Compliance Measurements Research Articles

METHOD OF VERIFICATION OF STANDARD ANTHROPOMETRICAL SURVEYS FOR CLOTHING

The performed research of normative documents made it possible to quantify the technical conditions of anthropometric body measurements and to determine how the nomenclature of anthropometric measurements depends on the classification of clothing. The aim of the study was to develop a methodology for verifying anthropometric measurements of the human body, taking into account the functional characteristics of clothing. A criteria approach to the synchronization of verification means of standards identification of measurement names by measurement method and measurement classification groups (horizontal, vertical, others) was used. Validation of standard measurements for the ergonomic design of garments and harmonization of control measurement code designations in finished garments have been performed. Standard control measurements were interpreted into additional dynamic compliance measurements to take into account the level of deformation of parts during operation and to ensure freedom of movement. Technical regulation of the anthropometric information volume is confirmed by the equivalence of the optimization problems of the considered anthropometric standards in the form of the linear programming problem of the set of anthropometric measurements. The matrix of conditions for fixing anthropometric measurements in six regulatory documents was studied. It was established that the set pair 25 < 28 determines the technical conditions of quality control on the dummy of the finished product. Using basic and auxiliary reference measurements in the clothing size designation provides a flexible combination of chest, waist and hip measurements for women and chest and waist measurements for men. Consideration of the range of additional control vertical measurements is confirmed by calculating the indices of balance in the longitudinal direction of the female figure of size 164-96-104.

Improving behavioural compliance with the COVID-19 precautionary measures by means of innovative communication strategies: Social experimental studies

ObjectivesBehavioural measures such as social distancing are crucial to prevent the spread of COVID-19. People sometimes have difficulty to comply with these behavioural measures for various reasons. Insight is needed into evidence-based strategies that can promote compliance. In the present study, we examined whether behaviour change techniques (volitional help sheet (VHS), behavioural journalism (BJ) and empathy inductions (EI)) could promote behavioural compliance with the COVID-19 measures.MethodsThree online experiments were carried out (N = 424–593) among Dutch adult citizens, using a randomized 2-group post-test and 1-week follow-up design. In each experiment, a control group was compared with the experimental condition (respectively VHS, BJ or EI condition).ResultsTwo out of the three different strategies did result in favourable changes with regard to the compliance-related measures. The VHS contributed to changes in perceived susceptibility of others (t = -2,78; f**2 = 0,019), perceived severity (t = -3,65; f**2 = 0,032) and individual behavioural compliance measures. People exposed to the VHS were more likely to receive less visitors (w = 16638; p = 0.003)and avoid crowds (w = 16631; p = 0.003). EI increased the perceived vulnerability of others. Video-based role model stories, based on BJ did not result in any changes.ConclusionsBehaviour change strategies may contribute to promoting behavioural compliance and could be used in public health communication. The empathy induction can be used to enhance other protection motives, while the volitional help sheet effectively can help people to overcome compliance barriers. Behavioural science can add to fighting the COVID-19 pandemic.

Moving Toward a Safer Health Care Facility: Improving Patient Identification at a Public Hospital in Saudi Arabia.

Patient misidentification errors continue to represent a significant risk to patients, health care staff, and hospitals. The study's purpose was to present a successful quality improvement project implemented in a public hospital in Saudi Arabia. The project focused on increasing staff's compliance with and awareness of the hospital's patient identification policy to thus reducing the number of patient misidentification-related incidents. Through a quality improvement project, we employed FOCUS PDSA to address the issue of patient misidentification at outpatient departments. A total of 640 staff members participated in the educational program including physicians, nurses, receptionists, radiologists, physiotherapists, and laboratory staff. Collected data included measures of compliance and awareness levels as well as patient misidentification incidents, before and after the project. Statistical analysis was conducted to measure significant differences in the study indicators before and after the project. Results from the post-project assessment revealed that the project was successful in achieving its objectives. The overall compliance rate and awareness level increased from 59% to 78% and from 75% to 90%, respectively. Improvement in the levels of compliance and awareness was statistically significant. The average number of patient misidentification errors also reduced after the project's implementation with an average of 3 errors per month. The mean difference of patient misidentification errors before and after the project was significant ( P < .01). This project demonstrated how quality improvement projects can be used to address a critical issue such as patient misidentification. The project furthers efforts made by national and international agencies to improve patient safety. It also highlights the importance of continuous education and training to ensure compliance with patient identification policies that ultimately contributes to a safer hospital environment.

