RESUMEN
BACKGROUND: Two invasive methods are available to estimate microvascular resistance: bolus and continuous thermodilution. Comparative studies have revealed a lack of concordance between measurements of microvascular resistance obtained through these techniques. AIMS: This study aimed to examine the influence of vessel volume on bolus thermodilution measurements. METHODS: We prospectively included patients with angina with non-obstructive coronary arteries (ANOCA) undergoing bolus and continuous thermodilution assessments. All patients underwent coronary CT angiography to extract vessel volume. Coronary microvascular dysfunction was defined as coronary flow reserve (CFR) < 2.0. Measurements of absolute microvascular resistance (in Woods units) and index of microvascular resistance (IMR) were compared before and after volumetric adjustment. RESULTS: Overall, 94 patients with ANOCA were included in this study. The mean age was 64.7 ± 10.8 years, 48% were female, and 19% had diabetes. The prevalence of CMD was 16% based on bolus thermodilution, while continuous thermodilution yielded a prevalence of 27% (Cohen's Kappa 0.44, 95% CI 0.23-0.65). There was no correlation in microvascular resistance between techniques (r = 0.17, 95% CI -0.04 to 0.36, p = 0.104). The adjustment of IMR by vessel volume significantly increased the agreement with absolute microvascular resistance derived from continuous thermodilution (r = 0.48, 95% CI 0.31-0.63, p < 0.001). CONCLUSIONS: In patients with ANOCA, invasive methods based on coronary thermodilution yielded conflicting results for the assessment of CMD. Adjusting IMR with vessel volume improved the agreement with continuous thermodilution for the assessment of microvascular resistance. These findings strongly suggest the importance of considering vessel volume when interpreting bolus thermodilution assessment.
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Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad de la Arteria Coronaria , Circulación Coronaria , Vasos Coronarios , Microcirculación , Valor Predictivo de las Pruebas , Termodilución , Resistencia Vascular , Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Vasos Coronarios/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Although heart failure (HF) patients often consider sexual activity as an essential aspect of their quality of life (QoL) and are usually uncertain if it is safe to perform sexual activity, this topic is overall poorly addressed in clinical practice. AIMS: The aim of this study was to explore the perceptions and practices of Flemish caregivers. METHODS: Healthcare providers were recruited through convenience sampling and filled in an adapted version of the UNITE Sexual Counselling Instrument. Several relevant network structures in Flanders were used to distribute the questionnaires-online as well as on paper-to healthcare workers being involved in the care to HF patients. RESULTS: Results of 180 participants indicated that 51.5% of the healthcare providers have never provided sexual counselling in HF patients. Being male, having a masters' degree, having more than 10 years of experience in cardiovascular disease, working in an ambulatory care department and having more positive attitudes were independently associated with a higher provision of sexual counselling in practice. CONCLUSION: Although healthcare providers perceive it as their responsibility to discuss patients' sexual concerns, these issues are not often addressed in daily practice. Increasing knowledge in healthcare providers and specific practical training in providing information on sexual activity in HF patients are recommended. Further studies are needed to investigate how sexual counselling can be provided in agreement with HF patients' expectations and needs.
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Insuficiencia Cardíaca , Calidad de Vida , Consejo , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Insuficiencia Cardíaca/terapia , Humanos , Masculino , PercepciónRESUMEN
OBJECTIVE: The aim of this study was to assess lifestyle behaviour as well as risk factor management across Belgian coronary patients who participated in the cross-sectional European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE) surveys. METHODS: Analyses are based on a series of coronary patients by combining data from the Belgian participants in the EUROASPIRE III (328 patients; in 2006-2007) and EUROASPIRE IV (343 patients; in 2012-2013) surveys. Four hospitals located in the Ghent area participated in the surveys. Patients included in the analyses were ≥18 years old and had been hospitalised for a coronary event. Information on cardiovascular risk factors, lifestyle behaviour and medical treatment were obtained. RESULTS: Overall, the proportion of smokers was 11% with 40% persistent smokers. Adequate physical activity levels were reported by 17%, 28% of patients were obese, 47% was central obese and known diabetes was prevalent in 21% of patients. Hypertension was observed in 46% of patients and 20% had a total cholesterol ≥5 mmol/L. About 80% had participated in a cardiac rehabilitation programme and the majority of patients were treated with blood pressure (92%) or lipid-lowering drugs (92%). Anxiety and depressive symptoms were reported by 30% and 24%, respectively. Differences between EUROASPIRE III and IV were limited. CONCLUSIONS: Compared to the overall EUROASPIRE results in Europe, Belgian CHD patients seem to do slightly better. However, tackling obesity, physical inactivity, hypertension and psychosocial distress remains an important challenge in the management of coronary patients.
