scholarly journals Establishing a cardiac training group for patients with heart failure: the “HIP-in-Würzburg” study

2021 ◽  
Author(s):  
Gülmisal Güder ◽  
Joana Wilkesmann ◽  
Nina Scholz ◽  
Robert Leppich ◽  
Peter Düking ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Kansas City ◽  
Nyha Class ◽  
German Society ◽  
Life Assessment ◽  
Training Groups ◽  
Supervised Exercise

Abstract Background Exercise training in heart failure (HF) is recommended but not routinely offered, because of logistic and safety-related reasons. In 2020, the German Society for Prevention&Rehabilitation and the German Society for Cardiology requested establishing dedicated “HF training groups.” Here, we aimed to implement and evaluate the feasibility and safety of one of the first HF training groups in Germany. Methods Twelve patients (three women) with symptomatic HF (NYHA class II/III) and an ejection fraction ≤ 45% participated and were offered weekly, physician-supervised exercise training for 1 year. Patients received a wrist-worn pedometer (M430 Polar) and underwent the following assessments at baseline and after 4, 8 and 12 months: cardiopulmonary exercise test, 6-min walk test, echocardiography (blinded reading), and quality of life assessment (Kansas City Cardiomyopathy Questionnaire, KCCQ). Results All patients (median age [quartiles] 64 [49; 64] years) completed the study and participated in 76% of the offered 36 training sessions. The pedometer was worn ≥ 1000 min per day over 86% of the time. No cardiovascular events occurred during training. Across 12 months, NT-proBNP dropped from 986 pg/ml [455; 1937] to 483 pg/ml [247; 2322], and LVEF increased from 36% [29;41] to 41% [32;46]%, (p for trend = 0.01). We observed no changes in exercise capacity except for a subtle increase in peak VO2% predicted, from 66.5 [49; 77] to 67 [52; 78]; p for trend = 0.03. The physical function and social limitation domains of the KCCQ improved from 60 [54; 82] to 71 [58; 95, and from 63 [39; 83] to 78 [64; 92]; p for trend = 0.04 and = 0.01, respectively. Positive trends were further seen for the clinical and overall summary scores. Conclusion This pilot study showed that the implementation of a supervised HF-exercise program is feasible, safe, and has the potential to improve both quality of life and surrogate markers of HF severity. This first exercise experiment should facilitate the design of risk-adopted training programs for patients with HF.

Exercise Capacity in Chronic Heart Failure

2012 ◽  
Vol 9 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Gina G Mentzer ◽  
Alex J Auseon
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Exercise Capacity ◽  
Positive Impact ◽  
Pharmacologic Therapy ◽  
The Past ◽  
Diagnosis And Prognosis ◽  
Future Therapy

Heart failure (HF) affects more than 5 million people and has an increasing incidence and cost burden. Patients note symptoms of dyspnea and fatigue that result in a decreased quality of life, which has not drastically improved over the past decades despite advances in therapies. The assessment of exercise capacity can provide information regarding patient diagnosis and prognosis, while doubling as a potential future therapy. clinically, there is acceptance that exercise is safe in hf and can have a positive impact on morbidity and quality of life, although evidence for improvement in mortality is still lacking. specific prescriptions for exercise training have not been developed because many variables and confounding factors have prevented research trials from demonstrating an ideal regimen. Physicians are becoming more aware of the indices and goals for hf patients in exercise testing and therapy to provide comprehensive cardiac care. it is further postulated that a combination of exercise training and pharmacologic therapy may eventually provide the most benefits to those suffering from hf.

Anxiety and Coping Based on Emotions may contribute to Reduced Quality of Life in Patients with Mild Systolic Heart Failure

2018 ◽  
pp. 1-6
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Self Efficacy ◽  
Sense Of Self ◽  
Coping Styles ◽  
Nyha Class ◽  
Systolic Heart Failure ◽  
Emotional Dimension ◽  
And Coping

