scholarly journals Assessment of Physical Activity Using Waist-Worn Accelerometers in Hospitalized Heart Failure Patients and Its Relationship with Kansas City Cardiomyopathy Questionnaire

2021 ◽  
Vol 10 (18) ◽  
pp. 4103
Author(s):  
Yasuyuki Shiraishi ◽  
Nozomi Niimi ◽  
Ayumi Goda ◽  
Makoto Takei ◽  
Takehiro Kimura ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Kansas City ◽  
Sedentary Time ◽  
Cardiopulmonary Exercise Testing ◽  
Short Version ◽  
Limited Information ◽  
Kansas City Cardiomyopathy Questionnaire ◽  
Metabolic Equivalents ◽  
Patient Reported

The health benefits of physical activity have been widely recognized, yet there is limited information on associations between accelerometer-related parameters and established patient-reported health status. This study investigated the association between the waist-worn accelerometer measurements, cardiopulmonary exercise testing (CPX), and results of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in heart failure (HF) patients hospitalized for acute decompensation. A total of 31 patients were enrolled and wore a validated three-axis accelerometer for 2 weeks and completed the short version of the KCCQ after removing the device. Daily step counts, exercise time (metabolic equivalents × hours), and %sedentary time (sedentary time/device-equipped time) were measured. Among the measured parameters, the best correlation was observed between %sedentary time and the KCCQ overall and clinical summary scores (r = −0.65 and −0.65, each p < 0.001). All of the individual domains of the KCCQ (physical limitation, symptom frequency, and quality of life), with the exception of the social limitation domain, showed moderate correlations with %sedentary time. Finally, oxygen consumption assessed by CPX demonstrated only weak associations with the accelerometer-measured parameters. An accelerometer could complement the KCCQ results in accurately assessing the physical activity in HF patients immediately after hospitalization, albeit its correlation with CPX was at most moderate.

scholarly journals Novel Trial Design: CHIEF-HF

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
John A. Spertus ◽  
Mary C. Birmingham ◽  
Javed Butler ◽  
Ildiko Lingvay ◽  
David E. Lanfear ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Ejection Fraction ◽  
Randomized Clinical Trial ◽  
Kansas City ◽  
Mobile Technologies ◽  
Patient Centered ◽  
Kansas City Cardiomyopathy Questionnaire ◽  
Diabetes Status ◽  
Patient Reported

Background: The expense of clinical trials mandates new strategies to efficiently generate evidence and test novel therapies. In this context, we designed a decentralized, patient-centered randomized clinical trial leveraging mobile technologies, rather than in-person site visits, to test the efficacy of 12 weeks of canagliflozin for the treatment of heart failure, regardless of ejection fraction or diabetes status, on the reduction of heart failure symptoms. Methods: One thousand nine hundred patients will be enrolled with a medical record-confirmed diagnosis of heart failure, stratified by reduced (≤40%) or preserved (>40%) ejection fraction and randomized 1:1 to 100 mg daily of canagliflozin or matching placebo. The primary outcome will be the 12-week change in the total symptom score of the Kansas City Cardiomyopathy Questionnaire. Secondary outcomes will be daily step count and other scales of the Kansas City Cardiomyopathy Questionnaire. Results: The trial is currently enrolling, even in the era of the coronavirus disease 2019 (COVID-19) pandemic. Conclusions: CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure) is deploying a novel model of conducting a decentralized, patient-centered, randomized clinical trial for a new indication for canagliflozin to improve the symptoms of patients with heart failure. It can model a new method for more cost-effectively testing the efficacy of treatments using mobile technologies with patient-reported outcomes as the primary clinical end point of the trial. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04252287.

