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Lund LH, Crespo-Leiro MG, Laroche C, Zaliaduonyte D, Saad AM, Fonseca C, Čelutkienė J, Zdravkovic M, Bielecka-Dabrowa AM, Agostoni P, Xuereb RG, Neronova KV, Lelonek M, Cavusoglu Y, Gellen B, Abdelhamid M, Hammoudi N, Anker SD, Chioncel O, Filippatos G, Lainscak M, McDonagh TA, Mebazaa A, Piepoli M, Ruschitzka F, Seferović PM, Savarese G, Metra M, Rosano GMC, Maggioni AP. Heart failure in Europe: Guideline-directed medical therapy use and decision making in chronic and acute, pre-existing and de novo, heart failure with reduced, mildly reduced, and preserved ejection fraction - the ESC EORP Heart Failure III Registry. Eur J Heart Fail 2024. [PMID: 39257278 DOI: 10.1002/ejhf.3445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/01/2024] [Accepted: 08/13/2024] [Indexed: 09/12/2024] Open
Abstract
AIMS We analysed baseline characteristics and guideline-directed medical therapy (GDMT) use and decisions in the European Society of Cardiology (ESC) Heart Failure (HF) III Registry. METHODS AND RESULTS Between 1 November 2018 and 31 December 2020, 10 162 patients with acute HF (AHF, 39%, age 70 [62-79], 36% women) or outpatient visit for HF (61%, age 66 [58-75], 33% women), with HF with reduced (HFrEF, 57%), mildly reduced (HFmrEF, 17%) or preserved (HFpEF, 26%) ejection fraction were enrolled from 220 centres in 41 European or ESC-affiliated countries. With AHF, 97% were hospitalized, 2.2% received intravenous treatment in the emergency department, and 0.9% received intravenous treatment in an outpatient clinic. AHF was seen by most by a general cardiologist (51%) and outpatient HF most by a HF specialist (48%). A majority had been hospitalized for HF before, but 26% of AHF and 6.1% of outpatient HF had de novo HF. Baseline use, initiation and discontinuation of GDMT varied according to AHF versus outpatient HF, de novo versus pre-existing HF, and by ejection fraction. After the AHF event or outpatient HF visit, use of any renin-angiotensin system inhibitor, angiotensin receptor-neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist and loop diuretics was 89%, 29%, 92%, 78%, and 85% in HFrEF; 89%, 9.7%, 90%, 64%, and 81% in HFmrEF; and 77%, 3.1%, 80%, 48%, and 80% in HFpEF. CONCLUSION Use and initiation of GDMT was high in cardiology centres in Europe, compared to previous reports from cohorts and registries including more primary care and general medicine and regions more local or outside of Europe and ESC-affiliated countries.
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Affiliation(s)
- Lars H Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Generosa Crespo-Leiro
- Cardiology, Hospital Universitario A Coruña (CHUAC), INIBIC (Institute investigacion Biomedica A Coruña), A Coruña, Spain
- CIBERCV, A Coruña, Spain
- Universidad de A Coruña (UDC), A Coruña, Spain
| | - Cécile Laroche
- European Society of Cardiology, Sophia-Antipolis, France
| | - Diana Zaliaduonyte
- Academy of Medicine, Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Cardiology, Kaunas Hospital, Kaunas, Lithuania
| | - Aly M Saad
- Cardiovascular Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Candida Fonseca
- Heart Failure Clinic, Internal Medicine Department, Hospital Sao Francisco Xavier, ULSLO, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Department of Personalized Medicine, Centre of Innovative Medicine, Vilnius, Lithuania
| | - Marija Zdravkovic
- University Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, Non-Invasive Cardiovascular Imaging, CMR Lab, Belgrade, Serbia
| | - Agata M Bielecka-Dabrowa
- Department of Cardiology and Congenital Heart Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Lodz, Poland
| | - Piergiuseppe Agostoni
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Kseniya V Neronova
- Department of Faculty Therapy Named after M.E. Volsky-M.M. Mirrakhimov, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Malgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland
| | - Yuksel Cavusoglu
- Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Barnabas Gellen
- Department of Cardiology, Heart Failure, ELSAN-Polyclinique de Poitiers, Poitiers, France
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Kasr AlAiny, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Naima Hammoudi
- Department of Cardiology, EHS Maouche Hospital-Benaknoun, Algiers, Algeria
| | - Stefan D Anker
- Department of Cardiology (CVK), German Heart Center Charité, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Charité Universitätsmedizin, Berlin, Germany
| | - Ovidiu Chioncel
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases 'C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | - Gerasimos Filippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Cardiology, Athens University Hospital Attikon, Chaidari, Greece
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Rakičan, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Alexandre Mebazaa
- Anesthesia and Critical Care Medicine, Université Paris Cité, Paris, France
| | - Massimo Piepoli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Clinical Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, Zürich, Switzerland
| | - Petar M Seferović
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
- University Medical Center, University of Belgrade - Faculty of Medicine, Belgrade, Serbia
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe M C Rosano
- Cardiac Academic Group, Chair of Cardiology, St George's University Medical School, London, UK
- Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, Rome, Italy
- Department of Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
| | - Aldo P Maggioni
- ANMCO Research Center - Heart Care Foundation, Florence, Italy
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2
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Bonfioli GB, Pagnesi M. KCCQ administration at home: Another step towards telemonitoring in HF? Int J Cardiol 2024; 417:132511. [PMID: 39242037 DOI: 10.1016/j.ijcard.2024.132511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/19/2024] [Accepted: 08/29/2024] [Indexed: 09/09/2024]
Affiliation(s)
- Giovanni Battista Bonfioli
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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Bernt Jørgensen SM, Johnsen NF, Maribo T, Brøndum S, Gislason G, Kristiansen M. Factors shaping return to work: a qualitative study among heart failure patients in Denmark. Disabil Rehabil 2024; 46:4205-4215. [PMID: 37818938 DOI: 10.1080/09638288.2023.2266998] [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: 02/05/2023] [Revised: 09/30/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE For people of working-age diagnosed with heart failure, return to work (RTW) is often a significant rehabilitation goal. To inform vocational rehabilitation strategies, we conducted a qualitative study aiming at exploring patient experienced support needs, and barriers and facilitators to RTW. MATERIALS AND METHODS Ten men and eight women with heart failure (48-60 years) were interviewed in Denmark during 2022. A thematic analysis was conducted using the Sherbrooke model as framework. RESULTS Multiple factors operating at different levels shaped participants' RTW processes. Personal factors included motivation, mental and physical health, social relations, and financial concerns. Factors in the health care system shaping RTW included access to medical treatment, mental health care, and cardiac rehabilitation. Factors in workplace system shaping RTW included job type, employer support, and social relations. Factors in the legislative and insurance system shaping RTW included authorities' administration of sickness benefits, professional assistance, vocational counselling, and interdisciplinary cooperation. CONCLUSION Findings illustrate a need to include vocational rehabilitation within comprehensive cardiac rehabilitation programmes, to identify people in need of support, to improve the coordination of care across the health and social care sectors, and to involve employers, health care professionals, and social workers in individualised RTW strategies.
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Affiliation(s)
- Sidsel Marie Bernt Jørgensen
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Nina Føns Johnsen
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Central Denmark Region, DEFACTUM, Aarhus, Denmark
| | - Stig Brøndum
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
| | - Gunnar Gislason
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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4
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Kao G, Xu G, Zhang Y, Li C, Xiao J. Predictive value of quality of life as measured by KCCQ in heart failure patients: A meta-analysis. Eur J Clin Invest 2024; 54:e14233. [PMID: 38666585 DOI: 10.1111/eci.14233] [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: 01/31/2024] [Revised: 03/07/2024] [Accepted: 04/06/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Studies on the predictive ability of disease-specific health quality of life (QoL) in patients with heart failure (HF) have produced conflicting results. To address these gaps in knowledge, we conducted a meta-analysis to evaluate the predictive value of QoL measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with HF. MATERIALS AND METHODS We searched PubMed, and Embase databases to identify studies investigating the predictive utility of baseline QoL measured by the KCCQ in HF patients. The outcome measures were all-cause mortality and HF hospitalisation. The predictive value of QoL was expressed by pooling the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the bottom versus the top category of KCCQ score or for per 10-point KCCQ score decrease. RESULTS Twelve studies reporting on 11 articles with a total of 34,927 HF patients were identified. Comparison of the bottom with the top KCCQ score, the pooled adjusted HR was 2.34 (95% CI 2.10-2.60) and 2.53 (95% CI 2.23-2.88) for all-cause mortality and HF hospitalisation, respectively. Additionally, a 10-point decrease in KCCQ score was associated with a 12% (95% CI 7%-16%) increased risk of all-cause mortality and a 14% (95% CI 13%-15%) increased risk of HF hospitalisation. CONCLUSIONS Poor health-related QoL as determined by the lower KCCQ score, was associated with an increased risk of all-cause mortality and HF hospitalisation in patients with HF. Measuring disease-specific health-related QoL using the KCCQ score may provide valuable predictive information for HF patients.
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Affiliation(s)
- Guoying Kao
- Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Gang Xu
- Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Ying Zhang
- Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Chuanwei Li
- Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Jun Xiao
- Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
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Wu JR, Moser DK, Lin CY, Chiang AA, Riegel B. Depressive Symptoms and Sleep Quality Mediate the Relationship Between Race and Quality of Life Among Patients With Heart Failure: A Serial Multiple Mediator Model. J Cardiovasc Nurs 2024; 39:449-455. [PMID: 38227624 PMCID: PMC11250622 DOI: 10.1097/jcn.0000000000001079] [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] [Indexed: 01/18/2024]
Abstract
BACKGROUND Black patients with heart failure (HF) report worse quality of life (QoL) than White patients. Few investigators have examined mediators of the association between race and QoL, but depressive symptoms and sleep quality are associated with QoL. OBJECTIVE The aim of this study was to determine whether depressive symptoms and sleep quality are mediators of the relationship between race and QoL among patients with HF. METHODS This was a cross-sectional study. We included 271 outpatients with HF. Self-reported race (White/Black), depressive symptoms (Patient Health Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), and QoL (Kansas City Cardiomyopathy Questionnaire) were collected at baseline. A serial multiple mediator analysis was conducted using the PROCESS macro for SPSS. RESULTS Ninety-six patients (35.4%) were Black. Black participants reported higher levels of depressive symptoms and poorer sleep quality than White participants. Race was not directly associated with QoL but indirectly associated with QoL through depressive symptoms and poorer sleep quality. Because of higher levels of depressive symptoms and poorer sleep quality, Black participants reported poorer QoL than White participants. CONCLUSIONS Depressive symptoms and sleep quality together mediated the relationship between race and QoL. These findings suggest that screening for depressive symptoms and sleep quality could identify patients at risk for poor QoL, especially in Black patients.
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Belay Agonafir D, Mulat Worku B, Alemu H, Nega Godana T, Fentahun Bekele S, Andargie Berhane A, Getahun Ayalew D, Sisay Assefa B, Alemiye Molla F, Lema Legese G. Health-related quality of life and associated factors in heart failure with reduced ejection fraction patients at University of Gondar Hospital, Ethiopia. Front Cardiovasc Med 2024; 11:1436335. [PMID: 39267807 PMCID: PMC11390572 DOI: 10.3389/fcvm.2024.1436335] [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: 05/28/2024] [Accepted: 08/15/2024] [Indexed: 09/15/2024] Open
Abstract
Introduction Living with heart failure poses challenges due to its poor prognosis and impact on quality of life, making it crucial to assess how it affects patients for better patient-centered management. This study aimed to assess quality of life and associated factors in heart failure with reduced ejection fraction patients at University of Gondar Comprehensive Specialized Hospital in Ethiopia, 2023. Methods An "institution-based" cross-sectional study was conducted at the University of Gondar Comprehensive Specialised Hospital. The data were collected using an interviewer-administered questionnaire. Health-related quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. Sociodemographic, behavioral, clinical, biochemical, and echocardiographic characteristics were included in the questionnaire. The collected data were entered into EpiData version 4.6 and exported into SPSS version 25 for analysis. Multiple linear regression analysis (p < 0.05) was used to measure the degree of association between quality of life and independent variables. Results A total of 240 patients with heart failure and reduced ejection fraction participated in the study. The health-related quality of life scores for the physical, emotional, and total were 17.60 ± 10.33, 10.58 ± 6.33 and 46.12 ± 26.06, respectively. Health-related quality of life was significantly associated with age, marital status, occupation, income, heart failure duration, recent hospitalization, New York Heart Association functional class, heart failure etiology, atrial fibrillation comorbidity, systolic blood pressure, heart rate, heart failure medications, severe left ventricular systolic dysfunction, and severe or moderate pulmonary hypertension. Conclusion This study found that patients with heart failure and reduced ejection fraction had poor health-related quality of life, influenced by identified factors. These findings aid professionals in assessing and identifying interventions that improve these patients' quality of life.
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Affiliation(s)
- Daniel Belay Agonafir
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Biruk Mulat Worku
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hailemaryam Alemu
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tilahun Nega Godana
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shibabaw Fentahun Bekele
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abel Andargie Berhane
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Desalew Getahun Ayalew
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belete Sisay Assefa
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fikadu Alemiye Molla
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebrehiwot Lema Legese
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Saldarriaga C, Rivera-Toquica A, Echeverry-Navarrete EJ, Lugo-Peña JR, Cerón JA, Rincón-Peña OS, Silva-Diazgranados LE, Osorio-Carmona HE, Posada-Bastidas A, García JC, Ochoa-Morón AD, Rolong B, Manzur-Jatin F, Echeverría LE, Gómez-Mesa JE. Impact of sex on clinical and laboratory parameters in patients with heart failure: insights from the Colombian Heart Failure Registry (RECOLFACA). Acta Cardiol 2024:1-8. [PMID: 39145526 DOI: 10.1080/00015385.2024.2391133] [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: 11/16/2023] [Revised: 03/06/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024]
Abstract
INTRODUCTION Heart failure (HF) is one of the leading causes of morbidity and mortality worldwide. This study aimed to assess the impact of sex on sociodemographic, clinical, and laboratory parameters in patients with HF who were included in the Colombian Heart Failure Registry (RECOLFACA). METHODS This was a cross-sectional analytical research. All 2528 patients included in RECOLFACA were analysed. The Mann-Whitney U test was used to compare median values as well as first and third quartiles (Q1-Q3). The age-related trend of NT-proBNP levels for both men and women groups was statistically evaluated. RESULTS The study included 2528 patients with HF (1072 women and 1456 men). The echocardiographic evidence showed that men presented reduced left ventricular ejection fraction (LVEF) (79.63 vs. 69.75%, respectively; p < 0.001) more often than women, which had a significantly higher proportion of preserved LVEF (20.46 vs.11.24%, respectively; p < 0.001). Women displayed a higher value of systolic blood pressure (p < 0.001) and heart rate (p = 0.014) compared to men. Haemoglobin, creatinine, and sodium levels were significantly higher in men. Men had a considerably lower glomerular filtration rate value, with the median reaching a G3a value for chronic renal failure. According to age, the levels of NT-proBNP in each sex increased equivalently with age. CONCLUSION Sex differences presented in this study are comparable to those discovered in other nations. However, certain variations show that these sex differences may differ by geographical area, which should encourage further investigations to describe them.
