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Clifford C, Twerenbold R, Hartel F, Löwe B, Kohlmann S. Somatic symptom disorder symptoms in individuals at risk for heart failure: A cluster analysis with cross-sectional data from a population-based cohort study. J Psychosom Res 2024; 184:111848. [PMID: 38941711 DOI: 10.1016/j.jpsychores.2024.111848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE Identifying whether experienced symptom burden in individuals with medical predisposition indicates somatic symptom disorder (SSD) is challenging, given the high overlap in the phenomenology of symptoms within this group. This study aimed to enhance understanding SSD in individuals at risk for heart failure. SUBJECTS AND METHODS Cross-sectional data from the Hamburg City Health Study was analyzed including randomly selected individuals from the general population of Hamburg, Germany recruited from February 2016 to November 2018. SSD symptoms assessed with the Somatic Symptom Scale-8 and the Somatic Symptom Disorder-12 scale were categorized by applying cluster analysis including 412 individuals having at least 5% risk for heart failure-related hospitalization within the next ten years. Clusters were compared for biomedical and psychological factors using ANOVA and chi-square tests. Linear regressions, adjusting for sociodemographic, biomedical, and psychological factors, explored associations between clusters with general practitioner visits and quality of life. RESULTS Three clusters emerged: none (n = 215; 43% female), moderate (n = 151; 48% female), and severe (n = 46; 54% female) SSD symptom burden. The SSS-8 mean sum scores were 3.4 (SD = 2.7) for no, 6.4 (SD = 3.4) for moderate, and 12.4 (SD = 3.7) for severe SSD symptom burden. The SSD-12 mean sum scores were 3.1 (SD = 2.6) for no, 12.2 (SD = 4.2) for moderate, and 23.5 (SD = 6.7) for severe SSD symptom burden. Higher SSD symptom burden correlated with biomedical factors (having diabetes: p = .005 and dyspnea: p ≤ .001) and increased psychological burden (depression severity: p ≤ .001; anxiety severity: p ≤ .001), irrespective of heart failure risk (p = .202). Increased SSD symptoms were associated with more general practitioner visits (β = 0.172; p = .002) and decreased physical quality of life (β = -0.417; p ≤ .001). CONCLUSION Biomedical factors appear relevant in characterizing individuals at risk for heart failure, while psychological factors affect SSD symptom experience. Understanding SSD symptom diversity and addressing subgroup needs could prove beneficial.
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Affiliation(s)
- Caroline Clifford
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Germany.
| | - Friederike Hartel
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Germany.
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Sebastian Kohlmann
- Department of General Internal and Psychosomatic Medicine, University Medical Center Heidelberg, Germany.
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Hoch CR, Klinedinst NJ, Larimer K, Gottlieb SS. Heart failure related fatigue: An exploratory analysis of serum osmolality from the national health and nutrition examination survey. Heart Lung 2024; 68:284-290. [PMID: 39181102 DOI: 10.1016/j.hrtlng.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Fatigue is a prominent symptom of heart failure (HF). However, underlying mechanisms remain poorly understood. Fluid volume status has been suggested as a physiologic mechanism of HF-related fatigue. Serum osmolality may fluctuate with changes in volume status associated with neurohormonal dysregulation. The relationship of fatigue to serum osmolality has not been assessed in adults with HF. OBJECTIVES Describe the relationship between serum osmolality and fatigue in adults with HF. METHODS We analyzed two waves of cross-sectional data from the National Health and Nutrition Examination Survey (2015-2016 and 2017-2018). Adults who self-reported having HF without select co-morbid conditions known to contribute to fatigue were included. Data were weighted to provide US national estimates, and complex sample design used for analyses. Sequential logistic regression was used to isolate the effect of serum osmolality on the odds of having fatigue. RESULTS Data from the sample represented 1.4 million Americans with HF (58.5 % male; median age 68 years), of whom 1,001,589 (67.9 %) reported fatigue. Participants with fatigue had lower serum osmolality compared to those without fatigue (t = -3.04, p = .009). Higher serum osmolality was associated with 8.8 % lower odds of experiencing fatigue when controlling for sex and body mass index (OR = 0.912, p = .007, CI 0.857 - 0.972). CONCLUSIONS HF-related fatigue is associated with lower serum osmolality. Low serum osmolality may indicate excess volume and the presence of a heightened neurohormonal response, both of which may influence fatigue. Alternatively, serum osmolality may directly affect other physiologic changes that may contribute to fatigue.
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Affiliation(s)
- Christine R Hoch
- Assistant Professor, University of Delaware, School of Nursing, United States.
| | - N Jennifer Klinedinst
- Associate Professor, Department of Organizational Systems and Adult Health, University of Maryland, School of Nursing, United States.
| | - Karen Larimer
- Director of Clinical Operations Cardiosense, United States.
| | - Stephen S Gottlieb
- Professor of Medicine, University of Maryland, School of Medicine, United States.
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Xu C, Sidey-Gibbons C, Lacourt TE. Development of a PROMIS multidimensional cancer-related fatigue (mCRF) form using modern psychometric techniques. Qual Life Res 2024:10.1007/s11136-024-03705-0. [PMID: 38980641 DOI: 10.1007/s11136-024-03705-0] [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] [Accepted: 05/29/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE To develop a PRO assessment of multidimensional cancer-related fatigue based on the PROMIS fatigue assessments. METHOD Cancer patients reporting fatigue were recruited from a comprehensive cancer care center and completed a survey including 39 items from the PROMIS Cancer Item Bank-Fatigue. Component and factor structures of the fatigue items were explored with Monte Carlo parallel factor and Mokken analyses, respectively. Psychometric properties were determined using item response theory, ensuring unidimensionality, scalability, and item independence. RESULTS Fatigue scores from a sample of 333 fatigued cancer patients (mean age = 59.50, SD = 11.62, 67% women) were used in all scale development analyses. Psychometric analyses yielded 3 dimensions: motivational fatigue (15 items), cognitive fatigue (9 items), and physical fatigue (9 items). The subscales showed strong unidimensionality, were scalable, and were free of differential item function. Confirmatory factor analyses in a new sample of 182 patients confirmed the findings. CONCLUSION The resulting 33-item PROMIS multidimensional cancer-related fatigue (mCRF) form provides a novel measure for the assessment of the different dimensions of cancer-related fatigue. It is the only multidimensional scale specific for cancer patients that has been developed using modern psychometric approaches. With its 3 dimensions (motivational, cognitive, and physical fatigue), this scale accurately captures the fatigue experienced by cancer patients, allowing clinicians to optimize fatigue management and improve patient care. The scale could also advance research on the nature and experience of cancer-related fatigue.
