Dissertations / Theses on the topic 'Heart risk'
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1
Bagés, Nuri. "Psychosocial risk factors and coronary heart disease." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 2000. http://arno.unimaas.nl/show.cgi?fid=6899.
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Freitag, Daniel Franz. "Inflammatory pathways and coronary heart disease risk." Thesis, University of Cambridge, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648461.
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Goncalves, Alexandra. "Alcohol Consumption and Risk of Heart Failure." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17613726.
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Aim: Alcohol is a known cardiac toxin and heavy consumption can lead to heart failure (HF). However, the relationship between moderate alcohol consumption and risk for HF, in either men or women, remains unclear.
Methods and results: We examined 14,629 participants of the Atherosclerosis Risk in Communities (ARIC) study (54±6 years, 55% women) without prevalent HF at baseline (1987-89) who were followed for 24±1 years. Self-reported alcohol consumption was assessed as the number of drinks/week (1 drink=14g of alcohol) at baseline, and updated cumulative average alcohol intake was calculated over 8.9±0.3 years. Using multivariable Cox proportional hazards models, we examined the relation of alcohol intake with incident HF and assessed whether associations were modified by sex. Overall, most participants were abstainers (42%) or former drinkers (19%), with 25% reporting up to 7 drinks per week, 8% reporting ≥7 to 14 drinks per week, and 3% reporting ≥14 to 21 and ≥ 21 drinks per week, respectively. Incident HF occurred in 1,271 men and 1,237 women. Men consuming up to 7 drinks/week had reduced risk of HF relative to abstainers (HR 0.80, 95% CI 0.68-0.94, p=0.006); this effect was less robust in women (HR 0.84, 95% CI 0.71-1.00, p=0.05). In the higher drinking categories the risk of HF was not significantly different from abstainers, either in men or in women.
Conclusion: In the community, alcohol consumption of up to 7 drinks/week at early-middle age is associated with lower risk for future HF, with a similar but less definite association in women than in men. These findings suggest that despite the dangers of heavy drinking, modest alcohol consumption in early-middle age may be associated with a lower risk of HF.
4
Ó, Hartaigh Bríain William-John. "Resting heart rate in cardiovascular ageing : from risk marker to risk factor." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4005/.
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An accumulation of epidemiological studies along with several lines of experimental research highlight sustained elevated resting heart rate as a significant predictor of cardiovascular morbidity and mortality. However, resting heart rate as a simple and inexpensive clinical parameter often remains overlooked by physicians. We therefore sought to raise awareness concerning the detrimental role of elevated resting heart rate in cardiovascular disease. Using three separate large prospective cohort studies, we examined the clinical importance of accelerated resting heart rate as a robust predictor of adverse cardiovascular prognosis. The current data supports the contention that a raised resting heart rate amplifies the risk of having several cardio-metabolic risk factors including type 2 diabetes mellitus, the metabolic syndrome, and increased pulse wave velocity. Resting tachycardia also appeared to increase the risk of cardiovascular mortality in otherwise healthy individuals, as well as negatively predicting outcome in patients already at-risk for the condition. Notably, we observed a strong synergistic effect between inflammatory activity and concurrent elevated resting heart rate among those who experienced a cardiovascular event. Overall, these findings underline the relevance of a high resting heart rate in the pathogenesis of atherosclerosis and in the clinical manifestations of cardiovascular mortality.
5
Ramsey, Priscilla W., and L. Lee Glenn. "Risk Factors for Heart Disease in Rural Appalachia." Digital Commons @ East Tennessee State University, 1998. https://dc.etsu.edu/etsu-works/7539.
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The objectives of the study were to identify which risk factors for heart disease were most prevalent in a poor, underserved, rural Appalachian county. A random sample of medical records was selected (n = 292) of adult men and women who participated in a countywide health care project. Data were obtained from a health risk appraisal questionnaire and other physical and demographic information and were analyzed using univariate and bivariate statistical procedures. The findings indicated that these rural Appalachian subjects had a significant number of heart disease risk factors: excessive smoking, lack of exercise, high fat diets, and abnormal serum lipid levels.
6
Woodside, Jayne Valerie. "Micronutrients in hyperhomocysteinaemia and cardiovascular risk." Thesis, Queen's University Belfast, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.388099.
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Streng, Vicki K. "CORONARY HEART DISEASE RISK STRATIFICATION IN FULL-TIME MIAMI VALLEY HOSPITAL EMPLOYEES." Wright State University / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=wright1165604997.
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Wu, Kelvin Kwan Hoe. "Gene-nutrient interactions and risk of coronary heart disease." Thesis, University of Cambridge, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.614117.
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Lo, Owen. "Heart data analysis, modelling and application in risk assessment." Thesis, Edinburgh Napier University, 2015. http://researchrepository.napier.ac.uk/Output/8833.
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The heart is a fundamental aspect of the human body. Significant work has been undertaken to better understand the characteristics and mechanisms of this organ in past research. Greater understanding of the heart not only provides advances in medicine but also enables practitioners to better assess the health risk of patients. This thesis approaches the study of the heart from a health informatics perspective. The questions posed in this thesis is whether research is capable of describing and modelling heart data from a statistical perspective, along with exploring techniques to improve the accuracy of clinical risk assessment algorithms that rely on this data. The contributions of this thesis may be grouped into two main areas: statistical analysis, modelling and simulation of heart data; and improved risk assessment accuracy of the Early Warning Score (EWS) algorithm using a quartile-based technique. Statistical analysis of heart data, namely RR intervals, contributes to more informed understanding of the underlying characteristics of the heart and is achieved using null-hypothesis testing through the Anderson-Darling (AD) test statistic. The modelling process of heart data demonstrates methodologies for simulation of this data type, namely individual distribution modelling and normal mixture modelling, and contributes to assessing techniques that are most capable of modelling this type of data. For improved accuracy on the EWS algorithms, a quartiles technique, inspired by anomaly-based intrusion detection systems, is presented which enables customisation of risk score thresholds for each patient defined during a training phase. Simulated heart data is used to evaluate the standard EWS algorithm against the quartile-based approach. The defined metric of accuracy ratio provides quantitative evidence on the accuracy of the standard EWS algorithm in comparison with the proposed quartile based technique. Statistical analysis in this thesis demonstrates that samples of heart data can be described using normal, Weibull, logistic and gamma distribution within the scope of two minute data samples. When there is strong evidence to suggest that RR intervals analysed fits a particular distribution, individual modelling technique is the ideal candidate whilst normal mixture modelling is better suited for long-term modelling, i.e. greater than two minutes of heart data. In comparative evaluation of the standard EWS algorithm and the quartile-based technique using modelled heart data, greater accuracy is demonstrated in the quartiles-based technique for patients whose heart rate is healthy, but outside the normal ranges of the general population.
