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1
Williams, Michael Todd. "Heart Failure Readmission Strategy via Heart Failure Script." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4189.
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Hospital administrators strive to reduce readmission and over use of the acute care setting for chronic health conditions. Historically hospitals have focused on readmission prevention strategies to improve the transition of patients from the hospital to the community and although the causes of a hospital readmission may span multiple providers along the continuum of care, the hospital is currently the only provider being penalized. The project facility implemented a readmission reduction strategy, Re-Engineered Discharge (Project RED), as a means to reduce readmissions and yet continued to have high readmission rates for heart failure (HF) patients. The continued high rate of readmissions led to the practice focused question, which examined the process of developing a discharge phone call script specific for HF patients as a way to reduce readmissions for HF patients. Kristin Swanson's structure of caring model provided the nursing framework for this project with a purpose to plan a telephone call follow up program for HF patients after hospital discharge. The project planning was accomplished in conjunction with the facility's readmission reduction team/LEAN team, resulting in a script about the most prevalent issues among HF patients. Kotter's 8 step change model will be used as a guide for the implementation of the telephone call follow up program at a later date. Readmission rates for HF patients will be monitored monthly as an outcome evaluation measure. Project team members provided evaluation of the project which demonstrated satisfaction and success of the planning process. The results of this project will bring about social change by providing access to healthcare providers regardless the socioeconomic status of the patient and by decreasing the use of acute care setting unnecessarily for chronic conditions.
2
MacDonald, Michael Ross. "Diabetes and heart failure." Thesis, University of Aberdeen, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.540346.
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The aim of this thesis was to explore the relationship between diabetes and heart failure, particularly focusing on epidemiology, aetiology and treatment. I was granted access to a number of databases that included patients with both diabetes and heart failure. Chapter one is a systematic review of the literature and each subsequent chapter describes an analysis of the individual patient cohorts. Chapters two to five examine the association of diabetes with both short and long-term outcomes in populations with different types of heart failure: out-patients with chronic heart failure; acute heart failure; incident heart failure; and patients at high risk of heart failure following myocardial infarction. In the short-term, diabetes is not associated with increased mortality. It is, however, associated with an increased risk of heart failure. In the long-term, diabetes is associated with an increased risk of death and heart failure. The association of diabetes with prognosis is independent of age and co-morbidity. Chapter six examines the risk of unrecognised myocardial infarction in a diabetic cohort from the RECORD study. Unrecognised myocardial infarction may be an aetiological factor in the development of heart failure in diabetes. Chapter 7 is a case-control study of the GPRD cohort that examines the use of anti-diabetic treatments in patients with heart failure. Of all the treatments metformin was the only treatment associated with improved mortality. Diabetes and heart failure are so common and carry such a poor prognosis, when present together, that even a small advance in their treatment could result in considerable improvement in outcomes.
3
Elborn, Joseph Stuart. "Studies in heart failure." Thesis, Queen's University Belfast, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335936.
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Tan, Yu Ting. "Understanding diastolic heart failure." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4392/.
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Many patients who present with symptoms of heart failure are found to have a normal left ventricular ejection fraction and therefore were labelled as having “diastolic heart failure” implying that the underlying pathophysiology is due to diastolic dysfunction alone. However, using a combination of echocardiographical techniques, a variety of abnormalities were found including reduced longitudinal function, impaired left ventricular twist and torsional dyssynchrony in systole leading to reduced and delayed untwisting, impaired suction and reduced early diastolic left ventricular filling not fully compensated for in late diastole due to left atrial dysfunction. Furthermore in a group of subjects with treated hypertension, the most common risk factor for this form of heart failure, despite a normal resting echocardiogram, there were already substantial abnormalities of both systolic and diastolic function which were only apparent on exercise. Thus these studies have demonstrated that in heart failure with a normal ejection fraction, there are major abnormalities of systolic function especially torsion or twist, which impact on diastolic filling and that the condition is not due to diastolic dysfunction alone. In addition, these findings emphasise the importance of exercise echocardiography for diagnosis and detecting early left ventricular dysfunction before patients progress to developing heart failure.
5
O'Donnell, Johanna. "Predicting heart failure deterioration." Thesis, University of Oxford, 2017. http://ora.ox.ac.uk/objects/uuid:f7e51226-128b-44eb-8f6a-557f1d0c9a53.
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Chronic heart failure (HF) is a condition that affects more than 900,000 people in the UK. Mortality rates associated with the condition are high, with nearly 20% of patients dying within one year of diagnosis. Continuous monitoring and risk stratification can help identify patients at risk of deterioration and may consequently improve patients' likelihood of survival. Current repeated-measure risk stratification techniques for HF patients often rely on subjective perception of symptoms, such as breathlessness, and markers of fluid retention in the body (e.g. weight). Despite the common use of such markers, studies have shown that they offer limited effectiveness in predicting HF-related events. This thesis set out to identify and evaluate new markers for repeated-measure risk stratification of HF patients. It started with an exploration of traditional HF measurements, including weight, blood pressure, heart rate and symptom scores, and aimed to improve the performance of these measurements using a data-driven approach. A multi-variate model was developed from data acquired during a randomised controlled trial of remotely-monitored HF patients. The rare occurrence of HF-related adverse events during the trial required the developement of a careful methodology. This methodology helped identify the markers with most predictive ability, which achieved moderate performance at identifying patients at risk of HF-related adverse events, clearly outperforming commonly-used thresholds. Subsequently, this thesis explored the potential value of additional, accelerometer-derived physical activity (PA) and sleep markers. For this purpose, the ability of accelerometer-derived markers to differentiate between individuals with and without HF was evaluated. It was found that markers that summarise the frequency and duration of different PA intensities performed best at differentiating between the two groups and may therefore be most suitable for future use in repeated-measure applications. As part of the analysis of accelerometer-derived HF markers, a gap in the methodology of automated accelerometer processing was identified, namely the need for self-reported sleep-onset and wake-up information. As a result, Chapter 5 of this thesis describes the development and evaluation of a data-driven solution for this problem. In summary, this thesis explored both traditional and new, accelerometer-derived markers for the early detection of HF deterioration. It utilised sound methodology to overcome limitations faced by sparse and unbalanced datasets and filled a methodological gap in the processing of signals from wrist-worn accelerometers.
6
Huiskes, Bonita Louise. "Advanced heart failure in older women with heart failure and preserved systolic function." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3390049.
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Khand, Aleem U. "Arterial fibrillation and heart failure." Thesis, University of Glasgow, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.288911.
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8
Gwadry-Sridhar, Femida Guyatt Gordon Henry. "Educating patients with heart failure /." [Hamilton, Ont.] : McMaster University, 2005.
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9
Wrigley, Benjamin J. "Monocyte subsets in heart failure." Thesis, University of Leicester, 2013. http://hdl.handle.net/2381/28383.
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Introduction: Monocytes play important roles in inflammation, thrombosis, angiogenesis and tissue repair and may contribute to the pathophysiology of heart failure (HF). Functional diversity is likely to stem from the presence of three distinct monocyte subsets, defined by flow cytometry (FC) as CD14++CD16-CCR2+ (Mon1), CD14++CD16+CCR2+ (Mon2) and CD14+CD16++CCR2- (Mon3). The aims of this thesis were to study the following parameters in patients with ischaemic HF: 1) monocyte subset numbers, 2) monocyte subset expression of surface receptors for inflammation, angiogenesis, cell adhesion molecules (CAM) and tissue repair, 3) cross-talk between monocytes and platelets in the formation of monocyte-platelet aggregates (MPAs). Methods: Monocyte subsets were analysed by FC on venous blood samples at baseline in 51 patients admitted with acute HF (AHF), 42 with stable HF (SHF), 44 with stable coronary artery disease (CAD) without HF and 40 healthy controls (HC). Plasma levels of inflammatory cytokines were also measured by flow cytometric bead array technology. In AHF, additional longitudinal samples were taken at discharge and 3 months. Results: Compared to CAD controls, patients with SHF had higher counts of Mon2 and MPAs associated with Mon2, alongside increased expression of inflammatory markers and CAM receptors on Mon2. Compared to SHF, those with AHF had higher counts of Mon1, Mon2 and MPAs associated with Mon1 and Mon2. Patients with AHF also had increased expression of angiogenic receptors on Mon1 and increased expression of angiogenic receptors, scavenger receptors and CAM receptors on Mon2. After adjusting for confounders, counts of Mon2, MPAs associated with Mon2 and expression of VCAM-1R on Mon2 were associated with clinical outcomes in AHF. Conclusions: Differences in monocyte subset numbers and cell surface receptor expression are seen in patients with HF. Mon2 appears to have a prognostic role in patients with AHF, however larger studies are required to confirm these findings.
