scholarly journals Prevalence and effect of cardiac cachexia in advanced heart failure patients living in northern ireland

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
M Carson ◽  
J Reid ◽  
L Hill ◽  
L Dixon ◽  
P Donnelly ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Northern Ireland ◽  
Muscle Mass ◽  
Nyha Class ◽  
Advanced Heart Failure ◽  
Class Iii ◽  
Upper Arm ◽  
Cardiac Cachexia

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Northern Ireland Chest Heart and Stroke Background/Introduction: Cardiac cachexia (CC) is a multifactorial wasting syndrome, resulting in significant weight loss and reduction in muscle mass. This is reflected in a detrimental effect on the patients’ physical condition, quality of life and increases the patient’s risk of premature death. Nonetheless, cardiac cachexia remains frequently unrecognised in clinical practice and therefore understudied. Purpose To determine the prevalence and effect of cardiac cachexia in 200 patients with advanced heart failure (NYHA class III-IV) living in Northern Ireland. Methods A mixed methods cross sectional study of patients recruited from a regional heart failure centre. A total of 200 patients with NYHA class III-IV heart failure were consented, enrolled and detailed data collected from their records. Anthropometric measures were taken (i.e. measures of lean muscle mass and fat tissue) and each individual completed three validated questionnaires - EQ-5D-5L (quality of life), FACIT-Fatigue and FAACT (various wellbeing subscales). Results This population was predominately male (65.5%), with an average age of 74.4 years. Of the 200 NYHA class III-IV patients recruited, 30 were identified as cachectic (15%) Physically, cachectic patients were approximately 25 kg lighter than non-cachectic patients (p < 0.01) with an average BMI of 21.8 ± 4.4. The cachectic group showed significant reductions in mid-upper arm circumference (p < 0.01), skinfold thickness (p < 0.01) and upper arm fat area (p < 0.01), in comparison to the non-cachectic group. Measures of muscle mass were reduced, for example upper arm muscle circumference and area (p < 0.01), as well as grip strength (p < 0.01 for both right and left hands). Quality of life results from the EQ-5D-5L [see figure part b)] indicated an overall reduction for the cachectic group (p = 0.047). Of the EQ-5D-5L subscales, mobility and ‘usual activities’ were significantly reduced (p = 0.02 and p < 0.01 respectively), highlighting a significant change in the daily routine and ability of these patients. The FACIT-Fatigue questionnaire showed cachectic patients to be significantly more fatigued (p < 0.01) [see figure part a)], whilst the FAACT demonstrated reduced physical wellbeing (p = 0.02) and greater issues with diet and appetite (p < 0.01). Conclusions This is the first prevalence study of cardiac cachexia within Northern Ireland. The 15% prevalence rate shows that the syndrome is relatively common in the advanced heart failure population. Cardiac Cachexia has severe physical consequences, attributed to an individual’s weight loss in both fat and muscle tissue. Such changes may explain the subsequent decrease in mobility and the ability of these patients to conduct their ‘usual activities’. Increased fatigue, reduced physical wellbeing and issues with diet and appetite only intensify these dire physical effects. It is hoped that these results will highlight the impact of this syndrome and promote targeted interventions.

scholarly journals An exploration of the prevalence and experience of cardiac cachexia: protocol for a mixed methods cross-sectional study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Matthew A. Carson ◽  
Joanne Reid ◽  
Loreena Hill ◽  
Lana Dixon ◽  
Patrick Donnelly ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Cancer Cachexia ◽  
Severe Heart Failure ◽  
Cross Sectional Study ◽  
Advanced Heart Failure ◽  
Sectional Study ◽  
Cross Sectional ◽  
Cardiac Cachexia

