Introduction Heart failure (HF) is an emerging epidemic with poor disease outcomes and differences in its prevalence, etiology and management between and within world regions. Hypertension (HT) and ischemic heart disease (IHD) are the leading causes of HF. In Suriname, South-America, data on HF burden are lacking. The aim of this Suriname Heart Failure I (SUHF–I) study, is to assess baseline characteristics of HF admitted patients in order to set up the prospective interventional SUHF-II study to longitudinally determine the effectiveness of a comprehensive HF management program in HF patients. Methods A cross-sectional analysis was conducted of Thorax Center Paramaribo (TCP) discharge data from January 2013-December 2015. The analysis included all admissions with primary or secondary discharge of HF ICD-10 codes I50-I50.9 and I11.0 and the following variables: patient demographics (age, sex, and ethnicity), # of readmissions, risk factors (RF) for HF: HT, diabetes mellitus (DM), smoking, and left ventricle (LV) function. T-tests were used to analyze continuous variables and Chi-square test for categorical variables. Differences were considered statistically significant when a p-value <0.05 is obtained. Results 895 patients (1:1 sex ratio) with either a primary (80%) or secondary HF diagnosis were admitted. Female patients were significantly older (66.2 ± 14.8 years, p < 0.01) at first admission compared to male patients (63.5 ± 13.7 years) and the majority of admissions were of Hindustani and Creole descent. HT, DM and smoking were highly prevalent respectively 62.6%, 38.9 and 17.3%. There were 379 readmissions (29.1%) and 7% of all admissions were readmissions within 30 days and 16% were readmissions for 31-365 day. IHD is more prevalent in patients from Asian descendant (52.2%) compared to African descendant (11.7%). Whereas, HT (39.3%) is more prevalent in African descendants compared to Asian descendants (12.7%). There were no statistically significant differences in age, sex, ethnicity, LV function and RFs between single admitted and readmitted patients. Conclusion RF prevalence, ethnic differences and readmission rates in Surinamese HF patients are in line with reports from other Caribbean and Latin American countries. These results are the basis for the SUHF-II study which will aid in identifying the country specific and clinical factors for the successful development of a multidisciplinary HF management program.
This report illustrates an undescribed mechanism causing magnetic angioplasty wire fracture and describes how to avoid its occurrence and how to correct it, if it occurs. The cause is the transition point in the wire between a flexible wire shaft and the inflexible magnetic tip of a magnetically enabled wire. In the first stage of the problem, the wire becomes trapped in a doubled-back position. Subsequently, traction causes the second stage that kinks the wire and hooks behind a structure, in this case, a stent, causing magnetic wire lock. Further traction has a high chance of wire fracture. Correction, although challenging, remains possible before wire fracture occurs. Although there is no intrinsic problem with the technology, attention to this problem by the operator will reduce its occurrence and therefore its sequelae.
Background Determining the effect of training on exercise capacity in chronic heart failure (CHF) patients is mainly done by measuring peak oxygen uptake (VO2 peak) through cardiopulmonary exercise testing (CPET) [1,2]. However, CPET is not always available, especially in low-and middle-income countries. On the contrary, the 6-minute walk test (6MWT), a simpler and inexpensive alternative can be utilized, even in low resource settings [2,3]. Moderate continuous intensity training (MCIT) is commonly recommended in CHF patients [4], but growing evidence demonstrates the superior benefits of high-intensity interval training (HIIT) on the exercise capacity [5,6]. However, the benefits are predominantly measured with the CPET and expressed in VO2 peak [1,2]. Especially for low resource settings, there is a need for studies describing the effect of HIIT in CHF patients using the 6MWT as an outcome measure. To the best of our knowledge, there is no systematic review on the effect of HIIT in CHF patients, measured solely with the 6MWT. Purpose This study aims to synthesize the literature on the effect of HIIT on the exercise capacity using the 6MWT in CHF patients. Methods We systematically searched within the PubMed, EBSCOhost, Cochrane and PEDro electronic databases to identify randomized controlled trials published until August 2020 with no date of publication or language restrictions. We included studies that met the following criteria: 1) a randomized controlled trial; 2) performed in a CHF population; 3) the use of the 6MWT as an outcome measure with a pre-and post-exercise measurement of the distance; 4) HIIT without the combination of another type of exercise training. The funnel plot was used to estimate publication bias and the Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) was used for quality assessment [7]. Results We found 169 studies, of which 164 were excluded for not meeting inclusion criteria, resulting in the inclusion of five studies (n=315, mean age = 61 years, 71.4% male). Three studies (n=163, mean age=58 years, 64.4% % male) used MCIT and two studies (n=152, mean age = 65 years, 78.5% male) usual care as the control group. The HIIT showed significant improvements on 6MWT distance (MD= 40.78 m; 95% CI 24.55–57.01; p value <0.00001; I2=56%) compared to control groups (Figure 1). The funnel plot (Figure 2) shows asymmetry upon visual examination and could indicate presence of publication bias. The quality assessment score was between 10–12 points with an overall median score of 11.2. Conclusions The distance on the 6MWT significantly improves with HIIT compared to sedentary controls and MCIT. However, our results are based on a small number of studies with heterogeneity across the control groups. Nevertheless, this study does provide information for physical therapist from low-resource settings about the expected effect on the 6MWT, when providing HIIT to CHF patients. Funding Acknowledgement Type of funding sources: None.
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