10
Narayan, Hafid. "Guanylin peptides in heart failure." Thesis, University of Leicester, 2013. http://hdl.handle.net/2381/28515.
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This study investigated the role of prouroguanylin (ProUGN) and proguanylin (ProGN), members of a novel class of peptides with natriuretic activity in heart failure (HF), a disorder of declining cardiac output associated with disturbed sodium and water homeostasis. The hypothesis was that ProUGN and ProGN activity is dysregulated in chronic and acute HF. Plasma ProUGN and ProGN were measured in 243 patients with chronic stable HF and plasma ProUGN and cGMP, an intracellular mediator of ProUGN activity, measured in 336 patients admitted to hospital with acute HF using immunoassays. ProUGN and cGMP levels were repeated in acute HF patients prior to discharge. The primary endpoints were all cause mortality, HF readmission and either outcome at 180 days. ProUGN and ProGN were significantly greater in patients with chronic HF compared to controls and inversely correlated with eGFR. ProUGN and ProGN were significantly greater in patients with hypertension and in those taking diuretics, with higher levels associated with increased severity of HF as assessed by NYHA class. In multivariate analysis, eGFR was the only independent predictor of plasma ProUGN and ProGN level. ProUGN and cGMP were significantly lower in patients with acute HF compared to in controls. Pre-discharge ProUGN and cGMP were significantly greater than at admission, with pre-discharge ProUGN significantly greater than in controls. Admission ProUGN was significantly greater in patients who died and a greater pre-discharge ProUGN was significantly associated with increased risk of early mortality. Pre-discharge cGMP levels were significantly lower in those readmitted with HF compared to those not, with higher levels significantly associated with reduced risk of early HF readmission. A greater pre-discharge ProUGN/cGMP ratio was significantly associated with increased risk of mortality or HF readmission. These results suggest that adverse outcomes in HF may be associated with hyporesponsiveness to ProUGN.
11
Cowburn, Pete James. "Endothelin and chronic heart failure." Thesis, University of Newcastle Upon Tyne, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324790.
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Cannon, Jane Ann. "Cognitive impairment in heart failure." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7839/.
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The clinical syndrome of heart failure is one of the leading causes of hospitalisation and mortality in older adults. Due to ageing of the general population and improved survival from cardiac disease the prevalence of heart failure is rising. Despite the fact that the majority of patients with heart failure are aged over 65 years old, many with multiple co-morbidities, the association between cognitive impairment and heart failure has received relatively little research interest compared to other aspects of cardiac disease. The presence of concomitant cognitive impairment has implications for the management of patients with heart failure in the community. There are many evidence based pharmacological therapies used in heart failure management which obviously rely on patient education regarding compliance. Also central to the treatment of heart failure is patient self-monitoring for signs indicative of clinical deterioration which may prompt them to seek medical assistance or initiate a therapeutic intervention e.g. taking additional diuretic. Adherence and self-management may be jeopardised by cognitive impairment. Formal diagnosis of cognitive impairment requires evidence of abnormalities on neuropsychological testing (typically a result ≥1.5 standard deviation below the age-standardised mean) in at least one cognitive domain. Cognitive impairment is associated with an increased risk of dementia and people with mild cognitive impairment develop dementia at a rate of 10-15% per year, compared with a rate of 1-2% per year in healthy controls. Cognitive impairment has been reported in a variety of cardiovascular disorders. It is well documented among patients with hypertension, atrial fibrillation and coronary artery disease, especially after coronary artery bypass grafting. This background is relevant to the study of patients with heart failure as many, if not most, have a history of one or more of these co-morbidities. A systematic review of the literature to date has shown a wide variation in the reported prevalence of cognitive impairment in heart failure. This range in variation probably reflects small study sample sizes, differences in the heart failure populations studied (inpatients versus outpatients), neuropsychological tests employed and threshold values used to define cognitive impairment. The main aim of this study was to identify the prevalence of cognitive impairment in a representative sample of heart failure patients and to examine whether this association was due to heart failure per se rather than the common cardiovascular co-morbidities that often accompany it such as atherosclerosis and atrial fibrillation. Of the 817 potential participants screened, 344 were included in this study. The study cohort included 196 patients with HF, 61 patients with ischaemic heart disease and no HF and 87 healthy control participants. The HF cohort consisted of 70 patients with HF and coronary artery disease in sinus rhythm, 51 patients with no coronary artery disease in sinus rhythm and 75 patients with HF and atrial fibrillation. All patients with HF had evidence of HF-REF with a LVEF < 45% on transthoracic echocardiography. The majority of the cohort was male and elderly. HF patients with AF were more likely to have multiple co-morbidities. Patients recruited from cardiac rehabilitation clinics had proven coronary artery disease, no clinical HF and a LVEF >55%. The ischaemic heart disease group were relatively well matched to healthy controls who had no previous diagnosis of any chronic illness, prescribed no regular medication and also had a LVEF >55%. All participants underwent the same baseline investigations and there were no obvious differences in baseline demographics between each of the cohorts. All 344 participants attended for 2 study visits. Baseline investigations including physiological measurements, electrocardiography, echocardiography and laboratory testing were all completed at the initial screening visit. Participants were then invited to attend their second study visit within 10 days of the screening visit. 342 participants completed all neuropsychological assessments (2 participants failed to complete 1 questionnaire). A full comprehensive battery of neuropsychological assessment tools were administered in the 90 minute study visit. These included three global cognitive screening assessment tools (mini mental state examination, Montreal cognitive assessment tool and the repeatable battery for the assessment of neuropsychological status) and additional measures of executive function (an area we believe has been understudied to date). In total there were 9 cognitive tests performed. These were generally well tolerated. Data were also collected using quality of life questionnaires and health status measures. In addition to this, carers of the study participant were asked to complete a measure of caregiver strain and an informant questionnaire on cognitive decline. The prevalence of cognitive impairment varied significantly depending on the neuropsychological assessment tool used and cut-off value used to define cognitive impairment. Despite this, all assessment tools showed the same pattern of results with those patients with heart failure and atrial fibrillation having poorer cognitive performance than those with heart failure in sinus rhythm. Cognitive impairment was also more common in patients with cardiac disease (either coronary artery disease or heart failure) than age-, sex- and education-matched healthy controls, even after adjustment for common vascular risk factors.
13
Khrebtiy, G. I. "Chronic heart failure (pathogenetic aspects)." Thesis, БДМУ, 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/17094.
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Wong, Chih Mun. "Heart failure in young adults." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/7336/.
