Chinese Heart Failure Patients Research Articles

The association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours: a cross-sectional study

BackgroundPatients with heart failure frequently report inadequate self-care behaviours. Physical symptoms can impact patients’ ability to perform self-care behaviours. However, studies investigating the association between physical symptoms and heart failure self-care behaviours have produced inconsistent findings, potentially due to variations in the determinants of self-care behaviours among patients with differing levels of self-care proficiency. Understanding the association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours could improve care for this subpopulation. The study aimed to explore the association between physical symptoms and self-care behaviours in Chinese heart failure patients with inadequate self-care behaviours.MethodsThis analysis was based on primary data from a cross-sectional study that aimed to investigate factors associated with self-care in heart failure patients. Physical symptoms were measured using the Heart Failure Somatic Perception Scale. Self-care behaviours (i.e., self-care maintenance and management) of heart failure were measured using the Self-Care of Heart Failure Index (version 6.2). Patients who reported scores < 70 on both self-care maintenance and management behaviours were eligible and included in the analysis. Hierarchical regression analysis was performed to explore the association between physical symptoms and self-care behaviours.ResultsA total of 189 patients were included in the analysis, with a mean age of 65 years and a median duration of living with heart failure of 24 months. Most participants were classified as New York Heart Association class III or IV. Dyspnoea symptoms were the most frequently reported physical symptoms. The results of the hierarchical regression analysis showed that the severity of physical symptoms was positively associated with self-care management behaviours (β = 0.157, 95% CI: 0.010, 0.368, p = 0.039) but not significantly associated with self-care maintenance behaviours (β = -0.133, 95% CI: -0.316, 0.026, p = 0.097).ConclusionsBased on the data collected in Changsha, China, we found that patients with HF with poor self-care experienced more dyspnoea symptoms. Severe HF physical symptoms might serve as drivers for better self-care management in patients with inadequate self-care behaviours. Effective care and support should be provided when physical symptoms worsen to facilitate patients’ engagement in self-care behaviour in this subpopulation.

Association of red cell distribution width with the risk of 3-month readmission in patients with heart failure: A retrospective cohort study.

In recent years, red cell distribution width (RDW) has been found to be associated with the prognosis of patients with heart failure (HF) in Western countries. However, evidence from Asia is limited. We aimed to investigate the relationship between RDW and the risk of 3-month readmission in hospitalized Chinese HF patients. We retrospectively analyzed HF data from the Fourth Hospital of Zigong, Sichuan, China, involving 1,978 patients admitted for HF between December 2016 and June 2019. The independent variable in our study was RDW, and the endpoint was the risk of readmission within 3 months. This study mainly used a multivariable Cox proportional hazards regression analysis. Smoothed curve fitting was then used to assess the dose-response relationship between RDW and the risk of 3-month readmission. In the original cohort of 1,978 patients with HF (42% male and 73.1% aged ≥70 years), 495 patients (25.0%) were readmitted within 3 months after discharge. Smoothed curve fitting showed a linear correlation between RDW and the risk of readmission within 3 months. In the multivariable-adjusted model, every 1% increase in RDW was associated with a 9% increased risk of readmission within 3months (hazard ratio = 1.09, 95% confidence interval: 1.00-1.15; P < 0.005). A higher RDW value was significantly associated with a greater risk of 3-months readmission in hospitalized patients with HF.

Prevalence and factors associated with cognitive impairment in Chinese heart failure patients: A pilot study.

