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RESPIRATORY DISEASES (103 journals)                     

Showing 1 - 103 of 103 Journals sorted alphabetically
Advances in Respiratory Medicine     Open Access   (Followers: 7)
American Journal of Respiratory and Critical Care Medicine     Full-text available via subscription   (Followers: 249)
American Journal of Respiratory Cell and Molecular Biology     Full-text available via subscription   (Followers: 19)
American Review of Respiratory Disease     Full-text available via subscription   (Followers: 4)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 16)
Annals of Thoracic Medicine     Open Access   (Followers: 6)
Archivos de Bronconeumología     Full-text available via subscription  
Archivos de Bronconeumología (English Edition)     Full-text available via subscription   (Followers: 1)
Asthma Research and Practice     Open Access   (Followers: 1)
BMC Pulmonary Medicine     Open Access   (Followers: 4)
BMJ Open Respiratory Research     Open Access   (Followers: 5)
Breathe     Open Access   (Followers: 4)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal  
Canadian Respiratory Journal     Open Access   (Followers: 2)
Case Reports in Pulmonology     Open Access   (Followers: 3)
Chest     Full-text available via subscription   (Followers: 102)
Chest Disease Reports     Open Access   (Followers: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9)
Clinical Lung Cancer     Hybrid Journal   (Followers: 5)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3)
Clinical Pulmonary Medicine     Hybrid Journal   (Followers: 2)
COPD Research and Practice     Open Access   (Followers: 1)
COPD: Journal of Chronic Obstructive Pulmonary Disease     Hybrid Journal   (Followers: 15)
Current Opinion in Pulmonary Medicine     Hybrid Journal   (Followers: 10)
Current Pulmonology Reports     Hybrid Journal  
Current Research in Tuberculosis     Open Access   (Followers: 3)
Current Respiratory Care Reports     Hybrid Journal   (Followers: 1)
Current Respiratory Medicine Reviews     Hybrid Journal   (Followers: 5)
Der Pneumologe     Hybrid Journal   (Followers: 1)
Egyptian Journal of Chest Diseases and Tuberculosis     Open Access   (Followers: 3)
ERJ Open Research     Open Access   (Followers: 2)
Eurasian Journal of Pulmonology     Open Access  
European Clinical Respiratory Journal     Open Access   (Followers: 3)
European Respiratory Journal     Full-text available via subscription   (Followers: 38)
European Respiratory Review     Open Access   (Followers: 7)
Experimental Lung Research     Hybrid Journal  
Expert Review of Respiratory Medicine     Hybrid Journal   (Followers: 5)
Heart & Lung: The Journal of Acute and Critical Care     Hybrid Journal   (Followers: 11)
Heart, Lung and Circulation     Full-text available via subscription   (Followers: 9)
Indian Journal of Respiratory Care     Open Access   (Followers: 3)
Indian Journal of Tuberculosis     Full-text available via subscription  
Influenza and Other Respiratory Viruses     Open Access   (Followers: 2)
International Journal of Chronic Obstructive Pulmonary Disease     Open Access   (Followers: 3)
Journal of Association of Chest Physicians     Open Access   (Followers: 2)
Journal of Asthma     Hybrid Journal   (Followers: 4)
Journal of Asthma Allergy Educators     Hybrid Journal   (Followers: 4)
Journal of Bronchology & Interventional Pulmonology     Hybrid Journal   (Followers: 3)
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases     Open Access  
Journal of Heart and Lung Transplantation     Hybrid Journal   (Followers: 12)
Journal of Respiratory Medicine     Open Access   (Followers: 4)
Journal of Respiratory Research     Open Access   (Followers: 1)
Journal of Tuberculosis Research     Open Access   (Followers: 1)
Jurnal Respirasi     Open Access  
Karger Kompass Pneumologie     Full-text available via subscription   (Followers: 1)
Kindheit und Entwicklung     Hybrid Journal  
Lung     Hybrid Journal   (Followers: 2)
Lung Cancer     Hybrid Journal   (Followers: 15)
Lung Cancer International     Open Access   (Followers: 2)
Lung Cancer: Targets and Therapy     Open Access   (Followers: 3)
Lung India     Open Access   (Followers: 1)
Multidisciplinary Respiratory Medicine     Open Access   (Followers: 4)
npj Primary Care Respiratory Medicine     Open Access   (Followers: 2)
Open Journal of Respiratory Diseases     Open Access   (Followers: 1)
Open Respiratory Medicine Journal     Open Access   (Followers: 1)
Paediatric Respiratory Reviews     Hybrid Journal   (Followers: 12)
Pediatric Quality & Safety     Open Access  
Pediatric Respirology and Critical Care Medicine     Open Access   (Followers: 1)
Pulmonary Circulation     Open Access   (Followers: 4)
Pulmonary Medicine     Open Access   (Followers: 2)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Pulmonary Therapy     Open Access   (Followers: 1)
Pulmonology and Respiratory Research     Open Access   (Followers: 1)
Respiratory Care     Full-text available via subscription   (Followers: 10)
Respiratory Investigation     Full-text available via subscription  
Respiratory Medicine     Hybrid Journal   (Followers: 17)
Respiratory Medicine : X     Open Access  
Respiratory Medicine Case Reports     Open Access  
Respiratory Medicine CME     Hybrid Journal  
Respiratory Medicine Extra     Full-text available via subscription   (Followers: 1)
Respiratory Medicine: COPD Update     Hybrid Journal   (Followers: 5)
Respiratory Physiology & Neurobiology     Hybrid Journal   (Followers: 4)
Respiratory Research     Open Access   (Followers: 1)
Respirology     Hybrid Journal   (Followers: 5)
Respirology Case Reports     Open Access  
Revista Americana de Medicina Respiratoria     Open Access  
Revista Chilena de Enfermedades Respiratorias     Open Access  
Revista Inspirar     Open Access  
Revista ORL     Open Access  
Revista Portuguesa de Pneumologia     Open Access  
Sarcoidosis Vasculitis and Diffuse Lung Disese     Full-text available via subscription   (Followers: 3)
Seminars in Respiratory and Critical Care Medicine     Hybrid Journal   (Followers: 14)
Sleep Medicine Reviews     Hybrid Journal   (Followers: 17)
The Clinical Respiratory Journal     Hybrid Journal   (Followers: 3)
The International Journal of Tuberculosis and Lung Disease     Full-text available via subscription   (Followers: 8)
The Lancet Respiratory Medicine     Full-text available via subscription   (Followers: 32)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 7)
Therapeutic Advances in Respiratory Disease     Open Access   (Followers: 1)
Thorax     Hybrid Journal   (Followers: 37)
Translational Respiratory Medicine     Open Access   (Followers: 1)
Tuberculosis     Hybrid Journal   (Followers: 12)
Tuberculosis Research and Treatment     Open Access   (Followers: 3)
Пульмонология     Full-text available via subscription  


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Journal Cover
Heart & Lung: The Journal of Acute and Critical Care
Journal Prestige (SJR): 0.757
Citation Impact (citeScore): 2
Number of Followers: 11  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0147-9563 - ISSN (Online) 1527-3288
Published by Elsevier Homepage  [3177 journals]
  • Amiodarone induced “Blue man syndrome”; an unusual
    • Abstract: Publication date: Available online 25 November 2019Source: Heart & LungAuthor(s): Troy J. Fishman, Sanjae Spencer, Robert Harrell, Joshua K. SalabeiAbstractAmiodarone is a common antiarrhythmic medication used in daily practice with excellent efficiency. While it has many benefits, there are several common adverse reactions, such as abnormal thyroid function and cornea verticillata, associated with its use. A much less common adverse reaction is the so-called “Blue man syndrome,” occurring in 1–3% of patients. Blue man syndrome is thought to stem from the deposition of lysosomal membrane-bound dense bodies, similar to lipofuscin, in the dermis of patients on chronic amiodarone therapy. We present the case of a 77-year-old male who presented to us post-cardiac arrest secondary to hyperkalemia of 7.0. Although it was noted in the patient's chart that he had an “allergy” to amiodarone (it was noted in his chart it only turned his leg black), it was used in the emergency department because of the failure of other antiarrhythmics to treat his arrhythmia and all other medical options were exhausted. It was decided that the benefits of using amiodarone far outweighed the risks of it. Ultimately it was found that the patient did not have a true allergy to amiodarone, but suffered from a known benign adverse effect of the drug resulting in a greyish-blue tinge to his bilateral lower extremities. His-presentation differs from the normal presentation of blue man syndrome which appears more commonly on sun-exposed areas of the body such as the face and arms. While this is a benign adverse effect of amiodarone, it can be very distressing to patients and must be addressed.
  • Cross-classification of physical and affective symptom clusters and
           180-day event-free survival in moderate to advanced heart failure
    • Abstract: Publication date: Available online 18 November 2019Source: Heart & LungAuthor(s): Quin E. Denfeld, Julie T. Bidwell, Jill M. Gelow, James O. Mudd, Christopher V. Chien, Shirin O. Hiatt, Christopher S. LeeAbstractBackgroundThe relationship between physical and affective symptom clusters in heart failure (HF) is unclear.ObjectivesTo identify associations between physical and affective symptom clusters in HF and to quantify outcomes and determinants of symptom subgroups.MethodsThis was a secondary analysis of data from two cohort studies among adults with HF. Physical and affective symptom clusters were compared using cross-classification modeling. Cox proportional hazards modeling and multinomial logistic regression were used to identify outcomes and determinants of symptom subgroups, respectively.ResultsIn this young, mostly male sample (n = 274), physical and affective symptom clusters were cross-classified in a model with acceptable fit. Three symptom subgroups were identified: congruent-mild (69.3%), incongruent (13.9%), and congruent-severe (16.8%). Compared to the congruent-mild symptom group, the incongruent symptom group had significantly worse 180-day event-free survival.ConclusionCongruence between physical and affective symptom clusters should be considered when identifying patients at higher risk for poor outcomes.
  • Adherence to diet and medication and the associated factors among patient
           with chronic heart failure in a multi-ethnic society
    • Abstract: Publication date: Available online 16 November 2019Source: Heart & LungAuthor(s): Rachel Zi Qian Ling, Nana Jiao, Norasyikin Bte Hassan, Honggu He, Wenru WangAbstractObjectiveTo investigate diet adherence, medication adherence and self-care behaviour among patients with chronic heart failure (CHF) in a multi-ethnic society and identify the significant factors associated with their diet and medication adherence.MethodsA cross-sectional descriptive correlational study was conducted with a convenience sample of 107 patients with CHF recruited from two cardiology wards of a public tertiary hospital in Singapore. Study variables were measured using the Dietary Sodium Restriction Questionnaire, the Medication Adherence Rating Scale-5 items and the European Heart Failure Self-care Behaviour Scale-12 items.ResultsOur sample reported positive attitudes towards diet adherence, poor self-care behaviour, and good medication adherence. The multiple linear regression results indicated that lower income, Chinese ethnicity, diabetic complications, current smoking, lower New York Heart Association classification I and II, and poorer self-care behaviour predicted poorer diet adherence. In addition, absence of hypertension, having non-myocardial infarction as a cause of CHF, and moderately diminished ejection fraction were identified as significant predictors of poorer medication adherence.ConclusionThe findings from this study have established the need to improve current education and rehabilitation programmes for patients with CHF by addressing those factors significantly influencing their adherence to diet and medication.