Abstract 2703: Clinical and neurohormonal correlates and prognostic value of Kansas City Cardiomyopathy Questionnaire in patients with chronic heart failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Maria Nikolaou ◽  
John Parissis ◽  
Dimitrios Farmakis ◽  
Vasiliki Bistola ◽  
Koula Venetsanou ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Immune Activation ◽  
Prognostic Value ◽  
Kansas City ◽  
Left Ventricular ◽  
Walking Distance ◽  
Left Ventricular Ejection ◽  
Kansas City Cardiomyopathy Questionnaire

Chronic heart failure (CHF) is characterized by limited exercise activity, enhanced immune activation, and increased morbidity and mortality. Although quality of life and physical activity assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ functional and overall) have been used for the clinical evaluation of CHF patients, the prognostic value as well as the relationship of this questionnaire with neurohormonal/immune activation remain uknown. Methods: One hundred thirty seven consecutive stable CHF patients (aged 64 ± 12 yrs, mean NYHA class: 2.9 ± 0.6, mean left ventricular ejection fraction: 26±7% ) were evaluated by the above questionnaire, Zung 20-item self rating and Beck Depression Inventory (BDI) scales, Duke physical activity score, plasma BNP, plasma cytokines (IL-6, IL-10 and TNF-a) and 6-min walking test. Patients were monitored for a 8-month follow-up period for disease progression defined as death and/or hospitalization. Results: The mean KCCQ functional and overall scores were 44±20% and 33±19%, respectively. Patients (n=41) with KCCQ overall score <50% had significantly higher Zung (46±10 vs 34±9, p<0.01) and BDI (18±10 vs 8±6, p<0.01) scales, plasma BNP (900±801 vs 543±374 pg/ml, p<0.05) and plasma IL-6 (12.7±7 pg/ml vs 8.5±6.4 pg/ml, p<0.05) as well as lower DUKE score (15±10 vs 28±13, p<0.01), 6-min walking distance (259±200 vs 363±113 m, p<0.001) and plasma anti-inflammatory cytokine IL-10 (6.1±3.2 pg/ml vs 9.4±5.4 pg/ml, p <0.05) as compared to those (n=96) with score >50%. KCCQ overall score was significantly corellated with plasma BNP levels (r=-0.42, p<0.01), 6-min walking distance (r=0.47, p<0.01) and BDI scale (r=-0.61, p<0.001). Finally, patients with KCCQ overall score >50% had longer event-free survival (182±13 vs 122±15 days, p<0.05) than those with score <50%. Conclusion: KCCQ is a valuable tool for the evaluation of severity of clinical and emotional symptoms of CHF patients, closely related with their neurohormonal/immune activation and seems to have important prognostic value in CHF.

scholarly journals Association of Tubular Solute Clearance with Symptom Burden in Incident Peritoneal Dialysis

2020 ◽  
Vol 15 (4) ◽  
pp. 530-538 ◽  
Author(s):  
Ke Wang ◽  
Michelle Nguyen ◽  
Yan Chen ◽  
Andrew N. Hoofnagle ◽  
Jessica O. Becker ◽  
...  
Keyword(s):  
Heart Failure ◽  
Peritoneal Dialysis ◽  
Confidence Interval ◽  
Kidney Function ◽  
Kansas City ◽  
Summary Score ◽  
Symptom Index ◽  
Kansas City Cardiomyopathy Questionnaire ◽  
Residual Kidney Function ◽  
Patient Reported

Background and objectivesResidual kidney function is important to the health and wellbeing of patients with ESKD. We tested whether the kidney clearances of proximal tubular secretory solutes are associated with burden of uremic and heart failure symptoms among patients on peritoneal dialysis with residual kidney function.Design, setting, participants, & measurementsWe enrolled 29 patients on incident peritoneal dialysis with residual urine output >250 ml daily. We used targeted liquid chromatography-mass spectrometry to quantify plasma, 24-hour urine, and peritoneal dialysate concentrations of ten tubular secretory solutes. We calculated the kidney and peritoneal dialysis clearances of each secretory solute, creatinine, and urea, and we estimated a composite kidney and peritoneal secretion score. We assessed for uremic symptoms using the Dialysis Symptom Index and heart failure–related symptoms using the Kansas City Cardiomyopathy Questionnaire. We used linear regression to determine associations of composite secretory solute clearances and GFRurea+Cr with Dialysis Symptom Index symptom score and Kansas City Cardiomyopathy Questionnaire summary score.ResultsMean residual kidney clearances of creatinine and urea were 8±5 and 9±6 ml/min per 1.73 m2, respectively, and mean GFRurea+Cr was 8±5 ml/min per 1.73 m2. The residual kidney clearances of most secretory solutes were considerably higher than creatinine and urea clearance, and also, they were higher than their respective peritoneal dialysis clearances. After adjustments for age and sex, each SD higher composite kidney secretion score was associated with an 11-point lower Dialysis Symptom Index score (95% confidence interval, −20 to −1; P=0.03) and a 12-point higher Kansas City Cardiomyopathy Questionnaire score (95% confidence interval, 0.5- to 23-point higher score; P=0.04). Composite peritoneal dialysis secretion score was not associated with either symptom assessment.ConclusionsResidual kidney clearances of secretory solutes are higher than peritoneal dialysis clearances. Kidney clearances of secretory solutes are associated with patient-reported uremic and heart failure–related symptoms.

