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1.
Oronzo Chialà Ercole Vellone Leonie Klompstra Giorgio Alberto Ortali Anna Strömberg Tiny Jaarsma 《Heart & lung : the journal of critical care》2018,47(5):465-470
Background
Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity.Objectives
The aim of this study was to explore the relationships between exercise capacity and anxiety, depression, and cognition in HF patients.Methods
This was a secondary analysis on the baseline data of the Italian subsample (n = 96) of HF patients enrolled in the HF-Wii study. Data was collected with the 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment.Results
The HF patients walked an average of 222 (SD 114) meters on the 6MWT. Patients exhibited clinically elevated anxiety (48%), depression (49%), and severe cognitive impairment (48%). Depression was independently associated with the distance walked on the 6MWT.Conclusions
The results of this study reinforced the role of depression in relation to exercise capacity and call for considering strategies to reduce depressive symptoms to improve outcomes of HF patients. 相似文献2.
Connie Schumacher Leslie Hussey Vincent Hall 《Heart & lung : the journal of critical care》2018,47(4):297-303
Objective
To explore the decision making processes undertaken by community-dwelling individuals with heart failure as they experience symptom changes.Background
Heart failure patients are responsible for daily self-management that includes responding to symptom fluctuations between exacerbations. Despite education, some patients fail to seek timely medical intervention when symptoms change.Methods
Semi-structured interviews were conducted with homecare patients after receiving self-management education. Grounded theory methods and qualitative software were used to collect and analyze the data.Results
Five themes were identified: perceiving symptoms, alleviating actions and control, normalizing symptoms, absence of help seeking behaviors, and decreased functional capacity. Normalizing symptoms included actions taken by participants to mitigate symptom fluctuations. Daily fluctuations were assimilated into normal life resulting in desensitization of symptom recognition and decreased functional capacity.Conclusions
Findings support the need to educate on early symptom recognition, the benefits of safe physical activity, and building a system to support self-management patient-physician collaboration. 相似文献3.
Background
Exercise-based Cardiac rehabilitation (CR) plays a major role in reducing mortality and morbidity in patients with coronary artery disease (CAD). The standard protocol is usually of moderate intensity exercise. High-intensity interval training (HIIT) consists of alternating periods of intensive aerobic exercise with periods of passive or active moderate/mild intensity recovery.Aim
This study aimed to assess HIIT program for ischemic patients attending CR after percutaneous coronary intervention (PCI) who have mild left ventricular dysfunction and to compare its effect on the functional capacity and quality of life with standard exercise CR program.Patients and methods
Our study included 40 patients with documented CAD, who participated in the outpatient CR program in Ain Shams University hospital (Al-Demerdash Hospital) divided into two equal groups, each included 20 patients. Group A included the patients who underwent standard cardiac rehabilitation program, while group B joined the high intensity interval training exercise protocol.Results
Groups A and B showed significant improvement in all items of comparison; especially functional capacity, lipid profile and quality of life. Group B showed better improvements in the emotional well-being items of QOL parameters.Conclusion
We emphasize the positive effects of exercise-based CR program on patients with CAD and mild left ventricular dysfunction after PCI. The novel high intensity cardiac training proved to be safe and at least as beneficial as the standard moderate intensity cardiac training protocols, with better quality of life improvement. 相似文献4.
Background
Regular exercise training has been shown to reduce mortality, improve functional capacity; and control the risk factors in myocardial infarction (MI) patients. Heart rate recovery (HRR) is a strong independent mortality predictor in patients with previous MI.Aim
The main objective of this study was to investigate the impact of exercise training on heart rate recovery in patients post anterior myocardial infarction.Methods
We recruited patients one month after having anterior MI who were referred to cardiac rehabilitation (CR) clinic in Ain Shams University hospital between October 2016 and July 2017. All the patients participated in exercise training sessions 3 times a week for 12?weeks. Symptom limited treadmill exercise test was done before and after exercise training program to calculate heart rate recovery in 1st minute (HRR1) and 2nd minute (HRR2).Results
A total of 50 patients, including 44 (88%) males, completed the exercise training program. The mean age was 51?years. Statistically significant improvement in HRR1 and HRR2 was observed (p value?<0.001) after completion of exercise based cardiac rehabilitation program. Significant improvement in resting heart rate was also observed (p value?<0.001). Moreover, metabolic equivalent (METs) and HR reserve were improved significantly (p value <0.001). No statistically significant changes were observed in resting systolic and diastolic blood pressures and maximum HR (p value?=?0.95, 0.76 and 0.31 respectively).Conclusion
Exercise training improves HRR, resting HR, METs and HR reserve in post anterior MI patients. 相似文献5.
