Status Of Heart Failure Patients Research Articles

Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy.

PurposeIt is well known that a significant proportion of heart failure patients (10–44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation.MethodsA cohort of 139 patients with a CRT-defibrillator (70 % men; age 65.7 ± 10.1 years) completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) prior to implantation (baseline) and at 2, 6, and 12–14 months post-implantation. Latent class analyses were used to identify trajectories and associates of disease-specific health status over time.ResultsAll health status trajectories showed an initial small to large improvement from baseline to 2-month follow-up, whereafter most trajectories displayed a stable pattern between short- and long-term follow-up. Low educational level, NYHA class III/IV, smoking, no use of beta-blockers, use of psychotropic medication, anxiety, depression, and type D personality were found to be associated with poorer health status in unadjusted analyses. Interestingly, subgroups of patients (12–20 %) who experienced poor health status at baseline improved to stable good health status levels after implantation.ConclusionsLevels of disease-specific health status vary considerably across subgroups of CRT-D patients. Classification into poorer disease-specific health status trajectories was particularly associated with patients’ psychological profile and NYHA classification. The timely identification of CRT-D patients who present with poor disease-specific health status (i.e., KCCQ score < 50) and a distressed psychological profile (i.e., anxiety, depression, and/or type D personality) is paramount, as they may benefit from cardiac rehabilitation in combination with psychological intervention.

Malnutrition and associated factors among heart failure patients on follow up at Jimma university specialized hospital, Ethiopia.

BackgroundMalnutrition and cachexia are serious consequences of numerous chronic diseases. Severe heart failure patients could be related with marked weight loss. Malnutrition is associated with poor prognosis among heart failure patients. Despite its implication, factors associated with malnutrition among heart failure patients in Africa and Ethiopia was not addressed. Hence, in this study we tried to determine factors associated with malnutrition among heart failure patients on follow up at Jimma University specialized hospital, Ethiopia.MethodsA cross-sectional study was done on 284 randomly selected heart failure patients. The nutritional status of the patients was assessed based on their serum albumin level (normal value 4–5 mg/dl) and triceps skin fold thickness. The data was analyzed using SPSS version 20.0. Multivariable logistic regression was used to identify factors associated with malnutrition among heart failure patients using SPSS 20.0.ResultsBased on serum albumin and triceps skin fold thickness, 77.8 % of patients were malnourished. Mean age of the patients was 48.3 ± 15.9 years. The commonest cause of heart failure was ischemic heart disease (34.9 %). Hypertension (36 %) was the commonest co morbid disease. Forty four percent of patients had New York heart association functional class II heart failure. Serum hemoglobin (AOR = 0.77, 95 % CI: 0.67–0.92) was found to be significantly associated with nutritional status of heart failure patients. As serum hemoglobin increases by 1gm/dl, the risk of malnutrition decreased by 15 % (P value = 0.03).ConclusionsThe majority of patients were malnourished. A higher hemoglobin concentration was associated with reduced odds of being malnourished.

Adding point of care ultrasound to assess volume status in heart failure patients in a nurse-led outpatient clinic. A randomised study

ObjectivesMedical history, physical examination and laboratory testing are not optimal for the assessment of volume status in heart failure (HF) patients. We aimed to study the clinical influence of focused...

A Home-Based Diaphragmatic Breathing Retraining in Rural Patients With Heart Failure.

Dyspnea limits physical activity and functional status in heart failure patients. This feasibility study examined effects of a diaphragmatic breathing retraining (DBR) intervention delivered over 8 weeks with follow-up at 5 months. The intervention group (n = 18) was trained at baseline and received four telephone calls. An attention control group (n = 18) received four telephone calls with general health information. Results from linear mixed model analysis with effect sizes (η(2)) showed dyspnea improved in both groups, with little difference between groups. Compared with attention alone, the intervention increased physical activity (calories expended; η(2) = .015) and functional status (η(2) = .013) across the 5-month follow-up and increased activity counts at 8 weeks (η(2) = .070). This intervention was feasible and demonstrated promising effects on activity and function but not by reducing dyspnea. Patients may have increased physical activity because of instructions to use DBR during activities of daily living. Further exploration of the intervention's underlying physiological effect is needed.

