Elderly Chronic Heart Failure Patients Research Articles

Study on the construction of nomogram prediction model for prognostic assessment of heart failure patients based on serological markers and echocardiography.

We aimed to construct a nomogram prediction model for prognostic assessment of patients with heart failure (HF) based on serological markers and echocardiography. A total of 200 HF patients admitted to the Second Affiliated Hospital of Nanchang University from January 2018 to January 2020 were selected as the research objects. According to the New York Heart Association (NYHA) cardiac function classification, they were divided into 3 groups, including 65 cases of grade II, 97 cases of grade III, and 38 cases of grade IV. Three groups of echocardiographic parameters were compared [including left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-systolic volume (LVESV)], differences in serum markers brain natriuretic peptide (BNP), soluble growth-stimulating expression gene 2 (sST2) and the Modified Early Warning Score (MEWS). The patients were divided into two groups according to their clinical outcomes during the follow-up period, including 52 cases in the death group and 148 cases in the survival group. The clinical data of the two groups were compared, and multi-factor logistic regression analysis was performed to screen out the independent risk factors affecting the patient's death. A nomogram model of the patient's mortality risk was constructed based on the independent risk factors. Receiver operating characteristic (ROC) curves and calibration curves were used to evaluate the discrimination and accuracy of the nomogram model. As the cardiac function class of elderly chronic heart failure (CHF) patients increases, LVEDD, LVESD, sST2, and MEWS increase and LVEF decreases (p<0.05). Multifactor analysis results showed that LVEF, LVEDD, sST2, and MEWS were independent factors affecting the clinical outcome of patients. The AUCs predicted using LVEF, LVEDD, sST2, and MEWS alone were 0.738, 0.775, 0.717, 0.831, and 0.768, respectively. There is a certain degree of discrimination, and the model has extremely high accuracy. MEWS, LVEDD, and sST2 increase as the NYHA cardiac function grade of HF patients increases and LVEF decreases, which can reflect the severity of the disease to a certain extent. Additionally, the nomogram model established based on this has a high predictive value for the long-term prognosis of patients and can formulate effective intervention measures for quantitative values.

Correlation between Neutrophil-to-Lymphocyte Ratio, Platelets-to-Lymphocyte Ratio, C-Reactive Protein-to-Albumin Ratio and Clinical Picture of Elderly Chronic Heart Failure Patients.

Neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR) and C-reactive protein-to-albumin ratio (CAR) are believed to be potential inflammatory markers that are closely related to the prognosis and course of cardiovascular diseases. The main goal of this study was the evaluation of NLR, PLR and CAR as factors reflecting the clinical picture and the prognosis of elderly chronic heart failure (CHF) patients. In 150 elderly patients with newly diagnosed CHF, the NLR, PLR and CAR were correlated with cardiac, laboratory and nutritional parameters. Systemic inflammatory ratios were correlated with selected patient's parameters. CAR was associated with an unfavorable clinical picture of CHF-a reduced EF (p = 0.007), an elevated PASP (p = 0.014), an increased LVESD in both males and females (p = 0.032 and 0.024, respectively) and a decreased TAPSE (p = 0.023). CAR allowed us to distinguish between NYHA I-III and NYHA IV classes with AUC of 0.830. By analyzing the five-year mortality rate in patients with different CAR values, the greater death rate was recorded for patients with high CAR values-one-year death rate (40.3% vs. 17.2%) and five-year death rate (80% vs. 58.3%) (p = 0.002). Both NLR and PLR correlated only with selected parameters. An analysis of inflammatory markers, mainly CAR, allows the management of CHF, because its value can reflect the cardiac and nutritional status of patients with a prognostic value. NLR and PLR can serve as supplementary examinations for CAR evaluation.

Efficacy of combined use of Tetradium ruticarpum (A. juss.) patch and Chinese massage (Tuina) for the treatment of insomnia in elderly chronic heart failure patients

Efficacy of combined use of Tetradium ruticarpum (A. juss.) patch and Chinese massage (Tuina) for the treatment of insomnia in elderly chronic heart failure patients

Prognostic value of serum IGF-1, Gal-3, and PTX-3 levels in elderly patients with chronic heart failure.

