty and avoiding the futility of interventions, but lack specific indications about decision-making. Also, there are limited data on how to specifically assess QoL in aortic stenosis patients since the most used questionnaires are validated in different populations (i.e. heart failure). The aim of this review is to summarize all the available tools for QoL assessment in patients with aortic stenosis; to report current evidence on the impact of TAVI on QoL; and to discuss the role of frailty and comorbidities in this setting.
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Affiliation(s)
- Marco Metra
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Crina-Ioana Radulescu
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- University of Medicine and Pharmacy Carol Davila
| | - Angelica Cersosimo
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mauro Massussi
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Laurito
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- University of Medicine and Pharmacy Carol Davila
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
| | - Marianna Adamo
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Mohebi R, Jones PG, Spertus JA, Lingvay I, Lanfear DE, Gosch KL, Birmingham M, Kosiborod MN, Butler J, Januzzi JL. Early Longitudinal Change in Heart Failure Health Status Following Initiation of Canagliflozin. JACC. HEART FAILURE 2024; 12:711-718. [PMID: 38385941 DOI: 10.1016/j.jchf.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Sodium glucose co-transporter 2 inhibitor (SGLT2i) therapy improves health status in heart failure (HF). There is insufficient description regarding the timing, rate, and extent of the health status changes in heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) after initiation of SGLT2is. OBJECTIVES The authors sought to model the association of canagliflozin treatment with rates of change in HF symptom status in HFpEF and HFrEF. METHODS Study participants with HFrEF and HFpEF were treated with either canagliflozin 100 mg or placebo for 12 weeks. The Kansas City Cardiomyopathy Questionnaire Total Symptom Score (KCCQ-TSS) was assessed at baseline and at 2, 4, 6, and 12 weeks. Longitudinal modeling assessed slope of KCCQ change across the study. RESULTS Among 448 individuals with HF (181 with HFrEF and 267 with HFpEF), participants with HFpEF had lower baseline KCCQ-TSS scores than those with HFrEF (54 ± 21 vs 64 ± 20). Modeling demonstrated initial rapid improvement in KCCQ-TSS in both HF groups, with deceleration over the next 4 to 6 weeks. The rate of change was greater among HFpEF participants (0.7 points/day; 95% CI: 0.3-1.1 points/day) than HFrEF participants (ΔKCCQ-TSS/day = 0.5; 95% CI: 0.1-1.0 points/day) randomized to canagliflozin, but these differences were not statistically significant (0.2 points/day; 95% CI: -0.4 to 0.7 points/day; P = 056). CONCLUSIONS After canagliflozin therapy, regardless of EF, modeling shows the KCCQ-TSS improves rapidly with the greatest improvements occurring within the first weeks of treatment. These results have implications for clinical use of SGLT2is and may be useful in the design of trials examining impact of these agents on health status in HF. (A Study on Impact of Canagliflozin on Health Status, Quality of Life, and Functional Status in Heart Failure [CHIEF-HF]; NCT04252287).
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Affiliation(s)
- Reza Mohebi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Ildiko Lingvay
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
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Li Y, Hung V, Ho K, Kavalieratos D, Warda N, Zimmermann C, Quinn KL. The Validity of Patient-Reported Outcome Measures of Quality of Life in Palliative Care: A Systematic Review. J Palliat Med 2024; 27:545-562. [PMID: 37971747 DOI: 10.1089/jpm.2023.0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Importance: A recent systematic review and meta-analysis found that palliative care was not associated with improvement in quality of life (QOL) in terminal noncancer illness. Among potential reasons for a null effect, it is unclear if patient-reported outcome measures (PROMs) measuring QOL were derived or validated among populations with advanced life-limiting illness (ALLI). Objective: To systematically review the derivation and validation of QOL PROMs from a recent meta-analysis of randomized controlled trials (RCT) of palliative care interventions in people with terminal noncancer illness. Evidence Review: EMBASE, MEDLINE, and PsycINFO were searched from inception to January 8, 2023 for primary validation studies of QOL PROMs in populations with ALLI, defined as adults with a progressive terminal condition and an estimated median survival of less than or equal to one year. The primary outcome was the proportion of PROMs that were derived or validated in ≥1 ALLI population. Findings: Twenty-one unique studies of derivation (n = 13) and validation (n = 11, 3 studies evaluated both) provided data on 9657 participants (mean age 63 years, 50% female) across 15 unique QOL PROMs and subscales. Among studies of validation, 9 were in people with cancer (n = 2289, n = 5 PROMs), 1 in neurodegenerative disease (n = 23, n = 1 PROM), and 1 with mixed diseases (n = 248, n = 1 PROM). Across 15 QOL PROMs and subscales, 47% (n = 7) were derived or validated in an ALLI population. The majority of these seven PROMs were exclusively derived or validated among people with cancer (57%, n = 4). QOL PROMs such as Quality of Life at End of Life, EuroQoL-5 Dimension 5-level, and 36-item Short Form Survey demonstrated validity in more than one terminal noncancer illness. Conclusions: Most QOL PROMs that measured the effect of palliative care on QOL in RCTs were neither derived nor validated in an ALLI population. These findings raise questions about the inferences that palliative care does not improve QOL among people with terminal noncancer illness.