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Heart failure (HF) is a major health concern affecting 15 million people in Europe and around 900 000 people in the U.K. HF predominantly affects the elderly, with the mean age of patients with a diagnosis of HF between 70 and 80 years. Most previous HF studies have accordingly focused on older patients. Although HF is less common in younger adults (< 65 years), 15% to 20% of patients hospitalised with HF are younger than 60 years of age. Very few studies have described the characteristics of younger adults with HF and its outcome. The aims of this thesis are to describe the clinical characteristics of younger adults with HF, explore the epidemiology of HF in younger adults and determine their short- and long-term outcomes. This was made possible by access multiple databases consisting of large patient cohorts with HF. The first chapter is a systematic literature review of younger adults with HF. Gaps in the current literature were identified and the thesis focused on some of these. The CHARM study allows detail characterisations of younger adults with HF. It recorded characteristics of patients with HF, including symptoms and signs of HF, electrocardiographic changes, chest radiographic findings, and also left ventricular ejection fraction. HF hospitalisations and its precipitating factors were also recorded systematically. Younger adults were more likely to have a third heart sound and hepatomegaly, but less likely to have pulmonary crackles and peripheral oedema. Similarly, radiological findings in younger adults were less likely to show interstitial pulmonary oedema or pleural effusion. Interestingly, younger adults aged < 40 years not only have similar HF hospitalisation rate to older patients, however during their presentation with decompensated HF, they were less likely to have clinical pulmonary oedema and radiological signs of HF. Physicians managing younger adults with HF need to be aware of this. Younger adults were also less compliant with medications and lifestyle restriction resulting in hospitalisation with decompensated HF. Fortunately, despite these challenges, mortality rates in younger adults with HF were lower compared to older patients. To further substantiate the findings from the CHARM study, the MAGGIC study, a meta-analysis consists of over 40 000 patients with HF from large observational studies and randomised controlled trials, was examined. In both databases, the commonest aetiology of HF in younger adults was dilated cardiomyopathy. The ejection fraction was the lowest in younger adults. Similar to the CHARM study, mortality rates in younger adults were lower compared to older patients. However, in the MAGGIC study, by stratifying mortality into patients with preserved ejection fraction and with reduced ejection fraction, younger patients with preserved ejection fraction have a much lower mortality rate compared to patients with reduced ejection fraction. Findings from clinical trials are not always reflective of the real life clinical practice. The U.K. Clinical Practice Research Datalink (CPRD), a large and well-validated primary care database with 654 practices contributing information into the database representing approximated 8% of the U.K. population, is a rich dataset offering a unique opportunity to examine the characteristics, treatments, and outcomes of younger adults with HF in the community. In contrast to the CHARM and MAGGIC studies, younger adults aged < 40 years were stratified into 20-29 and 30-39 years in the CPRD analysis. This is possible due to the larger number of younger adults with HF. Further stratifying the younger age groups demonstrated heterogeneity among younger adults with HF. In contrast to previous data showing younger adults have lower co-morbidities, the proportions of depression, chronic kidney disease, asthma, and any connective tissue disease were high among patients aged 20-29 years in the analysis from the CPRD. Surprisingly, the treatment rates for angiotensin converting enzyme (ACE) inhibitor, and aldosterone antagonist were the lowest in patients aged 20-29 years. With the exception of patients aged ≥80 years, treatment rate with beta-blocker was also the lowest in patients aged 20-29 years. With over two decades of follow up, long-term mortality rates in younger adults with HF can be determined. The mortality rates continued to decline from 1988 to 2011. Physicians managing younger adults with HF can now use this contemporary data to provide prognostic information to patients and their family. A hospital administrative database is the logical next platform to explore younger adults with HF. The Alberta Ministry of Health database links an outpatient database to a hospitalisation database providing ample data to examine the relationship between outpatient clinic visits and hospital admissions in younger adults with HF. Following a diagnosis of HF in the outpatient setting, younger adults were admitted to the hospital with decompensated HF much sooner than older patients. Younger adults also presented to emergency department more frequently following their first hospitalisation for HF. In conclusion, this thesis presented the characteristics and outcomes of younger adults with HF, and helped to extend our current understanding on this important topic. I hope the data presented here will benefit not only physicians looking after younger adults with HF, but also patients and their family.
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Damman, Kevin. "Cardiorenal interaction in heart failure." [S.l. : [Groningen : s.n.] ; University of Groningen] [Host], 2009. http://irs.ub.rug.nl/ppn/.
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Yao, Mu. "Study of mammalian heart failure." Thesis, The University of Sydney, 1997. https://hdl.handle.net/2123/27637.
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Heart failure is the end-stage of heart diseases. In this state the heart is unable to pump an adequate amount of blood to meet the metabolic requirement of the peripheral tissues. Heart failure is a complex clinical syndrome that can result from any heart disease. Clinically, it is manifested by cardiomegaly, breathlessness, and fluid retention. In spite of advances in
pharmacological treatment, it remains a highly disabling and lethal disorder. Until now, the mechanism underlying this syndrome remains obscure. The major focus of this study was to investigate this mechanism by analysis of both human and animal failing hearts.
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Shen, Li. "Sudden death and pump failure death in heart failure." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/8651/.
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Sudden death and pump failure death are two major modes of death in patients with heart failure and reduced ejection fraction (HF-REF) and in patients with heart failure and preserved ejection fraction (HF-PEF). There have been advances in evidence-based treatments in patients with HF-REF over the last two decades, along with the changing patient characteristics in both HF-REF and HF-PEF populations. It is of great interest and significance to discover if these changes have translated into temporal changes (and corresponding trends over time) in the risks of sudden death and pump failure death in both populations. Apart from examining any changes in the rates of mode-specific death in population level, it is also of interest and importance to estimate the risks for sudden death and pump failure death in individual patients. Accurate risk prediction can aid in better risk stratification. In patients with HF-REF, identifying high-risk subgroups would help target the device therapy to those most likely to benefit and identifying low-risk subgroups would avoid unnecessary implantation, thus improving the cost-effectiveness of the therapy. In patients with HF-PEF, identifying high-risk subgroups would enable further research into the efficacy of device therapy in this population. The aims of this work were to examine the trends in the rates of sudden death and pump failure death over time in patients with HF-REF and in patients with HF-PEF, and to separately develop validated models to predict sudden death and pump failure death in both populations. Given that there are limited data on mode-specific death from community-based studies, I used data from clinical trials which have more detailed and standardised sub-classification and adjudication of mortal events. Besides, compared to community-based studies, clinical trials have more detailed baseline characterisation, which allows more complete multivariable adjustment to account for confounding and between-study differences. Therefore, a cohort of 46,163 patients with HF-REF enrolled in 13 clinical trials conducted between 1995-2015 and a cohort of 10,517 patients with HF-PEF in 3 clinical trials over the period 1999-2013 were included in this thesis. Multiple linear regression analysis was used to examine the trends in the rates of sudden death and pump failure death over time in both populations respectively. The cumulative incidences for sudden death and pump failure death in each trial at different time points during follow-up were calculated with the cumulative incidence function method, counting the competing risk of death from other causes. The risk for each mode of death across trial arms and by HF duration was examined using the Cox regression models, with further adjustment for a number of confounding variables. The models to predict sudden death and pump failure death in patients with HF-REF were separately developed in PARADIGM-HF and validated in ATMOSPHERE. Models for both modes of death in HF-PEF were developed in I-PRESERVE and validated in CHARM-Preserved as well as TOPCAT. These models were constructed using a competing risk approach with the Fine-Gray sub-distributional hazards regression analysis. Model performance was examined by assessing calibration (i.e. the agreement between the observed and predicted cumulative incidences over time) and discrimination (i.e. the ability to separate patients at higher risk from those at lower risk). I found that the risks of sudden death and pump failure death in patients with HF-REF have fallen across 13 clinical trials over the period 1995-2015, consistent with a cumulative use of evidence-based therapies in this population. The absolute rates of sudden death and pump failure death were very low in the early follow-up after randomisation in patients with HF-REF who received modern evidence-based treatment. Longer standing HF was associated with greater risks of sudden death and, particularly, pump failure death in HF-REF. The risks of sudden death and pump failure death were consistently low across the 3 largest clinical trials in patients with HF-PEF, with little difference by experimental treatment in any trial. There was a downward trend in the rates of sudden death and pump failure death across these trials over time, in parallel with a changing characteristic of patients enrolled in these trials. Nevertheless, sudden death and pump failure death remained the most common modes of death, altogether accounting for the majority of CV death. The absolute rates of sudden death and pump failure death in patients with HF-PEF were extremely low in the early follow-up after randomisation. Longer standing HF was associated with a slightly higher risk of sudden death and a substantially higher risk of pump failure death in HF-PEF. The sudden death and pump failure death models in patients with HF-REF I developed in the largest and most contemporary cohort (PARADIGM-HF), included a number of variables collected in routine clinical practice, and accounted for the prognostic impact of the competing risk of death from other causes. The discriminating ability was modest for the sudden death model but excellent for the pump failure death model. Both models showed good calibration and were robust when externally validated in ATMOSPHERE. The prognostic models in patients with HF-PEF I developed in I-PRESERVE, using simple demographic and clinical variables, showed good discrimination and calibration for both sudden death and pump failure death, and were robust in external validation in CHARM-Preserved and TOPCAT. The performance of both models was further improved with the inclusion of NT-proBNP. In conclusion, I have found that the risks of sudden death and pump failure death have declined over time both in patients with HF-REF and in patients with HF-PEF based on clinical trial data. The patterns of change in the rates of both modes of death over time need to be examined in community-based populations. The prognostic models for both modes of death, showing reasonable performance, can be considered for use in risk stratification for mode-specific death in both populations, aiding in decision making in device therapy in similar patients in HF-REF and helping with patient selection for device interventions in future trials in HF-PEF.