China’s Leadership in BRICS Governance

The BRICS is an international summit institution that provides a platform for the world’s leading emerging economies to discuss issues of global governance from a development-centered perspective. This article examines of China’s leadership role in the BRICS, drawing on quantitative indicators of China’s performance within the BRICS since its first summit in 2009, to the most recent summit in 2021. This arti cle also develops a model of leadership based on quantitative performance measures of deliberation, decision-making, and compliance. This analysis shows that China is predominantly a facilitative and exemplary leader. Its leadership focuses on shaping BRICS discussions on its priority subjects, particularly development and macroeconomics, in addition to leading by positive example through achieving high compliance with its summit commitments.

Functional luminal imaging probe in the evaluation of esophago-gastric junction outflow obstruction.

Esophagogastric junction outflow obstruction (EGJOO) comprises a heterogeneous group of conditions that demonstrate impaired deglutitive relaxation of the esophagogastric junction (EGJ) with intact esophageal peristalsis on high-resolution manometry. Functional luminal imaging probe (FLIP) panometry is a powerful tool that can help to clarify the etiology of this manometric diagnosis. The aim of this review is to summarize the use of FLIP for the evaluation and management of EGJOO. FLIP panometry provides measures of esophageal compliance at the EGJ and information on esophageal body contractile responses to balloon distention that have important implications for the management of patients with EGJOO. After excluding anatomic causes of impaired EGJ distensibility, FLIP panometry is useful in differentiating true lower esophageal sphincter dysfunction from manometric artifact. FLIP panometry has been shown to be useful in determining the need for invasive treatment in patients with EGJOO, and in intraoperative tailoring of myotomy procedures. FLIP panometry is easy to perform during endoscopy and provides useful information for characterizing the EGJOO population. FLIP panometry can be used to guide treatment and improve outcomes in the management of patients with EGJOO.

Age-associated reductions in cardiovagal baroreflex sensitivity are exaggerated in middle-aged and older men with low testosterone.

Aging is associated with reductions in cardiovagal baroreflex sensitivity (cBRS), which increases cardiovascular disease risk. Preclinical data indicate that low testosterone reduces cBRS. We determined whether low testosterone is associated with greater age-associated reductions in cBRS in healthy men. Twenty-six men categorized as young (N = 6; age = 31 ± 4 yr; testosterone = 535 ± 60 ng/dL), middle-aged/older with normal (N = 10; aged 56 ± 3 yr; testosterone = 493 ± 85 ng/dL) or low (N = 10; age = 57 ± 6 yr; testosterone = 262 ± 31 ng/dL) testosterone underwent recordings of beat-by-beat blood pressure and R-R interval during rest and two Valsalva maneuvers, and measures of carotid artery compliance. IL-6, C-reactive protein (CRP), oxidized LDL cholesterol, and total antioxidant status (TAS) were also measured in blood. Middle-aged/older men had lower cBRS compared with young men (17.0 ± 6.5 ms/mmHg; P = 0.028); middle-age/older men with low testosterone had lower cBRS (5.5 ± 3.2 ms/mmHg; P = 0.039) compared with age-matched men with normal testosterone (10.7 ± 4.0 ms/mmHg). No differences existed between groups during Phase II of the Valsalva maneuver; middle-aged/older men with low testosterone had reduced cBRS (4.7 ± 2.6 ms/mmHg) compared with both young (12.8 ± 2.8 ms/mmHg; P < 0.001) and middle-aged/older men with normal testosterone (8.6 ± 4.4 ms/mmHg; P = 0.046). There were no differences in oxidized LDL (P = 0.882) or TAS across groups (P = 0.633). IL-6 was significantly higher in middle-aged/older men with low testosterone compared with the other groups (P < 0.05 for all) and inversely correlated with cBRS (r = -0.594, P = 0.007). Middle-aged/older men had reduced carotid artery compliance compared with young, regardless of testosterone status (P < 0.001). These observations indicate that low testosterone in middle-aged/older men may contribute to reductions in cBRS. These data suggest that increased inflammation may contribute to reductions in cBRS.NEW & NOTEWORTHY Middle-aged/older men with low testosterone have accelerated reductions in cardiovagal BRS compared with middle-aged/older men with normal testosterone. Increased concentrations of the proinflammatory cytokine IL-6 appear to contribute to the reductions in cardiovagal BRS in men with low testosterone.

