Breathlessness In Heart Failure Research Articles

Effect of opioids for breathlessness in heart failure: a systematic review and meta-analysis

BackgroundFor the treatment of breathlessness in heart failure (HF), most textbooks advocate the use of opioids. Yet, meta-analyses are lacking.MethodsA systematic review was performed for randomised controlled trials (RCTs) assessing...

Left Atrial Remodeling in Disease: Association with Clinical Markers

Background: The role of left atrial (LA) enlargement has a significant and independent association with moderate and severe diastolic dysfunction, atrial fibrillation, and left ventricular (LV) end-diastolic volume. Clinical features of heart failure have shown a correlation with LV dilatation and LV ejection fraction (LV). Aims: Correlation of clinical features with substrates of cardiac remodeling, especially left atrial (LA) remodeling, has not been well-documented. We sought to determine the major clinical factors that are associated with LA enlargement in subjects with heart failure. Materials and Methods: We studied 200 patients who presented with breathlessness due to underlying cardiac disease. The association of clinical features of cardiac disease with LA remodeling was studied using three-dimensional echocardiography. Results: This was a cross-sectional study conducted between January 2016 and January 2017. We found that clinical features of heart failure such as breathlessness, elevated jugular venous pressure, dilated LV, diastolic dysfunction, severe mitral regurgitation, pulmonary hypertension, and abnormal tricuspid annular plane systolic excursion were significantly associated with LA enlargement. LA volume was significantly and independently associated with moderate and severe diastolic dysfunction, atrial fibrillation, lower hemoglobin levels, and LV diastolic size on echocardiography. The sensitivity and specificity of breathlessness with LA enlargement were not significant. Conclusions: Clinical features of heart failure, namely breathlessness, were significantly associated with LA enlargement. LA enlargement was not a sensitive or specific marker of breathlessness in heart failure.

Rationale for targeted self-management strategies for breathlessness in heart failure.

To provide a conceptual rationale for targeted self-management strategies for breathlessness in chronic heart failure. Breathlessness is a defining symptom of chronic heart failure and is the primary cause for hospital readmissions and emergency room visits, resulting in extensive health care utilization. Chronic breathlessness, punctuated by acute physiological decompensation, is a sentinel symptom of the heart failure syndrome and often intensifies towards the end of life. Drawing upon evidence-based guidelines, physiological mechanisms and existing conceptual models for the management of breathlessness is proposed. Key elements of this model include adherence to evidence-based approaches (pharmacological and non-pharmacological management to optimize heart failure treatment), self-monitoring of symptoms, identification of modifiable factors (such as fluid overload), and targeted strategies for breathlessness including distraction and gas flow. Self-management is an essential component in heart failure management which could positively influences health outcomes and quality of life. Refining programs to focus on breathlessness may have the potential to reduce symptom burden and improve quality of life.

Oxygen use in chronic heart failure to relieve breathlessness: A systematic review.

To appraise published studies on the use of supplemental oxygen in chronic heart failure. Chronic breathlessness is a characterizing symptom of symptomatic heart failure resulting in substantial disability and healthcare utilization and is the primary reason for emergency room visits and hospitalizations. In spite of the variable evidence, oxygen therapy is commonly administered both acutely and chronically. Moreover, the role of oxygen therapy to relieve chronic breathlessness in heart failure is not well described, particularly in normoxemic or mild or intermittent hypoxemic states. In fact, several studies have shown the detrimental effects of oxygen therapy with normal oxygen saturation levels. A systematic review using PRISMA guidelines. Four databases PubMed, Embase, CINAHL, and Web of Science were systematically searched from January 2001 to January 2019 investigating the use of oxygen in heart failure. Duplicate articles were removed from the review. Titles and abstracts were screened for inclusion and exclusion criteria. The remaining full-text articles were reviewed and hand-searched for additional references. The quality of the full-text articles was assessed using standardized critical appraisal instruments by the Joanna Briggs Institute. A total of 11 studies, including three intervention and eight non-interventions studies, were included in this review from 1072 non-duplicated records retrieved. Sample size ranged from 4 to 5862. In spite of common usage, this review suggests that there are scant data available to justify the use of oxygen in individuals with non-hypoxemic chronic heart failure and chronic breathlessness.