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Affiliation(s)
- Cai Xu
- Section of Patient Centered Analytics, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chris Sidey-Gibbons
- Section of Patient Centered Analytics, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tamara E Lacourt
- Department of Psychiatry, Unit1454, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Gainey M, Niles A, Imeh-Nathaniel S, Goodwin RL, Roley LT, Win O, Nathaniel TI, Imeh-Nathaniel A. Comorbidities in patients with vascular dementia and Alzheimer's disease with Neuropsychiatric symptoms. Geriatr Nurs 2024; 57:217-223. [PMID: 38696879 DOI: 10.1016/j.gerinurse.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION This study aimed to examine baseline risk factors in Alzheimer's Disease (AD) and Vascular dementia (VaD) patients with neuropsychiatry symptoms (NPS), and determine whether specific risk factors differ by subtypes of dementia for AD and VaD patients with NPS. METHODS A retrospective data analysis was conducted to evaluate similarities and differences in the risk factors for AD and VaD with NPS. The analysis included 2949 patients with VaD and 6341 patients with clinical confirmation of AD and VaD with or without NPS collected between February 2016 and August 2021. The multivariate logistic regression analysis was used to determine the risk factors associated with AD and VaD with NPS, by predicting the increasing odds (odds ratios (ORs) of an association of a specific baseline risk factor with AD or VaD with NPS. The validity of the regression models was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of the models. RESULTS In the adjusted analysis TSH (OR = 1.781, 95 % CI, p = 0.0025) and CHF (OR = 1.620, 95 %, p = 0.016) were associated with VaD with NPS, while a history of emergency department(ED) admission (OR = 0.277, 95 % CI, p = 0.003) likely to be associated with VaD patients without NPS. For AD patients, a history of CVA (OR = 1.395, 95 % CI, p = 0.032) and cancer (OR = 1.485, 95 % CI, p = 0.013) were associated with AD patients with NPS. DISCUSSION The findings of this study indicate that an abnormal thyroid gland and CHF were linked to VaD patients with behavioral disturbances, while CVA and cancer were linked to AD patients with behavioral disturbances. These findings suggest the need to develop management strategies for the care of patients with AD and VaD with NPS.
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Affiliation(s)
- Mallory Gainey
- University of South Carolina, School of Medicine-Greenville, 701 Grove Rd, Greenville, SC, 29605, USA
| | - Addison Niles
- PRISMA Health UP-State South Carolina, 701 Grove Rd, Greenville, SC, 29605, USA
| | | | | | | | - Ohmar Win
- PRISMA Health UP-State South Carolina, 701 Grove Rd, Greenville, SC, 29605, USA
| | - Thomas I Nathaniel
- University of South Carolina, School of Medicine-Greenville, 701 Grove Rd, Greenville, SC, 29605, USA.
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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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Pavlovic N, Ndumele CE, Saylor MA, Szanton SL, Lee CS, Shah AM, Chang PP, Florido R, Matsushita K, Himmelfarb C, Leoutsakos JM. Identification of Fatigue Subtypes and Their Correlates in Prevalent Heart Failure: A Secondary Analysis of the Atherosclerosis Risk in Communities Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010115. [PMID: 38240158 PMCID: PMC10922158 DOI: 10.1161/circoutcomes.123.010115] [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: 04/11/2023] [Accepted: 10/31/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Among patients with heart failure (HF), fatigue is common and linked to quality of life and functional status. Fatigue is hypothesized to manifest as multiple types, with general and exertional components. Unique subtypes of fatigue in HF may require differential assessment and treatment to improve outcomes. We conducted this study to identify fatigue subtypes in persons with prevalent HF in the ARIC study (Atherosclerosis Risk in Communities) and describe the distribution of characteristics across subtypes. METHODS We performed a cross-sectional analysis of 1065 participants with prevalent HF at ARIC visit 5 (2011-2013). We measured exertional fatigue using the Modified Medical Research Council Breathlessness scale and general fatigue using the Patient Reported Outcomes Measurement Information System fatigue scale. We used latent class analysis to identify subtypes of fatigue. Number of classes was determined using model fit statistics, and classes were interpreted and assigned fatigue severity rating based on the conditional probability of endorsing survey items given class. We compared characteristics across classes using multinomial regression. RESULTS Overall, participants were 54% female and 38% Black with a mean age of 77. We identified 4 latent classes (fatigue subtypes): (1) high general/high exertional fatigue (18%), (2) high general/low exertional fatigue (27%), (3) moderate general/moderate exertional fatigue (20%), and (4) low/no general and exertional fatigue (35%). Female sex, Black race, lower education level, higher body mass index, increased depressive symptoms, and higher prevalence of diabetes were associated with higher levels of general and exertional fatigue. CONCLUSIONS We identified unique subtypes of fatigue in patients with HF who have not been previously described. Within subtype, general and exertional fatigue were mostly concordant in severity, and exertional fatigue only occurred in conjunction with general fatigue, not alone. Further understanding these fatigue types and their relationships to outcomes may enhance our understanding of the symptom experience and inform prognostication and secondary prevention efforts for persons with HF.
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Affiliation(s)
| | | | | | - Sarah L. Szanton
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | | | - Kunihiro Matsushita
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cheryl Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jeannie Marie Leoutsakos
- Johns Hopkins School of Medicine, Baltimore, MD
- Boston College Connell School of Nursing, Boston, MA
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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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Williams BA, Voyce S, Blankenship JC, Chang AR. Association between the diagnostic classification of newly diagnosed coronary artery disease and future heart failure development. Coron Artery Dis 2023; 34:341-350. [PMID: 37139564 DOI: 10.1097/mca.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE The first clinical manifestation of coronary artery disease (CAD) varies widely from unheralded myocardial infarction (MI) to mild, incidentally detected disease. The primary objective of this study was to quantify the association between different initial CAD diagnostic classifications and future heart failure. METHODS This retrospective study incorporated the electronic health record of a single integrated health care system. Newly diagnosed CAD was classified into a mutually exclusive hierarchy as MI, CAD with coronary artery bypass graft (CABG), CAD with percutaneous coronary intervention, CAD only, unstable angina, and stable angina. An acute CAD presentation was defined when the diagnosis was associated with a hospital admission. New heart failure was identified after the CAD diagnosis. RESULTS Among 28 693 newly diagnosed CAD patients, initial presentation was acute in 47% and manifested as MI in 26%. Within 30 days of CAD diagnosis, MI [hazard ratio (HR) = 5.1; 95% confidence interval: 4.1-6.5] and unstable angina (3.2; 2.4-4.4) classifications were associated with the highest heart failure risk (compared to stable angina), as was acute presentation (2.9; 2.7-3.2). Among stable, heart failure-free CAD patients followed on average 7.4 years, initial MI (adjusted HR = 1.6; 1.4-1.7) and CAD with CABG (1.5; 1.2-1.8) were associated with higher long-term heart failure risk, but an initial acute presentation was not (1.0; 0.9-1.0). CONCLUSION Nearly 50% of initial CAD diagnoses are associated with hospitalization, and these patients are at high risk of early heart failure. Among stable CAD patients, MI remained the diagnostic classification associated with the highest long-term heart failure risk, however, having an initial acute CAD presentation was not associated with long-term heart failure.
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Affiliation(s)
| | - Stephen Voyce
- Department of Cardiology, Geisinger Health System, Danville, Pennsylvania
| | | | - Alexander R Chang
- Department of Nephrology, Geisinger Health System, Danville, Pennsylvania USA
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Connolly M, Ryder M. Consideration of Symptom Management in Advanced Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15160. [PMID: 36429877 PMCID: PMC9690631 DOI: 10.3390/ijerph192215160] [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: 10/20/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
This work provides an opinion on palliative care for people with heart disease. The work focuses on the management of key symptoms associated with both end stage heart disease, applying a palliative approach and suggesting treatment options. The work also indicates the potential for greater collaboration of specialist teams including specialist palliative care in the assessment and management of patients with complex needs as they progress through their disease trajectory. The practical application of evidence-based guidelines and recommendations is key to the successful individualised management of complex symptoms.
