Insufficient Self-Care Is an Independent Risk Factor for Adverse Clinical Outcomes in Japanese Patients With Heart Failure

SummaryD-dimer, a marker of fibrin turnover, exhibits many interesting properties as a biological marker of thrombosis. Some of the properties of D-dimer might also be used to provide additional information about patients with heart failure. In this study, we evaluate the prognostic information acquired from D-dimer concerning increased risk of cardiovascular mortality in an elderly population with symptoms associated with heart failure. A cardiologist examined 458 elderly patients, out of 548 invited, attending primary care for symptoms of dyspnoea, fatigue and/or peripheral oedema and assessed NYHA functional class and cardiac function. Abnormal systolic function was defined as EF <40% on Doppler echocardiography. Abnormal diastolic function was defined as reduced E/A ratio and/or an abnormal pattern of pulmonary venous flow. Blood samples were drawn, and BNP and D-dimer were analysed. D-dimer was analysed using an automated micro-latex assay. A statistical analysis was performed to identify the prognostic value of increased plasma concentration of D-dimer. Results showed that during a median follow-up period of 5.5 years, 68 (14%) patients died of cardiovascular disease. No gender difference was noted. A plasma concentration of D-dimer >0.25mg/L increased the risk almost 4-fold. In conclusion, D-dimer is an independent risk factor for cardiovascular mortality that may be used to risk-stratify patients with heart failure.

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Patients with heart failure with and without a history of stroke in the Netherlands: a secondary analysis of psychosocial, behavioural and clinical outcomes up to three years from the COACH trial

BMJ Open ◽

10.1136/bmjopen-2018-025525 ◽

2019 ◽

Vol 9 (8) ◽

pp. e025525

Author(s):

Chantal F Ski ◽

Martje H L van der Wal ◽

Michael Le Grande ◽

Dirk J. van Veldhuisen ◽

Ivonne Lesman-Leegte ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Depressive Symptoms ◽

The Netherlands ◽

Clinical Outcomes ◽

Secondary Analysis ◽

Self Care ◽

Patients With Heart Failure ◽

All Cause Mortality

ObjectiveTo identify differences in psychosocial, behavioural and clinical outcomes between patients with heart failure (HF) with and without stroke.Design and participantsA secondary analysis of 1023 patients with heart failure enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure.SettingSeventeen hospitals located across the Netherlands.Outcomes measuresDepressive symptoms (Centre for Epidemiological StudiesDepressionScale), quality of life (Minnesota Living with Heart Failure Questionnaire, Ladder of Life Scale), self-care (European Heart Failure Self-Care Behaviour Scale), adherence to HF management (modified version of the Heart Failure Compliance Questionnaire) and readmission for HF, cardiovascular-cause and all-cause hospitalisations at 18 months, and all-cause mortality at 18 months and 3 years.ResultsCompared with those without stroke, patients with HF with a stroke (10.3%; n=105) had twice the likelihood of severe depressive symptoms (OR 2.83, 95% CI 1.27 to 6.28, p=0.011; OR 2.24, 95% CI 1.03 to 4.88, p=0.043) at 12 and 18 months, poorer disease-specific and generic quality of life (OR 2.80, 95% CI 1.61 to 4.84, p<0.001; OR 2.00, 95% CI 1.09 to 3.50, p=0.019) at 12 months, poorer self-care (OR 1.80, 95% CI 1.05 to 3.11, p=0.034; OR 2.87, 95% CI 1.61 to 5.11, p<0.0011) and HF management adherence (OR 0.39, 95% CI 0.18 to 0.81, p=0.012; OR 0.35, 95% CI 0.17 to 0.72, p=0.004) at 12 and 18 months, higher rates of hospitalisations and mortality at 18 months and higher all-cause mortality (HR 1.43, 95% CI 1.07 to 1.91, p=0.016) at 3 years.ConclusionsPatients with HF and stroke have worse psychosocial, behavioural and clinical outcomes, notably from 12 months, than those without stroke. To ameliorate these poor outcomes long-term, integrated disease management pathways are warranted.

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Effect of early cardiac rehabilitation on prognosis in patients with heart failure following acute myocardial infarction

BMC Sports Science Medicine and Rehabilitation ◽

10.1186/s13102-021-00368-z ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

He Cai ◽

Pengyu Cao ◽

Wenqian Zhou ◽

Wanqing Sun ◽

Xinying Zhang ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Risk Factor ◽

Ejection Fraction ◽

Cardiac Rehabilitation ◽

Anaerobic Threshold ◽

Independent Risk Factor ◽

Major Adverse Cardiovascular Events ◽

Patients With Heart Failure

Abstract Objective The purpose of this retrospective study is to evaluate the effectiveness of early cardiac rehabilitation on patients with heart failure following acute myocardial infarction. Methods Two hundred and thirty-two patients who developed heart failure following acute myocardial infarction were enrolled in this study. Patients were divided into heart failure with reduced ejection fraction group (n = 54) and heart failure with mid-range ejection fraction group (n = 178). Seventy-eight patients who accepted a two-week cardiac rehabilitation were further divided into two subgroups based on major adverse cardiovascular events. Key cardio-pulmonary exercise testing indicators that may affect the prognosis were identified among the cardiac rehabilitation patients. Results Early cardiac rehabilitation significantly reduced cardiac death and re-hospitalization in patients. There was more incidence of diabetes, hyperkalemia and low PETCO2 in the cardiac rehabilitation group who developed re-hospitalization. Low PETCO2 at anaerobic threshold (≤ 33.5 mmHg) was an independent risk factor for re-hospitalization. Conclusions Early cardiac rehabilitation reduced major cardiac events in patients with heart failure following acute myocardial infarction. The lower PETCO2 at anaerobic threshold is an independent risk factor for re-hospitalization, and could be used as a evaluating hallmark for early cardiac rehabilitation.