A proposed method for measuring noise from wind farms for the purpose of determining compliance with applicable limits and the comparison of results to ISO 9613-2 predictions

This paper describes methods for the measurement of noise emissions from utility-scale wind farms and the analysis of the resulting data for determining compliance with noise level limits and standards. The methods call for primarily unattended monitoring of noise levels, wind speeds, and turbine operating conditions over many weeks, in some cases months, in order to capture the recurring maximum turbine-only noise level at a receptor (e.g., residence). This condition occurs when the nearest turbines are producing full acoustic output, while noise from background sources is very low (particularly that from wind). This paper will present the results of noise compliance measurement studies applying these methods conducted by Hankard Environmental, encompassing over 13 projects and over 50 measurement locations in the Northeast, Midwest, and Plains regions of the United States (U.S.) The results of these measurements are used to assess the accuracy of the ISO 9613-2:1996 method in predicting wind turbine noise levels on both an overall A-weighted and octave band basis. These results can be used by wind energy developers to accurately design projects to meet applicable limits and standards and gives all parties in the permitting process a greater degree of confidence in predictions and compliance measurement results.

Intensive Care in India in 2018-2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study.

BackgroundWe aimed to study organizational aspects, case mix, and practices in Indian intensive care units (ICUs) from 2018 to 2019, following the Indian Intensive Care Case Mix and Practice Patterns Study (INDICAPS) of 2010–2011.MethodsAn observational, 4-day point prevalence study was performed between 2018 and 2019. ICU, patient characteristics, and interventions were recorded for 24 hours, and ICU outcomes till 30 days after the study day. Adherence to selected compliance measures was determined. Data were analyzed for 4,669 adult patients from 132 ICUs.ResultsOn the study day, mean age, acute physiology and chronic health evaluation (APACHE II), and sequential organ failure assessment (SOFA) scores were 56.9 ± 17.41 years, 16.7 ± 9.8, and 4.4 ± 3.6, respectively. Moreover, 24% and 22.2% of patients received mechanical ventilation (MV) and vasopressors or inotropes (VIs), respectively. On the study days, 1,195 patients (25.6%) were infected and 1,368 patients (29.3%) had sepsis during their ICU stay. ICU mortality was 1,092 out of 4,669 (23.4%), including 737 deaths and 355 terminal discharges (TDs) from ICU. Compliance for process measures related to MV ranged between 62.7 and 85.3%, 11.2 and 47.4% for monitoring delirium, sedation, and analgesia, and 7.7 and 25.3% for inappropriate transfusion of blood products. Only 34.8% of ICUs routinely used capnography. Large hospitals with ≥500 beds, closed ICUs, the APACHE II and SOFA scores, medical admissions, the presence of cancer or cirrhosis of the liver, the presence of infection on the study day, and the need for MV or VIs were independent predictors of mortality.ConclusionsHospital size and closed ICUs are independently associated with worse outcomes. The proportion of TDs remains high. There is a scope for improvements in processes of care.Registered at clinicaltrials.gov (NCT03631927).How to cite this articleDivatia JV, Mehta Y, Govil D, Zirpe K, Amin PR, Ramakrishnan N, et al. Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med 2021;25(10):1093–1107.

Determinants of Qualified Investor Sentiment during the COVID-19 Pandemic in North America, Asia, and Europe

This work delineates the factors determining investor sentiment in specific regions during the pandemic and the influence of attitudes towards vaccination. The findings show that the reactions of knowledgeable investors in different regions to the economic effects of the pandemic were not uniform but depended on a variety of individual factors. Risk perception varied widely due to idiosyncrasies in specific countries and regions, the level of pandemic information, reaction to case reports and deaths, attitudes towards vaccination, lockdown compliance, and government measures to support businesses. These various elements combined to create different outlooks in the minds of investors that strongly influenced their investment strategies. For this investigation, we tested three estimation models: the classic robust standard error for time series regression, the new robust standard errors regression, and the Prais robust estimation. This study applied the lasso system of machine learning to select relevant explanatory variables. The novelty of our work resides in its analysis of the conduct of informed investors, using a reliable proxy, and the discussion of how government policies and different pandemic-related factors, specifically the vaccination status, affected investor sentiment in different regions. As for practical implications, an understanding of how the various economic factors related to the pandemic influenced the behavior of qualified investors in different regions can help regulators, government leaders, fund managers, and investors deal with a future virus outbreak.

