scholarly journals Exploring the Waveform Characteristics of Tidal Breathing Carbon Dioxide, Measured Using the N-Tidal C Device in Different Breathing Conditions (The General Breathing Record Study): Protocol for an Observational, Longitudinal Study (Preprint)

2018 ◽  
Author(s):  
Daniel M Neville ◽  
Hitasha Rupani ◽  
Paul R Kalra ◽  
Kayode Adeniji ◽  
Matthew Quint ◽  
...  
Keyword(s):  
Heart Failure ◽  
Carbon Dioxide ◽  
Chronic Heart Failure ◽  
Breathing Pattern ◽  
Home Monitoring ◽  
Contributory Factor ◽  
Considerable Difficulty ◽  
History Of ◽  
Care Economy ◽  
Dysfunctional Breathing

BACKGROUND In an increasingly comorbid population, there are significant challenges to diagnosing the cause of breathlessness, and once diagnosed, considerable difficulty in detecting deterioration early enough to provide effective intervention. The burden of the breathless patient on the health care economy is substantial, with asthma, chronic heart failure, and pneumonia affecting over 6 million people in the United Kingdom alone. Furthermore, these patients often have more than one contributory factor to their breathlessness symptoms, with conditions such as dysfunctional breathing pattern disorders—an under-recognized component. Current methods of diagnosing and monitoring breathless conditions can be extensive and difficult to perform. As a consequence, home monitoring is poorly complied with. In contrast, capnography (the measurement of tidal breath carbon dioxide) is performed during normal breathing. There is a need for a simple, easy-to-use, personal device that can aid in the diagnosis and monitoring of respiratory and cardiac causes of breathlessness. OBJECTIVE The aim of this study was to explore the use of a new, handheld capnometer (called the N-Tidal C) in different conditions that cause breathlessness. We will study whether the tidal breath carbon dioxide (TBCO2) waveform, as measured by the N-Tidal C, has different characteristics in a range of respiratory and cardiac conditions. METHODS We will perform a longitudinal, observational study of the TBCO2 waveform (capnogram) as measured by the N-Tidal C capnometer. Participants with a confirmed diagnosis of asthma, breathing pattern disorders, chronic heart failure, motor neurone disease, pneumonia, as well as volunteers with no history of lung disease will be asked to provide twice daily, 75-second TBCO2 collection via the N-Tidal C device for 6 months duration. The collated capnograms will be correlated with the underlying diagnosis and disease state (stable or exacerbation) to determine if there are different TBCO2 characteristics that can distinguish different respiratory and cardiac causes of breathlessness. RESULTS This study’s recruitment is ongoing. It is anticipated that the results will be available in late 2018. CONCLUSIONS The General Breathing Record Study will provide an evaluation of the use of capnography as a diagnostic and home-monitoring tool for various diseases. REGISTERED REPORT IDENTIFIER RR1-10.2196/9767

scholarly journals Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure

2021 ◽  
Author(s):  
S. Sze ◽  
P. Pellicori ◽  
J. Zhang ◽  
J. Weston ◽  
I. B. Squire ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Clinical Frailty Scale ◽  
Mineralocorticoid Receptor Antagonist ◽  
Reduced Ejection Fraction ◽  
Frail Patients ◽  
History Of ◽  
Poor Outcomes ◽  
To Receive