  • An observational study of the management practices and outcomes of
           patients with new onset atrial fibrillation in non-cardiothoracic
    • Abstract: Publication date: Available online 15 November 2019Source: Heart & LungAuthor(s): Mihaela Tiru, Anis John Kadado, Vida Rastegar, Kanval Shah, Kirti K Joshi, Peter Lindenauer, Tara Lagu, Mihaela S StefanAbstractBackground and objectiveLimited data exist on characteristics and management of patients with postoperative atrial fibrillation (POAF) after noncardiothoracic surgeries and on the relationship between symptoms and outcomes. We sought to describe clinical features, in-hospital practices and outcomes in patients with new POAF by the presence or absence of clinical symptoms.MethodsRetrospective cohort study of adults with POAF in one tertiary center.ResultsAmong the 99 patients who fulfilled the eligibility criteria, median age was 75 years (IQR 64–83) and 57.6% were male. Only thirty percent of patients with POAF were symptomatic. Rate control/conversion to sinus rhythm was achieved in ≤ 4 h in 56% of the patients and in 80% was maintained for ≥ 24 h. Anticoagulation was prescribed in 50% of those discharged in AF; the CHADS2-VASc score was not associated with anticoagulation prescribed. One third of patients were readmitted and half of them were in AF. Asymptomatic patients had lower median heart rate than symptomatic patients but no other clinical characteristics, or outcomes were different.ConclusionsMost patients with POAF were asymptomatic but their presentation or outcomes were similar with symptomatic patients. One in four discharged patients was prescribed anticoagulation and the CHADS2-VASC score was not associated with this decision. These findings have important implications for practice and future research. There is a need to better delineate the risk associated with transient versus persistent POAF, symptomatic versus asymptomatic POAF, as well as for clinical trials to determine optimal strategies to improve their outcomes.
  • Comment on: “From labor and delivery to left ventricular assist device:
           A peripartum cardiomyopathy case report”
    • Abstract: Publication date: Available online 15 November 2019Source: Heart & LungAuthor(s): Özge Turgay Yıldırım, Özge Senem YÜCEL ÇİÇEK
  • Reaction time and functional balance in chronic obstructive pulmonary
    • Abstract: Publication date: Available online 15 November 2019Source: Heart & LungAuthor(s): Serdar Kalemci, Aydın Sarıhan, Abdullah Şimşek, Arife Zeybek
  • Aorto-cardiac fistula etiology, presentation, and management: A systematic
    • Abstract: Publication date: Available online 15 November 2019Source: Heart & LungAuthor(s): Tianne J. Foster, Ali Hama Amin, Tatiana Busu, Kinjan Patel, Peter Farjo, Abdulrahman Al Hallak, Nyaz Ali, Mohamad AlkhouliAbstractBackgroundAorto-cardiac fistulae are a rare but increasingly reported entity, and data are scarce.MethodThe authors performed a systematic review of ACFs to characterize the underlying etiology, clinical presentation, and compare outcomes of treatment strategies.Results3,733 publications were identified in the search. Of those, 292 studies including 300 patients were included. Etiology of ACFs was 38% iatrogenic, 25% infectious, 14% traumatic, and 15% due to other causes. Most patients (74%) presented with heart failure. Common locations were aortic-right atrium (37%), and aortic-pulmonary artery (25%). The majority of patients (71%) were treated surgically, while 13% were treated percutaneously, and 16% were treated conservatively. Patients who were managed conservatively had a higher mortality than those treated with invasive closure (53% vs. 12% vs. 3%, p =
  • A comparison of finger and forehead pulse oximeters in heart failure
           patients during maximal exercise
    • Abstract: Publication date: Available online 14 November 2019Source: Heart & LungAuthor(s): Kevin L. Kelly, Alex R. Carlson, Thomas G. Allison, Bruce D. JohnsonAbstractBackgroundPulse oximeters, clinically used to measure oxygen saturation (SpO2), rely on adequate perfusion of the tissues over which they are placed. Heart failure (HF) patients can have impaired peripheral perfusion which may compromise the accuracy of a peripherally placed pulse oximeter. This decrease in peripheral perfusion may be especially apparent during exercise. The objective of this study was to determine if pulse oximeter accuracy is dependent on location in heart failure patients during peak exercise.Methods20 participants with HF (7F, age 64.±11 yr) and 9 participants with coronary artery disease as controls (CAD: 3F, age 66±5 yr) performed a maximal exertion treadmill exercise stress test while wearing both finger and forehead pulse oximeters.ResultsAt peak exercise, the two pulse oximeters measurements of SpO2 differed from each other by 3.8 ± 3.3% in the HF group (p
  • Airway and transpulmonary driving pressures and mechanical powers selected
           by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients
    • Abstract: Publication date: Available online 14 November 2019Source: Heart & LungAuthor(s): Jean-Michel Arnal, Mathieu Saoli, Aude GarneroAbstractBackgroundDriving pressure (ΔP) and mechanical power (MP) are predictors of the risk of ventilation- induced lung injuries (VILI) in mechanically ventilated patients. INTELLiVENT-ASV® is a closed-loop ventilation mode that automatically adjusts respiratory rate and tidal volume, according to the patient's respiratory mechanics.ObjectivesThis prospective observational study investigated ΔP and MP (and also transpulmonary ΔP (ΔPL) and MP (MPL) for a subgroup of patients) delivered by INTELLiVENT-ASV.MethodsAdult patients admitted to the ICU were included if they were sedated and met the criteria for a single lung condition (normal lungs, COPD, or ARDS). INTELLiVENT-ASV was used with default target settings. If PEEP was above 16 cmH2O, the recruitment strategy used transpulmonary pressure as a reference, and ΔPL and MPL were computed. Measurements were made once for each patient.ResultsOf the 255 patients included, 98 patients were classified as normal-lungs, 28 as COPD, and 129 as ARDS patients. The median ΔP was 8 (7 − 10), 10 (8 − 12), and 9 (8 − 11) cmH2O for normal-lungs, COPD, and ARDS patients, respectively. The median MP was 9.1 (4.9 – 13.5), 11.8 (8.6 – 16.5), and 8.8 (5.6 – 13.8) J/min for normal-lungs, COPD, and ARDS patients, respectively. For the 19 patients managed with transpulmonary pressure ΔPL was 6 (4 − 7) cmH2O and MPL was 3.6 (3.1 – 4.4) J/min.ConclusionsIn this short term observation study, INTELLiVENT-ASV selected ΔP and MP considered in safe ranges for lung protection. In a subgroup of ARDS patients, the combination of a recruitment strategy and INTELLiVENT-ASV resulted in an apparently safe ΔPL and MPL.
  • Bicarbonate use and mortality outcome among critically ill patients with
           metabolic acidosis: A meta analysis
    • Abstract: Publication date: Available online 14 November 2019Source: Heart & LungAuthor(s): Kevin Bryan Lo, Veronica Garvia, Jessica M. Stempel, Pradhum Ram, Janani RangaswamiAbstractBackgroundThe use of sodium bicarbonate in the treatment of metabolic acidosis in critically ill subjects has long been a subject of debate. Despite empiric use in the setting of severe acidemia in critically ill patients, there is little data looking into the role of sodium bicarbonate in the treatment of severe metabolic acidosis in the intensive care unit (ICU) setting.MethodsWe conducted a comprehensive search of Pubmed and Cochrane Central Register of Controlled Trials addressing bicarbonate use in the metabolic acidosis in the intensive care unit (ICU) setting. We examined mortality as end point. Pooled odds ratios (OR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effect model.ResultsThe final search yielded 202 articles of which all were screened individually. A total of 11 studies were identified but 6 studies were excluded due to irrelevance in mortality outcome and methodology. Analysis was done separately for observational studies and randomized controlled trials. The pooled OR [95% CI] for mortality with bicarbonate use in the observational studies was 1.5 [0.62–3.67] with heterogeneity of 67%, while pooled OR for mortality in the randomized trials was 0.72 [0.49–1.05] (figure 2). In combining all studies, the pooled odds ratio was 0.93 95% [0.69–1.25] but with heterogeneity of 63%. After sensitivity analysis with removing the study done by Kim et al. 2013, heterogeneity was 0% with OR 0.8 [0.59–1.10].ConclusionThere is no significant difference in mortality in the use of bicarbonate among critically ill patients with high anion gap metabolic acidosis predominantly driven by lactic acidosis.
  • Board of Directors
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s):
  • Long-term health-related quality of life of adult patients treated with
           extracorporeal membrane oxygenation (ECMO): An integrative review
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s): Krista A. Knudson, Carolina M. Gustafson, Lois S. Sadler, Robin Whittemore, Nancy S. Redeker, Laura K. Andrews, Abeel Mangi, Marjorie FunkAbstractBackground: Extracorporeal membrane oxygenation (ECMO), a rescue treatment for patients with severe pulmonary and/or cardiac dysfunction, is increasingly being used worldwide. A better understanding of long-term health-related quality of life (HRQOL) is needed. Objective: To synthesize research on long-term (at least 6 months post-ECMO) HRQOL of adults treated with ECMO. Methods: In this integrative review, we searched 3 electronic databases and did a hand search of relevant journals for articles published 2000–2019, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Thirty-one studies, representing 913 patients treated with ECMO, were included. Long-term HRQOL was slightly better for patients treated with veno-venous ECMO than veno-arterial ECMO, and mental health outcomes tended to be better than physical ones. Survivors frequently experienced physical complications, functional limitations, anxiety, depression, and post-traumatic stress symptoms, although improvements were observed over time. Conclusions: Early identification and management of physical and mental health problems may improve HRQOL outcomes.
