Anxiety and self-care behaviour in patients with chronic systolic heart failure: A multivariate model

2017 ◽  
Vol 17 (2) ◽  
pp. 170-177 ◽  
Author(s):  
Thomas Müller-Tasch ◽  
Bernd Löwe ◽  
Nicole Lossnitzer ◽  
Lutz Frankenstein ◽  
Tobias Täger ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Anxiety Disorder ◽  
Sex Education ◽  
Nyha Class ◽  
Systolic Heart Failure ◽  
Self Care ◽  
Heart Association ◽  
Depression Score ◽  
Negatively Associated

Background: While comprehensive evidence exists regarding negative effects of depression on self-care behaviours in patients with chronic heart failure (CHF), the relation between anxiety and self-care behaviours in patients with CHF is not clear. The aim of this study was to analyse the interactions between anxiety, depression and self-care behaviours in patients with CHF. Methods: The self-care behaviour of CHF outpatients was measured using the European Heart Failure Self-care Behaviour Scale (EHFScBS). The Patient Health Questionnaire (PHQ) was used to assess anxiety, the PHQ-9 was used to measure depression severity. Differences between patients with and without anxiety were assessed with the respective tests. Associations between anxiety, self-care and other predictors were analysed using linear regressions. Results: Of the 308 participating patients, 35 (11.4%) fulfilled the PHQ criteria for an anxiety disorder. These patients took antidepressants more frequently (11.8% versus 2.3%, p = .02), had had more contacts with their general practitioner within the last year (11.8 ± 16.1 versus 6.7 ± 8.6, p = .02), and had a higher PHQ-9 depression score (12.9 ± 5.7 versus 6.5 ± 4.7, p < .01) than patients without anxiety disorder. Anxiety and self-care were negatively associated (ß = −0.144, r2 = 0.021, p = 0.015). The explanation of variance was augmented in a multivariate regression with the predictors age, sex, education, living with a partner, and New York Heart Association (NYHA) class ( r2 = 0.098) when anxiety was added ( r2 = 0.112). Depression further increased the explanation of variance (ß = −0.161, r2 = 0.131, p = 0.019). Conclusions: Anxiety is negatively associated with self-care behaviour in patients with CHF. However, this effect disappears behind the stronger influence of depression on self-care. The consideration of mental comorbidities in patients with CHF is important.

Plasma urocortin in human systolic heart failure

2004 ◽  
Vol 106 (4) ◽  
pp. 383-388 ◽  
Author(s):  
Leong L. NG ◽  
Ian W. LOKE ◽  
Russell J. O'BRIEN ◽  
Iain B. SQUIRE ◽  
Joan E. DAVIES
Keyword(s):  
Heart Failure ◽  
New York ◽  
Nyha Class ◽  
Systolic Heart Failure ◽  
Area Under The Curve ◽  
Logistic Models ◽  
Heart Association ◽  
Roc Curves ◽  
Relative Increase ◽  
And Gender

Urocortin (UCN), a member of the corticotrophin-releasing factor family, is expressed in heart, brain and gut. UCN has potent cardiostimulatory, cardioprotective, vasodilator and diuretic/natriuretic effects, and cardiac UCN expression is increased in heart failure (HF). In the present study, we investigated plasma levels of UCN in 119 patients with HF and 212 age- and gender-matched controls to clarify its relationship with gender and disease severity. UCN was elevated in HF [normal males, 19.5 (3.9–68.8) pmol/l and HF males, 50.2 (6.9–108.2) pmol/l, P<0.0005; normal females, 14.2 (3.9–53.5) pmol/l and HF females, 21.8 (3.9–112.5) pmol/l, P<0.001; values are medians (range)]. The relative increase was greater in males than females (P<0.03). UCN fell with increasing age, especially in HF patients (rs=-0.56, P<0.0005) and with increasing New York Heart Association (NYHA) class (rs=-0.55, P<0.0005). The fall in UCN levels with increasing NYHA class was reinforced by a significant correlation between UCN and ejection fraction (rs=0.45, P<0.0005) in HF patients. Although receiver operating characteristic (ROC) curves for diagnosis of all HF cases yielded an area under the curve (AUC) of 0.76, ROC AUCs for patients with early HF (NYHA class I and II) were better (0.91). ROC AUCs for logistic models incorporating N-terminal probrain natriuretic peptide (N-BNP) and UCN were better than either peptide alone. In conclusion, plasma UCN is elevated in HF, especially in its early stages. Its decline with increasing HF severity may expedite disease progression due to diminished cardioprotective/anti-inflammatory effects. UCN measurement may also complement N-BNP in the diagnosis of early HF.