Abstract 16099: Influence of Nutritional Status on Depressive Symptoms and Quality of Life in Patients With Heart Failure

Introduction: The important goal of heart failure (HF) management is to improve quality of life (QoL) and psychological status. Nutrition is a key component of HF management, but information on the impact of nutrition in HF is limited. Moreover, there is little evidence that nutritional status affects QoL and psychological status. Hypothesis: This study tested the hypothesis that nutritional status is associated with QoL and depressive symptoms in HF patients. Methods: A cross-sectional study was conducted in 102 HF patients (mean age: 68.4 ±13.1 years, male: 66%). QoL and depressive symptoms were assessed by the Minnesota Living with Heart Failure (MLWHF) questionnaire and Patient Health Questionnaire-9 (PHQ-9), respectively. Nutritional status was assessed by the Mini Nutritional Assessment (MNA) long version and patients were categorized as well nourished (≥24 points), at risk of malnutrition (17-23.5 points), or malnourished (&lt;17 points). Data on sociodemographic and clinical characteristics were also collected. Multiple linear regression analysis was performed to evaluate the association of nutritional status with depression and QoL. Results: In total, 50% patients were at risk of malnutrition and 2% were malnourished. HF patients at risk of malnutrition were more likely to have a history of valve surgery, implantable cardiac defibrillation (ICD), or smoking. Risk of malnutrition was not associated with left ventricular ejection fraction (LVEF) or brain natriuretic peptide (BNP) (P = 0.100 and P = 0.173, respectively). Malnourished patients or those at risk of malnutrition had significantly lower QoL and more depressive symptoms than well-nourished patients (QoL: 14.2 ± 13.9 vs 23.2 ± 17.9, P = 0.007; depressive symptoms: 4.49 ± 4.7 vs 2.02 ± 2.9, P = 0.002). In multiple linear regression analysis, these significant associations remained after controlling for age, sex, HF etiology, smoking, ICD therapy, LVEF, and BNP. Conclusions: Risk of malnutrition was associated with lower QoL and higher depressive symptoms in HF patients. This study confirmed that good nutrition was an important goal in HF management. Further research is required to identify key nutrients and dietary habits affecting QoL and psychological status in HF patients.

Remote Monitoring Reduces Mortality in ICD and CRT-D Patients

Remote monitoring using a multiparametric alert algorithm in patients with heart failure (HF) and a cardiac resynchronization therapy device (CRT-D) or implanted cardiac defibrillator (ICD) results in a decrease in all-cause mortality. This article presents data from a post hoc analysis of the Influence of Home Monitoring on the Clinical Status of Heart Failure Patients With an Impaired Left Ventricular Function trial [IN-TIME; NCT00538356].

B-type natriuretic peptide in patients after percutaneous trans-coronary-sinus mitral annuloplasty

Functional mitral regurgitation (MR) remains a significant clinical problem. Surgical valve repair carries a high procedural risk. Thus, percutaneous techniques are under development. One of the most advanced devices for percutaneous mitral annuloplasty (PTMA) is the Carillon™ device. B-type natriuretic peptide (BNP) is a marker of haemodynamic status in heart failure patients. So far, its usefulness in patients after PTMA is unknown. Thirteen consecutive patients after successful implantation of the Carillon™ device were enrolled. PTMA was achieved through the coronary sinus in order to improve leaflet coaptation. Before PTMA, immediately after, and at one month follow-up, transthoracic echocardiography was performed. Furthermore, plasma BNP levels, the six-minute walk test (6MWT) and the Naughton treadmill exercise test were evaluated before PTMA and after one month. In patients after successful PTMA, significant improvement in echocardiographic parameters was maintained at one-month follow-up: vena contracta (0.31 ± 0.03 vs. 0.64 ± 0.03 cm, p < 0.05), effective regurgitant orifice area (0.2 ± 0.02 vs. 0.32 ± 0.05 cm², p < 0.05), MR jet area/left atrial area (32.33 ± 1.98 vs. 47.06 ± 2.3%,p < 0.05) and regurgitant volume (27.84 ± 2.17 vs. 45.25 ± 7.47 mL, p < 0.05). Both the duration of the exercise test (4.3 ± 0.45 vs. 3.12 ± 0.18 min, p < 0.05) and 6MWT (320 ± 29.63 vs. 295.2 ± 13.4 m, p < 0.05) improved. Furthermore, improvement of the NYHA class was observed. Despite that, mean BNP levels remained unchanged (405.3 ± 133.9 vs. 596.5 ± 245.2 pg/mL, p = 0.191; after and before the procedure, respectively). In some patients with device located above the annulus level, an increase in BNP leve ls was observed. BNP seems to be useless for the assessment of patients after PTMA. This may be related to mechanical stress on the annulus and atrial wall caused by the device itself.