To evaluate the diagnostic and prognostic value of insulin-like growth factor-1 (IGF-1), galactoagglutinin-3 (GAL-3), and pentamerin-3 (PTX-3) levels in elderly patients with chronic heart failure (CHF). In this retrospective study, 107 elderly CHF patients treated in Xiangyang Central Hospital were designated as the observation group, and 60 healthy individuals were selected as the control group. The cardiac function indexes and serum IGF-1, Gal-3, and PTX-3 levels were compared between the two groups. Furthermore, the serum IGF-1, Gal-3, and PTX-3 levels in patients across different cardiac function grades were compared, as well as in patients with poor or favorable prognosis. Additionally, receiver operating characteristic (ROC) curve was adopted to explore the diagnostic value of serum IGF-1, Gal-3, and PTX-3 levels for senile CHF; and multivariate logistic regression analysis was used to screen the independent factors affecting patients' prognosis. The serum IGF-1 level was significantly lower, while the levels of Gal-3 and PTX-3 were significantly higher in the observation group than those of the control group (all P<0.05). The serum IGF-1 level in patients with cardiac function grade IV was lower than that of the patients with cardiac function grade II and III, while the levels of Gal-3 and PTX-3 were higher than those with cardiac function grade II and III (all P<0.05). The serum IGF-1 level in the patients with cardiac function grade III was lower than those with cardiac function grade II, while the levels of Gal-3 and PTX-3 were higher in patients with grade III than those with grade II (all P<0.05). The serum IGF-1 level was lower, while the levels of Gal-3 and PTX-3 were higher in the patients with poor prognosis than those with favorable prognosis (all P<0.05). In elderly CHF patients, IGF-1 level were decreases, while the levels of Gal-3 and PTX-3 were increase. These biomarkers show high sensitivity in diagnosing CHF and are closely linked to the prognosis, indicating their value for clinical assessment and management of CHF.

Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure.

With the intensification of social aging, the susceptibility of the elderly population to diseases has attracted increasing attention, especially chronic heart failure (CHF) that accounts for a large proportion of the elderly. To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF. This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received. The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group (SG; n = 62), and those who underwent routine detailed behavioral nursing intervention were included as a control group (CG; n = 54). Patients' negative emotions (NEs), quality of life (QoL), and nutritional status were assessed using the self-rating anxiety/ depression scale (SAS/SDS), the Minnesota Living with Heart Failure Ques-tionnaire (MLHFQ), and the Modified Quantitative Subjective Global Assessment (MQSGA) of nutrition, respectively. Differences in rehabilitation efficiency, NEs, cardiac function (CF) indexes, nutritional status, QoL, and nursing satisfaction were comparatively analyzed. A higher response rate was recorded in the SG vs the CG after intervention (P < 0.05). After care, the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG (P < 0.05). The post-intervention SAS and SDS scores, as well as MQSGA and MLHFQ scores, were also lower in the SG (P < 0.05). The SG was also superior to the CG in the overall nursing satisfaction rate (P < 0.05). Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients, and it can not only effectively enhance rehabilitation efficiency, but also mitigate patients' NEs and improve their CF and QoL.

Hepcidin as a Regulator of Iron Metabolism and Mediator of Inflammation in Patients with Chronic Heart Failure and Anemia of Chronic Diseases of the Elderly and Senile Age

