scholarly journals Effects of a mindfulness-based intervention on symptoms and signs in chronic heart failure: A feasibility study

2017 ◽  
Vol 17 (1) ◽  
pp. 54-65 ◽  
Author(s):  
Jonna Norman ◽  
Michael Fu ◽  
Inger Ekman ◽  
Lena Björck ◽  
Kristin Falk
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Usual Care ◽  
Feasibility Study ◽  
Nyha Class ◽  
Symptom Burden ◽  
Heart Association ◽  
Walking Distance ◽  
Nyha Classification ◽  
Symptoms And Signs

Aims: Despite treatment recommended by guidelines, many patients with chronic heart failure remain symptomatic. Evidence is accumulating that mindfulness-based interventions (MBIs) have beneficial psychological and physiological effects. The aim of this study was to explore the feasibility of MBI on symptoms and signs in patients with chronic heart failure in outpatient clinical settings. Methods: A prospective feasibility study. Fifty stable but symptomatic patients with chronic heart failure, despite optimized guideline-recommended treatment, were enrolled at baseline. In total, 40 participants (median age 76 years; New York Heart Association (NYHA) classification II−III) adhered to the study. Most patients ( n=17) were randomized into MBI, a structured eight-week mindfulness-based educational and training programme, or controls with usual care ( n=16). Primary outcome was self-reported fatigue on the Fatigue severity scale. Secondary outcomes were self-reported sleep quality, unsteadiness/dizziness, NYHA functional classification, walking distance in the six-minute walk test, and heart and respiratory rates. The Mann–Whitney U test was used to analyse median sum changes from baseline to follow-up (week 10±1). Results: Compared with usual care (zero change), MBI significantly reduced the self-reported impact of fatigue (effect size −8.0; p=0.0165), symptoms of unsteadiness/dizziness ( p=0.0390) and breathlessness/tiredness related to physical functioning (NYHA class) ( p=0.0087). No adverse effects were found. Conclusions: In stable but symptomatic outpatients with chronic heart failure, MBI alleviated self-reported symptoms in addition to conventional treatment. The sample size is small and further studies are needed, but findings support the role of MBI as a feasible complementary option, both clinically and as home-based treatment, which might contribute to reduction of the symptom burden in patients diagnosed with chronic heart failure.

Revisiting heart failure assessment based on objective measures in NYHA functional classes I and II

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317984
Author(s):  
Mariana Blacher ◽  
André Zimerman ◽  
Pedro H B Engster ◽  
Eduardo Grespan ◽  
Carisi A Polanczyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Heart Association ◽  
Functional Class ◽  
Class I ◽  
Objective Measures ◽  
Functional Evaluation ◽  
Self Perception ◽  
Reduced Ejection Fraction ◽  
Nyha Classification

ObjectiveNew York Heart Association (NYHA) functional class plays a central role in heart failure (HF) assessment but might be unreliable in mild presentations. We compared objective measures of HF functional evaluation between patients classified as NYHA I and II in the Rede Brasileira de Estudos em Insuficiência Cardíaca (ReBIC)-1 Trial.MethodsThe ReBIC-1 Trial included outpatients with stable HF with reduced ejection fraction. All patients had simultaneous protocol-defined assessment of NYHA class, 6 min walk test (6MWT), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and patient’s self-perception of dyspnoea using a Visual Analogue Scale (VAS, range 0–100).ResultsOf 188 included patients with HF, 122 (65%) were classified as NYHA I and 66 (35%) as NYHA II at baseline. Although NYHA class I patients had lower dyspnoea VAS Scores (median 16 (IQR, 4–30) for class I vs 27.5 (11–49) for class II, p=0.001), overlap between classes was substantial (density overlap=60%). A similar profile was observed for NT-proBNP levels (620 pg/mL (248–1333) vs 778 (421–1737), p=0.015; overlap=78%) and for 6MWT distance (400 m (330–466) vs 351 m (286–408), p=0.028; overlap=64%). Among NYHA class I patients, 19%–34% had one marker of HF severity (VAS Score >30 points, 6MWT <300 m or NT-proBNP levels >1000 pg/mL) and 6%–10% had two of them. Temporal change in functional class was not accompanied by variation on dyspnoea VAS (p=0.14).ConclusionsMost patients classified as NYHA classes I and II had similar self-perception of their limitation, objective physical capabilities and levels of natriuretic peptides. These results suggest the NYHA classification poorly discriminates patients with mild HF.

