Poor Functional Capacity Research Articles

Invasive haemodynamic assessment shows the obesity-HFpEF phenotype is common amongst patients with symptomatic AF

Abstract Background The obesity-HFpEF phenotype is a unique form of heart failure associated with elevated LA and RA pressures, cardiac remodelling and poor exercise capacity. The influence of this HFpEF phenotype amongst patients with AF is unknown. Objective We sought to determine the influence of the obesity-HFpEF phenotype amongst patients with symptomatic AF, using invasive testing, imaging and cardiopulmonary exercise testing to assess haemodynamics, cardiac remodelling and exercise capacity in patients undergoing AF ablation. Methods Consecutive patients with symptomatic AF due to undergo an AF ablation procedure were recruited. Participants were grouped according to the presence of obesity if body mass index (BMI) exceeded 30kg/m2. Mean LA pressure (mLAP) and mean RA pressure (mRAP) were measured invasively at AF ablation and HFpEF was defined as mLAP>15mmHg at rest or after infusion of 500mls saline. Cardiac remodelling was assessed using transthoracic echocardiography. Exercise capacity was evaluated using cardiopulmonary exercise testing and AF symptoms and quality of life were assessed using the AF Symptom Severity Questionnaire. Results Of 120 participants, 44 (36.7%) were obese and 76 (63.3%) were non-obese (Table 1). Despite younger age (p=0.003), obese participants were more likely to have a coexistent diagnosis of HFpEF (84.1% vs 67.1%, p=0.043). In addition to higher mLAP (p<0.001), obesity was associated with higher mRAP (p<0.001) compared to non-obese patients. Obesity was not associated with differences in LV volume (p=0.559) or function (p=0.381) but was associated with larger LA volumes (p=0.032). On functional assessment, obese participants demonstrated a higher burden of AF symptoms (p=0.049), poorer quality of life (p=0.017) and a trend towards reduced exercise capacity (p=0.068). Conclusion Obese patients with AF demonstrate characteristic features of the obesity-HFpEF phenotype, including elevated LA and RA pressure, left atrial enlargement and poorer functional capacity. Novel treatments for the obesity-HFpEF phenotype, such as GLP-1 inhibitors, may be useful in obese patients with AF.

Mindfulness-Based Asmaul Husna and changes in general adaptive function response among schizophrenia: A Quasi-experimental study

Background. Poor functional capacity is one of the factors that increase the risk of recurrence of positive and negative symptoms in schizophrenia. Mindfulness is a treatment potentially help patients become fully accepting of their conditions and conscious of it, allowing them to regulate unpleasant emotions and increase awareness of positive emotions. Methods. This study aimed to investigate effect of mindfulness-based Asmaul Husna on the overall adaptive functioning of individuals with schizophrenia. This quasi-experiment times series study involved 36 participants selected with simple random sampling. The inclusion criteria of participants were adult Muslim with schizophrenia who had a PANSS-EC score <10, mild symptoms, risk of violent behavior. Participants with severe symptoms and complications from other diseases were excluded. Mindfulness-based Asmaul Husna consisted of Musyahadah-witnessing, tassawur-imagination, tafakkur-contemplation, tadabbur-reflection, and muhasabah-self-introspection was given to each participant over five days. A modified-Global Assessment Functioning (m-GAF) scale used to measure participants' general adaptive functional responses before and after intervention including follow-up at the first and second month after the intervention. Results. There was a significant increase of the m-GAF score (p < 0.001) and a chi-square value of 177.2 after the implementation of mindfulness-based Asmaul Husna intervention. The highest mean score difference was observed at the first and second follow-ups, conducted one and two months after the interventions. The effect size calculated using Kendall’s Wa indicates a significant effect (0.821). Conclusion. The study suggests there is a positive effect of the mindfulness-based Asmaul Husna intervention on adaptive functioning of people with schizophrenia.

Genetic variants in the TNF pathway impact TNFi response in a mixed population with rheumatoid arthritis