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Enfermedad Coronaria/prevención & control , Encuestas Epidemiológicas , Estilo de Vida , Medición de Riesgo/métodos , Prevención Secundaria/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bélgica/epidemiología , Enfermedad Coronaria/epidemiología , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Heart failure (HF) is a highly prevalent chronic disease, for which there is no cure available. Therefore, improving disease management is crucial, with mobile health (mHealth) being a promising technology. The aim of the HeartMan study is to evaluate the effect of a personal mHealth system on top of standard care on disease management and health-related quality of life (HRQoL) in HF. METHODS: HeartMan is a randomized controlled 1:2 (control:intervention) proof-of-concept trial, which will enrol 120 stable ambulatory HF patients with reduced ejection fraction across two European countries. Participants in the intervention group are equipped with a multi-monitoring health platform with the HeartMan wristband sensor as the main component. HeartMan provides guidance through a decision support system on four domains of disease management (exercise, nutrition, medication adherence and mental support), adapted to the patient's medical and psychological profile. The primary endpoint of the study is improvement in self-care and HRQoL after a six-months intervention. Secondary endpoints are the effects of HeartMan on: behavioural outcomes, illness perception, clinical outcomes and mental state. DISCUSSION: HeartMan is technologically the most innovative HF self-management support system to date. This trial will provide evidence whether modern mHealth technology, when used to its full extent, can improve HRQoL in HF. TRIAL REGISTRATION: This trial has been registered on https://clinicaltrials.gov/ct2/show/NCT03497871 , on April 13 2018 with registration number NCT03497871.
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Técnicas de Apoyo para la Decisión , Insuficiencia Cardíaca/terapia , Atención Dirigida al Paciente/métodos , Telemedicina/métodos , Bélgica , Conocimientos, Actitudes y Práctica en Salud , Estilo de Vida Saludable , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/psicología , Humanos , Italia , Cumplimiento de la Medicación , Salud Mental , Estudios Multicéntricos como Asunto , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Autocuidado , Volumen Sistólico , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
BACKGROUND: Despite the clear benefits of cardiac rehabilitation (CR), a considerable number of patients drop out early. OBJECTIVE: Therefore, we wanted to evaluate dropout in CR with a special focus on comorbidities and psychosocial background. METHODS: Patients who attended CR after acute coronary syndrome, cardiac surgery, or heart failure (N = 489) were prospectively included. Dropout was defined as attending 50% of the training sessions or less (n = 96 [20%]). Demographic and clinical characteristics, exercise parameters, and psychosocial factors were analyzed according to dropout, and those with a trend toward a significant difference (P < .10) were entered in a multivariate logistic model. RESULTS: The presence of a cerebrovascular accident (4.18 [1.39-12.52]) involved a higher risk of dropout, and a comparable trend was seen for the presence of chronic obstructive pulmonary disease (2.55 [0.99-6.54]). Attending the training program only twice per week also implicated a higher risk of an early withdrawal (3.76 [2.23-6.35]). In contrast, patients on ß-blockers were less likely to withdraw prematurely (0.47 [0.22-0.98]). Singles were more likely to drop out (2.89 [1.56-5.35]), as well as those patients who were dependent on others to get to CR (2.01 [1.16-3.47]). Finally, the reporting of severe problems on the anxiety/depression subscale of the EuroQOL-5D questionnaire involved a higher odds for dropout (7.17 [1.46-35.29]). CONCLUSIONS: Neither demographic characteristics nor clinical status or exercise capacity could independently identify patients who were at risk of dropout. The presence of comorbidities and a vulnerable psychosocial background rather seem to play a key role in dropout.