Aim. To study the role of hepcidin as a regulator of iron metabolism and a mediator of inflammation in elderly and senile patients with chronic heart failure (CHF) with anemia of chronic diseases (ACD).Material and methods. The levels of hemogram parameters, ferrokinetics (serum iron, ferritin, transferrin, erythropoietin, hepcidin), inflammation [C-reactive protein (CRP), interleukin-6 (IL-6)], as well as correlations between hepcidin and these parameters were studied in patients with CHF with ACD (n=35), with CHF without anemia (n=35) and in elderly and senile patients without CHF and anemia (control group; n=20).Results. Normal levels of hepcidin (9.17±0.97 ng/ml) and the only significant correlation of hepcidin with the ferrokinetic parameter – serum iron [r(S)=0.480, p&lt;0.05] were found in the control group. Normal levels of hepcidin (12.01±1.19 ng/ml) and two significant correlations of hepcidin with the ferrokinetic parameter – ferritin [r(S)=0.525, p&lt;0.05] and transferrin [r(S)=-0.343, p&lt;0.05] were found in the CHF without anemia group. Significantly elevated levels of hepcidin (23.81±3.63 ng/ml) were found in the CHF with ACD group compared to the CHF without anemia group (p=0.008) and the control group (p=0.003). Also, five significant correlations of hepcidin with hemogram parameters – hemoglobin [r(S)=-0.461, p&lt;0.05] and the average concentration of hemoglobin in the erythrocyte [r(S)=-0.437, p&lt;0.05]; with ferrokinetic parameters – ferritin [r(S)=0.596,p&lt;0.05] and transferrin [r(S)=-0.474, p&lt;0.05]; with inflammation parameters – CRP [r(S)=0.561, p&lt;0.05] were found in the CHF with ACD group.Conclusion. The increased level of hepcidin in CHF patients with ACD and the formation of links of hepcidin with indicators of inflammation reflect its role as a mediator of inflammation, and the formation of connections with indicators of hemogram and ferrokinetics – its role as a regulator of iron metabolism involved in the development of ACD in elderly and senile CHF patients.

Application Value of NT-proBNP Combined with NLR in Evaluation of Major Adverse Cardiac Events in Elderly Patients with Chronic Heart Failure.

Objective To explore the application value of N-terminal pro-B type natriuretic peptide (NT-proBNP) combined with neutrophil-to-lymphocyte ratio (NLR) in evaluation of major adverse cardiac events (MACEs) in elderly patients with chronic heart failure (CHF). Methods 50 CHF patients admitted to the Department of Cardiovascular Medicine of our hospital from January 2021 to December 2021 were selected as the observation group. Another 50 non-CHF patients of our hospital were selected as the control group. Clinical data were collected from subjects who met the inclusion criteria, including general information, personal disease history, and laboratory test indicators. Patients with CHF were followed up for 6 months. Patients with CHF were divided into two groups, MACE group and non-MACE group. Results The levels of WBC, NEU, NLR, and NT-proBNP in observation group were higher than those in control group, but the level of LYM was the opposite (P < 0.05). The age, WBC, NEU, LYM, PLT, blood glucose, NLR, and NT-proBNP of MACE group and non-MACE group were significantly different (P < 0.05). The increased levels of NEU, NLR, NT-proBNP and the decreased levels of LYM and PLT are all independent risk factors for MACE in elderly patients with CHF (P < 0.05). The AUC of NLR in evaluating the occurrence of MACE in elderly CHF patients was 0.841. When the Youden index was 0.7692, the sensitivity was 76.92% and the specificity was 100.00%. The AUC of NT-proBNP in evaluating the occurrence of MACE in elderly CHF patients was 0.705. When the Youden index was 0.5260, the sensitivity was 76.92% and the specificity was 75.68%. The AUC of NT-proBNP combined with NLR in evaluating the occurrence of MACE in elderly CHF patients was 0.954. When the Youden index was 0.8420, the sensitivity was 92.31% and the specificity was 91.89%. Conclusion NT-proBNP combined with NLR has high value in the evaluation of MACE in elderly CHF patients and can be used as an auxiliary predictive index in clinic.

The Impact of Cardiac Rehabilitation on Activities of Daily Life in Elderly Patients With Heart Failure.

