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McClung JA, Frishman WH, Aronow WS. The Role of Palliative Care in Cardiovascular Disease. Cardiol Rev 2024:00045415-990000000-00182. [PMID: 38169299 DOI: 10.1097/crd.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The American Heart Association has recommended that palliative care be integrated into the care of all patients with advanced cardiac illnesses. Notwithstanding, the number of patients receiving specialist palliative intervention worldwide remains extremely small. This review examines the nature of palliative care and what is known about its delivery to patients with cardiac illness. Most of the published literature on the subject concern advanced heart failure; however, some data also exist regarding patients with heart transplantation, pulmonary hypertension, valvular disease, congenital heart disease, indwelling devices, mechanical circulatory support, and advanced coronary disease. In addition, outcome data, certification requirements, workforce challenges, barriers to implementation, and a potential caveat about palliative care will also be examined. Further work is required regarding appropriate means of implementation, quality control, and timing of intervention.
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Affiliation(s)
- John Arthur McClung
- From the Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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Cavalli C, Tarzia V, Marini M, Gregori D, Casella S, Bottio T, Toscano G, Fraiese AP, Gambino A, Volpe B, Gerosa G. A comparison of quality of life and psychological distress in heart transplantation patients at adult and pediatric ages. Clin Transplant 2020; 33:e13335. [PMID: 29935045 DOI: 10.1111/ctr.13335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/01/2018] [Accepted: 06/06/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the current study was to evaluate and compare the quality of life (QOL) and psychological status of adult patients who underwent heart transplant (HTx) at pediatric or adult ages. METHODS The population consisted of two groups: patients who received HTx after 18 years old and pediatrics who received HTx between the age of 1 and 18 years. At the time of the study, all patients were over 18 years old. QOL data were collected from patients using 36-item Short-Form Health Survey (SF-36) and psychological distress by the Symptom checklist 90-revised questionnaire (SCL-90-R). RESULTS A total of 232 HTx patients were evaluated; 217 were transplanted at an adult age and 15 at a pediatric one. QOL improved significantly in pediatrics patients in the general health perceptions subscale and physical pain subscale than adult patients. The Global Index of the psychological distress did not differ in the two groups, but the pediatric patients registered statistically significant higher scores on the interpersonal sensitivity symptom subscale (adult group 36 ± 0.42 vs pediatric group 81 ± 0.79), the hostility subscale (adult group m 39 ± 0.44 vs pediatric group 73 ± 0.76) and the paranoid ideation subscale (adult group 46 ± 0.46 vs pediatric group 96 ± 1.02). CONCLUSION The pediatric heart recipients showed better quality of life, but they show marked sensitivity, hostility and paranoid ideation which increases the risk of mental distress and therefore their adherence to medical treatment.
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Affiliation(s)
- Chiara Cavalli
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Vincenzo Tarzia
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Dario Gregori
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Tomaso Bottio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giuseppe Toscano
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Angela Pompea Fraiese
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonio Gambino
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Mariani S, Hanke JS, Li T, Merzah AS, Chatterjee A, Deniz E, Haverich A, Schmitto JD, Dogan G. Device profile of the heartware HVAD system as a bridge-to-transplantation in patients with advanced heart failure: overview of its safety and efficacy. Expert Rev Med Devices 2019; 16:1003-1015. [DOI: 10.1080/17434440.2019.1696674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin Sarah Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ali Saad Merzah
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Anamika Chatterjee
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ezin Deniz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D. Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Abstract
It is currently estimated that 5.7 million Americans live with heart failure. Of these, less than 3000 will receive a heart transplant this year, according to the US Department of Health and Human Services Organ Procurement and Transplantation Network. With successful transplantation can come significant emotional and physical symptoms that are not always addressed. Although palliative care is an interdisciplinary subspecialty designed to alleviate multiple domains of suffering in serious illness, many mistakenly associate it solely with the end of life. Traditionally associated with cancer, research into the role of palliative care in other chronic illnesses and complex life-changing therapies such as solid organ transplantation remains scarce but is nonetheless developing. Here, we try to investigate a potential role for palliative care for heart transplant recipients. Early research thus far has demonstrated importance of early involvement of palliative care teams and the significant improvement of physical and emotional symptoms in the pre- and post-transplant period. Nevertheless, more research is warranted to determine the ideal timing of palliative care integration, the effects on health care resource utilization, and whether improving quality of life can affect morbidity and mortality. By understanding these critical elements and others we may be able to develop a model for the role of palliative care for heart transplant patients.
