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Chen SM, Wu MK, Chen C, Wang LY, Guo NW, Wei CL, Zheng YC, Hsiao HY, Wu PJ, Chen YL, Chen CJ, Hang CL. Benefit of cardiac rehabilitation in acute heart failure patients with cognitive impairment. Heliyon 2024; 10:e30493. [PMID: 38726193 PMCID: PMC11079101 DOI: 10.1016/j.heliyon.2024.e30493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 04/13/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
Aims This study aimed to evaluate the prevalence of cognitive impairment among patients with acute heart failure (AHF), its prognosis, and the effects of cardiac rehabilitation (CR) on these patients' outcomes. Methods Overall, 247 consecutive AHF patients (median age, 60 years; males, 78.5 %) were evaluated from March 2015 to May 2021. Patients received an AHF disease management program coordinated by an HF specialist nurse and underwent a Luria-Nebraska Neuropsychological battery-screening test (LNNB-S) assessment during admission. Cognitive impairment was defined as an LNNB-S score ≥10. Patients who underwent at least one session of phase II CR and continued with the home-based exercise program were considered to have received CR. The primary endpoint was composite all-cause mortality or readmission after a 3.30-year follow-up (interquartile range, 1.69-5.09 years). Results Cognitive impairment occurred in 53.0 % and was associated with significantly higher composite endpoint, all-cause mortality, and readmission rates (p=<0.001, 0.001, and 0.015, respectively). In the total cohort, 40.9 % of patients experienced the composite endpoint. Multivariate analysis showed that the peak VO2 was a significant predictor of the composite endpoint. After adjustment, CR significantly decreased the event rate of the composite endpoint and the all-cause mortality in patients with cognitive impairment (log-rank p = 0.024 and 0.009, respectively). However, CR did not have a significant benefit on the composite endpoint and the all-cause mortality in patients without cognitive impairment (log-rank p = 0.682 and 0.701, respectively). Conclusion Cognitive impairment is common in AHF patients and can lead to poor outcomes. CR is a standard treatment to improve prognosis.
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Affiliation(s)
- Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
- Chang Gung University College of Medicine, Taiwan, Republic of China
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Ching Chen
- Clinical Psychologist, Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Nai-Wen Guo
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Taiwan, Republic of China
| | - Chin-Ling Wei
- Department of Nursing, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - You-Cheng Zheng
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Hao-Yi Hsiao
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Po-Jui Wu
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
- Chang Gung University College of Medicine, Taiwan, Republic of China
| | - Chien-Jen Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Chi-Ling Hang
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
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Zhou W, Lee A, Zhou A, Lombardo D. Integrative care: acupuncture based neuromodulation therapy for diabetes and heart failure. Front Neurosci 2024; 18:1332957. [PMID: 38298910 PMCID: PMC10827876 DOI: 10.3389/fnins.2024.1332957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
The relationship between heart failure and diabetes is intricate and bidirectional. Individuals with diabetes face an elevated risk of developing heart failure due to factors like insulin resistance, chronic inflammation, and metabolic irregularities. Elevated blood sugar levels can harm blood vessels and nerves, culminating in the buildup of fatty deposits in arteries, atherosclerosis, and hypertension, which significantly contribute to heart failure. Furthermore, diabetes can adversely impact the structure and function of the heart muscle, impairing its pumping capacity. Conversely, heart failure can also contribute to the onset of diabetes by disrupting the body's metabolic processes and amplifying insulin resistance. The complex interaction between these conditions mandates a comprehensive approach to managing individuals with both diabetes and heart failure, underscoring the importance of addressing both aspects for enhanced patient outcomes. Although existing pharmacological treatments are limited and frequently associated with undesirable side effects, acupuncture has established itself as a traditional practice with a legacy. It remains a supplementary option for treating cardiovascular diseases. Heart failure and diabetes are both heavily associated with chronic upregulation of the sympathetic nervous system, which has been identified as a pivotal factor in the progression of disease. Mechanistic interplays such as the attenuation of central nitric oxide signaling may interfere with the production or availability of nitric oxide in key areas of the central nervous system, including the brainstem and hypothalamus. This review will delve into the current understanding of acupuncture on the autonomic nervous system and offer insights into its potential role in the future treatment landscape for diabetes and heart failure.
