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1.
PLoS One ; 15(12): e0243974, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315935

RESUMO

INTRODUCTION: Information about how patients with advanced heart failure (HF) live and cope with their disease remains scarce. The objective of this study was to explore, from phenomenological and holistic perspectives, the experiences of patients suffering from advanced HF, attended at home in the primary care setting in 2018. MATERIALS AND METHODS: Qualitative study conducted in 4 primary healthcare centers in Barcelona (Spain). Twelve in-depth interviews were conducted in advanced HF patients, aged over 65 and visited regularly at home. We developed a purposeful sampling, accounting for variability in gender, age, and socioeconomic level. Leventhal's framework was used to analyze the interviews. RESULTS: Participants received insufficient and contradictory information about HF. They talked about their cognitive representation and claimed a better communication with healthcare professionals. Due to their advanced age, subjects considered their daily living limitations to be normal rather than as a consequence of HF. Gender differences in emotional representation were clearly observed. Women considered themselves the keystone of correct family "functioning" and thought that they were not useful if they could not correspond to gendered societal expectations. Cognitive coping strategies included specific diets, taking medication, and registering weight and blood pressure. Nevertheless, they perceived the locus of control as external and felt unable to manage HF progression. Their emotional coping strategies included some activities at home such as watching television and reading. Social support was perceived crucial to the whole process. CONCLUSIONS: Locus of control in advanced HF was perceived as external. Healthcare professionals should adapt emotional health interventions in patients with advanced HF based on a gender perspective. Social support was found to be crucial in facing the disease. Patients reported poor communication with healthcare professionals.


Assuntos
Adaptação Psicológica , Insuficiência Cardíaca/psicologia , Qualidade de Vida , Idoso , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/reabilitação , Humanos , Masculino , Apoio Social , Espanha , Inquéritos e Questionários
2.
Environ Health Prev Med ; 25(1): 48, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891113

RESUMO

BACKGROUND: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, people need to practice social distancing in order to protect themselves from SARS-CoV-2 infection. In such stressful situations, remote cardiac rehabilitation (CR) might be a viable alternative to the outpatient CR program. METHODS: We prospectively investigated patients hospitalized for heart failure (HF) with a left ventricular ejection fraction of < 50%. As for patients who participated in the remote CR program, telephone support was provided by cardiologists and nurses who specialized in HF every 2 weeks after discharge. The emergency readmission rate within 30 days of discharge was compared among the outpatient CR, remote CR, and non-CR groups, and the EQ-5D score was compared between the outpatient CR and remote CR groups. RESULTS: The participation rate of HF patients in our remote CR program elevated during the COVID-19 pandemic. As observed in the outpatient CR group (n = 69), the emergency readmission rate within 30 days of discharge was lower in the remote CR group (n = 30) than in the non-CR group (n = 137) (P = 0.02). The EQ-5D score was higher in the remote CR group than in the outpatient CR group (P = 0.03) 30 days after discharge. CONCLUSIONS: Remote CR is as effective as outpatient CR for improving the short-term prognosis of patients hospitalized for heart failure post-discharge. This suggests that the remote CR program can be provided as a good alternative to the outpatient CR program.


Assuntos
Reabilitação Cardíaca/métodos , Infecções por Coronavirus/epidemiologia , Insuficiência Cardíaca/reabilitação , Pneumonia Viral/epidemiologia , Autocuidado , Telemedicina/métodos , Idoso , Betacoronavirus , Humanos , Japão , Pessoa de Meia-Idade , Monitorização Ambulatorial , Pandemias , Estudos Prospectivos , Telefone
3.
Geriatr Gerontol Int ; 20(11): 1029-1035, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32927503