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Affiliation(s)
- Yifan Li
- Division of Palliative Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Hung
- Department of Medicine, Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada
| | - Kevin Ho
- Department of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Nahrain Warda
- Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Division of Palliative Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Kieran L Quinn
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
- ICES, Toronto and Ottawa, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Sukosd IE, Pescariu SA, Faur C, Danila AI, Prodan-Barbulescu C, Fira-Mladinescu O. Utility of Kansas City Cardiomyopathy Questionnaire (KCCQ) in Assessing Quality of Life among Patients with Heart Failure Undergoing Exercise Training Rehabilitation: A Systematic Review. Diseases 2024; 12:64. [PMID: 38667522 PMCID: PMC11049255 DOI: 10.3390/diseases12040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
This systematic review evaluates the effectiveness of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in assessing quality of life improvements among patients with heart failure (HF) undergoing various forms of exercise training rehabilitation, including telemedicine and in-person modalities, across all stages of HF, irrespective of ejection fraction (EF) and clinical status. The aim was to collate evidence from studies employing the KCCQ as a measure of quality of life (QoL). A comprehensive search strategy was implemented across PubMed, Scopus, and Embase databases, adhering to the PRISMA guidelines, including literature up until October 2023. Inclusion criteria encompassed studies on patients diagnosed with HF undergoing exercise training rehabilitation assessed by KCCQ. Nine articles met the inclusion criteria, involving a total of 3905 patients from various global locations and conducted between 2012 and 2022. Results indicated significant heterogeneity in exercise interventions and patient characteristics. Notably, high-intensity interval training (HIIT) showed a marked improvement in KCCQ scores (from 68.0 to 80.0) compared to moderate continuous training (MCT) and control groups, underscoring its potential for enhancing QoL. Additionally, a significant improvement in the 6-min walking test (6MWT) outcomes was observed, with an average increase of 106 m (95% CI: 60, 152) in one study, reflecting physical capacity enhancements. However, the difference in KCCQ scores between intervention and control groups was not statistically significant in several studies. In conclusion, the KCCQ's effectiveness is highlighted by its ability to detect clinically meaningful improvements in QoL across diverse exercise modalities, including HIIT and MCT, tailored to the specific needs of HF populations. The consistent correlation between KCCQ score improvements and enhanced physical outcomes, such as the 6MWT, supports its reliability in capturing the nuanced benefits of exercise interventions on patient well-being.
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Affiliation(s)
- Ilona Emoke Sukosd
- Doctoral School, Department of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (I.E.S.); (C.P.-B.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Silvius Alexandru Pescariu
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Cosmin Faur
- Department of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Alexandra Ioana Danila
- Department of Anatomy and Embriology, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Catalin Prodan-Barbulescu
- Doctoral School, Department of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (I.E.S.); (C.P.-B.)
- Department of Anatomy and Embriology, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- IInd Surgery Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ovidiu Fira-Mladinescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Yu Y, Liu J, Zhang L, Ji R, Su X, Gao Z, Xia S, Li J, Li L. Perceived Economic Burden, Mortality, and Health Status in Patients With Heart Failure. JAMA Netw Open 2024; 7:e241420. [PMID: 38512256 PMCID: PMC10958235 DOI: 10.1001/jamanetworkopen.2024.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/10/2024] [Indexed: 03/22/2024] Open
Abstract
Importance In the face of an emerging heart failure (HF) epidemic, describing the association between perceived economic burden (PEB) and health care outcomes is an important step toward more equitable and achievable care. Objectives To examine the association between PEB and risk of 1-year clinical outcomes and HF-specific health status in patients with acute decompensated HF. Design, Setting, and Participants This prospective, multicenter, hospital-based cohort study prospectively enrolled adult patients hospitalized for acute decompensated HF at 52 hospitals in China from August 2016 to May 2018, with 1-year follow-up. Data were analyzed on June 17, 2022. Exposure Perceived economic burden, categorized as severe (cannot undertake expenses), moderate (can almost undertake expenses), or little (can easily undertake expenses). Main Outcomes and Measures The clinical outcomes of the study were 1-year all-cause death and rehospitalization for HF. Heart failure-specific health status was assessed by the 12-Item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Results Among 3386 patients, median age was 67 years (IQR, 58-75 years) and 2116 (62.5%) were men. Of these patients, 404 (11.9%) had severe PEB; 2021 (59.7%), moderate PEB; and 961 (28.4%), little PEB. Compared with patients with little PEB, those with severe PEB had increased risk of 1-year mortality (hazard ratio [HR], 1.61; 95% CI, 1.21-2.13; P < .001) but not 1-year HF rehospitalization (HR, 1.21; 95% CI, 0.98-1.49; P = .07). The mean (SD) adjusted KCCQ-12 score was lowest in patients with severe PEB and highest in patients with little PEB at baseline (40.0 [1.7] and 50.2 [1.0] points, respectively; P < .001) and at each visit (eg, 12 months: 61.5 [1.6] and 75.5 [0.9] points respectively; P < .001). Patients reporting severe PEB had a clinically significant lower 1-year KCCQ-12 score compared with those reporting little PEB (mean difference, -11.3 points; 95% CI, -14.9 to -7.6 points; P < .001). Conclusions and Relevance In this cohort study of patients with acute decompensated HF, greater PEB was associated with higher risk of mortality and poorer health status but not with risk of HF rehospitalization. The findings suggest that PEB may serve as a convenient tool for risk estimation and as a potential target for quality-improvement interventions for patients with HF.
