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- Albert, N.M., et al.
(författare)
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Exercise Factors Associated with 1-Year Mortality in Ambulatory Patients with Heart Failure
- 2013
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Ingår i: Journal of cardiac failure. - 1071-9164 .- 1532-8414. ; 19:8
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Konferensbidrag (refereegranskat)abstract
- Background: In prior research no differences have been found in 1-year mortality in pts with HF who participated in exercise interventions vs usual care. In HF-ACTION, over half of exercise pts were not fully adherent to the exercise intervention, even early into the trial. Understanding associations of exercise-related factors and 1-year mortality might lead to new interventions that promote exercise adherence. Methods. Using a prospective, correlational design, out-pts with chronic HF from 6 clinics completed questionnaires on demographics, comorbidites, and factors thought to be important in exercise capability and adherence (fatigue, depression, functional status, knowledge about exercise expectations, value of exercise, barriers/benefits of exercise, and exercise self-efficacy). Investigators provided 1-year survival data. Cox proportional hazards models were used to test for significance of the effects of variables of interest on survival. P-values for estimates of comparisons of hazard within levels of categorical variables were from tests based on z-statistics. If more than 2 categories, multiple comparisons were made to test for differences in the hazard ratios between each pair of categories. Continuous variables were categorized using cut scores. Results. Of the cohort of 492 pts (mean (SD) age 63 (± 13.6) yrs; LVEF 34.9% (± 14.8%); BMI 29.3 (± 6.73) kg/ml/m2; 40.3% ; male, 64.8%; Caucasian, 76.2%; married, 58.9%; NYHA-FC III/IV, 30.9%) 21 (4.2%) died within 1 year after enrollment. Only 46% reported exercising at a moderate-vigorous level. Pt characteristics associated with mortality were older age (p=0.037), no one to confide in (p=0.046) and NYHA-FC (p=0.001). Of exercise factors, mortality was reduced in pts with higher knowledge about exercise expectations (p=0.019), higher value for being active (p=0.002) and exercising (p=0.007), longer 6MWT distance (p=0.005), higher exercise self-efficacy (p=0.033) and reports of exercising at a moderate-vigorous level compared with no-infrequent exercise patterns (p=0.036). Conclusion. Among stable, out-pts with HF, many exercise-related factors were associated with 1-year mortality. Healthcare providers need to clearly communicate the value of exercise, explain details of moderate-vigorous exercise expectations and develop processes to increase self-efficacy for exercise to promote moderate-vigorous exercise behaviors and ongoing adherence to exercise.
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- Alehagen, Urban, et al.
(författare)
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Are There Any Significant Differences Between Females and Males in the Management of Heart Failure? Gender Aspects of an Elderly Population With Symptoms Associated With Heart Failure
- 2009
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Ingår i: JOURNAL OF CARDIAC FAILURE. - : Elsevier BV. - 1071-9164. ; 15:6, s. 501-507
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Tidskriftsartikel (refereegranskat)abstract
- Background: An increasing interest has been shown in potential l., 11 With heart failure (HF), a serious condition for the individual. To evaluate whether there are any differences ill the prevalence of HF, cardiac function, biomarkers. and the treatment of HF with respect to gender. Methods and Results: All persons ages 70 to 80 in a rural municipality were invited to participate ill the project 876 persons accepted. Three cardiologists evaluated the patients including a new history, clinical examination. electrocardiogram, chest x-ray. blood samples. and Doppler echocardiography to assess both Systolic and diastolic function. The patients were followed during a mean period of 8 years. Conclusion: Females hypertension more frequently and included fewer smokers than their male Counterparts. A Female preponderance was seen in those with preserved systolic function. whereas males predominated among those with systolic dysfunction. During the follow-up period, 20% of the males and 14% of the females died of cardiovascular diseases. The results did not show any inferior treatment of females with HF. but it clearly was more difficult to correctly classify female patients presenting with symptoms of HE
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- Alehagen, Urban, et al.