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Affiliation(s)
- Michael Connolly
- School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
- Education & Research Centre, Our Lady’s Hospice & Care Services, Harold’s Cross, D6W RY72 Dublin, Ireland
| | - Mary Ryder
- School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
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Akbay E, Akinci S, Coner A, Adar A, Genctoy G, Demir AR. New perspective on fatigue in hemodialysis patients with preserved ejection fraction: diastolic dysfunction : Fatigue and diastolic dysfunction. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2143-2153. [PMID: 37726453 DOI: 10.1007/s10554-022-02609-9] [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: 12/10/2021] [Accepted: 03/25/2022] [Indexed: 11/05/2022]
Abstract
The relationship between diastolic dysfunction and fatigue in hemodialysis patients with preserved ejection fraction is unknown. In this context, the objective of this study is to assess fatigue using the relevant scales and to demonstrate its relationship with diastolic dysfunction. The patients who underwent hemodialysis were evaluated prospectively. Patients' fatigue was assessed using the Visual Analogue Scale to Evaluate Fatigue Severity (VAS-F). The echocardiographic works were performed as recommended in the American Society of Echocardiography guidelines. A total of 94 patients [mean age 64.7 ± 13.5 years, 54 males (57.4%)] were included in the study. The median VAS-F score of these patients was 68.5 (33.25-91.25), and they were divided into two groups according to this value. Peak myocardial velocities during early diastole (e') and tricuspid annular plane systolic excursion (TAPSE) values were found to be significantly lower in the group with high VAS-F scores, whereas the early diastolic flow velocities (E)/e' ratio and pulmonary artery peak systolic pressures (PAP) were found to be significantly higher (p < 0.05, for all). E/e' ratio (r 0.311, p 0.002) and PAP (r 0.281, p 0.006) values were found to be positively correlated with the VAS-F score, as opposed to the TAPSE (r - 0.257, p 0.012) and e' (r - 0.303, p 0.003) values, which were found to be negatively correlated with the VAS-F score. High fatigue scores in hemodialysis patients may be associated with diastolic dysfunction. In addition, in our study, we determined the correlation of VAS-F score with E/e' ratio, PAP and TAPSE.
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Affiliation(s)
- Ertan Akbay
- Department of Cardiology, Alanya Medical and Research Center, Baskent University Hospital, Saray Mahallesi Yunus Emre Caddesi No: 1, 07400, Alanya, Turkey.
| | - Sinan Akinci
- Department of Cardiology, Alanya Medical and Research Center, Baskent University Hospital, Saray Mahallesi Yunus Emre Caddesi No: 1, 07400, Alanya, Turkey
| | - Ali Coner
- Department of Cardiology, Alanya Medical and Research Center, Baskent University Hospital, Saray Mahallesi Yunus Emre Caddesi No: 1, 07400, Alanya, Turkey
| | - Adem Adar
- Department of Cardiology, Alanya Medical and Research Center, Baskent University Hospital, Saray Mahallesi Yunus Emre Caddesi No: 1, 07400, Alanya, Turkey
| | - Gultekin Genctoy
- Department of Nephrology, Alanya Medical and Research Center, Baskent University Hospital, Alanya, Turkey
| | - Ali Riza Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Protasiewicz Timofticiuc DC, Vladu IM, Ștefan AG, Clenciu D, Mitrea A, Pădureanu V, Efrem IC, Diaconu ID, Turcu A, Țenea-Cojan TȘ, Hâncu AM, Forțofoiu M, Mirea Munteanu O, Moța M. Associations of Chronic Diabetes Complications and Cardiovascular Risk with the Risk of Obstructive Sleep Apnea in Patients with Type 2 Diabetes. J Clin Med 2022; 11:jcm11154403. [PMID: 35956020 PMCID: PMC9368962 DOI: 10.3390/jcm11154403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/01/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) is associated with increased mortality and morbidity, including cardiovascular diseases and obstructive sleep apnea (OSA). The aim of this study was to assess the associations between cardiovascular risk, chronic diabetes complications and the risk of OSA in adult patients with T2DM. Methods: The study included 529 patients with T2DM in whom moderate-to-severe OSA risk was assessed using the STOP-Bang questionnaire, dividing the subjects into two groups: group 1: STOP-Bang score <5, and group 2: STOP-Bang score ≥5, respectively. In all the subjects, cardiovascular risk was assessed using the UKPDS risk engine. Statistical analysis was performed using SPSS 26.0, the results being statistically significant if p value was <0.05. Results: 59% of the subjects scored ≥5 on the STOP-Bang questionnaire. We recorded statistically significant differences between the two groups regarding diabetes duration, HbA1c, HOMA-IR, albuminuria, as well as cardiovascular risk at 10 years for both coronary heart disease (CHD) and stroke (p < 0.05). Furthermore, through logistic regression, adjusting for confounding factors, we demonstrated that the STOP-Bang score ≥ 5 is a risk factor for 10-year fatal and nonfatal CHD risk. Conclusions: It is extremely important to screen and diagnose OSA in patients with T2DM, in order to improve the primary and secondary prevention of cardiovascular events in these patients.
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Affiliation(s)
- Diana Cristina Protasiewicz Timofticiuc
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.C.P.T.); (I.-D.D.); (M.M.)
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Ionela Mihaela Vladu
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Correspondence: (I.M.V.); (A.M.); (M.F.); Tel.: +40-76367-0811 (I.M.V.); +40-72787-8853 (A.M.); +40-73586-4289 (M.F.)
| | | | - Diana Clenciu
- Department of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical Municipal Hospital “Philanthropy” of Craiova, 200143 Craiova, Romania
| | - Adina Mitrea
- Department of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical Municipal Hospital “Philanthropy” of Craiova, 200143 Craiova, Romania
- Correspondence: (I.M.V.); (A.M.); (M.F.); Tel.: +40-76367-0811 (I.M.V.); +40-72787-8853 (A.M.); +40-73586-4289 (M.F.)
| | - Vlad Pădureanu
- Department of Medical Semiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Department of Internal Medicine, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Ion Cristian Efrem
- Department of Internal Medicine and Medical Semiology, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Department of Internal Medicine, Clinical Municipal Hospital “Philanthropy” of Craiova, 200143 Craiova, Romania
| | - Ileana-Diana Diaconu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.C.P.T.); (I.-D.D.); (M.M.)
- Department of Pediatric Pneumology, “Marius Nasta” National Institute of Pneumophtisiology, 050159 Bucharest, Romania
| | - Adina Turcu
- Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Infectious Diseases Hospital “Victor Babes”, 200515 Craiova, Romania
| | - Tiberiu Ștefăniță Țenea-Cojan
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Department of General Surgery, C.F. Clinical Hospital, 200374 Craiova, Romania
| | | | - Maria Forțofoiu
- Department of Emergency Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Emergency Medicine, Clinical Municipal Hospital “Philanthropy” of Craiova, 200143 Craiova, Romania
- Correspondence: (I.M.V.); (A.M.); (M.F.); Tel.: +40-76367-0811 (I.M.V.); +40-72787-8853 (A.M.); +40-73586-4289 (M.F.)
| | - Oana Mirea Munteanu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Department of Cardiology, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Maria Moța
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.C.P.T.); (I.-D.D.); (M.M.)