RESUMO

AIM: The present study aimed to investigate factors relating to discharge to home of elderly patients with heart failure. METHOD: After applying exclusion criteria and excluding patients with missing data, 110 of 165 elderly patients with heart failure aged at least 75 years admitted to our institution were divided into discharge to home (n = 85) and non-discharge to home (n = 25) groups. Clinical characteristics, comorbidities, blood test data and echocardiographic data were retrospectively investigated and compared based on patients' medical records. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI) upon admission and at 2 weeks after admission (2-week GNRI). Correlations with discharge to home were investigated using multiple logistic regression analysis with discharge to home as the dependent variable and parameters for which significant intergroup differences were observed as explanatory variables, when considering multicollinearity. Ratio scales selected by multiple logistic regression analysis were analyzed using a receiver operating characteristic curve and cut-off values were calculated. RESULTS: Independent factors predicting discharge to home were 100-m walk achievement (P = 0.037; odds ratio [OR], 3.057; 95% confidence interval [CI], 2.418-8.751) and 2-week GNRI (P = 0.006; OR, 1.083; 95% CI, 1.023-1.146). Area under the receiver operating characteristic curve for 2-week GNRI was 0.735 (95% CI, 0.622-0.847) with a cut-off value for 2-week GNRI to determine discharge to home of 75.29 (sensitivity, 78.8%; specificity, 60.0%). CONCLUSION: The present findings suggest that 100-m walk achievement and 2-week GNRI may be predictors for discharge to home in elderly patients with heart failure. Geriatr Gerontol Int 2020; 20: 1029-1035..


Assuntos
Insuficiência Cardíaca/reabilitação , Estado Nutricional , Alta do Paciente , Caminhada , Idoso , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica , Hospitalização , Humanos , Japão , Masculino , Avaliação Nutricional , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade
4.
ESC Heart Fail ; 7(5): 2093-2097, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32696600

RESUMO

AIMS: A reduction of habitual physical activity due to prolonged COVID-19 quarantine can have serious consequences for patients with cardiovascular diseases, such as heart failure. This study aimed to explore the effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients. METHODS AND RESULTS: We analysed the daily number of steps in 26 heart failure patients during a 6-week period that included 3 weeks immediately preceding the onset of the quarantine and the first 3 weeks of the quarantine. The daily number of steps was assessed using a wrist-worn accelerometer worn by the patients as part of an ongoing randomized controlled trial. Multilevel modelling was used to explore the effect of the quarantine on the daily step count adjusted for weather conditions. As compared with the 3 weeks before the onset of the quarantine, the step count was significantly lower during each of the first 3 weeks of the quarantine (P < 0.05). When the daily step count was averaged across the 3 weeks before and during the quarantine, the decrease amounted to 1134 (SE 189) steps per day (P < 0.001), which translated to a 16.2% decrease. CONCLUSIONS: The introduction of the nationwide quarantine due to COVID-19 had a detrimental effect on the level of habitual physical activity in heart failure patients, leading to an abrupt decrease of daily step count that lasted for at least the 3-week study period. Staying active and maintaining sufficient levels of physical activity during the COVID-19 pandemic are essential despite the unfavourable circumstances of quarantine.


Assuntos
Infecções por Coronavirus/prevenção & controle , Exercício Físico/fisiologia , Insuficiência Cardíaca/reabilitação , Pandemias/prevenção & controle , Aptidão Física/fisiologia , Pneumonia Viral/prevenção & controle , Quarentena , Teste de Caminhada/estatística & dados numéricos , Acelerometria/métodos , Adulto , Idoso , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo
6.
Medicine (Baltimore) ; 99(27): e21062, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629734

RESUMO

BACKGROUND: The benefits of high-intensity interval training (HIIT) are well-known, there is insufficient evidence about the effects of HIIT on heart failure with preserved ejection fraction (HFpEF). METHOD: Multiple databases include MEDLINE, PubMed, EMBASE, CINAHL, Web of Science, PEDro, Cochrane Library, and Google Scholar are used to search for randomized controlled trials investigating the effects of HIIT on HFpEF. All related articles published with the English language with no time limitation will be included. Two reviews independently conducted the selection, data extraction, and quality assessment. The primary outcome is exercise capacity. The secondary outcomes include quality of life (QoL), blood pressure (BP), ventricular function, and left ventricular diastolic function, symptom improvement, endothelial function, and arterial stiffness. Data analysis is performed with Review Manager Software (Version 5.3). RESULT: This systematic review and meta-analysis aim to evaluate the efficacy of HIIT on HFpEF, its outcome will provide reliable evidence for future studies. CONCLUSION: The findings of this study will be published in a related peer-reviewed journal. REGISTRATION NUMBER: INPLASY202050097.