Abstract Background Cachexia is a complex and multifactorial syndrome defined as severe weight loss and muscle wasting which frequently goes unrecognised in clinical practice [1]. It is a debilitating syndrome, resulting in patients experiencing decreased quality of life and an increased risk of premature death; with cancer cachexia alone resulting in 2 million deaths per annum [2]. Most work in this field has focused on cancer cachexia, with cardiac cachexia being relatively understudied – despite its potential prevalence and impact in patients who have advanced heart failure. We report here the protocol for an exploratory study which will: 1. focus on determining the prevalence and clinical implications of cardiac cachexia within advanced heart failure patients; and 2. explore the experience of cachexia from patients’ and caregivers’ perspectives. Methods A mixed methods cross-sectional study. Phase 1: A purposive sample of 362 patients with moderate to severe heart failure from two Trusts within the United Kingdom will be assessed for known characteristics of cachexia (loss of weight, loss of muscle, muscle mass/strength, anorexia, fatigue and selected biomarkers), through basic measurements (i.e. mid-upper arm circumference) and use of three validated questionnaires; focusing on fatigue, quality of life and appetite. Phase 2: Qualitative semi-structured interviews with patients (n = 12) that meet criteria for cachexia, and their caregivers (n = 12), will explore their experience of this syndrome and its impact on daily life. Interviews will be digitally recorded and transcribed verbatim, prior to qualitative thematic and content analysis. Phase 3: Workshops with key stakeholders (patients, caregivers, healthcare professionals and policy makers) will be used to discuss study findings and identify practice implications to be tested in further research. Discussion Data collected as part of this study will allow the prevalence of cardiac cachexia in a group of patients with moderate to severe heart failure to be determined. It will also provide a unique insight into the implications and personal experience of cardiac cachexia for both patients and carers. It is hoped that robust quantitative data and rich qualitative perspectives will promote crucial clinical discussions on implications for practice, including targeted interventions to improve patients’ quality of life where appropriate.

scholarly journals Health Related Quality of Life in Systolic Heart Failure Patients at Tertiary Care Unit Cardiology OPD Hayatabad Medical Complex Peshawar Pakistan

2021 ◽  
Vol 10 (3) ◽  
pp. 140-146
Author(s):  
Ahsan Ullah ◽  
Ayaz Ayub ◽  
Bakhtawar Shah ◽  
Rahmat Ghaffarr ◽  
Awal Khan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Nyha Class ◽  
Tertiary Care ◽  
Systolic Heart Failure ◽  
Demographic Variables ◽  
Class Iii ◽  
Heart Failure Patients ◽  
Related Quality

Background: Heart failure is a leading cardiac morbidity prevalent across the globe. Its incidence is rising in direct proportion to increasing longevity all over the world. Demographic variables are important predictors of quality of life, morbidity, rehospitalization, and mortality due to systolic heart failure. The objective of our study was to assess the association of demographic variables with quality of life of systolic heart failure in patients presenting at Cardiology Out Patient Department, Hayatabad Medical Complex, Peshawar. Our study aims to inform policy making as it highlights some important demographics factors associated with quality of life. Methods: A cross sectional method was employed in the study to examine systolic heart failure and its prevalence across various demographic variables such as age, gender, marital status, activity, number of children, education, employment status, and BMI at cardiology OPD of a medical teaching institution in Peshawar. Consecutive sampling was used and data were collected through a structured questionnaire from 368 Systolic Heart Failure patients. Data were analyzed using SPSS version 22. Results: We had 368 participants, a majority of whom (n=290; 78.8%), were in NYHA class III. The rest (n=78; 21.2%) were in class IV. Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to categorize quality of life into ‘Good’, ‘Moderate’ and ‘Poor’. Most participants were in the ‘poor’ category with MLHFQ scores >45 (n=193; 52.4%). Those who had scores between 25 -45 were categorized as ‘moderate’ (n=116; 31.5%), and participants who scored < 24 were categorized as having a ‘good’ quality of life (n=59; 16%). Reliability of tools was checked by Cronbach alpha which was 0.86 Conclusion: It was concluded that demographic variables have a significant effect on the overall morbidity of heart failure patients and heart failure related quality of life.

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.

Abstract 14647: Stress Echocardiography Predicts Heart Failure Progression and Alters Management Strategies in Patients with Hypertrophic Cardiomyopathy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ethan J Rowin ◽  
Barry J Maron ◽  
Iacopo Olivotto ◽  
Susan A Casey ◽  
Anna Arretini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Management Strategies ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Outflow Tract ◽  
Class I ◽  
Class Iii ◽  
Outflow Obstruction ◽  
Heart Failure Progression