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 Knowledge about self-care and associated factors among heart-failure patients in Ayder Referral Hospital, Ethiopia, 2018: A cross-sectional study

2020 ◽  
pp. 201010582096214
Author(s):  
Tsegu Hailu Gebru ◽  
Haftea Hagos Mekonen ◽  
Kbrom Gemechu Kiros
Keyword(s):  
Heart Failure ◽  
New York ◽  
Logistic Regression ◽  
Self Care ◽  
Heart Association ◽  
Cross Sectional Study ◽  
Referral Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Knowledge Age

Background: Good knowledge of self-care related to heart failure (HF) is key to improve patient outcomes. However, information regarding how much patients know about self-care is lacking in developing countries, particularly in the study setting. Objective: The objectives of this study were to assess HF patients’ knowledge about self-care and to explore predictors among HF patients in Ayder comprehensive specialised referral hospital, Tigray, Ethiopia. Methods: This hospital-based cross-sectional study design was undertaken in Ayder comprehensive specialised referral hospital, Tigray, Ethiopia. A total of 408 HF patients participated, and the study was done between February and April 2018. An interviewer-assisted structured questionnaire was used to collect data. Bivariate logistic regression and multivariable logistic regression were conducted to identify the predictors associated with knowledge about self-care. Results: The mean age of the participants was 45.4 years (standard deviation=19 years). Around 255 (62.5%) of the participants had poor self-care knowledge. Age, New York Heart Association classes, duration of the disease and previous hospitalisation were the factors associated with knowledge about self-care. Conclusion: More than half of all participants had poor knowledge about self-care. Improving existing prevention strategies and strengthening patients’ knowledge are recommended to address this knowledge deficit.

Abstract 216: Left Ventricular Enlargement and Heart Failure Events: Is Bigger Better?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Farbod Raiszadeh ◽  
Neeraja Yedlapati ◽  
Ileana L Piña ◽  
Daniel M Spevack
Keyword(s):  
Heart Failure ◽  
New York ◽  
Cox Regression ◽  
Systolic Heart Failure ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Volumes ◽  
End Diastolic Volume ◽  
New York Heart Association ◽  
The Individual

Background: Since stroke volume (SV) is a function of ejection fraction (EF) and end-diastolic volume (EDV) (SV = EF x EDV), we hypothesized that increased EDV may be advantageous in systolic heart failure (HF), allowing the left ventricle to supply increased cardiac output. Methods: Echocardiograms from 968 consecutive patients seen in our hospital’s HF clinic were reviewed. Left ventricular volumes were measured both at end systole and end diastole using the bi-plane Simpson’s method and were indexed to body surface area. EF was calculated using (EDV-ESV)/EDV. Dates of subsequent HF events (death or admission for HF exacerbation) were obtained from our database. Results: Systolic HF (EF < 50%) was found in 649 of the study subjects. Increased SV index was associated with increased EDV index. The strength of this association varied with EF, Figure. In a bivariate Cox regression model, lower SV index and higher EDV index were each independent predictors of HF events. Increase in EDV by 50 cc was associated with a 20% increase in HF events, p<0.001. Decrease in SVI by 5 cc was associated with 5% increase in HF events, p<0.001. These associations were limited to those with systolic HF. The associations between both EDVI and SVI and HF events were not confounded by patient age, sex and New York Heart Association Class. Conclusion: Increased EDV index was independently associated with increased HF events, indicating that LV enlargement in HF is not favorable. These findings underscore the individual contributions of the components of EF (SV and EDV) in predicting HF outcomes.

scholarly journals Effects of Oral Amino Acid Supplements on Functional Capacity in Patients with Chronic Heart Failure