Assuntos
Insuficiência Cardíaca/reabilitação , Treinamento Intervalado de Alta Intensidade/métodos , Volume Sistólico/fisiologia , Pressão Sanguínea/fisiologia , Diástole/fisiologia , Endotélio Vascular/fisiologia , Estudos de Avaliação como Assunto , Tolerância ao Exercício/fisiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/psicologia , Humanos , Qualidade de Vida/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Rigidez Vascular/fisiologia , Função Ventricular Esquerda/fisiologia
7.
Monaldi Arch Chest Dis ; 90(2)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32548994

RESUMO

The COVID-19 outbreak is having a significant impact on both cardiac rehabilitation (CR) inpatient and outpatient healthcare organization. The variety of clinical and care scenarios we are observing in Italy depends on the region, the organization of local services and the hospital involved. Some hospital wards have been closed to make room to dedicated beds or to quarantine the exposed health personnel. In other cases, CR units have been converted or transformed into COVID-19 units.  The present document aims at defining the state of the art of CR during COVID-19 pandemic, through the description of the clinical and management scenarios frequently observed during this period and the exploration of the future frontiers in the management of cardiac rehabilitation programs after the COVID-19 outbreak.


Assuntos
Reabilitação Cardíaca/normas , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Síndrome Coronariana Aguda/reabilitação , Reabilitação Cardíaca/psicologia , Cardiotônicos/efeitos adversos , Cardiotônicos/uso terapêutico , Exercício Físico , Feminino , Insuficiência Cardíaca/reabilitação , Humanos , Itália/epidemiologia , Masculino , Terapia Nutricional , Pandemias , Tromboembolia/reabilitação
9.
Rev. esp. cardiol. Supl. (Ed. impresa) ; 20(supl.C): 3-12, jun. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197033

RESUMO

La insuficiencia cardiaca es una enfermedad que precisa un tratamiento multidisciplinario, dadas la diversidad de causas y entornos clínicos implicados que las tratan y las diferentes estrategias terapéuticas que precisan la participación indispensable de diversas disciplinas. La presencia en los servicios de cardiología de unidades de insuficiencia cardiaca centradas en el tratamiento de los pacientes con esta afección y unidades de rehabilitación cardiaca que, entre sus indicaciones para la reducción de la morbimortalidad, también están implicadas en la atención de esos mismos pacientes puede causar dificultades de coordinación y pérdida de una atención integral centrada en el paciente. Por estos motivos, en el presente documento se plantea una estrategia de coordinación entre las diferentes unidades implicadas en el tratamiento de los pacientes dentro de los servicios de cardiología y la continuidad asistencial con atención primaria, tanto tras haber conseguido la estabilidad como la interrelación para una coordinación posterior más efectiva


Heart failure is a condition that requires a multidisciplinary approach to treatment because of the wide range of causes and clinical contexts that may be involved and because the diverse treatment strategies used necessitate the participation of multiple disciplines. In cardiology departments, the presence of both heart failure units that focus on the treatment of affected patients and cardiac rehabilitation units that, as well as targeting reductions in morbidity and mortality, are also involved in caring for the same patients can create difficulties for coordination and can result in the loss of comprehensive patient-centered care. For these reasons, this paper presents a strategy for coordinating the different units involved in patient management in cardiology departments and for ensuring continuity of care in primary care, both immediately after achieving stabilization and subsequently, when these interactions are important for effective coordination