scholarly journals One-Year Survival and Renal Function Recovery of Acute Kidney Injury Patients with Chronic Heart Failure

2014 ◽  
Vol 5 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Wen Zhang ◽  
Dan Wen ◽  
Yan-Fang Zou ◽  
Ping-Yan Shen ◽  
Yao-Wen Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Clinical Characteristics ◽  
Nyha Class ◽  
Kidney Injury ◽  
Class Iii ◽  
Kidney Dysfunction ◽  
Nyha Classification

Objective: To describe and analyze the clinical characteristics of acute kidney injury (AKI) patients with preexisting chronic heart failure (CHF) and to identify the prognostic factors of the 1-year outcome. Methods: A total of 120 patients with preexisting CHF who developed AKI between January 2005 and December 2010 were enrolled. CHF was diagnosed according to the European Society of Cardiology guidelines, and AKI was diagnosed using the RIFLE criteria. Clinical characteristics were recorded, and nonrecovery from kidney dysfunction as well as mortality were analyzed. Results: The median age of the patients was 70 years, and 58.33% were male. 60% of the patients had an advanced AKI stage (‘failure') and 90% were classified as NYHA class III/IV. The 1-year mortality rate was 35%. 25.83% of the patients progressed to end-stage renal disease after 1 year. Hypertension, anemia, coronary atherosclerotic heart disease and chronic kidney disease were common comorbidities. Multiple organ dysfunction syndrome (MODS; OR, 35.950; 95% CI, 4.972-259.952), arrhythmia (OR, 13.461; 95% CI, 2.379-76.161), anemia (OR, 6.176; 95% CI, 1.172-32.544) and RIFLE category (OR, 5.353; 95% CI, 1.436-19.952) were identified as risk factors of 1-year mortality. For 1-year nonrecovery from kidney dysfunction, MODS (OR, 8.884; 95% CI, 2.535-31.135) and acute heart failure (OR, 3.281; 95% CI, 1.026-10.491) were independent risk factors. Conclusion: AKI patients with preexisting CHF were mainly elderly patients who had an advanced AKI stage and NYHA classification. Their 1-year mortality and nonrecovery from kidney dysfunction rates were high. Identifying risk factors may help to improve their outcome.

scholarly journals Prevalence of renal dysfunction and its influence on functional capacity in elderly patients with stable chronic heart failure

2012 ◽  
Vol 69 (10) ◽  
pp. 840-845 ◽  
Author(s):  
Dragana Stanojevic ◽  
Svetlana Apostolovic ◽  
Ruzica Jankovic-Tomasevic ◽  
Sonja Salinger-Martinovic ◽  
Milan Pavlovic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Renal Dysfunction ◽  
Functional Capacity ◽  
Exercise Tolerance ◽  
Nyha Class ◽  
The Elderly ◽  
Left Ventricular ◽  
Walking Distance ◽  
Left Ventricular Ejection

