HF Index Research Articles

Impact of eGFR slope upon mortality in a real world heart failure cohort

Abstract Background Heart failure (HF) frequently causes an imbalance in heart and kidney functions, and the prognosis of heart and kidney disease can worsen one another. In addition to the prognostic role of chronic kidney disease (CKD), dynamic changes in renal function have been recognized to portend a poor prognosis in HF patients. Purpose This study aimed to investigate the prevalence of impaired renal function at HF diagnosis and its association with short and long-term outcomes in a real-world cohort of HF patients. In addition, we assessed how dynamic changes in renal function after HF diagnosis might predict HF prognosis. Methods Using a natural language processing algorithm, clinical data of patients with at least one diagnosis of HF (index event) were retrospectively collected. Patients for which the most recent estimated glomerular filtration rate (eGFR) value prior to the index date was ≤ 60 mL/min/1.73m2 and/or had a documented medical history of CKD (including dialysis) were considered as having CKD. A linear mixed effects model was used to show the longitudinal eGFR trajectories during the follow-up period (after index). A Cox proportional hazard model was used to analyse the association between baseline variables and mortality. Finally, joint modelling was used to combine the linear mixed eGFR sub-model with the survival sub-model, to estimate the effect of the current eGFR value and the eGFR slope of the year prior on mortality. Results The study population consisted of 1992 patients with a mean (±SD) age of 74.8 ± 11.7 years and 58% males. In total, 17% had HF with preserved ejection fraction (HFpEF, n = 339) and 70% (n = 1156) presented CKD at the index event. The median follow-up time was 3.16 years and 13% (n = 198) of the patients were deceased after two years. The group of 2-year survivors had significantly lower proportion of CKD at index (55 vs 76%, p < 0.001). The calculated mean yearly decrease of the eGFR value was 4.2 mL/min/1.73m². The multivariate Cox PH model identified age, CVA, diastolic blood pressure, HDL, and log10proBNP as baseline predictors of mortality. Joint modelling showed that a 10 mL/min/1.73m2 lower current eGFR value amongst patients was associated with an increased mortality hazard of 1.30 ± 0.06 (p < 0.001). Additionally, a decrease of 10 mL/min/1.73m2 in eGFR during the year prior indicated an increased mortality hazard of 1.87 ± 0.19 (p < 0.001). Conclusion In a real-world cohort of HF patients, the prevalence of CKD is high and CKD is an independent predictor of mortality. The current eGFR value and the year prior’s eGFR slope adds additional prognostic information and helps to better fine tune the individual mortality hazard. Based on the findings of this analysis, patients with worse prognosis might benefit from a closer and more vigilant follow-up.

Informal caregivers involvement in heart failure self-care: perceived acceptability and contribution to heart failure self-care from a feasibility quasi-experimental study

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): HES-SO University of Applied Sciences and Arts Western Switzerland, Service d’Aide et de Soins à Domicile de la Sarine, Fribourg Background Heart failure (HF) self-care is recommended to reduce HF hospitalisation and mortality. Informal caregivers play a key role in HF self-care support and contribute to outcomes. Uncertainties remain about the acceptability to include informal caregivers to support self-care in people with HF, as well as informal caregivers’ responsiveness of being exposed to an intervention supporting symptom perception in HF, a specific HF self-care process. Purpose We aimed to test an intervention supporting symptom perception in people with HF including among informal caregivers. Methods We used a quasi-experimental feasibility study with a pre-test post-test design. Informal caregivers and people with HF were exposed to an evidence-informed self-care support intervention targeting symptom perception, delivered by trained homecare nurses during one month at people with HF home. We assessed acceptability of informal caregivers involved in HF self-care support using the Treatment Acceptability and Preferences (TAP) Measure adapted for this study (responses from 1=completely disagree to 5=completely agree). We assessed outcome responsiveness regarding contribution to HF self-care using the Caregiver Contribution to Self-care of HF Index version 2 (CC-SCHFI 2), and caregivers’ burden with the Zarit Burden Interview. We used descriptive statistics and calculated effect sizes using Cohen’s d based on mean absolute change between pre and post intervention. Results Seven informal caregivers (mean age 64.7 years, 6/7 women) were exposed to the intervention. All were spouse or child of the people with HF. Mean acceptability score was 4.28. Informal caregivers’ contribution to HF self-care positively responded after intervention exposure. There was a 10-point increase on the CC-SCHFI 2 symptom monitoring and perception post intervention (mean score 69.1) compared to baseline (mean score 58.9) with a large effect size (Cohen’s d=1.37). Contribution to HF self-care maintenance and management also responded positively to the intervention, respectively from 60 to 63.5 for self-care maintenance (Cohen’s d=0.28) and from 49.3 to 52.5 for self-care management (Cohen’s d=0.17). Caregiver burden slightly increased 2-points post intervention from 18.5 to 20.5 with a low effect size (Cohen’s d=0.14). Mean caregiver burden scored high at baseline before intervention exposure, and informal caregivers reported low burden to participate in the intervention (TAP mean item score 4.4). Conclusion Informal caregivers reported the intervention as highly acceptable. Informal caregiver contribution to symptom monitoring and perception was responsive to the intervention, as well as overall contribution to HF self-care. Caregiver burden should be carefully monitored when involved in HF self-care support interventions. Evaluating the effectiveness of including informal caregivers in HF self-care support and in specific symptom perception is needed.Caregivers outcomes responsiveness