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Affiliation(s)
- Yuan Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiamin Liu
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihua Zhang
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runqing Ji
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoming Su
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiping Gao
- Department of General Practice, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuang Xia
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liwen Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Yang E, Heckbert SR, Ding J, Spragg D, Calkins H, Shah S, Szklo M, Post WS, Sharma K. Prevalence of Subclinical Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction. JACC. HEART FAILURE 2024; 12:492-504. [PMID: 37999661 DOI: 10.1016/j.jchf.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in patients with heart failure with preserved ejection fraction (HFpEF) and is associated with poorer clinical outcomes. The prevalence of subclinical AF in patients with HFpEF remains unknown. OBJECTIVES The aim of this study was to determine whether subclinical AF was more prevalent in individuals with HFpEF than in individuals without histories of heart failure (HF). METHODS Patients with HFpEF with no prior diagnoses of AF were screened for subclinical AF, and the prevalence of subclinical AF was compared with that among control subjects without HF drawn from MESA (Multi-Ethnic Study of Atherosclerosis) who underwent the same electrocardiographic monitoring. Multivariable logistic regression was used to adjust for demographic and clinical comorbidities. RESULTS Ninety patients with HFpEF and 1,230 MESA participants were included. Patients with HFpEF were younger (median age 69 years [Q1-Q3: 63-76 years] vs 72 years [Q1-Q3: 66-80 years]; P = 0.02), more obese (median body mass index 36 kg/m2 [Q1-Q3: 30-45 kg/m2] vs 27 kg/m2 [Q1-Q3: 24-30 kg/m2]; P < 0.001), and more likely to have diabetes (34% vs 21%; P = 0.01). The prevalence of subclinical AF was 8.9% in patients with HFpEF and 4.1% in non-HF participants. After multivariable adjustment for age, sex, race, body mass index, diabetes, smoking, and total analyzable time on electrocardiographic monitor, there was a significantly higher odds of subclinical AF in patients with HFpEF compared with MESA (OR: 3.01; 95% CI: 1.13-7.99; P = 0.03). CONCLUSIONS Patients with HFpEF had a higher prevalence of subclinical AF than participants without HF from a community-based study. Screening for atrial arrhythmias may be appropriate among patients with HFpEF for timely initiation of thromboembolic prophylaxis and may identify individuals at greater risk for clinical decompensation.
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Affiliation(s)
- Eunice Yang
- Inova Schar Heart and Vascular Institute, Fairfax, Virginia, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan R Heckbert
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Jennifer Ding
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Spragg
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hugh Calkins
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sanjiv Shah
- Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Moyses Szklo
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wendy S Post
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kavita Sharma
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Aimo A, Teresi L, Castiglione V, Picerni AL, Niccolai M, Severino S, Agazio A, Carnevale Baraglia A, Obici L, Palladini G, Ponti L, Argirò A, Cappelli F, Perfetto F, Serenelli M, Trimarchi G, Licordari R, Di Bella G, Chubuchna O, Quattrone F, Nuti S, De Rosis S, Passino C, Rapezzi C, Merlini G, Emdin M, Vergaro G. Patient-reported outcome measures for transthyretin cardiac amyloidosis: the ITALY study. Amyloid 2024; 31:52-61. [PMID: 37668548 DOI: 10.1080/13506129.2023.2254451] [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: 03/31/2023] [Revised: 07/04/2023] [Accepted: 08/26/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Transthyretin cardiac amyloidosis (ATTR-CA) has a deep impact on the quality of life (QoL), yet no specific patient-reported outcome measures (PROMs) for ATTR-CA exist. METHODS The ITALY study involved 5 Italian referral centres (Pisa, Pavia, Ferrara, Florence, Messina) enrolling consecutive outpatients with ATTR-CA. RESULTS Two 30-item questionnaires were created for wild-type (wt) and variant (v) ATTR-CA. Scores ranged from 100 (best condition) to 0 (worst condition). Out of 140 patients enrolled (77% with ATTRwt-CA), 115 repeated the re-evaluation at 6 months. At baseline, only 30% of patients needed help to fill out the questionnaires. Among baseline variables, all KCCQ and SF-36 domains were univariate predictors of ITALY scores in ATTRwt-CA patients, with the KCCQ Symptom Summary score (beta coefficient 0.759), Social Limitations (0.781), and Overall summary score (0.786) being the strongest predictors. The SF-36 Emotional well-being score (0.608), the KCCQ Overall summary score (0.656), and the SF-36 Energy/fatigue score (0.669) were the strongest univariate predictors of ITALY scores in ATTRv-CA. Similar results were found at 6 months. CONCLUSIONS The ITALY questionnaires are the first specific PROMs for ATTRwt- and ATTRv-CA. Questionnaire completion is feasible. ITALY scores display close relationships with non-ATTR-specific measures of QoL.