Assuntos
Humanos , Equipe de Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Insuficiência Cardíaca/reabilitação , Reabilitação Cardíaca/métodos , Terapia por Exercício/métodos , Consenso , Alta do Paciente/normas , Atenção Primária à Saúde/organização & administração , Assistência Integral à Saúde/organização & administração , Tolerância ao Exercício , Cuidados de Enfermagem/organização & administração
11.
Rev. esp. cardiol. Supl. (Ed. impresa) ; 20(supl.C): 15-21, jun. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-197035

RESUMO

En la continuidad asistencial del paciente que ha sufrido un síndrome coronario agudo es fundamental la rehabilitación cardiaca. Es más, centrar los cuidados en el paciente obliga a coordinar la atención cardiológica con atención primaria para mejorar la adherencia a los programas y una atención continua adecuada. Los programas de rehabilitación cardiaca comunitaria son indispensables para cumplir con los objetivos preventivos, pero somos conscientes de las dificultades de implementación y la necesidad de apoyo de gestores y especialistas. Debemos ayudar a concienciar sobre esta necesidad y apoyar a los especialistas que tengan iniciativas en la creación de este tipo de programas. Este documento trata de sintetizar los puntos básicos de la atención y la coordinación entre cardiología y atención primaria para la creación y el desarrollo de estos programas comunitarios


Cardiac rehabilitation is an essential part of continuing care for patients who have experienced an acute coronary syndrome. Moreover, a patient-centered approach requires the coordination of cardiology care and primary care in order to improve adherence to rehabilitation programs and to ensure appropriate continuing care. Community cardiac rehabilitation programs are essential for achieving the objectives of disease prevention. However, implementation may be difficult and program managers and specialists may need support. It is important to raise awareness of the need to support specialists who have taken the initiative in creating these programs. The aim of this paper was to summarize the basic elements of care and of the coordination between cardiology departments and primary care needed to create and develop community cardiac rehabilitation programs


Assuntos
Humanos , Reabilitação Cardíaca/métodos , Insuficiência Cardíaca/reabilitação , Centros de Reabilitação/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Isquemia Miocárdica/prevenção & controle , Indicadores de Morbimortalidade , Terapia por Exercício/organização & administração , Infarto do Miocárdio/prevenção & controle , Colaboração Intersetorial , Avaliação de Processos e Resultados em Cuidados de Saúde
12.
BMC Cardiovasc Disord ; 20(1): 200, 2020 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-32334527

RESUMO

BACKGROUND: Exercise intolerance is a common finding in heart failure that generates a vicious cycle in which the individual starts to limit his activities even more due to progressive fatigue. Regular physical exercise can increase the cardiopulmonary exercise capacity of these individuals. A new approach to physical exercise, known as functional training, could improve the oxygen consumption and quality of life of patients with heart failure; however, there is no information about the effect of this modality of exercise in this patient population. This randomized trial will compare the effects of 36 sessions of functional training versus strength training in heart failure patients. METHODS: This randomized parallel-design examiner-blinded clinical trial includes individuals of both sexes aged ≥40 years receiving regular follow-up at a single academic hospital. Subjects will be randomly allocated to an intervention group (for 12-week functional training) or an active comparator group (for 12-week strength training). The primary outcomes will be the difference from baseline to the 3-month time point in peak oxygen consumption on cardiopulmonary exercise testing and quality of life assessed by the Minnesota Living with Heart Failure Questionnaire. Secondary outcome measures will include functionality assessed by the Duke Activity Status Index and gait speed test; peripheral and inspiratory muscular strength, assessed by hand grip and manovacuometry testing, respectively; endothelial function by brachial artery flow-mediated dilation; lean body mass by arm muscle circumference; and participant adherence to the exercise programs classified as a percentage of the prescribed exercise dose. DISCUSSION: The functional training program aims to improve the functional capacity of the individual using exercises that relate to his specific physical activity transferring gains effectively to one's daily life. In this context, we believe that that functional training can increase the cardiopulmonary exercise capacity and quality of life of patients with heart failure. The trial has been recruiting patients since October 2017. TRIAL REGISTRATION: NCT03321682. Registered on October 26, 2017.


