Reproducibility of a simple cardiac output response to stress test to diagnose and monitor heart failure in a primary care setting

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697109
Author(s):  
Djordje Jakovljevic ◽  
Sarah J Charman ◽  
Nduka C Okwose ◽  
Renae J Stefanetti ◽  
Kristian Bailey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Stress Test ◽  
Standing Position ◽  
Output Response ◽  
Non Invasive ◽  
Response To Stress ◽  
One Step ◽  
Lower Limits

BackgroundWe developed a simple non-invasive Cardiac Output Response to Stress (CORS) Test to improve diagnosis and monitoring of heart failure in primary care.AimThe aim of the present study was to assess test-retest reproducibility of the CORS test.MethodThirty-two healthy volunteers (age, 64±10, female n=18) were recruited. Cardiac output was measured continuously using bioreactance method in supine and standing position, and during a two 3-min stages of a step-exercise protocol (10 and 15 steps per minute) using a 15-cm height bench. The CORS test was performed twice i.e. Test 1 and Test 2.ResultsCardiac output and stroke volume were not significantly different between the two tests at supine (6.2±1.4 versus 6.3±1.7 L/min, P = 0.84; 102±24 versus 108±32 ml/beat, P = 0.36), standing (5.7±2.1 versus 5.7±1.9 L/min, P = 0.99; 82±32 versus 83±29 ml/beat, P = 0.93), stage one step-exercise (8.5± 1.8 versus 8.2±1.9 L/min, P = 0.56; 104±26 versus 104±27 ml/beat, P = 0.99) and stage two step-exercise (9.9±1.7 versus 9.6±2.0 L/min, P = 0.51; 109±29 versus 111±26 ml/beat, P = 0.76). There was a significant positive relationship between Test 1 and Test 2 cardiac outputs (r=0.92, P<0.01 with coefficient of variation of 7.1%). The mean difference in cardiac output (with upper and lower limits of agreement) between Test 1 and Test 2 was 0.1 (−1.9 to 2.1) L/min, combining rest and exercise data.ConclusionThe CORS test demonstrates acceptable reproducibility and can potentially be used in primary care to identify and monitor heart failure.

scholarly journals A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care

2018 ◽  
Vol 5 (4) ◽  
pp. 703-712 ◽  
Author(s):  
Sarah J. Charman ◽  
Nduka C. Okwose ◽  
Renae J. Stefanetti ◽  
Kristian Bailey ◽  
Jane Skinner ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Stress Test ◽  
Output Response ◽  
Response To Stress

scholarly journals Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: a qualitative study

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703421
Author(s):  
Sarah Charman ◽  
Nduka Okwose ◽  
Gregory Maniatopoulos ◽  
Sara Graziadio ◽  
Luke Vale ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Qualitative Study ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Diagnostic Testing ◽  
Clinical Test ◽  
Output Response ◽  
Response To Stress

BackgroundPrimary care physicians lack access to an objective cardiac function test during diagnostic testing for suspected heart failure.AimTo determine the role of the novel Cardiac Output Response to Stress (CORS) test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.MethodQualitative study using semi-structured in-depth interviews which were audiorecorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach. Fourteen healthcare professionals (six males, eight females) from primary (GPs, nurses, healthcare assistants, and practice managers) and secondary care (consultant cardiologists) participated.ResultsFour themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include establishment of clinical utility, suitability for immobile patients, and cost implication to GP practices.ConclusionThe development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose however, factors such as cost-effectiveness, diagnostic accuracy, and seamless implementation in primary care have to be fully explored.

scholarly journals Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e028122
Author(s):  
Sarah Charman ◽  
Nduka Okwose ◽  
Gregory Maniatopoulos ◽  
Sara Graziadio ◽  
Tamara Metzler ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Qualitative Study ◽  
Secondary Care ◽  
Clinical Test ◽  
Output Response ◽  
Diagnostic Technology ◽  
Response To Stress ◽  
Barriers To Implementation

ObjectiveTo explore the role of the novel cardiac output response to stress (CORS), test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.DesignQualitative study using semistructured in-depth interviews which were audio recorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach.SettingNewcastle upon Tyne, UK.ParticipantsFourteen healthcare professionals (six males, eight females) from primary (general practitioners (GPs), nurses, healthcare assistant, practice managers) and secondary care (consultant cardiologists).ResultsFour themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that the adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include: establishment of clinical utility, suitability for immobile patients and cost implication to GP practices.ConclusionThe development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose; however, factors such as cost effectiveness, diagnostic accuracy and seamless implementation in primary care have to be fully explored.