Rheumatoid arthritis (RA) is a multifactorial autoimmune inflammatory disease that mainly affects the joints, on reducing functional capacity and impacting quality of life. Cytokines such as tumor necrosis factor (TNF) and interleukin 6 (IL-6) are crucial in the pathogenesis and treatment of this disease. Some patients using TNF inhibitors (TNFi) do not respond or lose their response to these medications. Clinical, sociodemographic, and genetic data were used to evaluate the associations of single nucleotide polymorphisms (SNP) in TNF, TNFRSF1A, and TNFRSF1B genes with the diagnosis of RA, standardized score results, laboratory tests, and response to TNFi. In one subsample, TNF and IL-6 serum levels cytokines were performed. A total of 654 subjects (360 healthy controls and 294 diagnosed with RA) were included in the analysis. Higher levels of TNF have been found in individuals diagnosed with RA. IL-6 levels were higher in individuals who did not respond to TNFi treatment, while responders had levels comparable to those without the disease. No associations were found between the SNPs studied and the diagnosis of RA; however, rs767455-C seems to play a role in the response to golimumab treatment, being related to better therapeutic response and lower mean serum leukocyte levels. In addition, rs1061622-G was associated with poorer functional capacity and rs1800629-A was associated with higher leukocyte values and serum transaminase levels. The rs1061622-G and rs767455-C may play a role in the response to TNFi treatment, especially for patients using golimumab, although they do not seem to be associated with the diagnosis of RA. Polymosphisms in the TNF pathway may impact baseline levels of immune cells and markers of renal and hepatic function in RA patients. Our results highlight the importance of evaluating the impact of these polymorphisms on TNFi response and safety, particularly in larger-scale studies.

Short- and Mid-Term Outcomes of Early Alcohol Septal Ablation Therapy for Patients with Mildly Symptomatic Hypertrophic Obstructive Cardiomyopathy: A Tertiary Center Experience.

Background: Left ventricular outflow tract obstruction (LVOTO) impairs survival and diminishes quality of life in patients with hypertrophic obstructive cardiomyopathy (HOCM). In this study, we aimed to investigate the safety and the efficacy of earlier alcohol septal ablation (ASA) in patients with HOCM. Methods: A total of 47 patients with mildly symptomatic HOCM (NYHA II) and having poor functional capacity despite maximal tolerated medical therapy were included. Results: The mean age of the patients was 55 ± 14, and 57% of the patients were male. All clinical endpoint targets including 30 d mortality (1% vs. 0% p < 0.01), 30 d adverse complications (10% vs. 0% p < 0.01), 30 d complete heart block resulting in need for permanent pacemaker (10% vs. 4.2% p < 0.01), more than moderate residual mitral regurgitation (5% vs. 2.1% p < 0.01), repeat procedure rate (10% vs. 4.2% p < 0.01), improvement of (NYHA) class (90% vs. 95.7% p < 0.01), rest and provoked (LVOT) gradient < 50 mmHg (90% vs. 97.8% p < 0.01) were significantly reached. Conclusions: In patients with mildly symptomatic HOCM (NYHA II), earlier ASA may be performed as an effective and safe procedure in experienced centers.

Fully magnetically centrifugal left ventricular assist device and long-term outcomes: the ELEVATE registry.

HeartMate 3 (HM3) is a fully magnetically levitated continuous flow left ventricular assist device, which received CE marking in 2015. The ELEVATE Registry was initiated to collect real-world outcomes in patients treated with HM3 post-CE Mark approval. A total of 540 subjects implanted at 26 centres between March 2015 and February 2017 were included in this registry. Of these, 463 received the device as a primary implant (primary implant cohort, PIC), 19 as a pump exchange (pump exchange cohort), and in 58 patients, only anonymized survival data were collected (anonymized cohort, AC). Patients in the PIC contributed to the baseline demographics, survival, adverse events, quality of life (QoL) (EuroQoL-5 Dimensions-5 Levels visual analogue scale), and functional capacity (6 min walk distance) assessments, while patients in the AC contributed only to survival. Primary implant cohort patients had a mean age of 56 years and were predominantly male (89%) with 48% ischaemic aetiology. The majority of subjects was designated bridge to transplant (66%) and had INTERMACS Profiles 1-3 (70%). At baseline, the subjects had poor functional capacity (104 ± 140 m) and impaired QoL (35 ± 19 points). The overall survival rate of the PIC was 63.3% and survival free of stroke was 58.1% at 5 years. Significant improvements in functional capacity and QoL were observed and maintained for 5 years (301 ± 131 m and 64 ± 20 points, respectively). Real-world data from the ELEVATE registry demonstrate an overall survival rate for primary implants of 63.3%. In the PIC, reductions in adverse events for patients in the extended follow-up and improved QoL and functional capacity were observed at 5 years in this patient population with advanced heart failure.