Optimization and trade-off framework for coupled green-grey infrastructure considering environmental performance

Implementing runoff control infrastructure has been regarded as an efficacious measure in stormwater management. The issue of its cost-effectiveness is a primary concern for decision makers since it is an exorbitant investment. However, most of existed studies only concentrated on the cost-effectiveness optimization of runoff control infrastructure, especially green infrastructure, between hydrological and economic aspects, and therefore, the potential layout scenarios with high extra environmental benefits could be neglected in the traditional two-dimensional frameworks. In this study, a novel carbon dioxide equivalent-based index was quantified to represent the extra environmental benefits of runoff control infrastructure besides stormwater management and was further integrated into the assessment framework. The effectiveness of green and grey infrastructure was comprehensively evaluated and traded off between hydrological, environmental and economic aspects. The results demonstrated that grey infrastructure is a better measure than green infrastructure when only hydrological (HF index) and economic (CI index) performances were considered. Nevertheless, the environmental performance (EROI index) of green infrastructure prevails over grey infrastructure, and when optimizing green and grey infrastructure simultaneously in the three-dimensional framework considering environmental effectiveness, green infrastructure is comparable with grey infrastructure. Furthermore, an appropriate composition of coupled green-grey infrastructure is requisite, which could achieve an optimal trade-off between hydrological and environmental effectiveness. The sources of environmental benefits were also identified and analyzed from three representative preference scenarios. The findings of the study could serve as a trade-off basis between green and grey infrastructure, as well as between EROI and HF.

Effect of short-term restricted environment stimulation on perceived stress

stress relief techniques, including the Chamber restricted environment stimulation technique (REST), are becoming increasingly popular in Slovakia. Given this, it is necessary to investigate this method in an experimental setting. According to Urbiš (2012), dark therapy could be a suitable method for people living under constant stress, tension, and difficult living conditions and can also be used as training in coping with stressful situations. The focus of this study was to assess the relationship between a short‑term Chamber REST and perceived stress. Our research sample consisted of 42 participants who participated in a three‑hour stay in the laboratory of REST at Comenius University. Participants were psychology students. The selection of the research sample and length of stay was mainly based on the COVID-19 pandemic virus. The average age of the participants was 25 years (SD = 5.63). In terms of gender, 32 women (76.19%) and 10 men (23.81%) participated in the research. 21 respondents (50%) stated that they had some previous experience (not a one‑time, but repeated) with relaxation techniques. 20 participants (47.62%) had no prior experience. We measured experienced stress using the Perceived Stress Scale (PSS, Cohen et al., 1983) two days before the stay and one week after, and stress and arousal using The Stress Arousal Checklist (SACL, Mackay et al., 1978) before and after stay. The results show that the difference in perceived stress decreased significantly right after short‑term Chamber REST (p = 0.001; W = 556.00) and even one week after the stay (p = 0,016; W=0,932). There were no significant changes in the SDNN parameter before staying in the dark (M = 65.46, SD = 53.79) and after (M = 73.57, SD = 31.14) Wilk’s Lambda = .939, F (1.30) = 1.947, p = .173. No significant changes are also in the rMSSD index before (M = 62.45, SD = 66,42) and after (M = 70.57, SD = 43.80) Wilk’s Lambda = .961, F (1,30) = 1.214, p =.790; neither in HF before (M = 3 307.12, SD = 7 524.92) and after (M = 2 384.77, SD = 2 934.18) Wilk’s Lambda =.995, F (1,30) =.140, p =.711. There was not a significant effect of gender, Wilk’s Lambda =.991, F (1,30) =.283, p =.599 or previous experiences, Wilk’s Lambda = 1.000, F (1,30) =.001, p =.980 on SDNN. We also did not observe a significant effect of gender, Wilk’s Lambda =.996, F (1,30) =.133, p =.717 or previous experiences, Wilk’s Lambda = 1.000, F (1,30) = .014, p = .907 on rMSSD. The same results are in the HF index, with no significant effects of gender, Wilk’s Lambda = 0.985, F (1,30) = .469, p = .499 and previous experiences with relaxation methods Wilk’s Lambda = 1.000, F (1,30) = .000, p = .994. According to our expectations, staying in the dark should reduce the level of stress experienced. The results showed the statistical significance of the difference in the stress using PSS and SACL questionnaires scores before and after dark stay. Participants scored lower after their stay in the dark than before, which is in line with our expectations accord‑ ing to other authors (Malůš et al., 2016; Suedfeld & Borrie, 1999) and highlights the potential of Chamber REST to reduce the level of experienced stress. Based on HRV analysis, we conclude that there was a change in measured HRV indexes, however, the changes were not significant. We observed an increase in heart rate variability (SDNN, RMSSD) indicating an increase in parasympathetic tone, compatible with elevated relaxation. Gender factors and previous experience with relaxation methods have no effect. In conclusion, we found the difference in perceived stress decreased significantly right after short‑term Chamber REST and one week after the stay. An increase in heart rate variability (SDNN, RMSSD) after the stay indicated an increase in parasympathetic tone, however, the changes were not significant. There was no effect of factors of gender and previous experience with relaxation methods.