Background: In elderly chronic heart failure (HF) patients, activities of daily living (ADLs) require the use of a high proportion of patients’ peak aerobic capacity, heart rate, and ventilation.Objectives: To assess the effects of short-term comprehensive cardiac rehabilitation (CR) on the metabolic requirement of ADLs in elderly patients with chronic HF.Methods: The study population comprised 99 elderly chronic HF patients (mean age 72 ± 5 years, 80% male, 61% ejection fraction <40%, mean NT-proBNP 2,559 ± 4,511 pg/ml) participating in a short-term (mean days 19 ± 7) residential CR program. Before and after CR, participants, while wearing a portable ergospirometer, performed a standardized ADL battery: ADL1 (getting dressed), ADL2 (folding 8 towels), ADL3 (putting away 6 bottles), ADL4 (making a bed), ADL5 (sweeping the floor for 4 min), ADL6 (climbing 1 flight of stairs carrying a 1.5 Kg load), and ADL7 (a standard 6-min walking test).Results: After CR, task-related oxygen uptake did not change in any of the domestic ADLs. Notably, there was a significant decrease in the cumulative time required to perform ADLs (ADL 1–4 and ADL6; from 412 ± 147 to 388 ± 141 s, p = 0.001) and a reduction in maximal heart rate in ADL1 and 3 (p = 0.005 and p = 0.027, respectively). Changes occurred in the 6MWT with an increase in oxygen uptake (p = 0.005) and in the distance covered (p < 0.001) and a significant decrease in the Borg scale of dyspnea (p = 0.004).Conclusion: Elderly patients with chronic heart failure who are engaged in a short-term residential CR program improve the performance of routine ADLs.

Effects of Chronic Heart Failure on Longitudinal Changes of Cognitive Function in Elderly Patients.

Elderly patients with cognitive impairment present problems such as memory loss, impaired judgment, and loss of language function. Severe cases affect daily life and social functions. For the past few years, the possible disease and possible illness of chronic heart failure (CHF) in elderly patients have continued to increase. However, there is not enough research on the effect of CHF on the longitudinal change speed of cognitive function in elderly patients. Most studies focus on the effects of diseases like hypertension, coronary heart disease, and diabetes on cognitive function in elderly patients, which results in incomplete research. In this context, this article used a Bayesian network to build a cognitive function classification model for the elderly. The effects of CHF on the rate of longitudinal changes in cognitive function in elderly patients were studied by mental state examination and statistical methods. The experiment finally concluded by evaluating the attention, language ability, and memory ability of elderly patients. In the elderly with CHF, the incidence of cognitive impairment was about 71.66%. The experimental results further indicated that the higher the degree of CHF in elderly patients, the lower the level of cognitive function. This article could help advance research on preventing or delaying cognitive decline in patients with CHF.

Possibilities of bioimpedance method of investigation of elderly patients with chronic heart failure

Introduction.Diagnostics of congestive events in chronic heart failure (CHF) in elderly people is increasingly relevant due to the general aging of the population, which determines the search for new research methods.The aimis to evaluate the diagnostic capabilities of bioimpedance method in determining the severity of congestion in elderly patients with CHF.Materials and methods.86 elderly patients with CHF of different clinical stages were examined, 36.0% of them were burdened with varicose vein disease of the lower limbs. Total body water content was assessed by active impedance at 50 kHz, extracellular fluid content — at 5 kHz.Results.Active resistance at 50 kHz in patients with CHF II B was 473.92±29.39, with CHF II A - 569.24±58.97, with CHF I — 601.33±24.64 ohms, respectively, at 5 kHz — 555.52±27.44, 633.50±51.32 and 722.50±15.85 ohms respectively. No total and/or extracellular fluid retention was detected in CHF II A without lower limb varicosity, and in 10 (58.8%) patients — in cases of its presence. Retention of total and/or extracellular fluid was detected in 74.4% of CHF stage II B patients, and 48.3% of them had varicose vein disease of the lower limbs.Discussion.Patients with CHF stage II B have the highest amount of total and extracellular fluid in the body compared to patients with CHF stage II A and CHF stage I, but the method is insensitive for diagnosis of fluid retention in the small circle of the circulation and differential diagnosis of the genesis of edema in varicose vein disease of the lower limbs.Conclusion.Bioimpedance imaging can be used for additional diagnostics of CHF in elderly patients in order to estimate the amount of total/extracellular fluid in the body to build personalized treatment and prevention programs.

Improvement of Self-Monitoring in Elderly Chronic Heart Failure Patients through Telenursing Interactions with Nurses

Improvement of Self-Monitoring in Elderly Chronic Heart Failure Patients through Telenursing Interactions with Nurses

Incremental prognostic value of a novel metabolite-based biomarker score in congestive heart failure patients.