Abstract 17131: Association of Objectively Measured Sleep With 6-minute Walk Distance in Older Adults

Background: Decline in physical function in older adults is associated with higher risk of cardiovascular diseases. While disturbances in sleep may contribute to declines in physical function with aging, prior research is limited by the use of subjective sleep measures. Hypothesis: Older adults with sleep disturbance will have impaired functional capacity measured via 6-minute walk test. Aim: This study aimed to examine the association between objectively measured sleep parameters and 6-minute walk distance (6MWD), a marker of functional capacity, in a diverse sample of older adults aged ≥55 years. Methods: This analysis included 96 participants who were enrolled in the Disparities in Sleep and Cognitive Outcomes (DISCO) study, a prospective cohort study of older adults with objective measurement of sleep and functional capacity. Sleep duration (minutes), efficiency (%), and fragmentation (%) were measured using 7 days-wrist actigraphy. Sleep stages including non-REM stage 3 (N3) duration (minutes) and REM duration (minutes) were measured using an overnight home sleep monitor. Total distance (meters) completed in 6-minutes was the primary outcome. Covariates included age, sex, race, ethnicity, body mass index, smoking status, and pain/ inflammation. Linear regression models were used for analysis. Results: Mean age of participants was 69.1 ± 5.4 years (range 56-82 years), 69.8% were women, 72% were White and 97% were Non-Hispanic/Latino. The average 6MWD was 495.6 ± 87 meters. Sleep duration, N3 duration, and REM duration were not statistically associated with total distance walked. In the fully adjusted models, higher sleep efficiency was associated with higher total 6MWD (p&lt;0.001), and greater sleep fragmentation was associated with lower total 6MWD (p=0.016) (see Table 1). Conclusions: Less favorable sleep quality, as indicated by lower sleep efficiency and more fragmented sleep, was associated with poorer functional capacity in older adults.

Congestive Heart Failure in the Light of Ancient Wisdom of Unani Medicine: A Review

Congestive heart failure is a complex clinical syndrome that causes functional impairment of ventricular filling and ejection of blood. It can cause dyspnea, fatigue, and fluid retention, affecting exercise tolerance and causing pulmonary and peripheral edema. Moreover, it is a burgeoning and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. Worldwide congestive heart failure affects more than 64 million people. Nowadays: congestive heart failure is correlated with Suqūṭ-e-Qalb Imtilāʼī, by modern Unani physicians. However, the disease is mentioned in classical Unani literature under the headings of Ikhtilāj-e-qalbi (arrhythmia), Rabw (cardiac asthma), Buhr (cardiac asthma), Khafaqān (palpitation), Istisqā’ Laḥmī (anasarca), Du‘f al-Qalb (weakness of heart), Intiṣāb al-Nafas (orthopnoea), Sudda-e-Urooq-e-Qalb (coronary artery obstruction), Ghashī (syncope), Tasallub-al- Sharāyīn (arteriosclerosis) and Imtilā’ bi Hasbil Aw’iya (congestion of blood vessels). Congestive heart failure and mortality are on the rise despite the significant advancements in contemporary medicine and guidelines directed medical therapy for congestive heart failure. Congestive heart failure hospitalizations make up 1-2% of Western hospital admissions, with the highest 30-day readmission rate (20-25%) in congestive heart failure patients reflecting due to high comorbidity burden. Unani drugs, despite advancements in modern medicine, still significantly impact patient health. They are traditionally used for cardiac ailments like palpitations, coronary artery disease, heart weakness, and cardiotonic. Unani medicine especially Khamīrajat (fermented confections) used in various cardiac diseases is cardio-protective and cardiotonic. According to reports, complementary and alternative medicine is used by up to 61% of cardiac patients with coronary artery disease and those at risk for arteriosclerosis. Therefore, a thorough evaluation of the Unani literature on cardiac illness and its treatment in the Unani system of medicine is needed to decrease congestive heart failure social and economic burdens have become a major global public health priority. This review is an effort to summarize the Unani classical literature on congestive heart failure.

Cholecystitis in older patients following hip fracture: a case series and literature review