scholarly journals Quantification of the Impaired Cardiac Output Response to Exercise in Heart Failure: Application of a Non-Invasive Device

2008 ◽  
Vol 14 (6) ◽  
pp. S21
Author(s):  
Jonathan Myers ◽  
Pradeep Gujja ◽  
Suresh Neelagaru ◽  
Leon Hsu ◽  
Daniel Burkhoff
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Output Response ◽  
Non Invasive ◽  
Invasive Device ◽  
Response To Exercise

Cardiac Output Response to Continuous Positive Airway Pressure in Congestive Heart Failure

1992 ◽  
Vol 145 (2_pt_1) ◽  
pp. 377-382 ◽  
Author(s):  
T. Douglas Bradley ◽  
Richard M. Holloway ◽  
Peter R. McLaughlin ◽  
Bette L. Ross ◽  
Janice Walters ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Output ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Output Response

Non-invasive measurement of cardiac output during exercise in chronic heart failure

2005 ◽  
Vol 12 (3) ◽  
pp. 298-299
Author(s):  
Gaia Cattadori ◽  
Piergiuseppe Agostoni ◽  
Anna Apostolo ◽  
Giancarlo Marenzi
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Chronic Heart Failure ◽  
Non Invasive ◽  
Invasive Measurement

Non-invasive measurement of cardiac output in patients with chronic heart failure

2004 ◽  
Vol 9 (5) ◽  
pp. 277-280 ◽  
Author(s):  
Stephen J. Leslie ◽  
Sin??ad McKee ◽  
David E. Newby ◽  
David J. Webb ◽  
Martin A. Denvir
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Chronic Heart Failure ◽  
Non Invasive ◽  
Invasive Measurement

Abstract 14972: Sub-clinical Atrial Fibrillation in Elderly Primary Care Patients Without Clinical Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jeff S Healey ◽  
Stuart J Connolly ◽  
Veena Manja ◽  
Yan Liu ◽  
Kim D Simek ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Primary Care ◽  
Coronary Disease ◽  
Cryptogenic Stroke ◽  
Left Ventricular ◽  
Ecg Monitoring ◽  
High Background ◽  
Non Invasive ◽  
History Of

Introduction: Sub-clinical AF has been reported in 10% of pacemaker patients (≥ 6 minutes, with 3 months of monitoring) and 16% of patients following cryptogenic stroke (≥ 30 seconds, with 1 month of monitoring). It is unknown how common sub-clinical AF is among other patient groups, including the elderly. These data are needed to give context to the detection of sub-clinical AF in clinical practice. Methods: We prospectively investigated the prevalence of sub-clinical AF among individuals ≥ 80 years, without known AF or symptoms of arrhythmia, attending primary care clinics. Subjects had a history of hypertension and at least one of the following: diabetes, BMI ≥ 30, sleep apnea, smoking, coronary disease, heart failure or left ventricular hypertrophy. Patients were recruited from 7 Ontario family practice clinics (n=119) and one general medicine clinic (n=10). Patients underwent 30 days of continuous, non-invasive ambulatory ECG monitoring using a device with automatic AF detection (Vitaphone 3100). The primary outcome was a composite of atrial flutter (AFL) or AF ≥ 6 minutes in duration. Those without AF were invited to complete an additional 30 days of monitoring. Results: Of 129 patients screened and consented, 100 patients initiated monitoring for an average monitoring duration of 36± 21 days. The mean (SD) age was 84 ± 3 years and systolic blood pressure was 138 ± 17 mmHg; 50% had coronary disease, 28% had diabetes and 6% had heart failure. Only 4% had a history of prior stroke. Thirty days of monitoring was completed by 57% of patients and 31% completed an additional 30 days. AFL or AF ≥ 30 seconds duration was documented in 19/100 patients; ≥ 6 minutes in 15; ≥ 30 minutes in 12; ≥ 6 hours in 8 and ≥ 24 hours in 2. Shorter episodes of atrial tachycardia lasting less than 30 seconds were observed in 47 patients. Conclusions: In this prospective, outpatient study, using non-invasive ECG monitoring, we found AFL or AF ≥ 6 minutes in 15% of elderly individuals with stroke risk factors. This high background prevalence of AFL/AF among elderly patients suggests a possible role for AF screening in this population; but also should be taken into consideration when interpreting the prevalence of AFL/AF in other populations.

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