BackgroundThe prevalence of Cognitive impairment (CI) is high in patients with heart failure (HF). It leads to poor prognosis, such as self-care, hospital readmission and increased mortality. However, such information among Chinese population is unclear.ObjectiveThe purpose of this study was to examine the prevalence of CI in Chinese patients with HF, and explore its correlation with biomarkers and clinical factors to better manage HF patients with CI.MethodsThis study is a cross-sectional study of 200 hospitalized HF patients in China. The cognitive function of HF patients was assessed by the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE).ResultsThe majority are male (62.5%, n = 125), have primary school and below level of education (57.5%, n = 115), NYHA III and above (62%, n = 124). They have an average MoCA score of 15.10 ± 8.18, MMSE score of 19.55 ± 8.23. Age, NYHA class, and atrial fibrillation were independently associated with CI (p < 0.05). There was a significant association between CI and the 4th quartile of TNT (p = 0.013), and the 3rd and 4th quartile of NT-proBNP (p = 0.015, p = 0.038).ConclusionsThe prevalence of undiagnosed CI in Chinese HF patients is high (81%). HF patients with high levels of TNT or NT-proBNP or both values may be at risk of developing CI. Therefore, we suggest that HF patients with older age, atrial fibrillation, NYHA class II and III, as well as elevated TNT or NT-proBNP or both values to be followed up with a formal evaluation for CI. Nurses need to provide targeted health education program for cognitively impaired HF population to improve their self-care ability and nursing outcome.

Non-linear association of cystatin C and all-cause mortality of heart failure: A secondary analysis based on a published database.

BackgroundPrior reports have revealed that basal Cystatin-C (CysC) is positively associated with all-cause death in patients with heart failure (HF). Yet, this positive association is not necessarily generalizable to Chinese HF patients due to methodological limitations and lack of data from Chinese patients.Materials and methodsWe performed secondary data mining based on a retrospective cohort dataset published on the internet. This dataset contains 2008 patients with HF who were admitted to a tertiary hospital in Sichuan Province, China from 2016 to 2019. The exposure variable was baseline CysC and the outcome variable was all-cause death on day 28, day 90, and month 6. Covariates were baseline measurements, including demographic data, drug use, comorbidity score, organ function status (heart, kidney), and severity of heart failure.ResultsAmong 1966 selected participants, the mortality rates at 28 days, 90 days and 6 months were 1.83% (36/1966), 2.09% (41/1966) and 2.85% (56/1966) respectively. After adjustment for confounders, the non-linear associations between CysC and all-cause deaths were observed. We calculated the inflection points were about 2.5 mg/L of CysC. On the right of inflection point, each increase of 1 mg/L in CysC was associated with an increase in the risk of 28-day mortality (Relative risk [RR], 2.07; 95% confidence interval [CI], 1.09 to 3.93; P = 0.0266), 90-day mortality (RR, 2.51; 95% CI, 1.38 to 4.57; P = 0.003), and 6-month mortality (RR,2.25; 95% CI, 1.37 to 3.70; P < 0.001).ConclusionOur findings suggest that values about 2.5 mg/l of cystatin could be a danger threshold for the short-term risk of death in heart failure. Exceeding this threshold, for every 1 mg/L increase in CysC, the risk of all-cause mortality increased by more than one time.

The non-linear association between ascending aorta diameter and risk of 12-month mortality in Chinese patients with heart failure: A retrospective cohort study.

BackgroundThere is no conclusive proven link between ascending aorta diameter (AoD) and the risk of death from heart failure (HF). As a result, a retrospective cohort analysis was carried out to determine whether AoD is associated with 12-month mortality in Chinese HF patients.MethodsFrom January 2017 to March 2020, we collected data on 575 Chinese patients with HF. The exposure and outcome variables were baseline AoD and 12-month risk of mortality (all-cause + cardiac origin), respectively. Data on demographics, drug usage, clinical characteristics, recognized indicators of HF, and comorbidities were included as covariates. To investigate the independent relationships of AoD with the risk of 12-month death, binary logistic regression and two-piecewise linear models were utilized.ResultsOur findings imply that there was a non-linear relationship between AoD and the risk of 12-month mortality. For the AoD range of 23 to 37, there was no association with the risk of cardiac mortality [odds ratio (OR) 0.78, 95% confidence interval (CI), 0.62–1.04]. In the AoD range of 37–49, however, the risk of 12-month cardiac death increased by approximately 70% for every 1 mm increase in AoD (OR 1.70, 95% CI, 1.13–2.55). When all-cause death was chosen as the outcome, the same outcome was shown.ConclusionAn AoD larger than 37 mm is a hazardous threshold for Chinese HF patients. Beyond this limit increased the risk of cardiac death by 70% for every 1 mm increase in AoD.

