Heart Rate Classification Research Articles

Are There Distinct Cardiovascular Subclasses in Acute Respiratory Distress Syndrome? Maybe.

Are There Distinct Cardiovascular Subclasses in Acute Respiratory Distress Syndrome? Maybe.

Bradycardia may determine blood-pressure variability: results from real life office measurements of over half a million members of a large health maintenance organization in Israel.

Objective: Historically, guidelines for blood pressure (BP) measurement recommended adjusting the cuff deflation rate to the patient’s heart rate (2-3 mmHg per heartbeat). Current guidelines recommend a fixed cuff deflation rate of 2 mmHg/sec. This translates to that, on average, the number of Korotkoff sounds (or oscillometric pulse waves) on which BP measurement is based is larger in patients with higher compared with lower pulse rate. It follows that the precision (and accuracy) of BP may be compromised in patients with lower heart rate, leading to higher intra-individual BP variability. In this study, we assess the association between heart rate and BP variability. Design and Methods: Retrospective analysis of BP measurements of patients in a large health maintenance organization database. All BP measurements in adult patients with corresponding heart rate documentation were reviewed. For each heart rate category (6 categories between 40 and 99 beats per minute), all patients with at least 3 BP readings within that category were included. In each category, systolic and diastolic BP coefficient of variance (corrected for sample size) was plotted against the pulse category. Results: There were 551,595 unique patients with at least 3 BP measurements within a heart rate category (a total of 4,760,000 measurements) and 860,522 groups of 3 measurements or more per patient within a heart rate category. BP normalized coefficient of variance was inversely related to heart rate, ranging 0.0043 to 0.0003 (systolic), and 0.0024 to 0.0002 (diastolic), for the lowest to highest heart rate category, respectively. These results were consistent when sensitivity analyses were done with age below and above 60 years, gender, diabetes, kidney disease, treatment with β-blockers, calcium channel blockers, or no treatment. Conclusions: BP variability is inversely associated with heart rate, especially in lower heart rate, likely reflecting less precise BP measurements where the “sample size” of heart beats is small. The observed effect compromising precision might be accompanied by a concomitant reduced accuracy of BP measurement which is another theoretical implication of a smaller “sample size”, leading to a systematic bias towards measuring lower and higher than real systolic and diastolic BP respectively.

Prognostic impact of heart rate during atrial fibrillation on clinical outcomes in elderly non-valvular atrial fibrillation patients: ANAFIE Registry sub-cohort study

BackgroundElderly patients with atrial fibrillation (AF) are at a higher risk for all-cause mortality and heart failure. Rate control is an essential component in AF management. This exploratory study assessed the relationship between resting heart rate during AF at baseline and clinical outcomes in Japanese elderly non-valvular AF (NVAF) patients, using the All Nippon AF In the Elderly Registry (ANAFIE) dataset. MethodsThis sub-cohort included patients who agreed to participate and presented with AF at enrollment in the ANAFIE study. They were categorized into six groups according to the resting heart rate during AF. Outcomes included 2-year cumulative incidences of stroke/systemic embolic events (SEE), ischemic stroke, major bleeding, cardiovascular (CV) events, CV death, all-cause death, and net clinical outcome, a composite of stroke/SEE, major bleeding, and all-cause death. ResultsOf the 8292 patients included in this sub-cohort (paroxysmal, 1496; non-paroxysmal, 6796), 90 % of patients were using anticoagulants. Higher heart rate was more frequently reported in women and in patients with paroxysmal AF and was associated with increased use of direct oral anticoagulants (DOACs) and antiarrhythmic drugs. Heart rate ≥110 beats per minute (bpm) was associated with a significantly higher incidence of cardiac events and numerically higher incidences of CV death and all-cause death compared with a heart rate of 60 to <80 bpm, all of which were driven by an increased risk in patients with non-paroxysmal AF. Hazard ratios by the type of anticoagulant for each clinical outcome were comparable across all heart rate categories, indicating no significant interactions. ConclusionsElderly Japanese patients with non-paroxysmal NVAF and a heart rate ≥110 bpm have an increased risk of cardiac events. There was no interaction between heart rate category and the relative risk of adverse clinical events in patients taking DOACs compared with those taking warfarin.