Background and objectives
P-wave dispersion (PWD) and Interatrial block (IAB) are common in heart failure (HF), and could be associated with adverse cardiac events. We aimed to assess the prevalence of PWD and IAB and their relationship with functional status, hospitalization and mortality rate in patients with systolic HF.Methods
We enrolled 110 HF patients in sinus rhythm & LVEF <50%. Patients had undergone clinical evaluation, 6?min walking test (6MWT), 12-lead electrocardiography (ECG), 24-h Holter ECG & echocardiogram. Hospitalization and mortality rate were followed-up for one year. PWD was defined as the difference between maximum & minimum P-wave duration >40?ms. IAB was defined as maximum P duration >110?ms. Measurements were done by 2 blinded investigators using a caliber, a ruler and a magnifying lens.Results
Mean age was 58.9?±?9.7?years and 67.3% were males. Prevalence of PWD and IAB was 68.2% and 57.3%, respectively. Patients with PWD showed these features: 84% in NYHA class III or IV HF, 77.4% had LVEF <35%, 78.7% had paroxysmal Atrial Fibrillation (AF) and 89.4% couldn’t complete >200?m (m) in 6MWT. Patients with PWD had more hospitalizations (72% vs 28.6%, P value <0.02) and higher 1-year mortality rate (20% vs 8.6%, P value <0.04) than patients without PWD. Likewise, patients with IAB had nearly similar clinical features, hospitalization and mortality as patients with PWD.Conclusion
PWD and IAB are prevalent in patients with systolic HF and they are significantly associated with low LVEF, paroxysmal AF, poor functional capacity, hospitalization and mortality rate. 相似文献6.
Francis J. Ha Samia R. Toukhsati James D. Cameron Rosie Yates David L. Hare 《Heart & lung : the journal of critical care》2018,47(1):54-60
Background
Exercise confidence predicts exercise adherence in heart failure (HF) patients. The association between simple tests of functional capacity on exercise confidence are not known.Objectives
To evaluate the association between a single 6-min walk test (6MWT) and exercise confidence in HF patients.Methods
Observational study enrolling HF outpatients who completed the Cardiac Depression Scale and an Exercise Confidence Survey at baseline and following the 6MWT. Paired t-test was used to compare repeated-measures data, while Repeated Measures Analysis of Covariance was used for multivariate analysis.Results
106 HF patients were enrolled in the study (males, 82%; mean age, 64 ± 12 years). Baseline Exercise Confidence was inversely associated with age (p < 0.01), NYHA class (p < 0.001), and depression (p < 0.001). The 6MWT was associated with an improvement in Exercise Confidence (F(1,92) = 5.0, p = 0.03) after adjustment for age, gender, HF duration, NYHA class and depression.Conclusions
The 6MWT is associated with improved exercise confidence in HF patients. 相似文献7.
Purpose
It is unclear what constitutes the optimal strategy for management of atrial fibrillation (AF) in patients with systolic left ventricular (LV) dysfunction. We hypothesized that catheter ablation of AF had benefits compared with rate control in patients with systolic LV dysfunction.Methods
PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and nonrandomized, observational studies. Weighted mean differences (WMD) and 95?% confidence intervals (CIs) were calculated to compare the improvement of left ventricular ejection fraction (LVEF), functional capacity, and quality of life between a catheter ablation group and a rate control group.Results
Six trials with 324 patients were included in the analysis. Patients in the catheter ablation group had greater improvement of LVEF (WMD: 8.89; 95?% CI: 6.93–10.86; p?<?0.001), 6-min walk distance (WMD: 46.9; 95?% CI: 28.5–65.4; p?<?0.001), and lower Minnesota Living With Heart Failure Questionnaire (MLHFQ) scores (WMD: ??19.6; 95?% CI: ??23.6–??15.7; p?<?0.001) compared with patients in the rate control group. Overall, there were only ten procedure-related events and the procedure-related events rate was 4.9?% per procedure and 5.6?% per patient.Conclusion
The present analysis suggests that catheter ablation of AF has benefits in terms of an improvement in LVEF, in functional capacity, and in quality of life compared with rate control in patients with systolic LV dysfunction, and the risk of complications related to procedures is acceptable.8.