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Tonet E, Maietti E, Chiaranda G, Vitali F, Serenelli M, Bugani G, Mazzoni G, Ruggiero R, Myers J, Villani GQ, Corvi U, Pasanisi G, Biscaglia S, Pavasini R, Lucchi GR, Sella G, Ferrari R, Volpato S, Campo G, Grazzi G. Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): rationale and design of a randomized clinical trial. BMC Cardiovasc Disord 2018; 18:98. [PMID: 29783928 PMCID: PMC5963011 DOI: 10.1186/s12872-018-0839-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/11/2018] [Indexed: 01/06/2023] Open
Abstract
Background Reduced physical performance and impaired mobility are common in elderly patients after acute coronary syndrome (ACS) and they represent independent risk factors for disability, morbidity, hospital readmission and mortality. Regular physical exercise represents a means for improving functional capacity. Nevertheless, its clinical benefit has been less investigated in elderly patients in the early phase after ACS. The HULK trial aims to investigate the clinical benefit of an early, tailored low-cost physical activity intervention in comparison to standard of care in elderly ACS patients with reduced physical performance. Design HULK is an investigator-initiated, prospective multicenter randomized controlled trial (NCT03021044). After successful management of the ACS acute phase and uneventful first 1 month, elderly (≥70 years) patients showing reduced physical performance are randomized (1:1 ratio) to either standard of care or physical activity intervention. Reduced physical performance is defined as a short physical performance battery (SPPB) score of 4–9. The early, tailored, low-cost physical intervention includes 4 sessions of physical activity with a supervisor and an home-based program of physical exercise. The chosen primary endpoint is the 6-month SPPB value. Secondary endpoints briefly include quality of life, on-treatment platelet reactivity, some laboratory data and clinical adverse events. To demonstrate an increase of at least one SPPB point in the experimental arm, a sample size of 226 patients is needed. Conclusions The HULK study will test the hypothesis that an early, tailored low-cost physical activity intervention improves physical performance, quality of life, frailty status and outcome in elderly ACS patients with reduced physical performance. Trial registration Clinicaltrials.gov, identifier NCT03021044, first posted January, 13th 2017. Electronic supplementary material The online version of this article (10.1186/s12872-018-0839-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisabetta Tonet
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Elisa Maietti
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Giorgio Chiaranda
- Department of Public Health, AUSL Piacenza, and Sport Medicine Service, Piacenza, Italy
| | - Francesco Vitali
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Matteo Serenelli
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Giulia Bugani
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Gianni Mazzoni
- Center of Biomedical Studies applied to Sport, Public Health Department, Azienda USL di Ferrara, Ferrara, Italy
| | - Rossella Ruggiero
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Jonathan Myers
- VA Palo Alto Health Care System, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Ursula Corvi
- Cardiology Unit, Ospedale S, Giovanni da Saliceto, Piacenza, Italy
| | - Giovanni Pasanisi
- Department of Medicine, Division of Cardiology, "Delta" Hospital AUSL Ferrara, Ferrara, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | | | | | - Roberto Ferrari
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy
| | - Stefano Volpato
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy. .,Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy.
