scholarly journals Cardiac rehabilitation for patients with heart failure: a national Danish register-based study of predictors of referral and outcomes

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
LC Thygesen ◽  
L Zinckernagel ◽  
H Dalal ◽  
K Egstrup ◽  
C Glumer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Professional Education ◽  
Hospital Readmission ◽  
Lower Risk ◽  
Nyha Class ◽  
Temporal Trends ◽  
Functional Class ◽  
Alternative Methods ◽  
Chronic Obstructive

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background  Heart failure (HF) places a large burden on patients and society as a major cause of morbidity, mortality and healthcare costs. Participation in exercise-based cardiac rehabilitation (CR) in people with HF is a clinically and cost-effective strategy and recommended in international clinical guidelines. Purpose The aims of this study were to: (1) examine the temporal trends and predictors of national CR referral, and (2) compare the risk of hospital readmission and mortality in those referred for CR compared to no referral. Methods All patients in Denmark with incident HF were identified by the Danish Heart Failure Register in the period 2010 to 2018 (n = 33,257) and CR referral assessed within 120 days of hospital admission. Multivariable logistic regression models were used to evaluate the association between CR referral and predictors and to compare risk of hospital readmission and mortality until 1 year between referred and not referred patients. Results Overall, 45.0% of HF patients were referred to exercise-based CR, increasing from 31.7% in 2010 to 52.2% in 2018. Factors independently associated with higher CR referral were: NYHA functional class II, LVEF <50%, diagnosis of myocardial infarction and use of ACE inhibitor. Male gender, older age, region, unemployment, retirement, living alone, non-Danish ethnic origin, lower educational level, NYHA class IV, treatment for hypertension, existing chronic obstructive lung disease and stroke were associated with lower CR referral. CR referral was associated with lower risk of readmission (adjusted odds ratio: 0.90;95%CI: 0.85-0.95), HF-specific mortality (0.61; 0.39-0.95) and all-cause mortality (0.61; 0.55-0.69) as compared to no referral. Conclusions Although CR referral has increased over time, only some 1 in 2 diagnosed HF patients in Denmark are referred to exercise-based CR. CR referral is associated with lower risk in readmissions and mortality. Strategies to promote CR referral including healthcare professional education on the benefits of CR and alternative methods of CR delivery are urgently needed to improve access to CR, especially for high-risk groups.

scholarly journals Prevalence of co-morbid conditions in Heart failure: an experience at tertiary care hospital

2018 ◽  
Vol 6 (2) ◽  
pp. 35-41
Author(s):  
Sahadeb Prasad Dhungana ◽  
Ankit Chaparia ◽  
Sanjib Kumar Sharma
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Tertiary Care ◽  
Functional Class ◽  
Chronic Obstructive ◽  
Care Hospital ◽  
Class Iii ◽  
Cross Sectional ◽  
Co Morbidity ◽  
Morbid Conditions

Introduction: Patients with heart failure (HF) have various co-morbidities that complicate management and may adversely affect outcomes. HF guidelines provide little discussion on this topic and evidence is sparse.Material and Methods: This is a descriptive cross-sectional study on 240 consecutive patients with HF admitted from September 2016 to July 2017 at B.P. Koirala Institute of Health Sciences (BPKIHS), Nepal. All patients admitted with diagnosis of HF with reduced or preserved ejection fraction (NYHA functional class III/IV) based on Framingham Criteria and echocardiography assessments were included. Pre-defined co-morbid conditions were assessed.Results: Mean age of patients was 53.5 years and 53% were female. Most patients were in NYHA class III or IV (25% and 75% respectively) and 28.3% had ischemia as a cause of HF. Among co-morbidities, 85% of patients with HF had at least one co-morbidity. Anemia (68.3%), coronary artery disease (30.4%), hypertension (26.6%), diabetes (18.7%) and chronic kidney disease (7.5%) were the co-morbidities with the highest prevalence. Chronic obstructive pulmonary disease (3.7%), sleep apnea (2.5%), hypothyroidism (2.5%) and stroke (2.5%) were less common. Of all patients, only 15% had no co-morbidity, 40% had one co-morbidity, 22% had two co-morbidities, and 13 % had three or more co-morbidities.Conclusion: Co-morbidities are common problems and anemia is the most common in our scenario which could be of multi-factorial etiology. Careful attention to the diagnosis and management of specific co-morbidities may help to improve outcomes in patients with HF. Journal of Nobel Medical CollegeVolume 6, Number 2, Issue 11 (July-December, 2017) Page:35-41