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Khera R, Schuemie MJ, Lu Y, Ostropolets A, Chen R, Hripcsak G, Ryan PB, Krumholz HM, Suchard MA. Large-scale evidence generation and evaluation across a network of databases for type 2 diabetes mellitus (LEGEND-T2DM): a protocol for a series of multinational, real-world comparative cardiovascular effectiveness and safety studies. BMJ Open 2022; 12:e057977. [PMID: 35680274 PMCID: PMC9185490 DOI: 10.1136/bmjopen-2021-057977] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Therapeutic options for type 2 diabetes mellitus (T2DM) have expanded over the last decade with the emergence of cardioprotective novel agents, but without such data for older drugs, leaving a critical gap in our understanding of the relative effects of T2DM agents on cardiovascular risk. METHODS AND ANALYSIS The large-scale evidence generations across a network of databases for T2DM (LEGEND-T2DM) initiative is a series of systematic, large-scale, multinational, real-world comparative cardiovascular effectiveness and safety studies of all four major second-line anti-hyperglycaemic agents, including sodium-glucose co-transporter-2 inhibitor, glucagon-like peptide-1 receptor agonist, dipeptidyl peptidase-4 inhibitor and sulfonylureas. LEGEND-T2DM will leverage the Observational Health Data Sciences and Informatics (OHDSI) community that provides access to a global network of administrative claims and electronic health record data sources, representing 190 million patients in the USA and about 50 million internationally. LEGEND-T2DM will identify all adult, patients with T2DM who newly initiate a traditionally second-line T2DM agent. Using an active comparator, new-user cohort design, LEGEND-T2DM will execute all pairwise class-versus-class and drug-versus-drug comparisons in each data source, producing extensive study diagnostics that assess reliability and generalisability through cohort balance and equipoise to examine the relative risk of cardiovascular and safety outcomes. The primary cardiovascular outcomes include a composite of major adverse cardiovascular events and a series of safety outcomes. The study will pursue data-driven, large-scale propensity adjustment for measured confounding, a large set of negative control outcome experiments to address unmeasured and systematic bias. ETHICS AND DISSEMINATION The study ensures data safety through a federated analytic approach and follows research best practices, including prespecification and full disclosure of results. LEGEND-T2DM is dedicated to open science and transparency and will publicly share all analytic code from reproducible cohort definitions through turn-key software, enabling other research groups to leverage our methods, data and results to verify and extend our findings.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Martijn J Schuemie
- Department of Epidemiology Analytics, Janssen Research and Development, Titusville, New Jersey, USA
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, California, USA
| | - Yuan Lu
- Section of Cardiovascular Medine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Medical Center, New York, New York, USA
| | - RuiJun Chen
- Department of Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Medical Center, New York, New York, USA
- New York-Presbyterian Hospital, New York, New York, USA
| | - Patrick B Ryan
- Department of Epidemiology Analytics, Janssen Research and Development, Titusville, New Jersey, USA
- Department of Biomedical Informatics, Columbia University Medical Center, New York, New York, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marc A Suchard
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, California, USA
- Department of Biomathematics, University of California, Los Angeles, Los Angeles, California, USA
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, California, USA
- VA Informatics and Computing Infrastructure, US Department of Veterans Affairs, Salt Lake City, Utan, USA
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Redeker NS, Conley S, Hwang Y. Sleep Deficiency: A Symptoms Perspective: Exemplars from Chronic Heart Failure, Inflammatory Bowel Disease, and Breast Cancer. Clin Chest Med 2022; 43:217-228. [PMID: 35659020 PMCID: PMC9178708 DOI: 10.1016/j.ccm.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Sleep deficiency is associated with disabling daytime symptoms, including excessive daytime sleepiness (EDS) and fatigue. The purpose of this article is to discuss the contributions of sleep deficiency and sleep disorders to fatigue and EDS among people with chronic conditions. We use exemplars from the literature on chronic heart failure, inflammatory bowel disease, and breast cancer to (1) describe the prevalence of fatigue and EDS and their consequences; (2) examine the evidence for the contributions of sleep deficiency and sleep disorders to these symptoms; and (3) recommend implications for future research and practice.
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Affiliation(s)
- Nancy S Redeker
- UCONN School of Nursing, Yale University, University of Connecticut School of Nursing, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269-4026, USA.
| | - Samantha Conley
- Nursing Research Division, Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Youri Hwang
- Yale School of Nursing, PO Box 27399, West Haven, CT 06516-0972, USA
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Caggianelli G, Iovino P, Rebora P, Occhino G, Zeffiro V, Locatelli G, Ausili D, Alvaro R, Riegel B, Vellone E. A Motivational Interviewing Intervention Improves Physical Symptoms in Patients with Heart Failure: A Secondary Outcome Analysis of the Motivate-HF Randomized Controlled Trial. J Pain Symptom Manage 2022; 63:221-229.e1. [PMID: 34571194 DOI: 10.1016/j.jpainsymman.2021.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/28/2022]
Abstract
CONTEXT Heart failure (HF) patients experience high burden of physical symptoms during their disease trajectory. OBJECTIVE To evaluate the effects of Motivational Interviewing (MI) on the burden of physical symptoms in HF patients. METHODS We performed a secondary analysis of data from the MOTIVATE-HF randomized controlled trial. A sample of 510 patients (median 74 years, 58% male) and their caregivers (median 55 years, 75.5% female) was randomly allocated to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard of care). The MI intervention consisted of one face-to-face session plus three telephone calls conducted within two months from enrollment. Symptoms' burden was assessed with the Heart Failure Somatic Perception Scale (HFSPS) with the dimensions of Chest Discomfort, Dyspnea, Early and subtle and Edema. Data were collected at baseline and at 3, 6, 9, and 12 months after enrollment. RESULTS At 12 months, Chest Discomfort improved in Arms 1 and 2 vs Arm 3 (Δ: -8.13, 95% CI: -14.61; -1.65). Dyspnea improved in Arms 1 and 2 vs Arm 3 both at 9 and 12 months (Δ: -7, 95% CI: -13.18; -0.82 and -6.78, 95% CI: -13.19; -0.38); HFSPS total score improved in Arm 1 and Arm 2 vs Arm 3 at 9 months (Δ: -4.55, 95% CI: -9.05; -0.05). Over 1 year, Chest Discomfort and HFSPS total score in Arm 2 improved compared to Arm 3 (β= -2.61, 95% CI: -4.21; -1.00, P = 0.0015 and β=-1.35, 95% CI: -2.50; -0.21, P = 0.02). CONCLUSION MI reduces the burden of physical HF symptoms, particularly when caregivers are involved in the intervention.
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Affiliation(s)
- Gabriele Caggianelli
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
| | - Paolo Iovino
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy; School of Nursing, Midwifery and Paramedicine Faculty of Health Science (P.I., G.L.), Australian Catholic University, Melbourne, Australia.