Aims and Scope: Perception of health related quality of life (QoL) may result from the complex interplay between the severity of the disease and the patient’s psyche. It the present study we assumed that anxiety and coping based on emotions may contribute to reduced QoL in patients with mild systolic heart failure (HF). Methods: We examined mainly males with systolic HF (almost all with ischemic etiology of HF, all classified in the NYHA class II, receiving standard pharmacological treatment). Each patient underwent a physical examination, routine laboratory tests and standard transthoracic echocardiography and completed psychological questionnaires assessing: coping styles, sense of self efficacy, acceptance of illness, optimism and the level of anxiety and QoL (by Minnesota Living with Heart Failure Questionnaire). Results: Emotion-oriented coping was strongly positively related to an overall score reflecting QoL (r=0.37) as well as to both dimensions of QoL, with exceptionally high correlation with the emotional dimension (r=0.24 and r=0.62, respectively, all p<0.05). More reduced QoL (overall score as well as scores in both analysed dimensions) was significantly (all p<0.05) but weakly (r=-0.21, r=-0.20 and r=-0.26, respectively) related to lower acceptance of the illness. Higher level of anxiety was related to more reduced QoL (all p<0.05). Reduced QoL in emotional dimension was related to the tendency to avoidance-oriented coping (r=0.26, including also a sub style based on distraction, r=0.34) as well as to lower sense of self-efficacy (r=-0.20) and lower level of optimism (r=-0.20, all p<0.05). Conclusion: The results indicate that HF patients are psychologically diverse, which is not related to disease severity. However, QoL was related to emotion-oriented coping and anxiety. Psychological support for patients with HF should be focused on teaching adequate methods of coping and reducing anxiety.

scholarly journals Health-Related Quality of Life in the Spironolactone to Reduce ICD Therapy (SPIRIT) Trial

2020 ◽  
Author(s):  
Ana Carolina Sauer Liberato ◽  
Merritt H Raitt ◽  
Ignatius GE Zarraga ◽  
Karen S MacMurdy ◽  
Cynthia Dougherty
Keyword(s):  
Quality Of Life ◽  
Kansas City ◽  
Short Form ◽  
Nyha Class ◽  
Health Related Quality ◽  
Icd Therapy ◽  
Related Quality ◽  
Health Related ◽  
Icd Shock

Purpose: The Spironolactone to Reduce ICD Therapy (SPIRIT) trial was designed to determine whether once daily spironolactone would: 1) reduce the incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF), and 2) improve health related quality of life (HRQOL) and symptoms. The purpose of this paper is to describe the long term HRQOL outcomes in the SPIRIT trial and compare QOL in those who did or did not receive implantable cardioverter defibrillator (ICD) shocks during follow-up. Methods: Ninety participants age 66+10 years, 96% men, 75% with NYHA class II, with an ICD at moderately high risk for recurrent VT/VF were randomized to spironolactone 25mg (N=44) or placebo (N=46). HRQOL was measured every 6 months for 24 months using 3 instruments: Patient Concerns Assessment (PCA), Short Form Health Survey-Veterans Version (SF-36V), and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Linear mixed modeling was used to compare changes in HRQOL across 24-months. ANCOVA was used to compare HRQOL between those getting an ICD shock or not. Results: Over 24-months, there were no differences in HRQOL between the spironolactone vs. placebo groups. Those who experienced at least 1 ICD shock vs. those with no ICD shocks, reported significantly lower HRQOL and more symptoms at 6-months and 24 months. Conclusions: Spironolactone had no significant impact on HRQOL. Patients receiving one or more ICD shocks reported significant reductions in HRQOL and higher symptoms.

Abstract 6: Vitamin D3 Repletion Improves Heart Failure Patient Quality of Life and Neurohormonal Indices

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Heidi Moretti ◽  
Bradley Berry ◽  
Vince Colucci
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Vitamin D ◽  
Vitamin D3 ◽  
Nyha Class ◽  
Heart Failure Patients ◽  
Hydroxyvitamin D ◽  
Cardiopulmonary Exercise ◽  
25 Hydroxyvitamin D