Abstract Background Frailty is common in patients with chronic heart failure (CHF) and is associated with poor outcomes. The natural history of frail patients with CHF is unknown. Methods Frailty was assessed using the clinical frailty scale (CFS) in 467 consecutive patients with CHF (67% male, median age 76 years, median NT-proBNP 1156 ng/L) attending a routine follow-up visit. Those with CFS > 4 were classified as frail. We investigated the relation between frailty and treatments, hospitalisation and death in patients with CHF. Results 206 patients (44%) were frail. Of 291 patients with HF with reduced ejection fraction (HeFREF), those who were frail (N = 117; 40%) were less likely to receive optimal treatment, with many not receiving a renin–angiotensin–aldosterone system inhibitor (frail: 25% vs. non-frail: 4%), a beta-blocker (16% vs. 8%) or a mineralocorticoid receptor antagonist (50% vs 41%). By 1 year, there were 56 deaths and 322 hospitalisations, of which 25 (45%) and 198 (61%), respectively, were due to non-cardiovascular (non-CV) causes. Most deaths (N = 46, 82%) and hospitalisations (N = 215, 67%) occurred in frail patients. Amongst frail patients, 43% of deaths and 64% of hospitalisations were for non-CV causes; 58% of cardiovascular (CV) deaths were due to advancing HF. Among non-frail patients, 50% of deaths and 57% of hospitalisations were for non-CV causes; all CV deaths were due to advancing HF. Conclusion Frailty in patients with HeFREF is associated with sub-optimal medical treatment. Frail patients are more likely to die or be admitted to hospital, but whether frail or not, many events are non-CV. Graphical abstract

Emerging Therapies for Acute and Chronic Heart Failure

2016 ◽  
Vol 29 (1) ◽  
pp. 46-57 ◽  
Author(s):  
Sarah Hanigan ◽  
Robert J. DiDomenico
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiovascular Death ◽  
Phase 3 ◽  
Reduced Ejection Fraction ◽  
Emerging Therapies ◽  
Treat Heart Failure ◽  
Novel Drugs ◽  
The Us ◽  
History Of

Although the period from 1953 to 2001 resulted in the approval of more than 30 medications currently used to treat heart failure (HF), few novel drugs have been approved in the last decade. However, the investigational pipeline for HF medications once again appears promising. In patients with chronic heart failure with reduced ejection fraction (HFrEF), ivabradine and valsartan/sucubitril (LCZ696) were recently approved by the US Food and Drug Administration. Both agents have been shown to reduce the risk of cardiovascular death and HF hospitalization. In the treatment of acute HF, serelaxin and ularitide are the farthest along in development. Both agents have demonstrated favorable effects on surrogate end points and preliminary data suggest a possible mortality benefit with serelaxin. Consequently, phase 3 trials are ongoing to evaluate the effect of serelaxin and ularitide on clinical outcomes. Given the poor history of recent investigational acute HF drugs that have advanced to phase 3/4 studies, enthusiasm for both serelaxin and ularitide must be tempered until these trials are completed.

Problems arising when a system of automated weight monitoring is introduced into the home as part of the care for patients with chronic heart failure

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 29-31 ◽  
Author(s):  
Glenis Johnston ◽  
Gwyneth Weatherburn ◽  
Stephen Ward ◽  
Julie Hendry
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Monitoring System ◽  
Thematic Analysis ◽  
Electronic Monitoring ◽  
Call Centre ◽  
Telemedicine System ◽  
Telemedicine Service ◽  
History Of ◽  
Weight Monitoring

Patients with a history of chronic heart failure participated in a study to evaluate a home telemedicine system which monitored their weight daily. Within three weeks of beginning the study, interviews were conducted with patients (n = 5), their partners (n = 4) and their heart failure nurses (n = 3). A thematic analysis was carried out in order to probe their experiences of the illness and their perception of how telemedicine might affect those experiences. When asked, the participants and their partners did not consider that the electronic monitoring system would be much use to them. Nurses also had a number of misconceptions about the telemedicine service. The results demonstrated that patients needed better education, both in the management of their condition and in the use of the telemedicine equipment and the service provided by the call centre, before the telemedicine system could fulfil its potential.

scholarly journals Acetazolamide and Inhaled Carbon Dioxide Reduce Periodic Breathing During Exercise in Patients With Chronic Heart Failure

2014 ◽  
Vol 20 (4) ◽  
pp. 278-288 ◽  
Author(s):  
Anna Apostolo ◽  
Piergiuseppe Agostoni ◽  
Mauro Contini ◽  
Laura Antonioli ◽  
Erik R. Swenson
Keyword(s):  
Heart Failure ◽  
Carbon Dioxide ◽  
Chronic Heart Failure ◽  
Periodic Breathing
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