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Spriggs, David Arthur. "Risk factors for stroke : a case-controlled study." Thesis, University of Newcastle Upon Tyne, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308766.
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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.
12
Weinstein, Patricia. "Awareness of Increased Risk for Heart Disease and Cardiovascular Risk Factors in Women with Systemic Lupus Erythematosus." Doctoral diss., University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2652.
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Women with systemic lupus erythematosus (SLE) develop cardiovascular disease (CVD) earlier and at a more accelerated rate compared to women without SLE. Many women with SLE are unaware of their increased risk despite years spent in the health care system, thus giving the atherogenic process time to accrue damage. Research has not explained fully why women with SLE are unaware of their increased risk for CVD or why awareness does not correspond to risk-educing behaviors. Stage theories of behavior like the Precaution Adoption Process Model (PAPM) propose that health behavior change proceeds through qualitatively different stages, and people at one stage face similar barriers before they can progress to the next. The Common Sense Model (CSM), a self-regulatory model of health behavior, explains the emotional and cognitive processes involved in progression from one stage to the next and the formation of a personal risk/illness representation. Combining the PAPM and CSM helps understand the relationship between risk perception and adoption of risk reducing behaviors. The specific aims of this study were to assess in women with SLE: (1) general knowledge of heart disease compared to women without SLE; (2) awareness of increased CVD risk and CVD risk factors; and (3) personal and healthcare system factors that influence awareness of increased CVD risk and adoption of risk reducing behaviors. Sixty women with SLE, 18 years of age or older, were recruited to participate in this descriptive study. Data included demographic information, self-report questionnaires (perceived CVD risk, CVD risk factors, depression, physical activity), body measures (height, weight, waist circumference, blood pressure), and blood samples for physiologic markers of traditional and novel CVD risk factors (glucose, insulin, lipoprotein lipids, creatinine, C-reactive protein, homocysteine, antiphospholipid antibodies). The Beck Depression Inventory-Primary Care and the Physical Activity Disability Survey were used to determine depression and activity level respectively. General knowledge of heart disease was assessed using the American Heart Association (AHA) National Survey on women's awareness of heart disease. Logistic regression was used to categorize participants into subgroups according to perceived risk and identify important factors that influenced their PAPM stage categorization. Women with SLE in this study were more aware of women's leading cause of death than United States women who responded to the 2006 AHA survey (73% v 57%), but fewer than 25% perceived themselves at increased CVD risk. Age was a significant predictor (p=0.05) for awareness of increased risk; younger age correlated with increased awareness. Most women received information about heart disease from public media. On average, women had 4 CVD risk factors, but they perceived they had only 2. The number of perceived risk factors predicted adoption of risk reducing behaviors (p=0.03). Women in this study with SLE underestimated their CVD risk factors and did not personalize their increased CVD risk. Healthcare providers' identification and discussion of CVD risk factors in women with SLE may enhance their risk awareness and the adoption of risk reducing behaviors. This information may contribute to the development of stage-matched interventions, a potentially more effective and efficient approach than a generic program of risk-reduction, especially in individuals with SLE who face the additional burden of a chronic illness.Ph.D.
School of Nursing
Other
Nursing PhD
13
Ashton, Emma Louise, and emma ashton@deakin edu au. "Effects of dietary constituents on coronary heart disease risk factors." Deakin University. School of Biological and Chemical Sciences, 2000. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20061207.153511.
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Coronary Heart Disease (CHD) is a major cause of death in Western countries. Mediterranean and Asian populations have a lower risk of death from CHD compared to Westernised population, as do vegetarian versus omnivorous populations. Dietary constituents of traditional diets consumed by these populations are thought to influence both the classical risk factors for CHD, and the more recently identified risk factors, such as oxidative modification of low density lipoprotein (LDL), LDL particle size, arterial compliance and haemostatic factors. The aim of this thesis was to examine the effects of several food components, particularly soybean and monounsaturated fat (MUFA), on CHD risk factors through 3 carefully controlled dietary interventions, and a cross-sectional study.
A randomised crossover dietary intervention study was conducted in 42 healthy males to investigate the effect on CHD risk factors of replacing lean meat with tofu, a soybean product regularly consumed by Asian populations, while controlling all other dietary factors. The tofu diet resulted in significantly lower total cholesterol and triacylglycerol levels compared to the lean meat diet, and LDL particles that were more resistant to in vitro oxidative modification. However, insulin, fibrinogen, factor VII, and lipoprotein (a) were not significantly different on the 2 diets.
A postprandial study was subsequently conducted to investigate any acute effects of a tofu test meal on the oxidative modification of LDL in 16 male subjects. There was no significant difference between the susceptibility of LDL to oxidative modification before and after the tofu meal.
Twenty eight healthy subjects completed a separate randomised crossover dietary intervention comparing a high MUFA fat diet, using an Australian high oleic sunflower oil, with a low fat, high carbohydrate diet on CHD risk factors. The high MUFA oil diet significantly increased high density lipoprotein cholesterol compared to the low fat diet as well as producing LDL that were more resistant to oxidative modification. Neither the size of the LDL particle nor arterial compliance were significantly different on the 2 diets.
Twelve matched pairs of vegetations and omnivores were also studies to compare the habitual diet of a low and higher risk population group, to compare their risk factors and identify dietary constituents that may explain the differences. The vegetarians consumed less saturated fat (SFA) and dietary cholesterol while consuming more polyunsaturated fat, dietary fibre and vitamin E compared to omnivores. The vegetarians had lower total cholesterol, LDL cholesterol and triacylglycerol levels compared to the omnivores and had LDL particles that were more resistant to in vitro oxidation.
These findings contribute to our knowledge about the dietary constituents that can alter some CHD risk factors in healthy subjects, and which could reduce the risk of developing CHD. Investigations in high risk groups might reveal even more benefits.
14
Stamp, Kelly D. "Advanced registered nurse practitioners' judgments of coronary heart disease risk." [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001811.
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Erdenebileg, Ariuntsatsral Ariunaa. "Is Maternal Headache a Risk Factor for Congenital Heart Disease?" Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/iph_theses/70.
