scholarly journals Characterization of the respiratory pattern in patients with chronic heart failure applying joint symbolic dynamics

2017 ◽  
Author(s):  
◽  
T. F. Molina-Ramírez
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Symbolic Dynamics ◽  
Clinical Decision Making ◽  
Periodic Breathing ◽  
Clinical Decision ◽  
Classification Method ◽  
Respiratory Pattern ◽  
Breathing Patterns ◽  
Linear Discriminant

This work proposes a method to characterize the respiratory pattern of patients with chronic heart failure (CHF) to determine non-periodic breathing (nPB), periodic breathing (PB) and Cheyne-Stokes respiration (CSR) through non-linear, symbolic analysis of biological signals. A total of 43 patients were examined for their cardiorespiratory profiles, their ECG and respiratory pattern signals were processed, analyzed and studied for parameters that could be of potential use in clinical decision making, specifically in patient classification. Patients in the study were characterized through their cardiorespiratory signals, applying joint symbolic dynamics (JSD) analysis to cardiac beat and respiratory interval durations. The most statistically significant parameters across all groups were identified through a Kruskal-Wallis two tailed test (α = 0.05) and a linear discriminant analysis (LDA) classification method based on such parameters was developed. The best result achieved with this classification method uses 10 features to discriminate patients with a 97.67% Accuracy (Acc). The best features to discriminate among groups are related to cardiorespiratory interaction rather than just respiration patterns alone. Results further support the idea that abnormal breathing patterns derive from physiological abnormalities in chronic heart failure.

scholarly journals Characterization of the respiratory pattern in patients with chronic heart failure applying joint symbolic dynamics

2017 ◽  
Author(s):  
◽  
T. F. Molina-Ramírez
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Symbolic Dynamics ◽  
Clinical Decision Making ◽  
Periodic Breathing ◽  
Clinical Decision ◽  
Classification Method ◽  
Respiratory Pattern ◽  
Breathing Patterns ◽  
Linear Discriminant

This work proposes a method to characterize the respiratory pattern of patients with chronic heart failure (CHF) to determine non-periodic breathing (nPB), periodic breathing (PB) and Cheyne-Stokes respiration (CSR) through non-linear, symbolic analysis of biological signals. A total of 43 patients were examined for their cardiorespiratory profiles, their ECG and respiratory pattern signals were processed, analyzed and studied for parameters that could be of potential use in clinical decision making, specifically in patient classification. Patients in the study were characterized through their cardiorespiratory signals, applying joint symbolic dynamics (JSD) analysis to cardiac beat and respiratory interval durations. The most statistically significant parameters across all groups were identified through a Kruskal-Wallis two tailed test (α = 0.05) and a linear discriminant analysis (LDA) classification method based on such parameters was developed. The best result achieved with this classification method uses 10 features to discriminate patients with a 97.67% Accuracy (Acc). The best features to discriminate among groups are related to cardiorespiratory interaction rather than just respiration patterns alone. Results further support the idea that abnormal breathing patterns derive from physiological abnormalities in chronic heart failure.

Contemporary Heart Failure Treatment Based on Improved Knowledge and Personalized Care of Comorbidities

2019 ◽  
pp. 1565-1579
Author(s):  
Kostas Giokas ◽  
Charalampos Tsirmpas ◽  
Athanasios Anastasiou ◽  
Dimitra Iliopoulou ◽  
Vassilia Costarides ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Chronic Diseases ◽  
Clinical Decision Making ◽  
Medical Condition ◽  
Collective Intelligence ◽  
Clinical Decision ◽  
Mortality And Morbidity ◽  
Personalized Care ◽  
Care Approach

Chronic diseases are the leading cause of mortality and morbidity. A significant contribution to the burden of chronic diseases is the concurrence of co-morbidities. Heart failure (HF) is a complex, chronic medical condition frequently associated with co-morbidities. The current care approach for HF patients with co-morbidities is neither capable to deliver personalised care nor to halt the on-going increase of its socio-economic burden. Our approach aims to improve the complete care process for HF patients and related co-morbidities to improve outcome and quality of life. This will be achieved by the proposed standardised yet personalised patient-oriented ICT system that supports evidence-based clinical decision making as well as interaction and communication between all stakeholders with focus on the patients and their relatives to improve self-management. We propose that such a system should be build upon a novel European-wide data standard for clinical input and outcome and that it should facilitate decision making and outcome tracking by new collective intelligence algorithms.

scholarly journals A prospective evaluation of the Flacker-Kiely One Year Mortality Score and the added value of NT-proBNP

2020 ◽  
Vol 11 (2) ◽  
pp. 13
Author(s):  
Kjell Krüger ◽  
Bård R. Kittang ◽  
Sabine P. Solheim ◽  
Kristian Jansen
Keyword(s):  
Heart Failure ◽  
Failure Criterion ◽  
Clinical Decision Making ◽  
Cox Regression ◽  
Clinical Decision ◽  
Blood Chemistry ◽  
Discriminatory Power ◽  
Added Value ◽  
Youden Index ◽  
Mortality Data