ObjectiveThis study’s aim is to describe the characteristics of perioperative acute cholecystitis in older patients with hip fracture.MethodsFrom January 1, 2018, to April 30, 2023, 7,746 medical records were retrospectively collected for patients aged ≥ 65 years who were hospitalised for hip fracture in Beijing Jishuitan Hospital, Capital Medical University. We reviewed 10 cases with confirmed diagnoses of acute cholecystitis.ResultsOf these 10 cases, five femoral neck fractures and five intertrochanteric fractures received orthopaedic surgery. The ratio of males to females was 2:8, the median age was 83.1 years (71–91 years), and there was a median BMI of 25.35 (15.56–35.16). 50% of cases had a poor functional capacity before fracture of below four metabolic equivalents. The median onset time of acute cholecystitis was five days (2–14 days) after fracture, including five cases before orthopaedic surgery and five cases after orthopaedic surgery. All patients had anorexia and fever during the course of the disease. In seven cases of calculous cholecystitis, two underwent percutaneous transhepatic biliary drainage, and one underwent percutaneous cholecystostomy. Two cases of calculous cholecystitis had poor prognosis; one died 49 days after fracture operation, and the reason for death was multiple organ failure caused by severe infection. The other one developed acute cerebellar infarction after gallbladder surgery through treatment in an intensive care unit and neurology department. The case was discharged with dysphasia, and the duration from fracture to discharge was 92 days.ConclusionThis is the first study on the characteristics of acute cholecystitis in older patients with hip fracture in China. The incidence of acute cholecystitis in our study was 0.13%, with a high risk of in-hospital mortality and elevated hospitalisation costs. Our 10 cases with hip fractures accompanied by acute cholecystitis have common characteristics of poor-to-moderate functional capacity before fracture, increased blood glucose levels and enhanced protein metabolism after fracture. The death and the severe case have similar characteristics of low BMI, multiple underlying diseases, high plasma osmotic pressure and calculous cholecystitis, which occurred after orthopaedic surgery. These issues require attention and prompt, active intervention. Related issues require further research.

The effect of perioperative cardiac risk factors on postoperative outcomes in the elderly patients undergoing hip replacement surgery

Purpose: Cardiac risk factors are among the most important determinants of postoperative outcomes in elderly surgical patients. This study aimed to determine the effect of perioperative cardiac risk factors on postoperative adverse outcomes in elderly patients undergoing total hip replacement surgery.&#x0D; Materials and Methods: Patients aged 65 and older who underwent total hip replacement surgery at Cukurova University Hospital between 2014 and 2019 were analyzed retrospectively. The primary outcome measures were postoperative adverse outcomes and mortality rate.&#x0D; Results: Two hundred twenty-three patients with total hip replacement surgery within five years of experience in our hospital were screened. 34.5% had postoperative cardiac, pulmonary, cerebral, and infectious morbidity and systemic inflammatory response syndrome, and the in-hospital mortality rate was 2.2%. On multivariate analysis, perioperative risk factors associated with postoperative adverse outcomes included American Society of Anesthesiologists (ASA) II physical status (aOR 5.63, 95% CI 1.75-18.11), preoperative poor functional capacity (aOR 9.50, 95% CI 3.14-28.79), traumatic fracture (aOR 2.75, 95% CI 1.22-6.24), preoperative anemia (aOR 2.15, 95% CI 1.05-4.37), and prolonged surgery (aOR 1.02, 95% CI 1.01-1.02).&#x0D; Conclusion: A significant relationship was determined between preoperative poor functional capacity, pre-existing anemia, traumatic hip fracture, ASA II physical status, prolonged case duration and the risk of postoperative complications in elderly patients undergoing total hip replacement surgery.

Sex-related differences in functional capacity and its implications in risk stratification before major non-cardiac surgery: a post hoc analysis of the international METS study

Poor functional capacity has been identified as an important modifiable risk factor for postoperative complications. Cardiopulmonary exercise testing (CPET) provides objective parameters of functional capacity (e.g., oxygen consumption at peak exercise, peak VO2), with significant prognostication for postoperative complications. However, sex-specific thresholds for functional capacity to predict surgical risk are yet to be established. Therefore, we performed a post hoc analysis of the international, multicentre, prospective observational METS (Measurement of Exercise Tolerance before Surgery) study to evaluate if sex-specific thresholds of peak VO2 improve risk prediction of postoperative complications. We undertook a post hoc analysis (HREC/71824/PMCC) of the METS study, which was performed between March 2013 and March 2016. We investigated whether sex-specific differences exist for CPET-derived parameters and associated thresholds for predicting postoperative complications in this large cohort of patients that had major non-cardiac surgery (n=1266). Logistic regression models were analyzed for the association of low peak VO2 with moderate-to-severe in-hospital postoperative complications. Optimal sex-specific peak VO2 thresholds were obtained by maximizing the Youden index of receiver operating characteristic (ROC) curves. Finally, multivariable logistic regression models tested the resulting sex-specific thresholds against the established non-sex-specific peak VO2 threshold (14mLkg-1 min-1) adjusted for clinically relevant features such as comorbidities and surgical complexity. Models were evaluated by bootstrapping optimism-corrected area under the ROC curve and the net reclassification improvement index (NRI). Female patients (n=480) had a lower mean (SD) peak VO2 than males (16.7 (4.9) mL kg-1 min-1 versus 21.2 (6.5) mL kg-1 min-1, p<0.001) and a lower postoperative complication rate (10.4% versus 15.3%; p=0.018) than males (n=786). The optimal peak VO2 threshold for predicting postoperative complications was 12.4mLkg-1 min-1 for females and 22.3mLkg-1 min-1 for males, respectively. In the multivariable regression model, low non-sex-specific peak VO2 did not independently predict postoperative complications. In contrast, low sex-specific peak VO2 was an independent predictor of postoperative complications (OR 2.29; 95% CI: 1.60, 3.30; p<0.001). The optimism-corrected AUC-ROC of the sex-specific model was higher compared with the non-sex-specific model (0.73 versus 0.7; DeLong's test: p=0.021). The sex-specific model classified 39% of the patients more correctly than the baseline model (NRI=0.39; 95% CI: 0.24, 0.55). In contrast, the non-sex-specific model only classified 9% of the patients more correctly when compared against the baseline model (NRI=0.09; 95% CI:-0.04, 0.22). Our data report sex-specific differences in preoperative CPET-derived functional capacity parameters. Sex-specific peak VO2 thresholds identify patients at increased risk for postoperative complications with a higher discriminatory ability than a sex-unspecific threshold. As such, sex-specific threshold values should be considered in preoperative CPET to potentially improve risk stratification and to guide surgical decision-making, including eligibility for surgery, preoperative optimization strategies (prehabilitation) or seeking non-surgical options. There was no funding for the present study. The original METS study was funded by Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research, Innovation and Science, UK National Institute of Academic Anaesthesia, UK Clinical Research Collaboration, Australian and New Zealand College of Anaesthetists, and Monash University.