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Rehabilitación Cardiaca/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Adulto , Anciano , Rehabilitación Cardiaca/psicología , Comorbilidad , Ejercicio Físico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Cooperación del Paciente/psicología , Pacientes Desistentes del Tratamiento/psicología , Satisfacción del Paciente/estadística & datos numéricos , Estudios ProspectivosRESUMEN
PURPOSE: Pulmonary hypertension (PHT) is a predictor of mortality and morbidity in patients with chronic heart failure (HF). However, the prevalence, determinants, and prognostic significance of PHT in elderly patients admitted with acute decompensated HF are unclear. METHODS: We prospectively evaluated 401 patients aged ≥ 75 years (mean age 83 ± 5 years, 50% women) with acute HF, who were discharged alive, and whose tricuspid regurgitation (TR) gradient was measured by echocardiography during hospitalization. PHT was defined as a TR gradient ≥ 30 mmHg. The endpoint was all-cause mortality. RESULTS: PHT was found in 280/401 patients (69%), including in 67% of patients with HF with reduced ejection fraction (HFrEF) and 73% of patients with HF with preserved ejection fraction (HFpEF) (P = 0.19). Clinical characteristics and comorbidities were similar between patients with and without PHT. The prevalence of PHT increased with increasing severity of mitral regurgitation (MR) (mild: 65%; moderate: 67%; severe: 85%; P < 0.01). After a mean follow-up of 405 ± 399 days, 118 patients (30%) had died. In a multivariate Cox regression analysis, that included age, sex, serum creatinine, TR gradient, comorbidities, and medications at discharge, age (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.03-1.11, P < 0.001), serum creatinine (HR 1.41, 95% CI 1.15-1.73, P < 0.01), and PHT (HR 1.60, 95% CI 1.03-2.49, P < 0.01) were independent predictors of all-cause mortality. CONCLUSION: In elderly patients admitted with acute HF, PHT is common, mainly associated with the severity of MR and associated with a worse outcome after discharge.
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Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/epidemiología , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/epidemiología , Sistema de Registros/estadística & datos numéricos , Enfermedad Aguda , Anciano de 80 o más Años , Comorbilidad , Femenino , Estudios de Seguimiento , Hospitalización , Humanos , Masculino , Prevalencia , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Volumen Sistólico , UltrasonografíaRESUMEN
OBJECTIVE: Participation in cardiac rehabilitation (CR) after hospitalisation for heart failure (HF) is estimated to below, but specific data for Belgium are lacking. Therefore, we wanted to evaluate attendance after HF hospitalisation compared to patients after cardiac surgery or acute coronary syndrome (ACS). Moreover, the improvement in exercise capacity was compared with the other patient groups. METHODS AND RESULTS: Patients who were hospitalized for HF (n=428), cardiac surgery (n=358) or ACS (n=467) in a single hospital, were prospectively included between January 2010 and May 2012. After hospitalisation for HF only 9% participated, compared to 29% after ACS and 56% after cardiac surgery. Non-participants in HF were older, more frequently women (P <0.01) and had a better left ventricular ejection fraction (P < 0.05). In addition, they had more frequently atrial fibrillation and problems to walk independently (P <0.01). At the start of the CR, HF patients had a worse clinical status and exercise capacity than patients after cardiac surgery or ACS (all P <0.001). However, exercise training resulted in a significant improvement in each group separately (all P < 0.001) and the relative improvement in exercise capacity in HF was comparable with the other groups. CONCLUSIONS: Only 9% of HF patients participated in CR after hospitalisation. Age, female gender, a relatively well-preserved ventricular function and atrial fibrillation seem to impede attendance to CR. However, HF patients can have as much improvement in exercise capacity as other patient populations, suggesting that more effort is needed to increase participation in CR among HF patients.
