Chronic Heart Failure In Order Research Articles

Prognostic role of results of dynamic capnography in integral assessment of parameters of respiratory system in 6-minute walk test in patients with chronic heart failure

Aim. To study the prognostic value of the results of dynamic capnography in the complex assessment of parameters of the respiratory system in 6-minute walk test in patients with chronic heart failure (CHF).
 Materials and Methods. 73 Patients were examined: the group of study included 48 patients with IIA or IIB stage CHF (mean age 57.94.6 years, 23 men), the control group included 25 practically healthy volunteers (mean age 47.63.5 years, 9 men). The patients were conducted complex determination of parameters of the respiratory system: clinical scaling before and after 6-minute walk test (6MWT), instrumental examinations including spirometry, capnography and pulse oximetry before, during and after physical activity. The analysis of survival was conducted on the basis of the dynamic follow-up of patients within 5 years (60 months).
 Results. In the analysis of parameters of dyspnea at rest, all the parameters were higher in the group of patients with CHF (р0.05). The distance walked by the patients with CHF in 6 minutes was 488.2390.84 m, which was significantly less than in the control group (815.6053.89 m, р=0.009). Dyspnea as the cause of stoppage/slowing down of walking in 6MWT, was also more often recorded in patients with CHF (93.83.0% and 48.05.1%, р=0.049). Besides, in 6MWT the patients noted: weakness in legs (50.15.0% in the group of CHF and 40.05.0% in the control group, р=0.014), palpitation (29.04.6% and 20.04.1%, respectively, р=0.004). Worsening of dyspnea parameters in 6MWT was more evident in patients with CHF than in the control group (р0.01). In the CHF group, hypocapnic type of ventilation was revealed in 6MWT, analysis of РЕТСО2 trend graphs revealed a wave-like increase in the parameters, the so called periodic breathing (PB). CO2 trend was recorded in CHF group in 58.31.0% of cases (the difference with the control group with р=0.046), the trend of heart rate in 18.80.3% of cases (р=0.027). Cox proportional hazards regression analysis of mortality in patients with CHF showed a prognostic significance of a complex model comprising the following parameters of a patient: body mass index (р=0.005), left ventricular end-diastolic dimension (р=0.034), left ventricular end-systolic dimension (р=0.002), left ventricular ejection fraction (р=0.041), 6MWT distance (р=0.004), desaturation (р=0.009), and the presence of signs of PB during 6MWT (р=0.005). Model coefficients were statistically significant at р0.0001.
 Conclusions. Dynamic capnography and pulse oximetry allow to identify signs of PB in patients with CHF during 6MWT which may deepen a complex assessment of parameters of the cardio-respiratory system in patients with CHF in order to determine tolerance to physical exercise as well as the effectiveness of the conducted treatment. Complex assessment of survival of patients with CHF showed prognostic significance of the following parameters of a patient: body mass index, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, left ventricular ejection fraction, 6MWT distance, desaturation, PB during 6MWT.

Disease recognition and life demands in the elderly patients with chronic heart failure

Objective To explore the disease recognition and life demands in the elderly patients with chronic heart failure in order to help construction mode for the chronic patients in the community. Methods A qualitative, pilot study was conducted using semi structured interviews of 15 elderly chronic heart failure patients. Data were analyzed and verified using qualitative research techniques. Results Four themes were extracted including the difference about the diseases recognition; cognitive bias of the cardiac rehabilitation; want to improve the quality of life and want to have continue nursing. Conclusion Elderly chronic heart failure patients in the community have specially thought, strong relationships should build between hospital and community, strengthen the continue nursing, perfect the 7C intervene treatment system in order to improve the quality of life. Key words: Aged; Quality of life; Chronic heart failure; Home based care; Qualitative research