| | - Giovanni Grazzi
- Center of Biomedical Studies applied to Sport, Public Health Department, Azienda USL di Ferrara, Ferrara, Italy
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Couppé C, Dall CH, Svensson RB, Olsen RH, Karlsen A, Praet S, Prescott E, Magnusson SP. Skin autofluorescence is associated with arterial stiffness and insulin level in endurance runners and healthy controls - Effects of aging and endurance exercise. Exp Gerontol 2017; 91:9-14. [DOI: 10.1016/j.exger.2017.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/06/2017] [Accepted: 02/06/2017] [Indexed: 01/23/2023]
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Díaz-Molina B, Lambert JL, Vílchez FG, Cadenas F, Bernardo MJ, Velasco E, Martín M, Morís C. Quality of Life According to Urgency Status in De Novo Heart Transplant Recipients. Transplant Proc 2017; 48:3024-3026. [PMID: 27932137 DOI: 10.1016/j.transproceed.2016.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/19/2016] [Accepted: 09/02/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Elective heart transplantation (HTX) aims to improve physical ability, increase survival, and improve health-related quality of life (HRQoL) in patients with chronic heart failure. Nevertheless, most patients who undergo urgent HTX are previously healthy, and a transplant could be perceived as a limitation. The aim of this study is to compare HRQoL between elective and urgent heart transplant recipients. METHODS Cohort study including patients undergoing heart transplantation between January 1998 and March 2012 in a single center. Patients with retransplantation or multiorgan transplantation were excluded. Clinical variables including comorbidities were collected. For assessment of HRQoL, the Kansas City Cardiomyopathy Questionnaire (KCCQ) was completed by the survivors on March 2013. Univariate analysis (Mann-Whitney U test) was performed. RESULTS Questionnaires were collected from 95 of 106 elective recipients and 28 of 33 urgent recipients. Urgent heart recipients were younger, with more cardiovascular risk factors, and ischemic etiology was the leading cause of transplant. All domain results were higher in elective heart transplant recipients, but after univariate analysis only the punctuation of the self-efficacy domain remained superior in the elective HTX group (87.5 vs 79.7, P = .034). CONCLUSION Both urgent and elective heart transplant patients reported a good HRQoL, and there were no significant differences between their scores.
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Affiliation(s)
- B Díaz-Molina
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - J L Lambert
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - F G Vílchez
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - F Cadenas
- Department of Digestive Diseases, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M J Bernardo
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Velasco
- Department of Cardiology, Hospital de Cabueñes, Gijón, Spain
| | - M Martín
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - C Morís
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
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8
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Subclinical Cardiovascular Disease in Lymphoma Survivors by Sex. J Obstet Gynecol Neonatal Nurs 2016; 45:438-53. [DOI: 10.1016/j.jogn.2015.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 12/29/2022] Open
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Reilly CM, Higgins M, Smith A, Culler SD, Dunbar SB. Single subject design: Use of time series analyses in a small cohort to understand adherence with a prescribed fluid restriction. Appl Nurs Res 2015; 28:356-65. [PMID: 26608439 DOI: 10.1016/j.apnr.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE This paper presents a secondary in-depth analysis of five persons with heart failure randomized to receive an education and behavioral intervention on fluid restriction as part of a larger study. METHODS Using a single subject analysis design, time series analyses models were constructed for each of the five patients for a period of 180 days to determine correlations between daily measures of patient reported fluid intake, thoracic impedance, and weights, and relationships between patient reported outcomes of symptom burden and health related quality of life over time. RESULTS Negative relationships were observed between fluid intake and thoracic impedance, and between impedance and weight, while positive correlations were observed between daily fluid intake and weight. CONCLUSIONS By constructing time series analyses of daily measures of fluid congestion, trends and patterns of fluid congestion emerged which could be used to guide individualized patient care or future research endeavors. Employment of such a specialized analysis technique allows for the elucidation of clinically relevant findings potentially disguised when only evaluating aggregate outcomes of larger studies.