리듬 점프 트레이닝이 여중생의 체력과 스트레스 및 자율신경계 활성도에 미치는 영향

Objectives The purpose of this study was to analyze the influence of 12-week rhythm jump training on physical fitness, stress and autonomic nervous system activity in middle school girls. Methods The subjects were 45 middle school girls were selected at random and the allocated 15 students each for the rhythm jump training group(RJG), jump training group(JG) and control group(CG) and measured physical fitness, stress and autonomic nervous system activity before and after rhythm jump training. The program of rhythm jump training is implemented for 45 minutes of 3 times each week for 12 weeks. The data obtained from this study were analyzed using the SPSS 20.0 statistical program and two-way repeated ANOVA was used. Results First, physical fitness variables showed an interaction effect on cardiovascular endurance and power, RJG significantly increased in all variables, and JG showed significant increases in cardiovascular endurance and flexibility. Second, the stress variable showed an interactive effect in all variables of cumulative stress index, physical stress, and psychological stress, RJG was significantly improved in all three variables, and JG was significantly improved in cumulative stress index and physical stress. Third, autonomic nervous system activity variables showed an interactive effect in SDNN and HRV index, and RJG significantly increased in HF, SDNN and HRV index, and JG significantly increased in SDNN. Conclusions Jump training had a partial positive effect on physical fitness, stress, and autonomic nervous system activity in middle school girls, and it was confirmed that the effect was greater in the case of rhythm jump training to which rhythm was applied.

Motivational Interviewing improves caregiver self-efficacy in heart failure: a secondary outcome analysis of the MOTIVATE-HF trial

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Center of Excellence for Nursing Scholarship, Rome, Italy. Background Caregiver self-efficacy, which is caregiver confidence in her own abilities to help the patient in performing self-care, directly influences caregiver contribution (CC) to self-care, while acting as a mediator between predictors of CC to self-care and CC to self-care itself. Although caregiver self-efficacy is associated with patient and caregiver outcomes, evidence on interventions aiming to improve this variable, as well as CC to self-care, is scarce. Purpose To evaluate the effect of Motivational Interviewing (MI) on caregiver self-efficacy and CC to self-care in heart failure. Methods Secondary outcome analysis of the MOTIVATE-HF RCT. A total of 235 caregivers and 238 patients completed the study. Participants were recruited from three centres in Italy and randomized into Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), Arm 3 (standard care). The intervention consisted in one face-to-face MI session followed by three telephone contacts delivered to patients (Arm 1) or to patients and caregivers (Arm 2). Caregiver self-efficacy and CC to self-care were assessed with the Caregiver Contribution to Self-Care of HF Index. Data were collected at baseline, before the intervention, and after 3, 6, 9, 12 months from enrolment. Results Among the three arms, caregivers median age was 55 years, they were mainly female (76%), married (72%), spouses (37%), employed (73.5%), with a high school level or higher education (55%), and living with the patients (60%). Patients median age was 74 years, they were mainly male (58%), retired (76%), in NYHA Class II (61.9%). Over the year of the study, caregiver self-efficacy significantly improved in all arms, and was significantly higher in Arm 2 compared to Arm 3 at 9-month follow-up (difference: 8.36, 95% CI (3.13; 13.59), p = 0.002). At 12-month follow-up, caregiver self-efficacy was still higher in Arm 2 compared to Arm 3, but this difference only approached statistical significance (difference: 6.59, 95% CI (-0.41; 13.60), p = 0.064). The longitudinal mixed linear model on self-efficacy, accounting for time, living with the patient, randomization arm and their interaction, confirmed a significantly higher improvement of caregiver self-efficacy in Arm 2 compared to Arm 3 (β ̂ = 1.39, 95% CI (0.02; 2.75), p = 0.046). CC to self-care significantly improved over time in all Arms, but without significant differences among the three Arms. Conclusion Our results show that MI was effective in improving caregiver self-efficacy, but not CC to self-care. This may indicate that MI was able to improve how well caregivers were supporting patients, as showed by improvements in self-efficacy, but not how much they were doing it, as showed by the lack of improvement in CC to self-care. Further studies need to better understand how caregiver self-efficacy affects CC to self-care, how caregiver self-efficacy can be further improved, and the necessary intensity of MI to improve CC to self-care.

A Randomized Controlled Trial of Heart Failure Disease Management in Skilled Nursing Facilities.

