Abstract 4606: Appetite Ratings on Single-item Visual Analog Scale Identify Patients with Heart Failure at Risk for Malnutrition

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Terry A Lennie ◽  
Seongkum Heo ◽  
Susan J Pressler ◽  
Sandra B Dunbar ◽  
Misook L Chung ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Visual Analog Scale ◽  
Protein Intake ◽  
Nyha Class ◽  
Heart Association ◽  
Data Systems ◽  
Class Iii ◽  
Analog Scale ◽  
Patients With Heart Failure

Background : Patients with heart failure (HF) are at risk for malnutrition due to multiple factors. A simple, clinically feasible tool to identify risk for malnutrition is needed. Visual analog scales have been used in studies on appetite but it is unknown whether an appetite scale can be used to identify patients with HF at risk for malnutrition. Purpose : To determine whether differences in kcal and protein intake could be identified in patients with HF grouped by their appetite rating. Method : A total of 137 patients (63% male, 60 ± 12 years, 56% NYHA class III/IV, ejection fraction (39 ± 14%) were recruited from outpatient HF clinics in the Midwest and South. Patients provided detailed 4-day food diaries that were reviewed by a registered dietitian to verify serving sizes and preparation methods and to obtain missing information. Patients were also asked to rate their appetite over the 4 days of diet recording on a 10 mm visual analog with anchors of “no appetite” and “extremely good appetite” Diaries were analyzed by Nutrition Data Systems software. Three series of between-group comparisons of kcal and protein (total and referenced to kg body weight) were made by t-tests using 4 mm (below midpoint), 5 mm (mid-point), and 6 mm (above mid-point) cut-points. Results : Significant differences in kcal and protein intake were identified between groups using the 6 mm cut point. A total of 36% of the patients had low appetite ratings (<6mm). Patients with low appetite ratings consumed 20% fewer total kcals (1555 vs. 1936 kcal, p = .001) and 23% fewer kcal/kg (18 vs. 22 kcal, p = .005) than those with high ratings. The low appetite group also consumed 24% less protein than the high appetite group (62 g vs. 82 g, p = .001). The .71 g/kg protein intake of the low appetite group was below the recommended .8 g/kg protein intake for adults. In contrast, the .91 g/kg protein intake of the high appetite group was above the recommended level. Conclusion : Patients with lower appetite ratings had kcal and protein intakes below recommended levels while those with high appetite ratings had adequate intake. These results provide evidence that rating appetite on a visual analog scale may be a simple tool that could be used clinically to identify patients with HF at risk for malnutrition. This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).

scholarly journals The Effects of Sacubitril/Valsartan on Clinical, Biochemical and Echocardiographic Parameters in Patients with Heart Failure with Reduced Ejection Fraction: The “Hemodynamic Recovery”

2019 ◽  
Vol 8 (12) ◽  
pp. 2165 ◽  
Author(s):  
Giuseppe Romano ◽  
Giuseppe Vitale ◽  
Laura Ajello ◽  
Valentina Agnese ◽  
Diego Bellavia ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Ejection Fraction ◽  
Nyha Class ◽  
Heart Association ◽  
Class Iii ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Echocardiographic Parameters ◽  
The Impact

Background: Sacubitril/valsartan has been shown to be superior to enalapril in reducing the risks of death and hospitalization for heart failure (HF). However, knowledge of the impact on cardiac performance remains limited. We sought to evaluate the effects of sacubitril/valsartan on clinical, biochemical and echocardiographic parameters in patients with heart failure and reduced ejection fraction (HFrEF). Methods: Sacubitril/valsartan was administered to 205 HFrEF patients. Results: Among 230 patients (mean age 59 ± 10 years, 46% with ischemic heart disease) 205 (89%) completed the study. After a follow-up of 10.49 (2.93 ± 18.44) months, the percentage of patients in New York Heart Association (NYHA) class III changed from 40% to 17% (p < 0.001). Median N–Type natriuretic peptide (Nt-proBNP) decreased from 1865 ± 2318 to 1514 ± 2205 pg/mL, (p = 0.01). Furosemide dose reduced from 131.3 ± 154.5 to 120 ± 142.5 (p = 0.047). Ejection fraction (from 27± 5.9% to 30 ± 7.7% (p < 0.001) and E/A ratio (from 1.67 ± 1.21 to 1.42 ± 1.12 (p = 0.002)) improved. Moderate to severe mitral regurgitation (from 30.1% to 17.4%; p = 0.002) and tricuspid velocity decreased from 2.8 ± 0.55 m/s to 2.64 ± 0.59 m/s (p < 0.014). Conclusions: Sacubitril/valsartan induce “hemodynamic recovery” and, consistently with reduction in Nt-proBNP concentrations, improve NYHA class despite diuretic dose reduction.

