Spanish version of the Heart Failure Somatic Perception Scale (HFSPS v.3) - psychometric properties

Background

The Heart Failure Somatic Perception Scale (HFSPS) is an instrument that examine the existence and gravity of physical signs and symptoms in patients with heart failure, as well as early and subtle symptoms of HF that have clinical value, we aimed to translate and adapt the HFSPS from English to Spanish and evaluate the psychometric properties.

Method

HFSPS translation and back translation were carried out according to the method established by of Beaton et al. A confirmatory factor analysis (CFA) was performed to test the factor structures. To assess criterion-related validity, HFSPS factor scores were correlated with Kansas City Cardiomyopathy Questionnaire (KCCQ) scores using the Spearman correlation method. The reliability of the internal consistency of the HFSPS was determined by calculating the Cronbach's alpha coefficient and the factor score determination coefficient.

Results

Data from 173 patients with a mean age of 80.7 years (SD 9.1), women (51.1%), were analyzed. The majority (74.7%) were NYHA class II/III. The confirmatory factor analysis of four factors after eliminating one item showed fit indices close to the recommended indices: χ2 = 169.237, p < 0.001, CFI = 0.920, TLI = 0.901, RMSEA = 0.057 and SRMR = 0.061. Regarding the validity related to the criterion, all the scores of the HFSPS dimensions were correlated with all the scores of the KCCQ dimensions and were statistically significant. The reliability of the HFSPS factors of the coefficient of determination obtained scores of 0.73 for the dyspnea factor and early and subtle and lower for edema and chest discomfort with fewer items. Cronbach's alpha was acceptable for three of the scales >0.71 and poor 0.52 for chest discomfort with two items. The internal consistency index based on the model was 0.850.

Conclusion

The Spanish version of the HFSPS is a valid and reliable instrument that that would be feasible to use in clinical and research setting to evaluate in the perception of symptoms in patients with heart failure.

A patient with heart failure, who is frail: How does this affect therapeutic decisions?

Patients with heart failure (HF) are heterogeneous, not only related to comorbidities but also in the presentation of frailty syndrome. Frailty syndrome also affects patients with HF across the lifespan. Frailty in patients with HF has a significant impact on clinical features, diagnosis, management, adverse medical outcomes and costs. In everyday clinical practice, frail patients with HF require an individualized approach, often imposing the need to modify therapeutic decisions. The aim of this review is to illustrate how frailty and multimorbidity in HF can affect therapeutic decisions. The scientific evidence underlying this publication was obtained from an analysis of papers indexed in the PubMed database. The search was limited to articles published between 1990 and July 2022. The search was limited to full-text papers published in English. The database was searched for relevant MeSH phrases and their combinations and keywords including: "elderly, frail"; "frailty, elderly"; "frail older adults"; "frailty, older adults"; "adult, frail older"; "frailty, heart failure"; "frailty, multimorbidity"; "multimorbidity, heart failure"; "multimorbidity, elderly"; "older adults, cardiovascular diseases". In therapeutic decisions regarding patients with HF, additionally burdened with multimorbidity and frailty, it becomes necessary to individualize the approach in relation to optimization and treatment of coexisting diseases, frailty assessment, pharmacological and non-pharmacological treatment and in the implementation of invasive procedures in the form of implantable devices or cardiac surgery.

Importance of nutritional assessment tools in the critically ill patient: A systematic review

Background

Among the risks of the critically ill patient, one of the aspects to be taken into account is the high probability of occurrence of malnutrition risk (40-50%). This process leads to increased morbimortality and worsening. The use of assessment tools allows the individualization of care.

Objective

To analyze the different nutritional assessment tools used during the admission of critically ill patients.

Methods

Systematic review of the scientific literature related to the nutritional assessment of critically ill patients. Between January 2017 and February 2022, articles were rescued from the electronic databases "Pubmed," "Scopus," "CINAHL" and "The Cochrane Library"; which will analyze which instruments are used during nutritional assessment in the ICU, as well as their impact on mortality and comorbidity of patients.

Results

The systematic review was made up of 14 scientific articles that met the selection criteria, obtained from seven different countries. The instruments described were: mNUTRIC, NRS 2002, NUTRIC, SGA, MUST and the ASPEN and ASPEN criteria. All the included studies demonstrated beneficial effects after nutritional risk assessment. mNUTRIC was the most widely used assessment instrument, with the best predictive validity for mortality and adverse outcomes.

Conclusion

The use of nutritional assessment tools makes it possible to know the real situation of patients, and by objectifying situations, to allow different interventions to improve the nutritional level of patients. The best effectiveness has been achieved using tools such as mNUTRIC, NRS 2002 and SGA.

Clinical and sociodemographic profile of acute intoxications in an emergency department: A retrospective cross-sectional study

Background

Epidemiological studies about acute poisoning are useful for developing clinical toxicology, especially those carried out in hospital emergency departments. We aimed to evaluate acute intoxication clinical and sociodemographic profile in South Aragon Hospital, Spain.

Methods

We carried out a retrospective cross-sectional study. We included 442 patients treated for acute poisoning in the emergency department during the 3 years 2015-2018. In the inferential analysis, the Chi-square test was used to compare proportions, and the Mann-Whitney U-test was used to compare ranges. A confidence level of 95 per cent was considered in all tests.

