| 31. |
- Andreae, Christina, 1969-, et al.
(författare)
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Changes in Appetite During the Heart Failure Trajectory and Association With Fatigue, Depressive Symptoms, and Quality of Life
- 2021
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Ingår i: Journal of Cardiovascular Nursing. - : Lippincott Williams & Wilkins. - 0889-4655 .- 1550-5049. ; 36:6, s. 539-545
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Decreased appetite can contribute to malnutrition in patients with heart failure (HF). Little is known about the trajectory of appetite over time in patients with HF and the factors associated with decreased appetite after discharge from the hospital.OBJECTIVE: The aims of this study were to investigate changes in appetite over time and explore how fatigue, depressive symptoms, and quality of life are associated with decreased appetite.METHODS: Data from the multicenter randomized Coordinating study evaluating Outcomes of Advising and Counseling in Heart Failure were used. Logistic regression and mixed-effects logistic regression were used to investigate changes in appetite over time and to explore the relationship between appetite and fatigue, depressive symptoms, and quality of life.RESULTS: A total of 734 patients with HF (mean age, 69 years) were included. Decreased appetite was present at all follow-up measurements; however, decreased appetite was significantly lower at the 1-month (odds ratio [OR], 0.43; confidence interval [CI], 0.29-0.63), 6-month (OR, 0.31; CI, 0.20-0.47), 12-month (OR, 0.22; CI, 0.14-0.34), and 18-month (OR, 0.24; CI, 0.15-0.37) follow-ups compared with baseline. Decreased appetite was associated with fatigue (OR, 3.09; CI, 1.98-4.84), depressive symptoms (OR, 1.76; CI, 1.35-2.29), and low quality of life (OR, 1.01; CI, 1.01-1.02) across all measurement points adjusted for covariates.CONCLUSIONS: Appetite improved after discharge; however, at all time points, at least 22% of patients reported decreased appetite. Fatigue, depressive symptoms, and low quality of life are factors associated with decreased appetite. Decreased appetite is a long-standing problem in that it does not disappear spontaneously after an acute HF deterioration.
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| 32. |
- Bello, Natalie A, et al.
(författare)
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Increased risk of stroke with darbepoetin alfa in anaemic heart failure patients with diabetes and chronic kidney disease.
- 2015
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Ingår i: European journal of heart failure. - : Wiley. - 1879-0844 .- 1388-9842. ; 17:11, s. 1201-1207
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Tidskriftsartikel (refereegranskat)abstract
- The use of an erythropoesis-stimulating agent, darbepoetin alfa (DA), to treat anaemia in patients with diabetes mellitus and chronic kidney disease was associated with a heightened risk of stroke and neutral efficacy in the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT), despite epidemiological data suggesting the contrary. However, this association has not been evaluated in another randomized, placebo-controlled trial.
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| 33. |
- Cleland, John G F, et al.
(författare)
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Plasma concentration of amino-terminal pro-brain natriuretic peptide in chronic heart failure: prediction of cardiovascular events and interaction with the effects of rosuvastatin: a report from CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure).
- 2009
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 1558-3597 .- 0735-1097. ; 54:20, s. 1850-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We investigated whether plasma amino-terminal pro-brain natriuretic peptide (NT-proBNP), a marker of cardiac dysfunction and prognosis measured in CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure), could be used to identify the severity of heart failure at which statins become ineffective. BACKGROUND: Statins reduce cardiovascular morbidity and mortality in many patients with ischemic heart disease but not, overall, those with heart failure. There must be a transition point at which treatment with a statin becomes futile. METHODS: In CORONA, patients with heart failure, reduced left ventricular ejection fraction, and ischemic heart disease were randomly assigned to 10 mg/day rosuvastatin or placebo. The primary composite outcome was cardiovascular death, nonfatal myocardial infarction, or stroke. RESULTS: Of 5,011 patients enrolled, NT-proBNP was measured in 3,664 (73%). The midtertile included values between 103 pmol/l (868 pg/ml) and 277 pmol/l (2,348 pg/ml). Log NT-proBNP was the strongest predictor (per log unit) of every outcome assessed but was strongest for death from worsening heart failure (hazard ratio [HR]: 1.99; 95% confidence interval [CI]: 1.71 to 2.30), was weaker for sudden death (HR: 1.69; 95% CI: 1.52 to 1.88), and was weakest for atherothrombotic events (HR: 1.24; 95% CI: 1.10 to 1.40). Patients in the lowest tertile of NT-proBNP had the best prognosis and, if assigned to rosuvastatin rather than placebo, had a greater reduction in the primary end point (HR: 0.65; 95% CI: 0.47 to 0.88) than patients in the other tertiles (heterogeneity test, p = 0.0192). This reflected fewer atherothrombotic events and sudden deaths with rosuvastatin. CONCLUSIONS: Patients with heart failure due to ischemic heart disease who have NT-proBNP values <103 pmol/l (868 pg/ml) may benefit from rosuvastatin.