Hope in Patients Hospitalized With Heart Failure

2005 ◽  
Vol 14 (5) ◽  
pp. 417-425 ◽  
Author(s):  
Tone Rustøen ◽  
Jill Howie ◽  
Ingrid Eidsmo ◽  
Torbjørn Moum
Keyword(s):  
Heart Failure ◽  
New York ◽  
Satisfaction With Life ◽  
Heart Association ◽  
Response Shift ◽  
High Morbidity ◽  
Class Iii ◽  
Control Subjects ◽  
Patients With Heart Failure ◽  
Comorbid Diseases

• Background Hope is seldom described in patients with heart failure, despite high morbidity and mortality for this population. • Objectives To describe hope in hospitalized patients with heart failure and to evaluate influences of demographic and health-related variables on hope. • Methods Ninety-three patients with heart failure and 441 healthy control subjects completed questionnaires about sociodemographics, health indices, disease severity, and the Herth Hope Index. • Results The patients with heart failure had a mean age of 75 years; 65% were men, and 47% lived alone. Lung diseases and diabetes were the most common comorbid diseases, with 58% classified as New York Heart Association class III. The mean global hope score among patients with heart failure was 37.69 (SD 5.3). Patients with skin (P = .01) and psychiatric (P = .02) disorders reported lower hope scores. Number of comorbid diseases was the only predictor of hope related to disease-specific variables (P = .01). Mean age of the control subjects was 60 years, and 66 (15%) lived alone. Once demographic variables were controlled for, patients with heart failure had significantly higher global hope scores than did control subjects. • Conclusions Adaptation to a life-threatening illness may induce a “response shift” that causes such patients to have more hope than the general population. Patients with heart failure may be more concerned with the past than the future. How patients judge their health and satisfaction with life influences their hope. Interventions supporting hope in patients with heart failure may influence treatment goals.

scholarly journals Utilization of Bio Impedance Spectroscopy in lieu of Invasive Monitoring for Monitoring Fluid Overload

2018 ◽  
Vol 3 (10) ◽  
Keyword(s):  
Heart Failure ◽  
Impedance Spectroscopy ◽  
Nyha Class ◽  
Extracellular Fluid ◽  
Volume Overload ◽  
Heart Association ◽  
Insurance Companies ◽  
Invasive Monitoring ◽  
Class Iii ◽  
Non Invasive

Congestive heart failure (CHF) has become one of the most common diagnoses and a leading cost concern for Medicare and insurance companies. The majority of costs associated with CHF surround hospitalization and re-admissions. As a result of these rising costs, there has been a push to identify early markers of impending congestion as a surveillance tool and possible measure of effectiveness of treatment. The measurement of diastolic pulmonary artery (PA) pressure from invasive devices has been shown to be useful in the management of New York Heart Association (NYHA) class III heart failure (HF) patients. It has been suggested that bio impedance spectroscopy (BIS) could be used as a surrogate for volume overload, offering a non-invasive option for patients. We present a case of a NYHA class III HF patient with end stage liver disease. The patient had previously been implanted with a Cardio MEMS device. Over several weeks, diastolic PA pressures and weight were compared to BIS measures from a SOZO, (noninvasive fluid monitoring system). The use of BIS to estimate extracellular fluid accumulation shows excellent correlation to both diastolic PA pressure and weight, suggesting a use for non-invasive monitoring

Enhanced TNFα and oxidative stress in patients with heart failure: effect of TNFα on platelet O2 - production

2003 ◽  
Vol 90 (08) ◽  
pp. 317-325 ◽  
Author(s):  
Luciano Biase ◽  
Pasquale Pignatelli ◽  
Luisa Lenti ◽  
Giuliano Tocci ◽  
Fabiana Piccioni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nadph Oxidase ◽  
Nyha Class ◽  
Experimental Studies ◽  
Specific Inhibitor ◽  
Class Iii ◽  
Nyha Classification ◽  
Patients With Heart Failure ◽  
O2 Production