No Association of Early Postoperative Heart Rate With Outcomes After Coronary Artery Bypass Grafting.

Elevated perioperative heart rate potentially causes perioperative myocardial injury because of imbalance in oxygen supply and demand. However, large multicenter studies evaluating early postoperative heart rate and major adverse cardiac and cerebrovascular events (MACCEs) are lacking. To assess the associations of 4 postoperative heart rate assessment methods with in-hospital MACCEs after elective coronary artery bypass grafting (CABG). Using data from the eICU Collaborative Research Database in the United States from 2014 to 2015, the study evaluated postoperative heart rate measured during hospitalization within 24 hours after intensive care unit admission. Four heart rate assessment methods were evaluated: maximum heart rate, duration above heart rate 100/min, area above heart rate 100/min, and time-weighted average heart rate. The outcome was in-hospital MACCEs, defined as a composite of in-hospital death, myocardial infarction, angina, arrhythmia, heart failure, stroke, cardiac arrest, or repeat revascularization. Among 2585 patients, the crude rate of in-hospital MACCEs was 6.2%. In multivariable logistic regression analysis, the adjusted odds ratios (95% CI) for in-hospital MAC-CEs assessed by maximum heart rate in each heart rate category (beats per minute: >100-110, >110-120, >120-130, and >130) were 1.43 (0.95-2.15), 0.98 (0.56-1.64), 1.47 (0.76-2.69), and 1.71 (0.80-3.35), respectively. Similarly, none of the other 3 methods were associated with MACCEs. More research is needed to assess the usefulness of heart rate measurement in patients after CABG.

Cord Blood Cell-Free DNA Concentration: A Novel Marker for Neonatal Wellbeing.

Cord gas values and Apgar scores, currently used as markers for newborn wellbeing and postpartum complications, provide rough estimates, and their use remains elusive. Circulating cell-free DNA (cfDNA) may better represent newborn status at birth and the effect of parturition on the fetus. This pilot study investigates the association between cord blood (CB) cfDNA and neonatal outcomes. In a prospective cohort study, cfDNA concentration was measured in immediately following delivery collected CB sera of newborns using our rapid fluorescent assay. During the study period, blood samples from umbilical cords of 100 newborns were collected. Vaginal delivery was associated with a higher median CB cfDNA than cesarean delivery (277 [95% confidence interval [CI] 199-377] vs. 100 [95% CI 43-265] ng/mL, p < 0.01). cfDNA levels were significantly associated with gestational age at delivery (rho = 0.308, p = 0.002) and CB base deficit (BD, r = 0.252, p = 0.017). According to maternal and fetal complications, CB cfDNA was elevated in fetuses with category II of heart rate tracing (p < 0.05), with maternal positive vaginal culture (p < 0.01), and with premature rupture of membranes (PROM, p < 0.001). Logistic regression models of CB cfDNA fourth quartiles demostrate a double odds ratio for elevated BD (>3mmol/L) and for worse heart rate tracing category. Serum CB cfDNA concentration reflects the newborn's status and hazards with an excellent association with CB BD, fetal heart rate category, and maternal risk factors for infection (positive vaginal culture and PROM). This preliminary observation suggests that cfDNA can serve as a point of care biomarker for newborn status at the time of delivery. · CB cfDNA levels correlated with newborn's BD.. · CB cfDNA levels reflect parturition stress and inflammation.. · cfDNA serve as a diagnostic and prediction tool for the identification of newborns at risk for morbidity..

Effects of acute tocolysis using ritodrine hydrochloride on foetal heart rate patterns in intrauterine foetal resuscitation: a retrospective, single-centre observational study