Bacground/Aim. Chronic heart failure (CHF) is highly prevalent and constitutes an important public health problem around the world. In spite of a large number of pharmacological agents that successfully decrease mortality in CHF, the effects on exercise tolerance and quality of life are modest. Renal dysfunction is extremely common in patients with CHF and it is strongly related not only to increased mortality and morbidity but to a significant decrease in exercise tolerance, as well. The aim of our study was to investigate the prevalence and influence of the renal dysfunction on functional capacity in the elderly CHF patients. Methods. We included 127 patients aged over 65 years in a stable phase of CHF. The diagnosis of heart failure was based on the latest diagnostic principles of the European Society of Cardiology. The estimated glomerular filtration rate (eGRF) was determined by the abbreviated Modification of Diet in Renal Disease (MDRD2) formula, and patients were categorized using the Kidney Disease Outcomes Quality Initiative (K/DOQI) classification system. Functional capacity was determined by the 6 minute walking test (6MWT). Results. Among 127 patients, 90 were men. The average age was 72.5 ? 4.99 years and left ventricular ejection fraction (LVEF) was 40.22 ? 9.89%. The average duration of CHF was 3.79 ? 4.84 years. Ninty three (73.2%) patients were in New York Heart Association (NYHA) class II and 34 (26.8%) in NYHA class III. Normal renal function (eGFR ? 90 mL/min) had 8.9% of participants, 57.8% had eGFR between 60-89 mL/min (stage 2 or mild reduction in GFR according to K/DOQI classification), 32.2% had eGFR between 30-59 mL/min (stage 3 or moderate reduction in GFR) and 1.1% had eGFR between 15-29 mL/min (stage 4 or severe reduction in GFR). We found statistically significant correlation between eGFR and 6 minute walking distance (6MWD) (r = 0.390, p < 0.001), LVEF (r = 0.268, p < 0.05), NYHA class (? = -0.269, p < 0.05) and age (r = - 0.214, p < 0.05). In multiple regression analysis only patients? age was a predictor of decreased 6MWD < 300 m (OR = 0.8736, CI = 0.7804 - 0.9781, p < 0.05). Conclusion. Renal dysfunction is highly prevalent in the elderly CHF patients. It is associated with decreased functional capacity and therefore with poor prognosis. This study corroborates the use of eGFR not only as a powerful predictor of mortality in CHF, but also as an indicator of the functional capacity of cardiopulmonary system. However, clinicians underestimate a serial measurement of eGFR while it should be the part of a routine evaluation performed in every patient with CHF, particularly in the elderly population.

scholarly journals Differential Role of Circulating microRNAs to Track Progression and Pre-Symptomatic Stage of Chronic Heart Failure: A Pilot Study

Biomedicines ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. 597
Author(s):  
Yuri D’Alessandra ◽  
Mattia Chiesa ◽  
Maria Cristina Carena ◽  
Antonio Paolo Beltrami ◽  
Paola Rizzo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pilot Study ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Linear Regression Analysis ◽  
Heart Association ◽  
Left Ventricular ◽  
Analysis Of Covariance ◽  
Class I ◽  
Micro Rnas

(1)Background: Chronic heart failure (CHF) contributes to the overall burden of cardiovascular disease. Early identification of at-risk individuals may facilitate the targeting of precision therapies. Plasma microRNAs are promising circulating biomarkers for their implications with cardiac pathologies. In this pilot study, we investigate the possible exploitability of circulating micro-RNAs (miRNAs) to track chronic heart failure (CHF) occurrence, and progression from NYHA class I to IV. (2)Methods: We screened 367 microRNAs using TaqMan microRNA Arrays in plasma samples from healthy controls (HC) and CHF NYHA-class I-to-IV patients (5/group). Validation was performed by singleplex assays on 10 HC and 61 CHF subjects. Differences in the expression of validated microRNAs were evaluated through analysis of covariance (ANCOVA). Associations between N-terminal pro-BNP (NT-proBNP), left ventricular end-diastolic volume (LVEDV) or peak oxygen uptake (VO2 peak) and plasma microRNA were assessed by multivariable linear regression analysis. (3)Results: Twelve microRNAs showed higher expression in CHF patients vs. HC. Seven microRNAs were associated with NT-proBNP concentration; of these, miR-423-5p was also an independent predictor of LVEDV. Moreover, miR-499-5p was a predictor of the VO2 peak. Finally, a cluster of 5 miRNAs discriminated New York Heart Association (NYHA) class-I from HC subjects. (4)Conclusions: Our data suggest that circulating miRNAs have the potential to serve as pathophysiology-based markers of HF status and progression, and as indicators of pre-symptomatic individuals.