The Informative Contribution of the “Virtual Medical Visit” in a New Heart Failure Telemedicine Integrated System

Telemedicine systems consist of collection, transmission, and analysis of biometric data essentially based on instrumental measures. Our goal was to evaluate if information collected from patients has an incremental informative value in automatically rating the patient's health status. We present preliminary results of a new telemedicine system (ASCOLTA) obtained by observation of 12 heart failure patients (New York Heart Association Class IIb-III). Instrumental data (electrocardiogram, oxygen saturation level, and respiration rate) were wirelessly collected daily together with clinical data (weight, heart rate, and blood pressure values) and patients' information obtained through a Web-based questionnaire, simulating a virtual medical visit. Health status was independently judged by two blinded cardiologists and by the patient's cardiologist on the basis of 348 daily clinical reports. Random forest classification analysis was applied to 240 complete clinical report variables in order to estimate the judged health status. The use of "patient's information" led to a better predictive ability in comparison with using only physiological parameters assessed by instruments. The complete set of variables (Patient+Instrumental) achieved 84% concordance, compared with 72% for the instrumental-only variables and 69% for the patient-only variables. The receiver operator characteristics curves graphically confirmed the described results. Patients have an active role in home monitoring, and their information appears relevant for a new telemedicine approach integrating subjective and objective vital signs. Combining patient information with instrumental parameters, it is possible to achieve a more correct automatic classification of health status of heart failure patients.

Heart failure monitoring with a cardiac resynchronization therapy device-based cardiac contractility sensor: a case series

IntroductionThe SonR signal has been shown to reflect cardiac contractility. It is recorded with an atrial lead connected to a cardiac resynchronization therapy defibrillator. For the first time, clinical evidence on the use of the SonR signal in the monitoring of the clinical status of heart failure patients implanted with cardiac resynchronization therapy defibrillator are presented through three clinical cases.Case presentationIn the two first patients (non-Hispanic/Latino white), the SonR amplitude increases concomitantly to clinical status improvement subsequent to cardiac resynchronization therapy defibrillator implantation. In the third patient (non-Hispanic/Latino white), a decrease in SonR amplitude is observed concomitantly to atrial fibrillation and clinical status deterioration.ConclusionsThis case series reports the association between SonR signal amplitude changes and patients’ clinical status. Combined with remote monitoring, early SonR signal amplitude remote monitoring could be a promising tool for heart failure patients’ management.

Nutritional Status in Heart Failure Patients throughout Chronic Kidney Disease Stages

Background & aims: Heart failure (HF) is associated with significant morbidity and mortality, the prognosis of heart failure is poor, especially with coexisting chronic kidney disease (CKD). However little is known about how HF and CKD together influence the nutritional status, so the main objective of this study was to assess nutritional status in patients with heart failure coexisting with stage 1-5 renal disease. Methods: This retrospective study included a total of 113 patients with HF and CKD that were classified into stages 1-5 according to the Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines. The following characteristics were recorded: co-morbidities, New York Heart Association (NYHA) functional class, echocardiographic data, medication, and biochemical parameters (albumin, hemoglobin and electrolytes). Nutritional status was evaluated by bioimpedance vector analysis (BIVA) and subjective global assessment (SGA). Results: In the nutritional status evaluation by BIVA, 53.1% were cachectic, 23.9% obese and 21.12% normal. The prevalence of cachexia is higher with advancing stages of CKD, while hand grip strength, arm and waist circumferences decreased. In SGA 79.8% had a normal nutritional status, 16.8% mild malnutrition and 2.7% moderate-severe malnutrition. Hypoalbuminemia was presented in 22.5% of subjects, most commonly found in stages 1, 4 and 5; the prevalence of anemia was 47.2% and also increased with advancing stages of CKD, showing a prevalence of 13.3% in stage 1 and 100% stage 5. Conclusions: The prevalence of cachexia was higher in stages 3-5 of CKD, mild to severe malnutrition in stages 4 and 5, and anemia in stage 5, so HF and advanced CKD are associated with deteriorating nutritional status.

