Secondary prevention- an essential component of the comprehensive rehabilitation of patients with heart failure

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Introduction.Despite all advanced evidence-based therapeutic opportunities, heart failure remains a major public health burden, with a dramatically increasing in prevalence. Moreover, the diagnosis of chronic heart failure in obese patients brings unique challenges. So, the aim of this study was to identify the cardiovascular risk factors profile in heart failure obese patients, admitted in rehabilitation programs. Material and methods.This study enrolled 80 obese (body mass index ≥30 kg/m2) patients, 56.2% men with average age ranged of 69.75 ± 9.12 years who were hospitalized for decompensated heart failure in the Rehabilitation Hospital, Cardiology-Department, Cluj-Napoca, Romania. Baseline characteristics, clinical presentation, NT-proBNP values, echocardiographic parameters and in-hospital therapies were evaluated. The lot was divided into three groups: obese heart failure patients with reduced (<40%), preserved (≥50%), and midrange (40-49%) ejection fraction. Heart failure was defined according to 2016 ESC criteria. NT-pro-BNP values higher than 125 pg/ml were considered to be associated with heart failure development. Statistics were performed using SPSS 16.0 for Windows. Results.The mean age of the analyzed study population was 69.75 ± 9.12 years and 56.2% were men. The most frequent associated risk factor was smoking (45%), followed by diabetes mellitus (40%) and hypertension (25%). The mean ejection fraction value was 43.58±10.85% and the median value was 45%. The mean NT-pro-BNP registered levels were 2887.03±3157 pg/ml. An inverse relationship was found between NT-pro-BNP levels and plasma lipid fractions, total-cholesterol-r=-0.194, LDL-cholesterol-r=-0.0971, triglycerides-r=-0.155, HDL-cholesterol-r=-0.07. Also, NT-proBNP negatively correlated with left ventricular ejection fraction-r=-0.307, p=0.0086. In conclusion, obese heart failure patients presented particular characteristics, the most frequent observed cardiovascular risk factors were smoking, diabetes mellitus and arterial hypertension. Identifying the major comorbidities in this subgroup of patients is of major importance, especially for improving heart failure's prognosis and survival.

Section: Discussionmentioning

confidence: 99%

“…The smoking status is an important factor for heart failure's prognosis, smoking cessation being one of the main lifestyle changes recommendations in heart failure and not only [1,9].…”

Section: Discussionmentioning

confidence: 99%

The profile of cardiovascular risk factors in heart failure obese patients hospitalised in a rehabilitation romanian hospital

Dădârlat¹,

Sitar-Tăut²,

Zdrenghea³

et al. 2018

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“…Comprehensive evaluation of the patient's exercise capacity after permanent cardiac pacing, preferably through cardiopulmonary exercise testing, might prove to be an useful tool in the adjustment process of the pacemaker, having as main purposes the reduction of heart failure symptoms and the improvement of the quality of life [17,18].…”

Section: Discussionmentioning

confidence: 99%

The effect of cardiac pacemaker implantation on cardiac performance – the experience of a Cardiology – Rehabilitation Department

Caloian¹,

Gușetu²,

Costea³

et al. 2018

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Background. Although cardiac pacemakers can prevent the occurrence of heart failure secondary to low cardiac output in patients suffering from extreme bradycardia, they can also induce, in some circumstances, heart failure by decreasing the left ventricular stroke volume. In our study, we aim to describe the effect of permanent cardiac pacing on the evolution of patients with heart failure, objectively determined by the N-terminal pro b-type natriuretic peptide (NT-proBNP) dynamics. Material and methods. Complete clinical examination and determination of NT-proBNP were performed before and 5 days after pacemaker implantation. Results. We enrolled in our study 32 patients with an indication for permanent cardiac pacing in which we implanted 21 single-chamber ventricular pacemakers (VVI, 65.6%), 4 single-chamber atrial pacemakers (AAI, 12.5%) and 7 dual-chamber atrio-ventricular pacemakers (DDD, 21.9%). Patients with heart failure had an average NT-proBNP value of 2542.2±2311.12 pg/mL and patients without heart failure (control group), had an average NT-proBNP value of 190.58±98.16pg/mL. Patients in sinus rhythm that received a VVI pacemaker experienced an increase in NT-proBNP values of 103.73%, while patients in atrial fibrillation and VVI of only 0.27%. NT-proBNP values decreased in patients in sinus rhythm that received a DDD or AAI pacemaker by 20.94%. Conclusion. Permanent cardiac pacemakers are able to influence the clinical status of patients with heart failure, especially if they cause the loss of atrio-ventricular synchronism.

“…These programs vary but in order for them to be efficient they need to be multidisciplinary and comprehensive, similar to rehabilitation programs for other conditions such as diabetes [9,10]. Their goals are to recover (and restore) the physical, social and mental well-being, thus improving the outcomes and correcting the risk factors that influene the incidence (and outcome) of cardiovascular diseases [11,12]. HF has a detrimental effect on daily routine through various physical simptoms, psychological reactions and their treatment, thus lowering the quality of life (QoL) [13].…”

Section: Introductionmentioning

confidence: 99%

Quality of life – an important parameter of cardiac rehabilitation in heart failure patients

Fărcăş¹,

Cluj-Napoca²,

Năstasă³

et al. 2018

Heart failure is a significant healthcare problem, because of its impact at the individual and populational level, through multiple rehospitalizations and increased morbi-mortality. At the individual level, the multidimensional impact of this clinical condition and its treatment on patients' daily lives is reflected in the quality of life (QoL). QoL needs to be accurately measured, because it's related to high hospitalization and mortality rates and provides valuable information that cannot be directly obtained using clinical, biological or imaging measurements. For these reasons, QoL evaluation (global score, subscale scores, answers to various items, etc.) is a significant parameter for assessing the impact of and for structuring the cardiac rehabilitation programs (exercise training, nutritional counseling, psychosocial support and interventions, etc). In order to increase the long-term efficiency, these programs need also to include strategies to optimize and increase adherence to lifestyle changes and to medical therapy.