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Affiliation(s)
- Wei Zhou
- Division of Cardiology, University of California, Irvine, Orange, CA, United States
| | - Andy Lee
- Division of Cardiology, University of California, Irvine, Orange, CA, United States
| | - Aren Zhou
- Irvine Valley College, Irvine, CA, United States
| | - Dawn Lombardo
- Division of Cardiology, University of California, Irvine, Orange, CA, United States
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 222] [Impact Index Per Article: 222.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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Wang PY, Lin WC, Hsieh PC, Lin SH, Liu PY, Chao TH, Hsu CH. The Effects of Post-Acute Care in Patients with Heart Failure in Taiwan: A Single Center Experience. ACTA CARDIOLOGICA SINICA 2023; 39:287-296. [PMID: 36911546 PMCID: PMC9999181 DOI: 10.6515/acs.202303_39(2).20220923b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/23/2022] [Indexed: 03/14/2023]
Abstract
Background The National Health Insurance Administration in Taiwan has promoted the heart failure post-acute care (HF-PAC) program as a means to provide proactive integrated care within the optimal treatment timeframe to enhance functional recovery after acute decompensated heart failure (HF). Objectives The aim of this program was to reduce HF readmission rates, improved medication prescription rates, and improve the quality of life in HF patients. Methods Patients who had a reduced left ventricular ejection fraction (LVEF) of ≤ 40% were included and followed up for 6 months after discharge. They underwent cardiac rehabilitation and physiological, and nutritional status evaluations. The main clinical outcomes of the HF-PAC program were guideline-directed medical therapy prescription rate and 6-month readmission rate. Results A total of 122 patients were recruited from June 2018 to December 2020 at a medical center in southern Taiwan. The patients' activities of daily living, nutritional status, quality of life and LVEF were significantly improved during the HF-PAC program. More than 95% of the patients received guideline-directed medical prescriptions at the end of the HF-PAC program. The cardiovascular-related 6-month re-admission rate after the HF-PAC program ended was 27.7%, and it could be predicted by the New York Health Association functional class [hazard ratio (HR) 95% confidence interval (95% CI) = 4.12 (1.36-12.46)], value of the Mini Nutritional Assessment - Short Form [HR (95% CI) = 0.46 (0.31-0.68)] and LVEF [HR (95% CI) = 0.95 (0.91-0.99)]. Conclusions By incorporating multidisciplinary healthcare teams, the HF-PAC program improves the guideline- directed medical therapy prescription rate, thus improving patients' cardiac function, physical activity recovery, the quality of life, and also reduces their readmission rate.
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Affiliation(s)
- Pei-Yi Wang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- Department of Nursing, National Taiwan University Hospital, Taipei
| | - Wen-Chih Lin
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ting-Hsing Chao
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsin Hsu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Chen S, Wu P, Wang L, Wei C, Cheng C, Fang H, Fang Y, Chen Y, Huang DK, Lee F, Chen M. Optimizing exercise testing‐based risk stratification to predict poor prognosis after acute heart failure. ESC Heart Fail 2022; 10:895-906. [PMID: 36460605 PMCID: PMC10053263 DOI: 10.1002/ehf2.14240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/04/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022] Open
Abstract
AIMS The timely selection of severe heart failure (HF) patients for cardiac transplantation and advanced HF therapy is challenging. Peak oxygen consumption (VO2 ) values obtained by the cardiopulmonary exercise testing are used to determine the transplant recipient list. This study reassessed the prognostic predictability of peak VO2 and compared it with the Heart Failure Survival Score (HFSS) in the modern optimized guideline-directed medical therapy (GDMT) era. METHODS AND RESULTS We retrospectively selected 377 acute HF patients discharged from the hospital. The primary outcome was a composite of all-cause mortality, or urgent cardiac transplantation. We divided these patients into the more GDMT (two or more types of GDMT) and less GDMT groups (fewer than two types of GDMT) and compared the performance of their peak VO2 and HFSS in predicting primary outcomes. The median follow-up period was 3.3 years. The primary outcome occurred in 57 participants. Peak VO2 outperformed HFSS when predicting 1 year (0.81 vs. 0.61; P = 0.017) and 2 year (0.78 vs. 0.58; P < 0.001) major outcomes. The cutoff peak VO2 for predicting a 20% risk of a major outcome within 2 years was 10.2 (11.8-7.0) for the total cohort. Multivariate Cox regression analyses showed that peak VO2 , sodium, previous implantable cardioverter defibrillator (ICD) implantation, and estimated glomerular filtration rate were significant predictors of major outcomes. CONCLUSIONS Optimizing the cutoff value of peak VO2 is required in the current GDMT era for advanced HF therapy. Other clinical factors such as ICD use, hyponatraemia, and chronic kidney disease could also be used to predict poor prognosis. The improvement of resource allocation and patient outcomes could be achieved by careful selection of appropriate patients for advanced HF therapies, such as cardiac transplantation.