Functional electrical stimulation of peripheral muscles improves endothelial function and clinical and emotional status in heart failure patients with preserved left ventricular ejection fraction

Functional electrical stimulation (FES) improves exercise capacity, quality of life, emotional stress, and endothelial function in chronic heart failure with impaired systolic function. We sought to investigate the effects of FES on the above parameters in patients with preserved ejection fraction (HFpEF). Thirty HFpEF patients, 18 female and 12 male, aged 69 ± 8 years, in New York Heart Association class II or III and with mean ejection fraction 63% ± 6%, were randomly (1:1) assigned to a 6-week FES program or placebo. Assessment was performed at baseline and after completion of training protocol and included 6-minute walked distance, quality of life (Kansas City Cardiomyopathy Questionnaire and Minnesota Living with Heart Failure Questionnaire), depressive symptoms (Beck Depression Inventory and Zung self-rated depression scores), B-type natriuretic peptide, endothelial function (flow-mediated dilatation), and left ventricular diastolic function. A significant improvement in 6-minute walked distance (F = 21.61, P = .001), Kansas City Cardiomyopathy Questionnaire summary (F = 8.68, P = .006), Minnesota Living with Heart Failure Questionnaire (F = 6.43, P = .017), Beck Depression Inventory (F = 6.66, P = .015), Zung (F = 6.25, P = .019), and flow-mediated dilatation diameter (F = 11.98, P = .002) was observed in the FES group compared with placebo group; B-type natriuretic peptide also declined but not significantly (F = 0.249, P = .622), and there was a tendency toward lower mitral E/e' wave ratio (F = 3.066, P = .091). As in heart failure and reduced left ventricular ejection fraction, FES also improves exercise capacity, quality of life, emotional status, and endothelial function in HFpEF. Given the lack of effective evidence-based therapies in these patients, FES warrants further investigation.

Körperliches Training bei Herzinsuffizienz

In patients with chronic but stable heart failure (HF) exercise training is a recommended and widely accepted adjunct to an evidence-based management involving pharmacological and non-pharmacological therapies. Various pathophysiological mechanisms, such as central hemodynamics, vasculature, ventilation, skeletal muscle function as well as neurohormonal activation and inflammation are responsible for exercise intolerance described in HF patients. There is sufficient and growing evidence that exercise training in HF with reduced (HFrEF) and with preserved ejection fraction (HFpEF) is effective in improving exercise capacity, HF symptoms and quality of life. The positive effects of exercise training in HF are mediated by an improvement of central hemodynamics, endothelial function, inflammatory markers, neurohumoral activation, as well as skeletal muscle structure and function. In contrast to convincing data from a large meta-analysis, the large HF-ACTION study (Heart Failure-A Controlled Trial Investigating Outcomes of exercise TraiNing) only demonstrated a modest improvement of all cause mortality and hospitalizations in HFrEF. Outcome data in HFpEF are lacking. Whether interval training incorporating variable and higher intensities or the addition of resistance exercise to a standard aerobic prescription is superior in improving clinical status of HF patients is currently being examined. Despite increasing validation of the potential of exercise training in chronic HF, challenges remain in the routine therapeutic application, including interdisciplinary management, financing of long-term exercise programs and the need to improve short-term and long-term adherence to exercise training.