  • Use of handgrip dynamometry for diagnosis and prognosis assessment of
           intensive care unit acquired weakness: A prospective study
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s): Renan Detoffol Bragança, Cecilia Gómez Ravetti, Lídia Barreto, Thiago Bragança Lana Silveira Ataíde, Rafael Mourão Carneiro, Antônio Lúcio Teixeira, Vandack NobreAbstractObjectivesTo test the agreement between handgrip dynamometry and Medical Research Council (MRC) criteria for the diagnosis of intensive care unit acquired weakness (ICUAW) and to evaluate if dynamometry findings are associated with morbidity and mortality.MethodsA prospective single center cohort study was conducted in a Brazilian ICU. Adults requiring at least 5 days of critical care were included. Primary outcome was the agreement between ICUAW diagnosis as assessed by the MRC score and the handgrip strength dynamometry. Exploratory outcomes were in-ICU, in-hospital, 6-month and one-year mortality, days of mechanical ventilation, length of ICU and hospital stay (in the present hospitalization and during the 6-month follow-up) and ICU readmission in six months.ResultsWe included 45 consecutive subjects, of which 18 of them had ICUAW according to MRC criteria. Using sex specific thresholds, handgrip strength had high agreement with MRC criteria for ICUAW diagnosis (100% accuracy; Kappa coefficient = 1; p
  • Comparison of early and midterm outcomes after transsubclavian/axillary
           versus transfemoral, transapical, or transaortic transcatheter aortic
           valve implantation
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s): Hisato Takagi, Yosuke Hari, Kouki Nakashima, Toshiki Kuno, Tomo Ando, ALICE (All-Literature Investigation of Cardiovascular Evidence) GroupAbstractBackgroundOutcomes after transsubclavian/transaxillary (TSc/TAx)-transcatheter aortic valve implantation (TAVI) have been unclear.ObjectivesTo compare outcomes after TSc/TAx-TAVI versus transfemoral (TF)-TAVI, transapical (TAp)-TAVI, or transaortic (TAo)-TAVI, we performed meta-analysis of currently available studies.MethodsStudies considered for inclusion met the following criteria: the study population was patients undergoing TAVI; patients were assigned to TSc/TAx-TAVI and TF-TAVI, TAp-TAVI, or TAo-TAVI; and at least one of postprocedural early (30-day or in-hospital) or late (including early) outcomes was reported. An odds or hazard ratio of each early or late outcome with its 95% confidence interval for TSc/TAx-TAVI versus the other approach was extracted from each individual study and combined in the random-effects model.ResultsOur search identified 15 eligible reports from 12 studies including 10,528 patients. Pooled analysis of early all-cause mortality demonstrated a statistically significant reduction after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.003) or TAo-TAVI (P = 0.03). Pooled analysis of early pacemaker implantation demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.0001) or TAo-TAVI (P < 0.00001). Pooled analysis of midterm all-cause mortality demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TF-TAVI (P = 0.007).ConclusionsEarly all-cause mortality was lower after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, early pacemaker implantation was more frequent after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, and midterm all-cause mortality was higher after TSc/TAx-TAVI than TF-TAVI.
  • The association of preoperative atrial fibrillation with
           post-cardiopulmonary bypass hyperfibrinolysis in rheumatic valvular heart
           disease patients
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s): Zheng Guan, Yong-Jian Zhang, Lin Liu, Xin Shen, Yan-Feng Gao, Xiao-Gang Li, Rong-Sheng Zhou, Jing-Jie LiuAbstractObjectiveThe purpose of this study was to assess the fibrinolytic status after cardiopulmonary bypass in rheumatic valvular heart disease patients, and detect the associated factors of post-cardiopulmonary bypass hyperfibrinolysis.MethodsAccording to the fibrinolytic status after cardiopulmonary bypass, 203 rheumatic valvular heart disease patients were divided into two groups: hyperfibrinolysis group (H group, n = 78) and non-hyperfibrinolysis group (NH group, n = 125). The demographic characteristics, operative variables, and postoperative follow-ups were compared between these two groups.ResultsThe incidence of hyperfibrinolysis was 38.4% after cardiopulmonary bypass. Patients in the H group had a significant higher incidence of preoperative atrial fibrillation than patients in the NH group (92.3% vs. 55.2%, P 
  • A multi-component, family-focused and literacy-sensitive intervention to
           improve medication adherence in patients with heart failure–A randomized
           controlled trial
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s): Jia-Rong Wu, Barbara Mark, George J. Knafl, Sandra B. Dunbar, Patricia P. Chang, Darren A. DeWaltAbstractBackgroundMedication nonadherence is prevalent and links to serious outcomes (e.g., rehospitalization/death) in heart failure (HF) patients; therefore, an urgent need exists for an intervention to improve and sustain adherence after intervention completion.ObjectivesTo test the efficacy of a multi-component, family-focused, literacy-sensitive (FamLit) intervention on medication adherence in HF patients.MethodsForty-three HF patients and their care partners were enrolled and randomized to receive FamLit or attention-only intervention, including an in-person session at baseline and bi-weekly phone boosters for 3 months. We measured medication adherence from baseline to 3-month post-intervention using the Medication Event Monitoring System.ResultsAfter 3-month intervention, intervention patients had significantly better medication adherence than control patients. At 6 months (3-months post-intervention), intervention effect on adherence was sustained in the FamLit intervention group, while adherence decreased in the control group.ConclusionIncorporating care partner support and providing an easy-to-understand intervention to patients-care partners may improve/sustain adherence.
  • Self-care in Chinese heart failure patients: Gender-specific correlates
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s): Xi Cao, Sek Ying Chair, Xiuhua Wang, Han Shi Jocelyn Chew, Ho Yu ChengAbstractBackgroundExisting studies have indicated that poor self-care in heart failure (HF) patients may differ according to gender but such studies remain scarce among Chinese HF patients.ObjectiveTo explore gender difference in correlates of self-care in Chinese HF patients.MethodA cross-sectional study on Chinese HF patients (n = 127) from cardiac wards of two hospitals in China was conducted. Data on participants’ socio-demographic and clinical characteristics, self-care, HF knowledge, social support, and self-care confidence were collected. Correlates of HF self-care were explored using hierarchical multiple regression.ResultsGender differences were observed in Chinese HF patients, who generally performed poorly in self-care. In males, self-care maintenance was associated with HF knowledge while self-care management was associated with social support. In females, maintenance was associated with self-care confidence while management was associated with both self-care confidence and HF knowledge.ConclusionCorrelates of self-care differed between two genders in Chinese HF patients. These gender-specific factors should be considered when planning self-care intervention or educating HF patients.
  • Understanding communal coping among patients and informal caregivers with
           heart failure: A mixed methods secondary analysis of patient-caregiver
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s): Jennalee S. Wooldridge, Caroline Gray, Ambri Pukhraj, Jessica Geller, Ranak B. TrivediAbstractBackgroundDyads that view illnesses as shared stressors (“shared appraisal”), and collaboratively respond to it, have better outcomes. This process, known as communal coping, has received little attention in heart failure (HF).ObjectivesTo examine communal coping among patient-caregiver dyads managing HF.MethodsWe conducted semi-structured interviews with 34 dyads. Shared appraisal was measured using we-ratio, as calculated with Linguistic Inquiry Word Count. We-ratio was divided into “high” and “low” for patients and caregivers, and concordance was examined. Thematic analyses were used to explore collaboration.ResultsCaregivers had higher we-ratios than patients (p=.005); 29.6% and 33.3% dyads were concordant on high and low “we-ratio,” respectively. In thematic analyses, we found that 1) dyads collaborated around diet, appointments, and medications, but less around physical activity; 2) dyads collaborated across all illnesses, not just HF; and 3) dyads concordant on high we-ratio reported stronger collaborations.ConclusionsCommunal coping varied by shared appraisal and collaboration. Understanding this variability may help develop tailored self-management interventions.
  • Knowledge among patients with heart failure: A narrative synthesis of
           qualitative research
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s): Carly Daley, Monirah Al-Abdulmunem, Richard J. HoldenAbstractBackgroundPatients’ knowledge of heart failure (HF) is integral to improved outcomes. However, the HF literature has not adequately explored the nature of patients’ knowledge of HF as part of their lived experience.ObjectivesWe aimed to characterize the nature of patients’ knowledge of HF, in the context of living with the disease.MethodsWe conducted a narrative synthesis of qualitative studies that addressed patients’ knowledge of HF. Studies were systematically searched and retrieved from MEDLINE, CINAHL, PsycINFO and PsycARTICLES databases. Findings were synthesized using an iterative coding process carried out by multiple analysts and reported following Enhancing Transparency in the Reporting of Qualitative Health Research (ENTREQ) criteria.ResultsAnalysis of 73 eligible articles produced five themes: the content that comprises HF knowledge; development of HF knowledge over time; application of HF knowledge for decision making; communication of information between clinicians and patients; and patients’ experience of knowledge.ConclusionThe nature of patients’ knowledge of HF is both explicit and implicit, dynamic, and personal. This multidimensional model of knowledge-in-context calls for equally multidimensional research and intervention design.
  • Information for Authors
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s):
  • Information for Readers
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s):
  • Seasonal variation in physical activity in patients with heart failure
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s): Afshin Amirpour, Reihaneh Zavar, Javad Shahabi
  • Effects of the discontinuation sequence of norepinephrine and vasopressin
           on hypotension incidence in patients with septic shock: A meta-analysis
    • Abstract: Publication date: November–December 2019Source: Heart & Lung, Volume 48, Issue 6Author(s): Gary Duclos, Karine Baumstarck, Martin Dünser, Laurent Zieleskiewicz, Marc LeoneAbstractBackgroundAlthough the order of vasopressor initiation in patients with septic shock is established, limited information is available on the order of vasopressor discontinuation.MethodsWe performed a meta-analysis of nine studies involving 1245 patients in whom norepinephrine (n = 787) or vasopressin (n = 458) was withdrawn first to compare the risk of hypotension.ResultsThe risk of hypotension increased in patients whom vasopressin was withdrawn first (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.3–8.9; p = 0.01). A sensitivity analysis indicated that this effect was observed in four studies with a high risk of bias (OR, 5.4; 95%CI, 1.3–23.5; p = 0.02) and was not observed in five studies with a low risk of bias (OR, 2.4; 95%CI, 0.6–8.4; p = 0.18).ConclusionOur results suggest that the risk of hypotension is higher in patients with septic shock in whom vasopressin is withdrawn before norepinephrine.
  • Palliative care referral in ST-segment elevation myocardial infarction
           complicated with cardiogenic shock in the United States
    • Abstract: Publication date: Available online 6 November 2019Source: Heart & LungAuthor(s): Tomo Ando, Emmanuel Akintoye, Takeshi Uemura, Oluwole Adegbala, Said Ashraf, Mohit Pahuja, Mohamed Shokr, Hisato Takagi, Cindy L. Grines, Luis Afonso, Alexandros BriasoulisAbstractBackgroundST-segment elevation myocardial infarction complicated with cardiogenic shock (STEMI-CS) is associated with high mortality but the trends of utilization and predictors of palliative care (PC) referral in this population have not been well described.ObjectivesTo investigate the utilization trends and predictors of PC referral in STEMI-CS.MethodsNationwide inpatient sample from 2005–2014 was queried to identify patients with STEMI-CS of age ≥18. PC referral was identified International Classification of Diseases, Ninth Edition Clinical Modification, V66.7.ResultsA total of 33,294 admissions were identified and 1,878 (5.6%) had PC encounter. PC referral group were older and had higher comorbidities. PC consultation increased approximately 10 times over the study period in those who died (from 2.3% to 27.4%) and in those who survived (from 0.21% to 2.83%). In multivariable analysis, age, higher Exlixhauser score, no revascularization, teaching hospital, large bed hospital, mechanical circulatory support use, and lower income status were associated with increased PC referral whereas coronary artery bypass graft was associated with lower PC referral rates. Patients under PC group were more often discharged to an extended care facility and less likely discharged home.ConclusionPC utilization increased substantially during the 10-years study period in the United States in STEMI-CS. Several baseline, procedural, hospital, and socioeconomic factors were associated with PC referral in the setting STEMI-CS.