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Pratt, Rebekah Janet. "Broken hearts and the heart broken : living with, and dying from, heart failure in Scotland." Thesis, University of Edinburgh, 2012. http://hdl.handle.net/1842/8273.
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Heart failure is a common and serious chronic condition, which can be as ‘malignant’ as most forms of cancer (Stewart, MacIntyre, Hole, Capewell, & McMurray, 2001). Recent estimates are that around 40,000 men and 45,000 women are living with heart failure in Scotland (Stewart, MacIntyre, Capewell, & McMurray, 2003). Heart failure is significantly influenced by socioeconomic factors, with people on lower incomes being more likely to develop, and die faster from, heart failure (McAlister et al, 2004). There is a growing body of research on the experience of living with heart failure, however, none provides serious consideration of the role of socioeconomic factors in impacting the experience of heart failure, and some qualitative research may actually obscure such factors. There were two main aims in this thesis. One was to explore how qualitative research methods can better consider the relationship between experience and broader context, such as the influence of socio-economic factors on health. The other aim was to examine the experiences of people as they live with and die from heart failure in ways that situate their accounts in the broader context of their lives. An initial research study, on which I was the main researcher, focused on the experiences of 30 people living with advanced heart failure. These people, their carers and key health professionals were interviewed, where possible, three times over a six months period. This thesis re-examines that study, focusing on 20 of those participants, for which a total of 122 interviews were conducted. I used a dialogical approach to see whether the socioeconomic context of heart failure for these respondents, could be captured through exploring experiences, performance, relationships, discourses and institutional practices, the social processes that mediate the relationship between socioeconomic disadvantage and chronic diseases were explored. This offers important learning in relation to the experience of living with heart failure, along with the experience of providing care. The findings highlight the need to broaden our view of chronic illness beyond biomedical approaches, and grow our methodological approaches along with that, in order to develop knowledge and practice that has relevance for people who live with and die from heart failure.
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Lee, Wing-luen. "Multidisciplinary cardiac program for patients with heart failure." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43251328.
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Balmain, Bryce. "Thermoregulatory function during exercise in the heat in heart failure." Thesis, Griffith University, 2018. http://hdl.handle.net/10072/381512.
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This thesis examined thermoregulatory responses in heart failure (HF) patients during
exercise at a fixed relative intensity, and at an intensity that elicited a fixed rate of
metabolic heat production (Hprod) in a warm environment (30°C). Additionally, the
efficacy of a chronic, high-dose (5mg/d for 6wk) pharmacological intervention (folic
acid supplementation) as a strategy for improving skin blood flow (SkBF) responses
and thus, thermoregulatory control in these patients during exercise was assessed. The
findings of three experiments conducted to achieve these aims are presented in this
thesis.
Experiment #1 was designed to compare thermoregulatory responses in HF and controls
(CON) during exercise in the heat. Ten HF (New York Heart Association [NYHA] class
I-II), and eight CON were included in the study. Core temperature (Tc), skin
temperature (Tsk), and cutaneous vascular conductance (CVC – and index of SkBF)
were assessed at rest and during one hour of cycling exercise at 60% of maximal
oxygen uptake. Hprod and the evaporative requirements for heat balance (Ereq) were also
calculated. Whole-body sweat rate (WBSR) was determined from pre-post nude body
mass corrected for fluid intake. While Hprod (HF: 3.9 ± 0.9; CON: 6.4 ± 1.5 W/kg) and
Ereq (HF: 3.3 ± 0.9; CON: 5.6 ± 1.4 W/kg) were lower (p < 0.01) for HF compared to
CON, both groups demonstrated a similar rise in Tc (HF: 0.9 ± 0.4; CON: 1.0 ± 0.3°C).
Despite this similar rise in Tc, Tsk (HF: 1.6 ± 0.7; CON: 2.7 ± 1.2°C), and the elevation
in CVC (HF: 1.4 ± 1.0; CON: 3.0 ± 1.2 au/mmHg) were lower (p < 0.05) in HF
compared to CON. Additionally, WBSR (HF: 0.36 ± 0.15; CON: 0.81 ± 0.39 L/h) was
lower (p = 0.02) in HF compared to CON; however, was similar when corrected for
differences in Ereq (p = 0.83). Collectively, these data suggest that patients with HF maybe limited in their ability to manage a thermal load and distribute heat content to the
body surface (i.e., skin), secondary to impaired circulation to the periphery.
Experiment #2 was designed to examine thermoregulatory responses in HF and CON
during exercise at a fixed rate of Hprod, and therefore Ereq, in a 30°C environment. A
total of 20 men; 10 HF and 10 CON similar in body size, were included in the study.
Rectal temperature (Trec), local sweat rate (LSR), and CVC were measured throughout
60-min of cycle ergometry. WBSR was estimated from pre-post nude body weight
corrected for fluid intake. Despite exercising at the same rate of Hprod (HF: 338 ± 43;
CON: 323 ± 31 W, p = 0.25), the rise in Trec was greater (p < 0.01) in HF (0.81 ±
0.16°C) than CON (0.49 ± 0.27°C). In keeping with a similar Ereq (HF: 285 ± 40; CON:
274 ± 28 W, p = 0.35), no differences in WBSR (HF: 0.45 ± 0.11; CON: 0.41 ± 0.07
L/h, p = 0.38) or LSR (HF: 0.96 ± 0.17; CON: 0.79 ± 0.15 mg/cm2
/min, p = 0.50) were
observed between groups. However, the rise in CVC was lower in HF than CON (HF:
0.83 ± 0.42; CON: 2.10 ± 0.79 au/mmHg, p < 0.01). Additionally, the cumulative body
heat storage estimated from partitional calorimetry was similar between groups (HF:
154 ± 106; CON: 196 ± 174 kJ, p = 0.44). Collectively, these findings demonstrate that
HF patients exhibit a blunted SkBF response, but no differences in sweating. Given that
HF had similar body heat storage to controls at the same Hprod, their greater rise in core
temperature can be attributed to a less uniform internal distribution of heat between the
body core and periphery.