When trust is not enough. A longitudinal analysis of political trust and political competence during the first wave of the COVID-19 pandemic in Finland

AbstractIn this study, we explored the longitudinal relationship of political trust and subjective political competence during the COVID-19 outbreak. We also examined how levels of political trust and political competence were associated with compliance with COVID-19 recommendations. We used three-wave panel data including 2,205 observations (N = 735) to study changes within and between individuals from 2017 to 2020. The last round of the survey was conducted at the peak of the first wave of COVID-19. The measures included political trust, subjective political competence, political interest, multiple background variables, and measures for compliance with the social distancing recommendations. We found that Finns’ political trust increased significantly during the first wave of COVID-19. The between-individuals analysis suggested that political competence was negatively associated with trust. The results also indicated that citizens’ compliance with COVID-19 recommendations was directly linked to political trust but depended also on the interaction between competence and trust.

Analisis Kepatuhan Penggunaan Obat Antihipertensi Pasien Hipertensi Rawat Jalan Usia Geriatri Terhadap Tekanan Darah

Medication adherence is an important factor in controlling blood pressure in hypertensive patients. The purpose of this study was to analyze the correlation between therapy adherence and control of blood pressure factors, as well as to analyze the correlation between gender and gender on the adherence of geriatric patients in undergoing antihypertensive treatment. The method used is analytical observational method by designing a cohort study research. Data was collected retrospectively, manual and electronic data collection (medical records). Measurement of compliance using the Medication Possession Ratio (MPR) method. Data analysis used Chi-Square test with SPSS. The results showed that patients who visited the Outpatient Installation of RSUD dr.Rubini tended to be female (60.6%), patients with monotherapy regimen (50.7%), frequency of drug administration 1x1 a day (90.1%), and patients with uncontrolled blood pressure (73.2%). As many as 18.3% of patients adhered to antihypertensive treatment. Chi-square analysis showed that there was a significant relationship between gender (p=0.05) and blood pressure control (p=0.032), while the results of therapy analysis were not statistically significant with p-values of 0.387 and 1,000 ( 0, 05). It was concluded that there was a correlation between gender and blood pressure control on patient compliance in undergoing treatment.

Association Between Implementation of a Geriatric Trauma Clinical Pathway and Changes in Rates of Delirium in Older Adults With Traumatic Injury

Older adults (age ≥65 years) are at risk for high rates of delirium and poor outcomes; however, how to improve outcomes is still being explored. To assess whether implementation of a geriatric trauma clinical pathway was associated with reduced rates of delirium in older adults with traumatic injury. A retrospective case-control study of electronic health records of patients aged 65 years or older with traumatic injury from 2018 to 2020 was conducted at a single level I trauma center. Eligible patients were age 65 years or older admitted to the trauma service and who did not undergo an operation. The implementation of a clinical pathway based on geriatric best practices, which included order sets, guidelines, automated consultations, and escalation pathways executed by a multidisciplinary team. The primary outcome was delirium. The secondary outcome was hospital length of stay. Process measures for pathway compliance were also assessed. Of the 859 eligible patients, 712 patients were included in the analysis (442 [62.1%] in the baseline group; 270 [37.9%] in the postimplementation group; mean [SD] age: 81.4 [9.1] years; 394 [55.3%] were female). The mechanism of injury was not different between groups, with 247 in the baseline group (55.9%) and 162 in the postimplementation group (60.0%) (P = .43) experiencing a fall. Injuries were minor or moderate in both groups (261 in baseline group [59.0%] and 168 in postimplementation group [62.2%]; P = .87). The adjusted odds ratio for delirium in the postimplementation cohort was 0.54 (95% CI, 0.37-0.80; P < .001). Goals of care documentation improved significantly in the postimplementation cohort vs the baseline cohort with regard to documented goals of care notes (53.7% in the postimplementation cohort [145 of 270] vs 16.7% in the baseline cohort [74 of 442]; P < .001) and a shortened time to discussion from presenting to the emergency department (36 hours in the postimplementation cohort vs 50 hours in the baseline cohort; P = .03). In this study, implementation of a multidisciplinary clinical pathway for injured older adults at a single level I trauma center was associated with improved care and clinical outcomes. Interventions such as these may have utility in this vulnerable population, and findings should be confirmed across multiple centers.

Bedside ultrasound to assess acute central venous pressure change during treatment of decompensated heart failure.