Assuntos
Reabilitação Cardíaca/métodos , Aptidão Cardiorrespiratória , Terapia por Exercício , Tolerância ao Exercício , Insuficiência Cardíaca/reabilitação , Qualidade de Vida , Brasil , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
13.
Minerva Med ; 111(3): 226-238, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32166926

RESUMO

BACKGROUND: Despite therapeutic advances, chronic heart failure (CHF)-related mortality and hospitalization is still unacceptably high. Evidence shows that muscular wasting, sarcopenia, cachexia are independent predictors of mortality and morbidity in CHF and are signs of protein metabolism disarrangement (PMD), which involve all body proteins including circulating one. We postulate that circulating human serum albumin (HSA) could be a marker of PMD and catabolic low-grade inflammation (LGI) in CHF patients. METHODS: One hundred sixty-six stable CHF patients (73% males), with optimized therapy referred to cardiac rehabilitation, were retrospectively divided into three groups based on their HSA concentration: ≥3.5 g/dL (normal value), 3.2-3.49 g/dL (low value); ≤3.19 g/dL (severe value). Hematochemical analyses (including circulating proteins and inflammatory markers) and body mass composition (by Bioelectrical Impedance Vector Analysis) were collected and compared. Correlations and multivariate regression were performed. RESULTS: Despite being overweight (BMI=27 kg/m2), 75% of patients had reduced HSA (<3.5 g/dL) with suspectable sarcopenia, and 35% of all patients had remarkably lower albumin concentrations (<3.19 g/dL). Hypoalbuminemic patients were disable, older, with reduced muscular proteins, bilirubin and hemoglobin, increased extracellular water and LGI (P<0.01). HSA correlated with all of these parameters (all: P<0.01). Age, LGI, BMI, free-fat Mass, and bilirubin were independent predictors of HSA concentration. All these findings were male-dependent. CONCLUSIONS: HSA could be considered a simple marker of PMD and LGI in CHF patients. Evaluation of PMD and gender differences should be considered in new CHF clinical trials.


Assuntos
Insuficiência Cardíaca/sangue , Hipoalbuminemia/etiologia , Proteínas/metabolismo , Albumina Sérica/análise , Idoso , Biomarcadores/sangue , Composição Corporal , Índice de Massa Corporal , Caquexia/sangue , Doença Crônica , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/reabilitação , Humanos , Inflamação/metabolismo , Masculino , Proteínas Musculares/sangue , Sobrepeso/sangue , Desempenho Físico Funcional , Análise de Regressão , Estudos Retrospectivos , Sarcopenia/diagnóstico , Fatores Sexuais
14.
Phys Ther ; 100(1): 14-43, 2020 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-31972027

RESUMO

The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.


Assuntos
Insuficiência Cardíaca/reabilitação , Fisioterapeutas , Fisioterapia , Exercícios Respiratórios/métodos , Terapia Combinada/métodos , Terapia por Estimulação Elétrica/métodos , Exercício Físico , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Treinamento Intervalado de Alta Intensidade , Humanos , Educação de Pacientes como Assunto , Readmissão do Paciente , Fisioterapia/organização & administração , Treinamento de Resistência , Medição de Risco , Disfunção Ventricular Esquerda/fisiopatologia
15.
Adv Exp Med Biol ; 1216: 131-147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894553

RESUMO

Comprehensive cardiac rehabilitation programmes include multifactorial components to optimise cardiovascular risk reduction, promote healthy behaviours and an active lifestyle, reduce disability and improve health and wellbeing. There is compelling evidence that older people with certain cardiovascular conditions, such as heart failure, can benefit both physically and mentally from cardiac rehabilitation. This chapter discusses the evolution of cardiac rehabilitation, frailty assessment in cardiac rehabilitation and guideline recommendations in the context of ageing populations. Contemporary cardiac rehabilitation service models are presented along with potential solutions to meeting older people's preferences and improving access to effective treatment for those with frailty. Innovations in catheter-based surgical interventions mean that more people with frailty are undergoing cardiovascular surgery than ever before. Although traditionally, cardiac rehabilitation has been associated with secondary prevention after cardiac diagnoses, events and interventions, new models of preconditioning rehabilitation or 'prehab' are being offered to frail older people before surgery to improve functional outcomes and reduce hospital stay. Individual tailoring of cardiac rehabilitation programme components is a cornerstone of high-quality care. Importantly, participation in core components, such as exercise and nutritional interventions, can impact on both cardiac vascular disease and frailty, providing the potential to change the trajectory of both conditions.