Moderating Effect of Psychosocial Factors for Dyspnea in Taiwanese and American Heart Failure Patients

Dyspnea is the most common and distressing symptom of heart failure (HF). Evidence from empirical studies has shown that multiple factors apart from pathophysiological changes may influence this symptom. This study explored the moderating effect of psychosocial factors between clinical characteristics and dyspnea in patients with HF. To assess the potential effects of cultural background, this study also compared differences in psychosocial factor moderating effects between HF patients in Taiwan and the United States. We recruited patients with HF from outpatient clinics in Taiwan and the United States. Data were collected at clinics and research centers. Dyspnea was measured using the modified pulmonary function status and dyspnea questionnaire. Psychosocial factors considered were depression, anxiety, perceived control, and perceived social support. These factors were measured using the Brief Symptom Inventory, Revised Control Attitudes Scale, and Multidimensional Scale of Social Support Scale, respectively. Multiple regressions with interaction effect analysis tested the moderator effects across these two groups. Ninety-seven Taiwanese (mean age = 66.2 ± 12.1 years; 76% male; 28% NYHA [New York Heart Association] III/IV) and 96 American (mean age = 61.6 ± 11.7 years; 74% male; 42% NYHA III/IV) patients participated. In Taiwanese patients, only perceived social support (B = .08, p = .034) moderated the relationship between clinical variables and dyspnea. In American patients, depression (B = .75, p = .028) and anxiety (B = .85, p = .041) were moderators of the relationship between clinical status and dyspnea severity. Depression, anxiety, and perceived social support moderated the relationship of clinical characteristics with dyspnea in Taiwanese and American HF patients, respectively. Attention to these psychosocial factors may improve dyspnea status in HF patients. Symptom management should include a focus on patients' psychological distress and social perspectives.

Do Baseline Diastolic Echocardiographic Parameters Predict Outcome after Resynchronization Therapy? Results from the PROSPECT Trial

Cardiac resynchronization therapy (CRT) can improve clinical and cardiac structural status in heart failure patients. The role of baseline diastolic echocardiographic parameters to characterize the likelihood of positive outcomes is not well known. We explored relationships between diastolic parameters and outcomes 6 months after CRT implant in the Predictors of Response to CRT (PROSPECT) Trial. We hypothesized that diastolic echocardiographic parameters were associated with clinical and structural outcomes in CRT patients. For 426 patients in PROSPECT, a prospective observational trial of CRT, baseline E/A ratio, left atrial (LA) area, isovolumic relaxation time, left ventricular inflow deceleration time, E' velocity, and E/E' ratio were evaluated and related to 6-month clinical composite score (CCS) and left ventricular end-systolic volume (LVESV) reduction using Spearman rank-order correlations. Parameters associated with outcomes were analyzed further by discrete categorization. As continuous variables, only E/A ratio and LA area correlated with CCSs (P = 0.017, P = 0.045, respectively) and relative change in LVESV at 6 months (P < 0.0001, P = 0.001, respectively). As discrete variables, E/A ratio and LA area also correlated with CCSs and LVESV. Diastolic echo parameters E/A ratio and LA area were associated with clinical and structural outcomes in CRT patients at 6 months.

Health Status and Depression Remission in Patients With Chronic Heart Failure

Depression is a common comorbidity in heart failure and is strongly associated with increased mortality, morbidity, and reduced health status. Whether depression treatment may result in improvement of health status in heart failure patients with comorbid depression remains unknown. The Sertraline Against Depression and Heart Disease in Chronic Heart Failure study randomized 469 participants with chronic heart failure (left ventricular ejection fraction 45% and New York Heart Association class II) and major depressive disorder based on Diagnostic Statistics Manual fourth edition criteria to sertraline or placebo for 12 weeks. The Kansas City Cardiomyopathy Questionnaire, 36-Item Short-Form Health Survey, and 6-minute walk test were used to assess health status. Health status changes between treatment arms and remission status were evaluated adjusting for baseline variables and treatment assignment. The final Hamilton Depression Rating Scale scores were 3.50±2.08 and 12.97±4.33 in the remission and nonremission groups, respectively (P value=0.0001). Of 469 total participants, 378 (80.6%) completed the 6-minute walk test and 285 (70.1%) completed Kansas city cardiomyopathy questionnaire and 36-item short-form health survey, at baseline and at week 12. Depression remission was significantly associated with higher improvements in Kansas City Cardiomyopathy Questionnaire subscale scores (P<0.001) except on the Self-Efficacy (P=0.18) and Symptom Stability (P=0.91). On the 36-Item Short-Form Health Survey, depression remission was associated with significant improvement in subscales of the physical and mental component summary except the Pain Index (P=0.34). The 6-minute walk test improved more in depression remission compared with nonremission group (difference from baseline: 63.51±238.78 versus 16.24±115.70 m, P=0.03). Patients with heart failure whose depressive symptoms remitted had significantly greater improvement in physical function, social function, and quality of life.