Patients discharged from the hospital to a skilled nursing facility (SNF) are not typically part of a heart failure disease management program (HF-DMP). The objective of this study is to determine if an HF-DMP in SNF improves outcomes for patients with HF. Cluster-randomized controlled trial. The trial was conducted in 47 SNFs, and 671 patients were enrolled (329 HF-DMP; 342 to usual care). The HF-DMP included documentation of ejection fraction, symptoms, weights, diet, medication optimization, education, and 7-day visit post SNF discharge. The composite outcome was all-cause hospitalization, emergency department visits, or mortality at 60days. Secondary outcomes included the composite endpoint at 30days, change in the Kansas City Cardiomyopathy Questionnaire and the Self-care of HF Index at 60days. Rehospitalization and mortality rates were calculated as an exploratory outcome. Mean age of the patients was 79 ± 10years, 58% were women, and the mean ejection fraction was 51% ± 16%. At 30 and 60days post SNF admission, the composite endpoint was not significant between DMP (29%) and usual care (32%) at 30days and 60days (43% vs 47%, respectively). The Kansas City Cardiomyopathy Questionnaire significantly improved in the HF-DMP vs usual care for the Physical Limitation (11.3 ± 2.9 vs 20.8 ± 3.6; P= .039) and Social Limitation subscales (6.0 ± 3.1 vs 17.9 ± 3.8; P= .016). Self-care of HF Index was not significant. The total number of events (composite endpoint) totaled 517 (231 in HF-DMP and 286 in usual care). Differences in the 60-day hospitalization rate [mean HF-DMP rate 0.43 (SE 0.03) vs usual care 0.54 (SE 0.05), P= .04] and mortality rate (HF-DMP 5.2% vs usual care 10.8%, P < .001) were significant. The composite endpoint was high for patients with HF in SNF regardless of group. Rehospitalization and mortality rates were reduced by the HF-DMP. HF-DMPs in SNFs may be beneficial to the outcomes of patients with HF. SNFs should consider structured HF-DMPs for their patients.

HF-Index and Y-Index of Some New Graph of Operations

In this paper we derive HF index of some graph operations containing join, Cartesian Product, Corona Product of graphs and compute the Y index of new operations of graphs related to the join of graphs.

Associations between 24-h heart rate variability and aerobic fitness in high-level female soccer players.

The aim of this study was to investigate the changes in 24-h heart rate variability and aerobic fitness, and their associations, in female soccer players during the preseason period. Sixteen players were assessed (24-h HRV and Yo-Yo Intermittent Recovery Test, level 1 [YYIR1]) before and after 4weeks of preseason. The relationship between R-R24h length and high-frequency oscillations (HF24h) was analyzed by a quadratic regression model (revealing or not saturation of vagal activity) assessed 48-h before (PRE-preseason) and 48-h after (POST-preseason) the preseason period. Additionally, the mean HF24h was calculated from the linear portion of the R-R interval versus the HF24h regression curve (HF index). The average of the corresponding R-R24h values was defined as the R-R index. In PRE-preseason, seven players had a saturated HF24h, while in POST-preseason, five new cases of saturated HF24h were observed. The mean R-R24h, HF24h, R-R index, and HF index lengths significantly increased after preseason (p<0.001). Significant differences were found in YYIR1 PRE- compared with POST-preseason (930±286m [individual range: 400-1240m] versus 1265±252m [640-1640m], respectively; p<0.001). Additionally, the relative changes in HF24h and HF index were largely correlated with improvements in the distance covered during the YYIR1 (r=0.68 and r=0.56; respectively). Enhanced vagal activity after 4-week preseason period of soccer training increased the occurrence of vagal saturation in high-level female soccer players. Additionally, the increases in HF24h and HF index were significantly correlated with aerobic fitness change.

Abstract 10062: Administrative Data Algorithms Can Identify Patients with Advanced Heart Failure

Introduction: Advanced or “Stage D” heart failure (Adv HF) patients are at high risk of poor outcomes. However, recognition of Adv HF is limited as diagnostic criteria are complex. Administrative algorithms to identify Adv HF could enable better understanding of who has advanced HF and lead to enhanced therapeutics development, dissemination, and outcomes. Methods: In a population-based cohort of all Olmsted County, Minnesota residents with ≥1 HF billing code 2007-2017 (n=9881), we identified all patients with Adv HF (n=753) by applying the gold standard European Society of Cardiology Adv HF criteria via manual medical review by a HF cardiologist. The Adv HF index date was the date the patient first met all ESC criteria. We then developed candidate algorithms to identify Adv HF using only administrative data (billing codes and HF prescriptions or comorbidities known to affect HF outcomes), applied them to the entire HF cohort and assessed their ability to identify patients with Adv HF on or after their Adv HF index date. Results: A single hospitalization (Hsp) for HF or ventricular arrhythmias (VA, 2007-2017) identified all patients with Adv HF (sensitivity 100%), but the PPV was low (36.4%). Requiring more Hsp, other signs of Adv HF such as hyponatremia, acute kidney injury, hypotension or high-dose diuretic use decreased the sensitivity but improved specificity and PPV. As Adv HF was relatively uncommon, negative predictive values (NPV) were high regardless of algorithm characteristics. Conclusions: Algorithms using administrative data can identify patients with Adv HF with clinically useful accuracy.

