Heart failure (HF) is a chronic, progressive illness that is highly prevalent in the United States and worldwide. This morbid illness carries a very poor prognosis, and leads to frequent hospitalizations. Repeat hospi...Heart failure (HF) is a chronic, progressive illness that is highly prevalent in the United States and worldwide. This morbid illness carries a very poor prognosis, and leads to frequent hospitalizations. Repeat hospitalization in HF is both largely burdensome to the patient and the healthcare system, as it is one of the most costly medical diagnoses among Medicare recipients. For years, investigators have strived to determine methods to reduce hospitalization rates of HF patients. Despite such efforts, recent reports indicate that rehospitalization rates remain persistently high, without any improvement over the past several years and thus, this topic clearly needs aggressive attention. We performed a key-word search of the literature for relevant citations. Published articles, limited to English abstracts indexed primarily in the PubMed database through the year 2011, were reviewed. This article discusses various clinical parameters, serum biomarkers, hemodynamic parameters, and psychosocial factors that have been reviewed in the literature as predictors of re-hospitalization of HF patients. With this information, ourhope is that the future holds better risk-stratification models that will allow providers to identify high-risk patients, and better customize effective interventions according to the needs of each individual HF patient.展开更多
AIM: To evaluate the prevalence and severity of pain in patients with chronic stable heart failure (HF) in an outpatient clinic setting. METHODS: This is a cross-sectional study evaluating symptoms of generalized or s...AIM: To evaluate the prevalence and severity of pain in patients with chronic stable heart failure (HF) in an outpatient clinic setting. METHODS: This is a cross-sectional study evaluating symptoms of generalized or specific pain in patients with chronic stable heart failure. A standardized questionnaire (Edmonton Symptom Assessment System) was administered during a routine outpatient clinic visit. The severity of pain and other symptoms were assessed on a 10 point scale with 10 being the worst and 0 representing no symptoms. RESULTS: Sixty-two patients [age 56 ± 13 years, 51 males, 11 females, mean ejection fraction (EF) 33% ± 17%] completed the assessment. Thirty-two patients (52%) reported any pain of various character and location such as chest, back, abdomen or the extremities, with a mean pain score of 2.5 ± 3.1. Patients with an EF less than 40% (n = 45, 73%) reported higher pain scores than patients with an EF greater than 40% (n = 17, 27%), scores were 3.1 ± 3.3 vs 1.2 ± 1.9, P < 0.001. Most frequent symptoms were tiredness (in 75% of patients), decreased wellbeing (84%), shortness of breath (SOB, 76%), and drowsiness (70%). The most severe symptom was tiredness with a score of 4.0 ± 2.8, followed by decreased wellbeing (3.7 ± 2.7), SOB (3.6 ± 2.8), and drowsiness (2.8 ± 2.8). CONCLUSION: Pain appears to be prevalent and significantly affects quality of life in HF patients. Adequate pain assessment and management should be an integral part of chronic heart failure management.展开更多
Background Partial androgen deficiency syndrome in the aging male is associated with signs of aging such as a development of abdominal obesity,sexual dysfunction,increase body fat,weight gain and the development of ca...Background Partial androgen deficiency syndrome in the aging male is associated with signs of aging such as a development of abdominal obesity,sexual dysfunction,increase body fat,weight gain and the development of cardiac disease.Objective We assessed the outcome of a commercially available physician supervised nutrition and exercise program with concomitant testosterone replacement therapy in middle age obese men with partial androgen deficiency in order to reduce cardiac risks factors.Methods Fifty-six self referred men without diabetes mellitus,hypertension,or cardiovascular disease(ages 52.3±7.8 years)were randomly selected from a large cohort.Baseline weight,body fat composition,fasting glucose,hemoglobin A1c and fasting lipid levels,as well as free and total testosterone levels were assessed.All patients were assessed and followed 6–18 months after initiation of the program.The program consisted of a low glycemic load balanced nutrition diet,a recommended structured daily exercise program of 30–60 minutes,as well as once to twice weekly intramuscular testosterone injections(113.0±27.8 mg).Results At follow up,weight was reduced from 233.9±30.0 pounds(lbs)to 221.3±25.1 lbs(P<0.001),BMI was reduced from 33.2±3.3 kg/m2 to 31.3±2.8 kg/m^(2)(P<0.0001).Total body fat was 27.1%±5.2%vs.34.3%±5.7%at baseline(P<0.0001).Fasting glucose was reduced from 95.3±14.4 mg/dL to 87.5±12.6 mg/dL(P<0.0001).Total cholesterol was reduced from 195.4±33.0 mg/dL to 172.7±35.0 mg/dL(P<0.005).No clinically significant adverse events were recorded.Conclusions Testosterone replacement therapy in middle aged obese men with partial androgen deficiency appeared safe and might have promoted the effects of a weight reduction diet and daily exercise program as long as an adequate physician supervision and follow up was granted.The combination therapy significantly reduced coronary risk factors such as glucose intolerance and hyperlipidemia.展开更多
文摘Heart failure (HF) is a chronic, progressive illness that is highly prevalent in the United States and worldwide. This morbid illness carries a very poor prognosis, and leads to frequent hospitalizations. Repeat hospitalization in HF is both largely burdensome to the patient and the healthcare system, as it is one of the most costly medical diagnoses among Medicare recipients. For years, investigators have strived to determine methods to reduce hospitalization rates of HF patients. Despite such efforts, recent reports indicate that rehospitalization rates remain persistently high, without any improvement over the past several years and thus, this topic clearly needs aggressive attention. We performed a key-word search of the literature for relevant citations. Published articles, limited to English abstracts indexed primarily in the PubMed database through the year 2011, were reviewed. This article discusses various clinical parameters, serum biomarkers, hemodynamic parameters, and psychosocial factors that have been reviewed in the literature as predictors of re-hospitalization of HF patients. With this information, ourhope is that the future holds better risk-stratification models that will allow providers to identify high-risk patients, and better customize effective interventions according to the needs of each individual HF patient.