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Affiliation(s)
- Shyh‐Ming Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
- Chang Gung University College of Medicine Taoyuan City Taiwan, Republic of China
| | - Po‐Jui Wu
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
| | - Lin‐Yi Wang
- Department of Physical Medicine and Rehabilitation Kaohsiung Chang Gung Memorial Hospital Kaohsiung City Taiwan, Republic of China
| | - Chin‐Ling Wei
- Department of Nursing, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital Kaohsiung City Taiwan, Republic of China
| | - Cheng‐I Cheng
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
- Chang Gung University College of Medicine Taoyuan City Taiwan, Republic of China
| | - Hsiu‐Yu Fang
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
| | - Yen‐Nan Fang
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
| | - Yung‐Lung Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
- Chang Gung University College of Medicine Taoyuan City Taiwan, Republic of China
| | - David Kwan‐Ru Huang
- Division of Cardiovascular Surgery, Department of Surgery Kaohsiung Chang Gung Memorial Hospital Kaohsiung City Taiwan, Republic of China
| | - Fan‐Yen Lee
- Division of Cardiovascular Surgery, Department of Surgery Kaohsiung Chang Gung Memorial Hospital Kaohsiung City Taiwan, Republic of China
| | - Mien‐Cheng Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center Kaohsiung Chang Gung Memorial Hospital 123 Tai Pei Road, Niao Sung District Kaohsiung City 83301 Taiwan, Republic of China
- Chang Gung University College of Medicine Taoyuan City Taiwan, Republic of China
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Al-Hammouri MM, Rababah JA. Examining the underlying processes of different dimensions of self-care behavior among persons with heart failure. BMC Cardiovasc Disord 2022; 22:437. [PMID: 36203162 PMCID: PMC9541077 DOI: 10.1186/s12872-022-02876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/30/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose This study was conducted to compare how potential predictors differentially contribute to the different dimensions of self-care in persons with heart failure.
Methods A cross-sectional design was used in this study. Purposive sampling was used to recruit a sample (N = 252) in this study. The data were collected from three major referral hospitals in Jordan. Data analysis was performed using multiple linear regression. Results The results showed that around 89% of our sample had insufficiency in at least one dimension of self-care. The initial regression models showed that different combinations of predictors were significantly associated with different dimensions of self-care. These models were also different in terms of the variance explained and the coefficients of the significant predictors. After the follow-up analysis of the best fit models for these dimensions, these differences were maintained. Conclusion Despite the similarities in the proposed variables predicting different self-care dimensions, their differences may suggest variations in the underlying processes controlling different self-care dimensions. The current study showed that seven out of the nine proposed variables predicted different dimensions of self-care either in the initial or best-fit models.