The effect of lower limb osteoarthritis on work-related outcomes: a systematic review and meta-analysis

Purpose Lower limb osteoarthritis (OA) is a prevalent condition that has a profound impact on an individual’s life in several domains, including occupational activities. The objective of this study was to systematically describe and compare work-related outcomes (e.g., employment status, absenteeism, and productivity loss) in individuals with and without lower limb OA. Materials and methods Five databases were searched until 17 June 2023. Studies were eligible for inclusion if they compared work-related outcomes between individuals with lower limb OA and healthy controls (e.g., people without OA or the general population). Results Seven studies met the inclusion criteria of which two were included in a meta-analysis. Meta-analysis revealed that individuals with OA were less frequently in paid employment than control individuals (odds ratio: 0.25; 95% confidence intervals: 0.12, 0.53). Evidence from single studies indicated greater absenteeism and presenteeism and poorer functional capacity in people with lower limb OA compared to controls. Conclusions This systematic review suggests that individuals with lower limb OA have poorer work-related outcomes than those without OA. Low study numbers and lack of consistency in the way work outcomes are defined and measured make accurate quantification of the impact of OA on work challenging. Prospero: registration number: CRD42020178820.

The ABC of Heart Transplantation-Part 1: Indication, Eligibility, Donor Selection, and Surgical Technique.

Cardiac transplantation represents the gold standard of treatment for selected patients with advanced heart failure who have poor functional capacity and prognosis despite guideline-directed medical therapy and device-based therapy. Proper patient selection and appropriate referral of patients to centers for the treatment of advanced heart failure are the first but decisive steps for screening patients eligible for cardiac transplantation. The eligibility and the decision to list for cardiac transplantation, even for patients with relative contraindications, are based on a multidisciplinary evaluation of a transplant team. This review will discuss the practical indications, the process of patient eligibility for cardiac transplantation, the principle of donor selection, as well as the surgical technique.

Psychological Distress After Inpatient Noncardiac Surgery: A Secondary Analysis of the Measurement of Exercise Tolerance Before Surgery Prospective Cohort Study.