  • Endotracheal tube cuff pressure change: Proof of concept for a novel
           approach to objective cough assessment in intubated critically ill
    • Abstract: Publication date: Available online 6 November 2019Source: Heart & LungAuthor(s): Matthew Peter O'Neill, Pragasan Dean GopalanAbstractPurposeCough strength assessment aids in predicting extubation failure. Peak expiratory flow rate during cough manoeuvre (CPF) is the gold-standard tool and flow rates of
  • Cricoid pressure during intubation: A systematic review and meta-analysis
           of randomised controlled trials
    • Abstract: Publication date: Available online 2 November 2019Source: Heart & LungAuthor(s): Leigh White, Christopher Thang, Anthony Hodsdon, Thomas Melhuish, Ruan VlokAbstractPurposeThis systematic review and meta-analysis aimed to determine whether cricoid pressure protects against aspiration and whether this technique adversely affects intubating conditions in adult patients.MethodsA systematic review of five databases was performed for randomised controlled trials comparing cricoid pressure to no cricoid or sham cricoid during intubation. The primary outcome was incidence of aspiration and the secondary outcomes included first attempt intubation success, time to intubation, Cormack and Lehane Grade 3 or 4 and difficult intubation.ResultsThe search identified twelve high quality RCTs with 4,862 patients for inclusion. Among four studies reporting the primary outcome, there was no difference (RR=1.18; 95%CI=0.71 to 1.96; I2=0%; p=0.51). Only 3 studies were in patients at high risk of aspiration. There was significantly worse first attempt success (RR= 0.94; 95%CI= 0.89 to 0.99; I2=66%; p=0.02), time to intubation (WMD= 6.77seconds; 95%CI=4.40 to 9.14seconds; I2=97%) and laryngoscopy views (RR=1.69; 95%CI=1.41 to 2.02;I2=1%; p
  • Red cell distribution width and its prediction value of mortality
    • Abstract: Publication date: Available online 1 November 2019Source: Heart & LungAuthor(s): Özge Turgay Yıldırım, Fatih Aydın, Ayşe Hüseyinoğlu Aydın, Ercan Akşit
  • Validation of the Arabic Version of the Minnesota Living with Heart
           Failure Questionnaire
    • Abstract: Publication date: Available online 1 November 2019Source: Heart & LungAuthor(s): Mariam Zahwe, Hussain Isma'eel, Hadi Skouri, Amal Al-Hajje, Samar Rachidi, Hani Tamim, Samar NoureddineAbstractBackgroundThe Minnesota Living with Heart Failure Questionnaire (MLHFQ) is commonly used to measure quality of life (QOL) in patients with heart failure (HF). We examined the psychometric properties and cultural validity of an Arabic version of the MLHFQ.MethodsAn observational cross-sectional study was conducted with 210 adult HF outpatients. Patients were interviewed with the Arabic MLHFQ and the Patient Health Questionnaire (PHQ-9). Cronbach's alpha coefficient and confirmatory factor analysis were conducted. Patients with different NYHA classes and HF-hospitalization histories were compared on QOL to test known-group validity.ResultsThe confirmatory factor analysis yielded 3 factors: physical, emotional, and social. Three items (4, 8, and 15) had low loadings. The overall Cronbach's alpha coefficient was 0.92. There were significant differences in MLHFQ by PHQ-9 categories, NYHA class, and HF-hospitalization history.ConclusionsThis Arabic version of MLHFQ is valid and reliable and can be used in Arabic-speaking Lebanese HF populations.
  • Identifying the optimum chest compression point during cardiopulmonary
    • Abstract: Publication date: Available online 29 October 2019Source: Heart & LungAuthor(s): Davide Olivari, Daria De Giorgio, Francesca Fumagalli, Giuseppe Ristagno
  • Prognostic value of hemodynamics and comorbidities in pulmonary
           hypertension due to advanced heart failure
    • Abstract: Publication date: Available online 23 October 2019Source: Heart & LungAuthor(s): Ruilin Quan, Li Huang, Tao Yang, Wen Li, Qing Gu, Changming Xiong, Jianguo HeAbstractBackgroundThe prognostic predictors of pulmonary hypertension (PH) due to advanced heart failure (HF) have yet to be explored.ObjectivesTo examine the prognostic value of hemodynamics and comorbidities in this patient group.MethodsWe retrospectively enrolled consecutive patients with PH due to advanced HF diagnosed by echocardiography and right heart catheterization. Follow-up was performed every 6 months ± 2 weeks. Primary endpoints were all-cause mortality and heart or lung transplantation.ResultsIn total, 92 patients were included. The mean age was 46.82 years and mean left ventricular ejection fraction (LVEF) was 26.63%. During a median follow-up time of 9.72 months, 66 patients (71.7%) met primary endpoints. Pulmonary arterial compliance (PAC) was a significant predictor for primary endpoints and patients burdened with more than 3 comorbidities had worse prognoses (P = 0.0114).ConclusionsIn these patients, PAC can be a potential prognostic predictor and patients with a higher comorbidity burden have worse outcomes.
  • Quality of life of obstructive sleep apnoea patients receiving continuous
    • Abstract: Publication date: Available online 23 October 2019Source: Heart & LungAuthor(s): Vladimira Timkova, Iveta Nagyova, Sijmen A. Reijneveld, Ruzena Tkacova, Jitse P. van Dijk, Ute BültmannAbstractBackgroundPrevious studies have shown conflicting results on the effect of continuous positive airway pressure (CPAP) on quality of life (QoL) in obstructive sleep apnoea (OSA) patients.ObjectivesTo evaluate the effect of CPAP on QoL in OSA patients compared to sham CPAP, placebo pills, and conservative treatment.MethodsStudies were identified via Web of Knowledge, PubMed, PsychInfo, CINAHL, EMBASE, OpenGrey, and the Cochrane Library. Subgroup analyses and sensitivity analyses were conducted to assess the robustness of the findings.ResultsMeta-analysis of 13 randomised controlled trials showed no significant differences in overall and psychological QoL comparing values of CPAP treated patients with controls; however, physical QoL improved. CPAP significantly affected the overall QoL in studies with controls receiving sham CPAP, parallel design, low risk of bias, and mild OSA patients.ConclusionCPAP treatment may help to improve physical symptoms of OSA, whereas impaired psychological QoL still cannot be alleviated.
  • Leadership message—Age friendly care
    • Abstract: Publication date: Available online 15 October 2019Source: Heart & LungAuthor(s): Linda Wick
  • Comparison of reaction time and functional balance in chronic obstructive
           pulmonary disease and healthy participants
    • Abstract: Publication date: Available online 10 October 2019Source: Heart & LungAuthor(s): Shashank Shekar Singh, Anup Bhat, Aswini Kumar Mohapatra, Mohan K Manu, K VaishaliAbstractBackgroundReaction time is one of the components of functional balance and could contribute to balance impairment. Information regarding this relationship is scant among Chronic Obstructive Pulmonary Disease (COPD) participants.ObjectivesTo compare stepping reaction time between participants with COPD and age; gender-matched healthy individuals to find out whether reaction time in COPD population is affected.MethodsThis cross-sectional study included 41 COPD participants and 41 age and gender-matched healthy individuals. All the participants underwent measurements of stepping reaction time (SRT) and timed up and go test (TUG).ResultsSRT was significantly higher in COPD participants compared to healthy individuals [median of difference- 350 milliseconds (110, 830), p < 0.001]. TUG was significantly higher in COPD participants compared to healthy individuals [median of difference = 2.82 seconds (0.34 and 4.5), p < 0.001].ConclusionsParticipants with COPD exhibit marked increase in SRT and demonstrate a deficiency in functional balance compared to the healthy participants.
  • Time to move: Shifting the ICU paradigm to improve outcomes for survivors
           of critical illness
    • Abstract: Publication date: Available online 24 September 2019Source: Heart & LungAuthor(s): Jill L. Guttormson, Natalie S. McAndrew
  • Predictive risk factors of early onset left ventricular aneurysm formation
           in patients with acute ST-elevation myocardial infarction
    • Abstract: Publication date: Available online 14 September 2019Source: Heart & LungAuthor(s): Zenghui Zhang, Jun GuoAbstractBackgroundLeft ventricular aneurysm (LVA) is a severe complication of ST-elevation myocardial infarction (STEMI) and is associated with poor prognosis due to high mortality. However, predictors of LVA formation in early period are inadequately defined.ObjectivesThe purpose of this study is to determine potential predictors of LVA formation in early period (
  • Physical activity of patients with bronchiectasis compared with healthy
           counterparts: A cross-sectional study
    • Abstract: Publication date: Available online 14 September 2019Source: Heart & LungAuthor(s): Aslihan Cakmak, Deniz Inal-Ince, Hazal Sonbahar-Ulu, Cemile Bozdemir-Ozel, Ozge Ozalp, Ebru Calik-Kutukcu, Melda Saglam, Naciye Vardar-Yagli, Hulya Arikan, Ziya Toros Selcuk, Lutfi CopluAbstractBackgroundA few studies have implied that patients with bronchiectasis have a more inactive lifestyle than healthy counterparts do. The main objective of this study was to compare physical activity (PA) levels subjectively and objectively between patients with bronchiectasis and healthy individuals using an accelerometer and a questionnaire.MethodsThe study included 41 patients with bronchiectasis aged 18–65 years and 35 healthy age- and sex-matched control subjects. The PA level was assessed objectively using a multisensorial PA monitor, the SenseWear Armband (SWA), and subjectively with the International Physical Activity Questionnaire (IPAQ). All participants performed the incremental shuttle walk test (ISWT) for the assessment of exercise capacity. Pulmonary function, dyspnea, severity of bronchiectasis, respiratory and peripheral muscle strength, and quality of life were assessed.ResultsThe pulmonary function test parameters, respiratory and peripheral muscle strength, exercise capacity, step count, moderate- and vigorous-intensity PA duration were significantly lower in patients with bronchiectasis than in the healthy control group (p 
  • Exploring positive aspects of caregiving in family caregivers of adult icu
           survivors from ICU to four months post-ICU discharge
    • Abstract: Publication date: Available online 11 September 2019Source: Heart & LungAuthor(s): JiYeon Choi, Youn-Jung Son, Judith A. TateAbstractBackground: Despite growing attention to the positive meaning from ICU survivorship, little is known about positive experience among family caregivers of ICU survivors.Objectives: To explore positive aspects of caregiving in family caregivers from patients’ ICU admission to 4-month post-ICU discharge.Methods: A secondary analysis of data from 47 family caregivers of ICU patients who self-reported the measure, Positive Aspects of Caregiving (PAC, 11-item, score range 11–55).Results: Family caregivers rated their experience as positive overall across the time points (mean 42.42–44.95). Trends of higher mean PAC scores were observed in caregivers who were older than 50 years of age, parent or sibling of patients, not working, had religious background or preference, and had no financial difficulty. Better social support and psychological responses were associated with PAC.Conclusion: In our sample, family caregivers of ICU survivors rated their caregiving experience as positive during the ICU and post-ICU periods.