scholarly journals Effects of Sacubitril-Valsartan in Heart Failure With Preserved Ejection Fraction in Patients Undergoing Peritoneal Dialysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Sha Fu ◽  
Zhenjian Xu ◽  
Baojuan Lin ◽  
Junzhe Chen ◽  
Qiuyan Huang ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Peritoneal Dialysis ◽  
Ejection Fraction ◽  
Nyha Class ◽  
Heart Association ◽  
Signs And Symptoms ◽  
Preserved Ejection Fraction ◽  
Nyha Classification ◽  
Neprilysin Inhibitor

Aims: The effect of the angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril-valsartan in patients with heart failure with preserved ejection fraction (HFpEF) remains unclear, and data on ARNI treatment in peritoneal dialysis (PD) patients are lacking. The present study was designed to assess the efficacy and safety of sacubitril-valsartan in patients with HFpEF undergoing peritoneal dialysis.Methods and Results: End-stage kidney disease (ESKD) patients undergoing PD for 3 months with New York Heart Association (NYHA) class II–IV heart failure, ejection fraction of 50% or higher, and elevated levels of N-terminal pro–B-type natriuretic peptide (NT-proBNP) were assigned to receive sacubitril-valsartan. Patients were followed up regularly after medication treatment. The alterations in clinical and biochemical parameters before and after taking sacubitril-valsartan (generally 50–100 mg b.i.d) were investigated, and safety was also assessed. Twenty-one patients were recruited in this study. Compared with baseline levels, NT-proBNP levels [9769.0 (3093.5–21941.0) vs. 3034.0 (1493.2–6503.0), P = 0.002], and heart rate [80.0 (74.5–90.5) vs. 75.0 (70.3–87.0), P = 0.031] were markedly decreased after treatment with sacubitril-valsartan. Signs and symptoms of heart failure (21/21 vs. 15/21, P = 0.021) were obviously alleviated, NYHA classification and E/e' ratio showed a notable trend of improvement after 3–12 months of follow-up. None of the patients showed adverse drug reactions.Conclusions: The present data suggested that sacubitril-valsartan treatment in patients with HFpEF undergoing PD was effective and safe.

scholarly journals Does Platelet and Inflammatory Readings Differ Between Chronic Heart Failure Patients‘ Groups According to NYHA Functional Classes?

2019 ◽  
Vol 2 (4) ◽  
pp. e00111
Author(s):  
Aušra Mongirdienė ◽  
Jolanta Laukaitienė ◽  
Vilius Skipskis
Keyword(s):  
Heart Failure ◽  
New York ◽  
Platelet Aggregation ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Systolic Heart Failure ◽  
Heart Association ◽  
Fibrinogen Concentration ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients

It is stated in the literature that thrombosis in the chronic heart failure (CHF) patients may be caused by interaction of inflammation and platelets. The incidence of venous thromboembolism in heart failure patients is found to be the highest in the patients classified as NYHA IV. We aimed to test the hypothesis that prothrombotic state depends on inflammation. We have compared the C-reactive protein (CRP), fibrinogen concentration, platelet count (PLT), mean platelet volume (MPV) and platelet aggregation in CHF patients’ groups according to New York Heart Association (NYHA). 203 patients with CHF with reduced ejection fraction (systolic heart failure classes I‒IV according to NYHA) were included in the study. There were no statistically significant differences in fibrinogen concentration, CRP, PLT and platelet aggregation between the groups according to NYHA. The MPV was statistically significant higher in NYHA IV group than in NYHA III, NYHA II and NYHA I groups (10.86 ± 1.14 and 9.78 ± 1.21 and 9.65 ± 1.22 and 9.21 ± 0.59 respectively, p = 0.006). There was a weak correlation between CRP and PLT (r = 0.293, p = 0.010), and between MPV and fibrinogen concentration (r=0.205, p=0.012). There was a moderate correlation between MPV and NYHA (r = 0.361, p < 0.001) and between fibrinogen concentration and CRP (r = 0.381, p < 0.001). MPV rising in the patients’ groups and correlation between MPV and NYHA class, and plasma fibrinogen concentration, correlation between PLT and CRP, correlation between CRP and NT-proBNP concentration confirm, that low inflammation can take place in the MPV rising.

