Factors related to time to admission to specialized multidisciplinary clinics in patients with congestive heart failure

BACKGROUND:

Congestive heart failure (CHF) is a common cause of hospitalization and has a poor prognosis. Specialized multidisciplinary clinics are effective in the management of CHF.

OBJECTIVES:

To measure time of admission to the specialized clinics and explore factors related to the time of admission to these clinics.

METHODS:

Patients who were newly admitted to one of six CHF multidisciplinary clinics in the province of Quebec were enrolled in the study. Data were collected from the common clinical database used at these clinics as well as from questionnaires administered to the patients.

RESULTS:

A total of 531 patients with a mean age of 65.9 years were enrolled. Only 26% were women. The median duration of disease before admission to the CHF clinic was 1.2 years. The majority of patients (62%) were referred by a cardiologist or an internist, while 24% were referred by other specialists, and 14% by general practitioners. One-fifth of patients did not have regular follow-up for their CHF before being admitted to the clinic. Factors associated with shorter disease duration at admission to the clinic were referral by a specialist, not having regular medical follow-up for CHF, having a higher income and having visited the emergency room for CHF.

CONCLUSION:

There may be a need to improve dissemination of information regarding availability and benefits of CHF clinics and criteria for referral.     

不同心肌病充血性心力衰竭患者细胞因子的变化

目的 :探讨细胞因子在不同心肌病充血性心力衰竭 (CHF)中升高的触发机制。方法 :选择不同心肌病CHF患者 6 0例 (缺血性心肌病和扩张型心肌病各 30例 ) ,并选择 30例匹配的正常人作为对照组 ,放射免疫法检测肿瘤坏死因子 - α(TNF- α)、白细胞介素 - 1 (IL- 1 )、IL- 6和神经激素〔醛固酮 (AL D)、心钠素 (ANP)、肾素 (PRA)、血管紧张素 (AT )〕。结果 :TNF- α、IL- 1、IL- 6在 CHF患者中较正常人明显增高 (P <0 .0 0 1 )。不同心肌病CHF患者 ,在相同心功能分级时细胞因子水平无显著性差异。 TNF- α的升高与 ANP水平以及 IL- 6的升高与AL D水平均呈正相关。结论 :细胞因子在 CHF中起重要作用 ;但与不同心肌病无关。     

不同心律的慢性充血性心力衰竭患者对美托洛尔的耐受性比较

目的 :比较不同心律状态下的慢性充血性心力衰竭 (CHF)患者对美托洛尔治疗的剂量耐受情况。方法 :对 14 6例CHF患者 [其中窦性心律 (窦律 ) 10 3例、心房颤动 (房颤 )心律 2 8例、起搏器心律 15例 ]在常规心力衰竭 (心衰 )治疗基础上口服美托洛尔 ,逐渐加量至目标剂量。治疗目标分别为 :①心室率下降到 5 0～ 6 5次 /min(不低于 5 0次 /min) ;②稍加剂量心功能下降 1级 ;③收缩压不低于 90mmHg(1mmHg =0 .133kPa) ;④达最大剂量 :2 0 0mg/d。结果 :窦律者美托洛尔平均剂量低于房颤和起搏器心律者 [(72 .7± 36 .1)mg/d∶(10 4 .7±2 8.7)mg/d和 (10 8.7± 2 4 .6 )mg/d ,P <0 .0 1];窦律者达心率目标的平均剂量低于达心衰的目标剂量 ,房颤者心率和心衰的目标剂量相当 ,而 3种不同心律患者达心衰目标剂量无明显差异 (P >0 .0 5 )。结论 :不同心律的CHF患者对美托洛尔的耐受性均较好 ,且房颤和起搏器心律者好于窦律患者     