A Model for the Prediction of Mortality and Hospitalization in Chinese Heart Failure Patients.

Background: Although many risk prediction models have been released internationally, the application of these models in the Chinese population still has some limitations.Aims: The purpose of the study was to establish a heart failure (HF) prognosis model suitable for the Chinese population.Methods: According to the inclusion criteria, we included patients with chronic heart failure (CHF) who were admitted to the Department of Cardiac Rehabilitation of Tongji Hospital from March 2007 to December 2018, recorded each patient's condition and followed up on the patient's re-admission and death. All data sets were randomly divided into derivation and validation cohorts in a ratio of 7/3. Least absolute shrinkage and selection operator regression and Cox regression were used to screen independent predictors; a nomogram chart scoring model was constructed and validated.Results: A total of 547 patients were recruited in this cohort, and the median follow-up time was 519 days. The independent predictors screened out by the derivation cohort included age, atrial fibrillation (AF), percutaneous coronary intervention (PCI), diabetes mellitus (DM), peak oxygen uptake (peak VO2), heart rate at the 8th minute after the cardiopulmonary exercise peaked (HR8min), C-reaction protein(CRP), and uric acid (UA). The C indexes values of the derivation and the validation cohorts were 0.69 and 0.62, respectively, and the calibration curves indicate that the model's predictions were in good agreement with the actual observations.Conclusions: We have developed and validated a multiple Cox regression model to predict long-term mortality and readmission risk of Chinese patients with CHF.Registration Number: ChicTR-TRC-00000235.

Influence of Waist-to-Hip Ratio on the Prognosis of Heart Failure Patients With Revascularized Coronary Heart Disease.

Background: Heart failure (HF) is considered one of the most common complications of coronary heart disease (CHD), with a higher incidence of readmission and mortality. Thus, exploring the risk factors related to the prognosis is necessary. Moreover, the effect of the waist-to-hip ratio (WHR) on HF patients with revascularized CHD is still unclear. Thus, we aimed to assess the influence of WHR on the prognosis of HF patients with revascularized CHD.Methods: We collected data of HF patients with revascularized CHD who were referred to the Cardiac Rehabilitation Clinic of PLA Hospital from June 30, 2015, to June 30, 2019. Cox proportional hazard regression analysis was used to determine the relationship between WHR and prognosis of HF patients with revascularized CHD. Patients were divided into higher and lower WHR groups based on the cutoff WHR value calculated by the X-tile software. Cox regression analysis was used to analysis the two groups. We drew the receiver operating characteristic curve (ROC) of WHR and analyzed the differences between the two groups. Endpoints were defined as major adverse cardiac events (MACE) (including all-cause mortality, non-fatal myocardial infarction, unscheduled revascularization, and stroke).Results: During the median follow-up of 39 months and maximum follow-up of 54 months, 109 patients were enrolled, of which 91.7% were males, and the mean age was 56.0 ± 10.4 years. WHR was associated with the incidence of MACE in the Cox regression analysis (p = 0.001); an increase in WHR of 0.01 unit had a hazard ratio (HR) of 1.134 (95%CI: 1.057–1.216). The WHR cutoff value was 0.93. Patients in the higher WHR group had a significantly higher risk of MACE than those in the lower WHR group (HR = 7.037, 95%CI: 1.758–28.168). The ROC area under the curve was 0.733 at 4 years. Patients in the higher WHR group had a higher body mass index (BMI; 26.7 ± 3.5 vs. 25.4 ± 2.4, P = 0.033) than patients in the lower WHR group.Conclusions: WHR is an independent risk factor of the long-term prognosis of Chinese HF patients with revascularized CHD. Patients with WHR ≥ 0.93 require intensified treatment. Higher WHR is related to higher BMI and ΔVO2/ΔWR.

