scholarly journals Effects of home-based cardiac exercise rehabilitation with remote electrocardiogram monitoring in patients with chronic heart failure: a study protocol for a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e023923 ◽  
Author(s):  
Jiahui Li ◽  
Peng Yang ◽  
Dongliang Fu ◽  
Xiaojun Ye ◽  
Lifang Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Exercise Capacity ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Exercise Rehabilitation ◽  
Supervised Training ◽  
Home Based

IntroductionPatients with chronic heart failure (CHF) can benefit from exercise rehabilitation (ER) with significant improvements in exercise capacity, quality of life and reduction in hospitalisations. Despite its reported benefits, only a small number of patients with CHF attend ER due to poor adherence, and improper exercise may even lead to adverse events. Remote ECG monitoring system (REMS) has the potential to overcome these obstacles. We hypothesise that home-based cardiac ER using REMS in CHF patients is effective compared with conventional ER without monitoring.Methods and analysisThis study is a prospective, randomised, parallel controlled clinical trial designed to evaluate the effectiveness of home-based phase-II ER with REMS in the treatment of CHF with a target enrolment of 120 patients (left ventricular ejection fraction <50%, New York Heart Association (NYHA) classes I to III). Patients are randomised to either REMS rehabilitation group or conventional rehabilitation group in a 1:1 ratio. All patients start an exercise training in a supervised setting and then transition to a home-based regimen. The supervised training phase consists of 12 supervised training sessions, three sessions per week for 4 weeks. During the home exercise phase, patients exercise five times per week for 8 weeks. In the REMS group, patients wear monitors during exercise to ensure that exercise intensity is within the set ranges. REMS will also detect risky arrhythmia and alert the patients and their doctors on time. The training intensity is not monitored in the conventional rehabilitation group. The primary outcome is exercise capacity improvement measured by peak oxygen uptake (VO2 peak) (baseline vs 3 m). Secondary outcomes include 6-min walk test, NYHA classes, echocardiographic parameters, cardiac biomarkers, major adverse cardiovascular events, quality of life, psychological well-being and patients’ adherence to the rehabilitation programme.Ethics and disseminationThis study was approved by Ethics Committee of China-Japan Friendship Hospital for Clinical Research (No. 2018–55 K39). The results of this study will be disseminated via peer-reviewed publications and presentations at conferences.Trial registration numberChiCTR-RNR-17012446; Pre-results.

scholarly journals Eff ect of nebivolol and carvedilol on the functional state of patients with chronic heart failure and preserved left ventricular ejection fraction

2021 ◽  
Vol 99 (4) ◽  
pp. 282-287
Author(s):  
V. G. Tregubov ◽  
P. V. Khilkevich ◽  
I. Z. Shubitidze ◽  
V. M. Pokrovskii ◽  
N. V. Yukhnova
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Combination Therapy ◽  
Ejection Fraction ◽  
Functional State ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Group I

Objective. Compare the eff ect of combination therapy with nebivolol or carvedilol on the functional state of patients with chronic heart failure (CHF) and preserved ejection fraction (pEF) of the left ventricle (LV). Material and methods. The study involved 80 patients with diastolic CHF, who were randomized into two groups. In group I was appointed of nebivolol (7.7 ± 2.4 mg/day, n = 40), in group II — carvedilol (30.5 ± 8.7 mg/day, n = 40). As part of the combination therapy, quinapril was prescribed (13.7 ± 2.7 mg/day, n = 40 and 13.5 ± 2.6 mg/day, n = 40), and if indicated — atorvastatin (15.3 ± 4.6 mg/day, n = 17 and 16.2 ± 5.2 mg/day, n = 17) and acetylsalicylic acid in the intestinal soluble shell (96.4 ± 13.4 mg/day, n = 14 and 93.8 ± 13.3 mg/day, n = 13), respectively. Initially and after 6 months of therapy were carried out: quantitative assessment of regulatory-adaptive status (RAS) (by means of a sample of cardiac-respiratory synchronism), echocardioscopy, treadmill test, test with a six-minute walk, subjective assessment of quality of life, determination of the level of the N-terminal fragment of the brain natriuretic peptide in blood plasma, daily monitoring of blood pressure. Results. Both schemes of combined therapy comparably improved the structural and functional state of the heart, controlled arterial hypertension. In comparison with carvedilol, nebivolol diff ered positive eff ect on the RAS, more increased tolerance to physical activity and improved quality of life. Conclusion. In patients with CHF pEF LV in combination therapy, the use of nebivolol, in comparison with carvedilol, may be preferable due to the more pronounced positive eff ect on the functional state.

Effect of outpatient exercise training programmes in patients with chronic heart failure: a systematic review

2011 ◽  
Vol 19 (4) ◽  
pp. 795-803 ◽  
Author(s):  
Suzan van der Meer ◽  
Marlies Zwerink ◽  
Marco van Brussel ◽  
Paul van der Valk ◽  
Elly Wajon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Systematic Review ◽  
Chronic Heart Failure ◽  
Exercise Training ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Training Programmes

Background: Advantages of outpatient exercise training are reduced waiting lists, better compliance, reduced time investment by the patient with reduced travel expenses, and less dependence on other people to participate. Therefore, this systematic review studies the effects of outpatient exercise training programmes compared with usual care on exercise capacity, exercise performance, quality of life, and safety in patients with chronic heart failure. Design: Systematic review with meta-analysis. Methods: Randomized controlled trials concerning patients with chronic heart failure, with a left ventricular ejection fraction ≤40%, were included. A meta-analysis was performed. Results: Twenty-two studies were included. VO2max, 6-min walking test, and quality of life showed significant differences in favour of the intervention group of 1.85 ml/kg/min, 47.9 m, and 6.9 points, respectively. In none of the studies, a significant relationship was found between exercise training and adverse events. Conclusion: This meta-analysis illustrates the efficacy and safety of outpatient training programmes for patients with chronic heart failure.