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Terapia por Ejercicio/métodos , Tolerancia al Ejercicio/fisiología , Insuficiencia Cardíaca/rehabilitación , Hospitalización , Participación del Paciente/estadística & datos numéricos , Sistema de Registros , Anciano , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Volumen Sistólico , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
AIMS: Hospitalization for acute decompensated heart failure (HF) is associated with poor outcome. As specific data for Belgium are currently not available, the aim of the Belgian BIO-HF registry is to evaluate the clinical characteristics, in-hospital mortality and outcomes after discharge of patients hospitalized for acute HF. METHODS AND RESULTS: This is a prospective observational cohort study conducted in 2 Belgian hospitals. For the current analysis, the first 904 patients who were enrolled between 2008 and 2012 were selected for assessment of clinical characteristics and short-term outcome (all-cause mortality and all-cause mortality+ rehospitalization 3 months after discharge). Mean age of patients was 77 years (51% > or = 80 years), 44% were women and 64% had an eGFR < 60 ml/min/m2. Mean LVEF was 42% with only 40% with LVEF < or = 35%, 20% with LVEF between 36 and 49% and 40% with LVEF 50%. In-hospital mortality was 7.1% with a mortality of 22% in the subgroup of patients with a creatinine > or =2 mg/dl and systolic blood pressure < or = 110 mmHg on admission. Three months after discharge, the all-cause mortality rate was 7.6% and the all-cause mortality or hospitalization for HF 18.3%. Multivariate Cox regression analysis revealed eGFR, COPD, absence of beta blockers and atrial fibrillation at discharge (all P<0.05) as independent predictors of all-cause mortality. CONCLUSIONS: In this Belgian registry of mainly elderly patients admitted with acute HF, a relatively preserved EF and a reduced kidney function were present in the majority of patients. In-hospital and short-term mortality after discharge remain high and are mainly related to the presence of comorbidities such as renal failure and COPD. Comorbidities should be the focus for future efforts to improve the dire outcome of these patients.
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Insuficiencia Cardíaca , Volumen Sistólico , Anciano , Bélgica/epidemiología , Comorbilidad , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Mortalidad Hospitalaria , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Readmisión del Paciente/estadística & datos numéricos , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Sistema de Registros , Factores de RiesgoRESUMEN
BACKGROUND: The presence of ergoreflex activity and its current relationship to hyperventilation and prognosis in cardiac patients is unclear. Therefore, we evaluated ergoreflex activity in cardiac patients with and without heart failure (CHF) as well as in healthy subjects, and we examined how ergoreceptor activity was related to a mortality risk score in CHF (MAGGIC). METHODS AND RESULTS: Twenty-five healthy subjects and 76 patients were included, among whom were 25 with ischemic heart disease (IHD), 24 with stable CHF, and 27 with unstable CHF. Ergoreflex activity was measured with a dynamic handgrip exercise, followed by post-handgrip regional circulatory occlusion (PH-RCO). Ergoreflex activity contributed significantly to ventilation (median [interquartile range] %V) in unstable CHF (81 [73-91] %V without PH-RCO, 92 [82-107] %V with PH-RCO, and 11 [6-20] difference in %V; P < .001) and was positively correlated with the MAGGIC risk score (Spearman ρ = 0.431; P = .002). No ergoreflex activity was observed in healthy subjects (-4 [-10 to 5] difference in %V), IHD (0 [-8 to 3] Diff in %V) and stable CHF (-3 [-11 to 6] difference in %V). CONCLUSIONS: Ergoreflex activity contributes to hyperventilation, but only in CHF patients with persistent symptoms, and is closely related to the MAGGIC risk score. Ergoreflex activity was not present in patients with IHD or stable CHF, suggesting other reasons for the increased ventilatory drive in those patients.
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Isquemia Miocárdica , Prueba de Esfuerzo/efectos adversos , Prueba de Esfuerzo/métodos , Femenino , Fuerza de la Mano , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Hiperventilación/etiología , Hiperventilación/fisiopatología , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatología , Pronóstico , Medición de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
Exercise intolerance is a hallmark feature of chronic heart failure and is associated with poor prognosis. This review provides an update on cardiopulmonary exercise variables, proven to be prognostically important in heart failure. Besides the widely accepted peak oxygen consumption (peak VO2) and VEN/VCO2 slope, other exercise variables - exercise oscillatory ventilation (EOV) and partial pressure of end-tidal CO2, (PETCO2) - should gain attention in the interpretation of cardiopulmonary exercise testing. In addition to prognosis, the pathophysiological origin is also discussed. Different mechanisms underlie these exercise variables with an important contribution of haemodynamic, pulmonary and peripheral abnormalities. Given the different pathophysiological origin, a multivariate assessment with the inclusion of all the aforementioned parameters should be encouraged, not only for diagnostic and prognostic purposes but also for evaluating the effect of interventions.
