Dynamics of cardiorespiratory response during and after the six-minute walk test in patients with heart failure.

Purpose: The six-minute walk test (6MWT) is a useful measure to evaluate exercise capacity with a simple method. The kinetics of oxygen uptake ([Formula: see text]O2) throughout constant-load exercise on cardiopulmonary exercise testing (CPX) are composed of three phases and the [Formula: see text]O2 kinetics are delayed in patients with heart failure (HF). This study aimed to investigate the kinetics of the cardiorespiratory response during and after the 6MWT according to exercise capacity. Methods: Forty-nine patients with HF performed CPX and the 6MWT. They were divided into two groups by 6MWT distance: 34 patients walked ≥300 m (HF-M), and 15 patients walked <300 m (HF-L). [Formula: see text]O2, minute ventilation ([Formula: see text]E), breathing frequency, tidal volume, and heart rate, both during and after the 6MWT, were recorded. The time courses of each parameter were compared between the two groups. CPX was used to assess functional capacity and physiological responses. Results: In the HF-M group, [Formula: see text]O2 and [Formula: see text]E stabilized from 3 min during the 6MWT and recovered for 3 min, respectively, after the 6MWT ended. In the HF-L group, [Formula: see text]O2 and VE stabilized from 4 min, respectively, during the 6MWT and did not recover within 3 min after the 6MWT ended. On CPX in the HF-M group, [Formula: see text]O2 peak, and anaerobic threshold were significantly higher, while the relationship between minute ventilation and carbon dioxide production was lower compared with the HF-L group. Conclusion: In lower exercise capacity patients with HF had slower [Formula: see text]O2 and [Formula: see text]E kinetics during and after the 6MWT.

Dyspnea During In-Hospital Rehabilitation as a Predictor of Rehospitalization and Mortality in Patients With Acute Heart Failure.

PURPOSE: Consensus articles that explore rehabilitation exercise for heart failure (HF) mainly focus on stable patients with chronic HF. Results from investigations that focus on the relationship between clinical outcomes and exercise during rehabilitation of patients with acute heart failure (AHF) have produced insufficient data. The aim of this study was to evaluate the correlation between clinical outcomes and dyspnea during in-hospital early rehabilitation in patients with AHF. METHODS: Dyspnea was measured using a 5-point Likert scale (5PLS) during rest and at the initiation of upright sitting and standing. Dyspnea was defined as 5PLS ≥2. The primary endpoint was combined all-cause death or rehospitalization for HF. RESULTS: A total of 221 patients were included in this study; 81 patients (37%) died or were hospitalized during the follow-up period. In patients with dyspnea during upright sitting and standing, the event-free ratio was significantly lower compared with patients without dyspnea (P = .008 and P < .001, respectively). Body mass index (hazard ratio [HR] = 0.91, P = .011), noninvasive positive pressure ventilation usage (HR = 1.96, P = .042), and 5PLS ≥2 at the initiation of standing (HR = 2.63, P = .008) were detected as predictors of primary endpoint. New York Heart Association class IV at admission (OR = 3.17, P = .0114) and pre-admission Katz ADL index <6 (OR = 3.76, P = .0007) were isolated as risk factors for dyspnea when standing. CONCLUSIONS: Dyspnea during standing was associated with unfavorable events in patients with AHF as a comprehensive indicator.

An open-label study of algorithm-based treatment versus treatment-as-usual for patients with schizophrenia.

OBJECTIVE: The use of an algorithm may facilitate measurement-based treatment and result in more rational therapy. We conducted a 1-year, open-label study to compare various outcomes of algorithm-based treatment (ALGO) for schizophrenia versus treatment-as-usual (TAU), for which evidence has been very scarce. METHODS: In ALGO, patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) were treated with an algorithm consisting of a series of antipsychotic monotherapies that was guided by the total scores in the positive and negative syndrome scale (PANSS). When posttreatment PANSS total scores were above 70% of those at baseline in the first and second stages, or above 80% in the 3rd stage, patients proceeded to the next treatment stage with different antipsychotics. In contrast, TAU represented the best clinical judgment by treating psychiatrists. RESULTS: Forty-two patients (21 females, 39.0 ± 10.9 years-old) participated in this study. The baseline PANSS total score indicated the presence of severe psychopathology and was significantly higher in the ALGO group (n = 25; 106.9 ± 20.0) than in the TAU group (n = 17; 92.2 ± 18.3) (P = 0.021). As a result of treatment, there were no significant differences in the PANSS reduction rates, premature attrition rates, as well as in a variety of other clinical measures between the groups. Despite an effort to make each group unique in pharmacologic treatment, it was found that pharmacotherapy in the TAU group eventually became similar in quality to that of the ALGO group. CONCLUSION: While the results need to be carefully interpreted in light of a hard-to-distinguish treatment manner between the two groups and more studies are necessary, algorithm-based antipsychotic treatments for schizophrenia compared well to treatment-as-usual in this study.