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Congenital Heart Disease (CHD) is one of the most common birth defects. It is the single most modifiable cause of infant mortality under one year of age. Therefore, the causes of CHD have been extensively researched in the past but the etiology remains largely unknown. Environmental risks, particularly maternal risk factors for congenital cardiac malformation have been evaluated in the original BWIS previously. However, in this research we examined one of the additional risk factors. We sought to determine whether maternal headache during six months prior to conception and throughout gestation until birth is a risk factor for CHD in the BWIS dataset. Among 3274 singleton cases and 3519 controls, a maternal report of headache was found to be associated with a nearly 20% increase in the risk of a congenital heart defect (OR= 1.2 p=0.001). Moreover, any medications use for headache 1-6 months prior to conception increased the risk of abnormal cardiac development by 1.3 fold (OR = 1.3, p=0.0004). Aspirin or aspirin containing analgesics were found to increase the risk for CHD at the defined risk period. According to subgroup analysis, aspirin or aspirin containing analgesics and acetaminophen or acetaminophen containing analgesics were found to be the risk factor for CTD i.e. Conotruncal defects. Furthermore, aspirin or aspirin containing analgesics increased the risk for PVSD i.e. Peri-membranous Ventricular Defect in offspring when the mother uses these drugs 1-6 months prior to conception. Additionally, the risk for CVD i.e. critical valve disease were found to be increased when women were exposed to aspirin or aspirin containing analgesics during third trimester after pregnancy. In conclusion, maternal headache increased the risk for CHD by 20% and the use of headache medications specifically pain relievers during 1-6 months prior to conception modulated type of defect was observed.
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Aarabi, Mohsen. "Risk stratification of coronary heart disease in UK South Asians." Thesis, University of Sheffield, 2007. http://etheses.whiterose.ac.uk/6084/.
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It is clear that South Asians living in the West have substantially greater relative (coronary heart disease) CHD mortality and morbidity than the general population. Despite this current risk functions based on classical risk factors alone underestimate risk in non-diabetic South Asians. After reviewing the available literature for longitudinal studies exploring the relationship between South Asian ethnicity, as an independent factor, and CHD an adjustment factor suitable for use with the paper- based risk prediction functions was derived. The exploration of possible explanations for the excess risk identified dysglycaemia as one possible explain. Adding 10 years to age, although crude and based on the single prospective study, provides adequate sensitivity and specificity to take into account an "ethnicity factor" accounting for average excess risk in individual UK South Asians. Using this adjustment it was shown that more South Asian men and women, living in the UK, are candidates to receive lipid-lowering therapy for primary and secondary prevention than their Caucasian counterparts. Although the evidence base for a CVD risk estimation procedure in South Asians is slight it is better that they have their risk estimated, albeit with less precision, than be excluded. The present work provides a properly researched evidence base. Moreover, it provides its own very simple, but 1. practice acceptable, adjustment for currently used paper risk estimation tools. Acceptance of ant1hypertensives as a primary prevention treatment was looked at in the South Asians community. South Asians are at least equally accepting of treatment as Caucasians when given information about the personal impact of CVD and the effect and tolerability of antihypertensive treatment. With South Asians having a greater need and at least equal acceptance of preventive therapy, they should receive more such treatment. Current evidence suggests that this is not the case and targeted intervention may be needed. Further research is still required in many areas such as risk factors, risk estimation and recalibration, lifestyle intervention, and efficacy of preventive drug therapy in ethnic minorities. Because this population is at high risk, the benefits of appropriate research will also be high.
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Kunutsor, Setor Kwadzo. "Markers of liver dysfunction and risk of coronary heart disease." Thesis, University of Cambridge, 2014. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708216.
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Sarwar, Nadeem. "Emerging molecular and genetic risk factors for coronary heart disease." Thesis, University of Cambridge, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.611549.
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Sandridge, Amy Leona. "Risk factors for congenital heart defects in Saudi Arabian infants." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2007. http://researchonline.lshtm.ac.uk/1620411/.
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Two studies were undertaken. Firstly, congenital heart defect (CHD) data from the Saudi Arabian Congenital Heart Defects registry (CHD registry) were compared to data published by the Baltimore-Washington Infant Survey (BWIS) group and the European Surveillance of Congenital Anomalies registry (EUROCAT). Distributions of CHD diagnoses within the Saudi Arabian dataset (Riyadh region and Saudi Arabia as a whole) were similar to those from these more comprehensive efforts, providing evidence for the completeness and accuracy of the CHD registry, for Riyadh region in particular. Secondly, an unmatched case-control study of risk factors for all structural congenital heart defects in children resident in Riyadh, Saudi Arabia was undertaken. The primary exposure of interest was consanguinity up to and including third cousins. Incident cases were identified from the CHD Registry from June 1, 2002 to December 31, 2004. Controls were obtained from the Well Baby Clinic, Riyadh Anned Forces (Military) Hospital. Using a detailed and reverse translated questionnaire, a face to face interview was conducted with 235 case and 247 control mothers by research assistants fluent in the local dialect. Mothers were asked to consider their exposure to risk factors within the period of 3 months prior to and 3 months post conception. Consanguinity was collected by phylogram method. The majority of mothers were interviewed when the infant was less than one year of age. Analyses were conducted using four different case groups: all cases, isolated cardiac cases, and embryological earliest and latest cases. Twenty five percent of cases and controls were first cousins or closer. Sixteen percent of cases versus 13 percent of controls were first cousins once removed or equivalent and 12 percent of both cases and controls were second 01' third cousins. Consanguinity was not found to increase the risk of CHD in this population. The adjusted odds ratio for all cases was 1.0 (CI9S=O.7-1.7) and for isolated cardiac cases it was 1.2 (CI9S=O.7-2.0). Statistically significant associations were found for other exposures such as previous pregnancy losses, maternal age, multiplicity, maternal use of hair dyes and pesticides sprayed in the house, confirming findings from previous studies. It is unlikely that the findings for consanguinity can be explained by misclassification of exposure or, in the analysis of all cases, low statistical power.
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McCoy, Patience R. "Perceived versus actual risk of coronary heart disease in women." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2008. 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:3318517.
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Panahloo, Archia. "Plasminogen activator inhibitor-1 and cardiovascular risk." Thesis, University College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.286442.
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Phoku, Nkosinathi Terrence. "Cardiovascular risk factors among 15-20 years old rural subjects residing in Dikgale Demographic Surveillance Site (DDSS), Limpopo Province." Thesis, University of Limpopo (Turfloop Campus), 2013. http://hdl.handle.net/10386/1048.