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Improving Self Care Behavior and Clinical Outcomes in Rural Patients with Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2012.10.005 ◽

2012 ◽

Vol 18 (11) ◽

pp. 882-883 ◽

Cited By ~ 2

Author(s):

Kathleen Dracup ◽

Debra K. Moser ◽

Michele M. Pelter ◽

Thomas Nesbitt ◽

Jeffrey Southard ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcomes ◽

Self Care ◽

Patients With Heart Failure ◽

Rural Patients ◽

Care Behavior

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Early cardiac rehabilitation improved prognosis in patients with heart failure following acute myocardial infarction

10.21203/rs.3.rs-36808/v2 ◽

2020 ◽

Author(s):

He Cai ◽

Pengyu Cao ◽

Wanqing Sun ◽

Xinying Zhang ◽

Rongyu Li ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Risk Factor ◽

Ejection Fraction ◽

Cardiac Rehabilitation ◽

Serum Potassium ◽

Independent Risk Factor ◽

Exercise Intolerance ◽

Patients With Heart Failure

Abstract Background: Cardiac rehabilitation (CR) has been shown to improve exercise intolerance and QoL, and minimize re-hospitalizations in patients with congestive heart failure (CHF). However, studies on early CR in patients with acute myocardial infarction (AMI) who developed CHF following percutaneous coronary intervention (PCI) are rare. The purpose of this study is to evaluate the effectiveness of early CR on patients with CHF after AMI following PCI.Methods: Two hundred thirty-seven patients who developed heart failure after AMI following PCI were enrolled. Patients were divided into heart failure with reduced ejection fraction (HFrEF) group (n=55) and heart failure with mid-range ejection fraction (HFmrEF) group (n=182). Of the 237 patients, 78 (22 in HFrEF group and 56 in HFmrEF group) who accepted a two-week CR were further divided into two subgroups based on major adverse cardiovascular events (MACE). Key cardio-pulmonary exercise testing (CPX) variables that may affect the prognosis were identified among the CR patients.Results: Early CR significantly reduced cardiac death in patients with HFrEF (18.2% vs. 60.6%, P=0.02), and reduced re-hospitalization in patients with HFmrEF after AMI (3.6% vs. 21.4%, P=0.02). Serum potassium and CR ratio were independent risk factors for MACE in patients with both HFrEF and HFmrEF after AMI. In the CR group who developed MACE, there were more diabetics (22.2% vs. 66.7%, P=0.035), with higher serum potassium (3.96mmol/l vs. 4.31mmol/l, P=0.043), and lower PETCO2 at ventilatory threshold (VT) (P=0.016). PETCO2 at VT was an independent risk factor for re-hospitalization. The incidence of re-hospitalization was significantly lower when the PETCO2 at VT was greater than 33.5mmHg (0(0.00% vs. 6(13.64%), P=0.03).Conclusions: Early CR reduced the incidence of MACE in patients with heart failure after AMI following PCI. The PETCO2 at VT is an independent risk factor for re-hospitalization, and could be used as a key evaluating hallmark for early CR in patients who developed heart failure after AMI.

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Early Cardiac Rehabilitation Improved Prognosis in Patients with Heart Failure Following Acute Myocardial Infarction

10.21203/rs.3.rs-36808/v1 ◽

2020 ◽

Author(s):

He Cai ◽

Pengyu Cao ◽

Wanqing Sun ◽

Xinying Zhang ◽

Rongyu Li ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Risk Factor ◽

Ejection Fraction ◽

Cardiac Rehabilitation ◽

Serum Potassium ◽

Independent Risk Factor ◽

Exercise Intolerance ◽

Patients With Heart Failure

Abstract Background: Cardiac rehabilitation (CR) has been shown to improve exercise intolerance and QoL, and minimize re-hospitalizations in patients with congestive heart failure (CHF). However, studies on early CR in patients with acute myocardial infarction (AMI) who developed CHF following percutaneous coronary intervention (PCI) are rare. The purpose of this study is to evaluate the effectiveness of early CR on patients with CHF after AMI following PCI.Methods: Two hundred thirty-seven patients who developed heart failure after AMI following PCI were enrolled. Patients were divided into heart failure with reduced ejection fraction (HFrEF) group and heart failure with mid-range ejection fraction (HFmrEF) group. Of which, 78 patients who accepted a two-week CR were further divided into two subgroups based on major adverse cardiovascular events (MACE). Key cardio-pulmonary exercise testing (CPX) variables that may affect the prognosis were identified through the comparison of the cardio-respiratory fitness (CRF).Results: Early CR significantly reduced cardiac death in patients with HFrEF, and reduced re-hospitalization in patients with HFmrEF after AMI (P <0.01). Serum potassium and CR ratio were independent risk factors for MACE in patients with both HFrEF and HFmrEF after AMI. In the CR group who developed MACE, there were more diabetics (P=0.035), with higher serum potassium (P=0.043), and lower PETCO2 at VT (P=0.016). PETCO2 at VT was an independent risk factor for re-hospitalization. The incidence of re-hospitalization was significantly lower when the PETCO2 at VT was greater than 33.5mmHg (P=0.03).Conclusions: Early CR reduced the incidence of MACE in patients with heart failure after AMI following PCI. The PETCO2 at VT is an independent risk factor for re-hospitalization, and could be used as a key evaluating hallmark for early CR in patients who developed heart failure after AMI.

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