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Prueba de Esfuerzo/métodos , Terapia por Ejercicio/métodos , Tolerancia al Ejercicio/fisiología , Insuficiencia Cardíaca , Hemodinámica/fisiología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , PronósticoRESUMEN
OBJECTIVE: Autonomic disorders are common in chronic illness, and their symptoms may restrict the daily functioning of patients. However, in chronic heart failure, extensive knowledge about autonomic symptoms is still lacking. This study aims to explore self-perceived autonomic symptoms, associated factors, and their relationship with health-related quality of life in chronic heart failure. METHODS: One hundred and twenty-four patients with documented chronic heart failure (men and women; 50-86 years) and 124 sex and age-matched controls participated in this study. The participants filled validated questionnaires about autonomic symptom profile (COMPASS 31), fatigue (CIS, Checklist for individual strength), anxiety and depression (HADS, Hospital Anxiety and Depression), and health-related quality of life (SF36). Non-parametric statistics were performed to analyse the data. RESULTS: Total score for autonomic symptoms was higher in chronic heart failure compared to controls [Median: 14.9; IQR: 6.2-25.1 vs. 7.3; 0-18; p < 0.001], especially for orthostatic hypotension [Median: 8; IQR: 0-16 vs. 0; 0-12; p < 0.001], vasomotor [Median: 0; IQR: 0-0 vs. 0; 0-0; p < 0.001] and secretomotor function [Median: 0; IQR: 0-4.2 vs. 0; 0-2.1; p = 0.013]. High scores for autonomic symptoms were moderate correlated with higher scores of fatigue, anxiety and depression (0.343 ≤ rs ≥ 0.420; p < 0.001) and with decreased health-related quality of life (-0.454; p < 0.01). CONCLUSION: Autonomic symptoms, especially for orthostatic intolerance, vasomotor and secretomotor subdomains, are prevalent and are associated with fatigue complaints and poor health-related quality of life in CHF.
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Enfermedades del Sistema Nervioso Autónomo , Calidad de Vida , Masculino , Humanos , Femenino , Enfermedad Crónica , Fatiga/etiología , Sistema Nervioso Autónomo , Ansiedad/epidemiología , Ansiedad/etiología , Enfermedades del Sistema Nervioso Autónomo/complicaciones , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Enfermedades del Sistema Nervioso Autónomo/epidemiologíaRESUMEN
BACKGROUND: Cardiac stress tests remain the cornerstone for evaluating patients suspected of having obstructive coronary artery disease (CAD). Coronary microvascular dysfunction (CMD) can lead to abnormal non-invasive tests. AIMS: We sought to assess the diagnostic performance of exercise stress tests with indexes of epicardial and microvascular resistance as reference. METHODS: This was a prospective, single-arm, multicentre study of patients with an intermediate pretest probability of CAD and positive exercise stress tests who were referred for invasive angiography. Patients underwent an invasive diagnostic procedure (IDP) with measurement of fractional flow reserve (FFR) and index of microvascular resistance (IMR) in at least one coronary vessel. Obstructive CAD was defined as diameter stenosis (DS) >50% by quantitative coronary angiography (QCA). The objective was to determine the false discovery rate (FDR) of cardiac exercise stress tests with both FFR and IMR as references. RESULTS: One hundred and seven patients (137 vessels) were studied. The mean age was 62.1±8.7, and 27.1% were female. The mean diameter stenosis was 37.2±27.5%, FFR was 0.84±0.10, coronary flow reserve was 2.74±2.07, and IMR 20.3±11.9. Obstructive CAD was present in 39.3%, whereas CMD was detected in 20.6%. The FDR was 60.7% and 62.6% with QCA and FFR as references (p-value=0.803). The combination of FFR and IMR as clinical reference reduced the FDR by 25% compared to QCA (45.8% vs 60.7%; p-value=0.006). CONCLUSIONS: In patients with evidence of ischaemia, an invasive functional assessment accounting for the epicardial and microvascular compartments led to an improvement in the diagnostic performance of exercise tests, driven by a significant FDR reduction.