No consistent recommendations concerning the preferred tocolytic agents for intrauterine foetal resuscitation are available. We evaluated the effects of acute tocolysis (AT) using ritodrine hydrochloride on foetal heart rate (FHR) patterns and neonatal outcomes. We retrospectively analysed the data of patients undergoing emergency caesarean section because of non-reassuring foetal status indicated by foetal scalp electrodes. Patients were classified into AT (ritodrine hydrochloride approximately 500 µg/min) and control groups with 15 and 12 participants, respectively. FHR patterns, Apgar scores, umbilical arterial analysis, and neonatal admission were compared. All participants had FHR category II; decelerations disappeared in all foetuses in the AT group, with no significant difference in neonatal outcomes. The AT group had a higher baseline FHR and lower short-term FHR variability than the control group, indicating foetal autonomic responses. Further studies are needed to clarify the effects of AT on FHR patterns, neonatal outcomes, and foetal and neonatal autonomic responses. Impact statement What is already known on this subject? The usefulness of acute tocolysis using ritodrine hydrochloride has been well-documented in several studies; however, such an application often induces side effects, such as maternal tachycardia, palpitations, and tremors. What the results of this study add? The short-term administration of ritodrine hydrochloride eliminated decelerations, with no significant difference in neonatal outcomes in pregnant women with foetal heart rate category II. Meanwhile, there were higher foetal heart rate and lower short-term foetal heart rate variability in pregnant women administered with ritodrine hydrochloride, indicating foetal autonomic responses. What the implications are of these findings for clinical practice and/or further research? Ritodrine hydrochloride administration, even for short-term, appears to be associated with foetal autonomic responses. Further studies with stratification of patient groups based on the severity and aetiology of non-reassuring foetal status, including pregnant women with foetal category III, would elucidate the risk and benefit of acute tocolysis using ritodrine hydrochloride, based on foetal heart rate patterns, neonatal outcomes, and foetal and neonatal autonomic responses.

Analisis aktivitas fisik pada penyandang obesitas menggunakan smartwatch

The occurrence of obesity cannot be separated from lifestyle, such as decreased physical activity. Obesity is considered the first signal of the emergence of non-infectious diseases such as diabetes and cholesterol. This study aims to determine physical activity in obese people. Through SmartWatch, people will get data that is footsteps, heart rate, calories. Method: This research using experiment research or Single-Subject Research called SSR. Subjects had 110 kg in weight and 171cm in height with a BMI of 37,6 (Very Fat/Obesity). Analysis of the physical activity of obese people using the active lifestyle rubric and SmartWatch. The research findings that the average score obtained by obese subjects for the footstep category was 1,704 (very low category), which means that the physical activity carried out is also included in the light physical activity category. The average score for the heart rate category obtained by the subject was 67bpm which was included in the normal and low categories, while for the category of calories in and out, the average score obtained was 44 calories used, including into the low category. Physical activity of obese people based on monitoring using SmartWatch also concluded that the active lifestyle of an obese person is very low or low; this can be seen from the results of monitoring physical activity, namely footsteps, heart rate, calories, and Body Mass Index (BMI).

Concordance analysis of intrapartum cardiotocography between physicians and artificial intelligence-based technique using modified one-dimensional fully convolutional networks

Cardiotocography is a common method of electronic fetal monitoring (EFM) for fetal well-being. Data-driven analyses have shown potential for automated EFM assessment. For this preliminary study, we used a novel artificial intelligence method based on fully convolutional networks (FCNs), with deep learning for EFM evaluation and correct recognition, and its possible role in evaluation of nonreassuring fetal status. We retrospectively collected 3239 EFM labor records from 292 deliveries and neonatal Apgar scores between December 2018 and July 2019 at a single medical center. We analyzed these data using an FCN model and compared the results with clinical practice. The FCN model recognized EFM traces like physicians, with an average Cohen's kappa coefficient of agreement of 0.525 and average area under the receiver operating characteristic curve of 0.892 for six fetal heart rate (FHR) categories. The FCN model showed higher sensitivity for predicting fetal compromise (0.528 vs 0.132) but a higher false-positive rate (0.632 vs 0.012) compared with clinical practice. FCN is a modern technique that may be useful for EFM trace recognition based on its multiconvolutional layered analysis. Our model showed a competitive ability to identify FHR patterns and the potential for evaluation of nonreassuring fetal status.