Kansas City Cardiomyopathy Questionnaire Administered to Hospitalized Patients With Heart Failure

2016 ◽  
Vol 24 (2) ◽  
pp. 245-257
Author(s):  
Rebecca Tucker ◽  
Jill R. Quinn ◽  
Ding-Geng (Din) Chen ◽  
Leway Chen
Keyword(s):  
Heart Failure ◽  
Factor Analysis ◽  
Confirmatory Factor Analysis ◽  
Psychometric Properties ◽  
Convergent Validity ◽  
Kansas City ◽  
Community Dwelling ◽  
Kansas City Cardiomyopathy Questionnaire ◽  
Patients With Heart Failure ◽  
Confirmatory Factor

Background and Purpose: The psychometric properties of the Kansas City Cardiomyopathy Questionnaire (KCCQ) have been examined primarily in community-dwelling patients with heart failure (HF). The objective of this research was to examine the properties of the KCCQ administered to patients hospitalized with HF (N = 233). Methods: Confirmatory factor analysis, Cronbach’s alphas, and correlations were performed to examine the scale’s dimensions, reliability, and validity. Results: Confirmatory factor analysis indicated a 5-factor solution (63.6% of the variance). The Cronbach’s alpha levels were greater than .70, except for the self-efficacy dimension (.60). Convergent validity was not verified between the KCCQ and several illness severity measures. Conclusions: The psychometric properties of the KCCQ may be different based on the population in which the KCCQ is administered, which may have clinical implications.

Abstract 17891: Impact of Physical Activity and Sedentary Time on Heart Failure Outcomes

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Rami Doukky ◽  
Marie-France Poulin ◽  
Elizabeth Avery ◽  
Ashvarya Mangla ◽  
Zeina Ibrahim ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Cardiac Death ◽  
Physical Inactivity ◽  
Sedentary Time ◽  
Study Groups ◽  
Activity Time ◽  
Risk Of Death ◽  
Significant Difference ◽  
The Impact

Introduction: The impact of physical inactivity and sedentary time on heart failure (HF) outcomes in patients not participating in exercise program is unclear. Hypothesis: Physical inactivity and sedentary time are associated with worse HF outcomes. Methods: We analyzed data from the multicenter, HF Adherence and Retention Trial (HART) which enrolled 902 NYHA - II/III HF patients with preserved or reduced ejection fraction, followed for 36 months. Based on the mean weekly purposeful physical activity duration, patients were classified into inactive (0 min/wk), partially active (1-90 min/wk), and active (>90min/wk) groups. Patients were also classified according to average daily sedentary television (TV) time into <2 hrs/d, 2-4 hrs/d, and >4 hrs/d groups. Study groups were propensity score matched according to 33 baseline covariates in 1:1:1 ratio. The primary outcome was all-cause death. Secondary outcomes were cardiac death and HF hospitalization. Results: There were 196 inactive, 341 partially active and 365 active patients, of whom 492 (164 in each group) were successfully propensity matched. Physical inactivity was associated with higher risk of death and cardiac death than any level of physical activity, Fig 1. There was no significant difference in HF hospitalization. Furthermore, 465 subjects were propensity matched into three sedentary TV time groups (155 in each group). Sedentary TV time >4 hrs/d was independently and incrementally associated with all-cause death (Δ χ 2 = 6.05; P=0.049), beyond physical activity time, Fig 1. There was no significant difference in mortality between <2 and 2-4 hrs/d sedentary TV time groups, after adjusting to physical activity time, Fig 2. Conclusions: In symptomatic chronic HF patients, physical inactivity is associated with higher all-cause and cardiac mortality. Modest purposeful physical activity was associated with survival benefit. Extended sedentary time was associated incremental increased mortality.