In light of the findings of Experiments #1 and #2, Experiment #3 was subsequently
designed to examined the effect of folic acid supplementation (5mg/d for 6wk) on
vascular function (brachial artery flow-mediated dilation [FMD]), and SkBF responses
(CVC) during 60-min of exercise at a fixed Hprod (300 W) in a 30°C environment in 10
HF (NYHA class I-II) patients and 10 CON. Serum folic acid concentration increased in HF (pre-intervention: 1.4 ± 0.2; post-intervention: 8.9 ± 6.7 ng/ml, p = 0.01) and CON
(pre-intervention: 1.3 ± 0.6; post-intervention: 5.2 ± 4.9 ng/ml, p = 0.03). FMD
improved by 2.1 ± 1.3% in HF (p < 0.01), but no change was observed in CON postintervention (p = 0.20). During exercise, the external workload performed on the cycle
ergometer to attain the fixed level of Hprod for exercise was similar between groups (HF:
60 ± 13; CON: 65 ± 20 W, p = 0.52). Increases in CVC during exercise were similar in
HF (pre: 0.89 ± 0.43; post: 0.83 ± 0.45 au/mmHg, p = 0.80) and CON (pre: 2.01 ± 0.79;
post: 2.03 ± 0.72 au/mmHg, p = 0.73), although the values were consistently lower in
HF for both pre- and post-intervention measurement intervals (p < 0.05). Furthermore,
mean arterial pressure was similar in HF (pre: 98 ± 5; post: 94 ± 5 mmHg, p = 0.53) and
CON (pre: 102 ± 3; post: 100 ± 3 mmHg, p = 0.65), and no differences were observed
between groups during both exercise trials (all p > 0.05). These findings demonstrate
that folic acid improves vascular endothelial function in patients with HF, but does not
enhance SkBF during exercise at a fixed Hprod in a warm environment.
The work presented in this thesis serves to expand our current understanding of the
mechanisms responsible for impaired thermoregulatory control, particularly during
exercise in the heat, in patients with HF. Furthermore, whilst folic acid did not serve to
improve thermoregulatory SkBF during exercise in HF, folic acid improved vascular
endothelial function to a greater extent in HF than CON. These data indicate that while
folic acid does not alleviate the development of thermal strain during exercise in HF, its
utility as a viable treatment option for reducing and/or preventing disease-related
changes in vascular endothelial function in these patients warrants further investigation.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School Allied Health Sciences
Griffith Health
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Von, Lanzenauer Stephan Haehling. "Studies of immune function in chronic heart failure, inflammation in the progression of chronic heart failure." Thesis, Imperial College London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.516814.
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Berry, Renee A. "Learning needs of heart failure patients." Muncie, Ind. : Ball S[t]ate University, 2009. http://cardinalscholar.bsu.edu/694.
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Al-Nasser, Faisal. "Beta-blockers in chronic heart failure." Thesis, Imperial College London, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.406219.
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Davidoff, Allen Warren. "Congestive heart failure in the rat." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0022/MQ31340.pdf.
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Weernink, Corinne M. "Heart failure and respiratory muscle strength." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0001/MQ42222.pdf.
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Clark, Andrew Lawrence. "Exercise limitation in chronic heart failure." Thesis, Imperial College London, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.389907.
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Doehner, Wolfram. "Metabolic studies in chronic heart failure." Thesis, Imperial College London, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417893.
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Gupta, Sanjay. "Studies of diuretics in heart failure." Thesis, University of Manchester, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.538503.
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Oxberry, Stephen Grantley. "Opioids for breathlessness in heart failure." Thesis, University of York, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.550494.
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Breathlessness is a common and problematic symptom in heart failure. Opioids have traditionally been considered as analgesics, but a potential role for their use in breathlessness is beginning to emerge. This thesis commences with a review of the existing literature in support of a possible role for opioids in the management of breathless in heart failure. A systematic review of existing human symptom control studies in this thesis suggests that opioid administration may have a small but significant benefit in chronic heart failure. However, only six studies were included in the review and most were either small or of poor methodological quality. This presents a relative gap in the knowledge on this topic. A randomised controlled trial was therefore performed to assess the effect of opioids on breathlessness in chronic heart failure. This crossover trial involved the comparison of two oral opioids with placebo. Thirty-five participants completed the trial, making it the largest trial of its type in this area. Opioid administration was shown to be safe in this patient cohort. No statistically significant differences were demonstrated for breathlessness severity between treatments. Participants were subsequently invited to participate in a three month open label extension. Thirty three participants in total were followed up with thirteen remaining on active therapy. This is the first trial of its type in breathlessness in heart failure and represents the longest participant follow-up in this area. Whilst not as robust as the initial trial, this extension period revealed that opioid continuers rated a statistically significant improvement in breathlessness severity from baseline compared to non-continuers. Finally, a semi-structured interview study in ten participants with heart failure revealed for the first time that opioids are acceptable in this population and they describe troublesome symptoms that might respond to opioid treatment.
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Laoutaris, Ioannis. "Respiratory muscle training in heart failure." Thesis, University of Birmingham, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.446347.
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Witte, Klaus Karl August. "Exercise intolerance in chronic heart failure." Thesis, King's College London (University of London), 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.429606.
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Beadle, Roger. "Metabolic manipulation in chronic heart failure." Thesis, University of Aberdeen, 2013. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=201651.
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Treatments aimed at modifying cardiac substrate utilisation are designed to improve metabolic efficiency. In the fasting state, the heart mainly relies on fatty acid oxidation for its energy production. The heart can adapt to metabolise glucose, lactate and amino acids depending on the predominate milieu and demands placed upon it. A shift from fatty acid oxidation to carbohydrate oxidation leads to a lower oxygen consumption per unit of adenosine triphosphate produced. It is this concept of improving cardiac efficiency by a reduction in oxygen demand that underpins the use of metabolic manipulating agents as a therapeutic strategy in heart failure. Cardiac energy starvation is increasingly recognised as playing a central role in the pathophysiology of heart failure. Alterations in substrate utilisation thus underlie the hope that metabolic manipulating agents will be of benefit in heart failure of both ischaemic and non-ischaemic origin. This metabolic shift is achieved by promoting glucose utilisation and reducing the utilisation of fatty acids. This leads to a greater production of adenosine triphosphate per unit of oxygen consumed. With an ongoing demand for treatment options in ischaemic heart disease and the growing burden of chronic heart failure, new treatment modalities beyond contemporary therapy warrant consideration. This thesis aims to investigate the short term effects of metabolic manipulation on changes in cardiac energetic status, cardiac function, efficiency and substrate utilisation.
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Kiilavuori, Kai. "Physical training in chronic heart failure." Helsinki : University of Helsinki, 2000. http://ethesis.helsinki.fi/julkaisut/laa/kliin/vk/kiilavuori/.
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Jensen, Gwenneth Anne. "Outcomes of heart failure discharge instructions." Diss., University of Iowa, 2011. https://ir.uiowa.edu/etd/3318.
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Acute decompensation of chronic heart failure is common and results in many patients being re-hospitalized every year (Jancin 2008). One of four voluntary core measures deployed by the Joint Commission for evaluation of quality of heart failure care in hospitals is heart failure discharge instructions, also called core measure HF1. Although the core measure is a widely disseminated standardized measure related to discharge education, there is little evidence about its impact on patient or readmission outcomes. The purpose of this study was to determine the relationship between the completion of heart failure discharge instructions as defined by the Joint Commission core measure HF1 in a single site, 500 bed tertiary hospital population in the Upper Midwest and the primary endpoint of subsequent readmission to the hospital 30, 90, 180 and 365 days following an index discharge for primary diagnosis of heart failure. Secondary endpoints included hospital readmission charges and total hospital readmission days per year. Patient characteristics, clinical characteristics, unit factors and index visit utilization variables were controlled. This study also described the relationship between nursing unit factors and completion of HF1.
