Quality of Life and Depressive Symptoms in the Elderly: A Comparison Between Patients With Heart Failure and Age- and Gender-Matched Community Controls

BackgroundComparisons of heart failure (HF) patients with an unselected healthy sample in terms of quality of life (QoL) and depressive symptoms might prove misleading. We compared QoL and depressive symptoms of a HF population with an age- and gender-matched sample of community dwelling elderly.Methods and ResultsData were collected from 781 HF patients (36% female; age 72 ± 9; New York Heart Association II-IV) and 781 age- and gender-matched community-dwelling elderly. Participants completed the Medical Outcome Study 36-item General Health Survey, the Cantril's Ladder of life, and the Center for Epidemiological Studies-Depression scale (CES-D). Analysis of variance techniques with Welch F test and chi-square tests were used to describe differences in QoL and depressive symptoms between different groups. For both men and women with HF, QoL was reduced and depressive symptoms were elevated when compared with their elderly counterparts (CES-D ≥16: 39% vs. 21%, P < .001). HF patients had more chronic conditions—specifically diabetes and asthma/chronic obstructive pulmonary disease. Impaired QoL and depressive symptoms were most prevalent among HF patients with comorbidities. Prevalence was also higher in HF patients in the absence of these conditions.ConclusionsHF has a large impact on QoL and depressive symptoms, especially in women with HF. Differences persist, even in the absence of common comorbidities. Results demonstrate the need for studies of representative HF patients with direct comparisons to age- and gender-matched controls.     

Marital status, quality of life, and clinical outcome in patients with heart failure

AIM: This study investigated the impact of having a partner on quality of life (QoL), the number of hospital readmissions, and 9-month survival in patients with heart failure (HF). METHODS: The study population consisted of hospitalized patients with HF. QoL was measured by the Cantril Ladder of Life (0-10) during hospital admission. Clinical data, readmission rate, and number of deaths were registered by patient interview and chart review. RESULTS: Of the 179 patients, 96 (54%) were married or were living with a partner. Differences in QoL between married patients and those living alone were most pronounced with regard to future expectations of QoL (6.5 vs 5.0, P=.00). However, in a multivariate model QoL was primarily associated with socioeconomic status, age, and gender. Married patients had 12% less events in the 9-month follow-up period compared with patients living alone (P=not significant). CONCLUSION: This study indicates that most patients with HF who are living alone are mostly elderly women with a low socioeconomic status, who are at risk for recurrent events and a worse QoL.     

CARDIAC AUTONOMIC NEUROPATHY IN DIABETES MELLITUS

Forty-eight out of 95 patients with diabetes mellitus, who were asymptomatic for autonomic nervous system affections, were evaluated with 3 bedside tests to detect subclinical cardiac neuropathy. There were 25 males and 23 females in the age range of 10-60 years. The three tests carried out were, heart rate response to Valsalva manoeuvre, heart rate variation during deep breathing, and systolic blood pressure fall in response to standing. Of these 48 patients, 15 (31.3%) had evidence of neuropathy. Abnormality of the parasympathetic division was found in 13 patients and the remaining 2 patients had borderline affection. Three patients had evidence of a combined parasympathetic and sympathetic involvement. Sympathetic affection alone was not detected in any patient. Increased incidence was seen in older age group. Autonomic neuropathy was more common in patients who had the disease for over 5 years. There was no correlation with the sex of the patient or with metabolic control of diabetes.KEY WORDS: Autonomic nervous system diseases, Diabetes Mellitus, Neuropathy     

MANAGEMENT OF LUNG ABSCESS WITH PERCUTANEOUS CATHETER DRAINAGE

Percutaneous catheter drainage was used to treat 12 among 34 cases of lung abscesses, who were refractory to medical therapy, severely ill and high risk cases for surgery. A complete clinical and radiological recovery was achieved in all the cases who underwent catheter drainage, thereby obviating the need for surgery. None of the cases had catheter or procedures related complications. From this study it is inferred that percutaneous transthoracic catheter drainage is a safe and an effective modality of therapy for patients with lung abscess in whom medical therapy has failed and those who are unsuitable for surgery.KEYWORDS: Lung abscess, Percutaneous catheter drainage