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre - B4 School of Medicine and Surgery (P.R., G.O.), University of Milan-Bicocca, Monza, Italy
| | - Giuseppe Occhino
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre - B4 School of Medicine and Surgery (P.R., G.O.), University of Milan-Bicocca, Monza, Italy
| | - Valentina Zeffiro
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
| | - Giulia Locatelli
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy; School of Nursing, Midwifery and Paramedicine Faculty of Health Science (P.I., G.L.), Australian Catholic University, Melbourne, Australia
| | - Davide Ausili
- Department of Medicine and Surgery (D.A.), University of Milan-Bicocca, Monza, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
| | - Barbara Riegel
- School of Nursing (B.R.), University of Pennsylvania, Philadelphia, PA, USA; Mary McKillop Institute of Health Research (B.R.), Australian Catholic University, Melbourne, Australia
| | - Ercole Vellone
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
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Fatigue in Persons With Heart Failure: A Systematic Literature Review and Meta-Synthesis Using the Biopsychosocial Model of Health. J Card Fail 2022; 28:283-315. [PMID: 34329719 PMCID: PMC8795245 DOI: 10.1016/j.cardfail.2021.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fatigue is a common and distressing symptom of heart failure (HF) and has important implications for patient-reported and clinical outcomes. Despite being a common and bothersome symptom, fatigue has been understudied in HF. We sought to synthesize existing literature on fatigue in HF through a systematic literature review guided by the biopsychosocial model of health. METHODS AND RESULTS A systematic search of the literature was performed on March 18, 2020, using Pubmed, Embase, and CINAHL. Full-text, primary research articles, written in English, in which fatigue was a primary symptom of interest in adults with a diagnosis of HF, were included. The search yielded 1138 articles; 33 articles that met inclusion criteria were selected for extraction and synthesis. Biological and psychological factors associated with fatigue were New York Heart Association functional class, hemoglobin level, history of stroke, and depression. However, there are limited HF-specific factors linked to fatigue. Social factors related to fatigue included social roles, relationship strain, and loneliness and isolation. Few nonpharmacologic interventions have been tested by show some promise for alleviating fatigue in HF. Studies show conflicting evidence related to the prognostic implications of fatigue. CONCLUSIONS Important biological correlates of fatigue were identified; however, psychological and social variables were limited to qualitative description. There is need for expanded models to better understand the complex physiologic nature of fatigue in HF. Additionally, more research is needed to (1) define the relationships between fatigue and both psychological and social factors, (2) better describe the prognostic implications of fatigue, and (3) develop more therapeutic approaches to alleviate fatigue with the goal of improving overall quality of life.
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Fatigue in patients with chronic disease: results from the population-based Lifelines Cohort Study. Sci Rep 2021; 11:20977. [PMID: 34697347 PMCID: PMC8546086 DOI: 10.1038/s41598-021-00337-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/07/2021] [Indexed: 12/21/2022] Open
Abstract
(1) To evaluate the prevalence of severe and chronic fatigue in subjects with and without chronic disease; (2) to assess to which extent multi-morbidity contributes to severe and chronic fatigue; and (3) to identify predisposing and associated factors for severe and chronic fatigue and whether these are disease-specific, trans-diagnostic, or generic. The Dutch Lifelines cohort was used, including 78,363 subjects with (n = 31,039, 53 ± 12 years, 33% male) and without (n = 47,324, 48 ± 12 years, 46% male) ≥ 1 of 23 chronic diseases. Fatigue was assessed with the Checklist Individual Strength-Fatigue. Compared to participants without a chronic disease, a higher proportion of participants with ≥ 1 chronic disease were severely (23% versus 15%, p < 0.001) and chronically (17% versus 10%, p < 0.001) fatigued. The odds of having severe fatigue (OR [95% CI]) increased from 1.6 [1.5–1.7] with one chronic disease to 5.5 [4.5–6.7] with four chronic diseases; for chronic fatigue from 1.5 [1.5–1.6] to 4.9 [3.9–6.1]. Multiple trans-diagnostic predisposing and associated factors of fatigue were found, explaining 26% of variance in fatigue in chronic disease. Severe and chronic fatigue are highly prevalent in chronic diseases. Multi-morbidity increases the odds of having severe and chronic fatigue. Several trans-diagnostic factors were associated with fatigue, providing a rationale for a trans-diagnostic approach.
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"Whole life changed" - Experiences of how symptoms derived from acute pulmonary embolism affects life. A qualitative interview study. Thromb Res 2021; 205:56-62. [PMID: 34247098 DOI: 10.1016/j.thromres.2021.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Acute pulmonary embolism (PE) presents itself with a wide range of hemodynamic consequences. Respiratory symptoms as dyspnea and respiratory pain are common. The aim of this study was to explore patients' experiences of how symptoms affected their physical and social activities following the PE. MATERIALS AND METHODS Qualitative interviews were conducted with 14 patients, with median time of 7 months (range 3-34 months) since the PE and analysed with qualitative content analysis according to Graneheim and Lundman. RESULTS The findings indicated that respiratory symptoms affected many aspects of life, illustrated by an overall theme: "Whole life changed". Two major categories, on changes of psychological/social nature, and changes of perception towards physical activity, described how the participants experienced changes in themselves and their relations, and that the psychological affection resulted in an existential crisis. All participants experienced changes in their physical activity and that remaining respiratory symptoms hindered them from being active. Fear inhibited physical activity and created a feeling of low self-efficacy concerning activity in general. CONCLUSIONS To the best of our knowledge, this is the first study to present results on experiences of how the symptoms deriving from PE affected the physical and social activities of the participants during recovery phase. The results indicate that patients with PE need support from the health care system to manage both psychological and physical symptoms in the aftermath of their illness. Further research is needed to find out how optimal rehabilitation for these patients should be designed.
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Hwang M, Zhang K, Nagappa M, Saripella A, Englesakis M, Chung F. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnoea in patients with cardiovascular risk factors: a systematic review and meta-analysis. BMJ Open Respir Res 2021; 8:8/1/e000848. [PMID: 33664122 PMCID: PMC7934717 DOI: 10.1136/bmjresp-2020-000848] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Obstructive sleep apnoea (OSA) is highly prevalent in patients with cardiovascular risk factors and is associated with increased morbidity and mortality. This review presents the predictive parameters of the STOP-Bang questionnaire as a screening tool for OSA in this population. Methods A search of databases was performed. The inclusion criteria were: (1) use of the STOP-Bang questionnaire to screen for OSA in adults (>18 years) with cardiovascular risk factors; (2) polysomnography or home sleep apnoea testing performed as a reference standard; (3) OSA defined by either Apnoea–Hypopnoea Index (AHI) or Respiratory Disturbance Index; and (4) data on predictive parameters of the STOP-Bang questionnaire. A random-effects model was used to obtain pooled predictive parameters of the STOP-Bang questionnaire. Results The literature search resulted in 3888 articles, of which 9 papers met the inclusion criteria, involving 1894 patients. The average age of the included patients was 58±13 years with body mass index (BMI) of 30±6 kg/m2, and 64% were male. The STOP-Bang questionnaire has a sensitivity of 89.1%, 90.7% and 93.9% to screen for all (AHI ≥5), moderate-to-severe (AHI ≥15) and severe (AHI≥30) OSA, respectively. The specificity was 32.3%, 22.5% and 18.3% and the area under the curve (AUC) was 0.86, 0.65 and 0.52 for all, moderate-to-severe and severe OSA, respectively. Conclusion The STOP-Bang questionnaire is an effective tool to screen for OSA (AHI≥5) with AUC of 0.86 in patients with cardiovascular risk factors.