Accurate volume status assessment is crucial for the treatment of acute decompensated heart failure (ADHF). Volume status assessment by physical exam is often inaccurate, necessitating invasive measurement with right heart catheterization (RHC), which carries safety, pragmatic (scheduling, holding anticoagulants, etc.), and financial burdens. Therefore, a reliable, non-invasive, cost-effective alternative is desired. Previously, we developed an ultrasound (US) based technique to measure internal jugular vein (IJV) compliance during RHC which was used for single time point central venous pressure (CVP) predictions. We now aim to apply this technique to track acute changes in CVP during diuresis for ADHF in patients with an in-dwelling pulmonary artery catheter (PAC). We used an observational, prospective study design and recruited 15 patients from the cardiac critical unit (CCU) being treated for ADHF (systolic or diastolic) with intravenous (IV) diuretics with/without inotropic agents who underwent Swan- Ganz catheter/PAC insertion for continuous CVP monitoring. 13 of 15 patients received milrinone infusions. US images of the IJV were obtained at end-expiration and during the strain phase of Valsalva at multiple 2-3 hours intervals. Change in IJV cross-sectional area (CSA) (ImageJ) was used as a measure of IJV compliance. Patients unable to perform the Valsalva maneuver were excluded. Calculated percentage change (%Δ) in CSA of IJV was plotted against CVP. An inverse relationship was observed between CVP and %Δ in CSA of IJV. The data was fit with a polynomial regression curve (R2=0.36, root mean square error=3.19). Fivefold cross-validation showed a stable model for predicting CVP based on CSA (R2=0.31, root mean square error=3.18). Serial portable US assessment of IJV compliance can act as a surrogate measure of CVP and, therefore, can provide reliable information on acute hemodynamic changes in ADHF.

Self-Regulation of Ethical Behavior: The Case of Political Parties and Parliament in Spain

Spanish politicians have attempted to respond to the growing concern about declining trust in representative institutions through ethical self-regulation and meta-regulation instruments. This article focuses on a study of Parliament and the six major political parties with parliamentary representation. It attempts to explain the reasons for adopting these new regulations and proceeds with an in-depth analysis of the existing rules, oversight, and enforcement methods in Parliament and within party organizations. As a result of European pressure, Spanish Parliament has developed a new code of ethics, but it has not strengthened internal procedures and mechanisms to bring them into compliance with the standing rules. Furthermore, political parties have developed an entire set of basic compliance measures influenced by the law on the criminal liability of legal persons. In both cases, oversight and enforcement are exceedingly weak. None of these measures has improved confidence in politicians in Spain. Two lessons can be learned. First is that without politicians’ commitment, ethical reforms do not work. Secondly, today’s new technologies, linked to a social network society, make window-dressing deception more difficult.

On the historic exposure levels of Elemental Carbon from vehicle diesel exhaust based on “diesel smoke” concentrations

Air pollution by diesel traffic became a concern in the UK in the 1950s. Exposure levels were assessed via probing the light absorption of filter samples, which was translated to a mass concentration of “diesel smoke” (DS), based on the results of a measurements in the exhaust of a test diesel engine. We convert these DS values to concentrations of Elemental Carbon (EC), the current proxy for diesel exhaust. In a recent study in the literature and an earlier own investigation a high similarity (R2 = 0.97) was found of the light absorption by aerosol collected in parallel on glass and quartz fibre filters and probed by smoke-stain reflectometers similar to those used historically. For samples on quartz fibre filters the relation between light absorption and EC was taken from recent studies. The shape of the absorption/EC curve is highly similar to the absorption/DS curve, with an equivalency factor of 1.6 ± 20% between DS and EC concentration (expressed according to the EUSAAR2-TOT method). Converted EC concentrations for workday average 24-hr and morning rush hour samples were around 75 and 150 μg m−3 at the kerbside of the busy London A1 ring-road in 1960. In 1961–1962 the average weekday daytime EC concentration at a traffic island in inner city Fleet Street was 200–250 μg m−3. Only 45 m into a side-street the concentration was an order of magnitude less. At the end of the 1990-ies EC concentrations at the nearby Marylebone Road were around 9 μg m−3, dropping to 3 μg m−3 in recent years. In addition, we found the correct factor to convert light absorption to EC mass concentration of samples obtained in the FH62 beta gauge monitors used in Germany in compliance measurements for the national “soot law” preceeding the EU PM10 regulation of 1997.