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Affiliation(s)
- Mohammed Munther Al-Hammouri
- Department of Community and Mental, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
| | - Jehad A Rababah
- Department of Community and Mental, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
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Chen SM, Wang LY, Liaw MY, Wu MK, Wu PJ, Wei CL, Chen AN, Su TL, Chang JK, Yang TH, Chen C, Cheng CI, Chen PC, Chen YL. Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients-A Retrospective Propensity Score-Matched Study. Front Cardiovasc Med 2022; 9:763217. [PMID: 35498011 PMCID: PMC9039246 DOI: 10.3389/fcvm.2022.763217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR. Methods In this propensity score-matched retrospective cohort study, records of consecutive patients who survived acute HF (left ventricular ejection fraction <40) and participated in a multidisciplinary HF rehabilitation program post-discharge between May 2014 and July 2019 were reviewed. Patients in the CR group had at least one exercise session within 3 months of discharge; the others were in the non-CR group. After propensity score matching, the primary (all-cause mortality) and secondary (HF readmission and life quality assessment) outcomes were analyzed. Results Among 792 patients, 142 attended at least one session of phase II CR. After propensity score matching for covariates related to HF prognosis, 518 patients were included in the study (CR group, 137 patients). The all-cause mortality rate was 24.9% and the HF rehospitalization rate was 34.6% in the median 3.04-year follow-up. Cox proportional hazard analysis revealed that the CR group had a significant reduction in all-cause mortality compared to the non-CR group (hazard ratio [HR]: 0.490, 95% confidence interval [CI]: 0.308-0.778). A lower risk of the primary outcome with CR was observed in patients on renin-angiotensin-aldosterone system (RAAS) inhibitors, but was not seen in patients who were not prescribed this class of medications (interaction p = 0.014). Conclusions Cardiac rehabilitation participation was associated with reduced all-cause mortality after acute systolic heart failure hospital discharge. Our finding that the benefit of CR was decreased in patients not prescribed RAAS inhibitors warrants further evaluation.
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Affiliation(s)
- Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mei-Yun Liaw
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Jui Wu
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chin-Ling Wei
- Department of Nursing, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - An-Ni Chen
- Department of Physical Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tsui-Ling Su
- Department of Physical Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jui-Kun Chang
- Department of Occupational Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tsung-Hsun Yang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching Chen
- Clinical Psychologist, Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-I Cheng
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Siddiqui M, Ripplinger C, Chalchal H, Murthy D. Managing patients with heart failure: contemporary real-world experience. BMC Res Notes 2022; 15:41. [PMID: 35144677 PMCID: PMC8832763 DOI: 10.1186/s13104-022-05938-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Heart failure (HF) is a chronic disease with growing numbers of patients and a significant compromise in quality of life and high mortality. The main purpose of this study was to evaluate the current practices in managing patients with HF among patients admitted to the hospital and discharged with a primary diagnosis of HF and patients managed in the heart function clinic. RESULTS This study is a retrospective chart review of patients admitted to the hospital and discharged with a primary diagnosis of HF. A total of 448 patient charts were reviewed, of which 173 patients were in the hospital group and 275 patients in the Clinic group. 278 (62.1%) were men, and 170 (37.9%) were women. The Clinic group of patients were significantly received guideline-directed medical therapy (Beta-blockers, Angiotensin-converting enzyme inhibitors, Angiotensin receptor blockers, Diuretics, Mineralocorticoid receptor antagonists-p < 0.001). The Clinic group of patients (17.1%) were significantly less re-hospitalized (p < 0.001) compared to the Hospital group (28%) at 180 days. Physician led multidisciplinary Heart function clinics have better adherence to guideline directed medical therapy and significantly lower rates of re-hospitalization thereby providing cost effective heart failure management with usual care.
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Affiliation(s)
- Muhammad Siddiqui
- Department of Research, Saskatchewan Health Authority, Regina, SK, Canada.