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Affiliation(s)
- Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Lucio Teresi
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, University Hospital of Messina, Messina, Italy
| | - Vincenzo Castiglione
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Anna Lisa Picerni
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Martina Niccolai
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Silvia Severino
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Assunta Agazio
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Anna Carnevale Baraglia
- Centro per lo Studio e la Cura delle Amiloidosi Sistemiche, Fondazione Policlinico San Matteo, Pavia, Italy
| | - Laura Obici
- Centro per lo Studio e la Cura delle Amiloidosi Sistemiche, Fondazione Policlinico San Matteo, Pavia, Italy
| | - Giovanni Palladini
- Centro per lo Studio e la Cura delle Amiloidosi Sistemiche, Fondazione Policlinico San Matteo, Pavia, Italy
| | - Lucia Ponti
- Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
- Department of Internal and Experimental Medicine, University of Florence, Florence, Italy
| | - Alessia Argirò
- Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
- Department of Internal and Experimental Medicine, University of Florence, Florence, Italy
| | - Francesco Cappelli
- Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
- Department of Internal and Experimental Medicine, University of Florence, Florence, Italy
| | - Federico Perfetto
- Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
- Department of Internal and Experimental Medicine, University of Florence, Florence, Italy
| | | | | | | | | | - Olena Chubuchna
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Filippo Quattrone
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sabina Nuti
- Management and Healthcare Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sabina De Rosis
- Management and Healthcare Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Claudio Passino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Claudio Rapezzi
- Cardiology Centre, University of Ferrara, Italy
- Maria Cecilia Hospital, GVM Care and Research, Cotignola (Ravenna), Italy
| | - Giampaolo Merlini
- Centro per lo Studio e la Cura delle Amiloidosi Sistemiche, Fondazione Policlinico San Matteo, Pavia, Italy
| | - Michele Emdin
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Hill B, Grubic N, Liblik K, Johri AM. Patient Involvement in Care, Psychosocial Outcomes, and Quality of Life in Hypertrophic Cardiomyopathy: A Pilot Study. CJC Open 2024; 6:539-543. [PMID: 38559336 PMCID: PMC10980899 DOI: 10.1016/j.cjco.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/01/2023] [Indexed: 04/04/2024] Open
Abstract
This cross-sectional study evaluated the impact of patient involvement in care (PIC) on psychosocial outcomes and health-related quality of life (HRQoL) in patients with hypertrophic cardiomyopathy (HCM) (n = 34). Patients with low-to-moderate PIC were older than those with high PIC (66.8 years vs 57.3 years; P = 0.04). PIC was negatively correlated with depressive symptoms (r = -0.39; P = 0.02) and positively correlated with heart-focused attention (r = 0.39; P = 0.02). No significant correlations were observed between PIC and HRQoL. Greater PIC was associated with reduced depressive symptoms but increased cardiac anxiety. Future studies should investigate the relationship between PIC and HRQoL in a larger cohort.
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Affiliation(s)
- Braeden Hill
- Department of Medicine, Division of Cardiology, Cardiovascular Imaging Network at Queen’s University, Kingston, Ontario, Canada
| | - Nicholas Grubic
- Department of Medicine, Division of Cardiology, Cardiovascular Imaging Network at Queen’s University, Kingston, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kiera Liblik
- Department of Medicine, Division of Cardiology, Cardiovascular Imaging Network at Queen’s University, Kingston, Ontario, Canada
| | - Amer M. Johri
- Department of Medicine, Division of Cardiology, Cardiovascular Imaging Network at Queen’s University, Kingston, Ontario, Canada
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Beussink-Nelson L, Freed BH, Chirinos JA, Brubaker PH, Kitzman DW, Yeboah J, Rosas SE, Hu M, Lima JAC, Pandit J, Bertoni AG, Shah SJ. Multi-Ethnic Study of Atherosclerosis Early Heart Failure Study: Rationale, Design, and Baseline Characteristics. Circ Heart Fail 2024; 17:e010289. [PMID: 38456289 PMCID: PMC11073782 DOI: 10.1161/circheartfailure.122.010289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/20/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Current prevalence estimates of heart failure (HF) are primarily based on self-report or HF hospitalizations. There is an unmet need to define the prevalence and pathogenesis of early symptomatic HF, which may be undiagnosed and precedes HF hospitalization. METHODS The MESA (Multi-Ethnic Study of Atherosclerosis) Early HF study was conducted during MESA exam 6 to determine the prevalence of early HF and investigate the transition from risk factors to early HF in a diverse population-based cohort of older adults. Between 2016 and 2018, 3285 MESA participants from 6 field centers underwent comprehensive speckle-tracking echocardiography with passive leg raise maneuver, Kansas City Cardiomyopathy Questionnaire, 6-minute walk test, arterial stiffness assessment, and proteomics (including NT-proBNP [N-terminal pro-B-type natriuretic peptide]). RESULTS Median age was 73 (25th-75th percentile 67-81) years, 53.2% were female, 25.6% were Black, 12.8% were Chinese, and 40.0% were White. The prevalence of HF risk factors was high: hypertension, 61.9%; former or current smoking, 53.7%; obesity 34.8%; diabetes; 24.7%; and chronic kidney disease; 22%. Overt cardiovascular disease, which ranged from 2.1% (HF) to 13.6% (atrial fibrillation), was less common. Of the 3285 participants, 96% underwent proteomics, 94% Kansas City Cardiomyopathy Questionnaire, 93% speckle-tracking echocardiography with passive leg raise, 82% arterial stiffness exam, and 77% 6-minute walk test. Feasibility of resting speckle-tracking echocardiography (87%-99% across cardiac chambers) and passive leg raise Doppler/speckle-tracking echocardiography (>84%) measurements was high. A total of 120 unique echocardiographic indices were measured. CONCLUSIONS The MESA Early HF study is a key resource for cardiovascular researchers who are interested in improving the epidemiological and phenotypic characterization of early HF. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005487.
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Affiliation(s)
- Lauren Beussink-Nelson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Benjamin H Freed
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Julio A Chirinos
- Division of Cardiology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania and Perelman Center for Advanced Medicine, Philadelphia (J.A.C.)
| | - Peter H Brubaker
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Dalane W Kitzman
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Joseph Yeboah
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center (S.E.R.), Harvard Medical School, Boston, MA
| | - Mo Hu
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.A.C.L.)