Abstract 9906: Not All Heart Failure Patients Are Men, Not All Caregivers Are Women: Comparing Differences by Gender

Background: Male patients with female caregivers are well represented in dyadic HF research. However, patient-caregiver dyads that are all male, all female, or female patients with male caregivers are not well described. Aim: Compare self-care, clinical, and psychosocial characteristics of patient-caregiver dyads based on the genders of dyad members. Methods: Secondary analysis of a cross-sectional study of patient-caregiver dyads (n=277) using the Caregiver Contribution to Self-Care of HF Index (CC-SCHFI) v2. Dyads were grouped by Patient-Caregiver gender: Male patient-Female caregiver, Female patient-Male caregiver, Female-Female, and Male-Male. Self-care was assessed using the Self-Care of Heart Failure Index and the matching CC-SCHFI. Standardized scores for both indexes range from 0-100 points; higher scores equal better self-care. Characteristics of dyad gender groups (comorbidities, HF duration, NYHA functional class, quality of life (QOL), age, marriage, habitation status, and length and type of caregiving relationship) were compared using chi-square, ANOVA and Kruskal-Wallis equality-of-populations rank tests. Results: Female caregivers of male patients were typically spouses (48%), whereas the majority of caregivers in other dyads were adult children/children-in-law (63-73%). Female patients cared for by female caregivers were older, not married and had worse physical QOL. Male and female caregivers of similar gender patients were younger (47.3±14.0 and 47.7±12.1), less likely to live with the patient and spent the fewest number of hours/day caregiving. Patients in these dyads were more likely to live alone and male patients had the lowest self-care monitoring (48.2±20.1 vs 59.2±18.3 for male patients with female caregivers, p =.06). Males caring for female patients had the lowest contribution to self-care maintenance (63.3±20.3, p =.04) and lower contributions to self-care monitoring, management, and self-efficacy. Conclusion: Patient-caregiver dyads of similar and mixed genders differ across a number of self-care, clinical, and psychosocial characteristics. Results suggest that dyad members’ genders may need to be considered in clinical and research practice.

Prognostic value of ST2 biomarkers in hypertonic disease patients on the background of the chronic obstructive pulmonary disease

Introduction. Scientific research by domestic and foreign scientists and many years of clinical experience suggests that in patients with chronic obstructive pulmonary disease (COPD) a combination with arterial hypertension (AH) were often observed. Soluble form of ST2 protein of the patients is involved in certain inflammatory diseases and in the paracrine system of protection of the heart and lungs as marker, that determines the prognosis in patients with heart and lung deficiency and predicts the death of the patient during the year.&#x0D; The purpose of this study was to evaluate the expression of ST2 protein in patients with arterial hypertension on the background of chronic obstructive pulmonary disease.&#x0D; Materials and methods. In 23 patients were diagnosed arterial hypertension stage II and COPD stage II without clinically significant concomitant disease, with an average age 51.72 ± 1.22 years (49.33-54.09) (gender composition: 22 males and 1 female), the smoking status is comparable to COPD patients, 18 patients with AH of both sexes aged from 33 to 67 years (mean age 50.74 ± 1.49 years (47.81-53.76), male / female ratio 17 / 83%), stage II of the arterial hypertension with the level of I-III degree of hypertension, different cardiovascular risk, without adequate systematic antihypertensive therapy and 18 patients with COPD stage II, mean age 50.32 ± 0.99 years (48.22-52.16) (gender composition: 14 males and 4 females), duration of the disease 7.52 ± 1.14 years. 80% of active smokers, the index of bacon-years 17.23 ± 2.69 years, the harmful professional factors (industrial) indicated 23.53%. Participants expressed their willingness to be included in medical research.&#x0D; Research results. The obtained data indicate that the lowest level of expression of ST2 protein was detected in patients with hypertension without concomitant pathology – 21.05 ± 2.12 ng/mL, which is in 11.78% lower than in patients with COPD without concomitant pathology (23,53 ± 1.8 ng/mL). The highest expression ​​of ST2 protein were demonstrated in patients with comorbid pathology group with COPD on the background of AH – 33.01 ± 6.25 ng/mL, which is in 56.82% higher compared with patients with AH, and in 40.29% higher than analogous marker in patients with monopathology in the form of COPD.&#x0D; In the group of COPD patients with a high level of ST2 (more than 30 ng / ml), significantly more negatively controlled negative cardiovascular predictors, such as the presence of left ventricular hypertrophy (χ2 = 7.61 at p = 0.006) and sympathetic balance disturbances according to the LF / HF index (χ2 = 4.72 at p = 0.03) and ST2 elevation was reliably associated not only with extrapulmonary prognostic factors, but also with a decrease in FEV1 of less than 50% (χ2 = 5.45 at p = 0.02).&#x0D; Conclusions. Patients of the experimental group with comorbid pathology AH and COPD had the most significant increasing level of ST2 protein as unfavorable prognosis marker compared to the groups of patients without combination of this pathology.

