Abstract P333: Heart Rate Control in Patients With Chronic Atrial Fibrillation and Heart Failure

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Helme Silvet ◽  
Lee Ann Hawkins
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Rate Control ◽  
Nyha Class ◽  
Chronic Atrial Fibrillation ◽  
Walk Test ◽  
Heart Rate Control ◽  
6 Minute Walk Test ◽  
Minute Walk

Background. Heart rate (HR) control is one of the main goals in management of patients with chronic atrial fibrillation (AF). However, rate control can be challenging in patients with heart failure (HF). The goal of our study was to determine if aggressive heart rate control in patients with both chronic AF and HF results in better exercise tolerance and/or quality of life (QOL) as compared to the “usual” care. Methods. This was a single center interventional study at VA Loma Linda Healthcare System using patients as their own controls. Patients with chronic AF and LVEF ≤ 40% were recruited. Intervention consisted of increasing doses of Metoprolol XL to achieve target resting heart rate less than 70 bpm. Clinical data was collected at baseline (“usual care”) and at follow-up (3 months) and included HR data, 6-minute walk test, QOL questionnaire (Minnesota Living with Heart Failure), and brain natriuretic peptide (BNP) levels. Paired t-test was performed to evaluate statistically significant change in these clinical measures. The study had 80% power to detect clinically significant improvement in 6-minute walk test (50 meters). Results. 20 patients were recruited with an average follow-up of 98 days. Mean age was 66 years and all the patients were male with an average LVEF of 30 ± 8% and NYHA class of II-III. Average resting HR was 94 ± 14 bpm at baseline and 85 ± 12 bpm after the intervention. Average Metoprolol XL dose at the end of the study was 121mg with the average increase of the dose during the study of 59 mg. Further increases of Metoprolol doses to achieve target HR were not tolerated by the patients. Conclusion. In this small group of patients with chronic AF and HF aggressive HR control was difficult due to patient intolerance of increasing doses of beta-blockade and was not associated with better exercise tolerance, better QOL or improved HF based on BNP measurement. Further studies are needed to establish guidelines for target HR in patients with chronic AF who also have significant HF. Clinical parameter Baseline Follow-up p-value 6-min walk test (meters) 326 ± 83 330 ± 86 0.47 QOL score 42.5 ± 19 38 ± 21 >0.5 BNP 242 ± 306 279 ± 395 >0.5 NYHA class 2.4 ± 0.7 2.2 ± 0.7 0.009

Direct Myocardial Implantation of Human Fetal Stem Cells in Heart Failure Patients: Long-term Results

2010 ◽  
Vol 13 (1) ◽  
pp. 31 ◽  
Author(s):  
Federico Benetti ◽  
Ernesto Pe�herrera ◽  
Teodoro Maldonado ◽  
Yan Duarte Vera ◽  
Valvanur Subramanian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Cardiac Function ◽  
Nyha Class ◽  
Left Ventricular ◽  
Long Term Results ◽  
Walk Test ◽  
The Mean ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: End-stage heart failure (HF) is refractory to current standard medical therapy, and the number of donor hearts is insufficient to meet the demand for transplantation. Recent studies suggest autologous stem cell therapy may regenerate cardiomyocytes, stimulate neovascularization, and improve cardiac function and clinical status. Although human fetal-derived stem cells (HFDSCs) have been studied for the treatment of a variety of conditions, no clinical studies have been reported to date on their use in treating HF. We sought to determine the efficacy and safety of HFDSC treatment in HF patients.Methods and Results: Direct myocardial transplantation of HFDSCs by open-chest surgical procedure was performed in 10 patients with HF due to nonischemic, nonchagasic dilated cardiomyopathy. Before and after the procedure, and with no changes in their preoperative doses of medications (digoxin, furosemide, spironolactone, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, betablockers), patients were assessed for New York Heart Association (NYHA) class, performance in the exercise tolerance test (ETT), ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD) via transthoracic echocardiography, performance in the 6-minute walk test, and performance in the Minnesota congestive HF test. All 10 patients survived the operation. One patient had a stroke 3 days after the procedure, and although she later recovered, she was unable to perform the follow-up tests. Another male patient experienced pericardial effusion 3 weeks after the procedure. Although it resolved spontaneously, the patient abandoned his control tests and died 5 months after the procedure. An autopsy of the myocardium suggested that new young cells were present in the cardiomyocyte mix. At 40 months, the mean (SD) NYHA class decreased from 3.4 0.5 to 1.33 0.5 (P = .001); the mean EF increased 31%, from 26.6% 4% to 34.8% 7.2% (P = .005); and the mean ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% increase in metabolic equivalents, from 2.46 to 5.63) (P < .0001); the mean LVEDD decreased 15%, from 6.85 0.6 cm to 5.80 0.58 cm (P < .001); mean performance in the 6-minute walk test increased by 43.2%, from 251 113.1 seconds to 360 0 seconds (P = .01); the mean distance increased 64.4%, from 284.4 144.9 m to 468.2 89.8 m (P = .004); and the mean result in the Minnesota test decreased from 71 27.3 to 6 5.9 (P < .001).Conclusion: Although these initial findings suggest direct myocardial implantation of HFDSCs is feasible and improves cardiac function in HF patients at 40 months, more clinical research is required to confirm these observations.