0533: Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance: Moroccan profile

Background Abnormal liver function tests are common in ambulatory chronic heart failure but characterization and importance of liver dysfunction are poorly defined. The aim of this study was to evaluate the incidence of liver dysfuction in ambulatory patients diagnosed with chronic heart failure in order to establish a correlation with the risk factors, evolution and prognosis. Methods 1613 consecutive ambulatory patients with chronic heart failure were enrolled from 2006 to 2013 and registered in the therapeutic unit of chronic heart failure. Clinical, echocardiographic and biological data were investigated. In only 358 HF patients, liver function was determined by aspartate and alanine aminotransferase (AST, ALT). We divided our population into three groups: group 1 with elevated ALT>45 UI/l, group 2 with elevated AST >45 UI/l and group 3 with normal liver enzymes. Results Liver dysfunction was present in 13.68%. Mean serum levels of ALT and AST were 98.44 UI/l and 88.43 UI/l respectively. Liver dysfunction was associated with male sex (p=0.019), dyslipidemia, smoker and coronary heart disease (p=0.004). Compared with a normal liver function, those with dysfunction had a higher heart rate and more cardiac right and left decompensation. Also Transaminases elevated were associated with more tricuspid regurgitation (p Conclusions Liver dysfunction is frequent in chronic heart failure. Patients with heart failure and abnormal liver function had less optimized traitment with more hospitalizations for cardiac decompensation

0102 : Frequency and outcomes of hyponatremic ambulatory patients with chronic heart failure

Hyponatremia – lowering of sodium in blood serum below 135 mmol/l – is a frequent disorder of electrolyte metabolism in patients with chronic heart failure (CHF). It is an established predictor of adverse outcomes in hospitalized patients with reduced ejection fraction. To evaluate the incidence of hyponatremia in ambulatory patients diagnosed with chronic heart failure in order to establish a correlation with the risk factors, evolution and prognosis. We examined the prevalence, risk factors, and long-term outcomes of hyponatremia (serum sodium =< 135 mEq/L) in ambulatory HF with reduced EF The cohort consisted of 1240 admitted in the therapeutic unit of heart failure (TUHF) between 2006 and 2014. Hyponatremia was present in 19.6%. Mean serum levels of natremia and were 131.3 meq/l. Hyponatremia was associated with male sex, diabetes, strock attack, coronary heart disease. Compared with normonatremic patients, those with hyponatremia had lower systolic blood pressure and lower functional capacity during six – minute walk. Also, Hyponatremia was associated with cardiac decompensation, diastolic dysfunction (p=0.014), severe renal insufficiency and higher doses of diuretics (p<0.0001), whereas beta-blockers were inversely associated (P<0.0001). Patients with heart failure and hyponatraemia on showed a higher risk of long-term morbidity than patients without.

Barriers and facilitators to self-care in chronic heart failure: a meta-synthesis of qualitative studies.

Chronic heart failure (CHF) is a costly condition that places large demands on self-care. Failure to adhere with self-care recommendations is common and associated with frequent hospitalization. Understanding the factors that enable or inhibit self-care is essential in developing effective health care interventions. This qualitative review was conducted to address the research question, "What are the barriers and facilitators to self-care among patients with CHF?” Electronic databases including Medline, EMBASE, CINAHL, Web of Science, Scopus and Google scholar were searched. Articles were included if they were peer reviewed (1995 to 2012), in English language and investigated at least one contextual or individual factor impacting on self-care in CHF patients > 18years. The criteria defined by Kuper et al. including clarity and appropriateness of sampling, data collection and data analysis were used to appraise the quality of articles. Twenty-three articles met the inclusion criteria. Factors impacting on self-care were included factors related to symptoms of CHF and the self-care process; factors related to personal characteristics; and factors related to environment and self-care system. Important factors such as socioeconomic situation and education level have not been explored extensively and there were minimal data on the influence of age, gender, self-confidence and duration of disease. Although there is an emerging literature, further research is required to address the barriers and facilitators to self-care in patients with CHF in order to provide an appropriate guide for intervention strategies to improve self-care in CHF.