AimsThe Cardiac Lipid Panel (CLP) is a newly discovered panel of metabolite‐based biomarkers that has shown to improve the diagnostic value of N terminal pro B type natriuretic peptide (NT‐proBNP). However, little is known about its usefulness in predicting outcomes. In this study, we developed a risk score for 4‐year cardiovascular death in elderly chronic heart failure (CHF) patients using the CLP.Methods and resultsFrom the Cardiac Insufficiency Bisoprolol Study in Elderly trial, we included 280 patients with CHF aged >65 years. A targeted metabolomic analysis of the CLP biomarkers was performed on baseline serum samples. Cox regression was used to determine the association of the biomarkers with the outcome after accounting for established risk factors. A risk score ranging from 0 to 4 was calculated by counting the number of biomarkers above the cut‐offs, using Youden index. During the mean (standard deviation) follow‐up period of 50 (8) months, 35 (18%) subjects met the primary endpoint of cardiovascular death. The area under the receiver operating curve for the model based on clinical variables was 0.84, the second model with NT‐proBNP was 0.86, and the final model with the CLP was 0.90. The categorical net reclassification index was 0.25 using three risk categories: 0–60% (low), 60–85% (intermediate), and >85% (high). The continuous net reclassification index was 0.772, and the integrated discrimination index was 0.104.ConclusionsIn patients with CHF, incorporating a panel of three metabolite‐based biomarkers into a risk score improved the prognostic utility of NT‐proBNP by predicting long‐term cardiovascular death more precisely. This novel approach holds promise to improve clinical risk assessment in CHF patients.

Application of blood pre-albumin and NT-pro BNP levels in evaluating prognosis of elderly chronic heart failure patients.

Levels of blood pre-albumin (PA) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) in elderly patients with chronic heart failure (CHF) and their clinical value in prognosis evaluation were explored. A total of 410 elderly patients aged ≥65 years hospitalized for CHF were enrolled. The concentrations of blood PA and NT-pro BNP, routine blood test and biochemistry indicators were determined and color Doppler echocardiography was performed. Additionally, the patients were followed up after discharge, and based on the occurrence of major adverse cardiac events (MACE), they were divided into MACE group and non-MACE group. MACE group had an older age and a higher level of plasma NT-pro BNP than non-MACE group (77.82±6.57) years vs. (76.39±6.18) years, and (8,864.52±9,718.36) pg/ml vs. (4,165.62+6,437.28) pg/ml (P<0.05), and the left ventricular ejection fraction and serum PA level in MACE group were lower than those in non-MACE group (P<0.05). According to the results of multivariate regression analysis, serum PA [odds ratio (OR)=0.242, 95% confidence interval (CI)=0.137-0.406, P<0.001] and plasma NT-pro BNP (OR=1.847, 95% CI=1.024-3.158, P=0.036) were independent risk factors for the occurrence of cardiac events during follow-up. Decline in PA level and elevation in NT-pro BNP level have a strong correlation with poor prognosis of elderly CHF patients, and they can be used for clinically evaluating disease conditions, guiding treatment and improving prognosis.

Self-management behavior based on structural equation model in elderly chronic heart failure patients

Objective To investigate the self-management of elderly chronic heart failure (CHF) patients and to explore the structural equation modeling (SEM) on the influencing factors of self-management behavior among CHF patients so as to provide a basis for constructing the self-management education plan for elderly CHF patients suitable for the characteristics of our country. Methods From January 2015 to June 2017, The study selected 6 124 elderly patients in 102 hospitals of 16 provinces, cities and autonomous region from 5 areas, east China, west China, south China, north China and central China by random cluster sampling as subjects. All of patients were investigated with the self-management scale of heart failure patients, heart failure knowledge questionnaire, chronic disease self-efficacy scale, self-concept scale and the medica coping modes questionnaire. AMOS 22.0 was used to construct the model on the influencing factors of self-management behavior among CHF patients. Results The total score self-management of 6 124 elderly CHF patients was [49.00 (43.00, 54.00) ] with 61.25% for the scoring rate. The SEM on the direct or indirect influencing factors of self-management among elderly CHF patients fitted well. The influencing factors of self-management included the per-capita incomes, works, self-care, nations, religious belief, education levels, heart failure knowledge, self-concept, self-efficacy, coping styles. Conclusions Self-management of elderly CHF patients are in the below average level influenced by different demographers, cultural background and heart failure knowledge. Medical staff should formulate a systematic and individual self-management education plan for elderly CHF patients based on patients' demographic characteristics, cultural background, heart failure knowledge, self-concept and self-efficacy to improve their self-management. Key words: Aged; Chronic heart failure; Self-management; Structural equation model