Use of Sequential Compression Devices for Prevention of Maternal Hypotension After Epidural Analgesia in Birth

Reduce the use of vasopressors to treat hypotension when less invasive methods can be used and reduce adverse fetal outcomes. Sequential compression devices (SCDs) will be placed on all women until the second stage of labor or birth, immediately before placement of epidural analgesia in labor. Poster training of all nurses on the process occurred for 2 weeks before implementation of the practice, with nurses signing off on understanding the process. A chart reminder sheet was created and attached to the physical charts for all women in labor. The presence of SCDs was confirmed in each patient room and unit per level of SCD leg wraps increased. On July 15, SCD use began. From July 15 until October 15, 2019, data were collected on use of SCDs on all intrapartum patients meeting study parameters who received epidural analgesia. The principal outcome will be the reduced occurrence of maternal hypotension within 1 hour of epidural placement, defined as a systolic blood pressure (SBP) lower than 90 mm Hg or 80% lower than the value before epidural analgesia. In addition, the need for vasopressors (ephedrine, phenylephrine) and changes in fetal heart rate categories within 1 hour of epidural analgesia will be secondary outcomes. Cases from a historical cohort before introduction of SCD and cases in which SCDs were not placed during the study period will constitute the control group. Results will be controlled for maternal demographic, obstetric characteristics, and medical characteristics. Outcome information (mode of birth, indications for operative birth, neonatal outcome) will be recorded. Statistical analysis will use chi-square or Fisher’s exact test for categorical variables, and Student’s t test or one-way analysis of variance for continuous variables, with a two-tailed p value less than .05 will be considered significant. Change in use of SCDs (before this study, SCDs were primarily used at this facility on morbidly obese patients, patients receiving magnesium sulfate infusion, and postoperative patients). Application and documentation of application before placement of epidural analgesia. Use of SCDs during second-stage labor and the potential changes to the physical environment. Reduction in use of vasopressors.

Resting heart rate and incidence of venous thromboembolism

Background/ObjectivesHigher resting heart rate is a risk factor for arterial cardiovascular diseases. We assessed whether higher heart rate is a risk factor for venous thromboembolism (VTE). MethodsIn a prospective epidemiologic cohort, the Atherosclerosis Risk in Communities (ARIC) Study, we associated resting heart rate by electrocardiogram with physician‐validated incident hospitalized VTE through 2015. We also examined whether lower heart rate variability (HRV), a marker of cardiac autonomic imbalance, might be a risk factor for VTE. ResultsResting heart rate at Visit 1 (1987‐1989), when participants were 45 to 64 years old (mean, 54 years), was not associated with incidence of VTE (n = 882 cases). However, heart rate at Visit 4 (1996‐1998; mean age, 63 years) was associated positively with VTE (n = 557 cases). The adjusted hazard ratios (95% confidence intervals) of VTE across Visit 4 heart rate categories of <60, 60 to 69, 70 to 79, and ≥80 bpm were 1 (reference), 1.22 (1.01‐1.49), 1.39 (1.09‐1.78), and 1.44 (1.01‐2.06), respectively, and when evaluated continuously 1.11 (1.02‐1.21) per 10 bpm greater heart rate. For the most part, HRV indices were not associated with VTE or associations were explained by inverse correlations of HRV indices with heart rate. ConclusionWe found a significant positive and independent association of resting heart rate at ARIC Visit 4 with incidence of VTE. The reason why high heart rate is a risk marker for VTE warrants further exploration.

The effect of combined spinal epidural versus epidural analgesia on fetal heart rate in laboring patients at risk for uteroplacental insufficiency

Background The effects of neuraxial analgesia on fetal heart tracings have been studied in “healthy” pregnancies. Our objective was to compare the impact of intrapartum epidural analgesia (EA) versus combined spinal epidural analgesia (CSE) on fetal heart rate changes in pregnancies at risk for uteroplacental insufficiency (UPI). Methods Singleton pregnancies diagnosed with chronic hypertension, gestational hypertension and/or preeclampsia, and/or fetal growth restriction (FGR) and receiving neuraxial analgesia intrapartum from 2012 to 2015 were studied retrospectively. The primary outcome was change in fetal heart rate (FHR) category following neuraxial analgesia. Manual review of all FHR tracings was performed and classified by the National Institute of Child Health and Human Development (NICHD) categories. Data collection included maternal demographics, blood pressure, uterine tachysystole, uterine hypertonus, mode of delivery, interventions for FHR abnormalities and neonatal outcomes. Results Of laboring patients at risk for UPI, 110 patients received EA and 127 patients received CSE. The rate and change in FHR categories and abnormalities following neuraxial analgesia were the same in both groups. Both EA and CSE resulted in a significant increase in NICHD FHR category II, from 27.3 to 65.5% for EA and 20.9 to 64.3% for CSE. The occurrence of maternal hypotension, uterine tachysystole, interventions for FHR abnormalities, and uterine hypertonus following neuraxial analgesia was not found to be significantly different between the two groups. When compared to the EA group, CSE had a higher rate of NICU admission (29.5 versus 16.4%, p = .021). Conclusions FHR category increased following both CSE and EA. The side effects of maternal hypotension and need for fetal interventions was not different between CSE and EA.