CPAP in chronic heart failure

BACKGROUND Chronic Heart Failure (CHF) represents worldwide a clinical condition with increasing prevalence, high social, economical and epidemiological impact. Even if new pharmacological and non-pharmacological approachs have been recently used, mortality remains high in general population and quality of life is poor in these patients. DISCUSSION The association between CHF and sleep disorders is frequent but still undervalued: sleep apnoeas in CHF produce negative effects on cardiovascular system and an aggravation of prognosis. CPAP (Continuous Positive Airway Pressure) is commonly used to treat sleep apnoeas in patients without cardiac involvement and it is also used in first line treatment of acute cardiogenic pulmonary oedema thanks to its hemodynamic and ventilatory effects. The addition of nightly CPAP to standard aggressive medical therapy in patients with CHF and sleep apnoeas reduces the number of apnoeas, reduces the blood pressure, and the respiratory and cardiac rate, reduces the activation of sympathetic nervous system, the left ventricular volume and the hospitalization rate; besides CPAP increases the left ventricular ejection fraction, amd the oxygenation, it improves quality of life, tolerance to exercise and seems to reduce mortality in patients with a higher apnoeas suppression. CONCLUSIONS These implications suggest to investigate sleep apnoeas in patients with CHF in order to consider a possible treatment with CPAP. Further studies need to be developed to confirm the use of CPAP in patients with CHF without sleep disorders.

Analysis of related factors and nursing methods for hyponatremia in the elderly patients with chronic heart failure

Objective To study the related factors of hyponatremia in the elderly patients with chronic heart failure in order to provide evidences for preventing and nursing of hyponatremia.Methods Clinical data of 143 patients over 65 years old were investigated.The patients were divided into hyponatremia group (n =47)and control group (n =96).There were 29 cases with more than 80 years older and 19 cases with 65-79 years older in hyponatremia group.The data from the two groups were compared.Results The patients in hyponatremia group were significantly older than these in control group [(88.5 ± 4.8) vs (82.5 ± 7.5),t =4.895,P ＜0.01),and the incidences of hypertension,pneumonia,diabetes and acute heart failure,as well as the usage of diuretics and nasogastric tubes in hyponatremia group were significantly higher than that in the control group(x2 =26.034,14.492,5.385,10.881,12.674,5.389;P ＜ 0.05).Very elderly patients needed longer time to achieve normal natrium level in blood serum than that elderly patients (t =5.069,P ＜ 0.01).Conclusions Hyponatremia of the elderly patients with chronic heart failure was related to hypertension,pneumonia,diabetes,acute heart failure,usage of diuretics and nasogastric tubes.The symptoms of hyponatremia in very elderly patients is atypical,which are very likely to be neglected.We should pay more attention to the special population. Key words: Elderly people; Hyponatremia; Chronic heart failure

La recherche clinique en télémédecine : évaluer le service médical rendu aux patients

Telemedicine is a remote medical practice which uses tools related to information and communication technologies (ICT). Since July 21, 2009, French law permits this new medical practice and the decree of October 19, 2010, indicates the main procedures (tele-consultation, tele-expertise, medical tele-surveillance, medical tele-assistance, tele-advice from the hospital call center) and the conditions of their implementation. Clinical research is the practice of clinical trials which have the aim of evaluating the safety and efficacy of a diagnostic method or a new treatment. Clinical research is the main purpose of the National Association of Telemedicine (ANTEL) and of its new official journal European Research in Telemedicine. This editorial is opening the first issue of our journal. Several examples can illustrate the importance of clinical research in telemedicine. In type 1 diabetes, after the first discordant results due to insufficient or weak methodologies, the French study TeleDiab 1 brought for the first time a clinical improvement over 6 months in patients followed-up remotely by Diabeo software and teleconsultation. The main medical service to patients was a decrease of complication risks due to a significant decrease of HbA1c. Nevertheless, the encouraging results of this pilot study need confirmation over a longer period (the TELESAGE study over two years). In chronic heart failure, the first results of two meta-analyses showed a significant 30% reduction in morbidity and mortality. However, these results were not confirmed by two, more recent, prospective and randomised studies. Most authors think that it is necessary to define several subgroups of patients with chronic heart failure in order to recognize patient subgroups who could benefit from telemedicine at home. The medical service to stroke patients brought by telemedicine is not open to debate. Telestroke allows patients away from neurology centres to benefit from emergency thrombolysis (less than 4 h 30 min after the first signs) treatment that can allow the total or partial regression of a neurological deficit. Other telemedicine applications have been able to demonstrate a medical service to patients, for example remote blood pressure self-monitoring at home in hypertensive patients, live interactive teledermatology, teledialysis by peritoneal dialysis at home or by haemodialysis by a remote satellite unit, etc. Teleradiology brings a medical service to patients if it is carried out according to international or national guidelines. Many other applications of telemedicine may be the subject of clinical research such as telegeriatry, tele-psychiatry, tele-surgery, tele-rhumatology, tele-obstetric, tele-pathology, etc.). Telemedicine practice can have a significant economical impact, particularly due to reductions in hospitalisation numbers. Risk factors due to telemedicine are beginning to be known. Clinical research on the medical service to patients followed-up by telemedicine can prevent risks.