scholarly journals HUBUNGAN KELAS NYHA DENGAN FRAKSI EJEKSI PADA PASIEN GAGAL JANTUNG KRONIK DI BLU/RSUP PROF. DR. R.D. KANDOU MANADO

e-CliniC ◽  
2013 ◽  
Vol 1 (2) ◽  
Author(s):  
Patricia Ratna Sari ◽  
Starry H. Rampengan ◽  
Agnes Lucia Panda
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Heart Function ◽  
Nyha Class ◽  
Heart Association ◽  
Cross Sectional ◽  
New York Heart Association ◽  
Spearman Test

Abstract: The functional status of patients with chronic heart failure (CHF) has been standardized by the classification of NYHA [New York Heart Association] class I-IV. One of the parameters to assess the ability of the heart function is the ejection fraction (LVEF) were assessed using echocardiography parameters. The purpose of this study was to determine the relationship of NYHA class with ejection fraction in patients with chronic heart failure in the BLU/Prof. Dr. R. D. Kandou Manado. Methodology: This research method is analytic cross sectional study approach. The sample was CHF patients in BLU/Prof. Dr. R. D. Manado Kandou 30 people held during November-December 2012. Results: The distribution of patients according to NYHA class most are in NYHA II (43%), while the lowest are in NYHA IV (7%). Distribution according to the ejection fraction is at most 30-39% LVEF is 12 and there are at least LVEF <30%, is 6 people. The results obtained using the Spearman test (p = 0.177), indicating that there was no statistically significant association between NYHA class with ejection fraction in patients with chronic heart failure in the BLU/Prof. Dr. R. D. Kandou Manado.Conclusion: No significant relationship was found between NYHA class with ejection fraction. Keywords: Chronic Heart Failure, ejection fraction, NYHA class   Abstrak: Status fungsional penderita gagal jantung kronik (GJK) ini telah dibakukan berdasarkan klasifikasi NYHA [New York Heart Association] kelas I-IV. Salah satu parameter untuk menilai kemampuan fungsi jantung adalah fraksi ejeksi (LVEF) yang dinilai menggunakan parameter ekokardiografi. Tujuan penelitian ini adalah untuk mengetahui hubungan kelas NYHA dengan fraksi ejeksi pada penderita gagal jantung kronik di BLU/RSUP Prof. Dr. R. D. Kandou Manado. Metodologi: Metode penelitian ini bersifat analitik dengan pendekatan studi cross sectional.  Sampel penelitian ini adalah pasien GJK  di BLU/RSUP. Prof. Dr. R. D. Kandou Manado sebanyak 30 orang yang berlangsung selama bulan November – Desember 2012. Hasil : Distribusi pasien GJK menurut kelas NYHA terbanyak berada pada NYHA II (43%), sedangkan yang paling rendah berada pada NYHA IV (7%). Distribusi  menurut Fraksi Ejeksi terbanyak berada pada LVEF 30-39 % yaitu 12 orang dan paling rendah terdapat pada LVEF <30 % yaitu 6 orang. Hasil penelitian ini menggunakan uji Spearman diperoleh (p= 0,177), menunjukkan bahwa secara statistik tidak terdapat hubungan bermakna antara NYHA kelas dengan fraksi ejeksi pada pasien gagal jantung kronik di BLU/RSUP Prof. Dr. R. D. Kandou Manado. Kesimpulan:Tidak ditemukan hubungan yang signifikan antara kelas NYHA dengan fraksi ejeksi. Kata kunci : Fraksi ejeksI, Gagal Jantung Kronik, Kelas NYHA [New York Heart Association]