| | - Jay Pandit
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Alain G Bertoni
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
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Walli-Attaei M, Joseph P, Johansson I, Sliwa K, Lonn E, Maggioni AP, Mielniczuk L, Ross H, Karaye K, Hage C, Pogosova N, Grinvalds A, McCready T, McMurray J, Yusuf S. Characteristics, management, and outcomes in women and men with congestive heart failure in 40 countries at different economic levels: an analysis from the Global Congestive Heart Failure (G-CHF) registry. Lancet Glob Health 2024; 12:e396-e405. [PMID: 38218197 DOI: 10.1016/s2214-109x(23)00557-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND There is a paucity of data on the clinical characteristics, management, and outcomes of women compared with men with heart failure in low-income and middle-income countries compared with high-income countries. We examined sex differences in risk factors, clinical characteristics, and treatments, and prospectively assessed the risk of heart failure hospitalisation and mortality in patients with heart failure in 40 high-income, middle-income, and low-income countries. METHODS Participants aged 18 years or older with heart failure were enrolled from Dec 20, 2016, to Sept 9, 2020 in the prospective Global Congestive Heart Failure (G-CHF) study from 257 centres in 40 high-income, middle-income, and low-income countries. Participants were followed up until May 25, 2023. We recorded the demographic characteristics, medical history, and treatments of participants. We prospectively recorded data on heart failure hospitalisation and mortality by sex in the overall study, according to country economic status, and according to level of left ventricular ejection fraction (LVEF). FINDINGS 23 341 participants (9119 [39·1%] women and 14 222 [60·1%] men) were recruited and followed up for a mean of 2·6 years (SD 1·4). The mean age of women in the study was 62 years (SD 17) compared with 64 years (14) in men. Fewer women than men had an LVEF of 40% or lower (51·7% women vs 66·2% men). By contrast, more women than men had an LVEF of 50% or higher (33·2% women vs 18·6% men). Hypertensive heart failure was the most common aetiology in women (25·5% women vs 16·8% men), whereas ischaemic heart failure was the most common aetiology in men (45·6% men vs 26·6% women). Signs and symptoms of congestion were more common in women than men: 42·6% of women had a New York Heart Association functional class of III or IV compared with 37·9% of men. The use of heart failure medications and cardiac tests did not differ systematically between the sexes, although implantable cardioverter defibrillator (ICD) implantation was lower among women than men (8·7% women vs 17·2% men). The adjusted risk of heart failure hospitalisation was similar in women and men (women-to-men adjusted hazard ratio [HR] 0·99 [95% CI 0·92-1·05]). This pattern was consistent within groups of countries categorised by economic status, geographical region, and by LVEF level. However, women had a lower adjusted risk of mortality (women-to-men adjusted HR 0·79 [95% CI 0·75-0·84]) despite adjustments for prognostic factors-a pattern which was consistently observed across groups of countries irrespective of economic status, geography, and LVEF levels of patients. INTERPRETATION The underlying cause of heart failure and ejection fraction phenotype differ between women and men, as do the severity of symptoms. Heart failure treatments (except ICD use) were not consistently in favour of one sex. Paradoxically, while the rates of hospitalisations were similar among women and men, the risk of death was lower among women. These patterns were consistent regardless of the economic status of the countries. The higher mortality among men is unexplained and warrants further study. FUNDING Bayer.
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Affiliation(s)
- Marjan Walli-Attaei
- Population Health Research Institute and Hamilton Health Sciences, Hamilton, ON, Canada; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Isabelle Johansson
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Karen Sliwa
- Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Eva Lonn
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Aldo P Maggioni
- ANMCO Research Center-Heart Care Foundation, Florence, Italy
| | - Lisa Mielniczuk
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Heather Ross
- Peter Munk Cardiac Centre, Ted Rogers Center for Heart Research, University Health Network, Toronto, ON, Canada
| | - Kamilu Karaye
- Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Camilla Hage
- Karolinska Institutet, Department of Medicine, Cardiology Unit, Stockholm, Sweden
| | - Nana Pogosova
- Medical Research Center of Cardiology named after E.I. Chazov, Moscow, Russia
| | - Alex Grinvalds
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Tara McCready
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - John McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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Wefer F, Möhler R, Dichter MN, Mühring A, Gummert J, Köpke S. Nurse-based counselling on thirst in patients with advanced chronic heart failure : Study protocol for a pilot before-after study and process evaluation. Med Klin Intensivmed Notfmed 2024; 119:147-153. [PMID: 38097772 PMCID: PMC10902023 DOI: 10.1007/s00063-023-01091-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Many patients with chronic heart failure (CHF) are critically ill and experience increased thirst. Study aims are to develop and evaluate a nurse-based counselling intervention to promote self-care competencies related to thirst in hospitalised patients with advanced CHF eligible or listed for heart transplantation. METHODS A mixed-methods approach will be adapted with three study phases: (1) development of the nurse-based counselling intervention, (2) feasibility testing and training of nurses, and (3) implementation of the intervention and, evaluation of initial effects and process measures. In phase (1), interviews with hospitalised patients with advanced CHF listed for heart transplantation (n = 10), focus groups (n = 2) and a Germany-wide survey with nurses will be performed. In phase (2), experts experienced with caring for patients with advanced CHF and patients with advanced CHF will be consulted for content validation and pretest of the counselling intervention. The training concept for nurses will be evaluated using questionnaires. In phase (3), a pilot before-after study will be conducted (n = 60). Primary patient-related outcome for the pilot study is thirst intensity using a numeric rating scale. Furthermore, a process evaluation (interviews with patients [n = 10], survey with nurses and physicians) will be performed. Quantitative data will be analysed descriptively, and qualitative data will be analysed using content analysis. Mean values of thirst intensity of the individual measurement points will be evaluated as interrupted time-series analysis using regression analyses. CONCLUSION The development and implementation of a counselling intervention is influenced by various factors. Therefore, it is important to consider all factors throughout the process from development to evaluation.