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Affiliation(s)
| | - Alex Rivera-Toquica
- Department of Cardiology, Centro Médico para el Corazón, Pereira, Colombia
- Department of Cardiology, Clínica los Rosales, Pereira, Colombia
- Department of Cardiology, Universidad Tecnológica de Pereira, Pereira, Colombia
| | | | | | - Juan Alberto Cerón
- Department of Cardiology, Hospital Universitario Departamental de Nariño, Pasto, Colombia
| | | | | | | | | | | | | | - Balkis Rolong
- Department of Cardiology, Cardiología Integral, Barranquilla, Colombia
| | | | | | - Juan Esteban Gómez-Mesa
- Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
- Department of Health Sciences, Universidad Icesi, Cali, Colombia
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8
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Hamo CE, DeJong C, Hartshorne-Evans N, Lund LH, Shah SJ, Solomon S, Lam CSP. Heart failure with preserved ejection fraction. Nat Rev Dis Primers 2024; 10:55. [PMID: 39143132 DOI: 10.1038/s41572-024-00540-y] [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] [Accepted: 07/15/2024] [Indexed: 08/16/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases and has a prevalence that is expected to rise with the growing ageing population. HFpEF is associated with significant morbidity and mortality. Specific HFpEF risk factors include age, diabetes, hypertension, obesity and atrial fibrillation. Haemodynamic contributions to HFpEF include changes in left ventricular structure, diastolic and systolic dysfunction, left atrial myopathy, pulmonary hypertension, right ventricular dysfunction, chronotropic incompetence, and vascular dysfunction. Inflammation, fibrosis, impaired nitric oxide signalling, sarcomere dysfunction, and mitochondrial and metabolic defects contribute to the cellular and molecular changes observed in HFpEF. HFpEF impacts multiple organ systems beyond the heart, including the skeletal muscle, peripheral vasculature, lungs, kidneys and brain. The diagnosis of HFpEF can be made in individuals with signs and symptoms of heart failure with abnormality in natriuretic peptide levels or evidence of cardiopulmonary congestion, facilitated by the use of HFpEF risk scores and additional imaging and testing with the exclusion of HFpEF mimics. Management includes initiation of guideline-directed medical therapy and management of comorbidities. Given the significant impact of HFpEF on quality of life, future research efforts should include a particular focus on how patients can live better with this disease.
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Affiliation(s)
- Carine E Hamo
- New York University School of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Colette DeJong
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Nick Hartshorne-Evans
- CEO and Founder of the Pumping Marvellous Foundation (Patient-Led Heart Failure Charity), Preston, UK
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
| | - Scott Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore, Singapore.
- Baim Institute for Clinical Research, Boston, MA, USA.
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Thomson RJ, Grafton-Clarke C, Matthews G, Swoboda PP, Swift AJ, Frangi A, Petersen SE, Aung N, Garg P. Risk factors for raised left ventricular filling pressure by cardiovascular magnetic resonance: Prognostic insights. ESC Heart Fail 2024. [PMID: 39132877 DOI: 10.1002/ehf2.15011] [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: 02/09/2024] [Revised: 06/19/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) imaging shows promise in estimating pulmonary capillary wedge pressure (PCWP) non-invasively. At the population level, the prognostic role of CMR-modelled PCWP remains unknown. Furthermore, the relationship between CMR-modelled PCWP and established risk factors for cardiovascular disease has not been well characterized. OBJECTIVE The main aim of this study was to investigate the prognostic value of CMR-modelled PCWP at the population level. METHODS Employing data from the imaging substudy of the UK Biobank, a very large prospective population-based cohort study, CMR-modelled PCWP was calculated using a model incorporating left atrial volume, left ventricular mass and sex. Logistic regression explored the relationships between typical cardiovascular risk factors and raised CMR-modelled PCWP (≥15 mmHg). Cox regression was used to examine the impact of typical risk factors and CMR-modelled PCWP on heart failure (HF) and major adverse cardiovascular events (MACE). RESULTS Data from 39 163 participants were included in the study. Median age of all participants was 64 years (inter-quartile range: 58 to 70), and 47% were males. Clinical characteristics independently associated with raised CMR-modelled PCWP included hypertension [odds ratio (OR) 1.57, 95% confidence interval (CI) 1.44-1.70, P < 0.001], body mass index (BMI) [OR 1.57, 95% CI 1.52-1.62, per standard deviation (SD) increment, P < 0.001], male sex (OR 1.37, 95% CI 1.26-1.47, P < 0.001), age (OR 1.33, 95% CI 1.27-1.41, per decade increment, P < 0.001) and regular alcohol consumption (OR 1.10, 95% CI 1.02-1.19, P = 0.012). After adjusting for potential confounders, CMR-modelled PCWP was independently associated with incident HF [hazard ratio (HR) 2.91, 95% CI 2.07-4.07, P < 0.001] and MACE (HR 1.48, 95% CI 1.16-1.89, P = 0.002). CONCLUSIONS Raised CMR-modelled PCWP is an independent risk factor for incident HF and MACE. CMR-modelled PCWP should be incorporated into routine CMR reports to guide HF diagnosis and further management.
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Affiliation(s)
- Ross J Thomson
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts NHS Trust, West Smithfield, London, UK
| | - Ciaran Grafton-Clarke
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals, Norwich, UK
| | - Gareth Matthews
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals, Norwich, UK
| | - Peter P Swoboda
- The Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | | | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts NHS Trust, West Smithfield, London, UK
- Health Data Research UK, London, UK
- Alan Turing Institute, London, UK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts NHS Trust, West Smithfield, London, UK
| | - Pankaj Garg
- Barts Heart Centre, St Bartholomew's Hospital, Barts NHS Trust, West Smithfield, London, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals, Norwich, UK
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10
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Ali A, Siddiqui AA, Shahid I, Van Spall HGC, Greene SJ, Fudim M, Khan MS. Prognostic value of quality of life and functional status in patients with heart failure: a systematic review and meta-analysis. Egypt Heart J 2024; 76:97. [PMID: 39101961 DOI: 10.1186/s43044-024-00532-z] [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: 07/01/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Functional health status is increasingly being recognized as a viable endpoint in heart failure (HF) trials. We sought to assess its prognostic impact and relationship with traditional clinical outcomes in patients with HF. METHODS MEDLINE and Cochrane central were searched up to January 2021 for post hoc analyses of trials or observational studies that assessed independent association between baseline health/functional status, and mortality and hospitalization in patients with HF across the range of left ventricular ejection fractions to evaluate the prognostic ability of NYHA class [II, III, IV], KCCQ, MLHFQ, and 6MWD. Hazard ratios (HR) with 95% confidence intervals were pooled. RESULTS Twenty-two studies were included. Relative to NYHA I, NYHA class II (HR 1.54 [1.16-2.04]; p < 0.01), NYHA class III (HR 2.08 [1.57-2.77]; p < 0.01), and NYHA class IV (HR 2.53 [1.25-5.12]; p = 0.01) were independently associated with increased risk of mortality. 6MWD (per 10 m) was associated with decreased mortality (HR 0.98 [0.98-0.99]; p < 0.01). A 5-point increase in KCCQ-OSS (HR 0.94 [0.91-0.96]; p < 0.01) was associated with decreased mortality. A high MLHFQ score (> 45) was significantly associated with increased mortality (HR 1.30 [1.14-1.47]; p < 0.01). NHYA class, 6MWD (per 10 m), KCCQ-OSS, and MLHFQ all significantly associated with all-cause mortality in patients with HF. CONCLUSION Identifying such patients with poor health status using functional health assessment can offer a complementary assessment of disease burden and trajectory which carries a strong prognostic value.
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Affiliation(s)
- Abraish Ali
- Department of Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan
| | - Asad Ali Siddiqui
- Department of Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan.
| | - Izza Shahid
- Division of Preventive Cardiology, Houston Methodist Academic Institute, Houston, TX, USA
| | - Harriette G C Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Research Institute of St Joe's, Hamilton, ON, Canada
| | - Stephen J Greene
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Marat Fudim
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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11
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Tan YJ, Ong SC, Yong VS, Khor WW, Pang LJ, Choong YY, Zameram AM, Tan LY, Voo JYH, Lam KK, Yen CH, Wahab MJA, Abdulla ZB. Examining health-related quality of life in ambulatory adult patients with chronic heart failure: insights from Malaysia using EQ-5D-5L. Qual Life Res 2024; 33:2181-2195. [PMID: 38839679 DOI: 10.1007/s11136-024-03674-4] [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] [Accepted: 04/26/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Health-related quality-of-life (HRQoL) data for the chronic heart failure (HF) population in Malaysia are lacking. Using EQ-5D-5L, this study intended to describe their HRQoL, identify predictors of worse HRQoL, and derive EQ-5D-5L index scores for use in economic evaluations. METHODS A cross-sectional survey was conducted between April and September 2023 to collect EQ-5D-5L, sociodemographic, and clinical data from outpatients with HF across seven public specialist hospitals in Malaysia. Multivariable logistic and linear regression models were used to identify independent predictors of reported problems in the EQ-5D-5L dimensions, and predictors of index scores and EQ-VAS, respectively. RESULTS EQ-5D-5L data from 424 outpatients of multi-ethnic background (mean age: 57.1 years, 23.8% female, mean left ventricular ejection fraction: 35.7%, 89.7% NYHA class I-II) were collected using either Malay, English, or Chinese, achieving a 99.8% completion rate. Nearly half of the respondents reported issues in the Mobility, Usual Activities, and Pain/Discomfort dimensions. Mean EQ-5D-5L index was 0.820, lower than the general population, and significantly lower with NYHA class III-IV (0.747) versus NYHA class I (0.846) and NYHA class II (0.805). Besides NYHA class, independent predictors of worse HRQoL included Indian ethnicity, living alone, lower education, unemployment due to ill-health, and proxy-reported HRQoL, largely aligning with existing literature. CONCLUSION Community-dwelling Malaysians with HF reported poorer HRQoL compared to the general population. The observed disparities in HRQoL among HF patients may be linked to specific patient characteristics, suggesting potential areas for targeted interventions. HRQoL assessment using EQ-5D-5L proves feasible and should be considered for routine implementation in local clinics.
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Affiliation(s)
- Yi Jing Tan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia
- Seri Manjung Hospital, Ministry of Health Malaysia, 32040 Seri Manjung, Perak, Malaysia
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia.
| | - Vee Sim Yong
- Clinical Research Centre, Institute for Clinical Research, Hospital Queen Elizabeth II, National Institute of Health, Ministry of Health Malaysia, 88300, Kota Kinabalu, Sabah, Malaysia
| | - Wei Wern Khor
- Sarawak General Hospital, Ministry of Health Malaysia, 93586, Kuching, Sarawak, Malaysia
| | - Lie Jin Pang
- Sarawak General Hospital, Ministry of Health Malaysia, 93586, Kuching, Sarawak, Malaysia
| | - Yong Ying Choong
- Seri Manjung Hospital, Ministry of Health Malaysia, 32040 Seri Manjung, Perak, Malaysia
| | | | - Lin Yuing Tan
- Teluk Intan Hospital, Ministry of Health Malaysia, 36000, Teluk Intan, Perak, Malaysia
| | - James Yau Hon Voo
- Duchess of Kent Hospital, Ministry of Health Malaysia, 90000, Sandakan, Sabah, Malaysia
| | - Kar Kei Lam
- Duchess of Kent Hospital, Ministry of Health Malaysia, 90000, Sandakan, Sabah, Malaysia
| | - Chia How Yen
- Clinical Research Centre, Institute for Clinical Research, Hospital Queen Elizabeth II, National Institute of Health, Ministry of Health Malaysia, 88300, Kota Kinabalu, Sabah, Malaysia
| | | | - Zarina Banu Abdulla
- Penang General Hospital, Ministry of Health Malaysia, 10990, Georgetown, Penang, Malaysia
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12
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Fillies B, Stapel B, Lemke LH, Löffler F, Bauersachs J, Kahl KG, Westhoff-Bleck M. Remission from depression is associated with improved quality of life and preserved exercise capacity in adults with congenital heart disease. Front Cardiovasc Med 2024; 11:1418342. [PMID: 39022619 PMCID: PMC11251921 DOI: 10.3389/fcvm.2024.1418342] [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: 04/16/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Aims Improved long-term survival has widened the treatment goals for adults with congenital heart disease (ACHD) by addressing parameters that impact mental well-being and exercise capacity. Depression, a frequent co-morbidity in ACHD, is linked to both. Whether successful treatment of depression also affects cardiac parameters is a matter of debate. Methods This prospective, cross-sectional, longitudinal study included N = 150 ACHD (mean age 35.2 ± 11.3 years, 57% male) at baseline (t0) and N = 114 at follow-up (mean follow-up: 4.8 ± 0.6 years; t1). Patients were interviewed using a structured clinical interview, and severity of depression was assessed using the Montgomery-Asperg Depression Scale (MADRS). Additional testing was performed using self-rating questionnaires concerning depression, anxiety and quality of life (QoL). Exercise capacity (VO2max) was assessed by symptom limited exercise testing. Results Of N = 33 patients diagnosed with depression at t0, N = 18 patients remitted and N = 15 were non-remitters. Remitters displayed significantly decreased anxiety (P = 0.013), improved global QoL (P = 0.002), and preserved VO2max (P = 0.958) at t1 compared to t0. This was associated with favourable health behaviour at t1 and stable body-mass-index. Contrarily, non-remitters reported further increased anxiety (P = 0.021) and no significant improvement in QoL (P = 0.405). VO2max declined significantly (P = 0.006) and body-mass-index increased (P = 0.004). Never-depressed patients showed no significant changes in anxiety (P = 0.415) or QoL (P = 0.211). VO2max decreased significantly (P < 0.001). Conclusion In ACHD, remission from depression is associated with better physical functioning, mental health, and QoL. The assessment and treatment of depression in ACHD emerges as an important clinical goal that should be included in a comprehensive multimodal treatment plan.