Abstract P232: Poor Lower Extremity Physical Function Increases Risk For Heart Failure In Older Women: The OPACH Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
John Bellettiere ◽  
Andrea Z LaCroix ◽  
Chongzhi Di ◽  
Charles Eaton ◽  
Michael J Lamonte
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Physical Function ◽  
Older Women ◽  
Sedentary Time ◽  
Vigorous Physical Activity ◽  
Later Life ◽  
Cox Proportional Hazards ◽  
Inverse Association ◽  
Race Ethnicity

Background: A hallmark of clinically manifest heart failure (HF) is reduced levels of exercise tolerance and physical function. It is unclear, however, whether an association exists between poor physical function and future development of HF, particularly at older ages. Methods: Women (n=5327; mean±SD age = 79±7) with no history of HF completed the Short Physical Performance Battery (SPPB) to measure physical function. The SPPB consists of three timed tasks that assess standing balance (with 3 progressively difficult balance tests), strength (with 5 unassisted chair stands), and gait (with a 4m usual-pace walk), and is scored 0 (worst) to 12 (best). Four previously-defined categories were used: very low (SPPB 0-3; n=237); low (4-6; n=900), moderate (7-9; n=2139), and high (10-12; n=1767; referent group). Women were followed for up to 8 years for incident physician-adjudicated HF hospitalization. Cox proportional hazards regression models were adjusted for age, race-ethnicity, education, smoking, alcohol, diabetes, hypertension, COPD, osteoarthritis, depression, BMI, and accelerometer-measured moderate to vigorous physical activity (MVPA) and sedentary time. Results: The number of HF cases (crude rate/1000 person-years) across the above SPPB categories (very low to high) were 41 (33.5), 78 (15.5), 96 (7.8), and 41 (4.0). Covariate-adjusted HRs (95% CIs) were 3.39 (2.05-5.84), 2.20 (1.47-3.31), 1.74 (1.20-2.51) and 1.00 (ref), trend P<.001. After additional adjustment for MVPA and sedentary time, the fully-adjusted HRs (95% CIs) were 2.85 (1.71-4.75), 1.94 (1.29-2.93), 1.61 (1.10, 2.32) and 1.00 (ref), trend P<.001. When modeled continuously (per 3-unit decrement in SPPB score), fully-adjusted associations were consistent over stratum of age (<80: HR=1.72; ≥80: HR=1.56; interaction P=.05), race-ethnicity (white: HR=1.59; black: HR=1.59; Hispanic: HR=1.18; P=.57), and accelerometer-measured total physical activity (<5.6 hr/d: HR=1.54; ≥5.6 hr/d: HR=1.51; P=.81). Conclusions: A significant inverse association between SPPB score and HF incidence was observed in ambulatory older women, independent of age, physical activity levels, and other HF predictors. Physical function is a modifiable factor that may be important for HF prevention in later life.

scholarly journals Association of Cardiac Biomarkers With the Kansas City Cardiomyopathy Questionnaire in Patients With Chronic Kidney Disease Without Heart Failure

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
Sri Lekha Tummalapalli ◽  
Leila R. Zelnick ◽  
Amanda H. Andersen ◽  
Robert H. Christenson ◽  
Christopher R. deFilippi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Health Status ◽  
Kidney Disease ◽  
Kansas City ◽  
Troponin T ◽  
Cardiac Biomarkers ◽  
Kansas City Cardiomyopathy Questionnaire ◽  
Galectin 3 ◽  
Multivariable Adjustment