To describe the incidence and natural progression of psychological distress after major surgery. The recovery process after surgery imposes physical and mental burdens that put patients at risk of psychological distress. Understanding the natural course of psychological distress after surgery is critical to supporting the timely and tailored management of high-risk individuals. We conducted a secondary analysis of the "Measurement of Exercise Tolerance before Surgery" multicentre cohort study (Canada, Australia, New Zealand, and the UK). Measurement of Exercise Tolerance before Surgery recruited adult participants (≥40 years) undergoing elective inpatient noncardiac surgery and followed them for 1 year. The primary outcome was the severity of psychological distress measured using the anxiety-depression item of EQ-5D-3L. We used cumulative link mixed models to characterize the time trajectory of psychological distress among relevant patient subgroups. We also explored potential predictors of severe and/or worsened psychological distress at 1 year using multivariable logistic regression models. Of 1546 participants, moderate-to-severe psychological distress was reported by 32.6% of participants before surgery, 27.3% at 30 days after surgery, and 26.2% at 1 year after surgery. Psychological distress appeared to improve over time among females [odds ratio (OR): 0.80, 95% CI: 0.65-0.95] and patients undergoing orthopedic procedures (OR: 0.73, 95% CI: 0.55-0.91), but not among males (OR: 0.87, 95% CI: 0.87-1.07) or patients undergoing nonorthopedic procedures (OR: 0.95, 95% CI: 0.87-1.04). Among the average middle-aged adult, there were no time-related changes (OR: 0.94, 97% CI: 0.75-1.13), whereas the young-old (OR: 0.89, 95% CI: 0.79-0.99) and middle-old (OR: 0.87, 95% CI: 0.73-1.01) had small improvements. Predictors of severe and/or worsened psychological distress at 1 year were younger age, poor self-reported functional capacity, smoking history, and undergoing open surgery. One-third of adults experience moderate to severe psychological distress before major elective noncardiac surgery. This distress tends to persist or worsen over time among select patient subgroups.

Timing of aneurysm treatment in subarachnoid hemorrhage and grade of functional capacity at discharge: a retrospective cohort study

BackgroundAneurysmal subarachnoid hemorrhage (SAH) is a vascular pathology with high morbidity and mortality that requires timely management to reduce the risk of complications. However, the ideal time for aneurysm clipping is still controversial. This study aimed to compare the degree of functional capacity at discharge of patients who underwent surgery for rupture of a cerebral aneurysm at different periods of time until surgery.Results132 patients who underwent surgery for SAH due to aneurysm rupture were included. The mean age was 52.5 years and 69.7% of participants were female. At admission, 96.2% were given a score of 1–3 on the World Federation of Neurological Surgeons scale and 79.6% received a score of 1–2 on the Hunt Hess scale. 8.3% of cases underwent surgery within the first 3 days of bleeding. The average time from clinical manifestation to surgical intervention was 7.1 days. At discharge 77.27% of patients presented good functional capacity. After adjusting for confounders, multivariate analysis showed a trend towards increased, albeit not statistically significant, risk in patients undergoing surgery at between 4 and 10 days (RR = 2.95 95% CI 0.80–10.87) and at > 10 days after SAH (RR = 2.65. 95% CI 0.72–9.79).ConclusionsDespite the trend towards a higher probability of presenting poor functional capacity at discharge in patients undergoing aneurysm clipping more than 3 days after SAH, the differences were not statistically significant. There is a need for prospective randomized studies evaluating the best time to clip aneurysms, since aneurysm clipping is still a routine procedure in many countries.

Stair-Climbing Tests or Self-Reported Functional Capacity for Preoperative Pulmonary Risk Assessment in Patients with Known or Suspected COPD-A Prospective Observational Study.

This prospective study aims to determine whether preoperative stair-climbing tests (SCT) predict postoperative pulmonary complications (PPC) better than self-reported poor functional capacity (SRPFC) in patients with known or suspected COPD. A total of 320 patients undergoing scheduled for major non-cardiac surgery, 240 with verified COPD and 80 with GOLD key indicators but disproved COPD, underwent preoperative SRPFC and SCT and were analyzed. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection. Two multivariable regression models were fitted, the SRPFC model (baseline variables such as sociodemographic, surgical and procedural characteristics, medical preconditions, and GOLD key indicators plus SRPFC) and the SCT model (baseline variables plus SCTPFC). Within all stair-climbing variables, LASSO exclusively selected self-reported poor functional capacity. The cross-validated area under the receiver operating characteristic curve with bias-corrected bootstrapping 95% confidence interval (95% CI) did not differ between the SRPFC and SCT models (0.71; 0.65-0.77 for both models). SRPFC was an independent risk factor (adjusted odds ratio (OR) 5.45; 95% CI 1.04-28.60; p = 0.045 in the SRPFC model) but SCTPFC was not (adjusted OR 3.78; 95% CI 0.87-16.34; p = 0.075 in the SCT model). Our findings indicate that preoperative SRPFC adequately predicts PPC while additional preoperative SCTs are dispensable in patients with known or suspected COPD.