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Affiliation(s)
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
| | - Andrew Smith
- Emory University School of Medicine, Atlanta, GA 30322, USA
| | | | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
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10
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Delgado J, Almenar L, González-Vilchez F, Arizón J, Gómez M, Fuente L, Brossa V, Fernández J, Díaz B, Pascual D, Lage E, Sanz M, Manito N, Crespo-Leiro M. Health-related quality of life, social support, and caregiver burden between six and 120 months after heart transplantation: a Spanish multicenter cross-sectional study. Clin Transplant 2015; 29:771-80. [DOI: 10.1111/ctr.12578] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 11/29/2022]
Affiliation(s)
- J.F. Delgado
- Hospital Universitario 12 de Octubre; Madrid Spain
| | - L. Almenar
- Hospital Universitario La Fe; Valencia Spain
| | | | - J.M. Arizón
- Hospital Universitario Reina Sofía; Córdoba Spain
| | - M. Gómez
- Hospital Universitario Puerta de Hierro; Madrid Spain
| | - L. Fuente
- Hospital Clínico Universitario de Valladolid; Valladolid Spain
| | - V. Brossa
- Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - J. Fernández
- Hospital Universitario Gregorio Marañón; Madrid Spain
| | - B. Díaz
- Hospital Universitario Central de Asturias; Oviedo Spain
| | - D. Pascual
- Hospital Universitario Virgen de la Arrixaca; Murcia Spain
| | - E. Lage
- Hospital Universitario Virgen del Rocío; Seville Spain
| | - M. Sanz
- Hospital Universitario Miguel Servet; Zaragoza Spain
| | - N. Manito
- Hospital Universitario de Bellvitge; Barcelona Spain
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Dunbar SB, Reilly CM, Gary R, Higgins MK, Culler S, Butts B, Butler J. Randomized clinical trial of an integrated self-care intervention for persons with heart failure and diabetes: quality of life and physical functioning outcomes. J Card Fail 2015; 21:719-29. [PMID: 26028261 DOI: 10.1016/j.cardfail.2015.05.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Persons with concomitant heart failure (HF) and diabetes mellitus (DM) have complicated, often competing, self-care expectations and treatment regimens that may reduce quality of life (QOL). This randomized controlled trial tested an integrated self-care intervention on outcomes of HF and DM QOL, physical function, and physical activity (PA). METHODS AND RESULTS Participants with HF and DM (n = 134; mean age 57.4 ± 11 years, 66% men, 69% minority) were randomized to usual care (control) or intervention. The control group received standard HF and DM educational brochures with follow-up telephone contact. The intervention group received education and counseling on combined HF and DM self-care (diet, medications, self-monitoring, symptoms, and PA) with follow-up home visit and telephone counseling. Measures included questionnaires for HF- and DM-specific and overall QOL, PA frequency, and physical function (6-min walk test [6MWT]) and were obtained at baseline and 3 and 6 months. Analysis included mixed models with a priori post hoc tests. Adjusting for age, body mass index, and comorbidity, the intervention group improved in HF total (P = .002) and physical (P < .001) QOL scores at 3 months with retention of improvements at 6 months, improved in emotional QOL scores compared with control at 3 months (P = .04), and improved in health status ratings (P = .04) at 6 months compared with baseline. The intervention group improved in 6MWT distance (924 ft to 952 ft; P = .03) whereas the control group declined (834 ft to 775 ft; F1,63 = 6.86; P = .01). The intervention group increased self-reported PA between baseline and 6 months (P = .01). CONCLUSIONS An integrated HF and DM self-care intervention improved perceived HF and general QOL but not DM QOL. Improved physical functioning and self-reported PA were also observed with the integrated self-care intervention. Further study of the HF and DM integrated self-care intervention on other outcomes, such as hospitalization and cost, is warranted.