Assuntos
Reabilitação Cardíaca , Idoso Fragilizado , Cardiopatias/reabilitação , Idoso , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/reabilitação , Humanos
16.
Home Healthc Now ; 38(1): 24-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895894

RESUMO

Heart failure (HF) is one of the leading causes of rehospitalization in the United States. Due to the complex nature of HF, the provision of Medicare-certified home healthcare services has increased. Medicare-certified home healthcare agencies measure and report patients' outcomes such as functional status, activities of daily living (ADL), and instrumental activities of daily living to the Centers for Medicare and Medicaid Services. These metrics are assessed using the Outcome and Assessment Information Set (OASIS). As a large data set, OASIS has been used to advance care quality in multiple ways including identifying risk factors for negative patient outcomes. However, there is a lack of OASIS analyses to assess the relationship between functional status and the role of other factors, such as pain, in impeding recovery after hospitalization among HF patients. Therefore, the purpose of this study is to identify the relationship between functional status and pain using the OASIS database. Among 489 HF patients admitted to home healthcare, 83% were White, 57% were female, and the median age was 80. Patients who reported daily but not constant activity-interfering pain at discharge demonstrated the least improvement in functional performance as measured by ADLs, whereas patients without activity-interfering pain demonstrated the greatest improvement in ADL performance (p value = 0.0284). Tracking individual patient ADL scores, particularly the frequency of activity-interfering pain, could be a key indicator for clinical focus for patients with HF in the home healthcare setting.


Assuntos
Reabilitação Cardíaca/enfermagem , Insuficiência Cardíaca/reabilitação , Serviços de Assistência Domiciliar/organização & administração , Medicare , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Centers for Medicare and Medicaid Services, U.S. , Pessoas com Deficiência/reabilitação , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Alta do Paciente/estatística & dados numéricos , Estados Unidos
18.
Ann Thorac Surg ; 109(3): 787-793, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31470010

RESUMO

BACKGROUND: Congestive heart failure patients have hepatic congestion and abnormal coagulation profiles, increasing perioperative bleeding at time of ventricular assist device implantation. This study examined the impact of the preoperative administration of vitamin K on perioperative blood transfusion requirements. METHODS: Retrospectively, 190 patients met inclusion criteria. Patients received no vitamin K (n = 62) or two 10-mg doses of intravenous vitamin K (n = 128) in the 24 hours before assist device implantation. Primary end points included transfusion requirements and reexploration rates for bleeding. Secondary outcomes were pump thrombosis and in-hospital mortality. RESULTS: Baseline characteristics were similar between the 2 groups, with slight differences (not statistically significant) noted in the Interagency Registry for Mechanically Assisted Circulatory Support profile and total bilirubin levels. The only significant difference noted was the year of implantation (P < .001). Blood product usage was significantly lower in the vitamin K group compared to the no vitamin K group (P < .001). Higher rates of reexploration for bleeding (29.7% vs 13.6%, P = .023) and death at hospital discharge (16.2% vs 2.8%, P = .004) were noted for the no vitamin K group compared with the vitamin K group. After adjusting for age, sex, race, body mass index, Interagency Registry for Mechanically Assisted Circulatory Support profile, total bilirubin, surgeon, and year of operation, reexploration rates and death did not achieve statistical significance. No statistically significant difference was observed in stroke and pump thrombosis rates between the 2 groups. CONCLUSIONS: Preoperative vitamin K administration may help reduce blood product use without any increased risk for strokes or pump thrombosis.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Insuficiência Cardíaca/reabilitação , Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Hemorragia Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios/métodos , Vitamina K/administração & dosagem , Antifibrinolíticos/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Humanos , Incidência , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia , Função Ventricular Esquerda/fisiologia
19.
Heart Vessels ; 35(3): 360-366, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31489463