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| 34. |
- Coyne, James C, et al.
(författare)
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Lack of Prognostic Value of Type D Personality for Mortality in a Large Sample of Heart Failure Patients
- 2011
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Ingår i: Psychosomatic Medicine. - : Lippincott, Williams and Wilkins. - 0033-3174 .- 1534-7796. ; 73:7, s. 557-562
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Tidskriftsartikel (refereegranskat)abstract
- Background: Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms. Methods: We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression. Results: At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144). Conclusions: In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.
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| 35. |
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| 36. |
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| 37. |
- Funck-Brentano, Christian, et al.
(författare)
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Influence of order and type of drug (bisoprolol vs. enalapril) on outcome and adverse events in patients with chronic heart failure: a post hoc analysis of the CIBIS-III trial
- 2011
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1879-0844 .- 1388-9842. ; 13:7, s. 765-772
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Tidskriftsartikel (refereegranskat)abstract
- Aims Angiotensin-converting enzyme inhibitors (ACE-Is) and beta-blockers are associated with improved outcome in patients with chronic heart failure (CHF). In this post hoc analysis of the CIBIS III trial, we examined the influence of the order of drug administration on clinical events and achieved dose. We also assessed the relations between dose levels and baseline variables or adverse events. Methods and results In the CIBIS III trial, 1010 patients (mean age: 72.4 years; mean ejection fraction: 28.8%; male: 68.2%) with stable CHF were randomized to up-titration of monotherapy with either bisoprolol (target dose 10 mg o.d.) or enalapril (target dose 10 mg b.i.d.) for 6 months, followed by their combination for 6-24 months. Endpoints were mortality or all-cause hospitalization, mortality alone and mortality or cardiovascular hospitalization. The study drug (ACE-I or beta-blocker) was last prescribed at >= 50% of target dose to significantly more patients for the first initiated drug in both treatment groups (both P < 0.001). Sixty per cent of endpoints were reached during the monotherapy phase and randomized treatment during monotherapy was not a predictor of the three assessed outcomes. Monotherapy phase was the strongest independent predictor of outcome (P < 0.0001 for all endpoints). Older age, NYHA class III, impaired renal function, lower body weight and blood pressure at baseline, and hypotension, bradycardia and heart failure during treatment were associated with the inability to reach high dose of both study drugs. Conclusion The order of drug administration plays an important role in whether CHF patients reach target doses of bisoprolol and enalapril. For both study drugs, the dose level reached was associated with baseline characteristics and adverse events. In CHF patients not treated with an ACE-I or a beta-blocker, the duration of monotherapy with either type of drug should be shorter than 6 months.
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| 38. |
- Gheorghiade, Mihai, et al.
(författare)
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Assessing and grading congestion in acute heart failure : a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine.