稳定期慢性充血性心力衰竭患者睡眠呼吸障碍

目的了解稳定期、已得到良好治疗的慢性充血性心力衰竭(心衰)患者的睡眠呼吸障碍的发生情况及睡眠呼吸障碍对心衰的影响.方法应用多导睡眠监护仪(Polywin1000,RespironicsInc.)对稳定期充血性心衰患者进行监测.结果病人分为两组,Ⅰ组(21例)A-H指数≤15,Ⅱ组(15例,占41.7%)A-H指数》15.Ⅱ组A-H指数为16.8～78.8,平均42.6±15.5,其中阻塞性AHI为11.1±8.4,而中枢性AHI为31.5±9.6.同时,Ⅱ组有着显著多的醒觉指数,为36.8±21.3(Ⅰ组为19.4±11.2),这直接与呼吸暂停及低通气指数有关,并与睡眠中最低血氧饱和度[Ⅱ组(76.7±4.6)%,Ⅰ组(86.5±2.8)%、更低的左心室射血分数[Ⅱ组(24.2±8.8)%,Ⅰ组(31.5±10.6)%]有关.结论稳定期慢性充血性心衰患者有着很高的严重的睡眠呼吸障碍的发生率,主要为伴中枢性睡眠呼吸暂停的周期性呼吸.睡眠呼吸障碍的发生与严重的夜间氧合血红蛋白饱和度的下降及过多的觉醒有关.严重的未经治疗的睡眠呼吸障碍可能影响左心室功能,并能加剧充血性心衰患者的死亡.     

充血性心衰患者早期运动康复的应用研究

目的：评价早期运动康复对充血性心衰患的临床疗效疗,探讨其运动方式和安全性。方法：对本院近4年来25例充血性心衰患在实施临床医疗措施的同时,早期介入运动康复,并与周期25例对照组进行比较,结果：25例患均顺利完成早期运动康复,其平均住院时间及住院费用显节省,可促进临床表现的好转,并发症发生率明显较对照组低,可增强患身体活动能力,提高出院时生活质量。续集：早期运动康复对充血性心衰患疗效显,安全可行。     

A questionnaire-based assessment of daily physical activity in heart failure

Type and dose of daily energy expenditure (DEE) play a major role in modulations of health status and an increased knowledge of these dimensions of physical activity in congestive heart failure (CHF) patients would be valuable for clinical and epidemiological aims. We propose a new self-administered DEE questionnaire adapted to CHF patients and tested its validity. One hundred and five stable CHF participants, NYHA class I-IV, LVEF=33.2+/-6.1% performed an incremental symptom-limited Vo(2) (peak) test and filled in the questionnaire for DEE calculation. Reproducibility (n=24), sensitivity (n=21) of the questionnaire and inter-observer variability (n=105) were tested. Intensity levels were identified from DEE and their relationships to Vo(2)(peak), ventilatory and anthropometric characteristics were assessed by simple and multiple regression models. Reproducibility and sensitivity were high (r=0.98 and 0.88, respectively, P<0.0001) and inter-observer error reached 1.37%. DEE was highly correlated to physical activity energy expenditure (r=0.96, P<0.0001). Relationships between DEE, Vo(2)(peak), V(E)/Vo(2) and anthropometric characteristics were significant. An activity level above 3 MET was the best intensity criteria related to Vo(2)(peak) (r=0.62, P<0.0001) and DEE (r=0.80, P<0.0001). The questionnaire seems reproducible, sensible and valid for DEE estimation. Vo(2)(peak) appears related to DEE and especially to activities above 3 MET in CHF.     

Cardiac resynchronization therapy in patients with heart failure and atrial fibrillation: importance of new-onset atrial fibrillation and total atrial conduction time

Aims: Cardiac resynchronization therapy (CRT) is an established therapyfor patients with heart failure and sinus rhythm (SR), but itsvalue in atrial fibrillation (AF) remains unclear. Furthermore,response to CRT may be difficult to predict in these patients.The aim of our study was to investigate whether predictors forCRT success differ between patients with AF and SR and to studythe influence of present or developing AF on response to CRT. Methods and results: We examined consecutive patients in whom CRT was implanted disregardingthe atrial rhythm. Atrial fibrillation was defined as eithercurrent or earlier AF, response to CRT was defined as a decreasein the left ventricular end-systolic volume of 10% after 6 months.Total atrial conduction time (TACT), a measure to predict therisk of developing AF, was determined by echocardiography. Weincluded 114 patients, of whom 56 (49%) were known with AF (23current AF and 33 earlier AF). The other 58 patients had nohistory of AF. After 6 months, response in current and earlierAF and that in SR patients was comparable (56, 58 and 55%, respectively).In AF patients, multivariate analysis revealed a shorter TACTat baseline [odds ratio (OR) 16.7 (1.5–185.3), P = 0.02]and an interventricular mechanical delay (IVMD) >40 ms [OR10.4 (1.0–110.9), P = 0.05] as predictors for response.Non-responders more frequently suffered from new-onset AF (P= 0.02). Conclusion: Failure to CRT is associated with new-onset AF. Total atrialactivation time may be a parameter to predict response in AFpatients.     