Effectiveness of unreinforced masonry seismic retrofit programmes: review of policies in New Zealand and the United States

Implementing seismic risk mitigation programmes for earthquake-prone unreinforced masonry buildings (URM) is critical to ensure public safety and community resilience in regions of moderate and high seismicity. In New Zealand, it is a mandatory requirement to strengthen earthquake-prone buildings within a prescribed timeframe. However, the rate of compliance has been slow. Building owners delay or hesitate to undertake seismic strengthening, mainly due to uncertainties involved in cost (Egbelakin et al., 2014) [1]. While cost is the pivot of the owner's decision-making process, an effective design of government-led programmes is essential to engage the owners and increase the rate of compliance. This paper compared similar mandatory URM programmes in the United States and New Zealand to identify critical contributors to the success of each programme. In addition, this paper implements a regression analysis using actual remediation cost data gathered from a recent mandatory strengthening programme in New Zealand to identify significant cost factors in seismic strengthening. From the comparison, six key contributors to programme success were recognised, including 1) efficient and flexible financial options; 2) alternative retrofit design solutions; 3) fair penalties and enforcement tools; 4) a clearly laid out action plan and time limits for compliance; 5) dedicated local council staff and case managers; 6) consultation with building owners. The cost model suggested that building characteristics, location, and heritage status are significant in seismic strengthening costs. The findings contribute to the fine-tuning of future programme designs and the understanding of financial impediments building owners face in seismic strengthening. Significant cost factors identified in this study indicate where the allocation of government funding is required the most to maximise the incentivising of owners for early adoption of compliance measures.

A case of respiratory failure due to giant tumor with daily measurement of respiratory system compliance in ventilator weaning

A case of respiratory failure due to giant tumor with daily measurement of respiratory system compliance in ventilator weaning

Patterns of compliance with COVID-19 preventive measures among the public in Qatar and Kuwait

Policy responses to the COVID-19 pandemic are assessed by documenting the public’s perception, knowledge, and adherence to preventive behaviors to mitigate the spread of the virus. Using an online survey administered in both Qatar and Kuwait, this article examines the associated state-mandated compliance measures experienced by citizens and expats during the outbreak of COVID-19. The survey measured public attitudes, behavioral responses, and compliance with state-mandated preventive measures. The study showed that individuals were well informed about the pandemic, yet controversy exists concerning compliance with control measures to contain the virus, which continue to be challenged on the basis of multiple individual-level factors. These findings raise the imperative need to call for governments’ transparent communications with the public regarding information disclosure measures to gain public attention and trust, which are essential to strategic planning success.

The grand challenge: Effective anti-corruption measures in projects

A grand challenge in projects involves employing anti-corruption measures effectively for dealing with corruption. Existing research is scattered across a wide range of disciplines and thus understanding of the effectiveness of anti-corruption measures in projects remains obscure. Focusing on construction projects, which are the most studied and affected by corruption, we aim to establish what kinds of anti-corruption measures are effective, and how. We use design-oriented research synthesis to systematically study existing empirical evidence related to anti-corruption measures in construction projects, found in management journals across various disciplines. Our study shows that there is scarce empirical evidence documenting the effectiveness of anti-corruption measures in projects. Nevertheless, our findings show that compliance, managerial, probing, reactive, and regulatory measures can be effective. The two main mechanisms explaining how the different anti-corruption measures are effective are enhanced transparency of project operations and incentivised stakeholders. We conclude with a research agenda focused on project governance.

Quantitative Blood Volume Analysis and Hemodynamic Measures of Vascular Compliance in Patients With Worsening Heart Failure

The role of blood volume (BV) expansion vs a change in vascular compliance in worsening heart failure (HF) remains under debate. We aimed to assess the relationship between BV and resting and stress hemodynamics in worsening HF and to further elucidate the significance of BV in cardiac decompensation. Patients with worsening HF underwent radiolabeled indicator-dilution BV analysis and cardiac catheterization. Intravascular volumes and resting/stress hemodynamics were recorded. Provocative stress maneuvers included change in systolic blood pressure (ΔSBP) from lying to standing and Valsalva and intracardiac pressure changes with leg raise. Correlation between BV and invasive hemodynamics were assessed by linear regression. Of 27 patients with worsening HF, patients' characteristics included mean age 61 ± 12 years, 70% male, 19% Black, and mean ejection fraction 29% ± 15%. Of the patients, 13 (48%) had hypervolemia as measured by total BV, which weakly correlated with ΔSBP by position (R2 = 0.009) and Valsalva (R2 = 0.003) and with right atrial (R2 = 0.049) and pulmonary capillary wedge (R2 = 0.047) pressure changes during leg raise. In patients with worsening HF, BV mildly correlated with intracardiac pressures at rest. Provocative maneuvers intended to test vascular compliance did not correlate with BV, indicating that compliance may serve as a stand-alone metric in HF.