| | | | - Hafsah Chalchal
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Dakshina Murthy
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Division of Cardiology, Regina General Hospital, Saskatchewan Health Authority, Regina, SK, Canada
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Chang HY, Hung PL, Liao CT, Hsu CY, Liao YC, Lu KH, Wang CC. Assessing the facilities and healthcare services for heart failure: Taiwan versus European countries. J Formos Med Assoc 2021; 121:258-268. [PMID: 33840545 DOI: 10.1016/j.jfma.2021.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/05/2021] [Accepted: 03/22/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/PURPOSE The present study was designed to evaluate the local cardiology infrastructure and services for heart failure (HF) care in Taiwan hospitals and to compare the HF care with the hospitals in European countries. METHODS Available data from a total of 98 medical centers and regional hospitals in Taiwan were analyzed. Each facility was given a single copy of the questionnaire between September and December 2019, and service records were extracted from the National Health Insurance Database. European data were adopted from the 2017 European Society of Cardiology Atlas. RESULTS The number of cardiologists per million populations in Taiwan was 57.4, and it was lower than the European median (72.8). The median percentages of interventional and electrophysiologists among cardiologists were 64% and 15% in Taiwan, which were both higher than the European median values (12% and 5%, respectively). The accessibility rates to implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) in Taiwan were both higher (3.4 and 3.0 centers per million populations) comparing to those in European countries (median 1.6 and 1.5 centers per million populations). Comparing to 67 hospitals without HF care teams in Taiwan, 31 hospitals (31.6%) with HF teams have significantly more cardiology staff, enhanced procedural capabilities with more alternatives on oral or intravenous HF relevant medications. CONCLUSION Our analysis clearly demonstrated discrepancies in cardiology subspecialties and CRT/ICD accessibilities between European countries and Taiwan. Variations in HF-focused services and facilities plus HF-directed medications have demonstrated significant differences among Taiwanese hospitals with or without HF care team.
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Affiliation(s)
- Hung-Yu Chang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Pei-Lun Hung
- Division of Cardiology, Wei-Gong Memorial Hospital, Miaoli, Taiwan
| | - Chia-Te Liao
- Division of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yi Hsu
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Heart Institute, Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Chieh Liao
- Division of Cardiology, Department of Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Kai-Hsi Lu
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chun-Chieh Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung University & Chang Gung Memorial Hospital, Taipei & Linkou Branches, Taoyuan, Taiwan.
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Chen YL, Hang CL, Su CH, Wu PJ, Chen HC, Fang HY, Fang YN, Cheng CI, Fu M, Chen SM. Feature and impact of guideline-directed medication prescriptions for heart failure with reduced ejection fraction accompanied by chronic kidney disease. Int J Med Sci 2021; 18:2570-2580. [PMID: 34104088 PMCID: PMC8176167 DOI: 10.7150/ijms.55119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background: With respect to total mortality and cardiovascular mortality, the feature and impact of guideline-directed medication (GDM) prescriptions for heart failure with reduced ejection fraction (HFrEF) with chronic kidney disease (CKD) are unknown. Therefore, we aimed to determine these aspects. Methods: GDM prescriptions and their impact on discharged patients with and without CKD were analyzed. To analyze differences in one-year clinical outcomes, propensity score matching was conducted on a cohort of patients with concomitant HFrEF and CKD who received more and fewer GDM prescriptions. Results: A total of 1509 patients were enrolled in Taiwan's HFrEF registry from May 2013 to October 2014, and 1275 discharged patients with complete one-year follow-up were further analyzed. Of these patients, 468 (36.7%) had moderate CKD, whereas 249 (19.5%) had advanced CKD. Patients with advanced CKD received fewer prescribed GDMs than other patients. Multivariate analysis revealed that peripheral arterial occlusive disease, thyroid disorder, advanced HF at discharge, diastolic blood pressure, digoxin use, and fewer prescribed GDMs were independent predictors of one-year total mortality. After propensity score matching, patients with fewer prescribed GDMs had higher one-year total mortality rate than those with more prescribed GDMs (P=0.036). Conclusions: CKD at discharge from HF hospitalization was associated with fewer GDM prescriptions, particularly in patients with more advanced CKD. The propensity-matched analysis indicated that more GDM prescriptions led to better clinical outcomes in HFrEF patients with CKD. Careful interpretation of changes in renal function during HF hospitalization may improve GDM prescriptions.