2014 ◽  
Vol 8 ◽  
pp. CMC.S14016 ◽  
Author(s):  
Carlo Lombardi ◽  
Valentina Carubelli ◽  
Valentina Lazzarini ◽  
Enrico Vizzardi ◽  
Filippo Quinzani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
New York ◽  
Functional Capacity ◽  
Exercise Tolerance ◽  
Stress Test ◽  
Nyha Class ◽  
Heart Association

Amino acids (AAs) availability is reduced in patients with heart failure (HF) leading to abnormalities in cardiac and skeletal muscle metabolism, and eventually to a reduction in functional capacity and quality of life. In this study, we investigate the effects of oral supplementation with essential and semi-essential AAs for three months in patients with stable chronic HF. The primary endpoints were the effects of AA's supplementation on exercise tolerance (evaluated by cardiopulmonary stress test and six minutes walking test (6MWT)), whether the secondary endpoints were change in quality of life (evaluated by Minnesota Living with Heart Failure Questionnaire—MLHFQJ and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. We enrolled 13 patients with chronic stable HF on optimal therapy, symptomatic in New York Heart Association (NYHA) class II/III, with an ejection fraction (EF) <45%. The mean age was 59 ± 14 years, and 11 (84.6%) patients were male. After three months, peak VO2 (baseline 14.8 ± 3.9 mL/minute/kg vs follow-up 16.8 ± 5.1 mL/minute/kg; P = 0.008) and VO2 at anaerobic threshold improved significantly (baseline 9.0 ± 3.8 mL/minute/kg vs follow-up 12.4 ± 3.9 mL/minute/kg; P = 0.002), as the 6MWT distance (baseline 439.1 ± 64.3 m vs follow-up 474.2 ± 89.0 m; P = 0.006). However, the quality of life did not change significantly (baseline 21 ± 14 vs follow-up 25 ± 13; P = 0.321). A non-significant trend in the reduction of NT-proBNP levels was observed (baseline 1502 ± 1900 ng/L vs follow-up 1040 ± 1345 ng/L; P = 0.052). AAs treatment resulted safe and was well tolerated by all patients. In our study, AAs supplementation in patients with chronic HF improved exercise tolerance but did not change quality of life.

Ivabradine

2015 ◽  
Vol 21 (4) ◽  
pp. 335-343 ◽  
Author(s):  
Rahul Chaudhary ◽  
Jalaj Garg ◽  
Parasuram Krishnamoorthy ◽  
Neeraj Shah ◽  
Gregg Lanier ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Heart Rate ◽  
Systolic Heart Failure ◽  
Negative Inotropic Effect ◽  
Heart Association ◽  
The United States ◽  
High Rate ◽  
Inappropriate Sinus Tachycardia ◽  
Reduced Ejection Fraction

Heart failure affects over 5 million people in the United States and carries a high rate of mortality. Ivabradine, a new agent has been added to the current medical options for managing heart failure. It is a selective funny current ( If) inhibitor in sinoatrial node and slows its firing rate, prolonging diastolic depolarization without a negative inotropic effect. Ivabradine was only recently approved by Food and Drug administration after the results of Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) trial, for a reduction in rehospitalizations from chronic heart failure. This trial assessed patients with stable heart failure with reduced ejection fraction and a heart rate of at least 70 beats per minute at rest on maximally tolerated beta-blocker therapy and demonstrated statistically significant reduction in heart failure hospitalization and deaths. Additionally, ivabradine has been associated with reduced cardiac remodeling, reduced heart rate variability, improvement in exercise tolerance, improved heart failure class of New York Heart Association, and better quality of life. It has also been tried in other conditions, such as inappropriate sinus tachycardia and cardiogenic shock, and is currently in phase II trial for patients with newly diagnosed multiple organ dysfunction syndrome.

scholarly journals Predictive Value of HFA-PEFF Score in Patients With Heart Failure With Preserved Ejection Fraction

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuxi Sun ◽  
Jinping Si ◽  
Jiaxin Li ◽  
Mengyuan Dai ◽  
Emma King ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Ejection Fraction ◽  
Roc Analysis ◽  
Cox Regression ◽  
Nyha Class ◽  
Area Under The Curve ◽  
Heart Association ◽  
Preserved Ejection Fraction ◽  
All Cause Mortality