Background: Vitamin D deficiency has been associated with cardiovascular mortality and sudden cardiac death in heart failure patients. Vitamin D may influence parathyroid hormone, the renin-angiotensin axis, natriuretic peptide gene expression, cardiac contractility, and cardiopulmonary function. Heart Failure (HF) studies using vitamin D to date have typically not used adequate repletion doses. Objectives: The primary objectives of this research were to determine if vitamin D repletion over a six month period in New York Heart Association (NYHA) Class II-III HF patients would result in a change in neurohormonal markers, cardiopulmonary exercise parameters, circulating 25- hydroxyvitamin D, and quality of life. Methods: A randomized, double-blinded, placebo-controlled trial assessing adjunctive Vitamin D3 supplementation in the treatment of NYHA Class II-III HF patients was conducted. Patients received 10,000 International Units (IU) per day of vitamin D3 or placebo for 6 months. Inclusion Criteria: 1) 25-hydroxyvitamin D level ≤32 ng/ml 2) stable medical regimen for 3 months. Exclusion Criteria: 1) any clinically unstable medical disorder 2) supplementation of vitamin D3 or D2 of greater than or equal to 2,000 IU/day. Study endpoints were: 1) B-type Natriuretic Peptide (BNP), 2) cardiopulmonary exercise parameters using Shape HF, 3) 25-hydroxyvitamin D, 4) intact parathyroid hormone (PTH), and 5) quality of life with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Statistical analysis included independent samples t-test and multivariate regression. Results: A total of 34 patients completed the study. When adjusted for baseline 25-hydroxyvitamin D, the difference between groups for BNP was significant ([[Unable to Display Character: &#8710;]]540 ±1928 pg/ml placebo vs [[Unable to Display Character: &#8710;]] 35 pg/ml ±1054 pg/ml treatment p=0.009). 25-hydroxyvitamin D was [[Unable to Display Character: &#8710;]]48.9 ±32 ng/ml treatment vs [[Unable to Display Character: &#8710;]]3.6 ± 9.4 ng/ml placebo, p<0.001 (mean 68 ng/ml treatment vs 23 ng/ml placebo). No toxicity was observed with treatment. PTH and exercise chronotropic response index trended towards improvement in the treatment group vs placebo group, respectively (([[Unable to Display Character: &#8710;]]-20 ±20 pg/ml vs [[Unable to Display Character: &#8710;]]7 ±54pg/ml (p=0.06)) and ([[Unable to Display Character: &#8710;]]0.13±0.26 versus [[Unable to Display Character: &#8710;]]-0.03 ± 0.23, p=0.12)). KCCQ quality of life total symptom ([[Unable to Display Character: &#8710;]]16 ±16 treatment vs [[Unable to Display Character: &#8710;]]-12 ±15 placebo, p< 0.001) and individual scores significantly improved from baseline in the treatment group. Conclusions: Preliminary results show that vitamin D3 treatment of 10,000 IU/day in heart failure patients is safe, results in adequate circulating 25-hydroxyvitamin D levels, and achieves improvement in surrogate endpoint markers of HF outcomes.

scholarly journals Exercise Training Improved Longitudinal Intrinsic Left Ventricle Function in Heart Failure with Preserved Ejection Fraction

2019 ◽  
Vol 28 (01) ◽  
pp. 044-049
Author(s):  
Sidhi Purwowiyoto ◽  
Budhi Purwowiyoto ◽  
Amiliana Soesanto ◽  
Anwar Santoso
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
World Health ◽  
Volume Index ◽  
Lv Function ◽  
Preserved Ejection Fraction

Exercise improves morbidity, fatality rate, and quality of life in heart failure with low ejection fraction, but fewer data available in heart failure with preserved ejection fraction (HFPEF).The purpose of this study is to test the hypothesis that exercise training might improve the longitudinal intrinsic left ventricular (LV) function in HFPEF patients.This quasi-experimental study had recruited 30 patients with HFPEF. Exercise training program had been performed for a month with a total of 20 times exercise sessions and evaluated every 2 weeks. Echocardiography was performed before sessions, second week and fourth week of exercise training. Six-minute walk tests (6MWTs) and quality-of-life variables using Minnesota living with HF scoring and the 5-item World Health Organization Well-Being Index scoring were measured before and after exercise as well.Left ventricular filling pressure, represented by the ratio of early diastolic mitral flow velocity/early diastolic annular velocity and left atrial volume index, improved during exercise. The longitudinal intrinsic LV function, represented by four-chamber longitudinal strain, augmented during exercise (p < 0.001). Aerobic capacity, measured by 6MWT, increased significantly (p = 0.001). Quality of life improved significantly during exercise (p < 0.001).Exercise training was suggested to improve the longitudinal intrinsic LV function and quality of life in HFPEF. Clinical Trial Registration: ACTRN12614001042639.

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