A Cognitive Biotype of Depression and Symptoms, Behavior Measures, Neural Circuits, and Differential Treatment Outcomes

Cognitive deficits in depression have been associated with poor functional capacity, frontal neural circuit dysfunction, and worse response to conventional antidepressants. However, it is not known whether these impairments combine together to identify a specific cognitive subgroup (or "biotype") of individuals with major depressive disorder (MDD), and the extent to which these impairments mediate antidepressant outcomes. To undertake a systematic test of the validity of a proposed cognitive biotype of MDD across neural circuit, symptom, social occupational function, and treatment outcome modalities. This secondary analysis of a randomized clinical trial implemented data-driven clustering in findings from the International Study to Predict Optimized Treatment in Depression, a pragmatic biomarker trial in which patients with MDD were randomized in a 1:1:1 ratio to antidepressant treatment with escitalopram, sertraline, or venlafaxine extended-release and assessed at baseline and 8 weeks on multimodal outcomes between December 1, 2008, and September 30, 2013. Eligible patients were medication-free outpatients with nonpsychotic MDD in at least the moderate range, and were recruited from 17 clinical and academic practices; a subset of these patients underwent functional magnetic resonance imaging. This prespecified secondary analysis was performed between June 10, 2022, and April 21, 2023. Pretreatment and posttreatment behavioral measures of cognitive performance across 9 domains, depression symptoms assessed using 2 standard depression scales, and psychosocial function assessed using the Social and Occupational Functioning Assessment Scale and World Health Organization Quality of Life scale were analyzed. Neural circuit function engaged during a cognitive control task was measured using functional magnetic resonance imaging. A total of 1008 patients (571 [56.6%] female; mean [SD] age, 37.8 [12.6] years) participated in the overall trial and 96 patients participated in the imaging substudy (45 [46.7%] female; mean [SD] age, 34.5 [13.5] years). Cluster analysis identified what may be referred to as a cognitive biotype of 27% of depressed patients with prominent behavioral impairment in executive function and response inhibition domains of cognitive control. This biotype was characterized by a specific profile of pretreatment depressive symptoms, worse psychosocial functioning (d = -0.25; 95% CI, -0.39 to -0.11; P < .001), and reduced activation of the cognitive control circuit (right dorsolateral prefrontal cortex: d = -0.78; 95% CI, -1.28 to -0.27; P = .003). Remission was comparatively lower in the cognitive biotype positive subgroup (73 of 188 [38.8%] vs 250 of 524 [47.7%]; P = .04) and cognitive impairments persisted regardless of symptom change (executive function: ηp2 = 0.241; P < .001; response inhibition: ηp2 = 0.750; P < .001). The extent of symptom and functional change was specifically mediated by change in cognition but not the reverse. Our findings suggest the presence of a cognitive biotype of depression with distinct neural correlates, and a functional clinical profile that responds poorly to standard antidepressants and instead may benefit from therapies specifically targeting cognitive dysfunction. ClinicalTrials.gov Identifier: NCT00693849.

Relationship between Lower-Limb Bioelectrical Impedance Indicators of Hydration Status and Muscle Function in Aged Population: A Cross-Sectional Study

Background: Reduced Intracellular Water (ICW) has been related to poor muscle strength and functional capacity in aged populations. We aimed to evaluate hydration status and intracellular hydration of lower-limb lean mass in aged population and the relationship with thigh muscle function. Methods: Design and population: Cross-sectional study of community-dwelling ≥70 year old subjects. Measurements: Lower-limb hydration status was assessed by bioimpedance analysis and thigh muscle function was assessed by isokinetic evaluation. Frailty was established according to Fried criteria, sarcopenia according to EWGSOP-2 criteria, and physical performance according to the Timed Up-and-Go (TUG) test. Results: Assessed were 117 individuals (mean age 75.0 years, 50.4% women). Women had lower Fat-Free Mass (FFM), Total Body Water (TBW), and Phase Angle (PhA) values than men. Age was negatively correlated with ICW (r=-0.187; p=0.045), the ICW/FFM ratio (r=-0.192; p=0.039), and PhA (r=-0.311; p&lt;0.001). Extension and flexion strength and power of the knee were positively correlated with Total Water (TW) (L), FFM (kg), and the protein compartment (kg) of the lower-limb in both men and women, but not with TW as percentage of weight, ICW as percentage of TW, and the TW/FFM and ICW/FFM ratios, while the TUG test was negatively correlated with ICW as a percentage of TW. Conclusion: Knee flexion and extension strength, power, and work increase as thigh FFM, TBW, and protein compartment values increase. No correlation was observed between intracellular hydration and muscle function, but correlation was observed with performance. As plausible hypotheses, further studies are required to test for these correlations.

What are key characteristics of adults with advanced heart failure discharged from ICU?