A retrospective, descriptive design, and analyses using primarily generalized linear models, were used to study the relationship of HF1 to utilization outcomes (readmission, hospital days and cost) and unit context (discharge unit and number of inter-unit transfers). Individual level retrospective demographic, clinical, administrative and performance improvement data were used (n = 1034). Results suggested a weak and non-significant association of completion of the core measure HF1 bundle and readmission within 30 days for all cause readmissions (p = .22; OR 1.32), and no association with HF to HF readmissions at 30 days. There was an inverse association
2
after 6 months for all cause readmission, and after 90 days for HF to HF readmission. There was a non-significant trend toward a relationship to total hospital days, but no relationship of HF1 to total annual charges. The study did find a significant relationship between type of discharge nursing unit and HF1 completion, and type of discharge unit and readmission. The discharge nursing unit was quite consistently and strongly related to all cause readmissions in binary (p = .029: OR 1.58) and counts analyses (p = .001; OR 1.52), but was not related to the subset of HF to HF readmissions. The study concludes that there is limited relationship between HF1 and 30 day all cause hospital readmission and total readmission days, but a stronger relationship between HF1 and discharge from a cardiology specialty unit. There was also a relationship between cardiology discharge unit and reduction in all cause readmissions.
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Wingham, Jennifer. "Living with heart failure : self management, informed support and the role of the heart failure specialist nurse." Thesis, Exeter and Plymouth Peninsula Medical School, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.553683.
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People with heart failure frequently experience poor quality of life, often exacerbated by co-morbidities. This demands complex self-management activities, often supported by family members in care roles, and includes input from community Heart Failure Specialist Nurses (HFSNs) that is known to reduce hospital readmissions. There is, however, a paucity of knowledge about the perceptions of people living with heart failure concerning self-management strategies. Aim This thesis is a longitudinal study exploring emergent patterns and styles of self- management of persons with heart failure, the impact of family members and HFSNs. Method Thirty-one theoretically sampled participants with heart failure were recruited from a district general hospital between October 2004 and September 2006. The sample participated in home-based, audio-taped, semi-structured interviews prior to nurse intervention, describing how heart failure affected their lives, focusing on self-management strategies. The HFSNs conducted home visits and telephone contacts according to individual needs independent of the research. At five months, 23 participants completed a diary for 14 days. Twenty- seven participants (three died, and one withdrew) were interviewed at six 3 months to explore how self-management strategies had changed. The HFSNs participated in a focus group. Constructivist grounded theory and reflexive accounting informed data collection and analysis, leading to the inductive development of an explanatory framework for emergent themes, one of which, Informed Support, serves as an original and significant contribution to the literature. Results Successful management is a complex biopsychosocial activity, involving reconstructions of identity, symptom management, and relationship management, while living with a chronic and uncertain condition that severely compromises life activities. Central to successful management is Informed Support, where family members collaboratively develop a range of activities and attributes to augment self-management. This was perceived as most effective when the HFSNs were able to adopt a 'whole family' approach. Conclusion Heart failure self-management is a dynamic, complex and adaptive activity that can be positively and significantly shaped by Informed Support from family members. Community based HFSNs can influence, but need to recognise differing styles of, self-management.
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Mbasu, Richard Juma. "Distinguishing heart failure with preserved ejection fraction from heart failure with reduced ejection fraction using proteomics techniques." Thesis, University of Leicester, 2016. http://hdl.handle.net/2381/39013.
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Heart failure is the second leading cause of morbidity and mortality in the world after cancer. In the UK, over 500,000 people are living with heart failure of which 30-40% die within 1 year of diagnosis. Some biomarkers for diagnosis and prognosis of heart failure have been established. However, they suffer from poor levels of accuracy and efficacy and their roles in clinical use is poorly understood. Thus, new biomarkers are needed. In this research, mass spectrometry based proteomics was used to profile patients plasma for clinical biomarker discovery due to its ability to perform both quantitative and qualitative protein profiling on clinical samples. Ninety samples from control, heart failure with preserved ejection fraction and heart failure with reduced ejection fraction subjects were used. Plasma protein profiling was performed using an optimised UPLC-IMS-DIA-MSE label free quantitation method. Bioinformatics analysis was used to analyse the changes observed in the protein profiles to identify potential biomarkers of heart failure. A novel method, termed mixed mode matrix was used for pilot study prior to main study with lipid removal agent. Samples were analysed using Waters Synapt G2S HDMS QToF mass spectrometer in triplicate on positive mode electrospray ionisation. Statistical comparisons of protein profiles was carried out using Progenesis LC-MS prior to data mining using SPSS, RapidMiner and SIMCA 14 to identify potential biomarkers. Thirty proteins were identified as potential biomarkers and shown to be involved in various pathophysiological processes leading to heart failure. ASL which plays role in nitrogen oxide production in the epithelium was upregulated in heart failure cohort. Conversely, GPX3 which scavenges free radicals in blood preventing apoptosis and necrosis of cells was downregulated in heart failure cohort. These two proteins were proposed as potential biomarkers for heart failure with preserved ejection fraction. Future studies to validate these biomarkers with the developed targeted LC-MS based MRM assay is needed.
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李詠鸞 and Wing-luen Lee. "Multidisciplinary cardiac program for patients with heart failure." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251328.
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Andersson, Johanna. "The Heart Companion: : Designing an empowering application for heart failure patients." Thesis, KTH, Medieteknik och interaktionsdesign, MID, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-173382.
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Healthcare practices are changing as focus shifts fromtreating acute illnesses to chronic diseases. Theresponsibility of managing the treatment has shifted fromhealthcare providers to the individual in a higher degree. Toachieve good treatment the patients need to be empoweredso that they understand their condition and can makeinformed choices throughout their self-care. A researchthrough design approach was used to investigate how todesign a personalized empowering application for heartfailure patients. Aside from information relating to thecondition, the themes of physical activity, dieting and socialconnectedness were identified as central to address for theempowerment of this group. Patients, partners andhealthcare providers contributed with different perspectivesthroughout the design process. As a result five personas,representing potential users, were developed. Based on thepersonas and knowledge of the domain, user scenarios incurrent- and preferred state were constructed in order toguide the design of the empowering application called ‘TheHeart Companion’. It is a tablet application catering to thedifferent needs of the personas that also addresses the threethemes relevant for empowerment. The purpose of theapplication is to facilitate better understanding, a feeling ofsafety and a more active empowered life for the patient.The application enables personalization of the content byproviding bookmarking and addresses empowerment ofphysical activity by enabling various guided exercisesessions, personalized feedback, the possibility of reflectionand construction of personalized exercise sessions.Sjukvårdens praxis förändras i takt med att fokus skiftar från behandling av akuta sjukdomar till kroniska sjukdomar. Ansvaret för behandling av kroniska sjukdomar har överförts från vårdgivare till att inbegripa individen till en högre grad. För att uppnå god behandling måste patienterna stärkas så att de förstår sitt tillstånd och kan fatta välgrundade beslut i sin egenvård. ’Research through design’ användes som metod för att undersöka hur en personifierad stärkande applikation för hjärtsviktspatienter kan utformas. Bortsett från information om tillståndet så identifierades fysisk aktivitet, kosthållning och social samhörighet som centrala teman att adressera för att stärka denna grupp. Patienter, partners och vårdgivare bidrog med olika perspektiv under designprocessen. Som ett resultat utav detta utvecklades fem personas för att representera potentiella användare. Baserat på personorna och kunskap om domänen så konstruerades användarscenarion i det nuvarande- samt det föredragna tillståndet för att vägleda designen av den stärkande applikationen som kallas Hjärtkompanjonen. Hjärtkompanjonen är en tablet-applikation som tillmötesgår de olika personornas behov och som även tar upp de tre teman som är relevanta att införliva för att stärka hjärtsviktspatienter. Syftet med applikationen är att åstadkomma bättre förståelse, en känsla av säkerhet och ett mer aktivt stärkt liv för patienten. Applikationen möjliggör personalisering av innehållet genom att tillhandahålla bokmärkning och adresserar hur en patient kan stärkas vid fysisk aktivitet genom att öppna upp för olika guidade träningspass, personlig feedback, möjligheter till reflektion samt konstruktion av personliga träningspass.