Effectiveness of an educational self‐management program for outpatients with chronic heart failure

The occurrence rate of chronic heart failure (CHF) in Japan is estimated to be 50,000 per one million persons. It is important for the Japanese medical financial system to institute a program of disease management in order to prevent the deterioration of persons with CHF. However, there are still few studies on the disease management of CHF in Japan. Therefore, the purpose of this study was to provide an educational self-management program to Japanese outpatients with CHF in order to improve their clinical outcomes. A randomized, controlled trial with 102 outpatients with CHF was conducted. There were 50 participants in the intervention group and 52 participants in the control group. The control group received medical treatment and standard care. In addition to this, the intervention group also received an educational program for 6 months. The program consisted of six nurse-directed sessions that were provided to each outpatient once per month in a clinical setting for a total of 6 months. A follow-up session was conducted each month for 6 months. The data collection was carried out at the start of the program and at 3, 6, 9, and 12 months. Significant differences could be observed in the primary and secondary outcomes and in the process indicators between the two groups after the program began. In other words, all the indicators improved for the intervention group, compared to the control group. Therefore, this program was considered to be effective. Further long-term care is necessary for outpatients with CHF in order to prevent their deterioration and to maintain their health status, even though this 6 month program did provide them with proper knowledge regarding self-care for CHF and affected their therapy results.

The study of diagnostic value about plasma brain natriuretic peptide level in chronic heart failure

Objective To study the diagnostic value about plasma brain natriureticpeptide level in chronic heart failure in order to provide evidence for the diagnostic obout chronic heart failure. Methods 56examples with chronic heart failure patients from August 2007 to March 2009 in my courtyard treatment were divided into A group( 28 examples)and B group(28 examples)based on NYHA. 50 normal healthy person exam-ples were selected as the control group( C group). The plasma brain natriuretic peptide level of the three groups were compared and studied. Results After the comparative study, we found that the plasma brain natriuretic peptide level of A group and B group was higher that of C group,P ＜0.01 ,there was significant difference between thethree group. And the plasma brain natriuretic peptide level between the A group and B group were compared,P ＜ 0.05, the difference has statistical significance. Conclusion The diagnostic value about plasma brain natriuretic peptide level in chronic heart failure was obviously bigger. It can provide evidence for the diagnostic obout chronic heart failure, and is worth further studying. Key words: Plasma brain natriuretic peptide level; Chronic heart failure; Diagnostic value

Undetected paroxysmal atrial fibrillation in chronic heart failure patients: is it clinically relevant to catch the atrial phantom?

Chronic heart failure (CHF) is frequently accompanied by atrial fibrillation (AF). How often AF occurs in CHF patients is difficult to know since many episodes come and go undetected because of lacking symptoms. Therefore, assessing the total burden of AF calls for continuous rhythm monitoring. At present, we do not know whether assessing burden of AF is clinically relevant. Furthermore, we do not know whether AF has any impact on survival in CHF patients, since previous clinical studies show conflicting results. Caldwell et al. 1 shed light on this issue by retrospectively studying cardiac resynchronization therapy device downloads in 162 patients with CHF in order to address two questions. First, what is the prevalence of asymptomatic paroxysmal AF (PAF) in CHF patients? Secondly, what is the subsequent effect on mortality, thrombo-embolism and all-cause hospitalizations? They defined AF as a mode-switch event with an atrial rate >200 bpm for a minimum of 30 s. Using medical records, patients were divided into four groups: (i) patients who remained in sinus rhythm (SR), (ii) patients in chronic AF, (iii) patients who were known to have paroxysmal AF (known PAF), and (iv) patients thought to be persistently in SR in whom episodes of AF were newly identified (new PAF). One quarter of patients developed new PAF but AF burden was low. During the mean follow-up period of 424 days, no statistically significant differences in outcome between the SR, new PAF, and known PAF patients were found. There was, however, a trend towards higher mortality in patients with new PAF which matches with an important observation in the Euro Heart Survey on AF in which patients with first documented AF had higher mortality than patients with known PAF or persistent AF.2 Similarly, Pozzoli et al. 3 showed that new onset AF in a previously … *Corresponding author. Tel: +31 43 387 50 93, Fax: +31 43 387 51 04, Email: hjgm.crijns{at}mumc.nl