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Affiliation(s)
- Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
| | - Carolyn M Reilly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Rebecca Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Melinda K Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Steven Culler
- Rollins School of Public Health and School of Nursing, Emory University, Atlanta, Georgia
| | - Brittany Butts
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Javed Butler
- School of Medicine and School of Nursing, Emory University, Atlanta, Georgia; Stony Brook University, Stony Brook, New York
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12
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Dall CH, Gustafsson F, Christensen SB, Dela F, Langberg H, Prescott E. Effect of moderate- versus high-intensity exercise on vascular function, biomarkers and quality of life in heart transplant recipients: A randomized, crossover trial. J Heart Lung Transplant 2015; 34:1033-41. [PMID: 25840503 DOI: 10.1016/j.healun.2015.02.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/02/2015] [Accepted: 02/01/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Growing evidence in long-term treatment of heart transplant (HTx) recipients indicates effects of high-intensity interval training (HIIT) on several parameters, including oxygen uptake, vascular function and psychological distress. In this study we compare the effect of HIIT vs continued moderate training (CON) on vascular function, biomarkers and health-related quality of life (HRQoL) in HTx recipients. METHODS A randomized, controlled crossover trial of stable HTx recipients >12 months after transplantation was done on patients with 12 weeks of HIIT or 12 weeks of CON, followed by a 5-month washout and crossover. Outcomes included endothelial function, arterial stiffness, biomarkers, HRQoL and markers of anxiety and depression. RESULTS Sixteen HTx recipients (mean age 52 years, 75% male) completed the study. HIIT increased VO(2peak) more than CON (between-group difference, p < 0.001). The physical component score of the 36-item Short Form (SF-36) was increased significantly in HIIT patients (p = 0.02) and borderline increased in CON patients (p = 0.07), whereas there was no significant effect of exercise on the mental component. Depression score decreased significantly in HIIT patients (p = 0.04) with no change in CON patients (p = 0.75), whereas anxiety score decreased significantly in both HIIT (p < 0.01) and CON (p < 0.05) patients. There were no between-group differences in any of the measures (all p > 0.05). Arterial stiffness and biomarkers were not changed, nor did endothelial function change after HIIT (p = 0.08) or CON (p = 0.68). CONCLUSIONS HIIT and CON are both well tolerated and induce similar improvements in physical components of HRQoL and in markers of anxiety. Effects of either training modality on vascular function and biomarkers could not be confirmed.
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Affiliation(s)
- Christian H Dall
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen; Institute of Sports Medicine Copenhagen (ISMC/MRRU).
| | - Finn Gustafsson
- Department of Cardiology, Heart Centre, Rigshospitalet, University of Copenhagen
| | | | - Flemming Dela
- Xlab, Center for Healthy Aging, University of Copenhagen
| | - Henning Langberg
- CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen
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13
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Peyrovi H, Raiesdana N, Mehrdad N. Living with a heart transplant: a phenomenological study. Prog Transplant 2014; 24:234-41. [PMID: 25193723 DOI: 10.7182/pit2014966] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Heart transplantation is a relatively new medical treatment for end-stage heart failure. Many studies have addressed the outcomes and the complications and technical problems associated with heart transplants, but few have explored the whole clinical experience of being a heart transplant recipient. PURPOSE To understand and gain deeper insight into the lived experience of Iranian heart transplant recipients. METHODS Interviews of 11 heart transplant recipients were analyzed according to phenomenological guidelines set forth by Diekelmann. RESULTS Six major themes emerged from 29 subthemes, depicting the meaning of living with a transplanted heart. These themes include having a new life, living with new concerns, living with vigilance, paradoxical emotions, bearing others' behaviors, and the prominent role of God in life. CONCLUSION Heart transplant recipients in Iran experience a new life in which their faith in God helps them go through hardships and difficulties.
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Affiliation(s)
- Hamid Peyrovi
- Center for Nursing Care Research and School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran
| | | | - Neda Mehrdad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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14
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Grady KL, Naftel D, Stevenson L, Dew MA, Weidner G, Pagani FD, Kirklin JK, Myers S, Baldwin T, Young J. Overall quality of life improves to similar levels after mechanical circulatory support regardless of severity of heart failure before implantation. J Heart Lung Transplant 2013; 33:412-21. [PMID: 24360203 DOI: 10.1016/j.healun.2013.10.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 10/04/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The severity of pre-implantation heart failure may affect post-implantation health-related quality of life (HRQOL). The purpose of our study was to examine differences in HRQOL from before mechanical circulatory support (MCS) through 1 year after surgery by Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) patient profiles. METHODS Data from 1,559 adults with advanced heart failure who received primary continuous-flow pumps between June 23, 2006, and March 31, 2010, and were enrolled in INTERMACS were analyzed. HRQOL data were collected using the EQ-5D-3L survey before implantation and at 3, 6, and 12 months after implantation. Statistical analyses included chi-square and t-tests, using all available data for each time period. Paired t-tests and sensitivity analyses were also conducted. RESULTS HRQOL was poor before MCS implantation among patients with INTERMACS profiles 1 to 7 and significantly improved after MCS implantation for all profiles. Stratified by INTERMACS profile, problems within each of the 5 dimensions of HRQOL (i.e., mobility, self-care, usual activities, pain, and anxiety/depression) generally decreased from before to after implantation. By 6 months after implantation, patients with all INTERMACS profiles reported similar frequencies of problems for all HRQOL dimensions. Paired t-tests and sensitivity analyses supported almost all of our findings. CONCLUSIONS HRQOL is poor among advanced heart failure patients with INTERMACS profiles 1 to 7 before MCS implantation and improves to similar levels for patients who remained on MCS 1 year after surgery. Patients have problems in HRQOL dimensions before and after MCS; however, the frequency of reporting problems decreases for all dimensions within most profiles across time.
