Impact of a cardiovascular rehabilitation program on frailty indicators in elderly patients with heart disease

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
L Fonteles Ritt ◽  
F Matos E Oliveira ◽  
JV Santos Pereira Ramos ◽  
R Braga Linhares De Albuquerque ◽  
Q Borges De Oliveira ◽  
...  
Keyword(s):  
New York ◽  
Heart Disease ◽  
Elderly Patients ◽  
Functional Capacity ◽  
Heart Association ◽  
Rehabilitation Program ◽  
Categorical Variables ◽  
Class Iii ◽  
Chi Square ◽  
Cardiovascular Rehabilitation

Abstract Funding Acknowledgements Type of funding sources: Private hospital(s). Main funding source(s): Hospital Cardio Pulmonar INTRODUCTION Frailty has been considered an important predictor of morbidity and mortality in elderly patients with cardiovascular disease. Cardiovascular Rehabilitation (CVR) has a direct and unequivocal effect on improving functional capacity in patients with heart disease, however, the effect of CVR on frailty indicators has not yet been well established. PURPOSE: To evaluate the association of the CVR program with frailty indicators in elderly patients with heart disease referred to a cardiovascular rehabilitation program and to identify possible predictors of improvement in frailty in this population. METHODS: Retrospective cohort with patients over 65 years old referred to an CVR program in Salvador-BA, Brazil from August / 2017 to March / 2020. Frailty was assessed using the Edmonton Frail Scale (EFS) at baseline and at least 3 months after the start of the program. Student"s t and Chi-square tests were used to compare continuous and categorical variables, respectively, logistic regression to analyze independent predictors of improvement in frailty and p <0.05 adopted as statistically significant. RESULTS: 51 patients were included, with a mean age of 75 ± 6 years, 65% men, 39 (77%) with coronary artery disease, 23 (50%) with heart failure, 21 (41%) with diabetes, 34 (67%) with hypertension and 41 (80%) dyslipidemia. According to the American Heart Association (AHA) risk stratification for exercise, 21 (49%) were risk B and 22 (51%) risk C. Regarding functional capacity, 12 (31%) were class I, 21 (41%) class II, 5 (13%) class III and 1 (3%) class IV according to the New York Heart Association (NYHA). The average initial ejection fraction was 53 ± 16%. The mean time between the two assessments was 5 ± 2 months and the improvement observed in maximum oxygen consumption (VO2 max) was from 15 ± 4 to 16 ± 4 mL.Kg-1.min-1 (p = 0.001). Regarding frailty, there was an improvement from 5.4 ± 2.0 to 4.8 ± 1.9 in the average of the EFS score (p = 0.034), with 25 patients (49%) being considered responders. This group was predominantly formed by men, non-diabetics, using statins, at risk B (AHA) and with a higher score on the quality of life score and on the EFS. However, in the multivariate analysis, only the highest score on the EFS (OR 1.8 CI 95% 1.06-3.3; p <0.05) and the lowest risk on the AHA scale (OR 0.18 CI 95% 0.03-0.97; p <0.05) remained as independent predictors of response. CONCLUSIONS: There was a significant improvement in the frailty of elderly patients referred for CVR, the higher the baseline frailty score, the greater the chance of response.

Abstract 15709: Older and Younger Patients’ Perceptions, Evaluations, and Responses to Worsening Heart Failure Symptoms

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Chin-Yen Lin ◽  
Muna Hammash ◽  
Gia Mudd-martin ◽  
Martha J Biddle ◽  
Debra K Moser
Keyword(s):  
Heart Failure ◽  
New York ◽  
Older Patients ◽  
Early Recognition ◽  
Heart Association ◽  
Symptom Distress ◽  
Class Iii ◽  
Somatic Awareness ◽  
Chi Square ◽  
Younger Patients