  • Extended afternoon naps are associated with hypertension in women but not
           in men
    • Abstract: Publication date: Available online 11 September 2019Source: Heart & LungAuthor(s): Yuhang Yang, Wei Liu, Xiaopeng Ji, Chenjuan Ma, Xiuyan Wang, Kun Li, Junxin LiAbstractBackgroundThe impact of afternoon napping duration on the risk of hypertension has not been well established, particularly with regards to sex and age differences.ObjectiveTo examine the association between afternoon napping duration and hypertension stratified by sex and age among Chinese adults over 45 years of age.MethodsThe 2011–2012 survey of the China Health and Retirement Longitudinal Study (CHARLS) was used, including 7,980 participants. We conducted logistic regression models in the overall sample, and then stratified by sex and age groups.ResultsMiddle-aged and older women who napped over 90 min were 39% and 54% more likely to have hypertension, respectively; however, the associations were not significant in middle-aged and older men.ConclusionExtended afternoon napping (≥90 min) was associated with hypertension in both the middle-aged women and older women but not in men. Future studies are needed to further examine the association and possible mechanisms.
  • Advance directives and intensity of care delivered to hospitalized older
           adults at the end-of-life
    • Abstract: Publication date: Available online 3 September 2019Source: Heart & LungAuthor(s): Marsha H. Tyacke, Jill L. Guttormson, Mauricio Garnier-Villarreal, Kathryn Schroeter, Wendy PeltierAbstractBackgroundOlder adults prefer comfort over life-sustaining care. Decreased intensity of care is associated with improved quality of life at the end-of-life (EOL).ObjectivesThis study explored the association between advance directives (ADs) and intensity of care in the acute care setting at the EOL for older adults.MethodsA retrospective, correlational study of older adult decedents (N = 496) was conducted at an academic medical center. Regression analyses explored the association between ADs and intensity of care.ResultsAdvance directives were not independently predictive of aggressive care but were independently associated with referrals to palliative care and hospice; however, effect sizes were small, and the timing of referrals was late.ConclusionThe ineffectiveness of ADs to reduce aggressive care or promote timely referrals to palliative and hospice services, emphasizes persistent inadequacies related to EOL care. Research is needed to understand if this failure is provider-driven or a flaw in the documents themselves.
  • Floating LVAD hardware in an infected hematoma following a traumatic fall
    • Abstract: Publication date: Available online 30 August 2019Source: Heart & LungAuthor(s): Grace Lee, Sarah D. Schettle, John M. StulakAbstractLeft ventricular assist devices (LVAD) are used to support advanced heart failure patients who have failed optimal medical management, meet LVAD criteria, and are deemed to be appropriate surgical candidates. LVAD patients are further advised on symptoms that should prompt notification to the implanting center and are encouraged to contact their LVAD team with device questions and concerns due to morbidity risks unique to this patient population. Mechanical disruption of internal LVAD components is rare and typically requires hospitalization and potentially surgical intervention. External trauma to the LVAD resulting in driveline fracture, torn LVAD outflow grafts, pump displacement, and a kinked inlet cannula have been described.1 Because these occurrences are rare and often unexpected, identification of the root cause may not always be readily apparent. We describe a previously unreported presentation of a patient supported with an LVAD for more than 4 years who was found to have a broken and dislodged LVAD outflow cuff floating in an abdominal hematoma without pump failure.
  • Safely Ambulating Patients with a Pulmonary Artery Catheter: Changing
           Practice and Improving Care
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s): BackgroundPatients waiting for a heart transplant can be hospitalized for extended periods of time, ranging from months to over a year. During this time, patients typically require continuous hemodynamic monitoring with pulmonary artery catheters (PACs) to guide medical management. Out of concern for catheter movement/dislodgement, the standard of care for patients with PACs historically has their activity limited to bed rest. Decreased physical activity leads to deconditioning, osteoporosis and emotional distress. Recent data of ICU patients demonstrated beneficial effects from early mobility. There is limited data in the literature with regards to safely ambulating patients with PACs but from what has been studied, patients expressed a feeling of improved physical and emotional well-being (Harris et al., 2013).PurposeTo determine if patients with PACs can ambulate safely, without movement or dislodgement of their catheter, in order to prevent physical deconditioning and improve emotional well-being.MethodAll patients on the Cardiomyopathy Unit with a PAC in place were included in this quantitative analysis. Inclusion/Exclusion criteria were created as patients were considered unsafe to ambulate if they had the following: symptomatic arrhythmias, low blood pressure, low SV02, substantial oxygen requirements (=4L) or had inotropes started within 12 hours. Those with significant physical therapy constraints such as non-weight bearing, non-ambulatory, or an assist of =2 were not eligible. The Heart Failure Nurse Practitioner evaluated the patients and entered an order if ambulation was deemed appropriate. The patient was educated on ambulating with a PAC guidelines. The patient was allowed to ambulate on telemetry twice daily, accompanied by a RN only. Prior to ambulation, the RN measured PAC position externally, ensured securement of an occlusive dressing at the site and catheter immobilization, printed RA and PA waveform strips to be placed on a tracking sheet. The patient's transducer cables were then disconnected from the bedside monitor. The patient was allowed to ambulate as tolerated, while being monitored for arrhythmias on telemetry, (hemodynamic waveforms were not monitored during ambulation). Post ambulation, the patient's PAC transducer cable was reconnected to the monitor and zeroed. The RN then reassessed the PAC position externally, printed RA and PA waveforms to compare to prior and ensured integrity of the dressing. The RN replaced the dressing if it was no longer occlusive to prevent infection. If a complication occurred, the Heart Failure Nurse Practitioner was notified and the type of complication was documented on the tracking sheet.Results89 patients were observed for potential complications associated with PACs during ambulation including: migration of the PAC (forward/backward), fracture in the catheter, dislodgement of catheter, life threatening dysrhythmias. No complications were observed in 493 ambulation experiences.ConclusionsBy utilizing and inclusion/exclusion criteria, setting limits on the frequency a patient is allowed to ambulate and creating a protocol to ensure a controlled setting, patients with PACs can safely ambulate without monitoring the PA waveforms. The use of a standard dressing and immobilization technique prevents catheter dislodgement during ambulation. By increasing physical activity, patients will gain strength to help prevent deconditioning during prolonged hospitalizations
  • Inspiratory Capacity and NT-pro BNP Predict Key Cardiopulmonary Exercise
           Results but not Six-Minute Walk Test distance in Older Patients with Heart
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s): IntroductionHeart failure (HF) affects more than five million people, half of whom are at least 75 years old. Peak oxygen consumption (VO2peak), Ventilatory efficiency (VE/VCO2 slope) and the Six-Minute Walk test (6MWT) are powerful prognostic indicators and are useful for monitoring the therapeutic efficacy of symptom and disease management. Cardiopulmonary Exercise testing (CPX) and/or the 6MWT are often not performed as a part of symptom assessment and management in older adults with HF, presumably due to cost, comorbidities and/or potential frailty. NT-pro BNP, NYHA classification, and inspiratory capacity are all easily obtainable in an office setting and may correlate with VO2peak, the VE/VCO2 slope, Peak cardiac output (Qpeak) and/or 6MWT.HypothesisNT-pro BNP, NYHA classification, and/or inspiratory capacity predict VO2peak, the VE/VCO2 slope, Qpeak, and/or 6MWT.MethodsTwenty-three patients (73.6 + 4.5 years old) with HF underwent assessment and determination of NYHA classification status, venipuncture, inspiratory capacity measurement, and performed the 6MWT and CPX per standardized protocol, (Qpeak measured via acetylene washin method). VO2peak, VE/VCO2 slope and Qpeak were recorded during the CPX.ResultsThe strongest relationships were between inspiratory capacity and Qpeak, and between NT-pro BNP and the VE/VCO2 slope. There was a moderate relationship between inspiratory capacity and VO2peak and between NT-pro BNP and VO2peak. Inspiratory capacity and NT-pro BNP combined explained 42% of the variance in VO2peak (adjusted R2 = 0.42, F (2, 20) = 8.82, p < 0.002). Due to the lack of variance NYHA classification was not included in the analysis. The 6MWT distance did not correlate with inspiratory capacity or NT-pro BNP.ConclusionNT-pro BNP and inspiratory capacity can, either alone or combined, explain between 42% and 59% of variance in key exercise measurements. Both measurements are obtainable in the office setting for monitoring the therapeutic efficacy of symptom and disease management. Moreover, inspiratory capacity has the potential to be measured by older adults in their home.
  • It takes a Village to Care for the Mechanical Circulatory Support Device
           Patient throughout the Care Environment
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s): PurposeOver 23,000 mechanical circulatory support (MCS) devices have been implanted since 2006. Survival for patients with MCS at 3 years is approximately 60%. In the hospital environment, there are an increasing number of patients with devices from both index admissions, readmissions and non-device related admissions. Frequently patients in the Progressive and Acute Care settings are required to travel off the unit requiring nurses to leave their other patients while accompanying the MCS patient. Our urban, academic medical center needed a way to support these patients and the team members caring for them.ObjectivesCreating a safe environment for patients to receive care is of utmost importance in a complex patient population with essential life sustaining equipment. Empowering knowledge to our team members allows for smoother transitions throughout the practice areas and a shared ownership for their safety.MethodsA class was developed for support team members and taught by CT Surgery Clinical Nurse Specialists and VAD Coordinators. Transporters, care partners, occupational therapists, physical therapists, speech therapists, nurses in procedural/ambulatory areas, and others attended the educational class. The 2 hour class consisted of introduction to MCD devices - Heart Mate II, III / HeartWare and Total Artificial Hearts devices. Opportunities for hands on learning allowed for greater comfort with handling the equipment during everyday care or an emergency. This annual required education was offered monthly.ResultsStable ventricular assist device patients are able to travel off the Progressive and Acute care units without a nurse or VAD coordinator due to this collaborative effort. There has not been any serious safety events related to VADs being transported off the units since this practice was implemented in 2013.ConclusionsIt takes a village to care for patients with Mechanical Circulatory Support and this organization welcomes them throughout the care environment. Non-licensed team members in additional to nurses in ambulatory areas can safely care for patients when leaving their primary inpatient units, allowing for greater awareness of the special needs of this complex population.