Performance of Prognostic Risk Scores in Elderly Chinese Patients with Heart Failure.

PurposeElderly heart failure (HF) patients have different clinical characteristics and poorer prognosis compared with younger patients. Prognostic risk scores for HF have not been validated well in elderly patients. We aimed to validate the Seattle Heart Failure Model (SHFM) and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score in an elderly Chinese HF cohort.Patients and MethodsThis retrospective study enrolled 675 elderly HF patients (age≥70 years) discharged from our hospital between 2012 and 2017. The performance of the two risk scores was evaluated in terms of discrimination, using receiver-operating characteristic analysis, and calibration using a calibration plot and Hosmer–Lemeshow (H-L) test. Absolute risk reclassification was used to compare the two scores.ResultsDuring the mean follow-up time of 32.6 months, 193 patients (28.6%) died, and 1-year mortality was 10.5%. The predicted median 1-year mortality was 8% for the SHFM and 18% for the MAGGIC score. A Kaplan–Meier survival curve demonstrated that event rates of all-cause mortality significantly increased with increasing SHFM and MAGGIC scores. The discriminatory capacity of the SHFM was greater than that of the MAGGIC score (c-statistics were 0.72 and 0.67, respectively; P = 0.05). The calibration plot for the SHFM was better than that for MAGGIC score for 1-year mortality (SHFM: H-L χ2 =8.2, P = 0.41; MAGGIC: H-L χ2 =18.8, P =0.02). Compared with the MAGGIC score, the net reclassification index (NRI) of the SHFM was 2.96% (Z=5.88, P< 0.0001).ConclusionThe SHFM performs better than MAGGIC score, having good discrimination, calibration and risk classification for the prediction of 1-year mortality in elderly Chinese HF patients.

Symptom clusters and quality of life in Chinese patients with heart failure

BackgroundEffective symptom assessment and management can improve quality of life in patients with heart failure. However, how psychological symptom cluster, physical symptom cluster and heart failure symptom cluster influence the quality of life of patients with heart failure remains unknown. Aims(a) To describe the symptom clusters among Chinese patients with heart failure (HF), (b) explore the relationship between symptom clusters and quality of life (QOL), and (c) detect if physical and psychological symptoms are mediators of the association between heart failure symptom and QOL. MethodsThree hundred and one patients with heart failure completed measures of symptom (MSAS), QOL and demographic and clinical characteristics. Multiple regression analysis was used to analyse the data. FindingsThe mean age of participants was 72.19 years (range 31–96 years). Each patient was approximately accompanied by an average of 11.19 symptoms (range 0–31), and the top six most common symptoms of Chinese HF patients were shortness of breath, difficulty sleeping, difficulty breathing when lying flat, lack of energy, lack of appetite and cough. Both physical symptom cluster and psychological symptom cluster were the mediators of the relationship between heart failure symptom cluster and QOL. ConclusionsThere were mediating effects of physical symptom cluster and psychological symptom cluster between heart failure symptom cluster and QOL in Chinese patients with HF. Operative assessment, management and alleviation of physical symptoms and psychological symptoms should be prioritised in symptom management strategies for the clinical caregivers.