Abstract 15303: The Impact of Heart Rate on the Incidence of Cardiovascular Events in Patients With Chronic Atrial Fibrillation: The Fushimi Af Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Moritake Iguchi ◽  
Hisashi Ogawa ◽  
Hirofumi Sugiyama ◽  
Nobutoyo Masunaga ◽  
Mitsuru Ishii ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Rate Control ◽  
Cardiovascular Events ◽  
Chronic Atrial Fibrillation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
The Impact

Purpose: Previous reports suggested that lenient rate control was not inferior to strict rate control among patients with chronic atrial fibrillation (AF). However, the impact of heart rate (HR) on the incidence of cardiovascular events is not clearly understood. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in Fushimi-ku, Kyoto, Japan. At present, follow-up data were available in 3,514 patients (median follow-up period, 842 days). 1,622 patients had chronic AF, and we obtained ECG findings in 1,561 patients. We divided these patients into three groups based on their heart rate; high-HR (HR≥110) (n=179), intermediate-HR (80≤HR<110) (n=695), and low-HR (HR<80) (n=687), and explored the cardiovascular events (composite of cardiovascular death, hospitalization for heart failure, and arrhythmic events). Results: Mean HR was 128±13 bpm, 93±8 bpm, and 67±9 bpm, respectively. High HR group was younger than other groups, but the prevalence of heart failure was the highest (44.7%, 37.0%, 32.3%; p=0.007) and left-ventricular ejection fraction was the lowest (56.5±14.6%, 60.7±11.9%, 62.7±10.5%; p<0.0001). Prescription of beta-blocker (37.4%, 28.9%, 30.0%) and diltiazem (2.8%, 2.9%, 4.2%) was comparable, but prescription of verapamil was the highest in high-HR group (19.0%, 12.4%, 8.0%; p=0.0001), and prescription of digitalis was the highest in low-HR group (14.0%, 18.2%, 23.4%; p=0.005). Mean CHADS2 score was 2.3±1.3, 2.2±1.3, and 2.2±1.4, respectively. In Kaplan-Meier analysis, the incidence of cardiovascular events was higher in high-HR groups than intermediate- and low-HR group (9.2%/year vs 5.8%/year, p=0.02), but was similar between intermediate- and low-HR group (6.2%/year vs 5.4%/year, p=0.3). The incidence of stroke or systemic embolism was comparable between the three groups (2.6%/year, 3.6%/year, 2.4%/year). Cox proportional hazard ratios [95%CI] of high- and intermediate-HR for cardiovascular events compared to low-HR were 1.63 [1.06-2.44] and 1.10 [0.81-1.79], respectively. Conclusions: Among chronic AF patients, the incidence of cardiovascular events was higher in the patients with high-HR, but was similar between intermediate- and low-HR groups.

scholarly journals The relationship between physical activity and appetite in patients with heart failure: A prospective observational study

2019 ◽  
Vol 18 (5) ◽  
pp. 410-417 ◽  
Author(s):  
Christina Andreae ◽  
Kristofer Årestedt ◽  
Lorraine Evangelista ◽  
Anna Strömberg
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Functional Capacity ◽  
Prospective Observational Study ◽  
Nyha Class ◽  
Walk Test ◽  
Six Minute Walk Test ◽  
The Relationship ◽  
Minute Walk

Introduction: Physical activity and appetite are important components for maintaining health. Yet, the association between physical activity and appetite in heart failure (HF) populations is not completely understood. The aim of the present study was to investigate the relationship between physical activity, functional capacity, and appetite in patients with HF. Methods: This was a prospective observational study. In total, 186 patients diagnosed with HF, New York Heart Association (NYHA) class II–IV (mean age 70.7, 30% female), were included. Physical activity was measured using a multi-sensor actigraph for seven days and with a self-reported numeric rating scale. Physical capacity was measured by the six-minute walk test. Appetite was measured using the Council on Nutrition Appetite Questionnaire. Data were collected at inclusion and after 18 months. A series of linear regression analyses, adjusted for age, NYHA class, and B-type natriuretic peptide were conducted. Results: At baseline, higher levels of physical activity and functional capacity were significantly associated with a higher level of appetite in the unadjusted models. In the adjusted models, number of steps ( p = 0.019) and the six-minute walk test ( p = 0.007) remained significant. At the 18-month follow-up, all physical activity variables and functional capacity were significantly associated with appetite in the unadjusted regression models. In the adjusted models, number of steps ( p = 0.001) and metabolic equivalent daily averages ( p = 0.040) remained significant. Conclusion: A higher level of physical activity measured by number of steps/day was associated with better self-reported appetite, both at baseline and the 18-month follow-up. Further research is needed to establish causality and explore the intertwined relationship between activity and appetite in patients with HF.

