Cases Of Heart Failure Patients Research Articles

Volume-Guided Venous To Venous Ultrafiltration In Hospitalized Heart Failure Patients

Background Patients with heart failure often have wide variations in intravascular volume (Total Blood Volume (TBV) and Red Blood Cell Volume (RBCV)) that are part of the pathophysiology, symptomatology, and disease progression of their syndrome. Indirect volume measurements cannot measure intravascular volume with precision, often leaving clinicians without clear volume-guided treatment strategies. Ultrafiltration (UF) is a treatment capable of removing fluid from the body without changing RBCV or removing serum proteins and large molecules. Blood volume analysis (BVA) provides several patient specific metrics including TBV, plasma volume (PV), and RBCV as well as providing a normalized hematocrit (nHct), a reflection of the anticipated pHct after volume correction. Goals of using UF are safe removal of fluid without creation of hypovolemia and without exceeding the plasma refill rate. We report below two cases of heart failure patients co-managed using BVA and UF. Methods/Results Two men aged 83 and 64 years were admitted to the hospital for volume overload and management. Each was initially treated with intense IV diuresis which produced worsening renal insufficiency. At that time BVA confirmed increased total intravascular volume for which UF was initiated. Monitoring of the gap between the peripheral hematocrit and the normalized hematocrit allowed safe and adequate decongestion. Significant volume removal corelated with clinical improvement and the patients were discharged 3-4 days following combined use of BVA and UF. Table 1 summarizes these outcomes and documents the rise in pHct (Patient 2) as it approaches the nHct, signaling sufficient volume removal. Conclusions While the synergy of combining BVA with UF has been envisioned for more than a decade, limited information is available to understand the optimal use and define the value of combining these valuable tools. Earlier use of BVA in these two patients could have prevented acute renal injury from intensified diuresis, and by instituting UF, the kidneys could be provided with a ‘diuretic holiday’. Further, the normalized hematocrit, determined by BVA, provides clinicians with a specific metric to monitor UF progress and adequacy. Combined use of BVA and UF should improve outcomes in hospitalized diuretic-resistant or renal insufficient patients. Clinical trials of their combination need to be designed and completed. Patients with heart failure often have wide variations in intravascular volume (Total Blood Volume (TBV) and Red Blood Cell Volume (RBCV)) that are part of the pathophysiology, symptomatology, and disease progression of their syndrome. Indirect volume measurements cannot measure intravascular volume with precision, often leaving clinicians without clear volume-guided treatment strategies. Ultrafiltration (UF) is a treatment capable of removing fluid from the body without changing RBCV or removing serum proteins and large molecules. Blood volume analysis (BVA) provides several patient specific metrics including TBV, plasma volume (PV), and RBCV as well as providing a normalized hematocrit (nHct), a reflection of the anticipated pHct after volume correction. Goals of using UF are safe removal of fluid without creation of hypovolemia and without exceeding the plasma refill rate. We report below two cases of heart failure patients co-managed using BVA and UF. Two men aged 83 and 64 years were admitted to the hospital for volume overload and management. Each was initially treated with intense IV diuresis which produced worsening renal insufficiency. At that time BVA confirmed increased total intravascular volume for which UF was initiated. Monitoring of the gap between the peripheral hematocrit and the normalized hematocrit allowed safe and adequate decongestion. Significant volume removal corelated with clinical improvement and the patients were discharged 3-4 days following combined use of BVA and UF. Table 1 summarizes these outcomes and documents the rise in pHct (Patient 2) as it approaches the nHct, signaling sufficient volume removal. While the synergy of combining BVA with UF has been envisioned for more than a decade, limited information is available to understand the optimal use and define the value of combining these valuable tools. Earlier use of BVA in these two patients could have prevented acute renal injury from intensified diuresis, and by instituting UF, the kidneys could be provided with a ‘diuretic holiday’. Further, the normalized hematocrit, determined by BVA, provides clinicians with a specific metric to monitor UF progress and adequacy. Combined use of BVA and UF should improve outcomes in hospitalized diuretic-resistant or renal insufficient patients. Clinical trials of their combination need to be designed and completed.

Constructing Large Scale Cohort for Clinical Study on Heart Failure with Electronic Health Record in Regional Healthcare Platform: Challenges and Strategies in Data Reuse.

Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management. It is a common requirement to reuse the data for clinical research. However, we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform. In this paper, we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology. We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform. Secondly, we built special disease case repositories (i.e., heart failure repository) that utilize the graph to search the related patients and to normalize the data. Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure, we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository. After the propensity score matching, the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired. Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients. This paper presents the workflow and application example of big data mining based on regional EHR data.

Demands of self-monitoring in patients with chronic heart failure: a qualitative research

Objective To explore the self-monitoring needs of patients with chronic heart failure, so as to understand their needs for self-monitoring and provide references for clinical nursing healthcare education. Methods From October 2016 to January 2017, totally 9 cases of heart failure patients who met the inclusion criteria in an affiliated hospital were enrolled in this study. In-depth interviews were conducted and analyzed by phenomenological data analysis to form the main topic. Results At last, 5 subjects were extracted, namely, the needs for self-monitoring knowledge, the needs for suitable monitoring tools selection, the needs for self-monitoring skill, the willingness of self-monitoring and the needs for support from affection and friends. Conclusions The long-term treatment and rehabilitation of chronic heart failure patients was not only to improve symptoms and prolong life, but also to build a diversified health education and follow up model, to establish a professional health education team; to construct a rational service support system, to provide professional services for chronic heart failure patients, so as to meet the self-monitoring needs, help with symptom recognition and ultimately improve patients' quality of life. Key words: Heart failure; Qualitative research; Self-monitoring needs

GW24-e3765 A Correlational Study about Relationship between ACE Gene Polymorphisms with Heart Failure in Hainan Han Nationality.

ObjectivesTo study the correlation between angiotensin converting enzyme (ACE)gene polymorphisms with heart failure in Hainan Han Nationality.MethodsACE I/D gene polymorphisms were detected by polymerase chain reaction (PCR) in 150 cases...