scholarly journals Long-term Effects of Perceived Stress, Anxiety, and Anger on Hospitalizations or Death and Health Status in Heart Failure Patients

2021 ◽  
Author(s):  
Andrew J. Dimond ◽  
David S. Krantz ◽  
Andrew J. Waters ◽  
Keen Seong Liew ◽  
Stephen S. Gottlieb
Keyword(s):  
Heart Failure ◽  
Health Status ◽  
Perceived Stress ◽  
Kansas City ◽  
Acute Stress ◽  
Estimating Equation ◽  
Long Term Effects ◽  
Standard Deviation Increase ◽  
Reduced Ejection Fraction

Background. Chronic and acute stress and emotion predict incidence/recurrence of CHD, but long-term effects on HF exacerbations are poorly understood. This study determined long-term chronic and episodic effects of stress, anxiety, and anger on hospitalizations or death, and worsened health status in HF. Methods and Results. 147 patients with heart failure and reduced ejection fraction (HFrEF) completed measures of perceived stress (Perceived Stress Scale; PSS), state anxiety (STAI), recent anger (RA), and HF-related health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) every 6 months for up to 39 months. Relationships of chronic (Mean) stress and emotion and episodic changes (Deviation) to subsequent hospitalizations or death and health status were determined utilizing Generalized Estimating Equation models. All-cause hospitalizations were predicted by chronic (Mean) PSS (OR=1.06, 95% CI 1.02-1.11, p=0.004), Mean STAI (OR=1.06, 95% CI=1.03, 1.10, p<0.001), and episodic (Deviation) PSS (OR=1.03, 95% CI 1.01-1.06, p=0.022). Mean PSS and Mean STAI also predicted cardiovascular hospitalizations. Each 1 standard deviation increase in Mean PSS and Mean STAI was associated, respectively, with a 61% and 79% increase in hospitalization or death. Anger was not associated with hospitalizations. Poorer KCCQ health status was related to higher Mean and Deviation PSS, STAI, and RA. Relationships to hospitalizations and health status were significant for Anxiety and Perceived Stress, independently of the other psychological measures. Conclusions. In HF patients, chronic perceived stress and anxiety and episodic stress increases are predictive of hospitalizations or death and worsened health status over a >3-year period. Mechanisms may involve sympathetic activation, and/or exacerbations of perceived symptoms or health behaviors.

Risk Adjustment Model for Preserved Health Status in Patients With Heart Failure and Reduced Ejection Fraction: The CHAMP-HF Registry

2021 ◽  
Author(s):  
Andy T. Tran ◽  
Gregg C. Fonarow ◽  
Suzanne V. Arnold ◽  
Philip G. Jones ◽  
Laine E. Thomas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Status ◽  
Ejection Fraction ◽  
Risk Adjustment ◽  
Kansas City ◽  
Performance Measure ◽  
Kansas City Cardiomyopathy Questionnaire ◽  
Reduced Ejection Fraction ◽  
Adjustment Model ◽  
Risk Adjustment Model

Background: Health status outcomes are increasingly being promoted as measures of health care quality, given their importance to patients. In heart failure (HF), an American College of Cardiology/American Heart Association Task Force proposed using the proportion of patients with preserved health status as a quality measure but not as a performance measure because risk adjustment methods were not available. Methods: We built risk adjustment models for alive with preserved health status and for preserved health status alone in a prospective registry of outpatients with HF with reduced ejection fraction across 146 US centers between December 2015 and October 2017. Preserved health status was defined as not having a ≥5-point decrease in the Kansas City Cardiomyopathy Questionnaire Overall Summary score at 1 year. Using only patient-level characteristics, hierarchical multivariable logistic regression models were developed for 1-year outcomes and validated using data from 1 to 2 years. We examined model calibration, discrimination, and variability in sites’ unadjusted and adjusted rates. Results: Among 3932 participants (median age [interquartile range] 68 years [59–75], 29.7% female, 75.4% White), 2703 (68.7%) were alive with preserved health status, 902 (22.9%) were alive without preserved health status, and 327 (8.3%) had died by 1 year. The final risk adjustment model for alive with preserved health status included baseline Kansas City Cardiomyopathy Questionnaire Overall Summary, age, race, employment status, annual income, body mass index, depression, atrial fibrillation, renal function, number of hospitalizations in the past 1 year, and duration of HF (optimism-corrected C statistic=0.62 with excellent calibration). Similar results were observed when deaths were ignored. The risk standardized proportion of patients alive with preserved health status across the 146 sites ranged from 62% at the 10th percentile to 75% at the 90th percentile. Variability across sites was modest and changed minimally with risk adjustment. Conclusions: Through leveraging data from a large, outpatient, observational registry, we identified key factors to risk adjust sites’ proportions of patients with preserved health status. These data lay the foundation for building quality measures that quantify treatment outcomes from patients’ perspectives.