Prognostic value of Montreal Cognitive Assessment in heart failure patients

Objective: To explore the occurrence of cognitive impairment in Chinese heart failure (HF) patients and it's impact on prognosis. Methods: In this prospective observational study, a total of 990 HF patients were enrolled from 24 hospitals in China during December 2012 to November 2014. All patients were administrated with the interview-format Montreal Cognitive Assessment (MoCA), according to which they were divided into MoCA<26 (with cognitive impairment) group and MoCA≥26 (without cognitive impairment) group. Baseline data were collected and a 1-year follow up was carried out. Univariate and multivariate logistic or Cox regression were performed for 1-year outcomes. Results: Cognitive impairment was evidenced in 628 patients (63.4%) and they were more likely to be older, female, and with higher proportion of New York Heart Association(NYHA) class Ⅲ-Ⅳ, chronic obstructive pulmonary disease (COPD), ischemic heart disease, while body mass index (BMI), education level, and medical insurance rate were lower (all P<0.05) as compared to patients in MoCA≥26 group. The rate of percutaneous intervention, device implantation, cardiac surgery and evidence-based medications were significantly lower in MoCA<26 group than in MoCA≥26 group (all P<0.05). During the 1-year follow up, patients in the MoCA<26 group had higher all-cause mortality (10.2%(64/628) vs. 2.2%(8/362), P<0.01), cardiovascular mortality (5.9%(37/628) vs. 0.8%(3/362), P<0.01) and major adverse cardiac and cerebrovascular events (MACCE) (9.6%(60/628) vs. 2.5%(8/362), P<0.01) than patients in the MoCA≥26 group. In univariate regression, MoCA<26 was associated with increased all-cause mortality (HR(95%CI):4.739(2.272-9.885), P<0.01), cardiovascular mortality (HR(95%CI):7.258(2.237-23.548), P=0.001) and MACCE (OR(95%CI):4.143(2.031-8.453), P<0.01). After adjustment by multivariate regression, MoCA<26 was indicated as an independent risk factor for all-cause mortality (HR(95%CI): 6.387(2.533-16.104), P<0.01), cardiovascular mortality (HR(95%CI): 10.848(2.586-45.506), P=0.001) and MACCE (OR(95%CI): 4.081(1.299-12.816), P=0.016), while not for re-hospitalization for HF (OR(95%CI):1.010(0.700-1.457), P=0.957). Conclusions: Cognitive impairment is common in HF patients,and it is an independent prognostic factor for 1-year outcomes. Routine cognitive function assessment and active intervention are thus recommended for HF patients.

The Impact of Abdominal Obesity on Cardiopulmonary Fitness in Chinese Heart Failure Patients

Introduction There is an inverse relationship between abdominal obesity measured by waist circumference (WC) and cardiopulmonary fitness (peak oxygen consumption, VO2peak) among healthy white people. However, knowledge of Chinese heart failure patients remains scant because heart failure patients generally experience significant impaired cardiopulmonary fitness, and Asian populations tend to have more abdominal fat compared to white populations. Hypothesis Abdominal obesity based on Asian WC cut-off points results in significant changes in VO2peak and the WC can negatively impact the VO2peak in Chinese heart failure patients. Methods This is a cross-sessional study. Data was collected from 72 heart failure patients with NYHA classI∼IV (80% II) with mean ejection fraction of 46.5%. VO2peak was measured during a symptom-limited bicycle exercise test; and WC was measured between the lower rib and the iliac crest. Abdominal obesity was defined by the recommended Asian cut-off points (90 cm for men, 85 cm for women). Other clinical variables were collected from electronic medical records. Non-parametric tests, Spearman's correlation coefficients, and a linear regression model were used with p-value Results Among 72 patients, mean age was 65.4 (range: 36∼91); 80.6% were male; and mean BMI was 24.4 kg/m2 with 45 (63%) classified as abdominally obese. Overall, significant lower VO2peak value was found in the abdominal obesity group including men and women (-2.6 mL/kg/min, 95%CI: -4.5, -0.8) than in the normal WC group. When patients were stratified into two gender groups and three age groups (young: Conclusion Recommended Asian WC thresholds for abdominal obesity are a useful instrument for detecting clinically, statistically relevant decreases in VO2peak among Chinese heart failure patients. For male patients or those under 60, WC was inversely associated with their VO2peak. For each 5∼6cm increase in WC, reducing VO2peak showed a clinically significant decrease of 1 mL/kg/min among Chinese heart failure patients. Further research with larger samples sizes is needed to support WC as a cardiopulmonary fitness self-management tool.