Background: Adequate self-care abilities, such as early recognition of and appropriate responses to worsening heart failure (HF) symptoms, are important to prevent further deterioration and avoid unnecessary hospitalization. Patients with HF have difficulty recognizing and responding to worsening symptoms promptly and this problem seems to be worse in older compared to younger patients. Objective: The aims of this study were (1) to compare perceptions, evaluations, and responses to worsening HF symptoms before a hospital admission between older and younger patients, and (2) to compare older and younger patients’ responses when they perceived higher symptom distress. Methods: Data on patients’ perceptions, evaluations, and responses to worsening HF symptoms were collected using HF Somatic Awareness Scale and Modified Response to Symptoms Questionnaire from 185 patients hospitalized with HF (mean age 62 ± 13 years; 51% male; 66% New York Heart Association class III/IV). We compared data between younger and older patients using a cutoff at age 65. Independent t -test, chi-square, and two-way ANOVA were performed. Results: Compared with younger patients, older patients were more likely to attribute their symptoms to aging ( p = 0.003) and to have lower somatic awareness ( p = 0.014); however, there were no significant differences between older and younger patients in their responses to worsening HF symptoms. In response to higher perceived symptom distress, regardless of age grouping, patients at first did nothing and hoped their symptoms would go away ( p = 0.004), ignored symptoms and continued doing what was doing ( p = 0.002), or laid down and tried to relax ( p < 0.001). No other strategies such as self-medicated, contacted doctors, and went to hospital were significantly associated with higher symptom distress. Conclusions: Regardless of age, patients with HF do not respond appropriately to worsening HF symptoms. Older patients have lower somatic awareness, which may partially explain their lack of appropriate response, but younger patients with better somatic awareness do not respond any more appropriately. Interventions should be tested that target better symptom appraisal and promote appropriate symptom responses in patients with HF across all ages.

Early Experience With Sacubitril/Valsartan in Adult Patients With Congenital Heart Disease

2019 ◽  
Vol 10 (3) ◽  
pp. 292-295 ◽  
Author(s):  
Gentian Lluri ◽  
Jeannette Lin ◽  
Leigh Reardon ◽  
Pamela Miner ◽  
Katrina Whalen ◽  
...  
Keyword(s):  
New York ◽  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Nyha Class ◽  
Heart Association ◽  
Class Ii ◽  
Class Iii

Background: Heart failure (HF) is the leading cause of hospitalizations and death in patients with adult congenital heart disease (ACHD). Sacubitril/valsartan is a new agent in the treatment of HF, but its effects have not been assessed in ACHD. Methods: We retrospectively studied all 15 patients with ACHD at our center who were prescribed sacubitril/valsartan between June 2017 and June 2018. We assessed baseline characteristics and clinical and laboratory changes after initiation of sacubitril/valsartan. Adverse events, including renal function, medication intolerance, and worsening HF were documented. Results: The median age was 53.2 (27.6-83.6) years, with a median follow-up duration of 69 (8-419) days. At baseline, all patients had refractory HF despite guideline-directed medical therapy, with ten (67%) patients as New York Heart Association (NYHA) class II, and five (33%) patients NYHA class III. The medication was discontinued in one (7%) patient secondary to worsening kidney function. No patients reported clinical deterioration; four NYHA class III patients with complex CHD, pulmonary hypertension, and cyanosis reported significant improvement to NYHA class II. Baseline creatinine was 1.1 (0.9-1.7) and two weeks after starting sacubitril/valsartan it was 1.3 (0.8-2.5, P = .22). Conclusions: Sacubitril/valsartan seems to be well tolerated in patients with ACHD who present with refractory HF symptoms. Patients with complex CHD associated with cyanosis and pulmonary hypertension could benefit the most, but larger studies are needed to assess the safety as well as the effectiveness of sacubitril/valsartan in this patient population.

scholarly journals Heart Disease and its Consequence in Pregnancy

2012 ◽  
Vol 7 (1) ◽  
pp. 7-9
Author(s):  
Fatima Wahid ◽  
Firoza Begum ◽  
Umme Kulsum ◽  
Kaniz Fatema ◽  
Farzana Sharmin ◽  
...  
Keyword(s):  
New York ◽  
Heart Disease ◽  
Prospective Observational Study ◽  
Heart Diseases ◽  
Nyha Class ◽  
Heart Association ◽  
Normal Vaginal Delivery ◽  
Class Iii ◽  
New York Heart Association ◽  
Rheumatic Heart

The aim of the study is to evaluate the types of heart disease common in our pregnant woman and to assess its influence on the maternal outcome. This was a prospective observational study. The study was carried out in the department of obstetrics & Gynecology in BSMMU from Jan 2006 to Dec 2006. Thirty-five consecutive cases with heart diseases were included in the study. Out of 35 Cases, 26(74.3%) were suffering from rheumatic heart diseases and only 9 (25.7%) patients were suffering from congenital heart disease. Based on New York heart Association (NYHA) functional classification, 28(80%) belonged to NYHA class I, 5 (71.212%) belonged to NYHA class II and 2(28.57%) belonged to class III heart disease on presentation. The number of caeserian section was 33(94.28%) and normal vaginal delivery (5.71%). In this study only 1 woman of NYHA III disease expired. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10201 UHJ 2011; 7(1): 7-9