慢性心衰患者QRS时程和新发房颤的相关性研究

目的 探讨慢性心衰患者QRS时程（QRSd）增宽对新发房颤的预测价值.方法 选择患有心衰但无房颤病史的患者1098例,将其分为三组：QRSd≤120 ms、120 ms〈QRSd〈150 ms及QRSd≥150 ms组,随访跟踪各组新发房颤的概率.通过二元分析和多元logistic回归分析探讨QRS时程和房颤新发概率之间的相关性.结果 对患者群体的统计表明,房颤的新发概率为35.7%.通过二元分析发现,房颤的新发概率存在组间差别（21.7%、35.9%、42.5%,P〈0.01）;进一步通过多元回归发现,QRS时程是独立的影响因素.结论 QRS是慢性心衰患者新发房颤的独立预测因素.     

缬沙坦治疗充血性心力衰竭(附46例报告)

缬沙坦是新一代高选择性血管紧张素 (Ang ) 型受体 (AT1 )拮抗剂。自 2 0 0 1年以来 ,我们应用不同剂量缬沙坦治疗充血性心衰 (CHF)患者 46例 ,并进行对比。现报告如下。1　资料与方法1 .1　临床资料　随机选择 CHF患者 69例 ,男 3 8例 ,女 3 1例 ;年龄 3 4～ 75岁 ,平均为 5 8.2 9± 1 0 .6岁。其中冠心病 3 9例 ,高血压性心脏病 1 6例 ,扩张型心肌病 1 4例 ,所有病例均符合《内科学》[1 ]充血性心衰诊断标准。心功能 (NYHA分级 ) ～ 级。按照患者就诊顺序 ,随机单盲分为大剂量缬沙坦治疗组 (大剂量组 )、常规剂量组 (常规组 )及…     

老年心力衰竭患者自主神经功能与心功能的相关性研究

目的 探讨老年心力衰竭(CHF)患者自主神经功能活动与心功能受损严重程度的相关性。方法 分析61例老年CHF患者和30例对照者的心率变异性时域指标及心功能指标。结果 CHF组与对照组比较，HRV各测值均非常显著降低(均P＜0．001)；HRV各测值均随心功能的下降而呈递减性下降，在心功能各级别间具有显著差异(P＜0．05或P＜0．001)，SDNN和TI下降与心功能NYHA分级呈负相关(P＜0．01)。结论 老年CHF患者存在着严重的自主神经功能受损和失衡，且与心功能损害程度密切相关。     

β受体阻滞剂在充血性心力衰竭治疗中的应用

本文综述了 β-受体阻滞剂在充血性心力衰竭治疗的研究进展。重点包括了 β-受体阻滞剂治疗心力衰竭的临床应用 ,适应证 ,禁忌证和作用机制。同时也介绍了近年来有关β-受体阻滞剂治疗心力衰竭的循证医学研究结果     

环磷腺苷葡胺治疗充血性心力衰竭的疗效观察

目的：观察环磷腺苷葡胺治疗充血性心力衰竭的疗效。方法：100例充血性心力衰竭心功能Ⅲ—Ⅳ级住院患者，随机分为环磷腺苷葡胺治疗组(50例)和对照组(50例)。环磷腺苷葡胺治疗组：环磷腺苷葡胺150—180mg加入5％葡萄糖注射液250mg中，每日一次静脉滴注，连续7日；对照组：在充血性心力衰竭治疗中除不使用环磷腺苷葡胺外，其他治疗相似。结果：治疗l周后，治疗组总有效率94％，对照组总有效率72％(P＜0．001)。结论：环磷腺苷葡胺是治疗充血性心力衰竭有效的新型药物。     

抗炎症细胞因子在心力衰竭中的治疗进展

充血性心力衰竭是多种心血管疾病所致的一种临床综合征,近年来愈来愈多的研究证实,炎症细胞因子介导的免疫应答在心力衰竭的病理生理过程中起到了重要致病作用.干预此过程已经成为近年来研究的热点.本文总结了目前心力衰竭中抗炎症细胞因子治疗的现状,探讨通过此途径治疗心力衰竭的效果.     