The Impact of Body-Mass Index on Cardiopulmonary Fitness in Chinese Heart Failure Patients

Introduction Body-mass index (BMI) and cardiopulmonary fitness measured by peak oxygen consumption (VO2peak) are inversely related among healthy Caucasians. However, knowledge of Chinese heart failure patients remains scant because they experience significant impaired cardiopulmonary fitness, and Asians have lower BMI cut-offs than whites. Hypothesis Evaluate whether Asian-specific BMI cut-offs for overweight (23 kg/m2) and obese (27.5 kg/m2) reflect significant VO2peak changes, and BMI's impact on VO2peak in Chinese heart failure patients. Methods In this cross-sessional study, data was collected from 70 heart failure patients with NYHA class I∼IV (83% II) and mean ejection fraction of 46.3% in Guangdong Provincial Hospital of Chinese Medicine. Height and weight were measured to calculate BMI; and VO2peak was measured via symptom-limited bicycle exercise test. Participants were categorized as healthy (BMI 18.5-22.9 kg/m2), overweight (BMI 23-27.4 kg/m2), or obese (BMI ≥27.5 kg/m2). Those with BMI below 18.5 kg/m2 were excluded. Between-group differences were identified by one-way ANOVA and post-hoc analysi. Spearman's correlation coefficients and binary linear regression evaluated the relationship between BMI and VO2peak. p Results Among 70 patients, 24 (34%) were classified healthy (BMI >18 kg/m2), 34 (49%) overweight (BMI 23-27.4 kg/m2), and 12 (17%) obese (BMI ≥27.5 kg/m2). VO2peak differed between the three BMI groups (p=0.017); and the obese group had significantly lower VO2peak than the heathy group (-3.9 mL/kg/min, 95%CI: -6.6, -1.2). When patients were sex-age stratified (young: Conclusion Asian-specific BMI cut-offs are useful clinical instruments for detecting statistically relevant decreases in VO2peak among heart failure patients. A negative association exists between BMI and VO2peak, especially in those under 60. For each 1.5 unit increase in BMI, reducing VO2peak showed a clinically significant 1 mL/kg/min decrease among heart failure patients. Larger sample-size research could reveal robust quantitative relationships between BMI and cardiopulmonary fitness.

Self-care in Chinese heart failure patients: Gender-specific correlates

BackgroundExisting studies have indicated that poor self-care in heart failure (HF) patients may differ according to gender but such studies remain scarce among Chinese HF patients. ObjectiveTo explore gender difference in correlates of self-care in Chinese HF patients. MethodA cross-sectional study on Chinese HF patients (n = 127) from cardiac wards of two hospitals in China was conducted. Data on participants’ socio-demographic and clinical characteristics, self-care, HF knowledge, social support, and self-care confidence were collected. Correlates of HF self-care were explored using hierarchical multiple regression. ResultsGender differences were observed in Chinese HF patients, who generally performed poorly in self-care. In males, self-care maintenance was associated with HF knowledge while self-care management was associated with social support. In females, maintenance was associated with self-care confidence while management was associated with both self-care confidence and HF knowledge. ConclusionCorrelates of self-care differed between two genders in Chinese HF patients. These gender-specific factors should be considered when planning self-care intervention or educating HF patients.

Machine learning for prediction of sudden cardiac death in heart failure patients with low left ventricular ejection fraction: study protocol for a retroprospective multicentre registry in China

IntroductionLeft ventricular ejection fraction (LVEF) ≤35%, as current significant implantable cardioverter-defibrillator (ICD) indication for primary prevention of sudden cardiac death (SCD) in heart failure (HF) patients, has been widely recognised...

Influence of OATP1B1 and OATP1B3 mutations and glomerular filtration rate on trough serum digoxin concentration in the Chinese population: A prospective cohort study.