Illness Perception and Its Changes During Six Months After Cardiac Rehabilitation

2019 ◽  
Vol 26 (3) ◽  
pp. 90-100
Author(s):  
Justė Lukoševičiūtė ◽  
Kastytis Šmigelskas
Keyword(s):  
New York ◽  
Social Factors ◽  
Nyha Class ◽  
Illness Perception ◽  
Heart Association ◽  
Class Iii ◽  
Cognitive Representations ◽  
Coronary Syndrome ◽  
Type D ◽  
New York Heart Association

Abstract. Illness perception is a concept that reflects patients' emotional and cognitive representations of disease. This study assessed the illness perception change during 6 months in 195 patients (33% women and 67% men) with acute coronary syndrome, taking into account the biological, psychological, and social factors. At baseline, more threatening illness perception was observed in women, persons aged 65 years or more, with poorer functional capacity (New York Heart Association [NYHA] class III or IV) and comorbidities ( p < .05). Type D personality was the only independent factor related to more threatening illness perception (βs = 0.207, p = .006). At follow-up it was found that only self-reported cardiovascular impairment plays the role in illness perception change (βs = 0.544, p < .001): patients without impairment reported decreasing threats of illness, while the ones with it had a similar perception of threat like at baseline. Other biological, psychological, and social factors were partly associated with illness perception after an acute cardiac event but not with perception change after 6 months.

scholarly journals Association between ventilatory efficiency, oxygen uptake, and Glittre-ADL test results in patients with chronic heart failure: a preliminary study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Hebert Olímpio Júnior ◽  
Agnaldo José Lopes ◽  
Fernando Silva Guimarães ◽  
Sergio Luiz Soares Marcos da Cunha Chermont ◽  
Sara Lúcia Silveira de Menezes
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Functional Capacity ◽  
Treatment Plan ◽  
Minute Ventilation ◽  
Heart Association ◽  
Gas Analysis ◽  
Ventilatory Efficiency ◽  
Scale Scores

Abstract Objective The Glittre-ADL test (GA-T) is a functional capacity test that stands out for encompassing multiple tasks similar to activities of daily living. As ventilatory efficiency is one of the variables valued in the prognosis of chronic heart failure (CHF), this study aimed to evaluate associations between functional capacity and ventilatory variables in patients with CHF during the GA-T. Results Eight patients with CHF and New York Heart Association (NYHA) functional classification II–III underwent the GA-T coupled with metabolic gas analysis to obtain data by means of telemetry. The median total GA-T time was 00:04:39 (00:03:29–00:05:53). Borg dyspnoea scale scores before and after the GA-T were 2 (0–9) and 3 (1–10), respectively (P = 0.011). The relationship between the regression slope relating minute ventilation to carbon dioxide output (VE/VCO2 slope) was correlated with the total GA-T time (rs = 0.714, P = 0.047) and Borg dyspnoea score (rs = 0.761, P = 0.028). The other ventilatory variables showed no significant correlations. Our results suggest that the total GA-T time can be applied to estimate the ventilatory efficiency of patients with CHF. Future studies may use the GA-T in conjunction with other functional capacity tests to guide the treatment plan and evaluate the prognosis.

scholarly journals Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management

2019 ◽  
Vol 28 (1) ◽  
pp. 3-13 ◽  
Author(s):  
J. F. Veenis ◽  
J. J. Brugts
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Remote Monitoring ◽  
Heart Association ◽  
The United States ◽  
Pharmacological Therapy ◽  
Functional Class ◽  
Class Iii ◽  
Additional Tool

AbstractExacerbations of chronic heart failure (HF) with the necessity for hospitalisation impact hospital resources significantly. Despite all of the achievements in medical management and non-pharmacological therapy that improve the outcome in HF, new strategies are needed to prevent HF-related hospitalisations by keeping stable HF patients out of the hospital and focusing resources on unstable HF patients. Remote monitoring of these patients could provide the physicians with an additional tool to intervene adequately and promptly. Results of telemonitoring to date are inconsistent, especially those of telemonitoring with traditional non-haemodynamic parameters. Recently, the CardioMEMS device (Abbott Inc., Atlanta, GA, USA), an implantable haemodynamic remote monitoring sensor, has shown promising results in preventing HF-related hospitalisations in chronic HF patients hospitalised in the previous year and in New York Heart Association functional class III in the United States. This review provides an overview of the available evidence on remote monitoring in chronic HF patients and future perspectives for the efficacy and cost-effectiveness of these strategies.

