Unique symptoms at midlife of women with osteoporosis and cardiovascular disease in Taiwan.

OBJECTIVE: This study compared symptoms at midlife, menopause attitudes, and depression among three groups of late peri- or postmenopausal women, namely, women with cardiovascular disease (CVD group), women with osteoporosis (Os group), and women in generally good health (Co group). METHODS: We used a cross-sectional method. Participants were purposively sampled from a medical center and a residential community in southern Taiwan. A total of 500 women between 45 and 60 years of age participated in the study. Four measures were used: a demographics and health habits questionnaire, the Women's Health Initiative Symptom Scale, the Attitudes Towards Menopause Scale, and the Center for Epidemiological Studies-Depression Scale. RESULTS: Significant demographic differences among the groups were found in age, number of children, educational level, family income, employment status, exercise duration per session, smoking status, daily cigarette consumption, and number of years smoking. After significant covariates had been controlled for, the CVD group reported significantly more severe symptoms at midlife than did the Co group; significantly more severe "psychosomatic symptoms" than did the Co group; and significantly more severe "gastrointestinal symptoms and swelling" and "vasomotor symptoms" than did either the Os group or the Co group. The CVD group also reported significantly greater depressive symptoms than did the Os group. CONCLUSIONS: This study identified a number of differences in symptoms at midlife and depressive symptoms among the three groups. Results support the importance of providing unique care for peri- and postmenopausal women in different health categories. Findings may help healthcare professionals better appreciate the diversity of menopausal experiences and support the development of appropriate care strategies.

Ambulatory blood pressure and physical activity in heart failure.

This observational study used repeated measures over 24 hr to investigate ambulatory blood pressure (BP) and physical activity (PA) profiles in community-based individuals with heart failure (HF). The aims were to (a) compare BP dipping and PA between two groups of HF patients with different functional statuses, and (b) determine whether the strength of the association between ambulatory BP and PA varies by functional status in HF. Ambulatory BP was measured every 30 min with a SpaceLabs 90207; a Basic Motionlogger actigraph was used to measure PA minute-by-minute. Fifty-six participants (54% female, age 66.96 + or - 12.35 years) completed data collection. Functional status was based on New York Heart Association (NYHA) ratings. Twenty-seven patients had no limitation of PA (NYHA Class I HF), whereas 29 had some limitation of PA but no discomfort at rest (NYHA Class II or III HF). Patients with Class I HF had a significantly greater degree of BP dipping than those with Class II/III HF after controlling for left ventricular ejection fraction. In a mixed-model analysis, PA was significantly related to ambulatory systolic and diastolic BP and mean arterial pressure. The strength of the association between PA and BP was not significantly different for the two groups of patients. These findings demonstrate differences between Class I and Class II/II HF in BP dipping status and ambulatory BP but not PA. Longitudinal research is recommended to improve understanding of the influence of disease progression on changes in 24-hr PA and BP profiles of patients with HF.

[Evidence-based practice of fluid restriction in patients with heart failure].

Heart failure (HF) is prevalent in the aging population. Both pharmacological and non-pharmacological therapies are employed in HF and have yielded significant improvements in survival and quality of life. Body fluid must be maintained at a level sufficient to ensure hemodynamic stability and adequate tissue perfusion, which may decrease neurohormonal activation caused by low cardiac output in patients with HF. However, shortness of breath and peripheral edema caused by fluid overload remain the most common clinical symptoms of HF, causing patient distress. In addition to routine pharmacologic approaches, fluid restriction is frequently suggested in HF management strategies. The purpose of this review of published studies that examined use of fluid/water restriction as an intervention was to determine the optimal fluid intake for HF patients in clinical practice. Four articles describing three clinical trials were identified via PubMed and CINAHL. Their findings suggest that patients with clinically stable HF receiving optimal pharmacological treatment may not benefit from fluid restriction. Patients in these studies had preserved renal function, however, and the trials had no long-term follow-up period. Clinicians choosing to restrict fluid intake for patients with HF should consider an individualized fluid prescription, potentially based on patient body weight, sodium intake, and likelihood of adherence. Further clinical trials are warranted to improve clinical practice in caring for patients with HF.

A systematic review of exercise interventions in patients with heart failure.

The incidence of heart failure (HF) is increasing as the population ages. Pharmacotherapy is an important component of treatment and yields significant improvements in survival and quality of life. In recent decades, exercise has gradually become accepted as an intervention beneficial to patients with HF, but more information is needed to clarify the effects of exercise and optimize interventions. Therefore, a systematic review of randomized controlled trials published from 1966 to October 2006 was carried out via PubMed. About 69 trials were reviewed, which used as main outcome measures: (a) central hemodynamic parameters, (b) peripheral blood flow, (c) endothelial function, (d) activation of neurohormones and cytokine systems, (e) structure of and metabolism in skeletal muscles, and/or (f) quality of life. Study findings suggest that the favorable physiological responses to exercise might slow some of the pathophysiological progression of HF. However, most of the trials reviewed here were based on relatively small samples and selected participant groups, and the exercise programs varied widely. These limitations and inconsistencies need to be addressed through further studies. Furthermore, reliable strategies for maintaining the positive effects of exercise and extending them to patients' daily life and quality of life are scarce in these trials. These domains need further exploration through rationally designed, large-scale randomized controlled trials.