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Thesis (M.Sc. (Chemical Pathology) --University of Limpopo, 2013Cardiovascular diseases (CVDs) are among one of the well documented conditions and pose a significant health burden in the world as they areconsidered to be of adult onset. However, recent studies have shown that in developed countries CVD risk factors are becoming prevalent in young people which isof great concern. Therefore, the aim of this study was to determine if CVD risk factors are present in young subjects aged 15-20 years of age residing in a rural area of a developing country. Methods: Subjects aged between 15-20 years who participated in the “Gene - Environment interaction project” were included in this sub-study. Total cholesterol, triglycerides, HDL-cholesterol, LDLcholesterol, insulin, glucose, creatinine, Lp(a), apoB, apoA-1 and hs-CRPwere determined. Blood pressure, physical activity (number of steps/day), weight, height, waist circumference and hip circumference were obtained from the database. Subjects with CRP levels above 10mg/L and creatinine levels above 130 mmol/L were excluded. Results: The present study showed an overall high prevalence of some CVD risk factors. There was high prevalence of insulin resistance (23.0% in females and 34.7% in males), and high hs-CRP (18.4% in females, 12.9% in males). The prevalence of low HDL-C levels was high (55.2% in females and 16.8 % in males), however, the prevalence of abnormal levels of other lipids such as total cholesterol/HDL-cholesterol ratio was low in both males and females. The prevalence of an increased apoB/apoA ratio was significantly higher in females 26.4% compared to males 7.9%. The prevalence of overweight (12.6%) and obesity (9.2%) was higher in females than in males (overweight 1%, obesity 0 %). The prevalence of hypertension was comparable between the two genders (5.7% in females and 10.9 % in males). Conclusion: The results showed a relatively high prevalence of non-traditional risk factors for cardiovascular diseases in adolescents residing in a rural area, Limpopo Province, while the prevalence of traditional risk factors such as total cholesterol and triglycerides was low.
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Lo, Ling-fun, and 盧玲芬. "Cardiac risk factors in Hong Kong adults." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B25797463.
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Abstract
Many studies have been conducted in Caucasian populations on the optimal body mass index cut-off for obesity, as well as the relationship between body mass index and percentage body fat and their associations with cardiovascular risk factors. However, few studies of this kind have been conducted in the Hong Kong Chinese population, This research is deemed to be important due to ethnic differences between Asians and Caucasians, Therefore, this dissertation aims to determine any ethnic differences from a sample of the local Hong Kong Chinese population, in order to advance health care policies controlling known cardiovascular risk factors.
A total of 800 subjects were randomly selected from a pool of subjects participated in a Hong Kong Cardiovascular Risk Factor Prevalence study conducted in 1994-1996. These subjects were contacted and 453 disease-free subjects (210 males and 243 females) consented to participate in the current study, Data collected included serum and blood pressure measurements, body mass index, percentage body fat measured by bioelectrical impedance analysis, and a self-completed cardiovascular risk factor questionnaire,
The mean age of the 453 subjects was 51.64 years (SD=12.3). When obesity was defined as percentage body fat ~ 25 and 2: 30 in males and females respectively, 23 kg/m2 was found to be the optimum cut-off value, with 78% correct classification (95% CI = 69%-87%). The corresponding sensitivity and specificity were 88% (95% CI = 81 %-95%) and 67% (95% CI = 57%-77%) respectively. On the other hand, if obesity was defined as percentage body fat ~ 25 and 2: 35 in males and females respectively, then 25 kg/m2 was found to be the best cut-off value with 82% correct classification
(95% CI = 74%-90%). The corresponding sensitivity and specificity were 78% (95% CI = 69%-87%) and 85% (95% Cl = 78%-92%) respectively.
Moreover, body mass index was found to be quadratically body fat. The quadratic relationship did not appear two genders, except that the percentage body fat of of females by 9.97 (SE=0.33).
Finally, except for total cholesterol, high density lipoprotein cholesterol, and fasting glucose, body mass index did not provide any substantial information additional to percentage body fat on serum and blood pressure measurements. was the only measure on which percentage body fat did additional to body mass index. When waist-hip body mass index and percentage body fat,. except for
body mass index did not have additional information on measurements when percentage body fat or/and
[n conclusion, the optimal body mass index cut-off for obesity in Hong Kong Chinese was lower than the 30kg/m2 recommended by the World Health Organization, a clear reflection of ethnic difference between Asians and Caucasians. The quadratic relationship between percentage body fat and body mass index was similar in Hong Kong Chinese as in Caucasians and Blacks. Moreover, percentage body fat together with waist-hip-ratio were found to be better indicators of cardiovascular risk factors in Hong Kong. This was the first time such findings were found in the Hong Kong Chinese population.
IIabstract
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Medical Sciences
Master
Master of Medical Sciences
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Pikkujämsä, S. (Sirkku). "Heart rate variability and baroreflex sensitivity in subjects without heart disease:effects of age, sex and cardiovascular risk factors." Doctoral thesis, University of Oulu, 1999. http://urn.fi/urn:isbn:9514252276.
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Abstract
Healthy subjects show wide interindividual variation in their
heart rate behavior, but the factors affecting heart rate dynamics
are not well known. This research was undertaken to evaluate heart
rate variability (HRV) and baroreflex sensitivity (BRS) in a large
random sample of subjects without evidence of heart disease, and
to estimate the relation of heart rate behavior to age, sex and
cardiovascular risk factors.
Short-term HRV was analyzed from 15-minute periods of standardized
recording in supine and upright positions using time and frequency
domain measures, and BRS was calculated using the Valsalva maneuver
in an original randomly selected population of 600 hypertensive
and 600 control middle-aged subjects. In addition, HRV was analyzed
from the same segments using new measures based on fractals and
complexity (chaos theory) of R - R interval dynamics in
the same random population, and from 24-hour period in 114 healthy
subjects aged from 1 to 82 years.
Large interindividual variation was observed in the measures
of HRV and BRS in middle-aged subjects; coefficient of variation
(CV) of the standard deviation of R - R intervals (SDNN)
39% (54 ± 21 ms) and CV of BRS 49% (9.9 ± 4.9
ms/mmHg). In healthy middle-aged men, SDNN was weakly related
to age (r = -0.19, p < 0.01),
HDL cholesterol (0.19, p < 0.01), serum
insulin (-0.23, p < 0.001) and triglyceride
(-0.25, p < 0.001) levels.