Polymorphisms of organic anion transporting polypeptides (OATPs) have been reported to affect trough serum digoxin concentration (SDC). However, the association of these polymorphisms with trough SDC in Chinese heart failure patients has not been studied. We aim to explore whether OATP1B1 388A>G, OATP1B1 521T>C, and OATP1B3 699G>A influence trough SDC in Chinese heart failure patients and to make clinical recommendations.Chinese patients (n = 104) diagnosed with heart failure under long-term digoxin therapy (0.125 mg daily) were enrolled in this study. Blood samples were collected for the analysis of trough SDC (immunofluorescence) and the polymorphisms of OATP1B1 388A>G, OATP1B1 521T>C, and OATP1B3 699G>A (PCR-RFLP and Sanger sequencing).Patients with glomerular filtration rate (GFR) under 30 mL/min had significantly higher trough SDC (1.20 ± 0.50 ng/mL) than recommended trough SDC for heart failure patients. Trough SDC was not significantly influenced by mutations of OATP1B1 388A>G (P = .890), 521T>C (P = .054), and OATP1B3 699G>A (P = .854). Patients with OATP1B1 521T>C mutant-type carrier had slightly higher trough SDC (0.98 ± 0.53 ng/mL) than those with wild-type carrier (0.74 ± 0.40 ng/mL) when they have repaired renal function.Heart failure patients with severe renal dysfunction (GFR<60 mL/min) and/or OATP1B1 521T>C mutant-type carriers are recommended a smaller dosage of digoxin and strict therapeutic drug monitoring.

Plasma levels of pro-inflammatory molecules and their expressions are associated with severity of heart failure: An investigation in Chinese cohort

Heart failure (HF) is a syndrome with multiple clinical phenotypes affecting around 1%–2% of adult population worldwide, and about 230 million Chinese are affected by cardiovascular diseases. The important role of pro-inflammatory plasma cytokines with HF has been demonstrated in different populations. The aim of this study was to investigate importance of pro-inflammatory cytokines in Chinese HF patients. In all, 134 HF patients were enrolled in this study and further classified in to four clinical distinct groups according to New York Heart Association classification criteria (NYHA-I: n = 34, NYHA-II: n = 35, NYHA-III: n = 22 and NYHA-IV: n = 43). Sixty-eight healthy Chinese were enrolled as controls. Plasma levels of tumour necrosis factor-α (TNF-α), TNF-receptor 1 (TNFRI), TNF-receptor 2 (TNFRII), interleukin 6 (IL-6), soluble IL-6 receptor (sIL-6R), C-reactive protein (CRP), soluble cluster of differentiation 14 (sCD14) and interleukin 1 beta (IL-1β) were quantified by enzyme-linked immunosorbent assay (ELISA). Plasma levels of all parameters investigated in this study remained comparable among healthy controls and NYHA-I group. Plasma levels of TNF-α, TNFRI, TNFRII, IL-6, sIL-6R, CRP, sCD14 and IL-1β were significantly higher in NYHA-III and NYHA-IV clinical categories compared to other HF phenotype (NYHA-I and NYHA-II). Interestingly, TNFR-II levels were significantly higher in NYHA-II compared to NYHA-I. No significant difference of plasma sIL-6R was observed among various clinical categories. In conclusion, plasma levels of pro-inflammatory molecules are elevated in severe HF patients and may be used as possible biomarkers for accessing severity of HF.

Self-care confidence mediates the relationship between type D personality and self-care adherence in chinese heart failure patients

BackgroundExisting theory and evidence suggest that self-care confidence may mediate the relationship between Type D personality and self-care adherence. ObjectivesTo assess the mediating role of self-care confidence between Type D personality and self-care adherence in Chinese HF patients. MethodsThis is a secondary analysis of a cross-sectional study. Self-care confidence and self-care adherence (maintenance) were measured by the subscales of the Self-Care of Heart Failure Index (v6). The Type D Scale-14 was administered to assess negative affect (NA), social inhibition (SI), and Type D personality. Mediation analysis based on Baron and Kenny was performed. ResultsA total of 127 HF patients were included. Self-care confidence partially mediated the relationship between Type D personality and self-care adherence but completely mediated the relationship between NA/SI and self-care adherence. ConclusionsClinicians may effectively improve self-care adherence by enhancing self-care confidence in HF patients with Type D personality.