Glenna Schluck Wei Wu James Whyte Laurie Abbott 《Heart & lung : the journal of critical care》2018,47(5):458-464
Background
Emergency room utilization and hospital readmission rates are disproportionately high for heart failure patients (HF). Emergency department (ED) utilization is intimately intertwined with hospital readmissions.Objective
Describe the arrival time distribution of HF patients presenting to the ED.Method
The study analyzed heart failure discharge data from the Florida State Emergency Department Database and the Florida State Inpatient Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Data were treated as a Poisson process and analyzed using functional data analysis tools.Results
HF arrivals are multi-modal with the largest peak arrival time in the middle of the day as well as a smaller peak in the early morning hours, especially in rural areas.Conclusions
The arrival pattern has minor differences in rural and urban areas. HF clinic appointments should be established in the early morning hours when these patients utilize the ED. 相似文献9.
Nancy M. Albert James F. Bena Denise Buxbaum Linda Martensen Shannon L. Morrison Marilyn A. Prasun Kelly D. Stamp 《Heart & lung : the journal of critical care》2018,47(3):184-191
Background
Research findings on the value of nurse certification were based on subjective perceptions or biased by correlations of certification status and global clinical factors. In heart failure, the value of certification is unknown.Objectives
Examine the value of certification based nurses' decision-making.Methods
Cross-sectional study of nurses who completed heart failure clinical vignettes that reflected decision-making in clinical heart failure scenarios. Statistical tests included multivariable linear, logistic and proportional odds logistic regression models.Results
Of nurses (N = 605), 29.1% were heart failure certified, 35.0% were certified in another specialty/job role and 35.9% were not certified. In multivariable modeling, nurses certified in heart failure (versus not heart failure certified) had higher clinical vignette scores (p = 0.002), reflecting higher evidence-based decision making; nurses with another specialty/role certification (versus no certification) did not (p = 0.62).Conclusions
Heart failure certification, but not in other specialty/job roles was associated with decisions that reflected delivery of high-quality care. 相似文献10.
Voratima Silavanich Surakit Nathisuwan Arintaya Phrommintikul Unchalee Permsuwan 《Heart & lung : the journal of critical care》2019,48(2):105-110
Background
Little is known regarding the relationship between medication adherence and quality of life in heart failure patients. We therefore aimed to examine the nature of relationship between medication adherence and quality of life.Methods
A prospective, cross-sectional study of chronic heart failure patients with reduced ejection fraction was performed at a tertiary-care, university hospital in Thailand. Quality of life and medication adherence were assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Morisky Medication Adherence Scale-8 (MMAS-8), respectively. Relationship of MLHFQ and MMAS-8 were examined using Spearman's correlation coefficient and multiple regression analysis for covariates adjustment.Results
Among 180 patients, 38.3%, 50.0% and 11.7% were found to have high, medium and poor adherence, respectively. For quality of life, the overall median score on the MLHFQ was relatively low. A positive relationship was identified between medication adherence and quality of life. After covariate adjustment, medication adherence was found to have the strongest relationship with quality of life, compared to other covariates.Conclusions
Medication adherence has a small and positive relationship with quality of life among heart failure patients 相似文献11.
Cardiac Rehabilitation: Current Review of the Literature and Its Role in Patients with Heart Failure
Nishant P. Shah Ahmed AbuHaniyeh Haitham Ahmed 《Current treatment options in cardiovascular medicine》2018,20(2):12
Purpose of review
Cardiovascular (CV) disease remains the leading cause of death in the USA despite major advances in its treatment. With time, cardiac rehabilitation (CR) programs have gathered interest to help increase CV health and improve functional status after a CV event. Patients with heart failure have also been shown to benefit. In this review, we will evaluate the current literature showcasing the benefits of CR, particularly in patients with heart failure, discuss current limitations, and avenues for future investigation.Recent findings
Studies have shown that CR is beneficial in reducing morbidity, mortality, hospitalizations, activity-related symptoms, and increasing quality of life. Similar findings have also been observed in patients with heart failure who underwent CR in addition to optimal medical management.Summary
The positive effects of CR are well established in patients with coronary disease. Recent literature is also showing a trend to benefit in patients with heart failure, though much of the evidence is limited to patients with systolic dysfunction. Despite recommendations by professional societies, the use of CR remains underutilized. Further investigation is needed to better understand the impact of CR in heart failure. Moreover, strategies to increase CR utilization must be explored.12.