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Affiliation(s)
- Mark Hwang
- Faculty of Medicine, Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Zhang
- Faculty of Medicine, Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mahesh Nagappa
- Department of Anaesthesia & Perioperative Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Aparna Saripella
- Department of Anaesthesia and Pain Medicine, University Health Network, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Frances Chung
- Department of Anaesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
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Sobanski PZ, Krajnik M, Goodlin SJ. Palliative Care for People Living With Heart Disease-Does Sex Make a Difference? Front Cardiovasc Med 2021; 8:629752. [PMID: 33634172 PMCID: PMC7901984 DOI: 10.3389/fcvm.2021.629752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/14/2021] [Indexed: 12/26/2022] Open
Abstract
The distribution of individual heart disease differs among women and men and, parallel to this, among particular age groups. Women are usually affected by cardiovascular disease at an older age than men, and as the prevalence of comorbidities (like diabetes or chronic pain syndromes) grows with age, women suffer from a higher number of symptoms (such as pain and breathlessness) than men. Women live longer, and after a husband or partner's death, they suffer from a stronger sense of loneliness, are more dependent on institutionalized care and have more unaddressed needs than men. Heart failure (HF) is a common end-stage pathway of many cardiovascular diseases and causes substantial symptom burden and suffering despite optimal cardiologic treatment. Modern, personalized medicine makes every effort, including close cooperation between disciplines, to alleviate them as efficiently as possible. Palliative Care (PC) interventions include symptom management, psychosocial and spiritual support. In complex situations they are provided by a specialized multiprofessional team, but usually the application of PC principles by the healthcare team responsible for the person is sufficient. PC should be involved in usual care to improve the quality of life of patients and their relatives as soon as appropriate needs emerge. Even at less advanced stages of disease, PC is an additional layer of support added to disease modifying management, not only at the end-of-life. The relatively scarce data suggest sex-specific differences in symptom pathophysiology, distribution and the requisite management needed for their successful alleviation. This paper summarizes the sex-related differences in PC needs and in the wide range of interventions (from medical treatment to spiritual support) that can be considered to optimally address them.
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Affiliation(s)
- Piotr Z Sobanski
- Palliative Care Unit and Competence Center, Department of Internal Medicine, Spital Schwyz, Schwyz, Switzerland
| | - Malgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Sarah J Goodlin
- Geriatrics and Palliative Medicine, Veterans Affairs Portland Health Care System, Department of Medicine, Oregon Health and Sciences University, Patient-Centered Education and Research, Portland, OR, United States
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Al Maqbali M, Al Sinani M, Al Naamani Z, Al Badi K, Tanash MI. Prevalence of Fatigue in Patients With Cancer: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2021; 61:167-189.e14. [PMID: 32768552 DOI: 10.1016/j.jpainsymman.2020.07.037] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Fatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness among patients with cancer. OBJECTIVES The objective of this meta-analysis is to examine the present status of fatigue prevalence in patients with cancer. METHODS The following databases were searched: PubMed, MEDLINE, EMBASE, PsycINFO, Cochrane Library, from inception up to February 2020. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. RESULTS A total of 129 studies (N = 71,568) published between 1993 and 2020 met the inclusion criteria. The overall prevalence of fatigue was 49% (34,947 of 71,656 participants, 95% CI = 45-53) with significant heterogeneity between studies (P < 0.000; τ2 = 0.0000; I2 = 98.88%). Subgroup analyses show that the prevalence of fatigue related to type of cancer ranged from 26.2% in patients with gynecological cancer to 56.3% in studies that included mixed types of cancer. In advanced cancer stage patients, the highest prevalence of fatigue (60.6%) was reported. Fatigue prevalence rates were 62% during treatment and 51% during mixed treatment status. The prevalence of fatigue decreased from 64% in studies published from 1996 to 2000 to 43% in studies published from 2016 to 2020. Metaregression identified female gender as a significant moderator for higher prevalence of fatigue, whereas mean age is not associated with fatigue. CONCLUSION This meta-analysis highlights the importance of developing optimal monitoring strategies to reduce fatigue and improve the quality of life of patients with cancer.
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Affiliation(s)
| | - Mohammed Al Sinani
- Reproductive and Developmental Biology Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Zakariya Al Naamani
- School of Nursing and Midwifery, Queen's University Medical Biology Centre, Belfast, Northern Ireland
| | - Khalid Al Badi
- Al Khawarizmi International College, Abu Dhabi, United Arab Emirates
| | - Mu'ath Ibrahim Tanash
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Abstract
Purpose of Review Palliative care is increasingly acknowledged as beneficial in supporting patients and families affected by heart failure, but policy documents have generally focused on the chronic form of this disease. We examined palliative care provision for those with acute heart failure, based on the recently updated National Consensus Project Clinical Practice Guidelines for Quality Palliative Care. Recent Findings The commonest reason for hospitalization in those > 65 years, acute heart failure admissions delineate crisis points on the unpredictable disease trajectory. Palliative care is underutilized, often perceived as limited to end-of-life care rather than determined by regular systematic needs assessment. No dominant paradigm of palliative care provision has emerged from the nascent evidence base related to this clinical cohort, underscoring the need for further research. Summary Embedding palliative support as mainstream to heart failure care from the point of diagnosis may better ensure treatment strategies for those admitted with acute heart failure remain consistent with patients’ preferences and values.
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Changes in Appetite During the Heart Failure Trajectory and Association With Fatigue, Depressive Symptoms, and Quality of Life. J Cardiovasc Nurs 2020; 36:539-545. [PMID: 33136703 DOI: 10.1097/jcn.0000000000000756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Decreased appetite can contribute to malnutrition in patients with heart failure (HF). Little is known about the trajectory of appetite over time in patients with HF and the factors associated with decreased appetite after discharge from the hospital. OBJECTIVE The aims of this study were to investigate changes in appetite over time and explore how fatigue, depressive symptoms, and quality of life are associated with decreased appetite. METHODS Data from the multicenter randomized Coordinating study evaluating Outcomes of Advising and Counseling in Heart Failure were used. Logistic regression and mixed-effects logistic regression were used to investigate changes in appetite over time and to explore the relationship between appetite and fatigue, depressive symptoms, and quality of life. RESULTS A total of 734 patients with HF (mean age, 69 years) were included. Decreased appetite was present at all follow-up measurements; however, decreased appetite was significantly lower at the 1-month (odds ratio [OR], 0.43; confidence interval [CI], 0.29-0.63), 6-month (OR, 0.31; CI, 0.20-0.47), 12-month (OR, 0.22; CI, 0.14-0.34), and 18-month (OR, 0.24; CI, 0.15-0.37) follow-ups compared with baseline. Decreased appetite was associated with fatigue (OR, 3.09; CI, 1.98-4.84), depressive symptoms (OR, 1.76; CI, 1.35-2.29), and low quality of life (OR, 1.01; CI, 1.01-1.02) across all measurement points adjusted for covariates. CONCLUSIONS Appetite improved after discharge; however, at all time points, at least 22% of patients reported decreased appetite. Fatigue, depressive symptoms, and low quality of life are factors associated with decreased appetite. Decreased appetite is a long-standing problem in that it does not disappear spontaneously after an acute HF deterioration.