Objective: Several mortality indices have been constructed to aid clinical decision making in older adults. We aimed to prospectively validate the Flacker-Kiely (FK) mortality index in a Norwegian nursing home cohort, which has not been done before, and explore whether NT-ProBNP could improve its discriminatory power.Methods: We performed a cohort/mortality study. From November 2017 to July 2018, physicians in all public long-term nursing homes in Bergen, Norway, scored residents according to the original Flacker Kiely index. Mortality data were derived from the Norwegian Cause of Death Registry and NT-ProBNP values were obtained from routinely collected blood chemistry. An alternative FK index using the NT-ProBNP-value as a marker for the presence of heart failure was constructed (FK NT-ProBNP index). The ProBNP cut-off value was selected based on a Cox regression model (“dead/alive 1 year”/” NT-ProBNP (Ng/l)”, where the value with the highest Youden index was identified. We judged index performance by using c-statistics.Results: Both the original FK index and the constructed FK NT-ProBNP index discriminated between risk strata. The FK NT-ProBNP index yielded a C-index of 0.66 compared to 0.62 for the original FK index. Optimal discriminatory power was shown with a NT-ProBNP cut-off value of 1,595 Ng/l as heart failure criterion, and FK NT-ProBNP score 6.6.Conclusions: The prospective mortality estimation ability of the FK-index was comparable to previous retrospective studies. The inclusion of NT-ProBNP as a heart failure criterion strengthen the discriminatory power and utility of the index, both in clinic and administration.

scholarly journals Periodic breathing in heart failure patients: testing the hypothesis of instability of the chemoreflex loop

2000 ◽  
Vol 89 (6) ◽  
pp. 2147-2157 ◽  
Author(s):  
G. D. Pinna ◽  
R. Maestri ◽  
A. Mortara ◽  
M. T. La Rovere ◽  
F. Fanfulla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Minute Ventilation ◽  
Periodic Breathing ◽  
System Stability ◽  
Loss Of Stability ◽  
Loop Gain ◽  
Heart Failure Patients ◽  
Processing Techniques ◽  
Signal Processing Techniques

In this study, we applied time- and frequency-domain signal processing techniques to the analysis of respiratory and arterial O2 saturation (SaO2 ) oscillations during nonapneic periodic breathing (PB) in 37 supine awake chronic heart failure patients. O2 was administered to eight of them at 3 l/min. Instantaneous tidal volume and instantaneous minute ventilation (IMV) signals were obtained from the lung volume signal. The main objectives were to verify 1) whether the timing relationship between IMV and SaO2 was consistent with modeling predictions derived from the instability hypothesis of PB and 2) whether O2 administration, by decreasing loop gain and increasing O2 stores, would have increased system stability reducing or abolishing the ventilatory oscillation. PB was centered around 0.021 Hz, whereas respiratory rate was centered around 0.33 Hz and was almost stable between hyperventilation and hypopnea. The average phase shift between IMV and SaO2 at the PB frequency was 205° (95% confidence interval 198–212°). In 12 of 37 patients in whom we measured the pure circulatory delay, the predicted lung-to-ear delay was 28.8 ± 5.2 s and the corresponding observed delay was 30.9 ± 8.8 s ( P = 0.13). In seven of eight patients, O2 administration abolished PB (in the eighth patient, SaO2 did not increase). These results show a remarkable consistency between theoretical expectations derived from the instability hypothesis and experimental observations and clearly indicate that a condition of loss of stability in the chemical feedback control of ventilation might play a determinant role in the genesis of PB in awake chronic heart failure patients.

scholarly journals Accuracy, user-friendliness and usefulness of the Cobas h232 point-of-care test for NT-proBNP in primary care

2017 ◽  
Vol 71 (6) ◽  
pp. 539-545 ◽  
Author(s):  
Chiel Hex ◽  
Miek Smeets ◽  
Joris Penders ◽  
Viviane Van Hoof ◽  
Jan Verbakel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Linear Regression Analysis ◽  
Clinical Decision ◽  
User Friendliness ◽  
Point Of Care Test ◽  
Percentage Difference ◽  
Difference Plot

AimsN-terminal pro-B-type natriuretic peptide (NT-proBNP) has been shown to be useful for ruling out heart failure in primary care. In this study, we examined the accuracy of the Cobas h232 point-of-care (POC) instrument in primary care compared with an in-hospital measurement. Furthermore, we investigated the user-friendliness and usefulness of the POC device.MethodsFive general practitioner (GP) groups were asked to evaluate adult patients who were suspected of having heart failure and to test NT-proBNP with the Cobas h232. The samples were subsequently delivered to and analysed at a central hospital laboratory by the Cobas e602 using conventional transport and storage. Difference between the paired measurements was analysed using a percentage difference plot, and correlation was assessed using Passing-Bablok linear regression analysis. User-friendliness and usefulness were assessed using semistructured questionnaires.ResultsNineteen GPs studied 94 patients. Passing-Bablok analysis showed a slope of 1.05 (95% CI 1.00 to 1.11) (R2=0.97). The percentage difference plot showed a mean difference of 15.7% (95% CI −46.0% to –77.4%). User-friendliness and usefulness had median scores of 4 or 5 on a five-point Likert scale. Eighteen out of 19 GPs confirmed that the device influenced their clinical practice. During the study, GPs’ confidence in using NT-proBNP increased significantly from a mean score of 4.4 (95% CI 3.2 to 5.6) to 7.6 out of 10 (95% CI 7.1 to 8.2).ConclusionsThe Cobas h232 NT-proBNP POC test proved to be an accurate, user-friendly and useful test in primary care. Nearly all participating GPs were convinced that the test could benefit clinical decision making.

scholarly journals Response to Letter Regarding Article “Sleep and Exertional Periodic Breathing in Chronic Heart Failure: Prognostic Importance and Interdependence”

Circulation ◽  
2006 ◽  
Vol 114 (3) ◽  
Author(s):  
Ugo Corrà ◽  
Massimo Pistono ◽  
Alessandro Mezzani ◽  
Alberto Braghiroli ◽  
Enzo Bosimini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Periodic Breathing ◽  
Prognostic Importance
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