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Affiliation(s)
- Kathleen L Grady
- Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, Illinois.
| | - David Naftel
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lynne Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mary Amanda Dew
- Departments of Epidemiology, Biostatistics, and Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
| | - Gerdi Weidner
- Department of Biology, San Francisco State University, San Francisco, California
| | - Francis D Pagani
- Center for Circulatory Support, University of Michigan, Ann Arbor, Michigan
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Susan Myers
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Timothy Baldwin
- the National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - James Young
- Cleveland Clinic Foundation, Cleveland, Ohio
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15
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Dar O, Banner NR. Cardiac transplantation: who to refer and when. Br J Hosp Med (Lond) 2013; 74:258-63. [PMID: 23657020 DOI: 10.12968/hmed.2013.74.5.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Ivarsson B, Ekmehag B, Sjöberg T. Heart or lung transplanted patients' retrospective views on information and support while waiting for transplantation. J Clin Nurs 2012; 22:1620-8. [PMID: 23039262 DOI: 10.1111/j.1365-2702.2012.04284.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2012] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe the patients' retrospective experiences of the information and support they received while on the heart or lung transplant waiting list. BACKGROUND Patients differ in the way that they cope with the time spent waiting for a heart or lung transplant. Patients must already before the transplantation be taught about a new lifestyle, risk factors, medication, food restrictions and exercise, so they can take an active role and responsibility for disease management after transplantation. Little is known about patients' experiences of information and support in these situations. DESIGN Qualitative descriptive design. METHODS Sixteen patients (16-67 year) were strategically selected from one transplant centre in Sweden and interviewed six months after heart or lung transplantation. Using content analysis, transcribed data were organised into subcategories that reflected emerging categories. RESULTS Three categories that describe patients' experiences of information and support have been identified: 'Achieving confidence and trust by information and support', 'Experiencing a lack of input and understanding' and 'Struggling with a life-threatening illness and an insecure future'. Each category consists of different subcategories. CONCLUSIONS Information and support in connection to heart or lung transplantation are a complex and multifaceted issue involving patient-related, family-related, disease-related and treatment-related factors as well as experiences related to the social situation, the healthcare system and society. Transplant patients are very vulnerable, and a deeper understanding of patients' experiences should help healthcare providers in optimising the care for these very sick patients. RELEVANCE TO CLINICAL PRACTICE A holistic approach to the patient is necessary in meeting the needs of patients with chronic illness, especially patients with children at home, as well as the needs of their families. An important implication is the necessity to enhance awareness about transplant patients in society in general, in particular in other institutions, by sharing knowledge and by improving cooperation.
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Affiliation(s)
- Bodil Ivarsson
- Department of Cardiothoracic Surgery, Lund University and Skåne University Hospital, Lund, Sweden.