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Affiliation(s)
- Brit Fillies
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Lars H. Lemke
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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13
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Shah KP, Khan SS, Baldridge AS, Grady KL, Cella D, Goyal P, Allen LA, Smith JD, Lagu TC, Ahmad FS. Health Status in Heart Failure and Cancer: Analysis of the Medicare Health Outcomes Survey 2016-2020. JACC. HEART FAILURE 2024; 12:1166-1178. [PMID: 37930290 DOI: 10.1016/j.jchf.2023.10.003] [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: 07/18/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND People with heart failure (HF) and cancer experience impaired physical and mental health status. However, health-related quality of life (HRQOL) has not been directly compared between these conditions in a contemporary population of older people. OBJECTIVES The authors sought to compare HRQOL in people with HF vs those with lung, colorectal, breast, and prostate cancers. METHODS The authors performed a pooled analysis of Medicare Health Outcomes Survey data from 2016 to 2020 in participants ≥65 years of age with a self-reported history of HF or active treatment for lung, colon, breast, or prostate cancer. They used the Veterans RAND-12 physical component score (PCS) and mental component score (MCS), which range from 0-100 with a mean score of 50 (based on the U.S. general population) and an SD of 10. The authors used pairwise Student's t-tests to evaluate for differences in PCS and MCS between groups. RESULTS Among participants with HF (n = 71,025; 54% female, 16% Black), mean PCS was 29.5 and mean MCS 47.9. Mean PCS was lower in people with HF compared with lung (31.2; n = 4,165), colorectal (35.6; n = 4,270), breast (37.7; n = 14,542), and prostate (39.6; n = 17,670) cancer (all P < 0.001). Participants with HF had a significantly lower mean MCS than those with lung (31.2), colon (50.0), breast (52.0), and prostate (53.0) cancer (all P < 0.001). CONCLUSIONS People with HF experience worse HRQOL than those with cancer actively receiving treatment. The pervasiveness of low HRQOL in HF underscores the need to implement evidence-based interventions that target physical and mental health status and scale multidisciplinary clinics.
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Affiliation(s)
- Kriti P Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abigail S Baldridge
- Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, USA
| | - Kathleen L Grady
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Patient-Centered Outcomes, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Parag Goyal
- Program for the Care and the Study of the Aging Heart, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Justin D Smith
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tara C Lagu
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Health Information Partnerships, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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14
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Soltani S, Hollstein MM, Berliner D, Buhl T, Bauersachs J, Werfel T, Bavendiek U, Traidl S. Symptom severity reflected by NYHA grade is independently associated with pruritus in chronic heart failure patients. J Eur Acad Dermatol Venereol 2024; 38:1410-1418. [PMID: 38420867 DOI: 10.1111/jdv.19931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Pruritus is a symptom profoundly impairing patients' quality of life (QoL). It is a common symptom in chronic heart failure (CHF) patients of yet unknown nature. The aim of this study was to evaluate the risk factors of pruritus in CHF patients. METHODS For this monocentric, prospective cohort study, CHF patients were recruited and CHF symptoms, comorbidities and drug intake were assessed using a structured report. Additionally, a questionnaire evaluated pruritus symptoms. Detailed medical histories including laboratory test results were retrieved from patient files for all participants. RESULTS We evaluated data from 550 CHF patients. Of those, 25.3% reported pruritus to occur frequently (3-5 times per week), often (1-2 times per week) or daily. Patients of higher NYHA classes (NYHA III + IV) experienced significantly more pruritus (31.2%) than lower NYHA classes (NYHA I + II) (21.1%, p = 0.024). Patients with pruritus reported disproportionately often concomitant stasis dermatitis (p = 0.026) and chronic lung disease (p = 0.014). Other parameters reflecting cardiac, liver, kidney and thyroid function, as well as medical therapies showed no significant differences between patients with and without pruritus. In the multivariate logistic regression analysis, only NYHA class (p = 0.016, OR 1.55, 95% confidence interval (CI): [1.09; 2.20]) and elevated leukocyte count (p = 0.007, OR 1.11, CI [1.03; 1.21]) remained significantly associated with pruritus in CHF patients. CONCLUSIONS NYHA class is an independent predictor for pruritus in CHF patients. Besides NYHA class, leukocyte count was also associated with increased pruritus. Pruritus may impair QoL in CHF patients and should thus be included in the assessment of those patients. We suggest that providing best care for CHF patients can be achieved through an interdisciplinary approach of cardiologists and dermatologists and should include a pruritus assessment.
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Affiliation(s)
- Samira Soltani
- Department of Cardiology and Angiology, Hanover Medical School, Hanover, Germany
| | - Moritz M Hollstein
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hanover Medical School, Hanover, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hanover Medical School, Hanover, Germany
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Udo Bavendiek
- Department of Cardiology and Angiology, Hanover Medical School, Hanover, Germany
| | - Stephan Traidl
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
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15
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Feng J, Zhang Y, Zhang J. Reply: Heart Failure Burden in Asia: The Full Picture. JACC. ASIA 2024; 4:571-572. [PMID: 39101115 PMCID: PMC11291383 DOI: 10.1016/j.jacasi.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Affiliation(s)
- Jiayu Feng
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuhui Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Clinical Research for Cardiovascular Medications, National Health Committee, Beijing, China
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16
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Khan MS, Shahid I, Bennis A, Rakisheva A, Metra M, Butler J. Global epidemiology of heart failure. Nat Rev Cardiol 2024:10.1038/s41569-024-01046-6. [PMID: 38926611 DOI: 10.1038/s41569-024-01046-6] [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] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Heart failure (HF) is a heterogeneous clinical syndrome marked by substantial morbidity and mortality. The natural history of HF is well established; however, epidemiological data are continually evolving owing to demographic shifts, advances in treatment and variations in access to health care. Although the incidence of HF has stabilized or declined in high-income countries over the past decade, its prevalence continues to increase, driven by an ageing population, an increase in risk factors, the effectiveness of novel therapies and improved survival. This rise in prevalence is increasingly noted among younger adults and is accompanied by a shift towards HF with preserved ejection fraction. However, disparities exist in our epidemiological understanding of HF burden and progression in low-income and middle-income countries owing to the lack of comprehensive data in these regions. Therefore, the current epidemiological landscape of HF highlights the need for periodic surveillance and resource allocation tailored to geographically vulnerable areas. In this Review, we highlight global trends in the burden of HF, focusing on the variations across the spectrum of left ventricular ejection fraction. We also discuss evolving population-based estimates of HF incidence and prevalence, the risk factors for and aetiologies of this disease, and outcomes in different geographical regions and populations.
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Affiliation(s)
| | - Izza Shahid
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Ahmed Bennis
- Department of Cardiology, The Ibn Rochd University Hospital Center, Casablanca, Morocco
| | | | - Marco Metra
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
- Baylor Scott and White Research Institute, Dallas, TX, USA.
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17
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D’Amato A, Severino P, Mancone M, Mariani MV, Prosperi S, Colombo L, Myftari V, Cestiè C, Labbro Francia A, Germanò R, Pierucci N, Fanisio F, Marek-Iannucci S, De Prisco A, Scoccia G, Birtolo LI, Manzi G, Lavalle C, Sardella G, Badagliacca R, Fedele F, Vizza CD. Prognostic Assessment of HLM Score in Heart Failure Due to Ischemic Heart Disease: A Pilot Study. J Clin Med 2024; 13:3322. [PMID: 38893033 PMCID: PMC11172826 DOI: 10.3390/jcm13113322] [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: 04/06/2024] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Ischemic heart disease (IHD) represents the main cause of heart failure (HF). A prognostic stratification of HF patients with ischemic etiology, particularly those with acute coronary syndrome (ACS), may be challenging due the variability in clinical and hemodynamic status. The aim of this study is to assess the prognostic power of the HLM score in a population of patients with ischemic HF and in a subgroup who developed HF following ACS. Methods: This is an observational, prospective, single-center study, enrolling consecutive patients with a diagnosis of ischemic HF. Patients were stratified according to the four different HLM stages of severity, and the occurrence of CV death, HFH, and worsening HF events were evaluated at 6-month follow-up. A sub-analysis was performed on patients who developed HF following ACS at admission. Results: The study included 146 patients. HLM stage predicts the occurrence of CV death (p = 0.01) and CV death/HFH (p = 0.003). Cox regression analysis confirmed HLM stage as an independent predictor of CV death (OR: 3.07; 95% IC: 1.54-6.12; p = 0.001) and CV death/HFH (OR: 2.45; 95% IC: 1.43-4.21; p = 0.001) in the total population of patients with HF due to IHD. HLM stage potentially predicts the occurrence of CV death (p < 0.001) and CV death/HFH (p < 0.001) in patients with HF following ACS at admission. Conclusions: Pathophysiological-based prognostic assessment through HLM score is a potentially promising tool for the prediction of the occurrence of CV death and CV death/HFH in ischemic HF patients and in subgroups of patients with HF following ACS at admission.
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Affiliation(s)
- Andrea D’Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Silvia Prosperi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Lorenzo Colombo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Claudia Cestiè
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Aurora Labbro Francia
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Rosanna Germanò
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Nicola Pierucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | | | - Stefanie Marek-Iannucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Andrea De Prisco
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Gianmarco Scoccia
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Giovanna Manzi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Gennaro Sardella
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | | | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
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18
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Assmus B, Sossalla S. What we claim to do and what we really do - a discrepancy in heart failure treatment. Eur J Heart Fail 2024; 26:1419-1422. [PMID: 38740572 DOI: 10.1002/ejhf.3279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Birgit Assmus
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
- Department of Cardiology and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Kerckhoff Heart Center, Bad Nauheim, Hessen, Germany
| | - Samuel Sossalla
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
- Department of Cardiology and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Kerckhoff Heart Center, Bad Nauheim, Hessen, Germany
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19
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Savarese G, Lindberg F, Cannata A, Chioncel O, Stolfo D, Musella F, Tomasoni D, Abdelhamid M, Banerjee D, Bayes-Genis A, Berthelot E, Braunschweig F, Coats AJS, Girerd N, Jankowska EA, Hill L, Lainscak M, Lopatin Y, Lund LH, Maggioni AP, Moura B, Rakisheva A, Ray R, Seferovic PM, Skouri H, Vitale C, Volterrani M, Metra M, Rosano GMC. How to tackle therapeutic inertia in heart failure with reduced ejection fraction. A scientific statement of the Heart Failure Association of the ESC. Eur J Heart Fail 2024; 26:1278-1297. [PMID: 38778738 DOI: 10.1002/ejhf.3295] [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: 02/29/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Guideline-directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF) reduces morbidity and mortality, but its implementation is often poor in daily clinical practice. Barriers to implementation include clinical and organizational factors that might contribute to clinical inertia, i.e. avoidance/delay of recommended treatment initiation/optimization. The spectrum of strategies that might be applied to foster GDMT implementation is wide, and involves the organizational set-up of heart failure care pathways, tailored drug initiation/optimization strategies increasing the chance of successful implementation, digital tools/telehealth interventions, educational activities and strategies targeting patient/physician awareness, and use of quality registries. This scientific statement by the Heart Failure Association of the ESC provides an overview of the current state of GDMT implementation in HFrEF, clinical and organizational barriers to implementation, and aims at suggesting a comprehensive framework on how to overcome clinical inertia and ultimately improve implementation of GDMT in HFrEF based on up-to-date evidence.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | - Felix Lindberg
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Antonio Cannata
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', and University of Medicine Carol Davila, Bucharest, Romania
| | - Davide Stolfo
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Francesca Musella
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Cardiology Department, Santa Maria delle Grazie Hospital, Naples, Italy
| | - Daniela Tomasoni
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Magdy Abdelhamid
- Faculty of Medicine, Kasr Al Ainy, Department of Cardiology, Cairo University, Cairo, Egypt
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, Cardiovascular and Genetics Research Institute, St George's University, London, UK
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias I Pujol, CIBERCV, Badalona, Spain
| | | | - Frieder Braunschweig
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | | | - Nicolas Girerd
- Centre d'Investigation Clinique Plurithémathique Pierre Drouin & Département de Cardiologie Institut Lorrain du Cœur et des Vaisseaux, Université de Lorraine, CHRU-Nancy, Vandœuvre-lès-Nancy, France
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University and Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Yury Lopatin
- Volgograd State Medical University, Regional Cardiology Centre, Volgograd, Russia
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Brenda Moura
- Armed Forces Hospital, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Amina Rakisheva
- City Cardiology Center, Konaev City Hospital, Almaty Region, Kazakhstan
| | - Robin Ray
- Department of Cardiology, St George's University Hospital, London, UK
| | - Petar M Seferovic
- University Medical Center, Medical Faculty University of Belgrade, Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Hadi Skouri
- Cardiology Division, Internal Medicine Department, Balamand University School of Medicine, Beirut, Lebanon
| | - Cristiana Vitale
- Department of Cardiology, St George's University Hospital, London, UK
| | - Maurizio Volterrani
- Department of Exercise Science and Medicine, San Raffaele Open University of Rome, Rome, Italy
- Cardiopulmonary Department, IRCCS San Raffaele Roma, Rome, Italy
| | - Marco Metra
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe M C Rosano
- Department of Cardiology, St George's University Hospital, London, UK
- Cardiology, San Raffaele Hospital, Cassino, Italy
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20
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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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21
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Ribeiro GJS, Moriguchi EH, Pinto AA. Clustering of Cardiovascular Risk Factors and Heart Failure in Older Adults from the Brazilian Far North. Healthcare (Basel) 2024; 12:951. [PMID: 38727508 PMCID: PMC11082983 DOI: 10.3390/healthcare12090951] [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: 03/20/2024] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Given the aging global population, identifying heart failure (HF) phenotypes has become crucial, as distinct disease characteristics can influence treatment and prognosis in older adults. This study aimed to analyze the association between clustering of cardiovascular risk factors and HF in older adults. A cross-sectional epidemiological study was conducted with 1322 older adults (55% women, mean age 70.4) seen in primary health care. Diagnosis of HF was performed by a cardiologist based on diagnostic tests and medical history. Cardiovascular risk factors included hypertension, diabetes, hypercholesterolemia, and smoking. Using logistic regression, potential associations were tested. Individual risk factor analysis showed that older adults with hypertension, diabetes, or hypercholesterolemia had up to 7.6 times higher odds to have HF. The cluster where older adults had only one risk factor instead of none increased the odds of HF by 53.0%. Additionally, the odds of older patients having HF ranged from 3.59 times for the two-risk factor cluster to 20.61 times for the simultaneous presence of all four factors. The analysis of clusters substantially increasing HF risk in older adults revealed the importance of individualizing subgroups with distinct HF pathophysiologies. The clinical significance of these clusters can be beneficial in guiding a more personalized therapeutic approach.