Aims: HFA-PEFF score has been proposed for diagnosing heart failure with preserved ejection fraction (HFpEF). Currently, there are only a limited number of tools for predicting the prognosis. In this study, we evaluated whether the HFA-PEFF score can predict mortality in patients with HFpEF.Methods: This single-center, retrospective observational study enrolled patients diagnosed with HFpEF at the First Affiliated Hospital of Dalian Medical University between January 1, 2015, and April 30, 2018. The subjects were divided according to their HFA-PEFF score into low (0–2 points), intermediate (3–4 points), and high (5–6 points) score groups. The primary outcome was all-cause mortality.Results: A total of 358 patients (mean age: 70.21 ± 8.64 years, 58.1% female) were included. Of these, 63 (17.6%), 156 (43.6%), and 139 (38.8%) were classified into the low, intermediate, and high score groups, respectively. Over a mean follow-up of 26.9 months, 46 patients (12.8%) died. The percentage of patients who died in the low, intermediate, and high score groups were 1 (1.6%), 18 (11.5%), and 27 (19.4%), respectively. A multivariate Cox regression identified HFA-PEFF score as an independent predictor of all-cause mortality [hazard ratio (HR):1.314, 95% CI: 1.013–1.705, P = 0.039]. A Cox analysis demonstrated a significantly higher rate of mortality in the intermediate (HR: 4.912, 95% CI 1.154–20.907, P = 0.031) and high score groups (HR: 5.291, 95% CI: 1.239–22.593, P = 0.024) than the low score group. A receiver operating characteristic (ROC) analysis indicated that the HFA-PEFF score can effectively predict all-cause mortality after adjusting for age and New York Heart Association (NYHA) class [area under the curve (AUC) 0.726, 95% CI 0.651–0.800, P = 0.000]. With an HFA-PEFF score cut-off value of 3.5, the sensitivity and specificity were 78.3 and 54.8%, respectively. The AUC on ROC analysis for the biomarker component of the score was similar to that of the total score.Conclusions: The HFA-PEFF score can be used both to diagnose HFpEF and predict the prognosis. The higher scores are associated with higher all-cause mortality.

scholarly journals Mid-regional proatrial natriuretic peptide for predicting prognosis in hypertrophic cardiomyopathy

Heart ◽  
2019 ◽  
pp. heartjnl-2019-314826 ◽  
Author(s):  
Céline Bégué ◽  
Stellan Mörner ◽  
Dulce Brito ◽  
Christian Hengstenberg ◽  
John G F Cleland ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Hypertrophic Cardiomyopathy ◽  
Natriuretic Peptide ◽  
Nyha Class ◽  
Heart Association ◽  
Roc Curves ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

ObjectivesN-terminal probrain natriuretic peptide (NT-proBNP) predicts mortality and the development of heart failure in hypertrophic cardiomyopathy (HCM). Mid-regional proatrial natriuretic peptide (MR-proANP) is a stable by-product of production of atrial natriuretic peptide. We sought to compare the prognostic value of MR-proANP and NT-proBNP in HCM.MethodsWe prospectively enrolled a cohort of patients with HCM from different European centres and followed them. All patients had clinical, ECG and echocardiographic evaluation and measurement of MR-proANP and NT-proBNP at inclusion.ResultsOf 357 patients enrolled, the median age was 52 (IQR: 36–65) years. MR-proANP and NT-proBNP were both independently associated with age, weight, New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), wall thickness and left atrial dimension. During a median follow-up of 23 months, 32 patients had a primary end point defined as death (n=6), heart transplantation (n=8), left ventricular assist device implantation (n=1) or heart failure hospitalisation (n=17). Both NT-proBNP and MR-proANP (p<10–4) were strongly associated with the primary endpoint, and the areas under the receiver operating characteristic (ROC) curves for both peptides were not significantly different. However, in a multiple stepwise regression analysis, the best model for predicting outcome was NYHA 1–2 vs 3–4 (HR=0.35, 95% CI 0.16 to 0.77, p<0.01), LVEF (HR=0.96, 95% CI 0.94 to 0.98, p=0.0005) and MR-proANP (HR=3.77, 95% CI 2.01 to 7.08, p<0.0001).ConclusionsMR-proANP emerges as a valuable biomarker for the prediction of death and heart failure related events in patients with HCM.

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.

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.

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