- 2010
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 12:5, s. 423-33
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Tidskriftsartikel (refereegranskat)abstract
- Patients with acute heart failure (AHF) require urgent in-hospital treatment for relief of symptoms. The main reason for hospitalization is congestion, rather than low cardiac output. Although congestion is associated with a poor prognosis, many patients are discharged with persistent signs and symptoms of congestion and/or a high left ventricular filling pressure. Available data suggest that a pre-discharge clinical assessment of congestion is often not performed, and even when it is performed, it is not done systematically because no method to assess congestion prior to discharge has been validated. Grading congestion would be helpful for initiating and following response to therapy. We have reviewed a variety of strategies to assess congestion which should be considered in the care of patients admitted with HF. We propose a combination of available measurements of congestion. Key elements in the measurement of congestion include bedside assessment, laboratory analysis, and dynamic manoeuvres. These strategies expand by suggesting a routine assessment of congestion and a pre-discharge scoring system. A point system is used to quantify the degree of congestion. This score offers a new instrument to direct both current and investigational therapies designed to optimize volume status during and after hospitalization. In conclusion, this document reviews the available methods of evaluating congestion, provides suggestions on how to properly perform these measurements, and proposes a method to quantify the amount of congestion present.
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| 39. |
- Jaarsma, Tiny, et al.
(författare)
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Depression and the usefulness of a disease management program in heart failure : insights from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) study.
- 2010
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 55:17, s. 1837-43
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Our aim was to study the possible role of depressive symptoms in the effectiveness of a disease management program (DMP) in heart failure (HF) patients. BACKGROUND: Disease management programs are recommended in current HF guidelines, but certain patient groups, such as those with depression, might be less responsive to such programs. METHODS: From the data of a large multicenter study, in which we examined the effect of a DMP in HF patients, we investigated a potential interaction between depressive symptoms at baseline and the effect of such a program. RESULTS: Of the 958 HF patients (37% female; age 71 +/- 11 years; New York Heart Association functional class II to IV), 377 (39%) reported depressive symptoms at baseline. During 18 months of follow-up, the primary end point (composite of all-cause mortality and HF readmission) occurred in 39% of the nondepressed patients and 42% of depressed patients. In the overall sample, there was no significant effect of DMP on the composite primary end point. The effect of the DMP was significantly different in nondepressed than in depressed HF patients. A significant effect modification by depressive symptoms was observed in evaluating the effect of the DMP on all-cause mortality and HF readmission (p = 0.03). In patients without depressive symptoms, DMP resulted in a trend for lower incidence of the primary end point (hazard ratio: 0.8, 95% confidence interval: 0.61 to 1.04), whereas the reverse was observed in patients with depressive symptoms (hazard ratio: 1.3, 95% confidence interval: 0.95 to 1.98). CONCLUSIONS: Depressive symptoms in patients with HF have a major effect on the usefulness of DMP. Identification of depressive symptoms before enrollment in a DMP might lead to more accurate use of a DMP, because depressive patients might not benefit from a general program. (Netherlands Heart Foundation Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure; ISRCTN98675639).
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| 40. |
- Johansson, Peter, et al.
(författare)
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Association Between Prehospital Delay and Subsequent Clinical Course in Patients With/Hospitalized for Heart Failure
- 2012
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Ingår i: Journal of Cardiac Failure. - : Elsevier. - 1071-9164 .- 1532-8414. ; 18:3, s. 202-207
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Tidskriftsartikel (refereegranskat)abstract
- Background: The clinical consequences of prehospital delay in heart failure (HF) patients are unknown. This study explores the relationship between prehospital delay of HF patients and length of hospital stay, plasma values of brain natriuretic peptides (BNP) as well as the association of delay with all-cause mortality, readmission for HF, or all-cause readmissions during short-(60 days) and long-term (18 months) follow-up. less thanbrgreater than less thanbrgreater thanMethods: Data from 1023 hospitalized HF patients mean aged 71 years from the Coordinating study evaluating Outcomes of Advising and Counselling in HF study were analyzed. less thanbrgreater than less thanbrgreater thanResults: Patients who delayed less than 1 day had significantly shorter stay in hospital (10 days vs. 11 days, P = 0.033). They also had significantly (P = 0.004) lower median plasma values of BNP (377 pg/mL) at discharge compared to patients who delayed andgt;24 hours (492 pg/mL). Delay was not related to all-cause mortality and/or readmissions for HF. less thanbrgreater than less thanbrgreater thanConclusion: Although patients with a prehospital delay less than 1 day were more symptomatic on admission, they had a shorter hospital stay as well as lower plasma values of BNP at discharge. Delay was not associated hospital readmissions or mortality after discharge.
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