Heart rate variability: A biomarker of selective response to mindfulness-based treatment versus fluoxetine in generalized anxiety disorder

Background: Mindfulness-based interventions (MBIs) are effective for some, but not all patients with anxiety disorders, but no clinical features have been consistently able to differentiate which patients are more likely to respond. In this study, we tested heart rate variability (HRV), a proposed correlate of regulated emotional response, as a moderator of treatment response to an MBI compared with pharmacotherapy.Methods: Seventy-seven patients with GAD had HRV data collected before randomization to pharmacological treatment with fluoxetine or Body-in-Mind Training (an MBI focused on bodily movement attention). HRV was used to predict treatment response measured by the Hamilton anxiety rating scale at 0 (baseline), 5, and 8 weeks (end of the intervention).Results: The HF (nu) index of HRV was a strong moderator of treatment response between BMT and fluoxetine (estimate = 4.27 95%CI [1.19, 8.19]). Although fluoxetine was overall slightly superior to BMT in this study, no differences were found between groups in patients with high HF (nu) scores (estimate = -1.85 CI95% [-9.21, 5.52]). In contrast, patients with low HF (nu) achieved lower anxiety rating scores with fluoxetine treatment when compared with BMT (estimate = -10.29, 95% CI [-17.59, -2.99]).Limitations: A relatively small sample of patients was included.Conclusions: HRV was able to identify a subgroup for which MBI was less effective than pharmacotherapy and is a promising candidate as a selective biomarker for treatment response between an MBI and fluoxetine.

Heart failure inpatient"s self-care behaviour: mulricenter approach focousing on gender differences

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart failure is often characterized by low exercise capacity and great impairment on performance in activities of daily living. The correct management of the disease can prevent the worsening of symptoms and promote a better quality of life. Self-care behaviour plays an important role on patient"s quality of life. Aim The aims of this study are to evaluate the self-care behaviour in a sample of heart failure inpatients, using the Self-Care Heart Failure Index (SCHFI) and to understand whether gender and patophisiologic characteristics does interfere on it. Methods Cross-sectional multicenter study enrolling 225 heart failure inpatients from eight hospitals. At admission, patient’s functional capacity was evaluated as well as their self-care behaviour, using the SCHFI Portuguese v6.2. Comparison between self-care behaviour with gender was performed. Also some correaltions were perfomed with the total sample of patients, aiming to understand which were the variables that may interfere with the socre of each sub-scale of the self-care HF index. Results Patients’ mean age was 68.4 ± 10.7 years old, 68% were male and 82.3% have reduced ejection fraction. A mean value of 47.9, 35.6 and 38.8 points was found in the SCHFI score of the sections self-care maintenance (SCMt), self-care management (SCMg) and self-care confidence (SCC), respectively. Heart failure inpatients present inadequate levels of self-care behaviour. No difference was found between genders on any section of the SCHFI. Among all variables, only the number of CVRFs and the left ventricular ejection fraction had significant differences. Males had better results, but not with a statistically significant difference. Association tests (ANOVA) between different variables and the score of each section of the SCHFI were perfomred. Only in the NYHA there are variables associated with a better self-care, namely in the SCMg (p = 0.011) and in SCC (p = 0.010). Correlations were made using the numeric variables age, CVRF, BI, LCADL, SCMt, SCMg and SCC, in order to understand the influence of the variables with each other. All the three dimesnions present a positive correlation, at 99% confidence interval between them (SCMt with SCMg: r = 0.365, p &amp;lt; 0.000; SCMt with SCC: r = 0.272, p &amp;lt; 0.000 and SCMg with SCC: r = 0.670, p &amp;lt; 0.000). In addition, SCMt presents a positive correlation with age at a 95% confidence interval (r = 0.158, p = 0.018). Negative correlations were found between 1) BI and age (r=-0.151, p = 0.023), at a 95% confidence interval and 2) BI with LCALD (r=-0.407, p &amp;lt; 0.000), at a 99% confidence interval. Regarding NYHA functional class and left ventricular systolic function, only NYHA class II patients present a statistically significant difference in SCMg and SCC comparing to Class III and IV patients (who do not present differences between them). Conclusion The results do not suggest a relationship between gender and pathophysiological characteristics with self-care behaviour.