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Gecaite-Stonciene J, Bunevicius A, Burkauskas J, Brozaitiene J, Neverauskas J, Mickuviene N, Kazukauskiene N. Validation of the Multidimensional Fatigue Inventory with Coronary Artery Disease Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218003. [PMID: 33143183 PMCID: PMC7662819 DOI: 10.3390/ijerph17218003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Fatigue is a common distressing symptom in patients with coronary artery disease (CAD). The Multidimensional Fatigue Inventory (MFI) is used for measuring fatigue in various clinical settings. Nevertheless, its multidimensional structure has not been consistent across studies. Thus, we aimed to psychometrically evaluate the MFI in patients with CAD. METHODS In sum, 1162 CAD patients completed questionnaires assessing their subjective fatigue level (MFI-20), mental distress symptoms (HADS, STAI), and health-related quality of life (SF-36). Participants also completed exercise capacity (EC) testing. RESULTS Confirmatory factor analysis of the four-factor model, showed acceptable fit (CFI = 0.905; GFI = 0.895; NFI = 0.893, RMSEA = 0.077). After eliminating four items, confirmatory factor analysis testing showed improvement in the four-factor model of the MFI-16 (CFI = 0.910; GFI = 0.909; NFI = 0.898, RMSEA = 0.077). Internal consistency values were adequate for the total score and four MFI-16 subscales: General fatigue, physical fatigue, reduced activity, and mental fatigue with Cronbach's α range: 0.60-0.82. The inadequate value (Cronbach's α = 0.43) was received for the subscale of reduced motivation in both MFI-20 and MFI-16. Correlations between the MFI-16 and HADS, STAI, SF-36, and EC measures were statistically significant (all p's < 0.001). CONCLUSIONS The Lithuanian version of the modified MFI of 16 items showed good factorial structure and satisfactory psychometric characteristics, except for reduced motivation subscale.
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The Associations of Diagnoses of Fatigue and Depression With Use of Medical Services in Patients With Heart Failure. J Cardiovasc Nurs 2020; 34:289-296. [PMID: 31094761 DOI: 10.1097/jcn.0000000000000574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Fatigue and depression based on self-report and diagnosis are prevalent in patients with heart failure and adversely affect high rates of hospitalization and emergency department visits, which can impact use of medical services. The relationships of fatigue and depression to use of medical services in patients with preserved and reduced left ventricular ejection fraction (LVEF) may differ. PURPOSE We examined the associations of diagnoses of fatigue and depression with use of medical services in patients with preserved and reduced LVEF, controlling for covariates. METHODS Data were collected on fatigue, depression, covariates, and use of medical services. Patients (N = 582) were divided into 2 groups based on LVEF (<40%, reduced LVEF; ≥40%, preserved LVEF). Multiple linear regression analyses were used to analyze the data. RESULTS A diagnosis of fatigue was a significant factor associated with more use of medical services in the total sample (β = .18, P < .001, R = 54%) and patients with reduced LVEF (β = .13, P = .008, R = 54%) and also preserved LVEF (β = .21, P < .001, R = 54%), controlling for all covariates, but a diagnosis of depression was not. CONCLUSIONS This study demonstrates the important roles of a diagnosis of fatigue in use of medical services. Thus, fatigue needs to be assessed, diagnosed, and managed effectively.
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Abstract
BACKGROUND The literature on caregiver contributions to heart failure (HF) patient self-care has grown rapidly during the last few years, but theory guiding this growth is lacking. OBJECTIVE The purpose of this article is to describe a Situation-Specific Theory of Caregiver Contributions to HF Self-care. RESULTS We describe theoretical assumptions, the process by which caregivers contribute to HF self-care, factors influencing caregiver contributions to HF self-care, known predictors (caregiver, patient, and dyadic related) and outcomes of caregiver contributions to HF. These outcomes may be caregiver and patient related and positive and/or negative. Caregiver contributions to HF self-care include interacting processes of self-care maintenance, symptom monitoring and perception, and self-care management. Caregiver confidence and cultural values are discussed as important influences on caregiver contributions to HF self-care. Recursive pathways are hypothesized between processes and outcomes. Ten theoretical propositions are proposed. CONCLUSIONS The Situation-Specific Theory of Caregiver Contributions to HF Self-care is still in its infancy, and more research is needed to strengthen the evidence supporting the theory. But at this point, the theory may help to guide future studies addressing caregiver contributions to HF self-care and clinical practice aimed at improving caregiver and patient outcomes.
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Santos VB, Lopes CT, dos Anjos LD, Begot I, Cassiolatto F, Guizilinni S, Moreira RSL. Accuracy of the Defining Characteristics of Fatigue in Patients with Heart Failure as Identified by the 6‐Minute Walking Test. Int J Nurs Knowl 2019; 31:188-193. [DOI: 10.1111/2047-3095.12270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/07/2019] [Accepted: 12/01/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - Isis Begot
- Nursing Paulista SchoolFederal University of São Paulo São Paulo Brazil
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Walthall H, Floegel T, Boulton M, Jenkinson C. Patients experience of fatigue in advanced heart failure. Contemp Nurse 2019; 55:71-82. [PMID: 30961451 DOI: 10.1080/10376178.2019.1604147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Aims: Explore the experience of living with fatigue in persons with advanced heart failure. Design: Single-setting, qualitative interview study. Methods: In-depth interviews were conducted from November 2012 - June 2013. Participant responses to open-ended questions were analysed using thematic analysis. Inclusion criteria: 18 years and older, diagnosis of New York Heart Association class III-IV heart failure with reduced ejection fraction and able to participate in interviews in their own language. Exclusion criteria was cognitive deficit Twenty-three participated in the study. Results: Participants (age 72.5 ± 9.5 years, 10/23 female), identified experiencing fatigue daily with 14/23 reporting it as their worst symptom or combined worst symptom with breathlessness. Three key themes were identified: fatigue as a physical barrier, psychological response to fatigue, and living with fatigue as a part of daily life. Conclusion: As heart failure progresses fatigue influences patients' daily life and may negatively affect self-care abilities however patients strive to adapt to these limitations.