RESUMO

Although the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) is useful to assess decline of instrumental activities of daily living (IADL) in Japanese individuals, limited data are available in patients with heart failure (HF). This study was performed to investigate the prognostic value of IADL evaluated by TMIG-IC in initial HF hospitalization patients aged ≥ 65 years. We reviewed 297 elderly HF patients with independent basic ADL before hospitalization. Patients with prior HF were excluded. Five TMIG-IC items were investigated as IADL parameters. Patients with full IADL scores were defined as "independent" and others were defined as "dependent". The endpoint was all-cause mortality, and multivariable analysis was performed to identify IADL risk. The median age was 76 years, and 55% of the patients were male. Forty-one deaths occurred over a median follow-up period of 1.01 years. After adjusting for existing risk factors, including Seattle Heart Failure Score, dependent patients had higher mortality risk than independent patients [hazard ratio 3.64, 95% confidence interval (CI) 1.57-8.43], and mortality risk decreased by 16% for each 1-point increase in IADL score (hazard ratio 0.84, 95% CI 0.71-0.99). In conclusion, limited IADL indicated by TMIG-IC was associated with poorer long-term mortality rate in elderly patients with HF. This inexpensive and easily applicable tool will support decision making in cardiac rehabilitation.


Assuntos
Atividades Cotidianas , Técnicas de Apoio para a Decisão , Avaliação Geriátrica/métodos , Insuficiência Cardíaca/diagnóstico , Hospitalização , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Reabilitação Cardíaca , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/reabilitação , Humanos , Japão , Masculino , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
20.
Arch Phys Med Rehabil ; 101(4): 690-699, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31738893

RESUMO

OBJECTIVE: To compare treadmill versus cycling-based exercise in cardiac rehabilitation (CR) on functional capacity (FC) outcomes. DATA SOURCE: Databases were searched for randomized studies using single modality continuous exercise. STUDY SELECTION: Studies implemented a continuous cycling or treadmill protocol for patients with either coronary artery disease (CAD) or chronic heart failure (CHF). The effect of single modality exercise on FC (VO2peak) was analyzed. Differences in the effect of CR on FC was assessed between the mode subgroup (cycling vs treadmill) and disease state subgroup (CAD vs CHF) within both the cycling and treadmill groups. DATA EXTRACTION: Data were extracted from 23 studies including 600 patients (mean age 60y, 86% men). DATA SYNTHESIS: There was a significant difference in effect size between studies that used cycling, Hedges' g=0.85 (95% confidence interval [95% CI], 0.52-1.17; k=13) and studies that used treadmill exercise, Hedges' g=0.46 (95% CI, 0.22-0.70; k=8). Within cycling studies (n=14), FC was higher among CAD patients, Hedges' g=1.03 (95% CI, 0.65-1.42; k=9) compared to those with CHF, Hedges' g=0.40 (95% CI, 0.09-0.71; k=4, P<.001). Conversely, among treadmill studies (n=9), FC was higher among CHF patients, Hedges' g=0.94 (95% CI, 0.23-1.65; k=2) compared to CAD, Hedges' g=0.33 (95% CI, 0.19-0.47; k=5; P<.01). CONCLUSIONS: According to identified studies, when cycling was the primary mode of exercise in CR, there was larger change in FC compared to treadmill exercise. In addition, CAD patients experienced greater gains in FC when cycling was the primary mode of exercise in CR, while CHF patients benefited more from treadmill-based exercise programs.


Assuntos
Reabilitação Cardíaca/métodos , Ergometria , Doença da Artéria Coronariana/reabilitação , Insuficiência Cardíaca/reabilitação , Humanos , Consumo de Oxigênio
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