A combined aerobic and resistance exercise program improves physical functional performance in patients with heart failure: a pilot study.

Recent guidelines for exercise in patients with heart failure (HF) recommended aerobic and resistance exercise as being safe and effective; however, the clinical and functional significance of these combined training modalities has not been established. In this pilot study, combined aerobic and resistance training was hypothesized to improve physical function, muscle strength, and health-related quality of life (HRQOL) compared with an attention control wait list (ACWL). The 10-item Continuous Scale Physical Functional Performance Test (CS-PFP10), which simulates common household chores; muscle strength (handgrip and knee extension); and HRQOL (Kansas City Cardiomyopathy Questionnaire) were evaluated at baseline (T1) and at 12 weeks (T2). The home-based moderate-intensity walking and resistance training program was performed 5 days a week. Twenty-four New York Heart Association class II to III HF patients (mean [SD] age, 60 [10] years; mean [SD] left ventricular ejection fraction, 25% [9%]) were randomized to a combined aerobic and resistance exercise program or to an ACWL group. Of the total group, 58% were New York Heart Association class III HF patients, 50% were white, and 50% were female. The CS-PFP10 total scores were significantly increased in the exercise group, from 45 (18) to 56 (16). The Kansas City Cardiomyopathy Questionnaire overall summary score was significantly improved (P < .001) at T2 in the exercise intervention group compared with the ACWL group. Participants provided the home-based, combined aerobic and resistance exercise program had significantly improved physical function, muscle strength, symptom severity, and HRQOL compared with the ACWL group. The findings of this study must be interpreted cautiously owing to the limitations of a small sample, data collection from a single center, and differences between control and interventions groups at baseline. A combined aerobic and resistance exercise approach may improve physical function in stable HF patients, but further study in a larger, more diverse population is recommended. However, in this study, the CS-PFP10 instrument demonstrated its ability to identify functional health status in HF patients and thus warrants further testing in a larger sample for possible use in clinical practice.

Self care behavior in patients with heart failure in Taiwan

The aim of this study was to describe the self-care behaviors and associated demographic factors affecting such behaviors in the heart failure population in Taiwan. A descriptive, cross-sectional, correlational design was used in this study and 86 heart failure patients were sampled by convenience sampling. Demographic questionnaire and Self-Care of Heart Failure Index, V. 6 were used to collect these data. Descriptive statistic, correlation coefficient and multiple regression were used to analyze the data. The result indicated a low level of self-care maintenance and management although self-care confidence was adequate. Patients who were married had better self-care maintenance and self-care confidence than those who were single. Self-care confidence was a determinant of self-care maintenance. This study provided detailed information on self-care behavior status in heart failure patients in Taiwan.

Abstract P15: Psychometric Properties of the Kansas City Cardiomyopathy Questionnaire