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Affiliation(s)
- Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
| | - Chi-Ling Hang
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Chien-Hao Su
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Po-Jui Wu
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Huang-Chung Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Hsiu-Yu Fang
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Yen-Nan Fang
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Cheng-I Cheng
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
| | - Morgan Fu
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
| | - Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
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Chen SM, Wang LY, Wu PJ, Liaw MY, Chen YL, Chen AN, Tsai TH, Hang CL, Lin MC. The Interrelationship between Ventilatory Inefficiency and Left Ventricular Ejection Fraction in Terms of Cardiovascular Outcomes in Heart Failure Outpatients. Diagnostics (Basel) 2020; 10:E469. [PMID: 32664450 PMCID: PMC7399946 DOI: 10.3390/diagnostics10070469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/28/2022] Open
Abstract
The relationship between left ventricular ejection fraction (LVEF) and cardiovascular (CV) outcome is documented in patients with low LVEF. Ventilatory inefficiency is an important prognostic predictor. We hypothesized that the presence of ventilatory inefficiency influences the prognostic predictability of LVEF in heart failure (HF) outpatients. In total, 169 HF outpatients underwent the cardiopulmonary exercise test (CPET) and were followed up for a median of 9.25 years. Subjects were divided into five groups of similar size according to baseline LVEF (≤39%, 40-58%, 59-68%, 69-74%, and ≥75%). The primary endpoints were CV mortality and first HF hospitalization. The Cox proportional hazard model was used for simple and multiple regression analyses to evaluate the interrelationship between LVEF and ventilatory inefficiency (ventilatory equivalent for carbon dioxide (VE/VCO2) at anaerobic threshold (AT) >34.3, optimized cut-point). Only LVEF and VE/VCO2 at AT were significant predictors of major CV events. The lower LVEF subgroup (LVEF ≤ 39%) was associated with an increased risk of CV events, relative to the LVEF ≥75% subgroup, except for patients with ventilatory inefficiency (p = 0.400). In conclusion, ventilatory inefficiency influenced the prognostic predictability of LVEF in reduced LVEF outpatients. Ventilatory inefficiency can be used as a therapeutic target in HF management.
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Affiliation(s)
- Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (Y.-L.C.); (T.-H.T.); (C.-L.H.)
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (L.-Y.W.); (M.-Y.L.)
| | - Po-Jui Wu
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (Y.-L.C.); (T.-H.T.); (C.-L.H.)
| | - Mei-Yun Liaw
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (L.-Y.W.); (M.-Y.L.)
| | - Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (Y.-L.C.); (T.-H.T.); (C.-L.H.)
| | - An-Ni Chen
- Department of Physical Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
| | - Tzu-Hsien Tsai
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (Y.-L.C.); (T.-H.T.); (C.-L.H.)
| | - Chi-Ling Hang
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (Y.-L.C.); (T.-H.T.); (C.-L.H.)
| | - Meng-Chih Lin
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Chang Gung University College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
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Tavabie O, McKie P, Webzell I, Beckford R, Menon K, O'Grady J, Aluvihare VR. Anxiety and depression on the liver transplant waiting list: a case for psychological prehabilitation? GASTROINTESTINAL NURSING 2020. [DOI: 10.12968/gasn.2020.18.sup6.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: Anxiety and depression in patients awaiting liver transplantation are associated with worse clinical outcomes. However, optimising patient mental health is not routinely addressed in pre-transplant care. Aims: To understand the prevalence of anxiety and depression in patients awaiting transplantation and their access to pharmacological and psychological therapies. Methods: Patients awaiting transplantation were offered screening for anxiety and depression using the Hospital Anxiety and Depression Screening (HADS) tool. Data pertaining to patient demographics and previous treatment for anxiety and depression were recorded and analysed. Findings: Over 50% of patients recorded abnormal scores for anxiety and depression. Of the 19 patients screened, 42% had received treatment for either disorder, and most found the intervention unhelpful due to lack of follow-up appointments and limited understanding of their underlying chronic liver disease. There was a significant association between female sex and screening positive for depression. Conclusion: Anxiety and depression are prevalent in patients awaiting liver transplantation. The integration of a psychologist into the transplantation multidisciplinary team may improve patient outcomes.
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Affiliation(s)
- Oliver Tavabie
- Clinical Research Fellow; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - Paul McKie
- Specialist Social Worker; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - Ian Webzell
- Alcohol and Substance Misuse Clinical Nurse Specialist; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - Racquel Beckford
- Liver Transplant Co-ordinator; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - Krishna Menon
- Consultant Liver Transplant Surgeon and Hepatobiliary Surgeon; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - John O'Grady
- Professor of Hepatology and Liver Transplantation; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - Varuna R Aluvihare
- Consultant Transplant Hepatologist and Chair of the British Liver Transplant Group, the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
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