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Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Reserva del Flujo Fraccional Miocárdico , Humanos , Femenino , Masculino , Enfermedad de la Arteria Coronaria/diagnóstico , Prueba de Esfuerzo , Estenosis Coronaria/diagnóstico , Constricción Patológica , Estudios Prospectivos , Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Valor Predictivo de las Pruebas , Índice de Severidad de la EnfermedadRESUMEN
UNLABELLED: Early colour M-mode flow propagation velocity (Vpe) in the left ventricle is a well-known non-invasive index for assessing left ventricular relaxation. However, the utility and determinants of late colour M-mode flow propagation (Vpa) have received little attention to date. Vpa as a representation of the left ventricular vortex travelling velocity during late filling could have a distinct role in differentiating potential subgroups in diastolic failure. The aim of the present study was to establish the normal values of late flow propagation in a healthy population of various ages (18-79 years), and to examine the general and echocardiographic variables that affect Vpa. METHODS: We studied 75 apparently healthy subjects (age range, 18-79 years; 38 women, 37 men) as part of an outpatient clinic check-up screening. General parameters were recorded, including age, gender, height, weight, blood pressure, and heart rate. In addition, conventional grey-scale M-mode, 2D, as well as colour M-mode, 2D, and pulsed wave (tissue) Doppler echocardiographic parameters were obtained in a single centre and using a single operator setting. Backward linear regression analysis (dependent variable: Vpa) was performed to find the optimal model, taking into account multicollinearity and maximum coefficient of determination (R2). Due to the heteroscedasticity of the collected data, a logarithmic transformation was used. In addition, separate linear backward regression analysis was performed for the male and female subgroups. RESULTS: Vpa values were 26-179 cm/s. The optimal regression model after elimination included the following variables: age (beta = 0.684, P < 0.001), height (beta = 0.521, P < 0.001), gender (beta = 0.343, P < 0.05), left ventricular Vpe (beta = 0.299, P < 0.01), left ventricular posterior systolic (M-mode) wall thickness (beta = 0.288, P < 0.01), interventricular septum thickness diastole (beta = 0.346, P < 0.005), transmitral Doppler E-wave deceleration time apical 4-chamber (beta = -0.297, P < 0.05), and tissue Doppler peak E-wave mitral annulus (beta = 0.459, P < 0.005). The total coefficient of determination (R2) for this model was 0.540 (P < 0.001); 0.673 (P < 0.001) for men and 0.645 (P < 0.001) for women. CONCLUSION: Vpa, representing left ventricular vortex travelling velocity during late filling, shows a large range of values in normal healthy subjects. It is mainly depending on age, gender and left ventricular mass. Moreover, substantially different determinants are found between men and women. Further study is required to explore these findings.
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Ventrículos Cardíacos/diagnóstico por imagen , Contracción Miocárdica/fisiología , Función Ventricular Izquierda/fisiología , Adolescente , Adulto , Anciano , Ecocardiografía Doppler , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Adulto JovenRESUMEN
This study tested the effectiveness of HeartMan-a mobile personal health system offering decisional support for management of congestive heart failure (CHF)-on health-related quality of life (HRQoL), self-management, exercise capacity, illness perception, mental and sexual health. A randomized controlled proof-of-concept trial (1:2 ratio of control:intervention) was set up with ambulatory CHF patients in stable condition in Belgium and Italy. Data were collected by means of a 6-min walking test and a number of standardized questionnaire instruments. A total of 56 (34 intervention and 22 control group) participants completed the study (77% male; mean age 63 years, sd 10.5). All depression and anxiety dimensions decreased in the intervention group (p < 0.001), while the need for sexual counselling decreased in the control group (p < 0.05). Although the group differences were not significant, self-care increased (p < 0.05), and sexual problems decreased (p < 0.05) in the intervention group only. No significant intervention effects were observed for HRQoL, self-care confidence, illness perception and exercise capacity. Overall, results of this proof-of-concept trial suggest that the HeartMan personal health system significantly improved mental and sexual health and self-care behaviour in CHF patients. These observations were in contrast to the lack of intervention effects on HRQoL, illness perception and exercise capacity.
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Insuficiencia Cardíaca/terapia , Prueba de Estudio Conceptual , Automanejo , Telemedicina , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Cardiovascular disease is one of the main causes of morbidity and sick leave in Belgium, imposing a great socio-economic burden on the contemporary healthcare system and society. Cardiac rehabilitation is an evidence-based treatment strategy that not only improves the cardiac patients' health state but also holds promise so as to facilitate vocational reintegration in the society. This position paper was developed and endorsed by the Belgian Working Group of Cardiovascular Prevention and Rehabilitation. It provides an overview of the currently available Belgian data with regard to the role of cardiac rehabilitation in return to work after an initial cardiac event. It identifies the relevant barriers and facilitators of vocational integration of cardiac patients and summarises the contemporary Belgian legal and medical framework in this regard. Cardiac rehabilitation remains a primordial component of the post-acute event management of the cardiac patient, facilitating vocational reintegrating and thereby decreasing the pressure on social security. Despite the availability of a relevant legislative framework, there is a need for well-defined algorithms to assess readiness for return to work that can be used in daily clinical practice.