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Affiliation(s)
- Helen Walthall
- a Oxford School of Nursing and Midwifery , Oxford Brookes University , Oxford , UK
| | - Theresa Floegel
- b College of Nursing , East Carolina University , Greenville , NC , USA
| | - Mary Boulton
- a Oxford School of Nursing and Midwifery , Oxford Brookes University , Oxford , UK.,c NIHR Research Design Service South Central , Oxford , UK
| | - Crispin Jenkinson
- d Health Services Research and Health Service Research Unit , University of Oxford , Oxford , UK
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29
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Van Herck M, Spruit MA, Burtin C, Djamin R, Antons J, Goërtz YMJ, Ebadi Z, Janssen DJA, Vercoulen JH, Peters JB, Thong MSY, Otker J, Coors A, Sprangers MAG, Muris JWM, Wouters EFM, van 't Hul AJ. Fatigue is Highly Prevalent in Patients with Asthma and Contributes to the Burden of Disease. J Clin Med 2018; 7:E471. [PMID: 30477110 PMCID: PMC6306949 DOI: 10.3390/jcm7120471] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022] Open
Abstract
The 2018 update of the Global Strategy for Asthma Management and Prevention does not mention fatigue-related symptoms. Nevertheless, patients with asthma frequently report tiredness, lack of energy, and daytime sleepiness. Quantitative research regarding the prevalence of fatigue in asthmatic patients is lacking. This retrospective cross-sectional study of outpatients with asthma upon referral to a chest physician assessed fatigue (Checklist Individual Strength-Fatigue (CIS-Fatigue)), lung function (spirometry), asthma control (Asthma Control Questionnaire (ACQ)), dyspnea (Medical Research Council (MRC) scale), exercise capacity (six-minute walk test (6MWT)), and asthma-related Quality-of-Life (QoL), Asthma Quality of Life Questionnaire (AQLQ) during a comprehensive health-status assessment. In total, 733 asthmatic patients were eligible and analyzed (47.4 ± 16.3 years, 41.1% male). Severe fatigue (CIS-Fatigue ≥ 36 points) was detected in 62.6% of patients. Fatigue was not related to airflow limitation (FEV1, ρ = -0.083); was related moderately to ACQ (ρ = 0.455), AQLQ (ρ = -0.554), and MRC (ρ = 0.435; all p-values < 0.001); and was related weakly to 6MWT (ρ = -0.243, p < 0.001). In stepwise multiple regression analysis, 28.9% of variance in fatigue was explained by ACQ (21.0%), MRC (6.5%), and age (1.4%). As for AQLQ, 42.2% of variance was explained by fatigue (29.8%), MRC (8.6%), exacerbation rate (2.6%), and age (1.2%). Severe fatigue is highly prevalent in asthmatic patients; it is an important determinant of disease-specific QoL and a crucial yet ignored patient-related outcome in patients with asthma.
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Affiliation(s)
- Maarten Van Herck
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
| | - Martijn A Spruit
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), 6229 HX Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, 6229 ER Maastricht, The Netherlands.
| | - Chris Burtin
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
| | - Remco Djamin
- Department of Respiratory Medicine, Amphia Hospital, 4818 CK Breda, The Netherlands.
| | - Jeanine Antons
- Department of Pulmonary Medicine, Radboud University Medical Center (Radboudumc), 6525 GA Nijmegen, The Netherlands.
| | - Yvonne M J Goërtz
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
| | - Zjala Ebadi
- Department of Medical Psychology, Radboudumc, 6525 GA Nijmegen, The Netherlands.
| | - Daisy J A Janssen
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
- Centre of expertise for palliative care, MUMC+, 6229 HX Maastricht, The Netherlands.
| | - Jan H Vercoulen
- Department of Medical Psychology, Radboudumc, 6525 GA Nijmegen, The Netherlands.
| | - Jeannette B Peters
- Department of Medical Psychology, Radboudumc, 6525 GA Nijmegen, The Netherlands.
| | - Melissa S Y Thong
- Department of Medical Psychology, Amsterdam University Medical Centers, location AMC, 1105 AZ Amsterdam, The Netherlands.
| | - Jacqueline Otker
- Member of Lung Foundation Netherlands, 3818 LE Amersfoort, The Netherlands.
| | - Arnold Coors
- Member of Patient Advisory Board, Radboudumc, 6525 GA Nijmegen, The Netherlands.
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, location AMC, 1105 AZ Amsterdam, The Netherlands.
| | - Jean W M Muris
- Department of General Practice, MUMC+, 6229 HX Maastricht, The Netherlands.
| | - Emiel F M Wouters
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), 6229 HX Maastricht, The Netherlands.
| | - Alex J van 't Hul
- Department of Pulmonary Medicine, Radboud University Medical Center (Radboudumc), 6525 GA Nijmegen, The Netherlands.
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Reuter H, Herkenrath S, Treml M, Halbach M, Steven D, Frank K, Castrogiovanni A, Kietzmann I, Baldus S, Randerath WJ. Sleep-disordered breathing in patients with cardiovascular diseases cannot be detected by ESS, STOP-BANG, and Berlin questionnaires. Clin Res Cardiol 2018; 107:1071-1078. [PMID: 29845331 DOI: 10.1007/s00392-018-1282-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/15/2018] [Indexed: 12/11/2022]
Abstract
Sleep-disordered breathing (SDB) is highly prevalent in patients with cardiovascular diseases (CVD) and associated with poor outcome. At least 50% of heart failure (HF) patients present with SDB, equally divided in obstructive sleep apnea (OSA) and central sleep apnea (CSA). CVD patients with SDB do not always present with typical SDB symptoms. Therefore, we asked whether established questionnaires allow for the reliable detection of SDB. In this prospective cohort study, 89 CVD patients (54 male, 59 ± 15 years, BMI 30 ± 6 kg/m2) in stable clinical state underwent an ambulatory polygraphy. SDB was defined as an apnea-hypopnea index (AHI) ≥ 15/h. We evaluated the Epworth Sleepiness Scale (ESS), STOP-BANG and Berlin questionnaires as well as anthropometric data and comorbidities regarding their ability to predict SDB. The ESS showed no correlation with SDB. The sensitivity of the Berlin Questionnaire to detect SDB was 73%, specificity was 42%. The STOP-BANG questionnaire showed a sensitivity of 97% while specificity was 13%. Coronary heart disease and/or history of myocardial infarction, hyperuricemia and age significantly contributed to a logistic regression model predicting presence of SDB. However, our regression model explains only 36% of the variance regarding the presence or absence of SDB. The approach to find variables, which would allow an early and reliable differentiation between patients with CVD and coexistence or absence of SDB, failed. Thus, as CVD patients show a high SDB prevalence and poor outcome, only a systematic screening based on measures of respiration-related parameters (i.e., respiratory flow, blood oxygen saturation, etc.) allows for a reliable SDB assessment.
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Affiliation(s)
- Hannes Reuter
- Clinic III for Internal Medicine, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Evangelisches Klinikum Köln-Weyertal, Weyertal 76, 50931, Cologne, Germany
| | - Simon Herkenrath
- Institute for Pneumology at the University of Cologne, Aufderhöher Str. 169-175, 42699, Solingen, Germany
- Bethanien Hospital gGmbH, Solingen, Aufderhöher Str. 169-175, 42699, Solingen, Germany
| | - Marcel Treml
- Institute for Pneumology at the University of Cologne, Aufderhöher Str. 169-175, 42699, Solingen, Germany
| | - Marcel Halbach
- Clinic III for Internal Medicine, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Daniel Steven
- Clinic III for Internal Medicine, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Konrad Frank
- Clinic III for Internal Medicine, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | | | - Ilona Kietzmann
- Institute for Pneumology at the University of Cologne, Aufderhöher Str. 169-175, 42699, Solingen, Germany
| | - Stephan Baldus
- Clinic III for Internal Medicine, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Winfried J Randerath
- Institute for Pneumology at the University of Cologne, Aufderhöher Str. 169-175, 42699, Solingen, Germany.
- Bethanien Hospital gGmbH, Solingen, Aufderhöher Str. 169-175, 42699, Solingen, Germany.
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