Palliative care needs of heart failure patients in China: putting people first.

Recognizing the rising prevalence of heart failure in China, patients with heart failure have substantial palliative needs. This review highlights recent evidence on the epidemic of heart failure, identifies needs and potential benefit of palliative care in heart failure, and sets future strategic policy and research directions in China. Epidemiological studies demonstrate the prevalence of heart failure among women is higher than men in China and increases substantially with age. However, few studies have addressed the palliative needs of Chinese heart failure patients. The main themes from this review include: Healthcare providers should be culturally sensitive whenever assessing symptoms and needs. Locally validated, brief outcome measures are called for to identify symptoms and needs of Chinese heart failure patients. Palliative care should be better integrated into the management of heart failure through increased training for healthcare providers, policy development, financial support, and cultural acceptance of palliative care. Large-scale epidemiological studies are urgently needed to assess the current situation of heart failure in China, alongside interventional studies to drive the development of innovative palliative care services to address the needs of Chinese heart failure patients.

Perceptions and Acceptability of Receiving SMS Self-care Messages in Chinese Patients With Heart Failure: An Inpatient Survey.

Self-care is critical for postdischarge heart failure (HF) patients. Short message service (SMS) is a promising way to promote HF self-care. The aim of this study is to investigate knowledge status in Chinese HF patients, as well as the acceptance of SMS as a way to improve self-care. A survey using a self-developed questionnaire was conducted in patients with decompensated HF 2 days before discharge. A total of 540 patients completed the survey. Among them, only 69.8% and 63.3% of patients were aware of their HF status and medication regimen, respectively. A total of 95.6% patients were willing to receive SMS. Patient himself/herself, caregiver, or both patient and caregiver were almost equally selected as the preferred receiver of SMS. Educational and/or reminder SMS was considered "very helpful" by 50.2% of the patients as a way of promoting self-care, similar to that of telephone education and brochure education. "Take your medicine", "avoid getting flu," and "keep follow-up" were regarded as the most important self-care contents, whereas "weigh yourself every day" and "restrict fluid intake" were considered the least important. As a way of promoting HF self-care, SMS intervention combining educational and reminder function might be well accepted by HF patients in China. The status of HF, medication, weight control, and fluid restriction should be emphasized during the practice. Caution should be drawn as the survey was not tested elsewhere. Further clinical trials would be conducted to examine the effect of SMS intervention on self-care behaviors and outcomes of HF patients.

Type D personality negatively associated with self-care in Chinese heart failure patients.

BackgroundLittle is known about the association between type D personality and self-care behaviors in heart failure (HF) patients. We examined the effect of type D personality on self-care behaviors and self-efficacy among Chinese HF patients.MethodsA cross-sectional study with a convenience sample was conducted. All participants completed the questionnaires of the self-care of HF index (V6) and type D personality scale. Demographic and clinical variables were obtained from medical records and patient interviews. The methods used for data analysis included descriptive analysis, independent-sample t-test, χ2 test, and multiple linear regression.ResultsA total of 127 HF patients were included and 61.4% of them were male. The average age for this study sample was 64.9 ± 12.34 years. The majority of the participants were in a New York Heart Association class III or IV (87%), and the average length of living with HF was 38.24 ± 41.1 months. A total of 33.1% of the participants were identified as having type D personality. No significant differences were determined in the demographic and clinical variables between type D and non-type D patients, except for the mean age and the length of living with HF. Type D patients were younger and had a shorter time of living with HF than their non-type D counterparts. Multiple regression demonstrated significant associations between type D personality and self-care maintenance and self-efficacy after adjusting the demographic and clinical factors. However, type D personality was not significantly associated with self-care management behaviors.ConclusionsType D personality was negatively related to self-care maintenance and self-efficacy in Chinese HF patients. Future study is warranted to develop a tailored intervention to improve engagement in self-care behaviors in HF patients with type D personality.