Background Chronic obstructive pulmonary disease (COPD) patients can suffer from low blood oxygen concentrations. Peripheral blood oxygen saturation (SpO 2 ), as assessed by pulse oximetry, is commonly measured during the day using a spot check, or continuously during one or two nights to estimate nocturnal desaturation. Sampling at this frequency may overlook natural fluctuations in SpO 2 . Objective This study used wearable finger pulse oximeters to continuously measure SpO 2 during daily home routines of COPD patients and assess natural SpO 2 fluctuations. Methods A total of 20 COPD patients wore a WristOx 2 pulse oximeter for 1 week to collect continuous SpO 2 measurements. A SenseWear Armband simultaneously collected actigraphy measurements to provide contextual information. SpO 2 time series were preprocessed and data quality was assessed afterward. Mean SpO 2 , SpO 2 SD, and cumulative time spent with SpO 2 below 90% (CT90) were calculated for every (1) day, (2) day in rest, and (3) night to assess SpO 2 fluctuations. Results A high percentage of valid SpO 2 data (daytime: 93.27%; nocturnal: 99.31%) could be obtained during a 7-day monitoring period, except during moderate-to-vigorous physical activity (MVPA) (67.86%). Mean nocturnal SpO 2 (89.9%, SD 3.4) was lower than mean daytime SpO 2 in rest (92.1%, SD 2.9; P <.001). On average, SpO 2 in rest ranged over 10.8% (SD 4.4) within one day. Highly varying CT90 values between different nights led to 50% (10/20) of the included patients changing categories between desaturator and nondesaturator over the course of 1 week. Conclusions Continuous SpO 2 measurements with wearable finger pulse oximeters identified significant SpO 2 fluctuations between and within multiple days and nights of patients with COPD. Continuous SpO 2 measurements during daily home routines of patients with COPD generally had high amounts of valid data, except for motion artifacts during MVPA. The identified fluctuations can have implications for telemonitoring applications that are based on daily SpO 2 spot checks. CT90 values can vary greatly from night to night in patients with a nocturnal mean SpO 2 around 90%, indicating that these patients cannot be consistently categorized as desaturators or nondesaturators. We recommend using wearable sensors for continuous SpO 2 meas...

6MWT was found to be reliable and valid in patients with mild-to-moderate CHF. Maximal exercise capacity, renal function and age were significant determinants of the best 6MWD. These findings strengthen the clinical utility of the 6MWT in CHF.

Aims It is increasingly recognized that the presence of comorbidities substantially contributes to the disease burden in patients with heart failure (HF). Several reports have suggested that clustering of comorbidities can lead to improved characterization of the disease phenotypes, which may influence management of the individual patient. Therefore, we aimed to cluster patients with HF based on medical comorbidities and their treatment and, subsequently, compare the clinical characteristics between these clusters. Methods and results A total of 603 patients with HF entering an outpatient HF rehabilitation programme were included [median age 65 years (interquartile range 56–71), 57% ischaemic origin of cardiomyopathy, and left ventricular ejection fraction 35% (26–45)]. Exercise performance, daily life activities, disease‐specific health status, coping styles, and personality traits were assessed. In addition, the presence of 12 clinically relevant comorbidities was recorded, based on targeted diagnostics combined with applicable pharmacotherapies. Self‐organizing maps (SOMs; http://www.viscovery.net) were used to visualize clusters, generated by using a hybrid algorithm that applies the classical hierarchical cluster method of Ward on top of the SOM topology. Five clusters were identified: (1) a least comorbidities cluster; (2) a cachectic/implosive cluster; (3) a metabolic diabetes cluster; (4) a metabolic renal cluster; and (5) a psychologic cluster. Exercise performance, daily life activities, disease‐specific health status, coping styles, personality traits, and number of comorbidities were significantly different between these clusters. Conclusions Distinct combinations of comorbidities could be identified in patients with HF. Therapy may be tailored based on these clusters as next step towards precision medicine. The effect of such an approach needs to be prospectively tested.

A 81-year-old male patient is brought in by ambulance with persistent diarrhoea and subacute symptoms of lethargy, weakness of the leg muscles and malaise. He is taking perindopril 4 mg twice a day. On physical examination you find a decreased level of consciousness and a (pre-existing) systolic murmur, fitting his mitral valve insufficiency. His