FALLS IN PATIENTS WITH CHRONIC SYSTOLIC HEART FAILURE 65 AND MORE YEARS OLD

2021 ◽  
pp. 1103-1106
Author(s):  
А. А. Зарудский ◽  
К. И. Прощаев ◽  
Е. А. Перуцкая ◽  
Д. Н. Перуцкий ◽  
Е. С. Кравченко ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Main Group ◽  
Control Group ◽  
Balance Test ◽  
Number Of Patients ◽  
Risk Of Falls ◽  
Chronic Systolic Heart Failure ◽  
Risk Of Fall

В настоящее время значительно увеличилось число больных пожилого и старческого возраста с систолической ХСН. В этой категории пациентов существенное значение для прогноза и качества жизни могут играть гериатрические синдромы. Синдром падений является одним из ведущих гериатрических синдромов, способных влиять на качество жизни и прогноз у больных с данной патологией. Целью нашей работы явилось изучение распространенности синдрома падений у пациентов 65 лет и старше с систолической ХСН и выявление у них предикторов развития падений. Основную группу ( n =240) составили пациенты 65 лет и старше с ХСН с ФВ<50 %; контрольную ( n =200) - больные с сердечно-сосудистыми заболеваниями того же возраста без признаков ХСН и при отсутствии снижения ФВ и значимой клапанной патологии. В основной группе выявлено достоверно большее число пациентов, страдающих падениями и эквивалентами падений. Доказана высокая предсказательная роль теста стояния на одной ноге в данной группе пациентов; выявлено достоверное снижение времени стояния на одной ноге при сравнении с больными контрольной группы. Снижение ФВ<50 % повышает риск падений в 1,56 раза ( p =0,022), но при этом не определяется достоверной корреляции значения ФВ и риска падений. Риски падений достоверно коррелируют со степенью гипертрофии ЛЖ, выраженностью нарушений диастолической функции у пациентов 65 лет и старше с систолической ХСН. Today we can see a rapidly growing number of patients with systolic heart failure (HF) 65 and over years old. Geriatric conditions may play an important role in such patients. Falls are one of geriatric syndromes, which can influence in prognosis and quality of life in patients with chronic systolic heart failure. Aim of our research was to appreciate prevalence of falls in patients with systolic HF 65 and over years old, identify fall predictors in this group of patients. Patients with chronic HF 65 and over years old with depressed ejection fraction (EF less than 50 %) were included in the main group ( n =240). Control group ( n =200) was composed by patient with cardiac diseases but with no evidences of congestive HF, without EF decline and with no significant valve dysfunctions. Patients were asked about falls and fall equivalents. Risk of falls was also validated by 1 leg balance test. Falls and fall equivalents were more frequent in the main group of patients ( p =0,022). High predictive value of 1-leg balance test for such patients was validated. Time of 1-leg balance test was significantly lower in the main group of patients. Significant relations were observed between falls, fall equivalents and echocardiographic parameters. Depression of EF increase risk of fall in 1,56 times ( p =0,022) but with no correlation between EF and falling risk. Falls are significantly related with left ventricular hypertrophy and diastolic dysfunction in patients with chronic systolic heart failure 65 years old and older.

A single centre study assessing the effectiveness of active monitoring, using telemedicine, in preventing heart failure admissions and death in a primary care population with systolic heart failure.

2020 ◽  
Author(s):  
Nicola Bowers ◽  
Ben Lodge ◽  
Charlie Clifford ◽  
Ricardo Pio Monti ◽  
Marc Phippen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Active Group ◽  
Control Group ◽  
P Value ◽  
Evidence Based ◽  
Significant Difference

Abstract BackgroundPatients with systolic heart failure are at high risk of admission to hospital and death. This can be reduced by ensuring that they are receiving all evidence-based heart failure medications and by detecting early signs of deterioration in their condition.MethodsWe recruited 209 primary care patients with echocardiographically proven left ventricular systolic dysfunction (ejection fraction < 40%). 84 patients consented to be actively monitored by the heart failure team using telemedicine. 125 patients consented to receiving usual care but allowing access to their medical records. The primary end-point was cardiovascular death or admission to hospital for heart failure at 1 year. Secondary end-points included the prescription of evidence-based heart failure medications and patient satisfaction at the end of the study.ResultsThere was no difference in the mortality rate between the groups (6.02% in the active group and 5.56% in control). There was a significant difference in hospital admission (10.84% in the active group and 1.59% in control; p-value of 0.0078). At the end of the study, in the active group v control group, 92% v 52% of patients were on a beta-blocker, 92% v 48% on ACE-I/ARB, and 60% v 30% on an MRA. There were no differences in the final doses achieved.ConclusionsActive telemonitoring in an elderly population with systolic heart failure did not reduce cardiovascular mortality or admission to hospital for heart failure over the 1 year of the study. It did result in more patients receiving evidence based heart failure medications.Trial registrationThis trial received ethical approval from the Health Research Authority London-City Road and Hampstead Research Ethics Committee (REC Reference: 16/L0/0070, IRAS project ID: 173818). The ClinicalTrials.gov Identifier number is: NCT04371731. This trial was retrospectively registered on 30/4/2020 and this study adheres to CONSORT guidelines

scholarly journals U-shaped association between plasma sphingosine-1-phosphate levels and mortality in patients with chronic systolic heart failure: A prospective cohort study.