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Affiliation(s)
- Guilherme José Silva Ribeiro
- Graduate Program in Nutrition Science, Department of Nutrition, Federal University of Viçosa, Viçosa 36570-900, Brazil;
| | - Emilio Hideyuki Moriguchi
- Graduate Program in Cardiology and Cardiovascular Sciences, Department of Cardiology, Federal University of Rio Grande do Sul, Rio Grande do Sul 90010-150, Brazil;
| | - André Araújo Pinto
- Health Sciences Center, State University of Roraima, Roraima 69306-530, Brazil
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22
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Mulugeta H, Sinclair PM, Wilson A. Health-related quality of life of people with heart failure in low- and middle-income countries: a systematic review and meta-analysis. Qual Life Res 2024; 33:1175-1189. [PMID: 38070032 DOI: 10.1007/s11136-023-03563-2] [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] [Accepted: 11/10/2023] [Indexed: 04/26/2024]
Abstract
PURPOSE Heart failure is a global health concern and associated with poor health-related quality of life and increased mortality. There is a disproportionate burden on patients and health systems in low- and middle-income countries. This systematic review and meta-analysis estimates the health-related quality of life of people with heart failure in low- and middle-income countries. METHODS A systematic literature search was conducted to identify relevant studies from January 2012 to November 2022 using the following databases: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, Scopus and JBI EBP database. Study screening, quality appraisal and data extraction were conducted using JBI methodology. A random-effects model was used to perform the meta-analysis. Heterogeneity was assessed using the I2 statistic. All statistical analyses were done in STATA version 17. RESULTS A total of 33 studies with 5612 participants were included in this review. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Short-Form-36 questionnaire (SF-36) were the most used instruments across 19 and 8 studies, respectively. The pooled mean MLHFQ and SF-36 scores using the random-effects model were 46.08 (95% CI 35.06, 57.10) and 41.23 (95% CI 36.63, 45.83), respectively. In a subgroup analysis using both instruments, the highest health-related quality-of-life scores occurred in studies with inpatient participants. CONCLUSION The overall health-related quality of life of people with heart failure in low- and middle-income countries is poor. Strategies should be strategically developed to improve the health-related quality of life of people with heart failure in these countries. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022377781.
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Affiliation(s)
- Henok Mulugeta
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Amhara Region, Ethiopia.
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.
| | - Peter M Sinclair
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
| | - Amanda Wilson
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
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Awad AK, Abdelgalil MS, Gonnah AR, Mouffokes A, Ahmad U, Awad AK, Elbadawy MA, Roberts DH. Intravenous iron for acute and chronic heart failure with reduced ejection fraction (HFrEF) patients with iron deficiency: An updated systematic review and meta-analysis. Clin Med (Lond) 2024; 24:100211. [PMID: 38643833 PMCID: PMC11092397 DOI: 10.1016/j.clinme.2024.100211] [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: 02/04/2024] [Accepted: 02/23/2024] [Indexed: 04/23/2024]
Abstract
Patients with heart failure (HF) and iron deficiency are at increased risk of adverse clinical outcomes. We searched databases for randomised controlled trials that compared IV iron to placebo, in patients with HF with reduced ejection fraction (HFrEF). A total of 7,813 participants, all having HFrEF with 3,998 receiving IV iron therapy, and 3,815 control recipients were included. There was a significant improvement in Kansas City Cardiomyopathy Questionnaire favouring IV iron with MD 7.39, 95% CI [3.55, 11.22], p = 0.0002. Subgroup analysis, based on acute and chronic HF, has displayed a sustained statistical significance. Additionally, a significant increase in the left ventricular ejection fraction % was observed, with MD 3.76, 95% CI [2.32, 5.21], p < 0.00001. A significant improvement in 6-min walk test was noted, with MD 34.87, 95% CI [20.02, 49.72], p < 0.00001. Furthermore, IV iron showed significant improvement in NYHA class, peak VO2, serum ferritin, and haemoglobin levels. Finally, despite the lack of difference in terms of all-cause hospitalisation and HF-related death, IV iron was associated with a significant reduction in HF-related, any cardiovascular reason hospitalisations, and all-cause death; which supports the need for implementation of IV iron as a standard of care in patients with HF and iron deficiency.
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Affiliation(s)
- Ahmed K Awad
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | | | - Ahmed R Gonnah
- Imperial College Healthcare NHS Trust, London, United Kingdom.
| | - Adel Mouffokes
- Faculty of Medicine, University of Oran 1 Ahmed Ben Bella, Oran, Algeria
| | | | - Ayman K Awad
- Faculty of Medicine, El-Galala University, Suez, Egypt
| | | | - David Hesketh Roberts
- Lancashire Cardiac Centre, Blackpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
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24
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Wang Y, Yang Q, Liu Y, Zheng G, Fan F, Tian H, Zhang X. Psychosomatic mechanisms of heart failure symptoms on quality of life in patients with chronic heart failure: A multi-centre cross-sectional study. J Clin Nurs 2024; 33:1839-1848. [PMID: 38044710 DOI: 10.1111/jocn.16955] [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: 05/03/2023] [Revised: 08/29/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
AIMS To determine the contributions of different kinds of symptoms to the quality of life and mediating effect of psychological and physical symptoms between heart failure symptoms and quality of life. DESIGN A multi-centre cross-sectional study. METHODS 2006 chronic heart failure patients from four cities were recruited in China from January 2021 to December 2022. Patients' symptoms and quality of life were self-reported, and data were analysed using correlation analysis, dominance analysis and mediating effects analysis. RESULTS The dominance analysis revealed that the overall mean contributions of heart failure, psychological and physical symptoms were .083, .085 and .111; 29.5%, 30.2% and 39.5% of the known variance. And heart failure symptoms could negatively affect quality of life through psychological and physical symptoms, accounting for 28.39% and 22.95% of the total effect. Heart failure symptoms could also affect quality of life through the chain-mediated effect of physical and psychological symptoms, accounting for 16.74%. CONCLUSIONS Physiological symptoms had the strongest effect on quality of life and heart failure symptoms had the weakest. Most of the effect for heart failure symptoms on quality of life in chronic heart failure patients was mediated by psychological and physiological symptoms. RELEVANCE TO CLINICAL PRACTICE It is important to design non-pharmacological intervention plans for the enhancement of physical and psychological symptoms' management skills, to reduce the adverse impact of heart failure symptoms on quality of life. REPORTING METHOD Study methods and results reported in adherence to the STROBE checklist. NO PATIENT OR PUBLIC CONTRIBUTION No patients or members of the public were involved in the study.
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Affiliation(s)
- Yu Wang
- Department of Nursing, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Qiaofang Yang
- Department of Nursing, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yancun Liu
- Structural Heart Disease Wards, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Gaigai Zheng
- Heart Failure Wards, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Fanghui Fan
- Coronary Care Unit, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Huan Tian
- Heart Failure Wards, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xin Zhang
- Henan International Travel Health Care Center, Zhengzhou, China
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Tsangaris A, Ambrosy AP, Tschida M, Alexy T. Settling the IRONy of Anemia in Heart Failure: Current Evidence and Future Directions. J Card Fail 2024; 30:691-693. [PMID: 38401670 DOI: 10.1016/j.cardfail.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Affiliation(s)
| | - Andrew P Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Tamas Alexy
- Division of Cardiology, University of Minnesota, Minneapolis, MN
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26
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Thapa A, Kang J, Chung ML, Wu JR, Latimer A, Lennie TA, Lin CY, Thompson JH, Cha G, Moser DK. Perceived Control, Functional Status, Depressive Symptoms, and Anxiety: Mediating and Moderating Influences on Health-Related Quality of Life in Patients With Heart Failure. J Cardiovasc Nurs 2024:00005082-990000000-00187. [PMID: 38687114 DOI: 10.1097/jcn.0000000000001100] [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: 05/02/2024]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is poor in patients with heart failure. Psychological (ie, depressive symptoms [DS], anxiety, and perceived control) and physical (ie, functional status) factors are associated with HRQoL. The dynamic relationships among these variables and their impact on HRQoL remain unclear, limiting the ability to design effective interventions. PURPOSE Our aim was to evaluate a moderated mediation model, in which the association between perceived control and HRQoL was hypothesized to be mediated by DS and anxiety in the presence of a moderator, functional status. METHODS Patients (N = 426) with heart failure completed the Control Attitudes Scale-Revised to measure perceived control, Duke Activity Status Index for functional status, Patient Health Questionnaire-9 for DS, Brief Symptom Inventory for anxiety, and Minnesota Living with Heart Failure Questionnaire for HRQoL. We performed a moderated parallel mediation analysis. RESULTS Higher levels of perceived control were associated with better HRQoL through lower levels of anxiety and DS in the presence of functional status (index of moderated mediation for DS, b = 0.029; 95% confidence interval, 0.016-0.045; for anxiety: b = 0.009, 95% confidence interval, 0.002-0.018). The effect of perceived control on psychological symptoms was stronger at low and moderate functional statuses; however, this effect diminished with increasing functional status. CONCLUSION Functional status moderated the indirect effects of perceived control on HRQoL through DS and anxiety in patients with heart failure. Efforts to improve HRQoL by targeting perceived control may be more effective when considering DS and anxiety in patients with low to moderate levels of functional status.
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Zhang N, Qu X, Kang L, Liu X, Zhu W. Mapping Knowledge Landscapes and Emerging Trends of the Links Between Frailty and Heart Failure: A Bibliometric Analysis From 2000 to 2023. Cureus 2024; 16:e60511. [PMID: 38764704 PMCID: PMC11101057 DOI: 10.7759/cureus.60511] [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] [Accepted: 05/17/2024] [Indexed: 05/21/2024] Open
Abstract
Background Frailty, within the context of heart failure (HF), is strongly linked to poor patient outcomes. Investigating the vulnerable condition of individuals with HF is crucial, not only for medical reasons but also as a significant public health challenge, especially among the elderly population where both HF and frailty are common. Therefore, it is essential to prioritize HF patients with frailty over those without such symptoms. To begin, promptly assessing the impact of academic research in this area is crucial, considering factors such as geographical regions, authors, journals, and institutions. Additionally, it is important to explore current topics and identify potential areas that could inspire future researchers to conduct further studies to advance public health. Methodology We conducted a search in the Web of Science Core Collection database to identify articles and reviews in the English language focusing on frailty and HF which were published from January 1, 2000, to December 31, 2023. To perform bibliometric analysis, VOSviewer (v.1.6.18) and CiteSpace (v.6.1.R2) were utilized. Results A total of 1,381 original English-language articles were gathered, comprising 1,162 articles and 219 reviews. The quantity of research publications in this area has experienced significant growth since 2013. Among all countries, the United States has contributed the largest number of publications, accounting for 409 articles (29.62% of the total). Additionally, the United States has received the highest number of citations, being cited a total of 13,329 times, as well as boasting the greatest total link strength. Duke University stands out as the institution with the highest number of research papers, having published 40 articles (2.90% of the total). It has also received the most citations, with a total of 2,455 times, and possesses the highest total link strength, which amounts to 212. Within the realm of prolific authors, Kentaro Kamiya from Kitasato University emerges as the most productive, having authored 28 articles (2.03% of the total). When considering scholarly journals, "Esc Heart Failure" contains the highest number of articles pertaining to frailty and HF, publishing a noteworthy 36 articles (2.61% of the total). Noteworthy keywords within this field encompass frailty, heart failure, elderly, mortality, and cardiovascular disease. Over the past five years, the most popular keywords have centered around "frailty syndrome," "sarcopenia," and "therapeutic interventions." Conclusions Research on frailty and HF at a global scale has experienced substantial growth between 2000 and 2023, demonstrating a prospective field for further exploration with potential advantages from ongoing progress. Prospective studies could prioritize the enhancement of cardiac rehabilitation for patients coping with HF and frailty while ensuring the preservation of their overall quality of life.
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Affiliation(s)
- Ning Zhang
- Department of Geriatrics, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, CHN
| | - Xuan Qu
- Department of Geriatrics, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, CHN
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, CHN
| | - Xiaohong Liu
- Department of Geriatrics, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, CHN
| | - Wenling Zhu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, CHN
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Gouda P, Rathwell S, Colin-Ramirez E, Felker GM, Ross H, Escobedo J, Macdonald P, Troughton RW, O'Connor CM, Ezekowitz JA. Utilizing Quality of Life Adjusted Days Alive and Out of Hospital in Heart Failure Clinical Trials. Circ Cardiovasc Qual Outcomes 2024; 17:e010560. [PMID: 38567506 DOI: 10.1161/circoutcomes.123.010560] [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: 09/19/2023] [Accepted: 02/15/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND In heart failure (HF) trials, there has been an emphasis on utilizing more patient-centered outcomes, including quality of life (QoL) and days alive and out of hospital. We aimed to explore the impact of QoL adjusted days alive and out of hospital as an outcome in 2 HF clinical trials. METHODS Using data from 2 trials in HF (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure [GUIDE-IT] and Study of Dietary Intervention under 100 mmol in Heart Failure [SODIUM-HF]), we determined treatment differences using percentage days alive and out of hospital (%DAOH) adjusted for QoL at 18 months as the primary outcome. For each participant, %DAOH was calculated as a ratio between days alive and out of hospital/total follow-up. Using a regression model, %DAOH was subsequently adjusted for QoL measured by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score. RESULTS In the GUIDE-IT trial, 847 participants had a median baseline Kansas City Cardiomyopathy Questionnaire Overall Summary Score of 59.0 (interquartile range, 40.8-74.3), which did not change over 18 months. %DAOH was 90.76%±22.09% in the biomarker-guided arm and 88.56%±25.27% in the usual care arm. No significant difference in QoL adjusted %DAOH was observed (1.09% [95% CI, -1.57% to 3.97%]). In the SODIUM-HF trial, 796 participants had a median baseline Kansas City Cardiomyopathy Questionnaire Overall Summary Score of 69.8 (interquartile range, 49.3-84.3), which did not change over 18 months. %DAOH was 95.69%±16.31% in the low-sodium arm and 95.95%±14.76% in the usual care arm. No significant difference was observed (1.91% [95% CI, -0.85% to 4.77%]). CONCLUSIONS In 2 large HF clinical trials, adjusting %DAOH for QoL was feasible and may provide complementary information on treatment effects in clinical trials.
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Affiliation(s)
- Pishoy Gouda
- University of Alberta, Edmonton, Canada (P.G., J.A.E.)
| | - Sarah Rathwell
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (S.R., J.A.E.)
| | - Eloisa Colin-Ramirez
- Universidad Anáhuac México, Huixquilucan, Estado de México, Naucalpan, Mexico (E.C.-R.)
| | | | | | - Jorge Escobedo
- Instituto Mexicano del Seguro Social, Mexico City, Mexico (J.E.)
| | - Peter Macdonald
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.)
| | - Richard W Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.)
| | - Christopher M O'Connor
- Duke Clinical Research Institute, Durham, NC (G.M.F., C.M.O.)
- Inova Heart and Vascular Center, Falls Church, VA (C.M.O.)
| | - Justin A Ezekowitz
- University of Alberta, Edmonton, Canada (P.G., J.A.E.)