SummaryExperimental studies have suggested that TNFα, a pro-inflammatory cytokine, may contribute to the deterioration of cardiovascular function through various mechanisms, including the generation of reactive oxygen species. It has not yet been demonstrated whether TNFα has prooxidant activity in patients with heart failure, and what the mechanism eventually resulting in this effect are.We analyzed 42 patients (38 men and 4 women, aged 26 to 74 years) with heart failure, secondary to idiopathic dilated car-diomyopathy (n=21), coronary artery disease (n=15), and valve disease (n=6), and 20 controls (18 men and 2 women, aged 49 to 67 years). Ten patients were in class I,9 in class II,15 in class III and 8 in class IV according to NYHA Classification. Blood samples were obtained from each patient to evaluate basal and collagen-induced platelet O2 - production, and plasma TNFα. In vivo results showed increased platelet O2 - production and plasma TNFα levels in NYHA class III-IV compared with that in controls or in NYHA I-II (p<0,001); platelet O2 - production correlated significantly (R=0,6; p<0,01) with TNFα plasma levels. In vitro studies showed TNFα dose-dependently (5-40 pg/ml) induced platelet O2 - production, and that this effect was significantly inhibited by its specific inhibitor, WP9QY (1 μM); aspirin (100 μM), AACOCF3, a specific PLA2 inhibitor (14 μM), and DPI, an inhibitor of NADPH oxidase, significantly inhibited TNFα-mediated platelet O2 - production.This study suggests that in patients with heart failure, enhanced platelet O2 - production is mediated by TNFα via activation of arachidonic acid and NADPH oxidase pathways.

Abstract 18738: Use of Antithrombotic Therapies and Outcomes in Patients with Atrial Fibrillation and Heart Failure: Insights from the GARFIELD Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ramon Corbalan ◽  
Antonio C Pereira Barretto ◽  
Giuseppe Ambrosio ◽  
Wael Al Mahmeed ◽  
Jean-Yves Le Heuzey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
New York ◽  
Stroke Risk ◽  
Nyha Class ◽  
Heart Association ◽  
Class Iii ◽  
Stroke Risk Factor ◽  
Stroke Risk Factors

Background: Atrial fibrillation (AF) is commonly associated with heart failure (HF) and this combination is associated with a worse prognosis than either alone. However, it is unclear if these patients receive appropriate antithrombotic therapies and if they have a higher incidence of stroke or systemic embolism (SE). Methods: We compared clinical characteristics, antithrombotic therapies, and outcomes in patients with and without HF in the GARFIELD Registry, an ongoing, international, observational registry of consecutively recruited patients with newly diagnosed non-valvular AF and ≥1 additional stroke risk factor. A total of 12,458 prospective patients were enrolled in 30 countries between March 2010 and January 2013. Results are reported at 1-year follow-up. HF was defined at baseline as New York Heart Association (NYHA) I-II or III-IV. Antithrombotic therapy use and 1-year outcomes in patients with and without HF were analysed. Results: In total, 20% of patients had HF; they were older and had higher CHA2DS2-VASc and HAS-BLED scores compared with patients without HF. A higher proportion of patients with HF received antithrombotic therapies. The incidence of all-cause death was higher in HF patients than non-HF patients. Patients with NYHA class III-IV HF had a higher unadjusted incidence of all-cause death and stroke/SE compared with non-HF patients: 10.5 (95% confidence interval 8.8 to 12.7) vs 2.9 (2.7 to 3.2) per 100 person-years and 1.9 (1.2 to 3.0) vs 1.0 (0.8 to 1.2) per 100 person-years, respectively. Event rates slightly changed after adjustment for stroke risk factors. Conclusion: More AF patients with HF received antithrombotic therapies compared with those without HF. They also showed a higher incidence of all-cause death with increasing HF severity compared with AF patients without HF. After adjustment for stroke risk factors, this association was slightly attenuated.