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Affiliation(s)
- Franziska Wefer
- Care Development, Care Directorate, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany, Georgstr.11, 32545.
- Institute of Nursing Science, Medical Faculty and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Martin N Dichter
- Institute of Nursing Science, Medical Faculty and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Andrea Mühring
- Transplantation unit, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Medical Faculty and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
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Shiraishi Y, Ikemura N, Urashima M, Kohno T, Nakano S, Tanaka T, Nagatomo Y, Ikoma T, Ono T, Numasawa Y, Sakamoto M, Nishikawa K, Takei M, Hakuno D, Nakamaru R, Ueda I, Kohsaka S. Rationale and protocol of the LAQUA-HF trial: a factorial randomised controlled trial evaluating the effects of neurohormonal and diuretic agents on health-status reported outcomes in heart failure patients. BMJ Open 2024; 14:e076519. [PMID: 38355194 PMCID: PMC10868297 DOI: 10.1136/bmjopen-2023-076519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The current guidelines strongly recommend early initiation of multiple classes of cardioprotective drugs for patients with heart failure with reduced ejection fraction to improve prognosis and health status. However, evidence on the optimal sequencing of approved drugs is scarce, highlighting the importance of individualised treatment plans. Registry data indicate that only a portion of these patients can tolerate all four recommended classes, underscoring the need to establish the favoured sequence when using these drugs. Additionally, the choice between long-acting and short-acting loop diuretics in the present era remains uncertain. This is particularly relevant given the frequent use of angiotensin receptor-neprilysin inhibitor and sodium-glucose cotransporter 2 inhibitor, both of which potentiate natriuretic effects. METHODS AND ANALYSIS In a prospective, randomised, open-label, blinded endpoint method, LAQUA-HF (Long-acting vs short-acting diuretics and neurohormonal Agents on patients' QUAlity-of-life in Heart Failure patients) will be a 2×2 factorial design, with a total of 240 patients randomised to sacubitril/valsartan versus dapagliflozin and torsemide versus furosemide in a 1:1 ratio. Most enrolment sites have participated in an ongoing observational registry for consecutive patients hospitalised for heart failure involved dedicated study coordinators, and used the same framework to enrol patients. The primary endpoint is the change in patients' health status over 6 months, defined by the Kansas City Cardiomyopathy Questionnaire. Additionally, clinical benefit at 6 months defined as a hierarchical composite endpoint will be assessed by the win ratio as the secondary endpoint. ETHICS AND DISSEMINATION The medical ethics committee Keio University in Japan has approved this trial. All participants provide written informed consent prior to study entry. The results of this trial will be disseminated in one main paper and additional papers on secondary endpoints and subgroup analyses. TRIAL REGISTRATION NUMBER UMIN000045229.
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Affiliation(s)
- Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- University of Missouri's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Mitsuyoshi Urashima
- Department of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Toshikazu Tanaka
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Takenori Ikoma
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Ono
- Department of Cardiology, National Hospital Organization Saitama National Hospital, Saitama, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Munehisa Sakamoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kei Nishikawa
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan
| | - Makoto Takei
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Daihiko Hakuno
- Department of Cardiology, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Ryo Nakamaru
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Man JP, Dijkgraaf MG, Handoko ML, de Lange FJ, Winter MM, Schijven MP, Stienen S, Meregalli P, Kok WE, Kuipers DI, van der Harst P, Koole MA, Chamuleau SA, Schuuring MJ. Digital consults to optimize guideline-directed therapy: design of a pragmatic multicenter randomized controlled trial. ESC Heart Fail 2024; 11:560-569. [PMID: 38146630 PMCID: PMC10804150 DOI: 10.1002/ehf2.14634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/16/2023] [Accepted: 11/26/2023] [Indexed: 12/27/2023] Open
Abstract
AIMS Many heart failure (HF) patients do not receive optimal guideline-directed medical therapy (GDMT) despite clear benefit on morbidity and mortality outcomes. Digital consults (DCs) have the potential to improve efficiency on GDMT optimization to serve the growing HF population. The investigator-initiated ADMINISTER trial was designed as a pragmatic multicenter randomized controlled open-label trial to evaluate efficacy and safety of DC in patients on HF treatment. METHODS AND RESULTS Patients (n = 150) diagnosed with HF with a reduced ejection fraction will be randomized to DC or standard care (1:1). The intervention group receives multifaceted DCs including (i) digital data sharing (e.g. exchange of pharmacotherapy use and home-measured vital signs), (ii) patient education via an e-learning, and (iii) digital guideline recommendations to treating clinicians. The consults are performed remotely unless there is an indication to perform the consult physically. The primary outcome is the GDMT prescription rate score, and secondary outcomes include time till full GDMT optimization, patient and clinician satisfaction, time spent on healthcare, and Kansas City Cardiomyopathy Questionnaire. Results will be reported in accordance to the CONSORT statement. CONCLUSIONS The ADMINISTER trial will offer the first randomized controlled data on GDMT prescription rates, time till full GDMT optimization, time spent on healthcare, quality of life, and patient and clinician satisfaction of the multifaceted patient- and clinician-targeted DC for GDMT optimization.