As the number of people with heart failure and treatment complexity increases, many hospitals are implementing Advanced Heart Failure Intensive Care Units (AHFICU). However, little evidence concerning the clinical characteristics of people admitted to AHFICUs exists. Understanding the clinical characteristics of people admitted to the AHFICU will assist nurses with implementing tailored interventions to ensure high-quality care delivery. The purpose of this study was to describe the clinical characteristics of people who are admitted to and discharged from an AHFICU. Baseline data from a longitudinal descriptive study were collected on adults (N = 43) admitted to an AHFICU. Heart failure severity, self-management ability, cognition, sleep quality, and other clinical characteristics were assessed. Most study participants were New York Heart Association functional class IV (n = 24) or class III (n = 14), indicating poor functional capacity. Over half had mild cognitive impairment and poor sleep quality was prevalent (92.7%). Participants had adequate levels of heart failure knowledge, but low levels of heart failure self-management decision-making and ability. Interventions to address the unique clinical characteristics of AHFICU patients include sleep hygiene, integration of cognitive, sleep, and self-management assessments into the electronic medical record. Addressing the unique clinical needs of people with heart failure will lead to patient-centered, evidence-based, and safe care. Understanding characteristics of this population addresses this evidence gap and targeted clinical interventions to address unique discharge needs of this population are proposed. Sleep quality education should be done throughout hospitalization on sleep strategies and self-management coaching to facilitate adoption of new sleep routines. Healthcare providers should ensure each patient has care support upon discharge and take cognitive status into consideration during teaching. Addressing self-management readiness should include providing scenarios as part of discharge preparation. Providers must include addressing comorbidities and how they may affect heart failure self-management, such as teaching about sleep apnea device use and encouraging compliance.

Identification of male COPD patients with exertional hypoxemia who may benefit from long-term oxygen therapy.

Several studies have documented increased exercise capacity with supplemental oxygen therapy in patients with COPD and exertional hypoxemia, but a large trial failed to demonstrate a survival benefit in this population. Due to the heterogeneity observed in therapeutic responses, we sought to retrospectively evaluate survival in male COPD patients with exertional hypoxemia who had a clinically meaningful improvement in exercise capacity while using supplemental oxygen compared to their 6-minute walk test distance (6MWD) while walking on room air. We defined them as responders or non-responders based on a change in 6MWD of greater or less than 54m. We compared their clinical and physiologic characteristics, and their survival over time. From 817 COPD subjects who underwent an assessment for home oxygen during the study period, 140 met inclusion criteria, with 70 (50%) qualifying as responders. There were no significant differences in demographics, lung function, or baseline oxygenation between the groups. The only difference noted was in the baseline 6MWD on room air, with responders to oxygen therapy having significantly lower values (137 ± 74m, 27 ± 15% predicted) compared to non-responders (244 ± 108, 49 ± 23% predicted). Despite their poorer functional capacity, mortality was significantly lower in responders after adjusting for age, comorbidities, and FEV1 (HR 0.51; CI 0.31-0.83; p = 0.007) compared to non-responders after a median follow-up time of 3 years. We conclude that assessing the immediate effects of oxygen on exercise capacity may be an important way to identify individuals with exertional hypoxemia who may benefit in the long-term from ambulatory oxygen. Prospective long-term studies in this subset of patients with exercise induced hypoxemia are warranted.

Functional assessment and mortality in underweight critically ill patients one year after hospital discharge: A prospective cohort study

There in no data regarding outcomes after hospital discharge for underweight critically ill patients. This study aimed to assess long-term survival and functional capacity in underweight critically ill patients. Prospective observational study that included underweight critically ill patients (BMI <20kg/cm2) followed-up one year after hospital discharge. To assess functional capacity, we interviewed patients or caregivers and performed Katz index (KI) and Lawton scale. Patients were divided into two groups: (1) poor functional capacity, if the patient had less points than the median of the Katz and IADL score, and (2) good functional capacity, if at least one score was above the median. Extremely low weight defined as less than 45kg. We assessed the vital status of 103 patients. Mortality was 38.8% (median 362 [136, 422] days of follow-up). We interviewed 62 patients or proxies. No difference was observed between survivors and non-survivors regarding weight and BMI at intensive care unit admission and nutritional therapy received in the first days of intensive care admission. Patients with poor functional capacity had lower admission weight (43.9 vs 52±7.9kg, p<0.001) and BMI (17±2.1 vs 18.2±1.8kg/cm2, p=0.028). In a multivariate logistic regression, weight under 45kg was independently associated with poor functional capacity (OR=13.6, 95%CI, 3.7 to 66.5) CONCLUSION: Underweight critically ill patients have high mortality and a persistent functional impairment, the last being more important in extremely low weight. ClinicalTrials.gov number NCT03398343.