Venous Thromboembolism Prophylaxis Practices in Acutely Ill Medical Patients with Heart Failure (NYHA Class III or IV): Findings from IMPROVE.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1869-1869
Author(s):  
Ricardo Pavanello ◽  
James B. Froehlich ◽  
Victor Tapson ◽  
Jean-Francois Bergmann ◽  
Mashio Nakamura ◽  
...  
Keyword(s):  
Heart Failure ◽  
Venous Thromboembolism ◽  
Nyha Class ◽  
Medical Patients ◽  
Class Iii ◽  
Vte Prophylaxis ◽  
Heart Failure Patients ◽  
Patients With Heart Failure ◽  
The Usa ◽  
Pharmacologic Prophylaxis

Abstract Background Acutely ill medical patients with heart failure have an increased risk for venous thromboembolism (VTE) and expert consensus guidelines recommend that they should receive VTE prophylaxis. However, little data is available on physician’s practices for providing prophylaxis to these patients. Our aim was to characterize VTE prophylaxis practices in acutely ill hospitalized medical patients with heart failure (NYHA class III or IV) enrolled in the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE). Methods Patient recruitment began in July 2002. Patients aged ≥ 18 years and hospitalized for ≥ 3 days with an acute medical illness are enrolled consecutively. Exclusion criteria are: therapeutic antithrombotic agents or thrombolytics at admission, major surgery or trauma during 3 months prior to admission, and VTE treatment within 24 hours of admission. Results Of 6946 patients enrolled up to 31 March 2005 in 49 hospitals in 12 countries, 784 (11%) were heart failure patients. Compared with patients without heart failure, patients with heart failure were more likely to be in an ICU/CCU (13% vs 8%), immobile ≥ 4days (50% vs 30%), over 60 years old (85% vs 61%), perceived to be obese (20% vs 13%), or have respiratory failure (27% vs 17%; p<0.0001 for all). In total, only 51% of heart failure patients received pharmacologic prophylaxis and 61% received any type of prophylaxis. Pharmacologic prophylaxis type varied by region with low-molecular-weight heparin (LMWH) used less often, and unfractionated heparin (UFH) used more often in the USA compared with other participating countries (see Table). Aspirin and warfarin were used as VTE prophylaxis in 6% and 3% of heart failure patients, respectively. Intermittent pneumatic compression (IPC) was used more often in the USA than in other countries (24% vs 0.2%). Conclusions Although acutely ill medical patients with heart failure are at risk of VTE and should receive prophylaxis, only 61% of these patients in IMPROVE actually received any type of prophylaxis. This reflects poor physician-awareness of the benefits of prophylaxis in this patient group and suggests that significant opportunity exists to improve physician practices. Table. VTE prophylaxis in acutely ill medical patients with heart failure VTE prophylaxis (% patients) USA Other participating countries LMWH 15 46 UFH 27 13 Aspirin 8 4 Warfarin 5 1 Any pharmacologic prophylaxis 43 56 IPC 24 0.2 Elastic stockings 6 7

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 Utilization of Subcutaneous Cardioverter-Defibrillator in Poland and Europe–Comparison of the Results of Multi-Center Registries

2021 ◽  
Vol 18 (13) ◽  
pp. 7178
Author(s):  
Maciej Kempa ◽  
Andrzej Przybylski ◽  
Szymon Budrejko ◽  
Tomasz Fabiszak ◽  
Michał Lewandowski ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Nyha Class ◽  
Heart Association ◽  
European Population ◽  
Young Age ◽  
Class Iii ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Comparison Of The Results

The implantation of a subcutaneous cardioverter-defibrillator (S-ICD) may be used instead of a traditional transvenous system to prevent sudden cardiac death. Our aim was to compare the characteristics of S-ICD patients from the multi-center registry of S-ICD implantations in Poland with the published results of the European Snapshot Survey on S-ICD Implantation (ESSS-SICDI). We compared data of 137 Polish S-ICD patients with 68 patients from the ESSS-SICDI registry. The groups did not differ significantly in terms of sex, prevalence of ischemic cardiomyopathy, concomitant diseases, and the rate of primary prevention indication. Polish patients had more advanced heart failure (New York Heart Association (NYHA) class III: 11.7% vs. 2.9%, NYHA II: 48.9% vs. 29.4%, NYHA I: 39.4% vs. 67.7%, p < 0.05 each). Young age (75.9% vs. 50%, p < 0.05) and no vascular access (7.3% vs. 0%, p < 0.05) were more often indications for S-ICD. The percentage of patients after transvenous system removal due to infections was significantly higher in the Polish group (11% vs. 1.5%, p < 0.05). In the European population, S-ICD was more frequently chosen because of patients’ active lifestyle and patients’ preference (both 10.3% vs. 0%, p < 0.05). Our analysis shows that in Poland, compared to other European countries, subcutaneous cardioverters-defibrillators are being implanted in patients at a more advanced stage of chronic heart failure. The most frequent reason for choosing a subcutaneous system instead of a transvenous ICD is the young age of a patient.