scholarly journals Long-Term Effects of Angiotensin Receptor–Neprilysin Inhibitors on Myocardial Function in Chronic Heart Failure Patients with Reduced Ejection Fraction

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 522
Author(s):  
Gregor Poglajen ◽  
Ajda Anžič-Drofenik ◽  
Gregor Zemljič ◽  
Sabina Frljak ◽  
Andraž Cerar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariable Analysis ◽  
Serum Levels ◽  
Reverse Remodeling ◽  
Angiotensin Receptor ◽  
Long Term Effects ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor

Background. We sought to evaluate the long-term effects of angiotensin receptor blocker–neprilysin inhibitor (ARNI) therapy on reverse remodeling of the failing myocardium in HFrEF patients. Methods. We performed a prospective non-randomized longitudinal study on 228 HFrEF patients treated with ARNI at our center. Prior to ARNI introduction all patients received stable doses of ACEI/ARB for at least six months. Clinical, biochemical and echocardiography data were obtained at ARNI introduction and 12-month follow-up. Results At follow-up, we found significant improvements in LVEF (29.7% ± 8% vs. 36.5% ± 9%; p < 0.001), LVOT-VTI (14.8 ± 4.2 cm vs. 17.2 ± 4.2 cm; p < 0.001), TAPSE (1.7 ± 0.5 cm vs. 2.1 ± 0.6 cm; p < 0.001) and LV-EDD (6.5 ± 0.8 cm vs. 6.3 ± 0.9 cm; p = 0.001). NT-proBNP serum levels also decreased significantly (1324 (605, 3281) pg/mL vs. 792 (329, 2022) pg/mL; p = 0.001). A total of 102 (45%) of patients responded favorably to ARNI (ΔLVEF < +5%; Group A) and 126 (55%) patients achieved ΔLVEF ≥ +5% (Group B). The two groups differed significantly in age, heart failure etiology, baseline LVEF and baseline NT-proBNP. On multivariable analysis, nonischemic heart failure, LVEF < 30% and NT-proBNP < 1500 pg/mL emerged as independent correlates of favorable response to ARNI therapy. Conclusion. ARNI therapy appears to improve echocardiographic parameters of left and right ventricular function in HFrEF patients above the effect of pre-existing optimal medical management. These effects may be particularly pronounced in patients with nonischemic heart failure, LVEF < 30% and lower degree of neurohumoral activation.

scholarly journals Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction

2018 ◽  
Vol 108 (1) ◽  
pp. 48-60 ◽  
Author(s):  
Kamila Lachowska ◽  
Jerzy Bellwon ◽  
Krzysztof Narkiewicz ◽  
Marcin Gruchała ◽  
Dagmara Hering
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Long Term Effects ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients ◽  
Slow Breathing

Effect of Sacubitril/Valsartan Combined with Dapagliflozin on Long-Term Cardiac Mortality in Heart Failure with Reduced Ejection Fraction

Angiology ◽  
2021 ◽  
pp. 000331972110473
Author(s):  
Umut Karabulut ◽  
Kudret Keskin ◽  
Dilay Karabulut ◽  
Ece Yiğit ◽  
Zerrin Yiğit
Keyword(s):  
Heart Failure ◽  
Combination Therapy ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Mortality ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor

The angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan and sodium-glucose cotransporter-2 (SGLT-2) inhibitor dapagliflozin have been shown to reduce rehospitalization and cardiac mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to compare the long-term cardiac and all-cause mortality of ARNI and dapagliflozin combination therapy against ARNI monotherapy in patients with HFrEF. This retrospective study involved 244 patients with HF with New York Heart Association (NYHA) class II–IV symptoms and ejection fraction ≤40%. The patients were divided into 2 groups: ARNI monotherapy and ARNI+dapagliflozin. Median follow-up was 2.5 (.16–3.72) years. One hundred and seventy-five (71.7%) patients were male, and the mean age was 65.9 (SD, 10.2) years. Long-term cardiac mortality rates were significantly lower in the ARNI+dapagliflozin group (7.4%) than in the ARNI monotherapy group (19.5%) ( P = .01). Dapagliflozin [Hazard Ratio (HR) [95% Confidence Interval (CI)] = .29 [.10–.77]; P = .014] and left ventricular ejection fraction (LVEF) [HR (95% CI) = .89 (.85–.93); P < .001] were found to be independent predictors of cardiac mortality. Our study showed a significant reduction in cardiac mortality with ARNI and dapagliflozin combination therapy compared with ARNI monotherapy.