Creation of standardized tools for therapeutic education specifically dedicated to chronic heart failure patients: The French I-CARE project

Aim To develop educational programs in chronic heart failure (CHF), creation of standardized tools for therapeutic education specifically dedicated to CHF patients was performed as a part of the French I-CARE project. Methods and Results A working group was constituted of cardiologists, nurses and dieticians, specialized in both therapeutic education and CHF. The personal patient's document consisted of a ring binder with dividers containing index cards for 5 units. The unit “Educational diagnosis” comprised a guide for the user and an auto-questionnaire for the patient. The unit “Knowledge of the disease” comprised a whiteboard for explaining cardiovascular physiology, a 3D-model of heart, and a glossary. The unit “Diet control” was composed of posters, a food-card game with a game mat figuring the different meals of a day, a low-salt recipe book, and 1-g salt spoons. The unit “Physical activity and daily life” comprised recommendations for physical activity and questionable real-life situations, and a card game for evaluation. The unit “Medical treatment” consisted of index cards for different cardiovascular drugs. Conclusion These educational tools should help multidisciplinary teams to develop therapeutic education dedicated to CHF in order to improve self-management, morbidity and quality of life in CHF patients.

Systemic inflammation in heart failure – The whys and wherefores

Patients with chronic heart failure (HF) are characterized by systemic inflammation, as evident by raised circulating levels of several inflammatory cytokines with increasing levels according to the degree of disease severity. In addition to the myocardium itself, several tissues and cells can contribute to this inflammation, including leukocytes, platelets, tissue macrophages and endothelial cells. Although the mechanisms for the systemic inflammation is unknown, both infectious (e.g., endotoxins) and non-infectious (e.g., oxidative stress and hemodynamic overload) events could be operating, also including activation of Toll-like receptors as well as interaction with the neurohormone system. A growing body of evidence suggests that this systemic inflammation in chronic HF may play a role in the development and progression of this disorder, not only by promoting myocardial dysfunction, but also by inducing pathogenic consequences in other organs and tissues, thereby contributing to additional aspects of the HF syndrome such as cachexia, endothelial dysfunction and anemia. Although this inappropriate immune activation and inflammation could represent a new target for therapy in patients with chronic HF, the anti-tumor necrosis factor trials have been disappointing, and future research in this area will have to more precisely identify the most important mechanisms and actors in the immunopathogenesis of chronic HF in order to develop better immunomodulating agents for this disorder.

Inflammatory and anti‐inflammatory cytokines in chronic heart failure: Potential therapeutic implications

Persistent inflammation, involving increased levels of inflammatory cytokines, seems to play a pathogenic role in chronic heart failure (HF) by influencing heart contractility, inducing hypertrophy and promoting apoptosis, contributing to myocardial remodeling. While several stimuli may be operating such as heat shock proteins, microbial antigens and oxidative stress, it seems that the inflammatory response to these stimuli may represent a common final pathogenic pathway in HF regardless of the initial event. Traditional cardiovascular drugs appear to have little influence on the cytokine network, and immunomodulatory therapy has emerged as a possible new treatment modality in HF. Several animal studies and also some clinical studies have suggested that downregulation of inflammation may improve cardiac performance. However, the results from the placebo‐controlled anti‐tumor necrosis factor studies suggest no improvement or even adverse effects of such therapy. Although somewhat disappointing, these negative results do not necessarily argue against the ‘cytokine hypothesis’. These studies just underscore the challenges in developing treatment modalities that can modulate the cytokine network in HF patients resulting in beneficial net effects. Further research will have to identify more precisely the most important actors in the immunopathogenesis of chronic HF in order to develop more specific immunomodulating agents for this disorder.