芪苈强心胶囊治疗慢性心力衰竭疗效的Meta分析

目的对芪苈强心胶囊治疗慢性充血性心力衰竭的疗效进行系统评价。方法检索2013年12月31日之前发表的芪苈强心胶囊治疗慢性充血性心力衰竭的随机对照试验文献,按照纳入与排除标准纳入合格文献,采用Cochrane偏倚风险评估工具来对入选的16篇文献进行风险评估。由两位作者(评价员)独立从文本和表格中提取干预组和对照组治疗前后的评价指标及样本量。运用Rev Man5.2.7软件分析加权均数差及95%可信区间。结果共纳入16个研究试验,1422例研究对象,其中对照组699例,芪苈强心组723例。Meta分析显示在心力衰竭患者常规治疗的基础上加入芪苈强心胶囊后能够显著改善患者症状、提高临床综合疗效(RR=1.18,95%CI:1.13~1.24);增加左室射血分数(WMD=4.89,95%CI:3.03~6.75,P0.00001);降低血浆脑钠肽水平(WMD=95.86,95%CI:43.96~147.77,P0.00001);增加左室舒张末期内径(WMD=3.22,95%CI:1.64~4.80,P0.00001);有效增加患者的6分钟步行距离(WMD=41.44,95%CI:33.30~49.59,P0.00001);增加心排血量(WMD=0.22,95%CI:0.00~0.44,P=0.05);降低明尼苏达生活质量表积分(WMD=7.69,95%CI:4.39~10.99,P0.00001)。结论基于目前证据,芪苈强心胶囊治疗慢性充血性心力衰竭疗效良好。但纳入研究可能存在发表偏倚,对于芪苈强心胶囊治疗慢性心力衰竭的远期预后疗效还需更多的临床证据证实。     

培哚普利和安体舒通治疗慢性心衰临床疗效观察

目的　研究血管紧张素转换酶抑制剂 (ACEI)培哚普利和醛固酮 (ALD)拮抗剂安体舒通对慢性充血性心衰 (CHF)治疗的临床疗效及安全性影响。　方法　选择 74例无休克、严重肝肾功能不全及高血钾的CHF患者为对象 ,在基础治疗的同时 ,给予培哚普利 4mg d ,安体舒通 2 0mg d～ 60mg d ,3周为一个疗程 ,观察治疗效果、不良反应 ,服药前及服药 3周、6周后分别测定心电图 (ECG)、动态心电图 (Holter)、超声心动图及血生化指标。　结果　平均疗程 2 8个± 1 3个 ,心衰治疗总有效率为 77% ,6周后高血压控制率为 84 7% ,心率下降 2 1% ,室性早搏明显减少 ,低钾低镁纠正 ,62 %的心肌缺血不同程度得到改善 ,超声心动图显示 ,心脏结构及功能均有好转 ,对血生化无不良影响 ,未见严重不良反应。　结论　对CHF患者 ,在综合治疗的基础上 ,给予培哚普利 4mg d ,安体舒通 2 0mg d～60mg d ,安全有效     

Beneficial effects of sauna bathing for heart failure patients

Generally, the sauna bathing has been contraindicated for patients with chronic heart failure. However, it has been well tolerated and improved hemodynamics has been shown in patients with chronic heart failure after a single exposure and after a four-week period of sauna bathing (five days per week). Left ventricular ejection fraction increased from 24+/-7% to 31+/-9% and left ventricular end-diastolic dimension decreased from 66+/-6 mm to 62+/-5 mm after four weeks. In the present review, the mechanisms of action, the clinical data available to date and the possible beneficial effects of sauna bathing for patients with heart failure are discussed, as well as the precautions and the contraindications in this specific group of patients with chronic heart failure.     