Abstract P230: An Observational Study of Deployment of American Heart Association Heart Failure Protocols and Educational Content Within the Intel® Health Guide System Post Discharge

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Ileana L Pina ◽  
Nancy M Albert ◽  
Gregg M Fonarow ◽  
Gloria Catha ◽  
Patrick Wayte ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Status ◽  
Observational Study ◽  
Kansas City ◽  
Clinical Status ◽  
Class Iii ◽  
Educational Content ◽  
Post Discharge ◽  
Rehospitalization Rate ◽  
Guide System

Background: Telemonitoring (Tel) of heart failure (HF) patients (pts) post discharge has had variable results. However, Tel systems have not always integrated delivery of relevant pt education. The purpose of this study was to examine outcomes after implementation of the Intel Health Guide System (HGS). HGS was deployed with AHA guideline-based HF protocols for clinical status, symptoms and delivery of relevant pt education to enhance pts’ understanding of and management of HF. Methods: Twenty-six pts post discharge with a HF diagnosis were enrolled. Based on the pts’ clinical status, AHA-HF protocols were deployed into the HGS to assess key vital signs and health questions daily, weekly, or monthly for 60 days. Pts and caregivers were trained in use of the HGS and related peripherals, response to scheduled sessions, and access of educational content independent of scheduled sessions. Health status was assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ) pre and post monitoring. Results: Of 26 pts, 62% NYHA were Class II, 29% Class III. Mean age 75.2 ±10.1 yrs; 62% women; 39% African Americans; 23% ischemic. Mean EF = 47% ±16. Adherence was 88%. KCCQ Clinical and Overall scores increased significantly from 49±25 and 51±23 to 63±26 and 65±22, respectively (p=0.039). Thirteen pts (50%) were rehospitalized at mean of 16+5 days, 4 for HF and 9 for other reasons, (30 day rehospitalization rate = 23% all cause; 15% for HF). Median compliance (completing scheduled sessions) and utility (days with activity/monitored) for those not rehospitalized were greater (97.2%, 96.9%) than for those rehospitalized (67.4%, 82.6%; p=0.013, p=0.005, respectively). Using generalized estimating equations, greater utility but not compliance correlated with better health status’ clinical (p=0.013) and overall scores (p=0.0056). Conclusions: This observational study showed feasibility of adding AHA-HF guideline protocols and education content to the HGS. Health status improved post discharge. Although the rehospitalization rate was > 20%, pts who were not readmitted were more likely to have greater Tel utility and compliance. In addition, clinical and overall health status measures improved during the study, and were associated with greater pt utilization of the system.

scholarly journals Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection fraction

2017 ◽  
Vol 22 (4) ◽  
pp. 307-315 ◽  
Author(s):  
Kavita B Khaira ◽  
Ellen Brinza ◽  
Gagan D Singh ◽  
Ezra A Amsterdam ◽  
Stephen W Waldo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Left Ventricular ◽  
Term Survival ◽  
Long Term Survival ◽  
Reduced Ejection Fraction ◽  
History Of

The impact of heart failure (HF) on long-term survival in patients with critical limb ischemia (CLI) has not been well described. Outcomes stratified by left ventricular ejection fraction (EF) are also unknown. A single center retrospective chart review was performed for patients who underwent treatment for CLI from 2006 to 2013. Baseline demographics, procedural data and outcomes were analyzed. HF diagnosis was based on appropriate signs and symptoms as well as results of non-invasive testing. Among 381 CLI patients, 120 (31%) had a history of HF and 261 (69%) had no history of heart failure (no-HF). Within the HF group, 74 (62%) had HF with preserved ejection fraction (HFpEF) and 46 (38%) had HF with reduced ejection fraction (HFrEF). The average EF for those with no-HF, HFpEF and HFrEF were 59±13% vs 56±9% vs 30±9%, respectively. The likelihood of having concomitant coronary artery disease (CAD) was lowest in the no-HF group (43%), higher in the HFpEF group (70%) and highest in the HFrEF group (83%) ( p=0.001). Five-year survival was on average twofold higher in the no-HF group (43%) compared to both the HFpEF (19%, p=0.001) and HFrEF groups (24%, p=0.001). Long-term survival rates did not differ between the two HF groups ( p=0.50). There was no difference in 5-year freedom from major amputation or freedom from major adverse limb events between the no-HF, HFpEF and HFrEF groups, respectively. Overall, the combination of CLI and HF is associated with poor 5-year survival, independent of the degree of left ventricular systolic dysfunction.

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