Soluble (pro)renin receptor in elderly chronic heart failure patients.

Overactivation of renin-angiotensin system (RAS) is one of the main pathophysiological features in the evolution of chronic heart failure (CHF). The (pro)renin receptor ((P)RR) represents an important player in a tissue renin-angiotensin system (tissue RAS), which mediates tissue injury through fibrosis and hypertrophy of the affected organs in CHF patients. In our study we used plasma samples from 556 elderly subjects with CHF and 198 healthy participants in order to evaluate prognostic and diagnostic potential of s(P)RR in setting of CHF. The patients with CHF showed significantly higher plasma levels of s(P)RR than the healthy volunteers (p=0.0005). We observed association between higher s(P)RR plasma concentrations and lower left ventricular ejection fraction and higher degree of left ventricular dilatation on baseline echocardiography examination of the CHF patients. Elderly CHF patients with higher baseline s(P)RR plasma concentration were at same risk for death, stroke and hospitalization due to heart failure worsening at mean follow-up from forty-eight months in comparison to low s(P)RR counterparts.

Self-management status and influencing factors of elderly patients with chronic heart failure in Inner Mongolia

Objective To investigate the level of self-management and identify the influencing factors in elderly patients in Inner Mongolia with chronic heart failure (CHF) . Methods By convenience sampling, a total of 1 051 elder patients with CHF from 9 Class Ⅱ & Ⅲ hospitals in 5 cities of Inner Mongolia Autonomous Region were recruited to participate in this study from December of 2015 to July of 2018. The elderly CHF patients were investigated with General Data Questionnaire and Self-management Scale for Heart Failure Patients. Results The total score of Self-management Scale for Heart Failure Patientsof 1 051 elderly patients with CHF was (47.9±7.7) with a scoring rate of 59.9%. Multivariate linear regression analysis showed that ethnicity, work status and marital status were the influencing factors of self-management level of elderly CHF patients. Conclusions The self-management status of elderly CHF patients in Inner Mongolia is not ideal. Corresponding intervention measures should be formulated according to the influencing factors of self-management level of elderly CHF patients in Inner Mongolia. Key words: Chronic heart failure; Self-management; Influencing factors

National multicenter survey on self-management among elderly chronic heart failure patients

Objective To understand the self-management status among elderly chronic heart failure (CHF) patients and to compare the regional differences of self-management. Methods By random cluster sampling, we investigated 6 124 elderly CHF patients from 102 hospitals in five regions, East China (Jiangxi Province, Shanghai Municipality, Zhejiang Province) , West China (Qinghai Province, Xinjiang Uygur Autonomous Region, Shaanxi Province, Gansu Province, Ningxia Hui Autonomous Region, Yunnan Province) , South China (Hainan Province, Guangxi Zhuang Autonomous Region) , North China (Heilongjiang Province, Inner Mongolia Autonomous Region) , Central China (Henan Province, Hubei Province, Hunan Province) . The investigation result statistics were carried out and regional differences were compared. Results The self-management of elderly CHF patients had a low to medium level with 61.25% (49/80) <80% for the scoring rate. The scores of East China and Central China were higher and the score of West China was low; the regional differences were statistical (H=59.07, P<0.01) . The score of diet management was highest with 66.67% for the scoring rate (8/12) ; East China had the highest score, and West China had the lowest score; the regional differences were statistical (H=92.49, P<0.01) . The scoring rate of medication management was 65.00% (13/20) with the highest in East China and low in North China and West China; the regional differences were statistical (H=351.10, P<0.01) . Mental/social adjustment management was poor with 60.00% (12/20) for the scoring rate; the scores of Ease China were higher than those of North and West China; the regional differences were statistical (H=8.84, P<0.01) . Symptom management was the worst with 57.14% (16/28) for the scoring rate; the scores of East and Central China were high; the regional differences were also statistical (H=17.62, P<0.01) . Conclusions Self-management of elderly CHF patients needs to be improved. Systematic and targeted health education for different regions should be carried out to improve patients' self-management and to reduce the disease burden. Key words: Heart failure; Aged; Multicenter study; Self-management