Background: One-third of HCM patients without left ventricular outflow tract obstruction under resting conditions have the propensity to develop an outflow gradient with physiologic exercise. However, the natural history and management implications of exercise-induced (i.e., provocable) obstruction is unresolved. Methods: We prospectively studied 533 consecutive HCM patients without outflow obstruction at rest (<30mmHg) who underwent a symptom limiting stress (exercise) echocardiogram to assess development of outflow obstruction following physiologic provocation and followed for 6.5 ± 2.0 years. Of the 533 patients, obstruction ≥ 30 mmHg was present following exercise in 262 patients (49%; provocable obstruction), and was absent both at rest and with exercise in 271 (51%; nonobstructive). Results: Over the follow-up period, 43 out of 220 (20%) HCM patients with provocable obstruction and baseline NYHA class I/II symptoms developed progressive limiting heart failure symptoms to class III/IV, compared to 24 of 249 (10%) nonobstructive patients. Rate of heart failure progression was significantly greater in patients with provocable obstruction vs. nonobstructive patients (3.1%/year vs. 1.5%/year; RR=2.0, 95% CI of 1.3-3.2; p=0.003). However, the vast majority of patients with provocable obstruction who developed advanced heart failure symptoms achieved substantial improvement in symptoms to class I / II following relief of obstruction with invasive septal reduction therapy (n=30/32; 94%). In comparison, the majority of nonobstructive patients who developed advanced heart failure remained in class III/IV (16/24;67%), including 10 (42%) currently listed for heart transplant. Conclusions: Stress (exercise) echocardiogram identifies physiological provocable outflow tract obstruction in HCM, and is a predictor of future risk for progressive heart failure (3.1%/year), in patients who become candidates for invasive septal reduction therapy. Therefore, exercise echocardiography should be considered in all HCM patients without obstruction under resting conditions.

Virtual reality for pain management in advanced heart failure: A randomized controlled study

2021 ◽  
pp. 026921632110412
Author(s):  
Hunter Groninger ◽  
Diana Stewart ◽  
Julia M Fisher ◽  
Eshetu Tefera ◽  
James Cowgill ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Virtual Reality ◽  
Pain Management ◽  
Guided Imagery ◽  
Advanced Heart Failure ◽  
Controlled Study ◽  
Randomized Controlled ◽  
General Distress

Background: Hospitalized patients with advanced heart failure often experience acute and/or chronic pain. While virtual reality has been extensively studied across a wide range of clinical settings, no studies have yet evaluated potential impact on pain management on this patient population. Aim: To investigate the impact of a virtual reality experience on self-reported pain, quality-of-life, general distress, and satisfaction compared to a two-dimensional guided imagery active control. Design: Single-center prospective randomized controlled study. The primary outcome was the difference in pre- versus post-intervention self-reported pain scores on a numerical rating scale from 0 to 10. Secondary outcomes included changes in quality-of-life scores, general distress, and satisfaction with the intervention. Setting/participants: Between October 2018 and March 2020, 88 participants hospitalized with advanced heart failure were recruited from an urban tertiary academic medical center. Results: Participants experienced significant improvement in pain score after either 10 minutes of virtual reality (change from pre- to post −2.9 ± 2.6, p < 0.0001) or 10 minutes of guided imagery (change from pre- to post −1.3 ± 1.8, p = 0.0001); the virtual reality arm experienced a 1.5 unit comparatively greater reduction in pain score compared to guided imagery ( p = 0.0011). Total quality-of-life and general distress scores did not significantly change for either arm. Seventy-eight participants (89%) responded that they would be willing to use the assigned intervention again. Conclusion: Virtual reality may be an effective nonpharmacologic adjuvant pain management intervention in hospitalized patients with heart failure. Trial Registration: ClinicalTrials.gov database (NCT04572425).

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 Sex Differences in Quality of Life and Clinical Outcomes in Patients With Advanced Heart Failure

2020 ◽  
Vol 13 (4) ◽  
Author(s):  
Lauren K. Truby ◽  
Christopher O’Connor ◽  
Mona Fiuzat ◽  
Amanda Stebbins ◽  
Adrian Coles ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Sex Differences ◽  
Clinical Outcomes ◽  
Advanced Heart Failure

Clinical Outcome and Quality of Life with an Ambulatory Counterpulsation Pump (iVAS) in Advanced Heart Failure Patients

2018 ◽  
Vol 24 (11) ◽  
pp. 810
Author(s):  
V. JEEVANANDAM ◽  
D. ONSAGER ◽  
T. SONG ◽  
T. OTA ◽  
C. JURICEK ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Clinical Outcome ◽  
Advanced Heart Failure ◽  
Heart Failure Patients
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