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (S.R., J.A.E.)
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Wańczura P, Aebisher D, Wiśniowski M, Kos M, Bukowski H, Hołownia-Voloskova M, Przybylski A. Telemedical Intervention and Its Effect on Quality of Life in Chronic Heart Failure Patients: The Results from the Telemedicine and e-Health Solution Pilot Program. J Clin Med 2024; 13:2604. [PMID: 38731133 PMCID: PMC11084177 DOI: 10.3390/jcm13092604] [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: 04/10/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Heart failure (HF) is not only a common cardiovascular disease with a poor prognosis. Its prevalence in developed countries equals 1-2% of the general population of adults, while in Poland HF, patients constitute 3.2% of the total population. Modern heart failure treatment should be focused not only on reducing the risk of death and the number of readmissions due to HF exacerbation but quality of life as well. Telemedicine has been suggested as a viable tool for enhancing HRQL. Therefore, we present the results of telemedical intervention in a group of HF patients and its effect on quality of life in chronic heart failure patients from a pilot study dedicated to reducing social inequalities in health through the use of telemedicine and e-health solutions. (2) Method: The project was a multicenter, open, non-controlled trial conducted by the University of Rzeszów, Poland. The data points were collected in the June 2023-December 2023 period from fourteen primary care units from five voivodeships, mostly considered social exclusion areas. A total of 52.7% of the patients recruited were Podkarpackie Voivodeship inhabitants. The result and discussion are presented based on the Chronic Heart Failure Questionnaire (CHFQ) and the EuroQol Visual Analogue Scale (EQVAS). (3) Results: During the program, a total of over 100,000 telemedicine examinations were conducted in the form of body weight measurement, heart rate, blood pressure tests, and 7-day Holter or 14-day event Holter assessment. Over the course of this study, coordinating the pilot program medical staff has ordered 570 changes in the patient's pharmacotherapy, confirming the positive impact on quality of life in the study group. (4) Conclusions: A comprehensive telemedical intervention can contribute to an improvement in the quality of life of patients with HF beyond what was achieved with the basic standard of care in the group of HF patients from the social exclusion region. It is now unclear if the result of the basic telemedical intervention would be constant after discontinuation of the mentioned pilot program.
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Affiliation(s)
- Piotr Wańczura
- Department of Cardiology, Medical College of Sciences, University of Rzeszow, 35-310 Rzeszow, Poland;
- The Ministry of Internal Affairs and Administration Hospital, 35-111 Rzeszow, Poland;
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College, University of Rzeszow, 35-310 Rzeszow, Poland;
| | - Mateusz Wiśniowski
- The Ministry of Internal Affairs and Administration Hospital, 35-111 Rzeszow, Poland;
| | - Marek Kos
- Department of Public Health, Medical University of Lublin, 20-400 Lublin, Poland;
| | - Hubert Bukowski
- Institute of Innovation and Responsible Development, 02-621 Warsaw, Poland;
| | - Malwina Hołownia-Voloskova
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Andrzej Przybylski
- Department of Cardiology, Medical College of Sciences, University of Rzeszow, 35-310 Rzeszow, Poland;
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Fumagalli C, Ponti L, Smorti M, Pozza F, Argirò A, Zampieri M, Di Mario C, Marfella R, Sardu C, Paolisso G, Olivotto I, Perfetto F, Ungar A, Marchionni N, Cappelli F. Determinants of health status in older patients with transthyretin cardiac amyloidosis: a prospective cohort study. Aging Clin Exp Res 2024; 36:89. [PMID: 38598143 PMCID: PMC11006758 DOI: 10.1007/s40520-024-02750-6] [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: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Whether, and to what extent, frailty and other geriatric domains are linked to health status in patients with transthyretin cardiac amyloidosis (ATTR-CA) is unknown. AIMS To determine the association of frailty with health status [defined by the Kansas City Cardiomyopathy Questionnaire (KCCQ)] in patients with ATTR-CA. METHODS Consecutive ATTR-CA patients undergoing cardiovascular assessment at a tertiary care clinic from September 2021 to September 2023 were invited to participate. KCCQ, frailty and social environment were recorded. Frailty was assessed using the modified Frailty Index (mFI), mapping 11 variables from the Canadian Study of Health and Aging (frailty ≥0.36). RESULTS Of 168 screened ATTR-CA patients, 138 [83% men, median age of 79 (75-84) years] were enrolled in the study. Median KCCQ was 66 (50-75). wtATTR-CA was the most prevalent form (N = 113, 81.9%). The most frequent cardiac variant was Ile68Leu (17/25 individuals with vATTR-CA). Twenty (14.5%) patients were considered frail, and prevalence of overt disability was 6.5%. At multivariable linear regression analysis, factors associated with worsening KCCQ were age at evaluation, the mFI, NYHA Class, and NAC Score. Gender, ATTR-CA type, phenotype, and LVEF were not associated with health status. DISCUSSION In older patients diagnosed with ATTR-CA, frailty, symptoms, and disease severity were associated with KCCQ. CONCLUSIONS Functional status is a determinant of quality of life and health status in older individuals with a main diagnosis of ATTR-CA. Future research may provide more in-depth knowledge on the association of frailty in patients with ATTR-CA with respect to quality of life and prognosis.
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Affiliation(s)
- Carlo Fumagalli
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.
| | - Lucia Ponti
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
- Department of Humanities, University of Urbino, Urbino, Italy
| | - Martina Smorti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesca Pozza
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Alessia Argirò
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Mattia Zampieri
- Department of Humanities, University of Urbino, Urbino, Italy
| | - Carlo Di Mario
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Meyer Children Hospital, Florence, Italy
| | - Federico Perfetto
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- IV Internal Medicine Division, Careggi University Hospital, Florence, Italy
| | - Andrea Ungar
- Geriatric Intensive Care Unit, University of Florence, Florence, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Caggianelli G, Alivernini F, Chirico A, Iovino P, Lucidi F, Uchmanowicz I, Rasero L, Alvaro R, Vellone E. The relationship between caregiver contribution to self-care and patient quality of life in heart failure: A longitudinal mediation analysis. PLoS One 2024; 19:e0300101. [PMID: 38470867 PMCID: PMC10931462 DOI: 10.1371/journal.pone.0300101] [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: 08/12/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Patients with heart failure may experience poor quality of life due to a variety of physical and psychological symptoms. Quality of life can improve if patients adhere to consistent self-care behaviors. Patient outcomes (i.e., quality of life) are thought to improve as a result of caregiver contribution to self-care. However, uncertainty exists on whether these outcomes improve as a direct result of caregiver contribution to self-care or whether this improvement occurs indirectly through the improvement of patient heart failure self-care behaviors. AIMS To investigate the influence of caregiver contribution to self-care on quality of life of heart failure people and explore whether patient self-care behaviors mediate such a relationship. METHODS This is a secondary analysis of the MOTIVATE-HF randomized controlled trial (Clinicaltrials.gov registration number: NCT02894502). Data were collected at baseline and 3 months. An autoregressive longitudinal path analysis model was conducted to test our hypotheses. RESULTS We enrolled a sample of 510 caregivers [mean age = 54 (±15.44), 24% males)] and 510 patients [mean age = 72.4 (±12.28), 58% males)]. Patient self-care had a significant and direct effect on quality of life at three months (β = 0.20, p < .01). Caregiver contribution to self-care showed a significant direct effect on patient self-care (β = 0.32, p < .01), and an indirect effect on patient quality of life through the mediation of patient self-care (β = 0.07, p < .001). CONCLUSION Patient quality of life is influenced by self-care both directly and indirectly, through the mediation of caregiver contribution to self-care. These findings improve our understanding on how caregiver contribution to self-care improves patient outcomes.
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Affiliation(s)
| | - Fabio Alivernini
- Department of Psychology of Development and Socialization processes, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Chirico
- Department of Psychology of Development and Socialization processes, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Iovino
- Health Sciences Department, University of Florence, Florence, Italy
| | - Fabio Lucidi
- Department of Psychology of Development and Socialization processes, "Sapienza" University of Rome, Rome, Italy
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Laura Rasero
- Health Sciences Department, University of Florence, Florence, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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Ehrenfels MA, Fretter C, von Stein J, Körber MI, Wienemann H, Baldus S, Pfister R, Iliadis C. Role of preexisting right ventricular remodeling in symptoms and prognosis after transcatheter tricuspid valve repair. Clin Res Cardiol 2024:10.1007/s00392-024-02428-z. [PMID: 38446149 DOI: 10.1007/s00392-024-02428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is associated with chronic volume overload and right ventricular remodeling (RVR). Transcatheter tricuspid valve repair (TTVr) reduces TR and can improve quality of life (QoL), but the role of preprocedural RVR on TTVr outcomes remains unclear. AIMS To investigate the role of RVR on outcomes after TTVr for severe TR. METHODS Consecutive patients undergoing TTVr (61% edge-to-edge vs. 39% direct annuloplasty) for severe TR were retrospectively compared by preexisting RVR which was defined as dilation of RV mid-level diameter (> 35 mm) according to guidelines. QoL was evaluated using NYHA class, Minnesota Living with Heart Failure Questionnaire (MLHFQ), 36-Item Short Form Health Survey (SF-36), and 6-min walking distance (6MWD) 1-month after TTVr. Mid-term mortality and heart failure (HF) hospitalization were assessed through 1 year. RESULTS RVR was present in 137 of 223 patients (61%). Symptoms and QoL improved equally in both groups: ≥ 1 NYHA class (57% vs. 65% of patients with vs. without RVR, respectively), 6MWD (36% vs. 34%), MLHFQ (81% vs. 69%), and SF-36 (68% vs. 65%) improvement. One-year mortality and HF hospitalization were significantly higher in patients with RVR (24% and 30%, respectively) than in patients without (8% and 13%, both p < 0.05). In multivariable analysis, RVR was independently associated with mortality (HR 2.3, 95%CI (1.0-5.0), p = 0.04) and the combined endpoint of mortality or rehospitalization (HR 2.0, 95%CI (1.1-3.8), p = 0.03). CONCLUSIONS TTVr was associated with significant QoL improvement after 1 month, irrespective of RVR. Despite increased mortality and rehospitalization for heart failure, TTVr in the presence of RVR still provides substantial symptomatic benefit for patients with severe TR.
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Affiliation(s)
- Marc-André Ehrenfels
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Caroline Fretter
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Jennifer von Stein
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Maria Isabel Körber
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Hendrik Wienemann
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Stephan Baldus
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Roman Pfister
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Christos Iliadis
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
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Heif DM, Masa'Deh R, AbuRuz ME, Hamaideh SH, Rayan A, Al-Yateem N. The Effect of Benson's Relaxation Technique on Fatigue and Quality of Life of Patients Diagnosed With Heart Failure. Holist Nurs Pract 2024; 38:85-92. [PMID: 38363969 DOI: 10.1097/hnp.0000000000000632] [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: 02/18/2024]
Abstract
Patients with heart failure (HF) reported poor quality of life (QOL) due to different reasons among which fatigue is the most important. Improving QOL is a crucial objective for patients with HF and their primary health care providers. Managing fatigue with medication is not enough. Benson's relaxation technique (BRT) is a complementary therapy used to manage fatigue among different populations with limited studies checking its effect among patients diagnosed with HF. The purpose of this quasi-experimental study was to check the effect of BRT on fatigue and QOL among 140 (68 intervention and 72 control) patients diagnosed with HF. Intervention group performed BRT for 20 minutes twice a day for 2 months. Control group received regular care from their health care providers. At baseline, there were no differences between intervention and control groups regarding fatigue, physical component summary, and mental component summary. At follow-up, intervention group had higher scores in physical and mental component summaries than control group (45.48 ± 10.52 vs 37.97 ± 14.78) and (46.22 ± 8.39 vs 41.01 ± 10.36), respectively. Also, intervention group had lower levels of fatigue than control group (2.54 ± 0.87 vs 6.33 ± 0.61). In conclusion, the use of BRT as a complementary therapy for patients with HF might decrease fatigue level and improve QOL.
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Affiliation(s)
- Dunia M Heif
- Applied Science Private University, Amman, Jordan (Ms Heif); Psychiatric Mental Health, School of Nursing, Applied Science Private University, Amman, Jordan (Dr Masa'Deh); Critical Care Nursing, School of Nursing, Applied Science Private University, Amman, Jordan (Dr AbuRuz); Department of Community & Mental Health Nursing, Faculty of Nursing, Hashemite University, Zarqa, Jordan (Dr Hamaideh); Faculty of Nursing, Zarqa University, Jordan (Dr Rayan); and Department of Nursing, College of Health Sciences, University of Sharjah, United Arab Emirates (Dr Al-Yateem)
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Tian C, Zhang J, Rong J, Ma W, Yang H. Impact of nurse-led education on the prognosis of heart failure patients: A systematic review and meta-analysis. Int Nurs Rev 2024; 71:180-188. [PMID: 37335580 DOI: 10.1111/inr.12852] [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: 10/27/2022] [Accepted: 04/30/2023] [Indexed: 06/21/2023]
Abstract
AIM To perform a meta-analysis of randomized controlled trials to investigate the effect of nurse-led education on death, readmission, and quality of life in patients with heart failure. BACKGROUND The evidence of the effectiveness of nurse-led education in heart failure patients from randomized controlled trials is limited, and the results are inconsistent. Therefore, the impact of nurse-led education remains poorly understood, and more rigorous studies are needed. INTRODUCTION Heart failure is a syndrome associated with high morbidity, mortality, and hospital readmission. Authorities advocate nurse-led education to raise awareness of disease progression and treatment planning, as this could improve patients' prognosis. METHODS PubMed, Embase, and the Cochrane Library were searched up to May 2022 to retrieve relevant studies. The primary outcomes were readmission rate (all-cause or HF-related) and all-cause mortality. The secondary outcome was quality of life, evaluated by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), EuroQol-5D (EQ-5D), and visual analog scale for quality of life. RESULTS Although there was no significant association between the nursing intervention and all-cause readmissions [RR (95% CI) = 0.91 (0.79, 1.06), P = 0.231], the nursing intervention decreased HF-related readmission by 25% [RR (95% CI) = 0.75 (0.58, 0.99), P = 0.039]. The e nursing intervention reduced all-cause readmission or mortality as a composite endpoint by 13% [RR (95% CI) = 0.87 (0.76, 0.99), P = 0.029]. In the subgroup analysis, we found that home nursing visits reduced HF-related readmissions [RR (95% CI) = 0.56 (0.37, 0.84), P = 0.005]. In addition, the nursing intervention improved the quality of life in MLHFQ and EQ-5D [standardized mean differences (SMD) (95% CI) = 3.38 (1.10, 5.66), 7.12 (2.54, 11.71), respectively]. DISCUSSION The outcome variation between studies may be due to reporting methods, comorbidities, and medication management education. Patient outcomes and quality of life may also vary between different educational approaches. Limitations of this meta-analysis stem from the incomplete reporting of information from the original studies, the small sample size, and the inclusion of English language literature only. CONCLUSION Nurse-led education programs significantly impact HF-related readmission rates, all-cause readmission, and mortality rates in patients with HF. IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICIES The results suggest stakeholders should allocate resources to develop nurse-led education programs for HF patients.