  • Heart Failure Nurse Navigator Program Interventions Based on LACE Scores
           Reduces Inpatient Heart Failure Readmission Rates
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s): ObjectiveThis presentation will identify top causes for Heart Failure (HF) patient readmissions and strategies for HF readmission prevention. The HF Nurse Navigator's role in preventing readmissions will be described. The implementation of the HF standard work discharge tool with seven interventions based on LACE scores used in the HF Nurse Navigator program will also be defined.BackgroundHeart Failure continues to be one of the leading causes for hospitalization (national 30-day All-Cause HF readmission rates average: 22%). The goal of this community hospital is to decrease their average 30-day All-Cause HF patients' readmission rates from 21% to
  • The Effect of a Nurse-Driven Program Utilizing Implantable Pulmonary
           Artery Pressure Monitoring to Reduce Hospitalizations in Low-Socioeconomic
           Urban Patients with Heart Failure
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s): BackgroundHospitalizations in patients with heart failure (HF) remain high despite advances in treatment. While implantable pulmonary artery pressure monitors (Abbott CardioMEMS) reduce readmissions in largely white and male cohorts, their efficacy in poor, minority populations are not known. We hypothesized that a nurse-driven program using the CardioMEMS device could reduce HF hospitalizations in such patients.Methods22 high-utilizing patients (86% non-white, 55% female) with NYHA Class III HF were implanted with a CardioMEMS following a hospital admission for HF. Data from the CardioMEMS guided a speciallytrained nurse in adjusting medications. Enrolled patients were matched using 30 clinical and demographic variables with contemporaneous control HF patients who received usual care. Each patient's hospitalizations were recorded for 6 months and compared using Fisher's exact test.ResultsPatients who received a CardioMEMS experienced a 61% decrease in HF-related readmission and a 70% reduction in HF-related ED visits (p
  • Efficacy of Tafamidis in Transthyretin Amyloid Cardiomyopathy in the
           ATTR-ACT Trial
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s): BackgroundTransthyretin cardiomyopathy (ATTR-CM) is an underdiagnosed, fatal disease caused by the deposition of transthyretin amyloid fibrils in the heart leading to heart failure (HF). It can be hereditary due to mutations in the TTR gene (ATTRm) or acquired (wild-type [ATTRwt]). Tafamidis is a selective transthyretin stabilizer which prevents tetramer dissociation and amyloidogenesis. The Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT) was an international, multicenter, double-blind, placebo-controlled, randomized trial of Tafamidis in patients with ATTR-CM.ObjectivesGiven the limited number of patients with ATTR-CM, a novel study design was utilized to enable rigorous testing of the efficacy of tafamidis on hard cardiovascular (CV) endpoints in a study of relatively modest size compared with traditional CV trials. The primary results of this trial were further supported through the application of pre-specified sensitivity analyses.MethodsPatients with ATTR-CM were randomized (2:1:2) to tafamidis (80 mg or 20 mg of tafamidis meglumine), or placebo (orally, once daily), for 30 months. Enrollment was stratified by NYHA class and genotype. The primary efficacy analysis was a hierarchical combination of all-cause mortality and frequency of CV-related hospitalizations comparing the pooled tafamidis groups (20 mg and 80 mg) vs. the placebo group using the Finkelstein-Schoenfeld (F-S) method. The primary efficacy analysis result was examined using a series of sensitivity analyses. Key secondary endpoints were change from baseline to Month 30 in the six-minute walk test distance and the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall score. Safety assessments included adverse events, vital signs, and clinical laboratory tests.ResultsA total of 441 patients were randomized (tafamidis=264, placebo=177). Tafamidis was associated with a significant reduction in the hierarchical combination of all-cause mortality and CVrelated hospitalizations (P
  • Improvement in quality of life in patients with hereditary transthyretin
           amyloidosis with polyneuropathy and cardiomyopathy treated with inotersen
           in the phase 3 study NEURO-TTR
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s): IntroductionHereditary transthyretin (TTR) amyloidosis (hATTR) is a rare, progressive, and fatal disease. The disease is caused by misfolded TTR that builds up as amyloid in major organ systems, especially cardiac tissue and nerves, causing cardiomyopathy (CM) and polyneuropathy (PN), respectively. hATTR causes significant morbidity and a progressive decline in patient quality of life (QOL), severely limiting activities of daily living.PurposeTo evaluate the effect of inotersen, an antisense oligonucleotide inhibitor of TTR protein production, on QOL of patients with hATTR with CM and PN.MethodsNEURO-TTR (NCT01737398) is a global, randomised, double-blind, placebo-controlled phase 3 study. Adults (n=172) with hATTR-PN (stage 1 or 2) with or without CM were randomly assigned 2:1 and received 300-mg weekly subcutaneous inotersen or placebo for 15 months. CM was defined as diagnosis of hATTR-CM or =1.3 cm interventricular septum thickness (by echocardiography) at baseline. Primary endpoints were change from baseline to week 66 in Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) total score and the modified Neuropathy Impairment Score+7 (mNIS+7). The Optum SF-36v2 Health Survey (SF-36v2) score was an exploratory outcome.ResultsAt baseline, 69% of patients were male, mean age was 59 years (range, 27-81 years) and 63% (108/172) had CM. Of patients given placebo and inotersen, 55% (33/60) and 67% (75/112), respectively, had CM. Patients with CM had higher baseline mNIS+7 scores (higher scores indicate worse neuropathy), higher Norfolk QOL-DN total scores (higher scores indicate worse QOL) and lower SF-36v2 physical component summary scores (lower scores indicate worse QOL) than patients without CM. Inotersen-treated patients achieved highly statistically significant benefit compared with placebo in Norfolk QOL-DN total score (P=0.0006) and mNIS+7 (P
  • A strong and reliable indicator for early postoperative major cardiac
           events after elective orthopedic surgery: Aortic arch calcification
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s): Adem Adar, Orhan Onalan, Fahri Cakan, Ertan Akbay, Tugce Colluoglu, Uygar Dasar, Tansel MutluAbstractBackgroundCardiovascular events after orthopedic surgery may result in mortality. Therefore, predictors of early cardiovascular events after elective orthopedic surgery are required.AimThe aim of this study is to investigate the relationship between aortic arch calcification and 30-day major adverse cardiac events following elective orthopedic surgery.MethodsPatients who had undergone orthopedic surgery were screened. Preoperative detailed anamnesis was taken. Echocardiography and standard chest x-ray were performed.Patients were followed in terms of perioperative 30-days major cardiac events and were classified into two groups according to development of perioperative major adverse cardiac events.Aortic arch calcification was evaluated by two cardiologists, blinded to study findings and was graded as 0 to 3 on chest x-ray.ResultsA total of 1060 patients were approached for the study participation. Of these 714 were included in the study (mean age: 70.43, 65% female). Cardiovascular events occurred in 33 patients. As compared to the patients without cardiac events, the prevalence of aortic arch calcification, coronary artery disease, hypertension, and smoking were higher in patients with cardiac events. In addition, Lee index, left ventricular end-systolic, end-diastolic and left atrial diameter were significantly higher, GFR values were significantly lower in the group with cardiac events.Multivariate regression analysis showed that smoking (OR 5.031, 95% CI 1.602 to 15.794), presence of hypertension (OR 5.133, 95% CI 1.297 to 20.308) and aortic arch calcification (OR 6.920, 95% CI 3.890 to 12.310) are independent predictors of major cardiac events within 30-day of elective orthopedic surgery.ConclusionsPresence of aortic arch calcification is associated with development of major cardiac events within 30-days after elective orthopedic surgery.
  • Decisional regret in left ventricular assist device patient-caregiver
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s): Eric P. Stahl, Neal W. Dickert, Robert T. Cole, S. Raja Laskar, Alanna A. Morris, Andrew L. Smith, J. David Vega, Divya GuptaAbstractBackgroundThe objective of this study was to investigate decisional regret among left ventricular assist device (LVAD) patients and their caregivers.MethodsThis study was a single center, cross-sectional survey of patients after LVAD implantation and their caregivers. Subjects were recruited at their outpatient heart failure appointments. Patients and caregivers at least three months from LVAD implantation completed a 5-item, validated decisional regret scale. Summative scores on a 0–100 point scale were determined for patient and caregivers (0 = no regret). Subgroup analysis included gender, LVAD indication (bridge to transplant (BTT) or destination therapy (DT)), time from LVAD implantation, and caregiver relationship. Dyad discordance was defined as a patient-caregiver difference of ≥2 points on any regret scale question.ResultsFifty patients were approached for participation. Thirty-three LVAD patient-caregiver dyads were enrolled in the study (19 male, 14 female patients; 8 male, 25 female caregivers). Patients had a mean age of approximately 50 years. Caregivers had a mean age of approximately 54 years. Patients had a median regret score of 10 (Interquartile range (IQR): 0–30), while caregivers had a median regret score of 20 (IQR: 0–25). Median regret scores of female patients were significantly higher than that of male patients (27.5 vs 0, p = 0.0038). BTT patients had numerically lower regret than DT patients, but this was not statistically significant. Patients who had been implanted for greater than three years had the highest regret scores. Discordance in at least one domain of the regret scale was present in 19 out of 33 (57.6%) dyads.ConclusionsWhile decisional regret was reasonably low in this population, comparatively, there was significantly increased decisional regret among female patients and patients further from LVAD implantation. Differences between patients and caregivers were also observed. These findings highlight the need for robust support and continual attention to expectations before and after LVAD implantation.
  • Heart Failure Knowledge among CNAs in a Skilled Nursing Facility: A Pilot
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s): BackgroundHeart failure (HF) is one of the leading causes of hospitalization among patients over the age of 65 yrs. Many patients with HF are transitioned to skilled nursing facilities (SNF) following hospital discharge for rehabilitation. Limited formal education is currently available to SNF staff on HF treatment and management.PurposeThe purpose of this quality improvement pilot project was to develop a sustainable HF educational program specifically for SNF staff to improve their HF knowledge base. This educational intervention focused on the certified nurse aid's (CNA) HF care knowledge through computerized based education and competency demonstration offered during annual competency evaluation.MethodsAssessment of perceived knowledge gaps and current available education was reviewed at the SNF. Based on adult learning theory, current literature and ACC/AHA/HFSA guidelines were used to develop computer based educational modules. Module 1 offered basic HF knowledge and an introduction to HF care. Module 2 focused on specific guideline recommended care measures such as, modifying lifestyle choices and completing daily tasks necessary to manage the patient with HF in the SNF environment. The modules were reviewed by a HF expert who offered feedback, and revisions were made. A written 10 question pretest and post-test were developed and given prior and following viewing of the educational modules. Hands on competencies were developed which included, weight assessment, application of compression stockings, volume status monitoring, and low sodium diet recommendations. The educational program was implemented during the annual SNF competency fair.ResultsThirty-four of 40 employed CNAs participated in the program. CNA work experience ranged from 6 months to 17 years. Pretest scores ranged from 4 to 10 (M = 7.8, SD 1.4) and post-test scores ranged from 6 to 10 (M = 8.9, SD 1.0) demonstrating a significant improvement in knowledge (p < .00). Participants struggled with understanding symptoms of fluid volume overload and recognition of subtle symptoms of patient decline. Participants also struggled with medical terminology, including terms such as, dyspnea. Hands on competencies revealed some participants had difficulty with identifying steps for proper weight measurement and lower sodium food choices.ConclusionsHF education is important for all caregivers across the nursing continuum. As HF care continues to transition to SNFs, timely staff education is critically important to ensure optimal patient care and outcomes. Further study is warranted that explores implementation of this educational program in other SNFs and assessment of long range outcomes.