Abstract P2053: Blood Pressure Variability is Higher When Pulse Rate is Lower, in a Large Outpatient Database

Historically, guidelines for blood pressure measurement recommended adjusting the cuff deflation rate to the patient's heart rate (2-3 mmHg per heartbeat).Current guidelines recommend a fixed cuff deflation rate of 2 mmHg/sec.. In this study, we assess the association between pulse rate (PR) and BP variability. All BP measurements in adult patients with corresponding PR documentation were reviewed in a large outpatient database. In each category (6 categories between 40 and 99 bpm), patients with at least 3 BP readings within that category were included. In each category, systolic and diastolic BP coefficient of variance (corrected for sample size) was plotted against the PR category. There were 551,595 unique patients with a total of 4,760,000 measurements, and 860,522 groups of 3 measurements or more per patient within a PR category. BP normalized coefficient of variance was inversely related to PR (Figure), ranging 0.0043 to 0.0003 (Systolic), and 0.0024 to 0.0002 (Diastolic), for the lowest to highest heart rate category, respectively. BP variability is inversely associated with PR, especially in lower PR, likely reflecting less precise BP measurements where the "sample size" of pulse is small. The observed effect compromising precision might be accompanied by a concomitant reduced accuracy of BP measurement which is another theoretical implication of a smaller "sample size", leading to a systematic bias towards measuring lower and higher than real systolic and diastolic BP respectively.

A Model Practice Template for Hydrotherapy in Labor and Birth.

A Model Practice Template for Hydrotherapy in Labor and Birth.

Induction of labour with retrievable prostaglandin vaginal inserts: outcomes following retrieval due to an intrapartum adverse event.

ObjectiveTo assess adverse event (AE) resolution, delivery mode and neonatal outcomes after misoprostol or dinoprostone vaginal insert (MVI or DVI) retrieval due to AE during induction of labour (IOL).DesignRandomised, double‐blind trial, EXPEDITE.SettingThirty five obstetric departments, USA.PopulationConsisted of 1358 pregnant women with modified Bishop score ≤4 eligible for pharmacological IOL.Methods Post hoc analysis.Main outcome measures AEs prompting insert retrieval, times to AE resolution, delivery, delivery mode and neonatal intensive care unit (NICU) admissions.Results77/678 (11.4%) and 27/680 (4.0%) women had MVI and DVI retrieved due to AE, respectively (P < 0.001). The most common AEs prompting retrieval were uterine tachysystole with fetal heart rate (FHR) involvement and category II/III FHR pattern. Time to AE resolution varied for both treatments depending on the type of AE. For uterine tachysystole with FHR involvement, median resolution times were 1 hour 34.5 minutes (n = 36) and 8.5 minutes (n = 8) for MVI and DVI, respectively. Caesarean delivery occurred in a high proportion of women with insert retrieved due to AE (MVI: 44/77 (57.1%); DVI: 19/27 (70.4%)); the majority of caesareans were performed at least several hours after insert retrieval. Median times from retrieval to any delivery were not increased for women with insert retrieved due to AE. NICU admissions were 8/77 (10.4%) and 1/27 (3.7%) for MVI and DVI, respectively (P = 0.440).Conclusions AEs leading to insert retrieval were primarily uterine tachysystole with FHR involvement and category II/III FHR patterns. Insert retrieval due to an AE did not prolong time to delivery for either prostaglandin insert.Tweetable abstractInduction with prostaglandin vaginal inserts: outcomes following retrieval due to intrapartum adverse event.

Predictive factors for hospitalization of nonurgent patients in the emergency department.