Revisiting heart failure assessment based on objective measures in NYHA functional classes I and II

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317984
Author(s):  
Mariana Blacher ◽  
André Zimerman ◽  
Pedro H B Engster ◽  
Eduardo Grespan ◽  
Carisi A Polanczyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Heart Association ◽  
Functional Class ◽  
Class I ◽  
Objective Measures ◽  
Functional Evaluation ◽  
Self Perception ◽  
Reduced Ejection Fraction ◽  
Nyha Classification

ObjectiveNew York Heart Association (NYHA) functional class plays a central role in heart failure (HF) assessment but might be unreliable in mild presentations. We compared objective measures of HF functional evaluation between patients classified as NYHA I and II in the Rede Brasileira de Estudos em Insuficiência Cardíaca (ReBIC)-1 Trial.MethodsThe ReBIC-1 Trial included outpatients with stable HF with reduced ejection fraction. All patients had simultaneous protocol-defined assessment of NYHA class, 6 min walk test (6MWT), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and patient’s self-perception of dyspnoea using a Visual Analogue Scale (VAS, range 0–100).ResultsOf 188 included patients with HF, 122 (65%) were classified as NYHA I and 66 (35%) as NYHA II at baseline. Although NYHA class I patients had lower dyspnoea VAS Scores (median 16 (IQR, 4–30) for class I vs 27.5 (11–49) for class II, p=0.001), overlap between classes was substantial (density overlap=60%). A similar profile was observed for NT-proBNP levels (620 pg/mL (248–1333) vs 778 (421–1737), p=0.015; overlap=78%) and for 6MWT distance (400 m (330–466) vs 351 m (286–408), p=0.028; overlap=64%). Among NYHA class I patients, 19%–34% had one marker of HF severity (VAS Score >30 points, 6MWT <300 m or NT-proBNP levels >1000 pg/mL) and 6%–10% had two of them. Temporal change in functional class was not accompanied by variation on dyspnoea VAS (p=0.14).ConclusionsMost patients classified as NYHA classes I and II had similar self-perception of their limitation, objective physical capabilities and levels of natriuretic peptides. These results suggest the NYHA classification poorly discriminates patients with mild HF.

scholarly journals Temporal Trends and Factors Associated With Cardiac Rehabilitation Referral Among Patients Hospitalized With Heart Failure

2015 ◽  
Vol 66 (8) ◽  
pp. 917-926 ◽  
Author(s):  
Harsh Golwala ◽  
Ambarish Pandey ◽  
Christine Ju ◽  
Javed Butler ◽  
Clyde Yancy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Temporal Trends ◽  
Factors Associated

scholarly journals Heart Failure Drug Class Effects on 30-Day Readmission Rates in Patients with Heart Failure with Preserved Ejection Fraction: A Retrospective Single Center Study

Medicines ◽  
2020 ◽  
Vol 7 (5) ◽  
pp. 30
Author(s):  
Priyanka Parajuli ◽  
Odalys Lara-Garcia ◽  
Manjari Regmi ◽  
Warren Skoza ◽  
Mukul Bhattarai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Ejection Fraction ◽  
Hospital Readmission ◽  
Lower Risk ◽  
Loop Diuretics ◽  
Preserved Ejection Fraction ◽  
Day Hospital ◽  
Multivariate Logistic Regression ◽  
Early Readmission

Background: The pharmacologic management of heart failure with preserved ejection fraction (HFpEF) involves far fewer options with demonstrated additional benefit. Therefore, we examined the effect of combination of multiple classes of HF medication in the 30-day hospital readmission in patients with HFpEF. Methods: All adult patients discharged with a diagnosis of HFpEF and a left ventricular ejection fraction (LVEF) of ≥ 50% reported during the admission or within the previous six months from our institution were retrospectively studied for a 30-day hospital readmission risk. Individual as well as combination drug therapy at the time of hospital discharge were evaluated using Pearson chi2 test and multivariate logistic regression. Results: The overall 30-day readmission rate in this HFpEF cohort of 445 discharges was 29%. Therapy with loop diuretics (p = 0.011), loop diuretics and angiotensin receptor blocker (p = 0.043) and loop diuretics and beta blockers (p = 0.049) were associated with a lower risk of 30-day hospital readmission. Multivariate logistic regression revealed only loop diuretics to be associated with a lower risk of hospital readmission in patients with HFpEF (OR 0.59; 95% CI, 0.39-0.90; p = 0.013). Conclusions: Our study revealed that loop diuretics at discharge decreases early readmission in patients with HFpEF. Further, our study highlights the implication of a lack of guidelines and treatment challenges in HFpEF patients and emphasizes the importance of a conservative approach in preventing early readmission in patients with HFpEF.