(författare)
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Natriuretic Peptide Biomarkers as Information Indicators in Elderly Patients With Possible Heart Failure Followed Over Six Years : A Head-to-Head Comparison of Four Cardiac Natriuretic Peptides
- 2007
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Ingår i: Journal of Cardiac Failure. - : Elsevier BV. - 1071-9164 .- 1532-8414. ; 13:6, s. 452-461
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Tidskriftsartikel (refereegranskat)abstract
- Background: Little is known about the differences between natriuretic peptides used to evaluate elderly patients with heart failure. The aim of the study was to evaluate the information and the power to predict cardiovascular mortality derived from an analysis of cardiac natriuretic peptides from the same study population and at the same time. Methods and Results: In all, 415 elderly patients (age 65-82 years) in primary health care were evaluated and followed for 6 years. All patients had symptoms of heart failure and were examined by a cardiologist. An electrocardiogram and chest x-rays were taken, and the systolic and diastolic functions were assessed using Doppler echocardiography. Brain natriuretic peptide (BNP), N-terminal proBNP, atrial natriuretic peptide (ANP), and N-terminal proANP were analyzed. All 4 peptides were associated with age, and only 1 of them showed any gender difference. Three of the 4 peptides (not ANP) provided important information for identifying patients with impaired systolic function and diastolic dysfunction (pseudonormal or restrictive filling pattern), and for assessing the risk of cardiovascular death. Conclusions: Cardiac natriuretic peptides are useful tools for evaluating elderly patients with heart failure. Three of the 4 peptides were very similar. ANP exhibits inferior properties and cannot be recommended in clinical practice. © 2007 Elsevier Inc. All rights reserved.
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- Alehagen, Urban, et al.
(författare)
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Pro-A-Type Natriuretic Peptide, Proadrenomedullin, and N-Terminal Pro-B-Type Natriuretic Peptide Used in a Multimarker Strategy in Primary Health Care in Risk Assessment of Patients With Symptoms of Heart Failure
- 2013
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Ingår i: Journal of Cardiac Failure. - : Elsevier. - 1071-9164 .- 1532-8414. ; 19:1, s. 31-39
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Use of new biomarkers in the handling of heart failure patients has been advocated in the literature, but most often in hospital-based populations. Therefore, we wanted to evaluate whether plasma measurement of N-terminal pro B-type natriuretic peptide (NT-proBNP), midregional pro A-type natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM), individually or combined, gives prognostic information regarding cardiovascular and all-cause mortality that could motivate use in elderly patients presenting with symptoms suggestive of heart failure in primary health care. less thanbrgreater than less thanbrgreater thanMethods and Results: The study included 470 elderly patients (mean age 73 years) with symptoms of heart failure in primary health care. All participants underwent clinical examination, 2-dimenstional echocardiography, and plasma measurement of the 3 propeptides and were followed for 13 years. All mortality was registered during the follow-up period. The 4th quartiles of the biomarkers were applied as cutoff values. NT-proBNP exhibited the strongest prognostic information with andgt;4-fold increased risk for cardiovascular mortality within 5 years. For all-cause mortality MR-proADM exhibited almost 2-fold and NT-proBNP 3-fold increased risk within 5 years. In the 5-13-year perspective, NT-proBNP and MR-proANP showed significant and independent cardiovascular prognostic information. NT-proBNP and MR-proADM showed significant prognostic information regarding all-cause mortality during the same time. In those with ejection fraction (EF) andlt;40%, MR-proADM exhibited almost 5-fold increased risk of cardiovascular mortality with 5 years, whereas in those with EF andgt;50% NT-proBNP exhibited andgt;3-fold increased risk if analyzed as the only biomarker in the model. If instead the biomarkers were all below the cutoff value, the patients had a highly reduced mortality risk, which also could influence the handling of patients. less thanbrgreater than less thanbrgreater thanConclusions: The 3 biomarkers could be integrated in a multimarker strategy for use in primary health care. (J Cardiac Fail 2013;19:31-39)
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