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Affiliation(s)
- Chun Tian
- Department of Stomatology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian Zhang
- Department of Stomatology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Junmei Rong
- Department of Stomatology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wenhui Ma
- Department of Stomatology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hui Yang
- Department of Nursing, First Hospital of Shanxi Medical University, Taiyuan, China
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Figueroa-Valverde L, Rosas-Nexticapa M, Alvarez-Ramirez M, Melgarejo-Gutiérrez M, Mateu-Armand V, Garcimarrero-Espino A. Biological Activity of a Coumarin Derivative on Heart Failure Using an Ischemia/Reperfusion Injury Model. Drug Res (Stuttg) 2024; 74:47-52. [PMID: 38232750 DOI: 10.1055/a-2228-4258] [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: 01/19/2024]
Abstract
Heart failure is a health problem worldwide. There are some drugs for it, including digoxin, spironolactone, captopril, and valsartan, but some of these drugs can produce secondary effects, such as arrhythmia, cough, hyperkalemia, hyponatremia and hypotension. The aim of this research was to evaluate the biological activity of coumarin (2H-chromen-2-one) and its derivatives (3BrAcet-C, 3-4Br-Ph-C, 4-CN-7D-C, 4-Me-7-Ph-C and 6Br-3-D-C) against ischemia/reperfusion injury as a therapeutic alternative for heart failure. In addition, the biological activity of the coumarin derivative 4-Me-7-Ph-C on left ventricular pressure (LVP) was determined in the absence or presence of ouabain and nifedipine at a dose of 1 nM using an isolated rat heart model. The results showed that i) the coumarin derivative 4-Me-7-Ph-C significantly decreased the infarct area (p+=+0.05) compared with 3BrAcet-C, 3-4Br-Ph-C, 4-CN-7D-C, and 6Br-3-D-C; and ii) 4-Me-7-Ph-C increased LVP in a dose-dependent manner, which effect was inhibited by nifedipine. These data suggest that coumarin 4-Me-7-Ph-C may act as a type-L calcium channel activator, so it could be a good agent to treat heart failure.
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Affiliation(s)
- Lauro Figueroa-Valverde
- Laboratory of Pharmaco-Chemistry, Faculty of Chemical Biological Sciences, University Autonomous of Campeche, Campeche, Camp., Mexico
| | | | | | | | - Virginia Mateu-Armand
- Faculty of Nutrition, Universidad Veracruzana, Unidad del Bosque Xalapa Veracruz, Mexico
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Boeckmans J, Sandrin L, Knackstedt C, Schattenberg JM. Liver stiffness as a cornerstone in heart disease risk assessment. Liver Int 2024; 44:344-356. [PMID: 38014628 DOI: 10.1111/liv.15801] [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: 09/25/2023] [Revised: 11/05/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) typically presents with hepatic fibrosis in advanced disease, resulting in increased liver stiffness. A subset of patients further develops liver cirrhosis and hepatocellular carcinoma. Cardiovascular disease is a common comorbidity in patients with MASLD and its prevalence is increasing in parallel. Recent evidence suggests that especially liver stiffness, whether or not existing against a background of MASLD, is associated with heart diseases. We conducted a narrative review on the role of liver stiffness in the prediction of highly prevalent heart diseases including heart failure, cardiac arrhythmias (in particular atrial fibrillation), coronary heart disease, and aortic valve sclerosis. Research papers were retrieved from major scientific databases (PubMed, Web of Science) until September 2023 using 'liver stiffness' and 'liver fibrosis' as keywords along with the latter cardiac conditions. Increased liver stiffness, determined by vibration-controlled transient elastography or hepatic fibrosis as predicted by biomarker panels, are associated with a variety of cardiovascular diseases, including heart failure, atrial fibrillation, and coronary heart disease. Elevated liver stiffness in patients with metabolic liver disease should lead to considerations of cardiac workup including N-terminal pro-B-type natriuretic peptide/B-type natriuretic peptide determination, electrocardiography, and coronary computed tomography angiography. In addition, patients with MASLD would benefit from heart disease case-finding strategies in which liver stiffness measurements can play a key role. In conclusion, increased liver stiffness should be a trigger to consider a cardiac workup in metabolically compromised patients.
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Affiliation(s)
- Joost Boeckmans
- Metabolic Liver Research Center, I. Department of Medicine, University Medical Center Mainz, Mainz, Germany
- In Vitro Liver Disease Modelling Team, Department of In Vitro Toxicology and Dermato-Cosmetology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Christian Knackstedt
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands
- Faculty of Health, Medicine, and Life Sciences, CARIM School for Cardiovascular Diseases, Maastricht, the Netherlands
| | - Jörn M Schattenberg
- Metabolic Liver Research Center, I. Department of Medicine, University Medical Center Mainz, Mainz, Germany
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
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Butler J, Khan MS, Gasior T, Erickson TR, Vlajnic V, Kramer F, Blaustein RO, Goldsbury D, Roessig L, Lam CS, Anstrom KJ, Armstrong PW. Accelerometer vs. other activity measures in heart failure with preserved ejection fraction: the VITALITY-HFpEF trial. ESC Heart Fail 2024; 11:293-298. [PMID: 37985002 PMCID: PMC10804173 DOI: 10.1002/ehf2.14572] [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: 06/26/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023] Open
Abstract
AIMS The relationship between accelerometry data and changes in Kansas City Cardiomyopathy Questionnaire-Physical Limitation Score (KCCQ-PLS) or 6 min walk test (6MWT) is not well understood. METHODS AND RESULTS VITALITY-HFpEF accelerometry substudy (n = 69) data were assessed at baseline and 24 weeks. Ordinal logistic regression models were used to assess the association between accelerometry activity and deterioration, improved, or unchanged KCCQ-PLS (≥8.33 and ≤ -4.17 points) and 6MWT (≥32 vs. ≤ -32 m). KCCQ-PLS score deteriorated in 16 patients, improved in 34, and was unchanged in 19. 6MWT deteriorated in 8 patients, improved in 21, and was unchanged in 19. Mean accelerometer wear was 21.4 (±2.1) h/day. Changes in hours active from baseline to 24 weeks were not significantly different among patients who exhibited deterioration, improvement, or no change in KCCQ-PLS [odds ratio (OR) 0.91, 95% confidence interval (CI) 0.71-1.18; P = 0.48] or 6MWT (OR 1.21, 95% CI 0.91-1.60; P = 0.18). Similar lack of association was observed for other accelerometry metrics and change in KCCQ and 6MWT. These findings were unaffected when KCCQ and 6MWT were examined as continuous variables. CONCLUSIONS Accelerometer-based activity measures did not correlate with subjective or objective standard measures of health status and functional capacity in heart failure with preserved ejection fraction. Further investigation of their relationships to clinical outcomes is required.
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Affiliation(s)
- Javed Butler
- Baylor Scott and White Research InstituteDallasTXUSA
- University of Mississippi Medical CenterJacksonMSUSA
| | | | - Tomasz Gasior
- Boehringer Ingelheim International GmbHIngelheimGermany
| | - Tyler R. Erickson
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNCUSA
| | | | | | | | | | | | - Carolyn S.P. Lam
- National Heart Centre Singapore and Duke‐National University of SingaporeSingapore
| | | | - Paul W. Armstrong
- Canadian VIGOUR CentreUniversity of AlbertaKatz Group Centre for Pharmacy and Health Research, 4‐120EdmontonT6G 2E1ABCanada
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Möckel M, Pudasaini S, Baberg HT, Levenson B, Malzahn J, Mansky T, Michels G, Günster C, Jeschke E. Oral anticoagulation in heart failure complicated by atrial fibrillation: A nationwide routine data study. Int J Cardiol 2024; 395:131434. [PMID: 37827285 DOI: 10.1016/j.ijcard.2023.131434] [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: 08/16/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND This nationwide routine data analysis evaluates if oral anticoagulant (OAC) use in patients with heart failure (HF) and atrial fibrillation (AF) leads to a lower mortality and reduced readmission rate. Superiority of new oral anticoagulants (NOACs), compared to vitamin K antagonists (VKA), was analyzed for these endpoints. METHODS Anonymous data of patients with a health insurance at the Allgemeine Ortskrankenkasse and a claims record for hospitalization with the main diagnosis of HF and secondary diagnosis of AF (2017-2019) were included. A hospital stay in the previous year was an exclusion criterion. Mortality and readmission for all-cause and stroke/intracranial bleeding (ICB) were analyzed 91-365 days after the index hospitalization. Kaplan-Meier survival curves and multivariable Cox regression models were used to evaluate the impact of medication on outcome. RESULTS 180,316 cases were included [81 years (IQR 76-86), 55.6% female, CHA2DS2-VASc score ≥ 2 (96.81%)]. In 80.6%, OACs were prescribed (VKA: 21.7%; direct factor Xa inhibitors (FXaI): 60.0%; direct thrombin inhibitors (DTI): 3.4%; with multiple prescriptions per patient included). Mortality rate was 19.1%, readmission rate was 29.9% and stroke/ICB occurred in 1.9%. Risk of death was lower with any OAC (HR 0.77, 95% CI [0.75-0.79]) but without significant differences in OAC type (VKA: HR 0.73, [0.71-0.76]; FXaI: HR 0.77, [0.75-0.78]; DTI: HR 0.71, [0.66-0.77]). The total readmission rate (HR 0.97, [0.94 to 0.99]) and readmission for stroke/ICB (HR 0.71, [0.65-0.77]) was lower with OAC. CONCLUSIONS Nationwide data confirm a reduction in mortality and readmission rate in HF-AF patients taking OACs, without NOAC superiority.
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Affiliation(s)
- Martin Möckel
- Department of Emergency and Acute Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, 13353/10117 Berlin, Germany.
| | - Samipa Pudasaini
- Department of Emergency and Acute Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, 13353/10117 Berlin, Germany
| | - Henning Thomas Baberg
- Department of Cardiology and Nephrology, Helios Klinikum, Berlin-Buch, 13125 Berlin, Germany
| | - Benny Levenson
- German Society of Cardiologists in Private Practise (BNK), 10627 Berlin, Germany
| | - Jürgen Malzahn
- Federal Association of the Local Health Care Funds (AOK), 10178 Berlin, Germany
| | - Thomas Mansky
- Faculty of Economics and Management, Division of Structural Development and Quality Management in Healthcare, Technische Universität Berlin, 10623 Berlin, Germany
| | - Guido Michels
- Clinic for Acute and Emergency Medicine, St. Antonius Hospital Eschweiler, 52249 Eschweiler, Germany
| | - Christian Günster
- Research Institute of the Local Health Care Funds (WIdO), 10178 Berlin, Germany
| | - Elke Jeschke
- Research Institute of the Local Health Care Funds (WIdO), 10178 Berlin, Germany
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Zhang J, Dong F, Wang Y, Wang C, Zhang C, Xu K, Shen T, Lou H. N-acetyldopamine oligomers from Periplaneta americana with anti-inflammatory and vasorelaxant effects and their spatial distribution visualized by mass spectrometry imaging. JOURNAL OF ETHNOPHARMACOLOGY 2024; 318:116989. [PMID: 37532069 DOI: 10.1016/j.jep.2023.116989] [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: 05/13/2023] [Revised: 07/22/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Periplaneta americana is a medicinal insect that has been applied to promote blood circulation and remove blood stasis based on traditional Chinese medicine (TCM) for a long time. Its modern preparation, Xinmailong injection, was adopted for the treatment of congestive heart failure (CHF). The bioactive constituents of P. americana and their correlation with its traditional uses need further investigation. AIM OF THE STUDY This study aimed to elucidate the N-acetyldopamine (NADA) oligomers from P. american, determine their spatial distribution, and investigate their anti-inflammatory and vasorelaxant effects to provide scientific evidence supporting the clinical use of this medicinal insect. MATERIAL AND METHODS NADA oligomers were isolated from the CH2Cl2: CH3OH (2:1) extract of P. americana, through sequential chromatographic methods including silica gel, Sephadex LH-20, preparative HPLC, and chiral-phase separation. Their structures were determined by HRESIMS, 1D and 2D NMR spectroscopic analysis, chiral resolution, and calculated electronic circular dichroism analysis. With the aid of atmospheric pressure scanning matrix-assisted laser desorption/ionization mass spectrometry imaging (AP-SMALDI MSI), the isolated compounds in a spatial profile within P. americana were identified. NO production was measured to assess anti-inflammatory activity. Vasorelaxant activity assessments were performed on the norepinephrine-precontracted 3rd-order mesenteric arteries. RESULTS Seven new NADA trimers, peridopamines A-G (1-7), two new NADA dimers, peridopamines H and I (8 and 9), and six known NADA derivatives (10-15), were obtained from P. americana. The trimers and dimers were detected and showed similar pattern of distribution with accumulation in peripheral and rigid parts of P. americana, based on quasimolecular ion AP-SMALDI MS images of sections from the whole body and dissected areas of the insect. Furthermore, the anti-inflammatory and vasorelaxant effects of isolated compounds were investigated. Compounds 8 and 9 presented significant and moderate anti-inflammatory potentials, respectively. Compounds 8, 10, 12 and 15 possess significant vasorelaxant potentials at concentrations correlated with EC50 values of 6.7-23.7 μM. CONCLUSION Fifteen NADA oligomers were isolated from P. americana. The distribution of these compounds was visualized by AP-SMALDI imaging experiments and NADA oligomers were mainly observed in peripheral parts. Bioassays showed that the tested compounds had anti-inflammatory and vasorelaxant activities, which indicated that NADA oligomers are active ingredients of this insect-based TCM and have potential for the treatment of cardiovascular disease.