The Effects of Medication on Activity and Rehabilitation of Older People – Opportunities and Risks

Multiple medication use, or polypharmacy, is common in people undergoing rehabilitation. Polypharmacy is also common in older people, where it has the potential to impact on habitual physical activity. Despite this, the interactions between medication, disease, activity, and rehabilitation outcomes are insufficiently researched. In this review, we consider common classes of medications that can affect physical activity levels and outcomes of rehabilitation. We consider medications that improve disease processes and improve limiting symptoms (eg, breathlessness in heart failure and lung disease, pain in arthritis), unwanted side effects of medications (eg, central slowing caused by opioids and hypnotics), and also medication classes that might have the ability to improve activity and rehabilitation outcomes via beneficial effects on neuromuscular function (eg, angiotensin-converting enzyme inhibitors). We conclude by giving practical advice on how to review and optimise medication use to support habitual physical activity and ensure the best results from rehabilitation.

The mechanisms of breathlessness in heart failure as the basis of therapy

The review provides an overview of recent understanding in relation to the mechanisms relating to skeletal muscle and the sympathetic nervous system, and therapies for breathlessness which target these mechanisms. These are set in the context of established knowledge in this field. Despite strong evidence to support exercise training programmes, and recommendations in international guidelines, programmes are implemented poorly. Electrical stimulation appears to be a way of exercising people too frail to undertake a full exercise programme. There is evidence to support the use of opioids for breathlessness in other conditions, but as yet the evidence in chronic heart failure is mixed. Previous work in relation to the role of skeletal muscle and sympathetic nervous system has set the scene for targeted therapies for the relief of breathlessness in people with heart failure.

Shortness of breath: COPD or CHF?

I enjoyed your article on patient description of breathlessness in heart failure [ [1] Edmonds P.M. Rogers A. Addington-Hall J.M. McCoy A. Coats A.J.S. Gibbs J.S.R. Patient descriptions of breathlessness in heart failure. Int J Cardiol. 2005; 98: 61-66 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. You mentioned that breathlessness in congestive heart failure (CHF) is different from that in cancer, just as breathlessness in chronic obstructive pulmonary disease (COPD) is different from that in cancer. But you did not comment on how breathlessness in CHF is different from that of COPD. The purpose of this communication is to address this issue.

Patient descriptions of breathlessness in heart failure

Objective: To explore patient experience of breathlessness in heart failure. Methods: Semi-structured interviews were undertaken with 27 patients with chronic heart failure and were analysed using a constant comparative approach. Results: The patients had a mean age of 69 (range 38–94 years). All had chronic heart failure with a mean left ventricular ejection fraction of 33.1%. The patient narratives suggested three dominant experiences of breathlessness, “everyday”, “worsening” and “uncontrollable”. These descriptions predominantly focused on physical functioning, relating to patients' ability to manage breathlessness on a day to day basis. Patients were able to accommodate everyday breathlessness, using a number of coping strategies. In most cases this experience of breathlessness came to be accepted as “normal”. Worsening breathlessness was a symptom that patients were unable to manage and that prompted a hospital admission, whereas uncontrollable breathlessness was experienced as a symptom that even health care professionals struggled to control. Conclusions: Patients' descriptions of breathlessness are distinct from medical terminology and more clearly relate to physical adaptations to breathlessness. Further research is required to identify whether heart failure patients' descriptions of breathlessness are different to those of cancer patients, and to establish whether the categories generated from this data set are applicable to other heart failure patients in other settings.

Patient descriptions of breathlessness in heart failure version R1

Objective: To explore patient experience of breathlessness in heart failure. Methods: Semi-structured interviews were undertaken with 27 patients with chronic heart failure and were analysed using a constant comparative approach. Results: The patients had a mean age of 69 (range 38–94 years). All had chronic heart failure with a mean left ventricular ejection fraction of 33.1%. The patient narratives suggested three dominant experiences of breathlessness, “everyday”, “worsening” and “uncontrollable”. These descriptions predominantly focused on physical functioning, relating to patients' ability to manage breathlessness on a day to day basis. Patients were able to accommodate everyday breathlessness, using a number of coping strategies. In most cases this experience of breathlessness came to be accepted as “normal”. Worsening breathlessness was a symptom that patients were unable to manage and that prompted a hospital admission, whereas uncontrollable breathlessness was experienced as a symptom that even health care professionals struggled to control. Conclusions: Patients' descriptions of breathlessness are distinct from medical terminology and more clearly relate to physical adaptations to breathlessness. Further research is required to identify whether heart failure patients' descriptions of breathlessness are different to those of cancer patients, and to establish whether the categories generated from this data set are applicable to other heart failure patients in other settings.