scholarly journals The effect of foot massage on dyspnea ın heart faılure: Case report

2021 ◽  
Vol 2 (4) ◽  
pp. 01-03
Author(s):  
Arslan Gürcan
Keyword(s):  
Heart Failure ◽  
New York ◽  
Case Report ◽  
Nyha Class ◽  
Personal Data ◽  
Heart Association ◽  
Progressive Increase ◽  
Class Iii ◽  
Heart Failure Patients ◽  
New York Heart Association

Dyspnea is one of the reasons why many heart failure patients present to the emergency department. A 75 year-old female presented to a cardiologist with prominent dyspnea and orthopnea. Her heart failure was diagnosed by doctors as New York Heart Association (NYHA) Class III. Progressive increase in episodic shortness of breath forthe past 3 weeks. The patient had been in her normal state of health until 3 weeks ago that she had difficulty catching her breath while walking.The patient got 7 points from the first Borg Dyspnea Scale. The study is a case-report study. Personal Data Form (PDF), Borg Clinical Rating for Dyspnea (Borg CR-10) was evaluated by researcher. Classic foot massage was applied to each foot for a total of 30 minutes, up to 15 minutes, once a day for seven days. Dyspnea was measured after the massage following 10 min of resting. Foot massage was applied by the researcher. Distribution of dyspnea level first and seventh is given in Table 1. Dyspnea level of the patient intervention foot massage decreased to 5.00 from 7.00 at the end of seventh session. Foot massage which is an easy and safe method may be preferably used as a supportive treatment for elevated dyspnea. However, more studies are needed to examine the effect of foot massage on dyspnea level in heart failure patients.

scholarly journals The Impact of Advance Directive Perspectives on the Completion of Life-Sustaining Treatment Decisions in Patients with Heart Failure: A Prospective Study

2021 ◽  
Vol 10 (24) ◽  
pp. 5962
Author(s):  
JinShil Kim ◽  
Seongkum Heo ◽  
Bong Roung Kim ◽  
Soon Yong Suh ◽  
Jae Lan Shim ◽  
...  
Keyword(s):  
Higher Education ◽  
Heart Failure ◽  
Nyha Class ◽  
Heart Association ◽  
Advanced Age ◽  
Class Iii ◽  
Modifiable Factors ◽  
Life Sustaining Treatment ◽  
The Impact

Evidence for non-modifiable and modifiable factors associated with the utilization of advance directives (ADs) in heart failure (HF) is lacking. The purpose of this study was to examine baseline-to-3-month changes in knowledge, attitudes, and benefits/barriers regarding ADs and their impact on the completion of life-sustaining treatment (LST) decisions at 3-month follow-up among patients with HF. Prospective, descriptive data on AD knowledge, attitudes, and benefits/barriers and LSTs were obtained at baseline and 3-month follow-up after outpatient visits. Of 64 patients (age, 68.6 years; male, 60.9%; New York Heart Association (NYHA) classes I/II, 70.3%), 53.1% at baseline and 43.8% at 3-month follow-up completed LST decisions. Advanced age (odds ratio (OR) = 0.91, p = 0.012) was associated with less likelihood of the completion of LST decisions at 3-month follow-up, while higher education (OR = 1.19, p = 0.025) and NYHA class III/IV (OR = 4.81, p = 0.049) were associated with more likelihood. In conclusion, advanced age predicted less likelihood of LST decisions at 3 months, while higher education and more functional impairment predicted more likelihood. These results imply that early AD discussion seems feasible in mild symptomatic HF patients with poor knowledge about ADs, considering the non-modifiable and modifiable factors.

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