Anemia in advanced chronic heart failure: the importance of iron deficiency

Anemia is a common clinical problem and an independent negative prognostic factor in patients with end-stage chronic heart failure (CHF). We sought to investigate the etiology of anemia in end-stage CHF in order to select the appropriate therapy.

The relationship between QT intervals and mortality in ambulant patients with chronic heart failure. The united kingdom heart failure evaluation and assessment of risk trial (UK-HEART)

Mortality in patients with heart failure remains high and is difficult to predict. QT interval parameters on a 12-lead ECG have been shown to predict arrhythmic events in patients with a variety of myocardial diseases. There is some, but not consistent, evidence that QT interval parameters may act as predictors of mortality, in particular sudden death, in patients with heart failure. In an adequately powered prospective study we have studied QT interval parameters in patients with stable chronic heart failure in order to determine whether they are predictive of all-cause mortality or mode of death. Five hundred and fifty-four ambulant outpatients with chronic heart failure were recruited. A 12-lead ECG, chest radiograph, echocardiogram, 24 h ambulatory electrocardiogram and serum for biochemical analysis were obtained at baseline. Patients were followed for 471+/-168 days. QT intervals were measured in all leads blinded to patient's characteristics and outcome, were corrected for heart rate, and the maximum QT intervals, and QT dispersion (range of QT intervals) were determined. The same parameters were determined for JT intervals. The primary end-point was all-cause mortality, secondary end-points were sudden cardiac death and death due to progressive heart failure. Multivariate analysis with the Cox's proportional hazards model was used to determine which variables were independently related to outcome. Four hundred and ninety-five patients had analysable ECGs at study entry and of these 71 died during follow-up. The heart rate corrected QT dispersion and maximum QT interval were significant univariate predictors of all-cause mortality (P=0.026 and <0.0001 respectively), and also of sudden death and progressive heart failure death, but were not related to outcome in the multivariate analysis. The independent predictors of all-cause mortality were cardiothoracic ratio (P=0.0003), creatinine (P=0.0009), heart rate (P=0.007), echocardiographically derived left ventricular end-diastolic dimension (P=0.007) and ventricular couplets on 24 h electrocardiographic monitoring (P=0.015). In an adequately powered prospective study none of the QT or JT parameters were shown to be independent predictors of outcome in patients with mild to moderate congestive heart failure. These variables do not therefore add to the prognostic information which can be gained from simple radiographic, biochemical, echocardiographic and Holter data in this group of patients.

-adrenoceptor regulation in the human heart: can it be monitored in circulating lymphocytes?

In heart failure a decrease in cardiac beta-adrenoceptors presumably due to endogenous down-regulation by the elevated catecholamines is a general phenomenon. Thus, attempts have been made to assess beta-adrenoceptor function in patients with chronic heart failure in order to monitor the functional state of cardiac beta-adrenoceptors. The model most widely used is that of circulating lymphocytes that contain a homogeneous population of beta 2-adrenoceptors coupled to the adenylate cyclase/cyclic AMP system. The biochemical and pharmacological properties of beta 2-adrenoceptors present in lymphocytes are quite comparable to those of beta 2-adrenoceptors in the human heart, but clearly different from those of human cardiac beta 1-adrenoceptors. Furthermore, beta-adrenoceptor agonists and antagonists regulate lymphocyte beta 2- and cardiac beta 1- and beta 2-adrenoceptors in a subtype-selective fashion: while non-selective agonists (independent of exogenously applied or endogenously elevated) and antagonists affect both cardiac beta 1- and beta 2- as well as lymphocyte beta 2-adrenoceptors, beta 1-selective agonists and antagonists influence only cardiac beta 1-, but not cardiac and lymphocyte beta 2-adrenoceptors. Finally, direct comparison of lymphocyte and cardiac beta-adrenoceptor densities revealed that changes in lymphocyte beta 2-adrenoceptors are significantly correlated with changes in cardiac beta 2-adrenoceptors, but not related to changes in cardiac beta 1-adrenoceptors. Since beta 1-adrenoceptors predominate in all parts of the human heart, the use of lymphocyte beta 2-adrenoceptors as a tool for predicting the status of cardiac beta-adrenoceptors is, therefore, quite limited.