scholarly journals Outcome after percutaneous edge-to-edge mitral repair for functional and degenerative mitral regurgitation: a systematic review and meta-analysis

Heart ◽  
2017 ◽  
Vol 104 (4) ◽  
pp. 306-312 ◽  
Author(s):  
Mauro Chiarito ◽  
Matteo Pagnesi ◽  
Enrico Antonio Martino ◽  
Michele Pighi ◽  
Andrea Scotti ◽  
...  
Keyword(s):  
Systematic Review ◽  
New York ◽  
Mitral Regurgitation ◽  
Meta Analysis ◽  
Heart Association ◽  
Class Iii ◽  
Term Outcome ◽  
Mitral Repair ◽  
New York Heart Association ◽  
One Year

ObjectivesDifferences in terms of safety and efficacy of percutaneous edge-to-edge mitral repair between patients with functional and degenerative mitral regurgitation (MR) are not well established. We performed a systematic review and meta-analysis to clarify these differences.MethodsPubMed, EMBASE, Google scholar database and international meeting abstracts were searched for all studies about MitraClip. Studies with <25 patients or where 1-year results were not delineated between MR aetiology were excluded. This study is registered with PROSPERO.ResultsA total of nine studies investigating the mid-term outcome of percutaneous edge-to-edge repair in patients with functional versus degenerative MR were included in the meta-analysis (n=2615). At 1 year, there were not significant differences among groups in terms of patients with MR grade≤2 (719/1304 vs 295/504; 58% vs 54%; risk ratio (RR) 1.12; 95% CI: 0.86 to 1.47; p=0.40), while there was a significantly lower rate of mitral valve re-intervention in patients with functional MR compared with those with degenerative MR (77/1770 vs 80/818; 4% vs 10%; RR 0.60; 95% CI: 0.38 to 0.97; p=0.04). One-year mortality rate was 16% (408/2498) and similar among groups (RR 1.26; 95% CI: 0.90 to 1.77; p=0.18). Functional MR group showed significantly higher percentage of patients in New York Heart Association class III/IV (234/1480 vs 49/583; 16% vs 8%; p<0.01) and re-hospitalisation for heart failure (137/605 vs 31/220; 23% vs 14%; p=0.03). No differences were found in terms of single leaflet device attachment (25/969 vs 20/464; 3% vs 4%; p=0.81) and device embolisation (no events reported in both groups) at 1 year.ConclusionsThis meta-analysis suggests that percutaneous edge-to-edge repair is likely to be an efficacious and safe option in patients with both functional and degenerative MR. Large, randomised studies are ongoing and awaited to fully assess the clinical impact of the procedure in these two different MR aetiologies.

scholarly journals Long‐Term Outcome of Patients With Congenital Heart Disease Undergoing Cardiac Resynchronization Therapy

2021 ◽  
Author(s):  
Peter Kubuš ◽  
Jana Rubáčková Popelová ◽  
Jan Kovanda ◽  
Kamil Sedláček ◽  
Jan Janoušek
Keyword(s):  
New York ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Association ◽  
Cardiac Resynchronization ◽  
New York Heart Association ◽  
Crt Response

Background Cardiac resynchronization therapy (CRT) is rarely used in patients with congenital heart disease, and reported follow‐up is short. We sought to evaluate long‐term impact of CRT in a single‐center cohort of patients with congenital heart disease. Methods and Results Thirty‐two consecutive patients with structural congenital heart disease (N=30) or congenital atrioventricular block (N=2), aged median of 12.9 years at CRT with pacing capability device implantation, were followed up for a median of 8.7 years. CRT response was defined as an increase in systemic ventricular ejection fraction or fractional area of change by >10 units and improved or unchanged New York Heart Association class. Freedom from cardiovascular death, heart failure hospitalization, or new transplant listing was 92.6% and 83.2% at 5 and 10 years, respectively. Freedom from CRT complications, leading to surgical system revision (elective generator replacement excluded) or therapy termination, was 82.7% and 72.2% at 5 and 10 years, respectively. The overall probability of an uneventful therapy continuation was 76.3% and 58.8% at 5 and 10 years, respectively. There was a significant increase in ejection fraction/fractional area of change ( P <0.001) mainly attributable to patients with systemic left ventricle ( P =0.002) and decrease in systemic ventricular end‐diastolic dimensions ( P <0.05) after CRT. New York Heart Association functional class improved from a median 2.0 to 1.25 ( P <0.001). Long‐term CRT response was present in 54.8% of patients at last follow‐up and was more frequent in systemic left ventricle ( P <0.001). Conclusions CRT in patients with congenital heart disease was associated with acceptable survival and long‐term response in ≈50% of patients. Probability of an uneventful CRT continuation was modest.