文摘AIM: To evaluate the prevalence and severity of pain in patients with chronic stable heart failure (HF) in an outpatient clinic setting. METHODS: This is a cross-sectional study evaluating symptoms of generalized or specific pain in patients with chronic stable heart failure. A standardized questionnaire (Edmonton Symptom Assessment System) was administered during a routine outpatient clinic visit. The severity of pain and other symptoms were assessed on a 10 point scale with 10 being the worst and 0 representing no symptoms. RESULTS: Sixty-two patients [age 56 ± 13 years, 51 males, 11 females, mean ejection fraction (EF) 33% ± 17%] completed the assessment. Thirty-two patients (52%) reported any pain of various character and location such as chest, back, abdomen or the extremities, with a mean pain score of 2.5 ± 3.1. Patients with an EF less than 40% (n = 45, 73%) reported higher pain scores than patients with an EF greater than 40% (n = 17, 27%), scores were 3.1 ± 3.3 vs 1.2 ± 1.9, P < 0.001. Most frequent symptoms were tiredness (in 75% of patients), decreased wellbeing (84%), shortness of breath (SOB, 76%), and drowsiness (70%). The most severe symptom was tiredness with a score of 4.0 ± 2.8, followed by decreased wellbeing (3.7 ± 2.7), SOB (3.6 ± 2.8), and drowsiness (2.8 ± 2.8). CONCLUSION: Pain appears to be prevalent and significantly affects quality of life in HF patients. Adequate pain assessment and management should be an integral part of chronic heart failure management.
基金supported by the Cenegenics Education and Research Foundation,a non-profit entity.
文摘Background Partial androgen deficiency syndrome in the aging male is associated with signs of aging such as a development of abdominal obesity,sexual dysfunction,increase body fat,weight gain and the development of cardiac disease.Objective We assessed the outcome of a commercially available physician supervised nutrition and exercise program with concomitant testosterone replacement therapy in middle age obese men with partial androgen deficiency in order to reduce cardiac risks factors.Methods Fifty-six self referred men without diabetes mellitus,hypertension,or cardiovascular disease(ages 52.3±7.8 years)were randomly selected from a large cohort.Baseline weight,body fat composition,fasting glucose,hemoglobin A1c and fasting lipid levels,as well as free and total testosterone levels were assessed.All patients were assessed and followed 6–18 months after initiation of the program.The program consisted of a low glycemic load balanced nutrition diet,a recommended structured daily exercise program of 30–60 minutes,as well as once to twice weekly intramuscular testosterone injections(113.0±27.8 mg).Results At follow up,weight was reduced from 233.9±30.0 pounds(lbs)to 221.3±25.1 lbs(P<0.001),BMI was reduced from 33.2±3.3 kg/m2 to 31.3±2.8 kg/m^(2)(P<0.0001).Total body fat was 27.1%±5.2%vs.34.3%±5.7%at baseline(P<0.0001).Fasting glucose was reduced from 95.3±14.4 mg/dL to 87.5±12.6 mg/dL(P<0.0001).Total cholesterol was reduced from 195.4±33.0 mg/dL to 172.7±35.0 mg/dL(P<0.005).No clinically significant adverse events were recorded.Conclusions Testosterone replacement therapy in middle aged obese men with partial androgen deficiency appeared safe and might have promoted the effects of a weight reduction diet and daily exercise program as long as an adequate physician supervision and follow up was granted.The combination therapy significantly reduced coronary risk factors such as glucose intolerance and hyperlipidemia.