Results

The mean age was 44.1 years. 57.2% were men. Drugs of abuse were present in 243 patients (55%), drugs in 172 (38.9%), chemicals in 57 (12.9%) and three patients (0.7%) were poisoned by mushrooms. Nine different drugs of abuse, 73 drugs, 15 chemical compounds and 2 varieties of mushrooms were registered. Of the intoxicated patients, 92.3% had symptoms, 84.2% received treatment and 78.7% were discharged from the emergency department.

Conclusions

We obtain a clear clinical and sociodemographic profile of intoxicated patients who come to the emergency department; the five toxins that cause most acute poisoning are: alcohol, benzodiazepines, antiarrhythmics, cannabis and carbon monoxide.

Nutritional Status among patients with Heart Failure and Thyroid Diseases - Result of Nutritional Status Heart Study (NSHS)

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Wroclaw Medical University

Background

Nutritional status is related to the prognosis and the length of hospitalization of individuals with heart failure. The effects of thyroid dysfunction in patients with pre-existing heart failure and nutritional status have not been adequately studied.

Purpose

This study aims to assess how nutritional status affects thyroid disease in patients with heart failure.

Methods

We performed a retrospective study and analysis of medical records of 1056 patients admitted to the cardiology department of our University Clinical Hospital between September 2017 and September 2020 due to acute heart failure (HF) (ICD10: I50). We analyzed all the patients who met the inclusion criteria (diagnosis of HF, age ≥18 years old). A final group of 1056 patients’ medical records was analyzed. The analysis included data such as age, gender, patients’ body mass index (BMI), and laboratory results such as total data on past and comorbid disease units and assessment of the nutritional status of the patient via the NRS-2002. Our study was approved by the independent Bioethics Committee of the Wroclaw Medical University (decision no. KB–590/2020). Statistical analysis was performed using Statistica 13.1 (StatSoft, Inc., Tulsa, OK, USA). The results were considered statistically significant at p&lt;0.05

Results

A total of 1056 individuals were included in the analysis. It included more men than women (66,7%) Due to a lack of data for some parameters, those numbers are smaller and are provided for each variable. More than 76% of participants were overweight or obese. 4.3% of patients were in risk of malnutrition. Thyroid disease registered in 15.1% of patients (Hyperthyroidism – 5.3% and Hypothyroidism 9.8%)

Based on BMI, four groups were distinguished: &lt;18.5, 18.5–24.9, 25.0–29.9, and ≥30 The occurrence of Hyperthyroidism was more frequently observed in the group of overweight patients (p=0,02) (table 1).

Based on NRS2002, two groups were distinguished: &lt;3 and ≥3. In the group with risk of malnutrition (NRS ≥3) patients had a mean statistically significant higher FT4 (&lt;0.001) than the group with no risk of malnutrition (NRS &lt;3) ( x̅ : 2,02 ng/dl vs x̅ : 1.35 ng/dl, p&lt;0.001). Additionally, lower scores of FT3 were observed in the group NRS ≥3 (x̅ : 1.91 ng/dl, p&lt;0.001) (table2).

Conclusion

This study shows that patients with thyroid disease and heart failure were often overweight and obese. The risk of malnutrition status correlates with a lower result of FT3 and the highest FT4. Undoubtedly, those phenomena require further research.

Relationship between multimorbidity and prevalence of frailty syndrome in patients qualified for elective cardiac surgery

Funding Acknowledgements

Type of funding sources: None.

Intorduction

Frailty syndrome (FS) and multimorbidity are closely related but separate constructs that are associated with higher risk of death, higher rehospitalization rates, disability, and reduced quality of life. Identification of multimorbidity and FS in the cardiac surgery patient population appears to be important in terms of the qualification process, incidence of perioperative risk, and optimization of patient status before the cardiac surgery procedure.

Purpose

Analysis of the relationship between multimorbidity and FS in patients qualified for elective cardiac surgery.

Methods

The study included 100 patients ≥ 65 years of age (40 women and 60 men, mean age M±SD =71.69±4). The study included elderly patients qualified for elective cardiac surgery (coronary artery bypass grafting, valvular surgery or combined surgery). In the study group frailty was identified with the use of standardized research tools including those for one-dimensional and multidimensional assessment (FRAIL scale, Frailty Phenotype, 5-meter gaid speed, Tilburg Frailty Indicator, Tilburg Frailty Indicator - TFI). The presence of more than 3 chronic diseases was considered as multimorbidity. A significance level of 0.05 was assumed in the analysis, so all p&lt;0.05 values were interpreted as indicating significant relationships.

Results

Multimorbidity was reported in 88% of patients qualified for cardiac surgery. The prevalence of FS varied according to the screening tool used.Based on FRAIL was reported in 27% of patients, based on Frailty Phenotype in 17% of patients, based on 5-meter gaid speed in 43% of patients, and based on TFI in 63% of patients. In patients with multimorbidity FS was significantly more frequent than in patients without frailty syndrome, which was confirmed by FRAIL (96.3% vs. 60.0%; p-=0.003) and TFI questionnaire (95.2% vs. 75.7%; p=0.008) scores.

Conclusions

1. Most elderly patients qualified for elective cardiac surgery procedures are characterized by multimorbidity. 2 Multimorbidity is associated with a higher prevalence of FS in both unidimensional and multidimensional assessment. 3 This phenomenon requires further study, especially with regard to the occurrence of outcomes in this patient population.

Oxidizing CO2 with superhalogens

The Sb₃F₁₆ species was found to be capable of ionizing the CO₂ molecule.