scholarly journals Clinical course and prognosis of dilated cardiomyopathy in children

2019 ◽  
Vol 7 (11) ◽  
pp. 4218
Author(s):  
Iranna S. Hirapur ◽  
Ravindran Rajendran ◽  
Jayaranganath . ◽  
Manjunath Nanjappa
Keyword(s):  
New York ◽  
Dilated Cardiomyopathy ◽  
Clinical Course ◽  
Care Center ◽  
Nyha Class ◽  
Tertiary Care ◽  
Heart Association ◽  
Paediatric Population ◽  
Class Iii ◽  
Serious Disease

Background: Epidemiology and clinical course of dilated cardiomyopathy (DCM) in children and infants are not well established. Thus, this study aims to investigate the clinical course and prognosis of DCM in childrenMethods: This was a single-center, prospective, observational study conducted at a tertiary-care center in India between February 2011 and September 2012. A total of 31 patients admitted to the paediatric department diagnosed with DCM were included in the study. Patients were divided into three groups based on the age at the time of diagnosis: 0-3 years, >3-12 years and >12-16 years. Among the study population, 28 patients were followed up for a mean period of 1.44 years and three patients were lost to follow-up.Results: Of the 31 patients, 11 patients were male with a mean age of 8.9±6 years and 20 patients were female with a mean age of 8.3±6 years. All patients were presented with same characteristics of New York heart association (NYHA) class III-IV dyspnoea and fatigue. Among 28 patients who were followed-up for a mean period of 1.44 years, 20(71.4%) patients died and eight patients were on follow up. Of the eight patients, five patients were with NYHA class III symptoms and three patients were with NYHA class I-II symptoms.Conclusions: Dilated cardiomyopathy in children is a very serious disease with a grave prognosis. Patients with NYHA III-IV symptoms have a very high mortality rate and potential use of other therapies remains to be fully evaluated in paediatric population.

Transcatheter Aortic Valve Replacement for Degenerated Transcatheter Aortic Valves: The TRANSIT International Project

2021 ◽  
Author(s):  
Luca Testa ◽  
Mauro Agnifili ◽  
Nicolas M. Van Mieghem ◽  
Didier Tchétché ◽  
Anita W. Asgar ◽  
...  
Keyword(s):  
New York ◽  
Transcatheter Aortic Valve Replacement ◽  
Heart Association ◽  
York Heart Association Class ◽  
Class Iii ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Association Class ◽  
New York Heart Association ◽  
Overall Mortality

Background: Transcatheter aortic valve replacement (TAVR) has determined a paradigm shift in the treatment of patients with severe aortic stenosis. However, the durability of bioprostheses is still a matter of concern, and little is known about the management of degenerated TAV. We sought to evaluate the outcomes of patients with a degenerated TAV treated by means of a second TAVR. Methods: The TRANSIT is an international registry that included cases of degenerated TAVR from 28 centers. Among around 40 000 patients treated with TAVR in the participating centers, 172 underwent a second TAVR: 57 (33%) for a mainly stenotic degenerated TAV, 97 (56%) for a mainly regurgitant TAV, and 18 (11%) for a combined degeneration. Overall, the rate of New York Heart Association class III/IV at presentation was 73.5%. Results: Valve Academic Research Consortium 2 device success rate was 79%, as a consequence of residual gradient (14%) or regurgitation (7%). At 1 month, the overall mortality rate was 2.9%, while rates of new hospitalization and New York Heart Association class III/IV were 3.6% and 7%, respectively, without significant difference across the groups. At 1 year, the overall mortality rate was 10%, while rates of new hospitalization and New York Heart Association class III/IV were 7.6% and 5.8%, respectively, without significant difference across the groups. No cases of valve thrombosis were recorded. Conclusions: Selected patients with a degenerated TAV may be safely and successfully treated by means of a second TAVR. This finding is of crucial importance for the adoption of the TAVR technology in a lower risk and younger population. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04500964.

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