scholarly journals CORRELATION BETWEEN CONCENTRATION OF PATHOLOGICAL CYTOKINES AND ERYTHROPOIETIN IN PATIENTS WITH CHRONIC HEART FAILURE WITH ANEMIC SYNDROME

2015 ◽  
Vol 69 (1-2) ◽  
pp. 32-37
Author(s):  
K. Kh. Zahidova
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
New York Heart Association ◽  
Erythropoietin Treatment

Aim: to study correlation between concentration of pathological cytokines and erythropoietin in patients with chronic heart failure with anemic syndrome and also to prove importance of this communication for need of appointment erythropoietin excitants. Patients and methods: 94 patients with chronic heart failure of New York Heart Association (NYHA) class ІІІ–ІV a left ventricular ejection fraction of 40% or less with anemia w ere included in investigation (58 males, 36 females). Anemia was detected when hemoglobin (Hb) was less than 120 g/l in males and less than 110 g/l in females. 46 patients received traditional treatment of CHF (І group) and 48 patients were treated additionally with erythropoietin (EPO) (ІІ group). Percutaneous EPO 50 IU monthly to patients without iron deficiency for a period of 6 months. Echocardiography parameters, plasma NT and pro-BNP, cytokines, EPO, ferritin and 6-minute walking test were assessed at baseline and after treatment. Results: in patients with CHF and anemia in ІІ group erythropoietin treatment increased Hb levels by 22,4% (p IL 6 by 54,3% (p α by 48,3% (p increase of LVEF by 19,04% (p Conclusions: Correction of anemia in patients with chronic heart failure with percutaneous erythropoietin injections 50 IU monthly for 6 month period to improve erythropoietin deficit and cytokines aggression and associated anemia, symptoms and quality of life.

Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction

2004 ◽  
Vol 97 (5) ◽  
pp. 1667-1672 ◽  
Author(s):  
Timothy E. Meyer ◽  
Mustafa Karamanoglu ◽  
Ali A. Ehsani ◽  
Sándor J. Kovács
Keyword(s):  
Heart Failure ◽  
Diastolic Function ◽  
Exercise Capacity ◽  
Exercise Tolerance ◽  
Nyha Class ◽  
Linear Regression Analysis ◽  
Heart Association ◽  
Left Ventricular ◽  
Peak Oxygen Consumption ◽  
Nyha Classification

Impaired exercise tolerance, determined by peak oxygen consumption (V̇o2 peak), is predictive of mortality and the necessity for cardiac transplantation in patients with chronic heart failure (HF). However, the role of left ventricular (LV) diastolic function at rest, reflected by chamber stiffness assessed echocardiographically, as a determinant of exercise tolerance is unknown. Increased LV chamber stiffness and limitation of V̇o2 peak are known correlates of HF. Yet, the relationship between chamber stiffness and V̇o2 peak in subjects with HF has not been fully determined. Forty-one patients with HF New York Heart Association [(NYHA) class 2.4 ± 0.8, mean ± SD] had echocardiographic studies and V̇o2 peak measurements. Transmitral Doppler E waves were analyzed using a previously validated method to determine k, the LV chamber stiffness parameter. Multiple linear regression analysis of V̇o2 peak variance indicated that LV chamber stiffness k ( r2 = 0.55) and NYHA classification ( r2 = 0.43) were its best independent predictors and when taken together account for 59% of the variability in V̇o2 peak. We conclude that diastolic function at rest, as manifested by chamber stiffness, is a major determinant of maximal exercise capacity in HF.

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