РОЛЬ ЭСТРОГЕНОВ В ВЕГЕТАТИВНОЙ РЕГУЛЯЦИИ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ В МЕНОПАУЗЕ

Hot flashes are known to be associated with a variety of cardiovascular risk factors. There is evidence of a close relationship between hot flashes and autonomic dysfunction, while the parameter - heart rate variability (HRV) - is a surrogate marker for assessing the activity of the autonomic nervous system (ANS). However, changes in HRV can be caused by both aging and hormonal changes. The purpose of this work is to consider the role of endogenous estrogens in the autonomic regulation of the cardiovascular system on the model of "acute estrogen deficiency" in cases of total oophorectomy and "partial estrogen deficiency" - in cases of hysterectomy with / without appendages. 44 women were included, mean age - 46.9 ± 2.2 years, whose HRV was assessed before surgery (1 week before surgery) and after (not less than 4 and not more than 5 weeks after surgery). According to the results obtained, there were no statistically significant changes in both temporal and spectral HRV parameters in patients after hysterectomy (p&gt; 0.05). On the contrary, patients with total oophorectomy in the postoperative period showed decreased HRV parameters characterizing the parasympathetic activity of the ANS, namely SDRR, rMSSD, pNN50, HF and the LF index, reflecting both sympathetic and parasympathetic effects on heart rate. Patients with total oophorectomy have a higher ratio of the sympatovagal LF / HF index; the work shows that this fact is most likely due to the predominance of sympathetic nervous influences induced by "acute" withdrawal of ovarian hormones due to the performed volume of surgery, and not as a result of surgery. as such, or its psychological consequences. Thus, according to the above-described results of the study, patients in cases of total oophorectomy showed a decrease in the parameters of vagal HRV in the direction of sympathetic dominance, which may cause an increase in cardiovascular risk.

ELECTRE I-based group decision methodology with risk preferences in an imprecise setting for flexible manufacturing systems

A new hesitant fuzzy set (HFS)-ELECTRE for multi-criteria group decision-making (MCGDM) problems is developed in this paper. In real-world applications, the decision makers (DMs)’ opinions are often hesitant for decision problems; thus, considering the exact data is difficult. To address the issue, the DMs’ judgments can be expressed as linguistic variables that are converted into the HFSs, considered as inputs in the ELECTRE method. Meanwhile, an appropriate tool among the fuzzy sets theory and their extensions is the HFSs since the DMs can assign their judgments for an alternative under the evaluation criteria by some membership degrees under a set to decrease the errors. Introduced hesitant fuzzy ELECTRE (HF-ELECTRE) method is elaborated based on the risk preference of each DM with assigning some degrees. Moreover, the weight of each DM is computed and implemented in the proposed procedure to reduce judgments’ errors. Then, a new discordance HF index is provided. Pair-wise comparisons are used for outranking relations regarding HF information. Finally, the validation and verification of the proposed HF-ELECTRE method are demonstrated in a practical example of FMSs.

Abstract 14322: The Relationship Between Self-care and Health-related Quality Life in Patients With Heart Failure Differs by Age

Background: Although poor self-care is expected to negatively influence health-related quality of life (HRQOL), this relationship is not consistent. The possible reason might be related that older people reconceptualize or change their expectations for HRQOL. Therefore, vigilant monitoring daily symptom status and other self-care activity might not benefit for older patients with HF to improve their HRQOL. Objective: To examine whether the relationship between self-care and HRQOL differs between younger (age &lt;65 years) and older patients (age≥65 years) with HF. Methods: A total of 138 patients were included in this study (60 years, 29% female, 12.3% NYHA functional class III/IV). Patients were asked to complete the Kansas City Cardiomyopathy Questionnaire and the self-care maintenance of the Self-care HF index to measure overall HRQOL and self-care maintenance. To examine the association between self-care maintenance and HRQOL in younger and older patients, two separate linear regressions were performed after controlling for covariates (age, gender, marital status, NYHA functional class, perceived control, and social support). Results: Self-care maintenance and overall HRQOL were not different between younger (n=90) and older patients (n=48). However, self-care maintenance was an independent predictor of overall HRQOL in only older patients, but not their younger counterparts. In older patients, better self-care maintenance was associated with poorer overall HRQOL (β=-0.37, p=0.03). Conclusions: We found that the relationship between self-care and HRQOL is different between younger and older patients with HF. This finding indicates that improving self-care alone does not necessarily improve HRQOL in older patients so that interventions aimed to enhance HRQOL in older patients need to include strategies considering older patients’ conceptualization for HRQOL.

Abstract 13361: How Does Depression Influence Symptom Perception in Patients With Heart Failure?

Despite the high prevalence of depression in HF, little is known about how depression affects symptom perception processes of monitoring, detection, and evaluation. If depression impairs symptom perception, it may delay care-seeking. Aim: To explore how depression influences HF symptom perception. Methods: We enrolled a purposive sample of patients with an unplanned HF hospitalization in this convergent mixed-methods study. Semi-structured in-person interviews were used to explore how patients monitored, detected, and evaluated symptoms prior to hospitalization. HF symptom monitoring, physical symptom presence/severity, and symptom evaluation were measured using the Self-care HF Index, the HF Somatic Perception Scale, and the Illness Perception Scale, respectively. Depression was measured using the Patient Health Questionnaire (PHQ8); score≥10 indicates moderate/severe depression. Qualitative data were analyzed using content analysis to yield categories of symptom type, detection time, and barriers/facilitators for symptom monitoring, detection, and evaluation. To integrate the data, qualitative data were quantified by assigning binary values (e.g. immediacy of symptom detection). Pearson’s correlation and Chi 2 were used to analyze associations. Results: A sample of 40 patients (age 62±13 years, 50% female, 55% White, median HF duration 6 years, 75% NYHA III-IV, 58% PHQ8≥10) was enrolled. There was no significant association between depression and HF symptom monitoring, but moderate/severe depression was described as a barrier to symptom monitoring ("When I get into my depression days, I won't get on the scale, or I just won't do anything."). Depressed patients appeared to detect symptoms more rapidly (p=0.051). More depressed patients reported greater physical symptom severity (r=0.44, p=0.005), but the number of symptoms was not associated with depression. More depressed patients had stronger belief in negative consequences of HF (r=0.46, p=0.003), more negative emotional responses to HF (r=0.60, p&lt;0.001), and less perceived control over HF (r= -0.35, p=0.028). Conclusion: Depressed patients may have difficulties in symptom monitoring, but not in symptom detection. Depression negatively influences symptom evaluation.