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17
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Aaronson KD, Slaughter MS, Miller LW, McGee EC, Cotts WG, Acker MA, Jessup ML, Gregoric ID, Loyalka P, Frazier OH, Jeevanandam V, Anderson AS, Kormos RL, Teuteberg JJ, Levy WC, Naftel DC, Bittman RM, Pagani FD, Hathaway DR, Boyce SW. Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation. Circulation 2012; 125:3191-200. [PMID: 22619284 DOI: 10.1161/circulationaha.111.058412] [Citation(s) in RCA: 496] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contemporary ventricular assist device therapy results in a high rate of successful heart transplantation but is associated with bleeding, infections, and other complications. Further reductions in pump size, centrifugal design, and intrapericardial positioning may reduce complications and improve outcomes. METHODS AND RESULTS We studied a small, intrapericardially positioned, continuous-flow centrifugal pump in patients requiring an implanted ventricular assist device as a bridge to heart transplantation. The course of investigational pump recipients was compared with that of patients implanted contemporaneously with commercially available devices. The primary outcome, success, was defined as survival on the originally implanted device, transplantation, or explantation for ventricular recovery at 180 days and was evaluated for both noninferiority and superiority. Secondary outcomes included a comparison of survival between groups and functional and quality-of-life outcomes and adverse events in the investigational device group. A total of 140 patients received the investigational pump, and 499 patients received a commercially available pump implanted contemporaneously. Success occurred in 90.7% of investigational pump patients and 90.1% of controls, establishing the noninferiority of the investigational pump (P<0.001; 15% noninferiority margin). At 6 months, median 6-minute walk distance improved by 128.5 m, and both disease-specific and global quality-of-life scores improved significantly. CONCLUSIONS A small, intrapericardially positioned, continuous-flow, centrifugal pump was noninferior to contemporaneously implanted, commercially available ventricular assist devices. Functional capacity and quality of life improved markedly, and the adverse event profile was favorable. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00751972.
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Affiliation(s)
- Keith D Aaronson
- University of Michigan Medical Center, 1500 E Medical Center Dr, Cardiovascular Center, Room 2169, SPC 5853, Ann Arbor, MI 48109-5853, USA.
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18
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Tseng PH, Wang SS, Shih FJ. Changes in Health-Related Quality of Life Across Three Post–Heart Transplantation Stages: Preoperative Extracorporeal Membrane Versus Non–Extracorporeal Membrane Group/Clinical Trial Plan Group Versus Non–Clinical Trial Plan Group in Taiwan. Transplant Proc 2012; 44:915-8. [DOI: 10.1016/j.transproceed.2012.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Buendía F, Almenar L, Martínez-Dolz L, Sánchez-Lázaro I, Navarro J, Agüero J, Muñoz B, Sánchez-Gómez JM, Cebrian M, Salvador A. Relationship between functional capacity and quality of life in heart transplant patients. Transplant Proc 2012; 43:2251-2. [PMID: 21839248 DOI: 10.1016/j.transproceed.2011.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The goal of heart transplantation (HT) is not only to prolong the life of patients with end-stage heart failure, but also to offer them the sort of health they enjoyed before the disease. It is widely known that patients' functional capacity improves after HT but what about their quality of life (QoL)? Do functional capacity and QoL improve simultaneously? In the present study, we compared the progression of effort capacity and QoL in the first 2 years after HT. A prospective longitudinal study was performed in 58 heart transplant recipients (43 males, 15 females, age 51.6 ± 10 years) able to complete an effort test 2, 6, 12, and 24 months after transplantation. The studied variables included the five dimensions of the Euroqol-5D questionnaire (EQ-5D) test: mobility, self-care, daily activities, pain/discomfort, anxiety, and depression; a visual analog scale from 0 to 100; and the results (metabolic equivalent units [METs] and time of exercise) of the effort test at 2, 6, 12, and 24 months after transplantation. Analysis of variance was used to compare these variables at each point. Significance was set at P < .05. Functional capacity, measured by both METs and time of exercise, improved progressively (METs: 2 months: 5.2 ± 1.8, 6 months: 6.6 ± 2.1, 12 months: 7.5 ± 2.2, and 24 months: 8.5 ± 2.3, P < .001). As well, the result of EQ-5D questionare improved in parallel to exercise capacity. However, visual analog scale score did not change significatively during the follow-up (2 months: 78.9.3 ± 16.1, 6 months: 83.8 ± 11.3, 12 months: 83.3 ± 11.1, 24 months: 85.2 ± 14.9; P = .192), reaching a plateau at 6 to 24 months. In conclusion, the improvement in functional capacity shown by heart transplant recipients in the first 2 years after transplantation was not parallel to the feelings of well-being measured by the analog scale of the EQ-5D. Possibly long after transplantation patients will compare themselves to healthy people rather than to their state before HT, resulting in improvements the visual analog scale.