Association of Physical Activity and Prognostic Parameters in Elderly Patients With Heart Failure

2011 ◽  
Vol 19 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Melissa Jehn ◽  
Arno Schmidt-Trucksäss ◽  
Henner Hanssen ◽  
Tibor Schuster ◽  
Martin Halle ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Nyha Class ◽  
Clinical Status ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure

Objective:Assessment of habitual physical activity (PA) in patients with heart failure.Methods:This study included 50 patients with heart failure (61.9 ± 4.0 yr). Seven days of PA were assessed by questionnaire (AQ), pedometer, and accelerometer and correlated with prognostic markers including VO2peak, percent left-ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and New York Heart Association (NYHA) functional class.Results:Accelerometry showed a stronger correlation with VO2peak and NYHA class (R = .73 and R = −.68; p < .001) than AQ (R = .58 and R = −.65; p < .001) or pedometer (R = .52 and R = −.50; p < .001). In the multivariable regression model accelerometry was the only consistent independent predictor of VO2peak (p = .002). Moreover, when its accuracy of prediction was tested, 59% of NYHA I and 95% of NYHA III patients were correctly classified into their assigned NYHA classes based on their accelerometer activity.Conclusion:PA assessed by accelerometer is significantly associated with exercise capacity in patients with heart failure and is predictive of disease severity. The data suggests that PA monitoring can aid in evaluating clinical status.

scholarly journals Raised homocystein plasma concentration in patients with Heart Failure: clinical significance

2016 ◽  
Vol 68 (2) ◽  
Author(s):  
E. Vizzardi ◽  
S. Nodari ◽  
C. Fiorina ◽  
M. Metra ◽  
L. Dei Cas
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Vascular Disease ◽  
Plasma Levels ◽  
Nyha Class ◽  
Plasma Homocysteine ◽  
Functional Class ◽  
Nyha Functional Class ◽  
Control Subjects ◽  
Patients With Heart Failure

Elevated plasma levels of homocysteine is associated with increased risk of thrombotic and atherosclerotic vascular disease. Several studies have demonstrated that hyperhomocysteinemia is an indipendent risk factor for vascular disease and is associated to heart failure. However there are no data regarding the association between homocysteine and various objective as well as subjective measures of heart failure. We hypothesized that plasma homocysteine is associated with clinical and echocardiographic signs of heart failure. On this ground we have analysed levels of homocysteine in patients with heart failure and possible correlation between these levels and clinical-functional pattern (NYHA class and ejection fraction). Methods: Plasma homocysteine levels were determined in 123 patients with dilated cardiomyopathy (59 males, 64 females, mean age 67±10 years, mean EF 31±11% and mean NYHA 2.4±0.9, 47 idiopatic and 76 postischemic cardiomyopathy) and 85 healthy control subjects (homogeneus group for sex and age). Patients with chronic renal failure, vitamin B12 and folate deficiency or factors affecting homocysteine plasma levels were escluded from this study. Homocysteine levels were determined in coded plasma samples by immunoenzimatic methods. Results: Patients with heart failure had a higher homocysteine level (mcg/L) than control subjects (21.72±10.28 vs 12.9±6.86, p&lt;0,001) both postischemic (20.89±9.6 vs 12.9±6.86, p&lt;0,001) and idiopatic cardiomiopathy (23.0±11.2 vs 12.9±6.86, p&lt;0,001). A significant correlation was observed between homocysteine and NYHA functional class (p&lt;0,001), age (p&lt;0,001), creatinine (p&lt;0,001), colesterol (p&lt;0,05) while no correlations were observed with hemodynamic (HR, BP), functional (ejection fraction) and other metabolic parameters (triglycerides). Serum homocysteine was lowest in control and increased with increasing NYHA class. In idiopatic cardiomiopathy the correlation between homocysteine and NYHA functional class, creatinine (p&lt;0,001), fibrinogen (p&lt;0,05) was confirmed; in postischemic cardiomiopathy a significant correlation with creatinine and NYHA class (p&lt;0,001) and with triglycerides (p&lt;0,05) was also found. Conclusion: Plasma homocysteine was directly related to NYHA class. This observation may underline the strong relations of plasma homocysteine to congestive heart failure. Further research is indicated to evaluate a causal or noncausal mechanism for this association.