Abstract 13344: Do Heart Failure Patients’ Personal Priorities Influence Their Self-care Maintenance Behaviors?

Introduction: The personal priorities of community dwelling patients with HF may influence their self-care behavior. However, clinicians are unsure of the personal priorities that influence self-care choices in patients with HF. Objective: To explore personal priorities ranked highest among HF patients with poor or excellent self-care behaviors. Methods: We conducted a cross sectional convergent mixed methods study of community dwelling patients with HF in the US, excluding those with significant cognitive impairment (MoCA score ≤22). All completed the Self-Care of HF Index v7.2 (scores standardized 0-100). Extreme case sampling was used to select people with poor self-care maintenance scores (≤60) or excellent self-care maintenance scores (≥80). In interviews, participants placed their personal and healthcare needs into the same imaginary bucket and then rank-order them from highest to lowest priority. Interview data was audio-recorded, transcribed verbatim and analysed using qualitative inductive analysis. Results: We enrolled 33 patients with HF (aged 42-82 years, 57% male, 45.5% black, 45.5% married, 54.6% unemployed). Sixteen patients were poor in self-care maintenance and 17 were excellent. Two themes representing HF patients’ personal priorities emerged: a) Healthcare (60.6%, N=20), and b) Family and Housing (36.4%, N=12). Patients who chose healthcare identified medications, insurance and living a longer life as important. As stated by one patient, “without your health you have nothing.” Patients who chose family and housing identified; 1) rent, mortgage, or real estate taxes and 2) food for their children and a roof over their head as most important. They explained by saying “ I have to have some place to live and the utilities ” and “ I can be in a card box, but I just wanna make sure they are fed .” Of those who chose healthcare as their priority, 12 (60%) had excellent self-care maintenance. Only 4 patients (33.3%) who chose family and housing had excellent self-care. Conclusion: HF patients who identify healthcare needs as their highest priority may be better at self-care maintenance. Identifying the priorities of patients with HF will help clinicians tailor discharge instructions.

Characteristics and Outcomes of a Real-world Population with Heart Failure with Reduced Ejection Fraction Representative of Clinical Trial Patients

Introduction Heart failure with reduced ejection fraction (HFrEF) incurs significant mortality, morbidity and cost. Despite recent advances, opportunities for therapeutic improvement remains. Omecamtiv mecarbil (OM) is a first-in-class cardiac myotrope currently in a phase-3 clinical trial (GALACTIC-HF) for HFrEF treatment. Given known differences between real world (RW) and clinical trial populations, we sought to characterize RW patients who might benefit from OM. Methods In the Vanderbilt University Medical Center de-identified electronic health record of in- and outpatients (Synthetic Derivative) from 2006-2019, we created two RW cohorts of HFrEF patients: 1) Based on the validated eMERGE Network phenotype of HFrEF (left ventricular ejection fraction (LVEF) ≤ 40%; ‘clinical cohort’) and 2) Mirroring eligibility criteria of the GALACTIC-HF trial (LVEF ≤ 35%; ‘GALACTIC-HF-like cohort’) including hospitalizations, medications and laboratory values. Diagnosis and procedure codes, structured and unstructured problem lists, laboratory values, and medications were used to characterize demographics, clinical characteristics and outcomes. HF hospitalization rates were calculated from 5 days post HF index date to last encounter or death. Results The clinical cohort included 3,955 HFrEF patients and the GALACTIC-HF-like cohort included 1,541 (median age at index date 65 and 61 years, respectively), both approximately 67% male and 80% white. Aside from higher median BNP level in the GALACTIC-HF-like cohort, clinical characteristics such as blood pressure and heart rate of the two cohorts were similar. (Table). Comorbidities and utilization of cardiac devices were somewhat higher in the GALACTIC-HF-like cohort including chronic kidney disease (39 v 30%), atrial fibrillation (52 v 48%), and cardiac resynchronization or implantable cardioverter defibrillator (52 v 40%). HF hospitalization rate (per 1000py) was 242 (95% CI 203, 280) in the clinical and 396 (95% CI 350, 442) in the GALACTIC-HF like cohorts during median follow up of 2.7 and 4.1 years, respectively. Conclusions Approximately 40% of RW HFrEF patients met GALACTIC-HF trial criteria, suggesting that RW HFrEF populations may benefit from new therapies such as OM. The higher prevalence of comorbidities and higher rate of HF hospitalization in the GALACTIC-HF-like cohort may indicate a high-need, high-risk population that may achieve better clinical outcomes with OM.