Ann F. Jacobson Veronica Sumodi Nancy M. Albert Robert S. Butler Lori DeJohn Donna Walker Kelly Dion Hua-Li Lin Tai Donna M. Ross 《Heart & lung : the journal of critical care》2018,47(5):447-451
Background
More evidence is needed about factors that influence self-management behaviors in persons with heart failure.Objective
To test a correlational mediation model of the independent variables of health literacy, patient activation, and heart failure knowledge with heart failure self-management behaviors.Methods
The study used a prospective, cross-sectional, correlational design. Correlation and multiple regression were used to analyze associations among variables. Results: Of 151 participants, 57% were male, and mean age was 68 years. Heart failure self-management behaviors was positively correlated with patient activation level (p = .0008), but not with health literacy or heart failure knowledge.Conclusions
Persons with heart failure may better manage their condition if sufficiently activated, regardless of their level of health literacy or knowledge of heart failure disease and management processes. 相似文献13.
14.
Federica Dellafiore Harleah G. Buck Gianluca Pucciarelli Claudio Barbaranelli Marco Paturzo Rosaria Alvaro Ercole Vellone 《Heart & lung : the journal of critical care》2018,47(6):553-561
Background
Higher patient-caregiver mutuality is associated with improved patient and caregiver outcomes, but no studies have tested the psychometric characteristics of the mutuality scale (MS) in heart failure (HF) patient and caregiver population.Objectives
To test the validity and reliability of the MS.Methods
A cross-sectional design. The MS validity and reliability were tested with confirmatory factor analysis (CFA) and hypothesis testing, and with Cronbach's alpha and model-based internal consistency index, respectively.Results
CFA supported the validity of the MS in the HF patient and caregiver versions. Hypothesis testing showed significant correlations between both versions of the MS and anxiety, depression, quality of life, and self-care. Also, MS caregiver version scores correlated significantly with caregiver preparedness. Cronbach's alphas and the model-based internal consistency index ranged between 0.72 and 0.94 in both versions.Conclusions
The Mutuality Scale showed supportive validity and reliability for HF patients and caregivers. 相似文献15.
E. Herrmann S. Fichtlscherer S. H. Hohnloser A. M. Zeiher B. Aßmus 《Herzschrittmachertherapie & Elektrophysiologie》2016,27(4):371-377
Introduction
Patients with advanced heart failure suffer from frequent hospitalizations. Non-invasive hemodynamic telemonitoring for assessment of ventricular filling pressure has been shown to reduce hospitalizations. We report on the right ventricular (RVP), the pulmonary artery (PAP) and the left atrial pressure (LAP) sensor for non-invasive assessment of the ventricular filling pressure.Methods
A literature search concerning the available implantable pressure sensors for noninvasive haemodynamic telemonitoring in patients with advanced heart failure was performed.Results
Until now, only implantation of the PAP-sensor was able to reduce hospitalizations for cardiac decompensation and to improve quality of life. The right ventricular pressure sensor missed the primary endpoint of a significant reduction of hospitalizations, clinical data using the left atrial pressure sensor are still pending.Conclusion
The implantation of a pressure sensor for assessment of pulmonary artery filling pressure is suitable for reducing hospitalizations for heart failure and for improving quality of life in patients with advanced heart failure.16.
Chou-Chin Lan Mei-Chen Yang Hui-Chuan Huang Chih-Wei Wu Wen-Lin Su I.-Shiang Tzeng Yao-Kuang Wu 《Heart & lung : the journal of critical care》2018,47(5):477-484
Background and Objectives
Patients with chronic obstructive pulmonary disease (COPD) often have poor health-related quality of life (HRQL), exercise capacity and cardiopulmonary function. Pulmonary rehabilitation (PR) is beneficial to improve exercise capacity and HRQL. However, series changes of these parameters remain unclear.Methods
Forty-three subjects participated in a 3-months PR program. Subjects were evaluated at baseline and at 8, 16, and 24 sessions after PR.Results
After 8 sessions, there were significant improvements in the SGRQ-symptom domain, exertional dyspnea, and oxygen pulse (all p < 0.05). Maximal VO2, SGRQ-activity and SGRQ-impact domains, and respiratory muscle strength were significantly improved after 16 and 24 sessions (all p < 0.05).Conclusions
Eight sessions of exercise training lead to improvement of symptoms and exertional dyspnea. 16 to 24 sessions result in further improvement. We suggest patients receive 16 to 24 sessions of PR. 相似文献17.