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Rehabilitación Cardiaca , Enfermedades Cardiovasculares , Servicios Preventivos de Salud , Rehabilitación Vocacional , Bélgica/epidemiología , Rehabilitación Cardiaca/métodos , Rehabilitación Cardiaca/normas , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Humanos , Evaluación de Necesidades , Servicios Preventivos de Salud/métodos , Servicios Preventivos de Salud/organización & administración , Mejoramiento de la Calidad , Rehabilitación Vocacional/métodos , Rehabilitación Vocacional/normas , Reinserción al Trabajo , Integración SocialRESUMEN
(1) Background: the main objective of this study was to investigate information needs concerning sexual activity and experienced sexual problems in heart failure (HF) patients and, in addition, to examine the association between these sexual problems and health-related quality of life (HRQoL); (2) Methods: in this cross-sectional study, three self-administered questionnaires were distributed to 77 stable ambulatory HF patients to acquire data on HRQoL, sexual problems, and need for counselling; (3) Results: More than half (56.7%) of HF patients experienced a marked decrease or total cessation of sexual activity due to their illness. Additionally, more than one-third perceived a marked decrease or total absence of sexual pleasure (42.5%), interest (32.9%), and constant problems or being unable to perform sexual activity (37.3%). Furthermore, 43.1% of patients experienced an important overall need for counselling concerning sexual activity, with information on relationships (69.2%), symptoms (58.5%), and relaxation (49.2%) being the most desired topics. Multiple linear regression analysis revealed that sexual problems were independently associated with HRQoL, with more sexual problems (t = 3.19, p < 0.01) being related to poor HRQoL; (4) Conclusion: by investigating the experienced problems and counselling needs of HF patients, an alignment between current practice and HF patients' expectations and needs might be obtained.
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Insuficiencia Cardíaca/psicología , Calidad de Vida/psicología , Conducta Sexual/psicología , Conducta Sexual/estadística & datos numéricos , Anciano , Bélgica , Estudios Transversales , Femenino , Insuficiencia Cardíaca/fisiopatología , Humanos , Italia , Masculino , Persona de Mediana EdadRESUMEN
Background Since improved treatment of congestive heart failure has resulted in decreased mortality and hospitalisation rates, increasing self-perceived health-related quality of life (HRQoL) has become a major goal of congestive heart failure treatment. However, an overview on predictieve factors of HRQoL is currently lacking in literature. Purpose The aim of this study was to identify key factors associated with HRQoL in stable ambulatory patients with congestive heart failure. Methods A systematic review was performed. MEDLINE, Web of Science and Embase were searched for the following combination of terms: heart failure, quality of life, health perception or functional status between the period 2000 and February 2017. Literature screening was done by two independent reviewers. Results Thirty-five studies out of 8374 titles were included for quality appraisal, of which 29 were selected for further data extraction. Four distinct categories grouping different types of variables were identified: socio-demographic characteristics, clinical characteristics, health and health behaviour, and care provider characteristics. Within the above-mentioned categories the presence of depressive symptoms was most consistently related to a worse HRQoL, followed by a higher New York Heart Association functional class, younger age and female gender. Conclusion Through a systematic literature search, factors associated with HRQoL among congestive heart failure patients were investigated. Age, gender, New York Heart Association functional class and depressive symptoms are the most consistent variables explaining the variance in HRQoL in patients with congestive heart failure. These findings are partly in line with previous research on predictors for hard endpoints in patients with congestive heart failure.