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Affiliation(s)
- Jelle P. Man
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Marcel G.W. Dijkgraaf
- Department of Epidemiology and Data ScienceAmsterdam UMCAmsterdamThe Netherlands
- Department of MethodologyAmsterdam Public HealthAmsterdamThe Netherlands
| | - M. Louis Handoko
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Frederik J. de Lange
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Michiel M. Winter
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
- Cardiology Center of the NetherlandsAmsterdamThe Netherlands
| | | | - Susan Stienen
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Paola Meregalli
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Wouter E.M. Kok
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Dorianne I. Kuipers
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Pim van der Harst
- Department of CardiologyUniversity Medical Center UtrechtHeidelberglaan 1003584 CXUtrechtThe Netherlands
| | - Maarten A.C. Koole
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Cardiology Center of the NetherlandsAmsterdamThe Netherlands
- Department of CardiologyRed Cross HospitalBeverwijkThe Netherlands
| | - Steven A.J. Chamuleau
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mark J. Schuuring
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
- Department of CardiologyUniversity Medical Center UtrechtHeidelberglaan 1003584 CXUtrechtThe Netherlands
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Bekelman DB, Feser W, Morgan B, Welsh CH, Parsons EC, Paden G, Baron A, Hattler B, McBryde C, Cheng A, Lange AV, Au DH. Nurse and Social Worker Palliative Telecare Team and Quality of Life in Patients With COPD, Heart Failure, or Interstitial Lung Disease: The ADAPT Randomized Clinical Trial. JAMA 2024; 331:212-223. [PMID: 38227034 PMCID: PMC10792473 DOI: 10.1001/jama.2023.24035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 11/01/2023] [Indexed: 01/17/2024]
Abstract
Importance Many patients with chronic obstructive pulmonary disease (COPD), heart failure (HF), and interstitial lung disease (ILD) endure poor quality of life despite conventional therapy. Palliative care approaches may benefit this population prior to end of life. Objective Determine the effect of a nurse and social worker palliative telecare team on quality of life in outpatients with COPD, HF, or ILD compared with usual care. Design, Setting, and Participants Single-blind, 2-group, multisite randomized clinical trial with accrual between October 27, 2016, and April 2, 2020, in 2 Veterans Administration health care systems (Colorado and Washington), and including community-based outpatient clinics. Outpatients with COPD, HF, or ILD at high risk of hospitalization or death who reported poor quality of life participated. Intervention The intervention involved 6 phone calls with a nurse to help with symptom management and 6 phone calls with a social worker to provide psychosocial care. The nurse and social worker met weekly with a study primary care and palliative care physician and as needed, a pulmonologist, and cardiologist. Usual care included an educational handout developed for the study that outlined self-care for COPD, ILD, or HF. Patients in both groups received care at the discretion of their clinicians, which could include care from nurses and social workers, and specialists in cardiology, pulmonology, palliative care, and mental health. Main Outcomes and Measures The primary outcome was difference in change in quality of life from baseline to 6 months between the intervention and usual care groups (FACT-G score range, 0-100, with higher scores indicating better quality of life, clinically meaningful change ≥4 points). Secondary quality-of-life outcomes at 6 months included disease-specific health status (Clinical COPD Questionnaire; Kansas City Cardiomyopathy Questionnaire-12), depression (Patient Health Questionnaire-8) and anxiety (Generalized Anxiety Disorder-7) symptoms. Results Among 306 randomized patients (mean [SD] age, 68.9 [7.7] years; 276 male [90.2%], 30 female [9.8%]; 245 White [80.1%]), 177 (57.8%) had COPD, 67 (21.9%) HF, 49 (16%) both COPD and HF, and 13 (4.2%) ILD. Baseline FACT-G scores were similar (intervention, 52.9; usual care, 52.7). FACT-G completion was 76% (intervention, 117 of 154; usual care, 116 of 152) at 6 months for both groups. Mean (SD) length of intervention was 115.1 (33.4) days and included a mean of 10.4 (3.3) intervention calls per patient. In the intervention group, 112 of 154 (73%) patients received the intervention as randomized. At 6 months, mean FACT-G score improved 6.0 points in the intervention group and 1.4 points in the usual care group (difference, 4.6 points [95% CI, 1.8-7.4]; P = .001; standardized mean difference, 0.41). The intervention also improved COPD health status (standardized mean difference, 0.44; P = .04), HF health status (standardized mean difference, 0.41; P = .01), depression (standardized mean difference, -0.50; P < .001), and anxiety (standardized mean difference, -0.51; P < .001) at 6 months. Conclusions and Relevance For adults with COPD, HF, or ILD who were at high risk of death and had poor quality of life, a nurse and social worker palliative telecare team produced clinically meaningful improvements in quality of life at 6 months compared with usual care. Trial Registration ClinicalTrials.gov Identifier: NCT02713347.