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Affiliation(s)
- Jiaozhen Zhang
- Department of Natural Products Chemistry, Key Lab of Chemical Biology (MOE), School of Pharmaceutical Sciences, Shandong University, No. 44 West Wenhua Road, Jinan, 250012, PR China
| | - Fangfang Dong
- Department of Natural Products Chemistry, Key Lab of Chemical Biology (MOE), School of Pharmaceutical Sciences, Shandong University, No. 44 West Wenhua Road, Jinan, 250012, PR China
| | - Yongjie Wang
- Department of Natural Products Chemistry, Key Lab of Chemical Biology (MOE), School of Pharmaceutical Sciences, Shandong University, No. 44 West Wenhua Road, Jinan, 250012, PR China; Department of Pharmacy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, PR China
| | - Chan Wang
- Department of Natural Products Chemistry, Key Lab of Chemical Biology (MOE), School of Pharmaceutical Sciences, Shandong University, No. 44 West Wenhua Road, Jinan, 250012, PR China
| | - Chengmin Zhang
- Department of Natural Products Chemistry, Key Lab of Chemical Biology (MOE), School of Pharmaceutical Sciences, Shandong University, No. 44 West Wenhua Road, Jinan, 250012, PR China
| | - Ke Xu
- Department of Natural Products Chemistry, Key Lab of Chemical Biology (MOE), School of Pharmaceutical Sciences, Shandong University, No. 44 West Wenhua Road, Jinan, 250012, PR China
| | - Tao Shen
- Department of Natural Products Chemistry, Key Lab of Chemical Biology (MOE), School of Pharmaceutical Sciences, Shandong University, No. 44 West Wenhua Road, Jinan, 250012, PR China
| | - Hongxiang Lou
- Department of Natural Products Chemistry, Key Lab of Chemical Biology (MOE), School of Pharmaceutical Sciences, Shandong University, No. 44 West Wenhua Road, Jinan, 250012, PR China.
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Ventoulis I, Kamperidis V, Abraham MR, Abraham T, Boultadakis A, Tsioukras E, Katsiana A, Georgiou K, Parissis J, Polyzogopoulou E. Differences in Health-Related Quality of Life among Patients with Heart Failure. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:109. [PMID: 38256370 PMCID: PMC10818915 DOI: 10.3390/medicina60010109] [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: 11/16/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Heart failure (HF) is characterized by a progressive clinical course marked by frequent exacerbations and repeated hospitalizations, leading to considerably high morbidity and mortality rates. Patients with HF present with a constellation of bothersome symptoms, which range from physical to psychological and mental manifestations. With the transition to more advanced HF stages, symptoms become increasingly more debilitating, interfere with activities of daily living and disrupt multiple domains of life, including physical functioning, psychological status, emotional state, cognitive function, intimate relationships, lifestyle status, usual role activities, social contact and support. By inflicting profuse limitations in numerous aspects of life, HF exerts a profoundly negative impact on health-related quality of life (HRQOL). It is therefore not surprising that patients with HF display lower levels of HRQOL compared not only to the general healthy population but also to patients suffering from other chronic diseases. On top of this, poor HRQOL in patients with HF becomes an even greater concern considering that it has been associated with unfavorable long-term outcomes and poor prognosis. Nevertheless, HRQOL may differ significantly among patients with HF. Indeed, it has consistently been reported that women with HF display poorer HRQOL compared to men, while younger patients with HF tend to exhibit lower levels of HRQOL than their older counterparts. Moreover, patients presenting with higher New York Heart Association (NYHA) functional class (III-IV) have significantly more impaired HRQOL than those in a better NYHA class (I-II). Furthermore, most studies report worse levels of HRQOL in patients suffering from HF with preserved ejection fraction (HFpEF) compared to patients with HF with reduced ejection fraction (HFrEF) or HF with mildly reduced ejection fraction (HFmrEF). Last, but not least, differences in HRQOL have been noted depending on geographic location, with lower HRQOL levels having been recorded in Africa and Eastern Europe and higher in Western Europe in a recent large global study. Based on the observed disparities that have been invariably reported in the literature, this review article aims to provide insight into the underlying differences in HRQOL among patients with HF. Through an overview of currently existing evidence, fundamental differences in HRQOL among patients with HF are analyzed based on sex, age, NYHA functional class, ejection fraction and geographic location or ethnicity.
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Affiliation(s)
- Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St Kiriakidi 1, 54636 Thessaloniki, Greece;
| | - Maria Roselle Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, USA; (M.R.A.); (T.A.)
| | - Theodore Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, USA; (M.R.A.); (T.A.)
| | - Antonios Boultadakis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
| | - Efthymios Tsioukras
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Aikaterini Katsiana
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Konstantinos Georgiou
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
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Sethi S, Ravindhran B, Long J, Gurung R, Huang C, Smith GE, Carradice D, Wallace T, Ibeggazene S, Chetter IC, Pymer S. A preoperative supervised exercise program potentially improves long-term survival after elective abdominal aortic aneurysm repair. J Vasc Surg 2024; 79:15-23.e3. [PMID: 37714500 DOI: 10.1016/j.jvs.2023.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE A preoperative supervised exercise program (SEP) improves cardiorespiratory fitness and perioperative outcomes for patients undergoing elective abdominal aortic aneurysm (AAA) repair. The aim of this study was to assess the effect of a preoperative SEP on long-term survival of these patients. A secondary aim was to consider long-term changes in cardiorespiratory fitness and quality of life. METHODS Patients scheduled for open or endovascular AAA repair were previously randomized to either a 6-week preoperative SEP or standard management, and a significant improvement in a composite outcome of cardiac, pulmonary, and renal complications was seen following SEP. For the current analysis, patients were followed up to 5 years post-surgery. The primary outcome for this analysis was all-cause mortality. Data were analyzed on an intention to treat (ITT) and per protocol (PP) basis, with the latter meaning that patients randomized to SEP who did not attend any sessions were excluded. The PP analysis was further interrogated using a complier average causal effect (CACE) analysis on an all or nothing scale, which adjusts for compliance. Additionally, patients who agreed to follow-up attended the research center for cardiopulmonary exercise testing and/or provided quality of life measures. RESULTS ITT analysis demonstrated that the primary endpoint occurred in 24 of the 124 participants at 5 years, with eight in the SEP group and 16 in the control group (P = .08). The PP analysis demonstrated a significant survival benefit associated with SEP attendance (4 vs 16 deaths; P = .01). CACE analysis confirmed a significant intervention effect (hazard ratio, 0.36; 95% confidence interval, 0.16-0.90; P = .02). There was no difference between groups for cardiorespiratory fitness measures and most quality of life measures. CONCLUSIONS These novel findings suggest a long-term mortality benefit for patients attending a SEP prior to elective AAA repair. The underlying mechanism remains unknown, and this merits further investigation.
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Affiliation(s)
- Sifut Sethi
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | | | - Judith Long
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | - Roji Gurung
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | - Chao Huang
- Institute for Applied Clinical and Health Research, Hull York Medical School, Hull, United Kingdom
| | - George E Smith
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | - Daniel Carradice
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | - Tom Wallace
- Leeds Vascular Institute, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Said Ibeggazene
- College of Health, Wellbeing, and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
| | - Sean Pymer
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom.
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Al-Sutari MM, Abdalrahim MS. Symptom Burden and Quality of Life Among Patients With Heart Failure. SAGE Open Nurs 2024; 10:23779608241242023. [PMID: 38559894 PMCID: PMC10981229 DOI: 10.1177/23779608241242023] [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: 11/27/2023] [Revised: 02/16/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Heart failure is a debilitating condition that is associated with several burdensome symptoms that impede patients' quality of life. However, patients' experience of distressing symptoms and their impacts on their quality of life is not studied in Jordan. Objectives To assess the severity of distressing symptoms and to assess the relationships between these symptoms and the quality of life among patients with heart failure in Jordan. Methods A descriptive cross-sectional design was used. A convenience sampling approach was used to recruit the participants. Heart failure patients (n = 167) who visited the outpatient clinics in three hospitals in Amman between July and November 2021 were included. The Edmonton Symptom Assessment System and Short-Form 36 tool were used. Results Participants were more likely males with a mean age of 55.2 years (SD = 13.7). The most distressing symptoms among patients with heart failure were tiredness (M = 4.56, SD = 3.24), worse well-being (M = 4.34, SD = 2.52), and drowsiness (M = 3.5, SD = 3.06), respectively. Symptoms burden were negatively associated with the physical and the mental components summary of the quality of life. Pain, tiredness, nausea, loss of appetite, anxiety, and poor well-being were significant predictors of the physical components. The predictors of the mental components were tiredness, nausea, loss of appetite, and anxiety. Conclusions This study revealed that patients with heart failure facing significant symptom burden. The patients showed inadequate quality of life in both physical and mental components that were inversely associated with symptom burden. Given the debilitating effects of symptom burden on heart failure patients' quality of life, therefore, symptom assessment and management have to be a priority.
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Affiliation(s)
- Manal Mohammed Al-Sutari
- Acute and Chronic Care Nursing Department, Faculty of Nursing, Al-Ahliyya Amman University, Amman, Jordan
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Cheng CH, Hsu CH, Sie JR, Tsay SL, Tung HH. The Relationship Between Resilience and Health-Related Quality of Life Among Heart Failure Patients in New York Heart Association Functional Classes II and III. J Nurs Res 2024; 32:e312. [PMID: 38271064 DOI: 10.1097/jnr.0000000000000594] [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: 01/27/2024] Open
Abstract
BACKGROUND Heart failure is an intense, unpredictable, and stressful chronic disease caused by the decline in cardiac pumping function. The influence of heart failure affects patients not only in terms of physical capabilities but also in terms of their emotional and social dimensions, with patients in different functional classes experiencing different levels of effect. Although resilience and health-related quality of life have been studied in populations with heart failure, the scholarly understanding of different functional classes is limited. PURPOSE This study was designed to investigate the relationship between resilience and health-related quality of life among patients with heart failure in different physical functional classes in Taiwan. METHODS A cross-sectional design was applied to study patients with heart failure in northern Taiwan. Two structured questionnaires, including the Resilience Scale for Adults and the 12-item Short Form Health Survey, were used to assess resilience and health-related quality of life. New York Heart Association functional class was used to determine physical function status, and canonical correlation analysis was used to determine the weight of each resilience and quality-of-life domain for the different functional classes. RESULTS The 100 participants had an average age of 65.52 years. Slightly over half (56%) were classified as Functional Class II. A group difference in health-related quality of life was observed. Personal strength (rs = .759) and social competence (rs = -.576) were found to influence the resilience and emotional role dimension of quality of life (rs = -.996) in the Functional Class II group. In addition, family cohesion (rs = -.922), dominant resilience, physical function (rs = .467), and bodily pain (rs = .465) were found to influence quality of life in the Functional Class III group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The efficacy of measures taken to increase resilience to heart failure varied in patients in different functional classes. Functional Class II individuals were better able to manage the disease using their personal strength, whereas Functional Class III individuals relied more heavily on family support and assistance for this effort. Furthermore, participant feelings about quality of life also varied by functional class, with physical function and bodily pain taking on significantly more importance for Functional Class III individuals.
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Affiliation(s)
- Ching-Hui Cheng
- MSN, RN, Deputy Chief of Cardiac Nursing Department, Heart Center, Cheng-Hsin General Hospital, Taiwan, ROC
| | - Ching-Hwa Hsu
- PhD, RN, NP, Assistant Professor, School of Nursing, College of Medicine, Chang Gung University, Taiwan, ROC
| | - Jia-Rong Sie
- MSN, RN, NP, Doctoral Student, Department of Nursing, National Yang Ming Chiao Tung University, and Nurse Practitioner, Department of Emergency Medicine, National Taiwan University Hospital, Taiwan, ROC
| | - Shiow-Luan Tsay
- PhD, RN, APN, Professor, College of Nursing & Health Sciences, Da-Yeh University, Taiwan, ROC
| | - Heng-Hsin Tung
- PhD, RN, FNP, DNP, Distinguished Professor, Department of Nursing, National Yang Ming Chiao Tung University, and Adjunct Nursing Consultant, Tungs' Taichung MetroHarbor Hospital, Taiwan, ROC
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Abuş S. Relationship Between Pulmonary Artery Pressure and Inflammation Parameters. Cureus 2024; 16:e52427. [PMID: 38371031 PMCID: PMC10870339 DOI: 10.7759/cureus.52427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Background Inflammation can play a role in the development and progression of pulmonary hypertension (PHT). In this study, inflammatory parameters were compared in congestive heart failure (CHF) patients with and without PHT. The relationship between pulmonary artery pressure (PAP) and inflammatory parameters was investigated. Materials and methods Out of 80 CHF patients, 40 had PHT. The patients' age, gender, smoking status, comorbidities such as diabetes mellitus (DM) and hypertension (HT), and mortality rates were recorded. Inflammatory parameters were recorded. Results The mean age of the PHT group was 64.38 ± 9.17 and the mean age of the non-PHT group was 64.70 ± 8.99. There were 23 men and 17 women in the PHT group, and there were 21 men and 19 women in the non-PHT group. There was no significant difference between the two groups in terms of mean age and gender distribution (p = 0.874 and p = 0.653). Accordingly, the C-reactive protein to albumin ratio (CAR) value was statistically significantly higher in PHT patients (p = 0.023). The eosinophil count was found to be significantly higher in non-PHT patients (p = 0.015). Accordingly, a significant correlation was detected between CAR and PAP (r = 0.392 and p < 0.001). Conclusion In this study, the positive correlation between PAP and CAR and the significantly higher CAR value in PHT patients indicate the presence of inflammation in PHT patients. Studies on the relationship between inflammation and mortality in PHT patients may contribute more to the literature in the future.
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Affiliation(s)
- Sabri Abuş
- Cardiology, Adıyaman University, Adıyaman, TUR
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Wice M, Rudolph JL, Jiang L, Edmonson HM, Page JS, Wu WC, Defillo-Draiby J. Trends in Palliative Care Utilization in Deceased Veterans With Heart Failure. Palliat Med Rep 2023; 4:344-349. [PMID: 38155911 PMCID: PMC10754341 DOI: 10.1089/pmr.2023.0067] [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] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Background Specialist-level palliative care in the final days does not allow time to alleviate symptoms and suffering. This analysis examined the change in the time from initial specialty-level palliative care to death among Veterans with heart failure. Methods This retrospective cohort study examined Veterans with a diagnosis of heart failure (HF) who died between 2011 and 2021. We examined the decedents from each year as a separate cohort. The primary outcome was time from specialty-level palliative care (SPC) encounter to death in the year death occurred. Results Of the cohort (n = 232,079), 56.5% did not receive SPC. Specialist-level palliative care >90 days before death more than doubled from 10.1% (2011) to 26.2% (2021), and Specialist-level palliative care in the last day of life was cut from 2.5% to 0.9%. Conclusion For Veterans with HF, specialist-level palliative care moved earlier in the disease course and has a substantial growth opportunity.