2019 ◽  
Author(s):  
Yanbo Xue ◽  
Jiang Wei ◽  
Ma Qiong ◽  
Wang Xiqiang ◽  
Jia Pu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Control Group ◽  
Lipid Molecule ◽  
Heart Failure Patients ◽  
All Cause Mortality ◽  
Sphingosine 1 Phosphate ◽  
Chronic Systolic Heart Failure ◽  
Worse Prognosis

Abstract Background: The endogenous lipid molecule sphingosine-1-phosphate (S1P) has received attention in the cardiovascular field due to its significant cardioprotective effects, as revealed in animal studies. The purpose of our study was to identify the distribution characteristics of S1P in systolic heart failure patients and the prognostic value of S1P for long-term prognosis. Methods: We recruited 210 chronic systolic heart failure patients from June 2014 to December 2015. Meanwhile 54 healthy people in the same area were selected as controls. Plasma S1P was measured by liquid chromatography-tandem mass spectrometry. Patients were grouped according to the baseline S1P level quartiles, and restricted cubic spline plots described the association between S1P and all cause death. Cox proportional hazard analysis was used to determine the relationship between category of S1P and all-cause death. Results: Compared with the control group, the plasma S1P in chronic heart failure patients demonstrated a higher mean level (1.269 μmol/L vs 1.122 μmol/L, P=0.006) and a larger standard deviation (0.441 vs 0.316, P=0.022). After a follow-up period of 31.7 ± 10.3 months, the second quartile (0.967-1.192μml/L) with largely normal S1P levels had the lowest all-cause mortality and either an increase (HR=3.87, 95%CI 1.504-9.960, P=0.005) or a decrease (HR=3.271, 95%CI 1.277-8.381, P=0.014) predicted a worse prognosis. Being grouped into the quartile4 group after correction of other variables with prognostic values for all-cause mortality (adjusted HR=3.685 [1.391-9.763], p=0.009) still predicted a worse prognosis. The survival curves showed that S1P levels in the quartile1 and quartile4 groups significantly reduced the patient survival rate. Conclusions: Plasma S1P levels in systolic heart failure patients are related to the long-term all-cause mortality with a U-shaped correlation.

Abstract 2845: Differential Impact of Left Ventricular Remodeling on Septal and Lateral E/Ea Ratio in Predicting Diastolic Staging in Chronic Systolic Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
W. H. Wilson Tang ◽  
Kevin Shrestha ◽  
Wilfried Mullens ◽  
Allen Borowski ◽  
Richard W Troughton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Ventricular Remodeling ◽  
Diastolic Heart Failure ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Doppler Velocity ◽  
Left Ventricular Volumes ◽  
2D Echocardiography ◽  
Chronic Systolic Heart Failure

Background: The ratio of peak transmitral pulsed Doppler early velocity to early diastolic tissue Doppler velocity of the lateral or septal mitral annulus (E/Ea) is considered a reliable estimation of diastolic dysfunction, and their average has been incorporated as clinical determinant of diastolic heart failure. Their relative relaibility in the setting pf left ventricular volumes has not been established. Methods: We performed comprehensive 2D echocardiography in 214 ambulatory patients with chronic systolic heart failure (LVEF ≤35%, NYHA II-III). Diastolic staging was determined from patterns of transmitral and pulmonary vein flows. Results: In our study population (mean age 57 years, 73% male mean left ventricular end-diastolic volume [LVEDV] 228 ml, mean LVEF 25%) , the median lateral and septal Ea were 6.9 cm/s and 4.5 cm/s, respectively. The median E/lateral Ea, E/septal Ea, and E/average Ea [inter-quartile range] were 10.8 [7.1–15.1], 16.1 [11.1–23.0], and 12.7 [8.8–17.7], respectively. In the first two tertiles of indexed LVEDV (LVEDVi<92.6 ml/m 2 and 92.6–129.5 ml/m 2 ), all three E/Ea indices increased with increasing diastolic stages (all p<0.001). However, in the highest tertile of LVEDVi (>129.5 ml/m 2 ), E/septal Ea (but not E/lateral Ea) increased with increasing diastolic stages (Figure ). Conclusions: Unlike E/septal Ea, E/lateral Ea did not increase with increasing diastolic stage in patients with chronic systolic heart failure presenting with LV dilatation. These observations may suggest that the E/septal Ea measurements may be more reliable than E/lateral Ea to assess diastolic dysfunction in patients with enlarged ventricles.

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