Nonurgent emergency department (ED) patients are a controversial issue in the era of ED overcrowding. However, a substantial number of post-ED hospitalizations were found, which prompted for investigation and strategy management. The objective of this study is to identify risk factors for predicting the subsequent hospitalization of nonurgent emergency patients. This was a retrospective study of a database of adult nontrauma ED visits in a medical center for a period of 12 months from January 2013 to December 2013. Patient triages as either Taiwan Triage and Acuity Scale (TTAS) level 4 or 5 were considered "nonurgent." Basic demographic data, primary and secondary diagnoses, clinical parameters including blood pressure, heart rate, body temperature, and chief complaint category in TTAS were analyzed to determine if correlation exists between potential predictors and hospitalization in nonurgent patients.A total of 16,499 nonurgent patients were included for study. The overall hospitalization rate was 12.47 % (2058/16,499). In the multiple logistic regression model, patients with characteristics of males (odds ratio, OR = 1.37), age more than 65 years old (OR = 1.56), arrival by ambulance (OR = 2.40), heart rate more than 100/min (OR = 1.47), fever (OR = 2.73), and presented with skin swelling/redness (OR = 4.64) were predictors for hospitalization. The area under receiver-operator calibration curve (AUROC) for the prediction model was 0.70. Nonurgent patients might still be admitted for further care especially in male, the elderly, with more secondary diagnoses, abnormal vital signs, and presented with dermatologic complaints. Using the TTAS acuity level to identify patients for diversion away from the ED is unsafe and will lead to inappropriate refusal of care for many patients requiring hospital treatment.

Can a novel scoring system derived from hemodynamic and anthropometric variables predict sympathetic drive in young patients?

Sympathetic overdrive is generally the main pathophysiological abnormality in cardiovascular disease. However, its grading is not easy in clinical practice because of its complex interactions and differences in phenotypical expression. We proposed an easy, feasible, and global scaling system for sympathetic activity level. 'Sympathetic activity index' (SAI) is based on scores of heart rate, BMI, and blood pressure categories, which are the major representatives of sympathetic activity. Respectively, 1, 2, and 3 points were determined for heart rate below 69, 70-89, and above 90 bpm; -1, 1, and 2 points for BMI less than 20, 20-24.9, and at least 25 kg/m; and 1, 2, and 3 points for normal, prehypertension, and hypertension categories. Demographic and echocardiographic parameters, and left ventricular (LV) mass and mass indexes (LVMIBSA and LVMIHeight) of 545 young males were compared among groups with SAI 1-8. We observed that LVM, LVMIBSA, and LVMIHeight, left atrial diameter were significantly increased in association with SAI (P<0.001). SAI was correlated with LVM (R=0.314, P<0.001), LVMIBSA (R=193, P<0.001), and LVMIHeight (R=0.316, P<0.001). SAI of at least 5.5 could determine the left ventricular hypertrophy with a sensitivity and a specificity of 57 and 70%, respectively (AUC=682, 95% confidence interval 0.610-0.753, P<0.001). Integration of clinical, anthropometric, and hemodynamic variables in a novel index such as SAI may provide an objective and noninvasive means of grading actual sympathetic drive. SAI may be used to follow-up sympathetic activity and to predict clinical events in the management of young patients with cardiovascular and metabolic abnormalities.

Risks of parenteral antihypertensive therapy for the treatment of severe maternal hypertension are low

ABSTRACTObjective: To determine whether the incidence of hypotension or adverse fetal heart tracing (FHT) category change differed following antepartum administration of intravenous (IV) labetalol versus hydralazine. Methods: Blood pressure and FHT categories were assessed one hour before and after medication administration. Hypotension was defined as ≥30% reduction in baseline systolic blood pressure (SBP) or SBP <90 mmHg. Changes in mean arterial pressure (MAP) were also compared. The National Institute for Child Health and Human Development (NICHD) three-tier category system was used to describe the FHT. For all category II tracings, Parer and Ikeda’s system was also used. Results: Sixty-nine women received hydralazine and 31 women received labetalol during the study period. The incidence of hypotension (≥30% reduction in SBP) was similar between the labetalol (10%) and hydralazine (11%) groups (p = 0.98). No women experienced post-treatment SBP <90 mmHg. No association was observed between fetal heart rate category change and drug used. No women required emergent delivery for fetal indications. Conclusions: The incidence of maternal hypotension was low and did not differ following antepartum IV labetalol versus hydralazine use. These data should reassure providers about the use of parenteral labetalol and hydralazine for the treatment of severe hypertension.