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Affiliation(s)
- F Buendía
- Heart Failure and Heart Transplant Unit, Cardiology Department, La Fe Universitary Hospital, Valencia, Spain.
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Phan A, IsHak WW, Shen BJ, Fuess J, Philip K, Bresee C, Czer L, Schwarz ER. Persistent Sexual Dysfunction Impairs Quality of Life after Cardiac Transplantation. J Sex Med 2010; 7:2765-73. [DOI: 10.1111/j.1743-6109.2010.01854.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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21
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Holtzman S, Abbey SE, Stewart DE, Ross HJ. Pain After Heart Transplantation: Prevalence and Implications for Quality of Life. PSYCHOSOMATICS 2010. [DOI: 10.1016/s0033-3182(10)70690-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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Dyer MTD, Goldsmith KA, Sharples LS, Buxton MJ. A review of health utilities using the EQ-5D in studies of cardiovascular disease. Health Qual Life Outcomes 2010; 8:13. [PMID: 20109189 PMCID: PMC2824714 DOI: 10.1186/1477-7525-8-13] [Citation(s) in RCA: 278] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 01/28/2010] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease. METHODS A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included. RESULTS Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients. CONCLUSIONS The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area.
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Affiliation(s)
- Matthew TD Dyer
- Health Economics Research Group, Brunel University, Uxbridge, UK
- National Collaborating Centre for Mental Health, The Royal College of Psychiatrists, London, UK
| | - Kimberley A Goldsmith
- Papworth Hospital NHS Trust, Cambridge UK
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Linda S Sharples
- Papworth Hospital NHS Trust, Cambridge UK
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Martin J Buxton
- Health Economics Research Group, Brunel University, Uxbridge, UK
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Effect of heart transplantation on survival in ambulatory and decompensated heart failure. Transplantation 2009; 86:1515-22. [PMID: 19077883 DOI: 10.1097/tp.0b013e31818b3328] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the absence of randomized trials comparing heart transplantation (HTx) with medical therapy for the treatment of advanced heart failure (HF), the role of HTx remains uncertain. Using data from a national audit, we examined the effect of HTx on HF mortality in the United Kingdom. METHODS Two thousand two hundred nineteen adults listed for HTx from April 1995 to October 2003 and followed to June 2007 were analyzed. In a substudy of 627 patients from two centers, ambulatory patients were risk-stratified by the heart failure survival score. A time-dependent nonproportional hazards model was used to estimate the effect of HTx. RESULTS Fourteen percent of patients were nonambulatory at listing. Death while waiting was higher among nonambulatory patients (19% vs. 14% in the ambulatory group, P<0.001 with 76% vs. 71% being transplanted). Posttransplant survival to 3 years was 78% and 75% in nonambulatory and ambulatory groups, respectively (P=0.68). HTx was found to benefit all groups. For nonambulatory patients, the risk of dying after HTx fell below the risk of dying while waiting after 10 days (95% CI 2-18) with a net survival benefit after 26 days (95% CI 5-53); for the ambulatory group the estimates were 42 days (95% CI 36-47) and 274 days (95% CI 214-359), respectively. In the substudy cohort net survival benefit was seen after 20, 124, 291, and 729 days for the nonambulatory, high, moderate, and low heart failure survival score risk groups, respectively. CONCLUSION HTx remains an effective treatment of advanced HF. Prioritization of patients with refractory HF is rational, because they are the first to benefit.
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Moro J, Almenar L, Martńez-Dolz L, Agüero J, Sánchez-Lázaro I, Iglesias P, Igual V, Salvador A. Support Program for Heart Transplant Patients: Initial Experience. Transplant Proc 2008; 40:3039-40. [DOI: 10.1016/j.transproceed.2008.08.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock*. Crit Care Med 2008; 36:1404-11. [DOI: 10.1097/ccm.0b013e31816f7cf7] [Citation(s) in RCA: 477] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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