scholarly journals New York Heart Association Functional Class correlated with Depression: Study in Saiful Anwar Hospital

2021 ◽  
Vol 2 (3) ◽  
pp. 25-30
Author(s):  
Yusuf Arifin ◽  
Mohammad Saifur Rohman ◽  
Cholid Tri Tjahjono ◽  
Djanggan Sargowo ◽  
Anna Fuji Rahimah
Keyword(s):  
Heart Failure ◽  
New York ◽  
Marital Status ◽  
Rating Scale ◽  
Nyha Class ◽  
Heart Association ◽  
Functional Class ◽  
Baseline Characteristic ◽  
Significant Difference ◽  
New York Heart Association

Background: Heart Failure prevalence was raising as one of the most Objective: to find the correlation of New York Heart Association Functional Class in heart failure patient with Depression Method: This cross-sectional study recruited 342 patients diagnosed with HF with previously for more than 3 months, at dr. Saiful Anwar General Hospital during December 2016 to March 2021. Each patient was interviewed for their demography data, and their clinical data, and assessed for their depression with Montgomery-Asberg Depression Rating Scale for Indonesian version. We used Spearman coefficients (rs) to evaluate the correlations between variables. Results: Baseline characteristic among depression and non-depression group demonstrated no significant difference (p>0.05), but for marital status. Populations was predominantly male, with ACE-i/ARB and Beta-blockers treatment. Non predominant treatment was MRAs, Diuretics, Digoxin. Baseline age was 22 years old until 87 years old. Baseline LVEF was 50.4±12.9%. (p >0.05). There were significant correlations between NYHA Class and marital status (p < 0.05), while the other baseline was not significantly different. We performed log regression for the confounding. The result was NYHA Class significantly correlated with and effects the depression. Conclusion: In heart failure patients, NYHA Class was significantly correlated with depression.

scholarly journals Biomarker sST2 in Adults with Transposition of the Great Arteries Palliated by Mustard Procedure

2020 ◽  
Vol 3 ◽  
Author(s):  
Haley Ferguson ◽  
Hugo Martinez ◽  
Melanie Pride ◽  
Roger Hurwitz ◽  
Mark Payne
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Mechanical Strain ◽  
Functional Class ◽  
Control Group ◽  
Class Iii ◽  
Healthy Individuals ◽  
Mustard Operation ◽  
Lipid Panel ◽  
Mustard Procedure

Background: Transposition of the great arteries (TGA) is a congenital heart defect (CHD) in which the aorta and pulmonary artery are transposed; it requires urgent surgical intervention. The Mustard procedure was an early surgery allowing survival into adulthood. However, this procedure is associated with long-term adverse effects including arrhythmias and heart failure (HF). A key factor impairing HF management in adults with CHD is lack of biomarkers to predict outcome. Soluble ST2 (sST2) is a protein secreted by myocytes in response to mechanical strain and fibrosis. No studies have focused specifically on sST2 in TGA individuals that underwent a Mustard procedure.  In this study, we hypothesized adults with TGA palliated with a Mustard procedure would have higher levels of sST2 than healthy individuals, and this would correlate with functional class status.      Methods: We screened the Pediatric Cardiology database for D-TGA subjects and Mustard operation. Healthy controls were recruited from clinic and the community. Patients were matched by age to a control group of 21 healthy individuals.  Severity of symptoms was assessed by NYHA functional classification. sST2 levels were obtained using Critical Diagnostics Presage ST2 Assay kit. Additionally, cTnI, BNP, lipid panel, insulin, glucose, and EKG and echocardiography (TGA) were obtained at IUSM clinical laboratories.      Results: We identified 45 patients with D-TGA and Mustard operation. 19 patients were included in analysis: 12 male and 7 female subjects aged 18 to 46, mean of 34.9 years. In the Mustard group, 9 subjects were assigned to NYHA class II, and 9 to class III. The control group was asymptomatic. sST2 levels in the Mustard group were elevated in 53%, while only 29% in the controls. Of the Mustard subjects with elevated sST2, 67% had elevated cTnI, 80% arrhythmias, 70% EKG T-wave abnormalities, and 80% took cardiac medications.  90% of these patients had low HDL, 40% high LDL, and 40% low insulin.      Conclusion: This study demonstrates patients with Mustard operation averaged higher sST2 levels than healthy subjects. Importantly, of the patients with elevated levels, there was a significant association of sST2 with biomarker abnormalities and clinical heart failure signs.  This suggests in patients with D-TGA palliated with Mustard procedure, sST2 may add predictive value to cardiac related morbidity and mortality.  