B-type natriuretic peptide testing for structural heart disease screening: a general population-based study

BACKGROUND: Several types of structural heart disease are important precursors for congestive heart failure or cardioembolic stroke. We have previously demonstrated that plasma B-type natriuretic peptide (BNP) measurement is useful for detection of structural heart disease in a multiphasic health screening setting. To extend our hypothesis to the general population, the utility of BNP testing for identifying structural heart disease was assessed in a general population and in subgroups divided by sex, age, and presence/absence of risk factors. METHODS AND RESULTS: This cross-sectional cohort study measured plasma BNP concentrations in 993 randomly selected community-dwelling adults (mean age 58 years). All subjects underwent plasma BNP measurement and transthoracic echocardiography. Using prejudged criteria, 41 subjects were diagnosed to have some form of structural heart disease (mild left ventricular systolic dysfunction in 11, valvular heart disease in 9, hypertensive heart disease in 3, hypertrophic cardiomyopathy in 2, ischemic heart disease in 2, lone atrial fibrillation in 14). The utility of BNP testing was evaluated by receiver operating characteristic (ROC) analysis and by cost analysis for detection of 1 case within each subgroup of the cohort. Overall, the sensitivity and specificity of BNP testing for identification of structural heart disease were 61% and 92%, respectively. The area under the ROC curve was 0.77 (95% CI; 0.74-0.79). When sex-specific ROC analyses were performed, sensitivity and specificity were 61% and 91% in men, and 50% and 95% in women, respectively. Although the performance of BNP testing on the basis of these figures might be suboptimal, efficacy was improved in subgroups with a high prevalence of heart disease (>8%) such as the cohort aged > or =65 years (men, area under ROC curve = 0.88; cost 相似文献   

心脏再同步化治疗在严重心力衰竭中的应用

心力衰竭是各种心脏病的终末阶段,用心脏再同步化(CRT)的技术治疗中重度心力衰竭患者是一个新的治疗方法。CRT又名心房同步双心室起搏装置,近年来一系列短期和长期的临床试验已报道了这项治疗的临床效益,认为是严重心力衰竭合并心电学异常患者的一种理想的非药物辅助治疗选择。文章综述了心脏再同步化治疗的机制,相关的临床试验,临床思考和存在的技术问题,同时强调该方法目前还处于探索研究阶段,但已显示其光明的前景。     

充血性心力衰竭患者的血浆一氧化氮及内皮素的临床研究

目的探讨充血性心力衰竭（CHF）患者的血浆一氧化氮（NO）及内皮素（ET）含量及其在CHF发生发展中所起的作用。方法分别采用比色分析法及放射免疫分析法测定了42例CHF患者的血浆NO及ET。结果CHF患者的血浆NO及ET（64．47±21．42μmol／L及59．71±17．26pg／ml）显著高于正常对照组（51．62±13．62μmol／L及50．83±7．50pg／ml），且心功能Ⅲ－Ⅳ级患者的血浆NO及ET显著高于心功能Ⅱ级者。结论CHF患者的血浆NO及ET含量增高，且与病情严重程度相关。     

促红细胞生成素联合铁剂辅助治疗慢性充血性心力衰竭合并贫血临床观察

目的:观察在慢性充血性心力衰竭(CHF)合并贫血时,标准治疗基础上加用促红细胞生成素(EPO)联合铁剂的临床疗效。方法:40例CHF合并贫血的患者,随机分为治疗组(20例)和对照组(20例)。对照组给予CHF常规治疗,用血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)、洋地黄毒苷、利尿剂、美托洛尔等内科常规治疗,治疗组给予CHF的标准治疗基础上加用EPO及铁剂(EPO 2000IU/次,2～3次∕w,皮下注射至患者血红蛋白浓度在120 g/L稍高水平后,间断给药维持;同时予硫酸亚铁口服,3次∕d),观察并比较2组治疗3个月前后血红蛋白(Hb)、6min步行距离、心功能分级及左心室射血分数(LVEF)。结果:Hb、6min步行距离、心功能分级及LVEF较治疗前差异有统计学意义(P<0.05)。结论:EPO联合铁剂辅助治疗CHF合并贫血患者有效,能改善患者心功能指标,提高患者的生活质量。