Heart rate at first postdischarge visit and outcomes in patients with heart failure

Heart ◽  
2017 ◽  
Vol 104 (13) ◽  
pp. 1086-1092 ◽  
Author(s):  
Tae-Hun Kim ◽  
Hyungseop Kim ◽  
In-Cheol Kim ◽  
Hyuck-Jun Yoon ◽  
Hyoung-Seob Park ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Clinical Outcomes ◽  
Rate Control ◽  
Outpatient Visit ◽  
Adverse Outcomes ◽  
Clinical Event ◽  
Heart Rate Control ◽  
Patients With Heart Failure

ObjectiveHeart rate control is important to prevent adverse outcomes in patients with heart failure (HF). However, postdischarge activity may worsen heart rate control, resulting in readmission. This study aimed to explore the implications of the heart rate differences between discharge and the first outpatient visit (D-O diff).MethodsWe retrospectively identified 458 patients (male: 46%; mean age: 72 years) discharged after HF. The heart rates at admission, discharge and first outpatient visit were analysed. The primary outcome was a composite of cardiovascular (CV) death and readmission of non-fatal myocardial infarction (MI), non-fatal stroke or non-fatal HF over a mean follow-up of 16 months.ResultsDuring follow-up, the clinical outcomes were noted in 223 patients (49%): HF, 199; stroke, 9; MI, 6; CV death, 9. The heart rate at the first outpatient visit (r=−0.311, P<0.001) and D-O diff (r=0.416, P<0.001) showed a better correlation with the time-to-clinical event than the heart rate at admission or discharge. The events group displayed a pronounced heart rate increase (13 beats/min) from discharge to the first outpatient visit compared with the event-free group (a decrease of 2 beats/min). A decrease less than −15 in the D-O diff showed a 4.5-fold risk of clinical outcomes during follow-up (P<0.001).ConclusionsA decreased D-O diff was related to the adverse outcomes of HF. The failure of heart rate control within more than 15 beats/min at the first outpatient visit was an independent factor for CV events.

Six-minute walk test and heart rate variability: lack of association in advanced stages of heart failure

1997 ◽  
Vol 6 (5) ◽  
pp. 348-354 ◽  
Author(s):  
MA Woo ◽  
DK Moser ◽  
LW Stevenson ◽  
WG Stevenson
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Sudden Death ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Walk Test ◽  
Advanced Stages ◽  
6 Minute Walk Test ◽  
Minute Walk

BACKGROUND: The 6-minute walk and heart rate variability have been used to assess mortality risk in patients with heart failure, but their relationship to each other and their usefulness for predicting mortality at 1 year are unknown. OBJECTIVE: To assess the relationships between the 6-minute walk test, heart rate variability, and 1-year mortality. METHOD: A sample of 113 patients in advanced stages of heart failure (New York Heart Association Functional Class III-IV, left ventricular ejection &lt; 0.25) were studied. All 6-minute walks took place in an enclosed, level, measured corridor and were supervised by the same nurse. Heart rate variability was measured by using (1) a standard-deviation method and (2) Poincare plots. Data on RR intervals obtained by using 24-hour Holter monitoring were analyzed. Survival was determined at 1 year after the Holter recording. RESULTS: The results showed no significant associations between the results of the 6-minute walk and the two measures of heart rate variability. The results of the walk were related to 1-year mortality but not to the risk of sudden death. Both measures of heart rate variability had significant associations with 1-year mortality and with sudden death. However, only heart rate variability measured by using Poincare plots was a predictor of total mortality and risk of sudden death, independent of left ventricular ejection fraction, serum levels of sodium, results of the 6-minute walk test, and the standard-deviation measure of heart rate variability. CONCLUSIONS: Results of the 6-minute walk have poor association with mortality and the two measures of heart rate variability in patients with advanced-stage heart failure and a low ejection fraction. Further studies are needed to determine the optimal clinical usefulness of the 6-minute walk and heart rate variability in patients with advanced-stage heart failure.

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