Background The Kansas City Cardiomyopathy Questionnaire ( KCCQ ) is a measure of heart failure ( HF ) health status. Worse KCCQ scores are common in patients with chronic kidney disease ( CKD ), even without diagnosed heart failure ( HF ). Elevations in the cardiac biomarkers GDF‐15 (growth differentiation factor‐15), galectin‐3, sST2 (soluble suppression of tumorigenesis‐2), hsTnT (high‐sensitivity troponin T), and NT ‐pro BNP (N‐terminal pro‐B‐type natriuretic peptide) likely reflect subclinical HF in CKD . Whether cardiac biomarkers are associated with low KCCQ scores is not known. Methods and Results We studied participants with CKD without HF in the multicenter prospective CRIC (Chronic Renal Insufficiency Cohort) Study. Outcomes included (1) low KCCQ score <75 at year 1 and (2) incident decline in KCCQ score to <75. We used multivariable logistic regression and Cox regression models to evaluate the associations between baseline cardiac biomarkers and cross‐sectional and longitudinal KCCQ scores. Among 2873 participants, GDF‐15 (adjusted odds ratio 1.42 per SD ; 99% CI , 1.19–1.68) and galectin‐3 (1.28; 1.12–1.48) were significantly associated with KCCQ scores <75, whereas sST2, hsTnT, and NT ‐pro BNP were not significantly associated with KCCQ scores <75 after multivariable adjustment. Of the 2132 participants with KCCQ ≥75 at year 1, GDF‐15 (adjusted hazard ratio, 1.36 per SD ; 99% CI , 1.12–1.65), hsTnT (1.20; 1.01–1.44), and NT ‐pro BNP (1.30; 1.08–1.56) were associated with incident decline in KCCQ to <75 after multivariable adjustment, whereas galectin‐3 and sST2 did not have significant associations with KCCQ decline. Conclusions Among participants with CKD without clinical HF , GDF‐15, galectin‐3, NT ‐pro BNP , and hsTnT were associated with low KCCQ either at baseline or during follow‐up. Our findings show that elevations in cardiac biomarkers reflect early symptomatic changes in HF health status in CKD patients.

Actigraphy as an objective measure of performance status in patients with advanced cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 62-62 ◽  
Author(s):  
William F. Pirl ◽  
Daisuke Fujisawa ◽  
Jamie Stagl ◽  
Justin Eusebio ◽  
Lara Traeger ◽  
...  
Keyword(s):  
Physical Activity ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Objective Measure ◽  
Stage Iv ◽  
Self Report ◽  
Subjective Rating ◽  
Metabolic Equivalents ◽  
Patient Reported ◽  
Ecog Ps

62 Background: Treatment decisions are often based on performance status (PS), a subjective rating of patient functioning derived from observation and patient-report. Devices that monitor physical activity, such as wrist actigraphs, can accurately measure the percent of time a person is immobile while awake (awake immobile). Thus, actigraphy may have potential to better estimate true PS. We compared actigraphy to both Eastern Cooperative Oncology Group PS (ECOG PS) and patient-reported physical activity as predictors of survival in patients with stage IV non-small cell lung cancer (NSCLC). Methods: Participants (n = 41) were ambulatory patients with stage IV NSCLC receiving care at MGH. Participants wore a watch-sized accelerometer device (ACTIWATCH 2) for three consecutive 24-hour periods (72 hours) and completed a self-report questionnaire about physical activity, scored as METS (metabolic equivalents) per week. Patients’ oncologists rated their ECOG PS (0-5) at the end of the 72-hour actigraphy period. Relationships among ECOG PS, awake immobile, and METs per week were tested with Pearson correlations. A ROC curve for 6-month survival was used to determine a meaningful cut-off for awake immobile. Unadjusted Cox regression models tested associations with survival from assessment times. Results: Participants’ ECOG PS ratings were: 0 (22%), 1 (63%), 2 (12%), and 3 (2%). ECOG PS and awake immobile were correlated (r = .42, p < .01). METS per week was correlated only with ECOG PS (r = -.35, p = .03). At time of analysis, 15 patients had died with a minimum follow up of 9 months. Among all patients, survival was predicted by ECOG PS, HR = 3.77 (95% CI 1.70-8.35), p < .01; awake immobile as both as a continuous (percentage points) and categorical ( > 23%) variable, HR = 1.04 (95% CI 1.00-1.09), p = .05 and HR = 4.12 (95% CI 1.37-12.39), p = .01, respectively; but not METS per week. Among patients with good EGOC PS (0-1), only awake immobile ( > 23%) predicted survival, HR = 5.80 (95% CI 1.39-24.12), p = .02. Moreover, within the largest ECOG group (PS1), awake immobile ( > 23%) still predicted survival, HR = 5.53 (95% CI 1.18-25.94), p = .03. Conclusions: Actigraphy, an objective measure of patient activity, may have utility in determining patient PS.

Sign in / Sign up

Export Citation Format

Share Document