scholarly journals Comparison of effectiveness of therapy with lisinopril and fosinopril in patients with diastolic chronic heart failure in the presence of hypertension disease

2019 ◽  
Vol 16 (2) ◽  
pp. 6-11
Author(s):  
Svetlana N Merzlyakova ◽  
Iosif Z Shubitidze ◽  
Vitalii G Tregubov ◽  
Vladimir M Pokrovskiy
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Combination Therapy ◽  
Systolic Function ◽  
Subjective Evaluation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Aim. Сompare the effectiveness of combination therapy with lisinopril and fosinopril in patients with diastolic chronic heart failure (CHF) in the presence of hypertension disease (HD), considering its impact on the regulatory adaptive status (RAS). Materials and methods. The study take parted 69 patients with CHF II functional class according to the classification of the New York Heart Association in the presence of HD III stage with preserved systolic function of the left ventricle (left ventricular ejection fraction ≥50%), who were randomized into two groups for treatment with lisinopril (13.7±3.7 mg/day, n=34) or fosinopril (14.5±4.1 mg/day, n=35). As part of combination pharmacotherapy, patients were included nebivolol (7.2±2.4 mg/day and 7.0±2.2 mg/day), and acetylsalicylic acid when required (100 mg/day, n=8 and 100 mg/day, n=7), atorvastatin (15.7±4.9 mg/day, n=14 and 16.9±4.6 mg/day, n=16) respectively. Initially and after six months, the following was done: a quantitative evaluation of the RAS (by cardio-respiratory synchronism test), echocardiography, holter monitoring of blood electrocardiograms, all-day monitoring of pressure, treadmill test, determination of the N-terminal precursor of the natriuretic brain peptide level in blood plasma, six-minute walking test, subjective evaluation of quality of life. Results. Both combined pharmacotherapy schemes comparably improved structural and functional state of the heart, neurohumoral activation and optimized blood pressure. However, in this case, the use of fosinopril, in comparison with lisinopril, positively affected on RAS, increased exercise tolerance and improved quality of life more. Conclusion. In patients with diastolic CHF in the presence of HD III stage as part of the combination therapy, the use of fosinopril, in comparison with lisinopril, may be preferable because of a more pronounced positive effect on RAS.

scholarly journals Assessment of the effect of nebivolol and сarvedilol on the functional state of patients with diastolic chronic heart failure

2021 ◽  
Vol 11 (4) ◽  
pp. 25-29
Author(s):  
Vitalii G. Tregubov ◽  
Pavel V. Khil′kevich ◽  
Iosif Z. Shubitidze ◽  
Anna V. Tregubova
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Combination Therapy ◽  
Functional State ◽  
Combined Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Aim. To determine the effect of combined therapy with nebivolol or carvedilol on the functional state of patients with diastolic chronic heart failure (CHF). Material and methods. The study involved 68 patients with CHF and preserved left ventricular ejection fraction, who were randomized into two groups for treatment with bisoprolol or carvedilol. As part of the combination therapy was prescribed quinapril, and if indicated atorvastatin, acetylsalicylic acid in the intestinal soluble shell. Initially and after 24 weeks of therapy were carried out: quantitative assessment of regulatory-adaptive status (RAS), echocardioscopy, treadmill test, six-minute walking test, subjective assessment of quality of life, determination of level of N-terminal fragment of the brain natriuretic peptide precursor in blood plasma. Results. Both schemes of combined therapy comparably improved the morpho-functional parameters of the heart and quality of life. In comparison with carvedilol, nebivolol more pronouncedly increased RAS and tolerance to physical activity. Conclusion. In patients with diastolic CHF in combination therapy, the use of nebivolol, in comparison with carvedilol, may be preferable due to the positive effect on the functional state.

scholarly journals CPAP in chronic heart failure

2013 ◽  
pp. 47-51
Author(s):  
F. Lari ◽  
G.P. Bragagni ◽  
G. Pilati ◽  
N. Di Battista
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Sleep Disorders ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Negative Effects ◽  
Ventricular Ejection Fraction

BACKGROUND Chronic Heart Failure (CHF) represents worldwide a clinical condition with increasing prevalence, high social, economical and epidemiological impact. Even if new pharmacological and non-pharmacological approachs have been recently used, mortality remains high in general population and quality of life is poor in these patients. DISCUSSION The association between CHF and sleep disorders is frequent but still undervalued: sleep apnoeas in CHF produce negative effects on cardiovascular system and an aggravation of prognosis. CPAP (Continuous Positive Airway Pressure) is commonly used to treat sleep apnoeas in patients without cardiac involvement and it is also used in first line treatment of acute cardiogenic pulmonary oedema thanks to its hemodynamic and ventilatory effects. The addition of nightly CPAP to standard aggressive medical therapy in patients with CHF and sleep apnoeas reduces the number of apnoeas, reduces the blood pressure, and the respiratory and cardiac rate, reduces the activation of sympathetic nervous system, the left ventricular volume and the hospitalization rate; besides CPAP increases the left ventricular ejection fraction, amd the oxygenation, it improves quality of life, tolerance to exercise and seems to reduce mortality in patients with a higher apnoeas suppression. CONCLUSIONS These implications suggest to investigate sleep apnoeas in patients with CHF in order to consider a possible treatment with CPAP. Further studies need to be developed to confirm the use of CPAP in patients with CHF without sleep disorders.

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