The 6-min Walk Test Reflects Functional Capacity in Primary Care and Obese Patients.

The main purpose of this study was to determine the association between the 6-min walk test distance (6MWTD) and physical functional capacity (PF) in primary care patients, as well as in obese individuals. We studied 351 subjects (age=56.8±14.6 years; BMI=29.4±5.7 kg/m2; 68% women), including 141 obese subjects (BMI≥30 kg/m2), recruited in 10 different family practices. Physical (PCS) and mental component summary of the health-related quality of life (HRQOL) and the 8 sub-scores were measured using the Short Form-36 Health Survey. Anthropometry, vital signs and physical testing were measured according to standardized protocols. Recreational physical activity (LPA) and sedentary levels were determined using the Canadian Community Health Survey. In a stepwise multivariate analysis, 65% of the 6MWTD variance was explained by PF of the HRQOL, age, quadriceps strength, number of chronic diseases, LPA categories, BMI, resting heart rate, PCS, height and TV-viewing categories in primary care subjects. In the obese individuals, PF, age, quadriceps strength and BMI explained 57% of the 6MWTD variance. In these 2 groups, 44% of the 6MWTD variance is explained by PF only. To conclude, the 6MWTD is strongly associated with PF of the HRQOL. Thus, it adequately reflects physical limitations in daily life activities of primary care patients, including obese individuals.

The 6-min Walk Test Reflects Functional Capacity in Primary Care and Obese Patients.

The main purpose of this study was to determine the association between the 6-min walk test distance (6MWTD) and physical functional capacity (PF) in primary care patients, as well as in obese individuals. We studied 351 subjects (age=56.8±14.6 years; BMI=29.4±5.7 kg/m(2); 68% women), including 141 obese subjects (BMI≥30 kg/m(2)), recruited in 10 different family practices. Physical (PCS) and mental component summary of the health-related quality of life (HRQOL) and the 8 sub-scores were measured using the Short Form-36 Health Survey. Anthropometry, vital signs and physical testing were measured according to standardized protocols. Recreational physical activity (LPA) and sedentary levels were determined using the Canadian Community Health Survey. In a stepwise multivariate analysis, 65% of the 6MWTD variance was explained by PF of the HRQOL, age, quadriceps strength, number of chronic diseases, LPA categories, BMI, resting heart rate, PCS, height and TV-viewing categories in primary care subjects. In the obese individuals, PF, age, quadriceps strength and BMI explained 57% of the 6MWTD variance. In these 2 groups, 44% of the 6MWTD variance is explained by PF only. To conclude, the 6MWTD is strongly associated with PF of the HRQOL. Thus, it adequately reflects physical limitations in daily life activities of primary care patients, including obese individuals.

Incidence of Uterine Tachysystole in Women Induced with Oxytocin

To determine the incidence of uterine tachysystole (UT) using nomenclature defined by the American College of Obstetricians and Gynecologists (ACOG) and Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). Cohort study using retrospective chart reviews and concomitant independent analyses of fetal monitor strips. A 10-bed labor and delivery unit in a community hospital with an average of 400 deliveries monthly. Of 346 total deliveries in October 2009, 55 patients qualified for this study. Inclusion criteria were women with a singleton, viable fetus in vertex presentation and who received oxytocin infusion for induction of labor. We analyzed 798.5 hours of fetal monitor strips in 30-minute increments according to each of four UT criteria. We collected data on the dose of oxytocin, the National Institute of Child Health and Human Development (NICHD) fetal heart rate categories, maternal age, parity, pregnancy risk factors, indication for induction, mode of delivery, birth weight, and Apgar scores. We identified 661 incidences of UT out of 1,597 increments with an overall UT rate of 41%. Fifty-four of 55 patients (98%) demonstrated one or more occurrences of UT. Interrater reliability achieved an 86.3% correlation (718 vs. 698 occurrences). Results of this study highlight the need for careful titration of oxytocin and prompt management of UT. This increased awareness can enhance the health, safety, and well-being of pregnant women and their fetuses.