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Affiliation(s)
- David B. Bekelman
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - William Feser
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora
| | - Brianne Morgan
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
| | - Carolyn H. Welsh
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Elizabeth C. Parsons
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
| | - Grady Paden
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Anna Baron
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora
| | - Brack Hattler
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Division of Cardiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Connor McBryde
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Andrew Cheng
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Allison V. Lange
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - David H. Au
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
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Wahlberg KJ, Infeld M, Plante TB, Novelli AE, Habel N, Burkhoff D, Barrett T, Lustgarten D, Meyer M. Effects of Continuous Accelerated Pacing on Cardiac Structure and Function in Patients With Heart Failure With Preserved Ejection Fraction: Insights From the myPACE Randomized Clinical Trial. J Am Heart Assoc 2024; 13:e032873. [PMID: 38156545 PMCID: PMC10863817 DOI: 10.1161/jaha.123.032873] [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: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Heart failure with preserved ejection fraction ≥50% is prevalent with few evidence-based therapies. In a trial of patients with heart failure with preserved ejection fraction with specialized pacemakers, treatment with accelerated personalized pacing averaging 75 bpm (myPACE) markedly improved quality of life, NT-proBNP (N-terminal pro-brain natriuretic peptide), physical activity, and atrial fibrillation burden compared with the standard lower rate setting of 60 bpm (usual care). METHODS AND RESULTS In this exploratory study, provider-initiated echocardiographic studies obtained before and after the trial were assessed for changes in left ventricular (LV) structure and function among participants who continued their pacing assignment. The analytic approach aimed to detect differences in standard and advanced echocardiographic parameters within and between study arms. Of the 100 participants, 16 myPACE and 20 usual care arm had a qualifying set of echocardiograms performed a mean (SD) 3 (2.0) years apart. Despite similar baseline echocardiogram measures, sustained exposure to moderately accelerated pacing resulted in reduced septal wall thickness (in cm: myPACE 1.1 [0.2] versus usual care 1.2 [0.2], P=0.008) and lower LV mass to systolic volume ratio (in g/mL: myPACE 4.8 [1.9] versus usual care 6.8 [3.1], P=0.038) accompanied by a minor reduction in LV ejection fraction (in %: myPACE 55 [5] versus usual care 60 [5], P=0.015). These changes were paralleled by improvements in heart failure-related quality of life (myPACE Minnesota Living with Heart Failure Questionnaire improved by 16.1 [13.9] points, whereas usual care worsened by 6.9 [11.6] points, P<0.001). Markers of diastolic function and LV performance were not affected. CONCLUSIONS Exposure to continuous accelerated pacing in heart failure with preserved ejection fraction is associated with a reduced LV wall thickness and a small amount of LV dilation with small reduction in ejection fraction.
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Affiliation(s)
- Kramer J. Wahlberg
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Margaret Infeld
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Timothy B. Plante
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Alexandra E. Novelli
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Nicole Habel
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | | | - Trace Barrett
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Daniel Lustgarten
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Markus Meyer
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
- Department of MedicineLillehei Heart Institute, University of Minnesota College of MedicineMinneapolisMN
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50
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Pang PS, Berger DA, Mahler SA, Li X, Pressler SJ, Lane KA, Bischof JJ, Char D, Diercks D, Jones AE, Hess EP, Levy P, Miller JB, Venkat A, Harrison NE, Collins SP. Short-Stay Units vs Routine Admission From the Emergency Department in Patients With Acute Heart Failure: The SSU-AHF Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2350511. [PMID: 38198141 PMCID: PMC10782263 DOI: 10.1001/jamanetworkopen.2023.50511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/15/2023] [Indexed: 01/11/2024] Open
Abstract
Importance More than 80% of patients who present to the emergency department (ED) with acute heart failure (AHF) are hospitalized. With more than 1 million annual hospitalizations for AHF in the US, safe and effective alternatives are needed. Care for AHF in short-stay units (SSUs) may be safe and more efficient than hospitalization, especially for lower-risk patients, but randomized clinical trial data are lacking. Objective To compare the effectiveness of SSU care vs hospitalization in lower-risk patients with AHF. Design, Setting, and Participants This multicenter randomized clinical trial randomly assigned low-risk patients with AHF 1:1 to SSU or hospital admission from the ED. Patients received follow-up at 30 and 90 days post discharge. The study began December 6, 2017, and was completed on July 22, 2021. The data were analyzed between March 27, 2020, and November 11, 2023. Intervention Randomized post-ED disposition to less than 24 hours of SSU care vs hospitalization. Main Outcomes and Measures The study was designed to detect at least 1-day superiority for a primary outcome of days alive and out of hospital (DAOOH) at 30-day follow-up for 534 participants, with an allowance of 10% participant attrition. Due to the COVID-19 pandemic, enrollment was truncated at 194 participants. Before unmasking, the primary outcome was changed from DAOOH to an outcome with adequate statistical power: quality of life as measured by the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). The KCCQ-12 scores range from 0 to 100, with higher scores indicating better quality of life. Results Of the 193 patients enrolled (1 was found ineligible after randomization), the mean (SD) age was 64.8 (14.8) years, 79 (40.9%) were women, and 114 (59.1%) were men. Baseline characteristics were balanced between arms. The mean (SD) KCCQ-12 summary score between the SSU and hospitalization arms at 30 days was 51.3 (25.7) vs 45.8 (23.8) points, respectively (P = .19). Participants in the SSU arm had 1.6 more DAOOH at 30-day follow-up than those in the hospitalization arm (median [IQR], 26.9 [24.4-28.8] vs 25.4 [22.0-27.7] days; P = .02). Adverse events were uncommon and similar in both arms. Conclusions and Relevance The findings show that the SSU strategy was no different than hospitalization with regard to KCCQ-12 score, superior for more DAOOH, and safe for lower-risk patients with AHF. These findings of lower health care utilization with the SSU strategy need to be definitively tested in an adequately powered study. Trial Registration ClinicalTrials.gov Identifier: NCT03302910.
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Affiliation(s)
- Peter S. Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis
| | - David A. Berger
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Simon A. Mahler
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Xiaochun Li
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
| | | | - Kathleen A. Lane
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
| | - Jason J. Bischof
- Department of Emergency Medicine, The Ohio State University, Columbus
| | - Douglas Char
- Department of Emergency Medicine, Washington University in St Louis, St Louis, Missouri
| | - Deborah Diercks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Alan E. Jones
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson
| | - Erik P. Hess
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Phillip Levy
- Wayne State University School of Medicine and Integrative Biosciences Center, Detroit, Michigan
| | - Joseph B. Miller
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Nicholas E. Harrison
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis
| | - Sean P. Collins
- Department of Emergency Medicine, Vanderbilt University School of Medicine and Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center, Nashville, Tennessee
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