Aims To determine the effect of an integrated heart failure management programme, involving patient and family, primary and secondary care, on quality of life and death or hospital readmissions in patients with chronic heart failure. Methods and ResultsThis trial was a cluster randomized, controlled trial of integrated primary/secondary care compared with usual care for patients with heart failure. The intervention involved clinical review at a hospital-based heart failure clinic early after discharge, individual and group education sessions, a personal diary to record medication and body weight, information booklets and regular clinical follow-up alternating between the general practitioner and heart failure clinic. Follow-up was for 12 months. One hundred and ninety-seven patients admitted to Auckland Hospital with an episode of heart failure were enrolled in the study. There was no significant difference between the intervention and control groups for the combined end-point of death or hospital readmission. The physical dimension of quality of life showed a greater improvement in the intervention group from baseline to 12 months compared with the control group ( 11·1 vs 5·8 respectively, 2P=0·015). The main effect of the intervention was attributable to the prevention of multiple admissions (56 intervention group vs 95 control group, 2P=0·015) and associated reduction in bed days.Conclusions This integrated management programme for patients with chronic heart failure improved quality of life and reduced total hospital admissions and total bed days.
Background: Multidisciplinary heart failure programs including patient education and self-management strategies such as daily recording of body weight and use of a patient diary decrease hospital readmissions and improve quality of life. However, the degree of uptake of individual components of these programs and their contribution to patient benefit are uncertain. Methods: Patients with heart failure admitted to Auckland Hospital were randomised into the management or usual care groups of the Auckland heart failure management study (AHFMS). Patients in the management group were given a heart failure diary for the recording of daily weights, attended a heart failure clinic and were encouraged to attend three education sessions. Patients in the usual care group received routine clinical care, mainly from general practitioners. Patients were followed to 12 months. This study investigated the uptake of self-management by assessing diary use and self-weighing behaviour in the group receiving the heart failure intervention, and compared the level of knowledge of heart failure self-management of the management group to the control group after 12 months. Results: Of the 197 patients in the AHFMS, 100 patients were included in the management group and received a diary and education about heart failure self-management including monitoring weight daily. Of these patients, 76 patients used the diary. These patients were on more medication; were more likely to attend the education sessions, heart failure clinic, and primary care, and had a lower mortality rate over the course of the study. Variables independently associated with use of the diary included less severe symptoms (OR 15, 95% confidence intervals 1.7, 144), frequent attendance at the heart failure clinic (OR 15, 95% CI 3, 78) and attendance at an education session (OR 8, 95% CI 1.5, 42). Of the 76 patients who used the diary, 51 weighed themselves regularly. More of these patients owned scales at home; they were also more likely to attend the education sessions, and experienced fewer hospital admissions than those patients who did not weigh themselves regularly. Variables independently associated with regular self-weighing included the presence of scales at home (OR 6.3, 95% CI 1.7, 14.1), left ventricular ejection fraction )30% (OR 4.3, 95% CI 1.1, 17.5), and attendance at the education session(s) (OR 6.3, 95% CI 1.7, 14.1). Patients in the management group exhibited higher levels of knowledge at 12 months of follow-up and were more likely to monitor their condition using daily weighing, compared to the control group. Conclusions: At 12 months of followup, implementation of self-management strategies including daily weight monitoring and level of education on self-management was significantly higher in the management group than the control group. For the patients in the management group, not using the diary or inability to perform daily weighing were associated with less frequent attendance at the heart failure clinic and education sessions and poorer he...
In a general hospital population of older patients with CHF, PN filling was associated with hospital admission rates similar to those seen with restrictive filling. The combined end point of death/CHF hospital admission was similar for restrictive filling and AR. Measurement of these variables is easy to add to routine clinical echocardiography and may provide important prognostic information in a wide range of patients with CHF.
Both LVM and LVEDD are predicted by FFM in endurance athletes, and when indexed to FFM, no training-related differences were observed. Thus, the extent of LV remodeling (athletic heart) in trained individuals may reflect a normal physiologic response to increased FFM induced by training.
Left ventricular diastolic filling and systolic function of young and older trained and untrained men. J Appl Physiol 95: 2570-2575. First published July 25, 2003 10.1152/japplphysiol.00441.2003.-Aging is associated with impaired early diastolic filling; however, the effect of endurance training on resting diastolic function in older subjects is unclear. Heart rate and ventricular loading conditions affect mitral inflow velocities measured by Doppler echocardiography; therefore, tissue Doppler imaging of mitral annular velocity, which is relatively preload independent, was combined with mitral inflow velocity and maximal oxygen consumption (V O2 max) in young (20-35 yr) and older (60-80 yr) trained and untrained men to determine whether endurance training is associated with an attenuation of age-associated changes in diastolic filling. As expected, V O2 max was higher in trained men (P Ͻ 0.01) and lower in older men (P Ͻ 0.01). Peak early mitral inflow velocity (E) and early-to-late mitral inflow velocity ratios were lower in older vs. young men (P Ͻ 0.01); however, there was no training effect (P Ͼ 0.05). Peak early mitral annular velocity (EЈ) was higher and peak late mitral annular velocity (AЈ) was lower in young vs. older men (P Ͻ 0.01). A significant interaction effect was found for AЈ, EЈ/AЈ, and peak systolic mitral annular velocity (SЈ). Training was associated with lower AЈ in young and higher AЈ in older men. SЈ was greater in trained vs. untrained older men (P Ͻ 0.05), but it was similar in trained and untrained young men. These findings suggest that early diastolic filling is not affected by training in older men, and the effect of training on AЈ and SЈ is different in young and older men. diastolic function; aging; endurance training; maximal aerobic capacity (maximal oxygen consumption), tissue Doppler imaging AGING IS ASSOCIATED WITH AN increase in left ventricular stiffness (7), which results in a prolongation of isovolumic relaxation time (9) and incomplete relaxation of the ventricle during early diastolic filling (25). Numerous investigations have shown that peak early diastolic mitral inflow velocity (E) is reduced in aged individuals (2,10,17,18,34). To maintain ventricular filling and stroke volume, peak late diastolic filling velocity (A) increases with age (2, 17), resulting in an age-associated decline in the early-to-late mitral inflow velocity ratio (E/A) ratio (17).Aerobic fitness is associated with improved early diastolic function in young healthy subjects. Young trained athletes have increased E (20) and E/A (8, 11, 22, 26) compared with their nontrained counterparts. However, evidence to suggest that training has a similar effect in older athletes, or that training attenuates the normal age-associated decrease in E/A is inconclusive (8,10,28,31). Endurance training has been shown to improve peak filling rate in older healthy men (19), and the E/A has been shown to be higher in highly trained older endurance athletes compared with agematched healthy controls (8). However, Fleg et...
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