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Estado de Salud , Insuficiencia Cardíaca/psicología , Pacientes Ambulatorios , Calidad de Vida , Autoimagen , Encuestas y Cuestionarios , Humanos , Índice de Severidad de la EnfermedadRESUMEN
Background The effect of adherence to cardiac rehabilitation (CR) on outcome is not clear. Therefore, we aimed to assess the impact of drop-out for non-medical reasons of CR on event-free survival in coronary artery disease (CAD). Methods A total of 876 patients who attended CR after acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) were included. Drop-out was defined as attending ≤50% of the training sessions. A combined endpoint of all-cause mortality and rehospitalization for a cardiovascular event was used to specify event-free survival. Differences in clinical characteristics were assessed and parameters with p < 0.10 were entered in a multiple Cox regression analysis. Results A total of 15% died or had a cardiovascular event during a median follow-up period of 33 months (interquartile range 24, 51). Overall, 17% dropped out before finishing half of the program. Patients who withdrew prematurely had a risk twice as high for a cardiovascular event or death (hazard ratio 1.92, 95% confidence interval 1.28-2.90) than those who attended more than half of the sessions. Both ACS (2.36, 1.47-3.58) and PCI (2.20, 1.22-3.96), as primary indicators for CR, were associated with an adverse outcome and also a prior history of chronic heart failure (CHF) remained negatively associated with event-free survival (3.67, 1.24-10.91). Finally, the presence of hyperlipidemia was independently related to a worse outcome (1.48, 1.02-2.16). Conclusions Drop-out for non-medical reasons was independently associated with a negative outcome in CAD. Therefore, underlying factors for drop-out should gain more attention in future research and should be taken into account when organizing CR.
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Síndrome Coronario Agudo/rehabilitación , Rehabilitación Cardiaca , Enfermedad de la Arteria Coronaria/rehabilitación , Cooperación del Paciente , Pacientes Desistentes del Tratamiento , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/fisiopatología , Anciano , Distribución de Chi-Cuadrado , Comorbilidad , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/fisiopatología , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Intervención Coronaria Percutánea , Modelos de Riesgos Proporcionales , Sistema de Registros , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: The aim of our study was to compare Euroqol-5D (EQ-5D) outcomes in coronary heart disease (CHD) patients with those from the general population. We aimed to identify those dimensions which were mostly impaired. METHODS: EQ-5D results (both the dimensions and the EQ-5D visual analogue scale (EQ-VAS)) from a European sample (11 countries) of coronary patients were compared with published age- and gender-specific normative data. RESULTS: EQ-5D outcomes differed across countries and gender. Overall, the age-adjusted EQ-VAS scores were significantly lower in coronary patients compared with the general population, both in males (mean difference (MD)= -5.24(-7.59 to -2.88)) and in females (MD= -8.32 (-11.69 to -4.95)). Coronary patients had a significantly higher risk to report moderate or severe problems related to anxiety/depression (odds ratio (OR) male=1.84 (1.14-2.95); OR female=3.20 (2.32-4.40)). Furthermore, female coronary patients reported more problems on the mobility (OR=2.00 (1.38-2.90)), usual activity (OR= 2.54 (1.81-3.57)) and pain/discomfort dimension (OR=1.73 (1.23-2.43)) whereas in males, a borderline significant OR was found on the mobility (OR=1.43 (0.97-2.11)) and usual activity dimension (OR=1.44 (0.94-2.20)). The difference between the general population and the CHD patients attenuated as age increased. CONCLUSIONS: CHD has a negative influence on patient's self-reported health status, both the EQ-VAS as well as the EQ-5D dimensions (with the exception of self-care in both genders and pain/discomfort in males) were impaired. The relative impairment was the greatest in female patients and the differences in the proportion of reported problems diminished with increasing age. The EQ-5D instrument is appropriate in capturing problems related to anxiety/depression, pain/discomfort, mobility and usual activities. Within clinical practice, particular attention should be given to females and younger CHD patients.
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Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/psicología , Estado de Salud , Calidad de Vida , Autoimagen , Actividades Cotidianas , Adulto , Anciano , Estudios de Casos y Controles , Europa (Continente) , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Autoinforme , Factores SexualesRESUMEN
OBJECTIVES: The purpose of this study was to investigate the risk factor level awareness in coronary patients and to assess its associations with health-related quality of life (HRQoL)/psychological distress. METHODS: Data on 8,743 coronary patients from 22 European countries, interviewed and examined at least 6 months after their acute event was available. RESULTS: 81.7% of patients indicated to be aware of their own blood pressure level, whereas only 46.6% of patients indicated to be aware of their cholesterol level. Furthermore, 43.7% of patients were aware of their blood glucose level, whereas in diabetes patients blood glucose level awareness reached 81.8%. Risk factor level awareness was significantly associated with HRQoL/psychological distress, with patients being unaware of their risk factor levels having worse outcomes. The relationship between awareness and HRQoL/psychological distress seemed to be partly mediated by the attempt of patients to adopt a healthier behaviour. CONCLUSIONS: Health care workers should be encouraged to inform their patients about the importance of their coronary risk factors, the actual level and their personal target.