  • Information for Authors
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s):
  • Information for Readers
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s):
  • Board of Directors
    • Abstract: Publication date: September–October 2019Source: Heart & Lung, Volume 48, Issue 5Author(s):
  • Response to letter to the editor: Seasonal variation in physical activity
           in patients with heart failure
    • Abstract: Publication date: Available online 29 August 2019Source: Heart & LungAuthor(s): Leonie Klompstra, Tiny Jaarsma, Anna Strömberg, Martje H.L. Van der Wal
  • Comparison of oxidant/antioxidant balance in COPD and non-COPD smokers
    • Abstract: Publication date: Available online 23 August 2019Source: Heart & LungAuthor(s): Serdar Kalemci, Aydın Sarıhan, Arife Zeybek, Abdullah Şimşek, Nihat Taşdemir
  • Doing more to serve our patients
    • Abstract: Publication date: Available online 23 August 2019Source: Heart & LungAuthor(s): Kimberly Nelson
  • Body composition changes assessment by bioelectrical impedance vectorial
           analysis in right heart failure and left heart failure
    • Abstract: Publication date: Available online 15 August 2019Source: Heart & LungAuthor(s): Dulce González-Islas, Estefanía Arámbula-Garza, Arturo Orea-Tejeda, Lilia Castillo-Martínez, Candace Keirns-Davies, Fernanda Salgado-Fernández, Luis Hernández-Urquieta, Samantha Hernández-López, Yuridia Pilotzi-MontielAbstractBackgroundHeart Failure (HF) patients developed changes in body composition as overhydration, muscle-skeletal wear and cardiac cachexia (CC). The possible factors involved in the development of CC in Right Heart Failure (RHF) patients are venous congestion, nutrient malabsorption. However, in HF, the overhydration obscure the loss of fat-free mass and difficult the body composition assessment. Bioelectrical impedance vectorial analysis (BIVA) is a method validated and used for hydration status and body composition assessment in HF. The aim of this study was to investigate the body compositions changes assessment by BIVA in the subjects with and without RHF and evaluate the risk factors for devolvement CC in HF subjects.Material and methodsProspective cohort study. Subjects with confirmed diagnoses of HF,>18 years old without CC according to BIVA criteria were included. Subjects with congenital heart disease, cancer, HIV, and end-stage renal disease were excluded. Body composition was an assessment by BIVA. 288 HF patients were evaluated. RHF subjects had an impedance vector reduction (9.26 dR/H and -1.92 dXc/H, T2=14.9, D = 0.45, p
  • Exploring the experiences of individuals with an insertable cardiac
           monitor: Making the decision for device insertion
    • Abstract: Publication date: Available online 7 August 2019Source: Heart & LungAuthor(s): Aprel F. Ventura, Carolyn E. Horne, Patricia B. Crane, Michele A. Mendes, Samuel SearsAbstractBackgroundLittle is known about the decision-making process for insertable cardiac monitors (ICM) in those with suspected arrhythmias.ObjectiveThe purpose of this qualitative study was to describe how individuals make a decision to insert an ICM.MethodsA qualitative descriptive design was used. Data were analyzed using content analysis and constant comparison. NVivo 10 was used for data grouping and patterns.ResultsParticipants (N = 12) ranged in age from 41to 95. Most (n = 7) had the device inserted because of syncope or atrial fibrillation (AF), and others (n = 5) for cryptogenic stroke. Three categories emerged: pre-decision, definitive decision, and deliberated decision. Event symptoms, including physical, cognitive and emotional, and trust emerged as factors in decision-making.ConclusionsThose who perceived their experience as life-threatening, trusted the healthcare provider and assented to the ICM insertion. Conversely, those who perceived symptoms as episodic, used other strategies to resolve symptoms prior to making the decision for insertion.
  • Sodium restriction, water intake, and diuretic regimen in patients with
           congestive heart failure
    • Abstract: Publication date: Available online 31 July 2019Source: Heart & LungAuthor(s): Ertan Yetkin, Bilal Cuglan, Hasan Turhan, Selcuk Ozturk
  • Comparison of oxidant/antioxidant balance in COPD and non-COPD smokers
    • Abstract: Publication date: Available online 29 July 2019Source: Heart & LungAuthor(s): Yusuf Aydemir, Özlem Aydemir, Aysun Şengül, Adil Can Güngen, Hikmet Çoban, Canatan Taşdemir, Hasan Düzenli, Abidin ŞehitoğullarıAbstractBackground/aimOxidative stress plays an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Smoking is the leading source of oxidants in lungs. However, it is currently unknown why some individuals are more resistant to the detrimental effects of smoking and do not develop COPD. The aim in this study is to measure and compare the oxidant/antioxidant balance between in non-COPD individuals who smoke and COPD patients who smoke.Materials and methodsIncluded in the study were 137 patients with COPD and 102 healthy individuals. Participants were divided into groups as COPD patients (former and current smokers), non-COPD individuals who smoke and non-smokers healthy persons. In the following stage, the total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels were measured in serum for all participants.ResultsIn the current-smoker COPD group, the level of oxidant status were significantly higher than the former-smoker COPD group (p 
  • Pilot randomized trial of brief behavioral treatment for insomnia in
           patients with heart failure
    • Abstract: Publication date: Available online 27 June 2019Source: Heart & LungAuthor(s): Kristie M. Harris, Steven E. Schiele, Charles F. EmeryAbstractBackgroundInsomnia is prevalent among patients with heart failure (HF) and is associated with reduced physical and mental functioning, including possible exacerbation of cognitive deficits.ObjectivesThis study evaluated the effects of Brief Behavioral Treatment for Insomnia (BBTI) on insomnia and related factors among HF patients.MethodsTwenty-three HF patients with insomnia (70% women; 65% white; Mage = 55.7 ± 11.3 years; NYHA Class II = 70%) were randomized to a behavioral intervention (BI; n = 12) or sleep monitoring (SM; n = 11) group. Sleep, cognitive functioning, quality of life, distress, self-care, and functional status were assessed pre- and post-intervention.ResultsBI participants experienced reduced insomnia and increased sleep quality and efficiency, with 58% demonstrating clinically meaningful improvements in insomnia and 25% achieving remission of insomnia symptoms. Depression and anxiety also improved in BI participants.ConclusionsBBTI was tolerated well within this symptom-limited patient population and was associated with reduced symptoms of insomnia and distress.
  • Doing more to serve our patients
    • Abstract: Publication date: Available online 26 June 2019Source: Heart & LungAuthor(s): S. Craig Thomas
  • Heart failure symptom clusters and quality of life
    • Abstract: Publication date: Available online 13 June 2019Source: Heart & LungAuthor(s): Jeanne Salyer, Maureen Flattery, Debra E. LyonAbstractBackgroundHeart failure (HF) is a progressive symptomatic illness with reports suggesting that patients experience multiple symptoms. Symptom clusters constitute symptoms that co-occur, are related, and influence outcomes.ObjectivesThe specific aims of this study were to (1) examine prevalent symptoms experienced by persons with HF, (2) identify symptoms forming clusters, and (3) evaluate the impact of HF symptom clusters on quality of life (QOL).Methods117 participants (62% male; 50% black; age = 56) were recruited. Prevalent symptoms were evaluated; principle components analysis (PCA) was used to extract symptom clusters; regression analysis was used to evaluate factors influencing QOL, defined as life satisfaction.ResultsThree symptom clusters–sickness behavior, discomforts of illness, and GI distress–were extracted. Sickness behavior significantly influenced QOL (β = −0.603 p = 0.0001), explaining 40% of the variance (F = 75.12; R2 = 0.404; p = 0.0001).ConclusionsThe Sickness Behavior cluster had a negative impact on QOL and suggests that incorporating an evaluation of these symptoms may facilitate identification and treatment of symptoms having an additive and detrimental influence on QOL. Studies to examine the stability of the clusters are warranted.
  • Increased admission central venous-arterial CO2 difference predicts
           ICU-mortality in adult cardiac surgery patients
    • Abstract: Publication date: Available online 12 June 2019Source: Heart & LungAuthor(s): Bjoern Zante, Hermann Reichenspurner, Mathias Kubik, Joerg C. Schefold, Stefan KlugeAbstractBackgroundInvasive procedures such as cardiac surgery are associated with perioperative dysfunction of macrocirculation and/or microcirculation and organ failures. Maintenance or resuscitation of an adequate macrocirculation and/or microcirculation is thus crucial in patients after cardiac surgery. We investigated the prognostic power of early central venous-arterial carbon dioxide pressure difference (delta-pCO2) after cardiac surgery.MethodsRetrospective analysis of data from 1,019 cardiac surgery patients treated in the ICU of a tertiary medical care academic center. Clinical outcomes and laboratory measures including metabolic indices and calculated delta-pCO2 were assessed. Receiver operating characteristic (ROC) curves were generated and sensitivity / specificity analysis was performed. Univariate and multivariate regression models were analyzed.ResultsThe area under the ROC curve for delta-pCO2 to predict ICU mortality was 0.72 (sensitivity 65% / specificity 76%) with an optimal delta-pCO2 cut-off value of 8.6 mmHg. In multivariate regression, delta-pCO2 was associated with increased ICU mortality (HR 3.72, 95%-CI 1.3–10.66, p = 0.02). After adjustment for typical confounders, delta-pCO2 remained as independent predictor of ICU mortality after cardiac surgery.ConclusionsIn a retrospective data analysis in a large sample of adult post cardiac surgery patients treated in the ICU, we observed that admission central venous-arterial delta-pCO2 independently predicts ICU mortality. Delta-pCO2 might thus contribute risk stratification in ICU patients after cardiac surgery.