Impact of sarcopenia on muscle strength and exercise capacity in elderly patients with chronic heart failure

Objective To investigate the impact of sarcopenia on muscle strength and exercise capacity in elderly patients with chronic heart failure (CHF). Methods One hundred and sixteen inpatient aged ≥65 years with CHF were enrolled in the study. General clinical characteristics were collected with questionnaire; the appendicular skeletal muscle mass (ASM) was assessed with body composition analyzer; the arm muscle strength was measured and a 6m-walk test was performed. The sarcopenia was evaluated according to the Asian Working Group for Sarcopenia (AWGS) criteria. Simple regression analysis and logistic regression were used to analyze the correlation between sarcopenia and decreased muscle strength, exercise capacity in elderly CHF patients. Results Among 116 elderly CHF patients, sarcopenia was confirmed in 42 patients(36.2%). Patients with sarcopenia had poorer cardiac function and lower muscle strength, ASM and 6m-walking speed than patients without sarcopenia did(allP<0.05). Simple regression analysis showed positive correlation between ASM and muscle strength in both groups. Logistic regression analysis showed that after adjustment for confounders, ASM reduction was an independent risk factor for reducedexercisecapacity(OR=0.158, 95%CI: 0.055-0.455, P<0.05). Conclusion Sarcopenia is a common complication in elderly patients with CHF and may lead to decreased muscle strength and exercise capacity. Key words: Aged; Chronic heart failure; Sarcopenia; Exercise capacity

Comparison of Different Strategies to Measure Medication Adherence via Claims Data in Patients With Chronic Heart Failure.

Medication adherence correlates with morbidity and mortality in patients with chronic heart failure (CHF), but is difficult to assess. We conducted a retrospective methodological cohort study in 3,808 CHF patients, calculating adherence as proportion of days covered (PDC) utilizing claims data from 2010 to 2015. We aimed to compare different parameters’ influence on the PDC of elderly CHF patients exemplifying a complex chronic disease. Investigated parameters were the assumed prescribed daily dose (PDD), stockpiling, and periods of hospital stay. Thereby, we investigated a new approach using the PDD assigned to different percentiles. The different dose assumptions had the biggest influence on the PDC, with variations from 41.9% to 83.7%. Stockpiling and hospital stays increased the values slightly. These results queries that a reliable PDC can be calculated with an assumed PDD. Hence, results based on an assumed PDD have to be interpreted carefully and should be presented with sensitivity analyses to show the PDC's possible range.

Construction of nurse training course based on intercultural target incentive self-management model of elderly patients with chronic heart failure

Objective To construct the nurse training course based on intercultural target incentive self-management model of elderly patients with chronic heart failure (CHF) . Methods From August 2017 to November 2017, the three rounds of enquiry of 16 experts were carried out with the Delphi method to construct the nurse training course based on intercultural target incentive self-management model of elderly CHF patients. Results Among three rounds of enquiry, the recovery rates of valid questionnaire were all 100%; the expert authority coefficient was 0.863; the total Kendall coordination coefficients were 0.194, 0.431 and 0.371 respectively (P<0.05) . The nurse training course included 18 primary indexes and 39 secondary indexes. Conclusions The construct of the nurse training course based on intercultural target incentive self-management model of elderly CHF patients is scientific and practical which provides a reference for carrying out personalized self-management education. Key words: Aged; Nurses; Heart failure; Transcultural nursing; Target incentive; Self-management; Course construction