In women, SDNN was only related to insulin levels (r = -0.23,
p < 0.001). BRS was related to systolic
blood pressure (r = -0.31 and -0.30,
in men and women respectively, p < 0.001
for both) and blood glucose (r = -0.25,
p < 0.01) and serum insulin levels (r = -0.34,
p < 0.001) in women. Lesser intersubject
variation was observed in the non-linear measures of HRV; CV 14% of
short-term scaling exponent (a1), a measure of fractal-like correlation
properties of HRV, (1.21 ± 0.17) and
CV 12% of approximate entropy, a measure of complexity,
(1.13 ± 0.14). Neither a1 or ApEn was
related to any risk factors. Women had lower overall short-term
HRV (p < 0.01) and BRS (p < 0.001),
but a higher spectral high-frequency component of HRV, higher ApEn
and lower a1 (p < 0.001 for all) compared
to men. The impairment in overall HRV was confined to the hypertensive
subjects with metabolic features of the insulin resistance syndrome
(IRS, n = 69), but the BRS and spectral
high-frequency component were also impaired in hypertensive subjects
without IRS compared to normotensive subjects. The 24-hour cardiac
interbeat interval dynamics changed markedly from childhood to
old age. Children showed similar complexity and fractal correlation
properties of R - R intervals as young adults. Healthy aging
resulted in R - R interval dynamics with higher regularity
and predictability and altered fractal scaling.
The traditional measures of HRV and BRS are weakly related
to many cardiovascular risk factors in subjects without heart disease,
but the interindividual variation of HRV and BRS is only partly
explained by these factors, suggesting a genetic background of
the intersubject variation in cardiovascular autonomic regulation.
The new dynamical measures of HRV show less interindividual variation
than the conventional measures of HRV in healthy subjects and are
not related to cardiovascular risk variables, suggesting that these
dynamical measures quantify the "intrinsic" capacity of a healthy
cardiovascular control system without the significant influence
of life-style, metabolic or demographic variables. However, there
are sex and age-related differences also in the fractal and complexity
measures of heart rate behavior.
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Smith, William Cairns Stewart. "An epidemiological study of coronary heart disease and its risk factors in Scotland : the Scottish Heart Health Study." Thesis, University of Dundee, 1989. https://discovery.dundee.ac.uk/en/studentTheses/63823b71-1377-4e78-bc4b-4c662c58a289.
Full textAbstract:
The Scottish Heart Health Study was conducted in response to a report by a Working Group of the Chief Scientist Organisation and followed an initial of the Cardiovascular Epidemiology Unit. The aims of the study were to establish the levels of coronary risk factors in Scotland, to determine the extent to which these risks factors explained the geographical variation in coronary heart disease, and their relative contribution to the prediction of coronary heart disease in a cohort of men and women.The Scottish Heart Health Study is a study of lifestyle and coronary heart disease risk factors in 10 359 men and women aged 40-59 years, in 22 districts of Scotland. The study was conducted in 1984-86, when Scotland had the highest national coronary mortality reported by the World Health Organisation. The study employed standardised methods emphasing quality e4 control based on a World Health Organisation protocol to allow comparisons in place and time, and therefore to provide a definitive baseline against which interventions can be assessed. The cross sectional aspect of the study has been analysed and addresses the first two study objectives. The third objective will only be achieved when sufficient prospective coronary events have occurred.Current cigarette smokers constitute 39% of men and 38% of women, higher levels than those reported in England but lower than previous Scottish reports. Considerable variation in smoking was noted across the study districts from 29% to 52% in men. Mean blood pressure levels were 134/84 mmHg for men and 131/81 mmHg in women, these levels are lower than previous studies in Britain and there was a narrow range of levels across the districts. Mean levels of blood cholesterol were 6.4 mmol/l in men and 6.6 mmol/l in women - as high as other British studies and high by international standards. There was little geographical variation in blood cholesterol noted.High levels of blood cholesterol and cigarette smoking provide a classical explanation for the excess coronary deaths in Scotland, justifying action, but other factors, such as dietary deficiencies, also merit further investigation. The geographical variation in coronary mortality can best be explained by a group of risk factors which all show a social gradient and these include cigarette smoking, physical activity, blood pressure, and the consumption of alcohol, fruit and green vegetables.
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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.
Full textAbstract:
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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Van, Zyl Johet Engela. "Accuracy of risk prediction tools for acute coronary syndrome : a systematic review." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/97069.
Full textAbstract:
Thesis (MCur)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Background: Coronary artery disease is a form of cardiovascular disease (CVD) which manifests itself in three ways: angina pectoris, acute coronary syndrome and cardiac death. Thirty-three people die daily of a myocardial infarction (cardiac death) and 7.5 million deaths annually are caused by CVD (51% from strokes and 45% from coronary artery disease) worldwide. Globally, the CVD death rate is a mere 4% compared to South Africa which has a 42% death rate. It is predicted that by the year 2030 there will be 25 million deaths annually from CVD, mainly in the form of strokes and heart disease. The WHO compared the death rates of high-income countries to those of low- and middle-income countries, like South Africa, and the results show that CVD deaths are declining in high-income countries but rapidly increasing in low- and middle-income countries. Although there are several risk prediction tools in use worldwide, to predict ischemic risk, South Africa does not use any of these tools. Current practice in South Africa to diagnose acute coronary syndrome is the use of a physical examination, ECG changes and positive serum cardiac maker levels. Internationally the same practice is used to diagnose acute coronary syndrome but risk assessment tools are used additionally to this practise because of limitations of the ECG and serum cardiac markers when it comes to NSTE-ACS. Objective: The aim of this study was to systematically appraise evidence on the accuracy of acute coronary syndrome risk prediction tools in adults. Methods: An extensive literature search of studies published in English was undertaken. Electronic databases searched were Cochrane Library, MEDLINE, Embase and CINAHL. Other sources were also searched, and cross-sectional studies, cohort studies and randomised controlled trials were reviewed. All articles were screened for methodological quality by two reviewers independently with the QUADAS-2 tool which is a standardised instrument. Data was extracted using an adapted Cochrane data extraction tool. Data was entered in Review Manager 5.2 software for analysis. Sensitivity and specificity was calculated for each risk score and an SROC curve was created. This curve was used to evaluate and compare the prediction accuracy of each test. Results: A total of five studies met the inclusion criteria of this review. Two HEART studies and three GRACE studies were included. In all, 9 092 patients participated in the selected studies. Estimates of sensitivity for the HEART risks score (two studies, 3268 participants) were 0,51 (95% CI 0,46 to 0,56) and 0,68 (95% CI 0,60 to 0,75); specificity for the HEART risks score was 0,90 (95% CI 0,88 to 0,91) and 0,92 (95% CI 0,90 to 0,94). Estimates of sensitivity for the GRACE risk score (three studies, 5824 participants) were 0,03 (95% CI0,01 to 0,05); 0,20 (95% CI 0,14 to 0,29) and 0,79 (95% CI 0,58 to 0,93). The specificity was 1,00 (95% CI 0,99 to 1,00); 0,97 (95% CI 0,95 to 0,98) and 0,78 (95% CI 0,73 to 0,82). On the SROC curve analysis, there was a trend for the GRACE risk score to perform better than the HEART risk score in predicting acute coronary syndrome in adults. Conclusion: Both risk scores showed that they had value in accurately predicting the presence of acute coronary syndrome in adults. The GRACE showed a positive trend towards better prediction ability than the HEART risk score.