Background: To explore the structure of the Kansas City Cardiomyothy Questionnaire (KCCQ) and compare it to the published version. The KCCQ is a well-established 5 domain, 23-item instrument evaluating the health status of heart failure patients. This analysis seeks to find the best factor fit for the items and subscale structure, thereby building evidence of the reliability and validity of the tool. Methods and Results: A sample of 280 adults with Stage C heart failure was enrolled from three sites in the northeast US. A principal component factor analysis was performed using Promax rotation, allowing for correlation between the subscales. Cronbach’s α scores were computed on the resulting item clusters. All data was analyzed using SPSS version 17.0. The analysis confirmed a five-factor solution; however, some of the items loaded on different factors from those published. The first five factors with Eigen values &gt;1 explained 67.13% of the variance. The internal consistency/reliability was 0.92 overall and as follows in each domain: social interference (7 items, 0.90), physical limitation (4 items, 0.84), symptoms (8 items, 0.86), independent care (2 items, 0.80) and self-efficacy (2 items, 0.63). Two items related to independent care failed to correspond to a previously identified factor so a new domain was added and the items intending to measure quality of life loaded in the social interference domain. Conclusions: This analysis verifies the reliability and supports the validity of the KCCQ. To strengthen the KCCQ we recommend eliminating the quality of life domain and including those items in the social interference domain, renaming the self-efficacy domain because these items are not consistent with the theoretical definition of the concept, and re-evaluating the two items which address limitations in dressing and bathing. Key Words: heart failure, factor analysis, quality of life, Kansas cardiomyopathy questionnaire (KCCQ).

Heart failure patients monitored with telemedicine: patient satisfaction, a review of the literature

Background: Remote monitoring of the clinical status of heart failure patients has developed rapidly and is the subject of several trials. Patient satisfaction is an important outcome and is recommended by the FDA to use in clinical research. Therefore, it should be included in studies concerning remote monitoring. Patient satisfaction with telemedicine is a multi-dimensional concept and has to be measured with standardised and validated measurement tools. Objective: To describe the current state of literature on patient satisfaction with non-invasive telemedicine, with regard to the description, measurement and overall level of patient satisfaction with telemedicine. Results: In total 193 articles were screened and fourteen articles were included in this review. None of the included articles described a clear definition or concept of patient satisfaction with telemedicine. Patient satisfaction with telemedicine was measured with selfdeveloped questionnaires, face-to-face or telephonic interviews. None of the articles used the same questionnaire or telephonic survey to measure patient satisfaction. One questionnaire was assessed for validity and reliability. In general, patients seemed to be satisfied or very satisfied with the use of telemedicine. Conclusions: Measurement of patient satisfaction is still under-exposed in telemedicine research; well-developed and validated instruments are hardly available. It is strongly recommended that patient satisfaction becomes more prominent and that well designed, validated and standardised instruments with theoretical foundation will be used to measure patient satisfaction with telemedicine.

196 Non response after cardiac resynchronisation therapy is associated with a more severe cardiomyopathy

Cardiac resynchronisation therapy (CRT) has been shown to improve clinical status in heart failure patients. Some patients treated by CRT fail to respond to the treatment. Predisposing factors for non-response should be investigated to optimize patient selection. The purpose of the study was to evaluate before device implantation and 3, 6 and 12 month after, echocardiographic and biological parameters with respect to CRT response. Thirty two patients with heart failure (72% of men; age 66 ± 10 years; 59% non-ischaemic cardiomyopathy; NYHA III–IV; left ventricular ejection fraction (LVEF) 22.7 ± 6.7%; QRS width 146 ± 26 ms) were implanted with CRT device and followed during twelve month. Responders (R) were defined as patients with improvement of one or more NYHA functional class, with a significant improvement in quality of life and without episode nor hospitalization for heart failure during follow-up. 34% of the patients constitute the non-responder group (NR). No difference between R and NR was observed in LVEF, QRS width, NYHA, cardiovascular risk factors nor drug medication. Non-ischaemic dilated cardiomyopathy was significantly more present in R (71% vs 27%; p = 0.03). Before CRT, NR had more important left ventricular end-diatolic diameter, left ventricular end-systolic diameter and more elevated left pressions. Atrioventricular dyssynchrony was significantly more observed in R (66% vs 9%; p = 0.006) so as intraventricular dyssynchrony (95% vs 27%; p = 0.001).BNP is significantly more elevated in NR (602 ± 385 vs 320 ± 361; p = 0.03) before CRT.After 3 and 6 month, a significant decrease in left ventricular end-diatolic and end-systolic diameters, LVEF and normalisation of left and right pressions occur in R. Likewise, BNP levels were lower in R. NR patients have before implantation a more severe cardiomyopathy. At follow-up, left ventricular remodelling could only be observed in R patients. These data suggest that cardiac CRT should not be proposed too late so that left ventricular remodelling could be expected.