scholarly journals Efficiency of vaccine prophylaxis concentrated pneumococcal vaccine in patients with chronic obstructive lung disease and chronic heart failure

2018 ◽  
Vol 90 (8) ◽  
pp. 53-62 ◽  
Author(s):  
G L Ignatova ◽  
V N Antonov
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Pneumococcal Vaccine ◽  
Clinical Symptoms ◽  
Dynamic Assessment ◽  
Chronic Obstructive Lung Disease ◽  
Management Plan ◽  
Functional Class ◽  
Chronic Obstructive ◽  
Vaccine Prophylaxis

The article uses the analysis of clinical and pharmacoeconomic effectiveness of 13-valent conjugated pneumococcal vaccine in patients with combined course of chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD) and chronic heart failure (CHF). Materials and methods. 429 male patients with diagnoses of COPD, IHD, CHF were included in the study. The main endpoints of observation, for 5 years, for evaluation of effectiveness were dynamic assessment for class CHF, the number of exacerbations, hospitalizations, the number of pneumonias. The 13-valent conjugated pneumococcal vaccine (PCV13) Prevenar-13 was used for vaccine prophylaxis. Results and discussion. The increase in age with the combined course of COPD and cardiovascular pathology leads to a deterioration in the basic clinical and functional indicators. With the increase in the clinical symptoms of the defeat of the respiratory system. There is an increase in the functional class of heart failure. Inclusion of vaccine prophylaxis PCV13 in the management plan of patients with combined pathology. Reduce the degree of dyspnea and stabilize the main functional indicators. Conclusions. Vaccination of patients with COPD using PCV13 combined with CHF and IHD made it possible to manage the health system expenses by 74-84%.

Abstract 13936: Practitioners’ Inaccuracy in Decision-making With Assessing NYHA Functional Class of Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marilyn A Prasun ◽  
Kelly D Stamp ◽  
Thomas P McCoy ◽  
Lisa Rathman
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Nyha Class ◽  
The United States ◽  
Functional Class ◽  
Evidence Based ◽  
Advanced Practice ◽  
Nyha Functional Class

Introduction: Heart failure (HF) is a major public health problem and timely evidence-based guideline directed treatment is essential to ensure optimal patient outcomes. New York Heart Association (NYHA) functional class of HF patients is a clinically important assessment as it relates to treatment recommendations. Purpose: The purpose of this study was to examine HF providers’ decision making and ability to correctly assign NYHA functional class. Methods: A cross-sectional, correlational study using survey methods with 244 physicians, advanced practice nurses and physician assistants practicing in the United States in acute and ambulatory care settings that treat adult patients with HF was conducted. Providers completed 8 validated clinical vignettes focused on decision making that related to the four NYHA functional classes. Descriptive statistics and multivariable regression were used to analyze the data. Results: Participants were predominately female (83%), Caucasian (87%) and were on average 51 years of age (SD=11). Sixty-five percent were nurse practitioners and 18% physicians, most were certified in HF (59%) and on average worked with HF patients for 15.1 years (SD=9.6). Providers reported assigning NYHA class to 83% of their patients, with 39% reporting it was useful. Accurate identification of NYHA Class I was 78.7%, for Class II 57.4%, for Class III 59.8% and for Class IV 36.9%. Correct NYHA class scores were associated with providers who typically reported assigning HF stage (p<0.001), increased number of HF patients seen per week (p=0.024) and MD/DO providers relative to other advanced practice providers (p=0.021). Correct NYHA class scores were not associated with years working in a healthcare role, years working in HF, or years of certification adjusting for other provider and practice characteristics. Conclusions: Advanced practice providers who saw fewer HF patients had greater difficulty with accurately assigning NYHA Functional Class. When patients are incorrectly classed, they may not be recommended for evidence-based therapies at the optimal time, thus decreasing patient outcomes. Future research should focus on ways to improve accuracy in assigning NYHA Functional Class to improve patient outcomes.

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