AFRIKAANSE OPSOMMING: Agtergrond: Koronêre bloedvatsiekte is ‘n vorm van kardiovaskulêre siekte. Koronêre hartsiekte manifesteer in drie maniere: angina pectoris, akute koronêre sindroom en hartdood. Drie-en-dertig mense sterf daagliks aan ‘n miokardiale infarksie (hartdood). Daar is 7,5 miljoen sterftes jaarliks as gevolg van kardiovaskulêre siektes (51% deur beroertes en 45% as gevolg van koronêre hartsiektes) wêreldwyd. Globaal is die sterfte syfer as gevolg van koronêre vaskulêre siekte net 4% in vergelyking met Suid Afrika, wat ‘n 42% sterfte syfer het. Dit word voorspel dat teen die jaar 2030 daar 25 miljoen sterfgevalle jaarliks sal wees, meestal toegeskryf aan kardiovaskulêre siektes. Die hoof oorsaak van sterfgevalle sal toegeskryf word aan beroertes en hart siektes. Die WHO het die sterf gevalle van hoeinkoms lande vergelyk met die van lae- en middel-inkoms lande, soos Suid Afrika, en die resultate het bewys dat sterf gevalle as gevolg van kardiovaskulêre siekte is besig om te daal in hoe-inkoms lande maar dit is besig om skerp te styg in lae- en middel-inkoms lande. Daar is verskeie risiko-voorspelling instrumente wat wêreldwyd gebruik word om isgemiese risiko te voorspel, maar Suid Afrika gebruik geen van die risiko-voorspelling instrumente nie. Huidiglik word akute koronêre sindroom gediagnoseer met die gebruik van n fisiese ondersoek, EKG verandering en positiewe serum kardiale merkers. Internationaal word die selfde gebruik maar risiko-voorspelling instrumente word aditioneel by gebruik omdat daar limitasies is met EKG en serum kardiale merkers as dit by NSTE-ACS kom. Doelwit: Die doel van hierdie sisematiese literatuuroorsig was om stelselmatig die bewyse te evalueer oor die akkuraatheid van akute koronêre sindroom risiko-voorspelling instrumente vir volwassenes. Metodes: 'n Uitgebreide literatuursoektog van studies wat in Engels gepubliseer is was onderneem. Cochrane biblioteek, MEDLINE, Embase en CINAHL databases was deursoek. Ander bronne is ook deursoek. Die tiepe studies ingesluit was deurnsee-studies, kohortstudies en verewekansigde gekontroleerde studies. Alle artikels is onafhanklik vir die metodologiese kwaliteit gekeur deur twee beoordeelaars met die gebruik van die QUADAS-2 instrument, ‘n gestandaardiseerde instrument. ‘n Aangepaste Cochrane data instrument is gebruik om data te onttrek. Data is opgeneem in Review Manager 5.2 sagteware vir ontleding. Sensitiwiteit en spesifisiteit is bereken vir elke risiko instrument en ‘n SROC kurwe is geskep. Die SROC kurwe is gebruik om die akkuraatheid van voorspelling van elke instrument te evalueer en te toets. Resultate: Twee HEART studies en drie GRACE studies is ingesluit. In total was daar 9 092 patiente wat deelgeneeem het in die gekose studies. Skattings van sensitiwiteit vir die HEART risiko instrument (twee studies, 3268 deelnemers) was 0,51 (95% CI 0,47 to 0,56) en 0,68 (95% CI 0,60 to 0,75) spesifisiteit vir die HEART risiko instrument was 0,89 (95% CI 0,88 to 0,91) en 0,92 (95% CI 0,90 to 0,94). Skattings van sensitiwiteit vir die GRACE risiko instrument (drie studies, 5824 deelnemers) was 0,28 (95% CI 0,13 to 0,53); 0,20 (95% CI 0,14 to 0,29) en 0,79 (95% CI 0,58 to 0,93). Die spesifisiteit vir die GRACE risiko instrument was 0,97 (95% CI 0,95 to 0,99); 0,97 (95% CI 0,95 to 0,98) en 0,78 (95% CI 0,73 to 0,82). Met die SROC kurwe ontleding was daar ‘n tendens vir die GRACE risiko instrument om beter te vaar as die HEART risiko instrument in die voorspelling van akute koronêre sindroom in volwassenes. Gevolgtrekking: Altwee risiko instrumente toon aan dat albei instrumente van waarde is. Albei het die vermoë om die teenwoordigheid van akute koronêre sindroom in volwassenes te voorspel. Die GRACE toon ‘n positiewe tendens teenoor beter voorspelling vermoë as die HEART risiko instrument.
28
Ingelsson, Erik. "Insulin Resistance and Inflammation as Risk Factors for Congestive Heart Failure." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5879.
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Harris, Christopher Peter David. "Lipoprotein quality, anti-(xanthine oxidase) antibodies and coronary heart disease risk." Thesis, University of Bath, 1995. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.760669.
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Parmenter, Kathryn Emma. "Nutrition knowledge and dietary behaviour." Thesis, University College London (University of London), 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.265695.