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Jones, David Gareth. "Interventional electrophysiology in advanced heart disease atrial fibrillation and heart failure." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/10946.
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The optimal therapy for atrial fibrillation (AF) associated with heart failure (HF) is unclear. Drug-based rhythm control has not proved clinically beneficial. Catheter ablation-based rhythm control improves cardiac function in HF patients, but impact on physiological performance has not been formally evaluated in a randomised trial. A randomised trial was designed and conducted, comparing catheter ablation with rate control in adults with symptomatic heart failure, radionuclide left ventricular ejection fraction (EF) ≤35%, and persistent AF. The primary outcome was change in peak oxygen consumption (VO2) at cardiopulmonary exercise test. Secondary endpoints included change in quality of life (Minnesota), 6-minute walk, BNP, and EF. Patients were followed-up for 12 months, and results analysed by intention-to-treat. 52 patients (63±9y, EF 24±8%, VO2 17.3±5.1ml/kg/min) were randomised, 26 to each arm. In the ablation arm, at 12 month follow up, 88% maintained SR, with a single procedure success of 69%. In the rate control arm, rate criteria were achieved in 96% at 12 months. At 12 months, peak VO2 had increased by 2.13 (95%CI -0.1 to 4.36) ml/kg/min in the ablation arm, compared with a decrease (-0.94ml/kg/min, 95%CI -2.21 to 0.32) under rate control: mean benefit of ablation +3.07ml/kg/min, 95% CI 0.56-5.59, p=0.018. The change appeared progressive, with a difference of only 0.79ml/kg/min at 3 months (95% CI -1.01 to 2.60, p=0.38). Compared with rate control, ablation reduced 12-month Minnesota score (p=0.019) and BNP (p=0.045), and showed trends toward increased 6 min walk distance (p=0.095) and EF (p=0.055). LA size fell significantly after ablation (p=0.001). Catheter ablation of persistent AF in patients with HF, with the ablation strategy achieving sinus rhythm in the majority, improves prognostically important objective cardiopulmonary exercise performance, symptoms and neurohormonal status. The effects are clear at 1 year but less distinct earlier, suggesting a period of cardiac remodelling and recovery.
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Strömberg, Anna. "Caring for patients with chronic heart failure : with focus on patient education and nurse-led heart failure clinics /." Linköping : Univ, 2001. http://www.bibl.liu.se/liupubl/disp/disp2001/med708s.pdf.
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Batbold, Dulguun. "Addressing the Hidden Heart Failure in Mongolia; a Proposal of Heart Failure Patient Education and Disease Management Program." Digital Archive @ GSU, 2013. http://digitalarchive.gsu.edu/iph_theses/280.
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The prevalence of heart failure became a major and growing public health problem globally, with rising mortality numbers causing a great financial burden. In Mongolia, the hospitalization for cardiovascular diseases makes up 55% of all hospitalizations, and mortality rate of circulatory diseases was the highest nationwide, accounting for 36.7% of all deaths (S.Ariuntuya et al., 2011). However, there is still no formal research addressing the prevalence of heart failure in Mongolia. Therefore, this paper is meant to bring awareness of the problem of hidden heart failure in Mongolia, which might be contributing significantly to the cardiovascular disease mortality and health care costs. This paper describes the Mongolian health care structure and the high incidence of heart failure risk factors is identified. Moreover, this paper proposes to develop and adapt a heart failure disease management program, as well as the heart failure patient education program in Mongolia. It is important that Mongolian health care providers and health policy makers acknowledge that if a proper disease management plan is not adapted soon, the prevalence of heart failure will continue to increase along with health care costs. Mongolia needs more public health and clinical researchers addressing heart failure.
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Bosco-Lévy, Pauline. "Heart failure in France : chronic heart failure therapeutic management and risk of cardiac decompensation in real-life setting." Thesis, Bordeaux, 2019. http://www.theses.fr/2019BORD0348.
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En France, environ un million de personnes seraient touchées par l’insuffisance cardiaque (IC) ; on recense près de 70 000 décès liés à l’IC, et plus de 150 000 hospitalisations et cela, malgré une prise en charge thérapeutique bien codifiée. Ces chiffres devraient s’accroitre dans les années futures du fait notamment du vieillissement de la population.L’objectif de ce travail était d’étudier l’utilisation des traitements pharmacologiques indiqués dans le traitement de l’IC (beta bloquant, inhibiteur de l’enzyme de conversion, anti-aldostérone, antagoniste des récepteurs à l’angiotensine II, diurétiques, digoxine, ivabradine) en situation réelle de soin, et d’identifier les facteurs cliniques ou pharmacologiques associés à la survenue d’un épisode de décompensation cardiaque.Un premier travail a permis de mesurer la fiabilité des bases de données médico-administratives françaises pour identifier des patients IC.Une deuxième étude a permis d’estimer que 17 à 37% de patients IC n’étaient exposés à aucun traitement de l’IC dans l’année suivant une première hospitalisation pour IC.Les troisième et quatrième parties de cette thèse ont mis en évidence qu’environ un quart des patients IC étaient réhospitalisés dans les 2 ans suivant une première hospitalisation. Les principaux facteurs cliniques prédictifs de cette réhospitalisation étaient l’âge, l’hypertension artérielle, la fibrillation auriculaire et le diabète. L’association retrouvée entre l’utilisation de fer bivalent et la réhospitalisation pour IC, souligne l’importance du risque lié à la présence d’une anémie ou d’une déficience en fer dans la survenue d’un épisode de décompensation cardiaque.Ces résultats permettent de reconsidérer la prise en charge thérapeutique chez les patients IC et mettent en avant la nécessité de renforcer la surveillance des patients les plus à risque de décompenser leur ICIn France, around one million persons would be affected by heart failure (HF); there are nearly 70 000 deaths related to HF and more than 150 000 hospitalizations despite a well defined treatment management. These numbers should increase in the next years due in particular to the ageing of the population.The objective of this work was to study the use of the pharmacological treatments indicated in HF (beta-blocker, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone antagonist, diuretics, digoxin, ivabradine) in real-world setting and to identify the clinical or pharmacological predictors associated with a new episode of cardiac decompensation.A first work has enabled to estimate the accuracy of French claims databases in identifying HF patients.A second study estimated that 17 to 37% HF patients were not exposed to any HF treatment in the year following an incident HF hospitalization.The third and fourth parts of this thesis showed that almost one forth of HF patients was rehospitalized within the 2 years following a first hospitalization. The main clinical predictors of rehospitalization were age, high blood pressure, atrial fibrillation and diabetes. The association found between bivalent iron use and HF rehospitalization underlines the importance of the risk related to anemia or iron deficiency in the occurrence of a cardiac exacerbation episode.These results allow to reconsider the treatment management of HF patients and highlight the need to reinforce the surveillance of patients with a highest risk of cardiac exacerbation
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Gusdal, Annelie K. "Family caregiving for persons with heart failure : Perspectives of family caregivers, persons with heart failure and registered nurses." Doctoral thesis, Mälardalens högskola, Hälsa och välfärd, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-35194.