Abhinav Sood Krista Dobbie W. H. Wilson Tang 《Current treatment options in cardiovascular medicine》2018,20(5):43
Purpose of review
This review illustrates the dynamic role of palliative care in heart failure management and encapsulates the commonly utilized pharmacologic and non-pharmacologic therapeutic strategies for symptom palliation in heart failure. In addition, we provide our experience regarding patient care issues common to the domain of heart failure and palliative medicine which are commonly encountered by heart failure teams.Recent findings
Addition of palliative care to conventional heart failure management plan results in improvement in quality of life, anxiety, depression, and spiritual well-being among patients.Summary
Palliative care should not be confused with hospice care. Palliative care teams should be involved early in the care of heart failure patients with the aims of improving symptom palliation, discussing goals of care and improving quality of life without compromising utilization of evidence-based heart failure therapies. A consensus on the appropriate timing of involvement and evidence for many symptom palliation therapies is still emerging.18.
Theresa A. Floegel Jared M. Dickinson Cheryl DerAnanian Marianne McCarthy Steven P. Hooker Matthew P. Buman 《Journal of cardiac failure》2018,24(2):126-130
Purpose
The aim of this work was to investigate the predictive value of in-hospital posture and ambulatory activity for 30 days following discharge on functional status in older patients with heart failure.Methods and Results
We undertook a prospective observational pilot study of 27 patients (78?±?9.8 y, 51.8% female) admitted with heart failure. Participants wore 2 inclinometric accelerometers to record posture in-hospital and an ankle accelerometer to record ambulatory activity in-hospital and 30 days after discharge. Function was assessed on the day after discharge (Timed Up and Go [TUG], Short Physical Performance Battery [SPPB], hand grip strength) and 30 days after discharge. Length of stay was 5.1?±?3.9 days. Participants spent 63.0?±?19.2% of their hospital time lying down, 30.2?±?18.7% sitting, 5.3?±?4.2% standing, and 1.9?±?8.6% ambulating. Thirty-day mean post-discharge stepping was 4890?±?2285 steps/day. Each 10% increase in hospital lying time was associated with 0.7?s longer TUG time (95% confidence interval [CI] 0.2–1.9) at 30 days. Each 1000 additional daily steps in the post-discharge period was associated with a 0.8-point higher SPPB score (95% CI 0.1–1.0) at 30 days. Handgrip strength was unchanged.Conclusions
Older patients with heart failure were sedentary during hospitalization, which may contribute to decreased functional performance. Physical activity after discharge may minimize this negative effect. 相似文献19.
Jemima Boyd Jenny Paratz Oystein Tronstad Lawrence Caruana Paul McCormack James Walsh 《Heart & lung : the journal of critical care》2018,47(2):81-86
Rationale
Consensus recommendations have been developed to guide exercise rehabilitation of mechanically ventilated patients in the intensive care unit.Objective
This study aimed to investigate the safety of exercise rehabilitation of mechanically ventilated patients and evaluate the consensus recommendations.Methods
This was a prospective, single-centre, cohort study conducted in a specialist cardiothoracic intensive care unit of a tertiary, university affiliated hospital in Australia.Results
91 mechanically ventilated participants; 54 (59.3%) male; mean age of 56.52 (16.3) years; were studied with 809 occasions of service recorded. Ten (0.0182%) minor adverse events were recorded, with only one adverse event occurring when a patient was receiving moderate level of vasoactive support.Conclusions
The consensus recommendations are a useful tool in guiding safe exercise rehabilitation of mechanically ventilated patients. Our findings suggest that there is further scope to safely commence exercise rehabilitation in patients receiving vasoactive support. 相似文献20.
Mohamed Waheed Basyouni Adel Mohamed Shabana Wael Mahmoud El Kilani 《The Egyptian Heart Journal》2018,70(4):295-299