Full textAbstract:
There is now unequivocal evidence that dietary behaviour is related to illness and risk of chronic diseases such as cardiovascular disease and cancer. Attempts to improve the nation's diet are based on providing information, assuming that given more information, the public will choose healthier diets. Many studies indicate, however, that nutrition knowledge has little association with dietary behaviour; but a review of the literature reveals that nutrition knowledge has been inadequately measured. In addition, dietary behaviour has been assessed in terms of food intake and not in relation to changes in, or readiness to change, food intake. Following the Introduction, this research begins, in Chapter 2, by reviewing the literature measuring nutrition knowledge. It is found that while many studies measure knowledge, typically the measure forms only part of the study which assesses either a particular subpopulation or a particular aspect of nutrition. In consequence, questionnaires are designed for a one-off and specific purpose and little attention is paid to the psychometric properties of the instrument. Dietary behaviour is measured with one of the well-established methods of assessing intake, the problems of which are acknowledged in the literature. Chapter 3 describes these methods with their shortcomings and use in psychological research. In response to these reviews, a comprehensive nutrition knowledge questionnaire was developed (in 1994) and intake was conceptualised in terms of dietary change, in keeping with psychologists' role in nutrition. Following the development and pilot study of this questionnaire (Chapter 4), its validity and reliability were assessed further in Chapter 5, with positive results. Significant differences were found between criterion groups (dietetic and computer science students), providing evidence of construct validity. Internal consistency correlations ranged from 0.50 to 0.92 and test-retest reliability correlations ranged from 0.80 to 0.98. This measure was then used (Chapter 6) to assess the level of nutrition knowledge among a large representative sample of British adults in a postal survey (in 1995). Nutrition knowledge was found to be poor concerning the dietary recommendations for meat, starchy foods, fruit and vegetables; the different types of fat (saturated, poly- and monounsaturated); and associations between diet and diseases, such as fruit and vegetables, heart disease and cancer. Both stages of change (using Prochaska and DiClemente's model) and consumption of fat, fruit and vegetables (to test the stages' validity) were also assessed as measures of dietary behaviour. Most respondents replied that they had been limiting their fat intake for more than 6 months, but not been thinking of increasing their fruit and vegetable intake. Multivariate analyses showed that being female, having more educational qualifications and being in a higher socioeconomic class were predictive of knowing more about nutrition and having a healthier dietary behaviour. Relationships between nutrition knowledge, stages of change and dietary intake were examined in Chapter 7 and significant associations identified. In contrast to this cross-sectional research, the final study in Chapter 8 was longitudinal and examined changes in nutrition knowledge and dietary behaviour over a one-year period (from 1993 to 1994). This study aimed to provide information on the extent to which healthier changes in dietary intake are related to increases in nutrition knowledge. While changes occurred in dietary intake (fat and sugar intake decreased significantly, the increases in fruit and vegetable consumption were insignificant), knowledge scores remained unchanged. The final chapter discusses the key findings of this research, its implications and areas worthy of future investigation. For example, the results from this research suggest that knowledge is an important factor in food choice and should not be discounted as a part of health promotion. It may also be useful to integrate the construct of knowledge into the social cognition models of dietary choice or indeed to develop a new model to include knowledge along with motivational constructs from the social cognition models.
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Ashton, William David. "Coronary risk factors in women in the United Kingdom." Thesis, University of Salford, 1997. http://usir.salford.ac.uk/42977/.
Full textAbstract:
Coronary heart disease (CHD) has traditionally been regarded as a male disease and, because of this, the magnitude of the problem in women is often overlooked. Yet, cardiovascular disease (CVD) and CHD in particular, remains, next to cancer, the leading cause of morbidity and mortality in women. The longstanding emphasis on the problem of CHD in men, has resulted in a widespread tendency to minimise the incidence and severity of the disease in women. Moreover, most epidemiologic studies examining morbidity and mortality from CHD have focused largely on men, producing a significant gender gap in the research. The lack of information on CHD risk factors and prevention of heart disease in women in Britain is of particular concern, given that British women have one of the highest rates of coronary disease in the world. The Marks and Spencer Coronary Risk Factor Study (MSCRFS) is a cross-sectional and prospective study of CHD risk factors in female employees of the Marks and Spencer retail organisation. The present study is confined to an analysis of cross-sectional data from 14,077 women screened between June 1988 and July 1991. The prevalence and distribution of a variety of lipid, lipoprotein, biochemical, anthropometric and lifestyle-related CHD risk factors among women in the United Kingdom is described, together with their key interrelationships. In addition, the metabolic impact of exogenous hormones, specifically oral contraceptives and postmenopausal hormone replacement, is described. This study - the largest of its kind in the UK - provides reference ranges for a wide range of CHD risk factors in women in the UK, and gives a unique insight into the impact of a variety of lifestyle-related factors on CHD risk. There is an enormous potential for reducing the very high risk of CHD among women in the UK, which needs to be addressed. Based on these data, health strategies designed to reduce morbidity and mortality from CHD can be planned and implemented more effectively.
32
Jongsma, Michael Howard. "Care Transition Gaps: Risk Identification and Intervention." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/446.
Full textAbstract:
Hospital readmissions related to chronic heart failure (CHF) are costly, widespread, and often avoidable. Patient education that includes diagnosis, causes, medications, diet, exercise, and exacerbation warning signs has been shown to reduce the number of CHF readmissions. The purpose of this study was to use risk stratification to identify CHF patients at high risk for 30-day readmission. Once a high-risk CHF patient was identified, nursing interventions would be triggered to reduce readmissions and close the gaps in the continuum of care following acute care admission. Transitions of care theory was used as the framework for this project. The methodology had a quality improvement focus. The patient population consisted of high-risk CHF patients (n = 25) with NYHA classification of II-IV using the risk identification tool. Patients were identified using the tool, were followed for 30 days, and received nursing interventions to reduce the possibility of readmission. Only one of the identified patients was readmitted within 30 days for a diagnosis unrelated to CHF, resulting in no readmissions within this sub group. This study suggests that risk stratification can identify and direct resources to CHF patients, decreasing their likelihood for readmission. Nurse leaders can use standardized tools such as the risk identification tool, thereby reducing readmissions along with associated costs for readmissions.
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ElShikieri, Ahlam BadrEldin. "Dietary fat intake and CHD risk in Sudan : a case-control study." Thesis, Queen Margaret University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251864.
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Lu, Fei. "The automatic nervous system, ventricular repolarisation and risk of sudden cardiac failure." Thesis, University of London, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.309312.
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Hartnick, Maria Diana. "Echocardiography for early detection of heart disease in high risk diabetic patients." Thesis, Cape Peninsula University of Technology, 2015. http://hdl.handle.net/20.500.11838/1566.
Full textAbstract:
Masters of Technology: Radiography
in the Faculty of Health and Wellness Sciences
at the Cape Peninsula University of Technology
2015Introduction: Diabetes mellitus is a chronic disease with a significant impact on personal lifestyle and wellbeing. It is associated with a high prevalence of myocardial disease, the early detection of which is important for prevention of disease progression. Although echocardiography is recognised as a leading cardiovascular imaging modality, there has been limited work on its role in the early detection of diabetes-related myocardial dysfunction. The aim of this study was therefore to evaluate the role of echocardiography in the early detection of diabetes-related myocardial disease, in a population with a high prevalence of type 2 diabetes mellitus. Methodology: A single sonographer, blinded to individual biochemical markers conducted detailed echocardiographic examinations on 407 participants from a Cape Town community with a high prevalence of diabetes mellitus. Participants were subsequently stratified by biochemical status, as normoglyceamia or hyperglycaemia. The echocardiographic features of the two groups were compared using the Pearson chi-squared and Mann-Whitney U tests. Findings: Hyperglycaemia was associated with left atrium (LA) enlargement (p ˂ 0.0014), aortic enlargement (p ˂ 0.0067) and inter-ventricular septal (IVS) thickening (p ˂ 0.0001). Conclusion: The findings suggest that echocardiography can be a useful screening tool for myocardial dysfunction in Type 2 diabetes mellitus.