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Heart failure is a growing public health problem associated with significant morbidity and mortality. Family support positively affects outcomes for the person with heart failure while also leading to caregiver burden. Registered nurses have a key role in supporting and meeting the needs of family caregivers. The overall aim was to explore the situation and needs of family caregivers to a person with heart failure, and explore requisites and ways of supporting and involving family caregivers in heart failure nursing care. Two interview studies, one web survey study and one intervention study were conducted between 2012 and 2017. A total of 22 family caregivers, eight persons with heart failure and 331 registered nurses participated in the studies. Family caregivers' daily life was characterized by worry, uncertainty and relational incongruence but salutogenic behaviours restored new strength and motivation to care. Family caregivers experienced that their caregiving was taken for granted by health care professionals. Family caregivers expressed a need for a permanent health care contact and more involvement in the planning and implementation of their near one’s health care together with health care professionals. Registered nurses acknowledged family caregivers’ burden, lack of knowledge and relational incongruence. A registered nurse was suggested as a permanent health care contact to improve continuity and security. Registered nurses neither acknowledged family caregivers as a resource nor their need for involvement. Registered nurses working in primary health care centres, in nurse-led heart failure clinics, with district nurse specialization, with education in cardiac nursing care held the most supportive attitudes toward family involvement in heart failure nursing care. Family health conversations via telephone in nurse-led heart failure clinics were found to successfully support and involve families. The conversations enhanced nurse-family relationship and relations within the family. They also provided registered nurses with new, relevant knowledge and understanding about the family as a whole. Family health conversations via telephone were feasible to both families and registered nurses, although fewer and shorter conversations were preferred by registered nurses. This thesis highlights the divergence between family caregivers’ experiences and needs, and registered nurses’ perceptions about family caregivers’ situation and attitudes toward the importance of family involvement. It adds to the knowledge on the importance to acknowledge family caregivers as a resource and to support and involve them in heart failure nursing care. One feasible and successful way is to conduct Family health conversations via telephone in nurse-led heart failure clinics.
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Smart, Neil Andrew. "Mechanisms of response to exercise training in heart failure /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe19281.pdf.
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Sörensen, Jens. "PET in Heart Failure - Methods and Applications." Doctoral thesis, Uppsala University, Clinical Physiology, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4654.
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Positron Emission Tomography (PET) permits regional myocardial perfusion, fibrosis and oxidative metabolism to be non-invasively quantified with radioactive tracers such as [15O]-water and [1-11C]-acetate. PET is an established research tool in congestive heart failure (CHF), a major cause of morbidity and mortality. However, as CHF is a syndrome that eventually affects all aspects of cardiac and systemic hemodynamic function, more clinically relevant information from a single PET scan is desirable. The aim of this thesis therefore was to develop and implement some new concepts in cardiac PET.
A new method for the measurement of cardiac output with any tracer was validated in animal experiments and CHF patients. The early pulmonary retention of [1-11C]-acetate was inversely related to left ventricular (LV) function in animals and was directly proportional to lung water content and severity of LV diastolic dysfunction in patients.
Eight patients with acute myocardial infarction were followed with serial PET from 3 hours to 3 weeks after trombolytic treatment. PET revealed that myocardial perfusion and the extraction and utilization of fuel substrates all decreased closer to the infarct centre. The rate of oxygen utilization within the infarct at 3 h predicted degree of myocardial fibrosis, pulmonary oedema and tissue viability at 3 weeks.
Seventeen patients with CHF due to chronic ischemic cardiomyopathy and severely reduced LV function were evaluated with [1-11C]-acetate PET before and after coronary artery bypass surgery. There was a dramatic improvement in physical performance and symptoms, which was not correlated to the standard LV ejection indices. PET revealed that functional improvement was associated with improved LV loading conditions, reversed remodeling and homogenization of oxidative metabolism rather than increased output.
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Davies, Lewis Ceri. "Cardiovascular control mechanisms in chronic heart failure." Thesis, Imperial College London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.397946.
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Hsiao, Lien-Cheng. "Cardiac stem cell therapy for heart failure." Thesis, University of Oxford, 2012. https://ora.ox.ac.uk/objects/uuid:c4fcb449-2d05-4dc6-9a8d-f7450c0b200c.
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Cardiovascular disease is a leading cause of death worldwide and becomes increasingly prevalent in the elderly population. Independent of etiopathogenesis, heart failure (HF) is the final common stage of numerous heart diseases. Cardiac stem cell (CSC) therapy has emerged as a promising cell-based strategy for treatment of HF. However, cell replacement is not able to fully restore a structurally damaged myocardium in advanced and end-stage HF. The objective of this project was to test the following hypotheses: that a bioengineered heart extracellular matrix (ECM) with preserved intact geometric structure could be generated using decellularization by coronary perfusion; and that autologous CSCs, to repopulate this ECM, could be isolated and expanded from the adult heart, with the caveat that autologous CSCs are depleted and impaired by both aging and chronic dilated cardiomyopathy. This will help to develop a possible therapeutic approach for advanced HF, using a combination of CSCs and engineering technique. Resident CSCs were isolated from explant-derived cells (EDCs) and expanded into cardiosphere-derived cells (CDCs) via cardiosphere formation. The CDCs expressed CSC markers (c-kit and Sca-1), pluripotent markers (Oct3/4 and Sox2), and the cardiac lineage-committed marker (Nkx2.5), and showed clonal expansion, self-renewal, and cardiomyogenic potential in vitro. In tissue engineering experiments, CDCs survived and proliferated within biomaterial alginate scaffolds for up to 7 weeks. An engineered bioartificial ECM scaffold was successfully produced from a whole rat heart using retrograde coronary perfusion and possessed an intact 3D architecture with functionally perfusable vascular network. Compared with ventricles, cultures derived from atria produced significantly higher number of c-kit+ and Sca-1+ CSCs (c-kit: 13% vs. 3.4%; Sca-1: 82% vs. 53%, respectively) and exhibited greater clonogenic and proliferative capacity. CDCs could be grown from young and aged mice, but the yield of CSCs significantly declined with age, as did cell migration and differentiation potential. In comparison to wild-type mice, atrial-CDCs from dystrophic mice showed no significant differences in CSC subpopulations and characteristics, despite confirmation of cardiac dysfunction using MRI. In conclusion, CDCs could be considered to be a viable cell candidate for cardiac therapy and may be used to treat HF at various stages, in combination with myocardial tissue engineering.
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Smith, Lindsay Anne. "Sleep-disordered breathing and chronic heart failure." Thesis, University of Edinburgh, 2009. http://hdl.handle.net/1842/29371.
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Methods: Patients with stable symptomatic chronic heart failure were screened for sleep-disordered breathing by home sleep study. Daytime sleepiness was assessed by Epworth Sleepiness Scale and heart failure severity by symptom class, left ventricular ejection fraction and serum N-terminal pro-brain natriuretic peptide concentrations. In a subset of patients, synchronous in-laboratory limited sleep studies and polysomonography, and home limited sleep studies, were performed prospectively. Patients with obstructive sleep apnoea and stable symptomatic chronic heart failure were randomised to nocturnal auto-titrating continuous positive airway pressure or sham for six weeks each in crossover design. Results: In the era of modern therapy, sleep-disordered breathing is common in patients with stable symptomatic chronic heart failure, predominantly obstructive in aetiology, without clear relationship to heart failure severity and is difficult to diagnose because of major overlap in symptomatology. Limited sleep studies compare well diagnostically to polysomnography when tested under identical patient and environmental conditions but less so when tested in the home setting. Auto-titrating continuous positive airway pressure improves daytime sleepiness is patients with obstructive sleep apnoea and chronic heart failure but not other subjective or objective measures of heart failure severity. Conclusions: Sleep-disordered breathing is difficult to detect clinically in patients with chronic heart failure, and as such, the diagnosis is reliant on accurate sleep studies. However, the clinical utility of limited sleep studies in detection and diagnosis of sleep-disordered breathing is restricted by a number of technical and situational factors which are exacerbated in patients with chronic heart failure. The potential therapeutic benefits of continuous positive airway pressure in patients with obstructive sleep apnoea and chronic heart failure are achieved by alleviation of obstructive sleep apnoea rather than by improvement in cardiac function.
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Murchie, Karen J. (Karen Jo) 1973. "Arterial function in hypertension and heart failure." Monash University, Faculty of Medicine, 2000. http://arrow.monash.edu.au/hdl/1959.1/8884.
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Ahlers, Belinda A. "Regulated L-Arginine transport in heart failure." Monash University, Faculty of Medicine, 2003. http://arrow.monash.edu.au/hdl/1959.1/9521.
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