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Affiliation(s)
- Mitchell Wice
- Center of Innovation in Long Term Services and Support, Providence VA Healthcare System, Providence, Rhode Island, USA
- Geriatrics and Extended Care, Providence VA Healthcare System, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James L. Rudolph
- Center of Innovation in Long Term Services and Support, Providence VA Healthcare System, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Center for Gerontology and Health Services Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Support, Providence VA Healthcare System, Providence, Rhode Island, USA
| | - Hal M. Edmonson
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John S. Page
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Wen Chih Wu
- Center of Innovation in Long Term Services and Support, Providence VA Healthcare System, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Julio Defillo-Draiby
- Center of Innovation in Long Term Services and Support, Providence VA Healthcare System, Providence, Rhode Island, USA
- Geriatrics and Extended Care, Providence VA Healthcare System, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Lund LH, Crespo-Leiro MG, Laroche C, Garcia-Pinilla JM, Bennis A, Vataman EB, Polovina M, Radovanovic S, Apostolovic SR, Ašanin M, Gackowski A, Kaplon-Cieslicka A, Cabac-Pogorevici I, Anker SD, Chioncel O, Coats AJS, Filippatos G, Lainscak M, Mcdonagh T, Mebazaa A, Metra M, Piepoli M, Rosano GM, Ruschitzka F, Savarese G, Seferović PM, Iung B, Popescu BA, Maggioni AP. Rationale and design of the ESC Heart Failure III Registry - Implementation and discovery. Eur J Heart Fail 2023; 25:2316-2330. [PMID: 37990135 DOI: 10.1002/ejhf.3087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/31/2023] [Accepted: 11/04/2023] [Indexed: 11/23/2023] Open
Abstract
AIMS Heart failure outcomes remain poor despite advances in therapy. The European Society of Cardiology Heart Failure III Registry (ESC HF III Registry) aims to characterize HF clinical features and outcomes and to assess implementation of guideline-recommended therapy in Europe and other ESC affiliated countries. METHODS Between 1 November 2018 and 31 December 2020, 10 162 patients with chronic or acute/worsening HF with reduced, mildly reduced, or preserved ejection fraction were enrolled from 220 centres in 41 European or ESC affiliated countries. The ESC HF III Registry collected data on baseline characteristics (hospital or clinic presentation), hospital course, diagnostic and therapeutic decisions in hospital and at the clinic visit; and on outcomes at 12-month follow-up. These data include demographics, medical history, physical examination, biomarkers and imaging, quality of life, treatments, and interventions - including drug doses and reasons for non-use, and cause-specific outcomes. CONCLUSION The ESC HF III Registry will provide comprehensive and unique insight into contemporary HF characteristics, treatment implementation, and outcomes, and may impact implementation strategies, clinical discovery, trial design, and public policy.
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Affiliation(s)
- Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Generosa Crespo-Leiro
- Department of Cardiology, Hospital Universitario A Coruña (CHUAC), A Coruña, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña (UDC), A Coruña, Spain
- Instituto Investigación Biomedica A Coruña (INIBIC), A Coruña, Spain
| | - Cecile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France
| | - Jose M Garcia-Pinilla
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga Biomedical Research Institute (IBIMA), Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Ahmed Bennis
- Department of Cardiology, Ibn Rochd University Center, Casablanca, Morocco
| | - Eleonora B Vataman
- Heart Failure Department, Institute of Cardiology, Chișinău, Moldova
- Cardiac Rehabilitation Department, Institute of Cardiology, Chișinău, Moldova
| | - Marija Polovina
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - Slavica Radovanovic
- Department of Cardiology, Heart Failure Center, University Hospital Center 'Dr Dragisa Misovic-Dedinje', Belgrade, Serbia
| | - Svetlana R Apostolovic
- Department of Cardiology, University Clinical Centre of Serbia, Nis, Serbia
- Medical School, University Clinical Centre of Serbia, Nis, Serbia
| | - Milika Ašanin
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - Andrzej Gackowski
- Department of Coronary Disease and Heart Failure, Jagiellonian University, Medical College, John Paul II Hospital, Krakow, Poland
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland
| | | | - Irina Cabac-Pogorevici
- Department of Cardiology, State University of Medicine and Pharmacy 'Nicolae Testemitanu', Chișinău, Moldova
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité, Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ovidiu Chioncel
- 1st Cardiology Department, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania
- University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Andrew J S Coats
- Office of the CEO, Heart Research Institute, Sydney, NSW, Australia
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian, University of Athens, Athens, Greece
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Theresa Mcdonagh
- Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Alexandre Mebazaa
- Anaethesia and Critical Care, APHP, Hôpital Lariboisière, Paris, France
- Burn and the multi-organ retrieval, APHP, Hôpital Saint Louis, Paris, France
- Cardiovascular MArkers in Stressed COndiTions, UMRS INSERM 942, Université Paris-Cité, Paris, France
| | - Marco Metra
- Department of Cardiology, Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Cardiology, ASST Spedali Civili, Brescia, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe M Rosano
- Department of Medical Sciences, IRCCS Ospedale San Raffaele, Rome, Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Gianluigi Savarese
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petar M Seferović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Bernard Iung
- Department of Cardiology, APHP, Hôpital Bichat Claude-Bernard, Paris, France
- LVTS INSERM 1148, Université Paris-Cité, Paris, France
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
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Chatur S, Vaduganathan M, Claggett BL, Cunningham JW, Docherty KF, Desai AS, Jhund PS, de Boer RA, Hernandez AF, Inzucchi SE, Kosiborod MN, Lam CS, Martinez FA, Shah SJ, Petersson M, Langkilde AM, McMurray JJ, Solomon SD. Outpatient Worsening Among Patients With Mildly Reduced and Preserved Ejection Fraction Heart Failure in the DELIVER Trial. Circulation 2023; 148:1735-1745. [PMID: 37632455 PMCID: PMC10664793 DOI: 10.1161/circulationaha.123.066506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Hospitalization is recognized as a sentinel event in the disease trajectory of patients with heart failure (HF), but not all patients experiencing clinical decompensation are ultimately hospitalized. Outpatient intensification of diuretics is common in response to symptoms of worsening HF, yet its prognostic and clinical relevance, specifically for patients with HF with mildly reduced or preserved ejection fraction, is uncertain. METHODS In this prespecified analysis of the DELIVER trial (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure), we assessed the association between various nonfatal worsening HF events (those requiring hospitalization, urgent outpatient visits requiring intravenous HF therapies, and outpatient oral diuretic intensification) and rates of subsequent mortality. We further examined the treatment effect of dapagliflozin on an expanded composite end point of cardiovascular death, HF hospitalization, urgent HF visit, or outpatient oral diuretic intensification. RESULTS In DELIVER, 4532 (72%) patients experienced no worsening HF event, whereas 789 (13%) had outpatient oral diuretic intensification, 86 (1%) required an urgent HF visit, 585 (9%) had an HF hospitalization, and 271 (4%) died of cardiovascular causes as a first presentation. Patients with a first presentation manifesting as outpatient oral diuretic intensification experienced rates of subsequent mortality that were higher (10 [8-12] per 100 patient-years) than those without a worsening HF event (4 [3-4] per 100 patient-years) but similar to rates of subsequent death after an urgent HF visit (10 [6-18] per 100 patient-years). Patients with an HF hospitalization as a first presentation of worsening HF had the highest rates of subsequent death (35 [31-40] per 100 patient-years). The addition of outpatient diuretic intensification to the adjudicated DELIVER primary end point (cardiovascular death, HF hospitalization, or urgent HF visit) increased the overall number of patients experiencing an event from 1122 to 1731 (a 54% increase). Dapagliflozin reduced the need for outpatient diuretic intensification alone (hazard ratio, 0.72 [95% CI, 0.64-0.82]) and when analyzed as a part of an expanded composite end point of worsening HF or cardiovascular death (hazard ratio, 0.76 [95% CI, 0.69-0.84]). CONCLUSIONS In patients with HF with mildly reduced or preserved ejection fraction, worsening HF requiring oral diuretic intensification in ambulatory care was frequent, adversely prognostic, and significantly reduced by dapagliflozin. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03619213.
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Affiliation(s)
- Safia Chatur
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
| | - Brian L. Claggett
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
| | - Jonathan W. Cunningham
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
| | - Kieran F. Docherty
- BHF Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health University of Glasgow, Scotland (K.F.D., P.S.J., J.J.V.M.)
| | - Akshay S. Desai
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
| | - Pardeep S. Jhund
- BHF Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health University of Glasgow, Scotland (K.F.D., P.S.J., J.J.V.M.)
| | - Rudolf A. de Boer
- Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands (R.A.d.B.)
| | | | | | - Mikhail N. Kosiborod
- Saint Luke’s Mid America Heart Institute and University of Missouri-Kansas City (M.N.K.)
| | - Carolyn S.P. Lam
- National Heart Centre Singapore & Duke-National University of Singapore (C.S.P.L.)
| | | | - Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (M.P., A.M.K.)
| | - Anna Maria Langkilde
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
- BHF Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health University of Glasgow, Scotland (K.F.D., P.S.J., J.J.V.M.)
- Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands (R.A.d.B.)
- Duke University Medical Center, Durham, NC (A.F.H.)
- Yale School of Medicine, New Haven, CT (S.E.I.)
- Saint Luke’s Mid America Heart Institute and University of Missouri-Kansas City (M.N.K.)
- National Heart Centre Singapore & Duke-National University of Singapore (C.S.P.L.)
- Universidad Nacional de Córdoba, Argentina (F.A.M.)
- Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (M.P., A.M.K.)
| | - John J.V. McMurray
- BHF Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health University of Glasgow, Scotland (K.F.D., P.S.J., J.J.V.M.)
| | - Scott D. Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., M.V., B.L.C., J.W.C., A.S.D., S.D.S.)
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Zhou J, Chen S, Xu M, Guo Y, Xia X, Qin Q, Zhang H. Adjuvant treatment with shenfu injection improve quality of life in chronic heart failure patients: A meta-analysis of randomized controlled trials. Heliyon 2023; 9:e20594. [PMID: 37867825 PMCID: PMC10589792 DOI: 10.1016/j.heliyon.2023.e20594] [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: 02/01/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023] Open
Abstract
Objective Shenfu Injection (SFI) derived from Shenfu decoction, has been widely used for treating heart failure in China. This meta-analysis aimed to assess the effect of SFI as an adjuvant therapy on quality of life in patients with chronic heart failure (CHF). Methods A systematic literature search was conducted in CKNI, VIP, Wanfang, Sinomed, Cochrane Library, PubMed, and Embase database until March 16, 2023. Randomized controlled trials (RCTs) evaluating the effect of SFI plus conventional therapy versus conventional therapy alone for treating CHF were included. Outcome measures were quality of life defineded by the Minnesota Living with Heart Failure questionnaire (MLHFQ), left ventricular ejection fraction (LVEF), 6-min walking distance, and blood brain natriuretic peptide (BNP)/N-terminal pro-brain natriuretic peptide (NT-proBNP) level. Results Thirteen RCTs enrolling 1042 CHF patients were included. SFI plus conventional therapy significantly reduced the total MLHFQ score (mean difference [MD] -8.69 points; 95% confidence intervals [CI] -13.46 to -3.91) compared with the conventional therapy alone. Moreover, adjuvant treatment with SFI significantly improved the 6-min walking distance (MD 65.42 m; 95% CI 44.23 to 86.62), LVEF (MD 3.89; 95% CI 1.03 to 6.75), and blood level of BNP/NT-proBNP (SMD -1.73; 95% CI -2.43 to -1.03). Conclusions Adjuvant treatment with SFI can achieve additional benefits in improving quality of life and exercise tolerance in patients with CHF. These beneficial effects of SFI may correlate with its improving cardiac function. However, our findings should be interpreted with presence of significant heterogeneity and suboptimal quality of the analyzed trials.
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Affiliation(s)
- Junya Zhou
- Department of Cardiology, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Songge Chen
- Department of Cardiology, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Minghui Xu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450003, China
| | - Yali Guo
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 452252, China
| | - Xue Xia
- Department of Equipment Section, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 452252, China
| | - Qingzhu Qin
- Department of Cardiology, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Hongmei Zhang
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
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Chioncel O, Tomasoni D, Metra M. Addressing comorbidities in heart failure: When feeling better and living longer go in the same direction. Eur J Heart Fail 2023; 25:1619-1622. [PMID: 37581243 DOI: 10.1002/ejhf.2998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/10/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
- Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Mapelli M, Mattavelli I, Paolillo S, Salvioni E, Magrì D, Galotta A, De Martino F, Mantegazza V, Vignati C, Esposito I, Dell’Aversana S, Paolillo R, Capovilla T, Tamborini G, Nepitella AA, Filardi PP, Agostoni P. Effects of sacubitril/valsartan on exercise capacity: a prognostic improvement that starts during uptitration. Eur J Clin Pharmacol 2023; 79:1173-1184. [PMID: 37368004 PMCID: PMC10427709 DOI: 10.1007/s00228-023-03527-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Sacubitril/valsartan is a mainstay of the treatment of heart failure with reduced ejection fraction (HFrEF); however, its effects on exercise performance yielded conflicting results. Aim of our study was to evaluate the impact of sacubitril/valsartan on exercise parameters and echocardiographic and biomarker changes at different drug doses. METHODS We prospectively enrolled consecutive HFrEF outpatients eligible to start sacubitril/valsartan. Patients underwent clinical assessment, cardiopulmonary exercise test (CPET), blood sampling, echocardiography, and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Sacubitril/valsartan was introduced at 24/26 mg b.i.d. dose and progressively uptitrated in a standard monthly-based fashion to 97/103 mg b.i.d. or maximum tolerated dose. Study procedures were repeated at each titration visit and 6 months after reaching the maximum tolerated dose. RESULTS Ninety-six patients completed the study, 73 (75%) reached maximum sacubitril/valsartan dose. We observed a significant improvement in functional capacity across all study steps: oxygen intake increased, at peak exercise (from 15.6 ± 4.5 to 16.5 ± 4.9 mL/min/kg; p trend = 0.001), while minute ventilation/carbon dioxide production relationship reduced in patients with an abnormal value at baseline. Sacubitril/valsartan induced positive left ventricle reverse remodeling (EF from 31 ± 5 to 37 ± 8%; p trend < 0.001), while NT-proBNP reduced from 1179 [610-2757] to 780 [372-1344] pg/ml (p trend < 0.0001). NYHA functional class and the subjective perception of limitation in daily life at KCCQ-12 significantly improved. The Metabolic Exercise Cardiac Kidney Index (MECKI) score progressively improved from 4.35 [2.42-7.71] to 2.35% [1.24-4.96], p = 0.003. CONCLUSIONS A holistic and progressive HF improvement was observed with sacubitril/valsartan in parallel with quality of life. Likewise, a prognostic enhancement was observed.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Damiano Magrì
- Department of Clinical and Molecular Medicine, University “La Sapienza”, Rome, Italy
| | | | - Fabiana De Martino
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Casa di Cura Tortorella, Salerno, Italy
| | - Valentina Mantegazza
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Immacolata Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Simona Dell’Aversana
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Roberta Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Teresa Capovilla
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Trieste, Trieste, Italy
| | | | - Alessandro Alberto Nepitella
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Policlinico Universitario D. Casula, Cardiologia – AOU Cagliari Cagliari, Italy
| | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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