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Oliver-Williams, Clare. "Miscarriage and risk of coronary heart disease : potential confounders and common determinants." Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.709286.
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Shakya, Shrestha Subodha. "Dietary and plasma carotenoids and heart disease risk : a population based study." Thesis, University of Cambridge, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.610022.
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Betihavas, Vasiliki. "Predicting risk: developing and testing of a nomogram to predict hospitalisation in chronic heart failure (CHF- Risk Study)." Thesis, Curtin University, 2013. http://hdl.handle.net/20.500.11937/552.
Full textAbstract:
Chronic heart failure (CHF) is the leading cause of hospital admission in the elderly. Currently, no absolute risk model for rehospitalisation exists. The CHF-Risk Study was a 3 phase study that led to the development of a nomogram using a derivation cohort of a contemporaneous Australian CHF population. Factors associated with an increased risk of cardiovascular rehospitalisation were: age; living alone; a sedentary lifestyle and the presence of multiple co-morbid conditions.
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Ramsay, Jean Marilyn Christina. "Psychosocial risk factors for coronary artery disease and symptom reporting." Thesis, University of East London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.361848.
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Woodhouse, Peter Robert. "Seasonal variation of cardiovascular disease risk factors in older adults." Thesis, University of Southampton, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295672.
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Veenstra, Jan. "Moderate alcohol consumption and risk of coronary heart disease an experimental approach /." Maastricht : Maastricht : Rijksuniversiteit Limburg ; University Library, Maastricht University [Host], 1991. http://arno.unimaas.nl/show.cgi?fid=5625.
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Wilkins, Kathryn. "Socioeconomic status and risk factors for coronary heart disease, Canada, 1971-1985." Thesis, McGill University, 1987. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=64061.
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Hartwell, Debbie L. "The clinical management of patients at increased risk of coronary heart disease." Thesis, Oxford Brookes University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.284757.
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Morley-Davies, A. J. "Predicting death in chronic heart failure : electrocardiographic, autonomic and neuroendocrine risk assessment." Thesis, University of Glasgow, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272860.
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Lopes, Philippe. "The relationships between respiratory sinus arrhythmia and coronary heart disease risk factors." Thesis, University of Ulster, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287137.
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Dean, Chalkley Tracey Shelly. "The effects of soy isoflavones on risk factors for coronary heart disease." Thesis, King's College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269628.
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Shaw, BS, I. Shaw, and JA Brown. "Resistance training and predicted risk of coronary heart disease in sedentary males." African Journal for Physical, Health Education, Recreation and Dance, 2009. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1001664.
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Abstract
The purpose of this study was to determine the impact of resistance training, designed to prevent
the development of coronary heart disease (CHD) based on the Framingham Risk Assessment
(FRA) score. Twenty-five healthy sedentary men with low CHD risk were assigned to participate
in a 16-week (three days per week) resistance training programme (n = 13) or non-exercising
control group (CG) (n = 12). Resistance training was performed using eight whole-body
exercises for three sets of 15 repetitions at 60% of one-repetition maximum. Resistance training
did not significantly (p > 0.05) reduce the number of cigarettes smoked daily (p > 0.133) or TC
(p > 0.917), while significant improvements were found in SBP (p < 0.003), HDLC (p < 0.005)
and FRA score (p < 0.021); thus improving absolute 10-year risks for CHD. The CG subjects
were found to have had no significant changes in number of cigarettes smoked daily (p > 0.831),
TC (p > 0.678), HDLC (p > 0.672) or FRA score (p > 0.504), but SBP increased significantly (p
< 0.030). These data indicate that resistance training can effectively reduce the predicted risk of
developing CHD, even in men with already low risk.
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Yasmin. "Coronary heart disease : relationships between some metabolic risk factors and anthropometric variables." Thesis, University of Cambridge, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339727.
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Hashemi, Djawid [Verfasser]. "Synkopen – Risikofaktor bei Herzinsuffizienz? : Syncopes – risk factor in heart failure? / Djawid Hashemi." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2021. http://d-nb.info/1241538476/34.
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Pellicori, Pierpaolo. "Newer imaging modalities to identify high-risk ambulatory patients with heart failure." Thesis, University of Hull, 2016. http://hydra.hull.ac.uk/resources/hull:14756.
Full textAbstract:
The lack of widely accepted objective measures of cardiac dysfunction other than left ventricular ejection fraction (LVEF) has hampered, and continues to hamper, clinical research in patients with heart failure (HF). Identifying patients at higher risk of adverse outcome would allow better targeting of therapy to those with most to gain. The thesis is divided in three parts. In the first part, I report the results of studies of the association between echocardiographic measures of right atrial pressure (by measuring the inferior vena cava (IVC) diameter) and outcome in ambulatory patients with HF. I also studied the associations with prognosis of a newer echocardiographic method (global longitudinal strain, GLS) to assess left ventricular systolic function in patients with normal LVEF on conventional imaging. In the second part, I report the results of studies of the associations of left atrial function by cardiac magnetic resonance (cMRI) with outcome in ambulatory patients with HF. I also studied the relationship between QRS morphology on ECG with cardiac structure and function measured by cMRI in ambulatory patients with HF. In the third part, I report the results of developing and prospectively evaluating an ultrasound method to measure the internal jugular vein diameter (as an objective estimate of the right atrial pressure) and its changes with respiratory manoeuvres. I studied the association between the jugular vein diameter, clinical and echocardiographic variables, and its relations with outcome in ambulatory patients with HF and controls. My results showed that upstream consequences of a dysfunctional left ventricle, such as impaired left atrial function measured by cMRI, a distended IVC or internal jugular vein by ultrasound, provide powerful prognostic information, similar to that obtained by measuring N-terminal pro-B-type natriuretic peptide plasma levels, in individuals with HF regardless of whether they have a reduced or normal LVEF. As residual congestion (dilated IVC or jugular vein) and impaired left atrial function appear strongly related to an adverse outcome, tailoring treatment to minimise congestion or improving left atrial function is an attractive concept worth testing.