  • Using video education to improve outcomes in heart failure
    • Abstract: Publication date: Available online 4 June 2019Source: Heart & LungAuthor(s): Kimone R.Y. Reid, Kathryn Reid, Jill Howie Esquivel, S. Craig Thomas, Virginia Rovnyak, Ivora Hinton, Cathy CampbellAbstractBackgroundHeart Failure (HF) guidelines recommend HF self-care education. An optimal method of educating HF patients does not currently exist.ObjectivesTo evaluate the effectiveness of supplementing usual HF education with video education and evaluate patients’ satisfaction with video education.MethodsA mixed methods design was used. A convenience sample of 70 patients was recruited from an academic medical center. Participants completed the Atlanta Heart Failure Knowledge Test and the Self-care of Heart Failure Index before and after receiving video education, to measure HF knowledge, self-efficacy, and self-care respectively. Video usage and satisfaction with video education data were collected. All-cause 30-day readmissions data were compared to a historical group.ResultsHF knowledge and self-care maintenance scores increased significantly. Self-efficacy, self-care management and all-cause 30-day readmissions did not significantly improve. Most HF patients were highly satisfied.ConclusionSupplementing usual HF education with VE was associated with improved HF knowledge and self-care maintenance.
  • Pot smokers puffing away lung health
    • Abstract: Publication date: Available online 23 May 2019Source: Heart & LungAuthor(s): Keerthi Yarlagadda, Pratiksha Singh, Isha Shrimanker, Joshua C. Hoffman, Vinod K. NookalaAbstractBackgroundMarijuana is the second most commonly used inhalational agent after tobacco. It has been used for therapeutic benefits in cancer, epilepsy, inflammation and pain. Inhalation of marijuana causes reversible and irreversible lung injury.CaseWe present a 26-year-old female with cough, chest pain, epistaxis, hemoptysis, night sweats and breathlessness few hours after smoking marijuana. Physical exam was positive for tachycardia, tachypnea, and diminished coarse breath sounds. Further investigation revealed elevated white blood cell count, chest X-ray, computed tomography of the chest showed bilateral patchy infiltrates. The patient was managed with short term steroid, as antibiotics alone did not work. Radiological improvement of lung injury was noted within 36–48 h.ConclusionThere is a paucity of treatment guidelines for acute lung injury secondary to marijuana inhalation. We advocate early use of short-term steroids and also more awareness on quitting marijuana smoking to prevent life-threatening complications like myocardial infarction, diffuse alveolar hemorrhage and acute respiratory distress syndrome.
  • Seasonal variation in physical activity in patients with heart failure
    • Abstract: Publication date: Available online 20 May 2019Source: Heart & LungAuthor(s): Leonie Klompstra, Tiny Jaarsma, Anna Strömberg, Martje H.L. van der WalAbstractBackground and objectivesPhysical activity is important for all heart failure (HF) patients to improve quality of life and physical function. Since adherence to physical activity is low and could differ between seasons, it is essential to explore factors related to change that may depend on seasonal changes. The purpose of this study was to describe the seasonal differences in physical activity and assess factors that influence these differences in a country with markedly different winter-to-summer weather conditions (in temperature, hours of daylight and snow fall).MethodsThe study had a cross-sectional survey design. Outpatients with HF completed a questionnaire on physical activity, motivation and self-efficacy to exercise and HF symptom severity in the summer and the winter in a northern hemisphere country. We used analysis of variance to evaluate seasonal differences in physical activity, motivation, self-efficacy and HF symptom severity.ResultsEighty-seven patients with HF (29% women, mean age 70 ± 9 years) were included and 35% performed less physical activity (METs) in the winter, compared to the summer. Increased symptom severity during the winter was associated with lower activity levels.ConclusionOne-third of the patients performed less physical activity during the winter compared to the summer, and this was associated with symptom severity. Decreased physical activity was not related with motivation and self-efficacy. This study emphasises the need for personalised physical activity programmes that also assess symptom severity and change in symptom severity depending between seasons.
  • Serum biochemical determinants of peripheral congestion assessed by
           bioimpedance vector analysis in acute heart failure
    • Abstract: Publication date: Available online 18 May 2019Source: Heart & LungAuthor(s): Francesco Massari, Pietro Scicchitano, Massimo Iacoviello, Roberto Valle, Mariella Sanasi, Assunta Piscopo, Piero Guida, Filippo Mastropasqua, Pasquale Caldarola, Marco Matteo CicconeAbstractBackgroundThe pathophysiology of peripheral congestion is poorly investigated in patients with acute heart failure (AHF).Objectivesto evaluate the relative contribution of serum colloid osmotic pressure (COP), relative plasma volume status (PVS), biomarkers of renal function, electrolytes, haemoglobin, and brain natriuretic peptide (BNP) in peripheral fluid overload using bioimpedance vector analysis (BIVA).MethodsWe retrospectively analysed data from 485 patients with AHF. Hydration status was evaluated by semiquantitative and quantitative approach using BIVA (R/Xc graph) and Hydration Index (HI), respectively. COP was calculated from albumin and total protein concentration, while relative PVS was calculated from validated equations.ResultsCongestion assessed by BIVA was observed in 304 (63%) patients and classified as mild (30%), moderate (42%), and severe (28%). On univariate analysis, HI was inversely correlated with COP (P 
  • Development, piloting and validation of the Recommending Cardiac
           Rehabilitation (ReCaRe) instrument
    • Abstract: Publication date: Available online 14 May 2019Source: Heart & LungAuthor(s): Chantal F. Ski, Martin Jones, Carolyn Astley, Lis Neubeck, David R. Thompson, Robyn Gallagher, Huiyun Du, Robyn A. ClarkAbstractBackgroundHealth practitioners’ values, attitudes and beliefs largely determine their referrals to cardiac rehabilitation (CR).ObjectiveTo develop and test the Recommending Cardiac Rehabilitation scale (ReCaRe), designed to assess health professionals attitudes, values and beliefs to CR referral.MethodsReCaRe was appraised for: content validity (Delphi method, expert panel); interpretability and face validity (interview, health professionals); factor structure and internal consistency (survey, health professionals); and test-retest reliability (survey, health professionals). Normative scores were collated.ResultsReCaRe initially comprised 75 items. Initially, a Content Validity Index (CVI) was calculated for ratings of item relevance (CVI range; 0.27–1.0), which resulted in the removal of 19 items. After preliminary validation and psychometric testing, 34 items were factor-analysed (n = 24) providing a 17-item, four-factor scale: perceived severity and susceptibility (α = 0.93, κ = 0.37); perceived service accessibility (α = 0.91, κ = 0.67); perceived benefit (α = 0.97, κ = 0.47); perceived barriers and attitudes (α = 0.82, κ = 0.49). ReCaRe normative scores (n = 75) are reported.ConclusionsThis psychometric analysis found ReCaRe to demonstrate good face validity, internal consistency and fair to substantial test-retest reliability. The next step is to validate these initial findings on a larger sample size to confirm whether ReCaRe can enable identification of factors impacting CR referral.
  • Do obstructive sleep apnea and chronic obstructive pulmonary disease
           overlap coincidently or intrinsically'
    • Abstract: Publication date: Available online 13 May 2019Source: Heart & LungAuthor(s): Jiang Xie
  • A systematic review of non-pharmacological interventions to improve
           therapeutic adherence in tuberculosis
    • Abstract: Publication date: Available online 11 May 2019Source: Heart & LungAuthor(s): Dolores Riquelme-Miralles, Antonio Palazón-Bru, Armina Sepehri, Vicente Francisco Gil-GuillénABSTRACTBackgroundReviews examining non-pharmacological interventions to improve therapeutic adherence in tuberculosis have several limitations (design, quality assessment…). Consequently, for clinical practice, it is important to generate a review containing all the information to improve patient adherence, solving the previous issues.ObjectivesTo examine non-pharmacological interventions to improve therapeutic adherence in tuberculosis through clinical trials.MethodsA systematic review in MEDLINE/EMBASE was performed.ResultsThirty seven papers were analysed. The disease treatment interventions were disparate, grouped into: education, psychological interventions, new technologies, directly observed treatment, incentives and improved access to health services. In the treatment of latent infection, the majority of studies were conducted in the marginal population (drug addicts, homeless individuals and prisoners) and were based mainly on the provision of incentives. Study quality was generally low.ConclusionsGreat variability exists in the studies comparing strategies for identifying interventions, objectives and effects. The designs carried out generally have methodological deficits.
  • Prevalence of pulmonary embolism in patients with obstructive sleep apnea
           and chronic obstructive pulmonary disease: The overlap syndrome
    • Abstract: Publication date: Available online 27 April 2019Source: Heart & LungAuthor(s): Serdar Kalemci, Aydın Sarıhan, Arife Zeybek, Nihat Taşdemir
  • One-year cost-effectiveness of supervised centre-based exercise training
           in addition to a post-discharge disease management program for patients
           recently hospitalized with acute heart failure: The EJECTION-HF study
    • Abstract: Publication date: Available online 15 April 2019Source: Heart & LungAuthor(s): Shoko Maru, Alison M. Mudge, Jessica M. Suna, Paul A. Scuffham, on behalf of the EJECTION-HF Trial InvestigatorsAbstractBackgroundCombining supervised exercise training (ET) and disease management program (DMP) may benefit people with heart failure (HF) but will require additional resources.ObjectivesTo assess the 1-year cost-effectiveness of a 24-week ET program added to a post-discharge DMP in patients recently hospitalized with HF.MethodsUsing randomized controlled trial data, within-trial cost-utility analyses were undertaken in the overall population (n = 278), patients aged
  • Red cell distribution width in acute pulmonary embolism patients: A simple
           aid for improvement of the 30-day mortality risk stratification based on
           the pulmonary embolism severity index
    • Abstract: Publication date: Available online 22 March 2019Source: Heart & LungAuthor(s): Ivana Jurin, Vladimir Trkulja, Marko Ajduk, Tomislav Letilović, Irzal HadžibegovićAbstractBackgroundPulmonary embolism (PE) severity index (PESI) well predicts 30-day mortality in acute PE patients, yet improvements have been advocated.ObjectivesTo evaluate predictivity of the red cell distribution width (RDW) through a comparison with PESI and to explore their interaction as a potential improvement in this respect.MethodsRetrospective analysis of consecutive adult PE patients.ResultsOf the 299 patients, 19 severely unstable died within 48 h. Among the stabilized patients, 30-day mortality was 12.1% (34/280). With PESI ≤125, mortality was 4.9% (9/185), but it was 0.7% (1/140) if RDW ≤15.0% and 17.8% (8/45) if RDW>15.0%; with PESI>125, mortality was 26.3% (25/95), but it was 15.9% (7/44) if RDW ≤15.0% and 35.3% (18/51) if RDW>15.0%. Adjusted relative risk with PESI>125 vs. ≤125 was 17.5 (95%CI 2.37–129) at RDW ≤15.0% and 1.60 (0.76–3.36) at RDW>15.0%.ConclusionsThirty-day mortality predictions based on the PESI score may be improved by accounting for RDW.
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