心内科临床实践中心衰竭患者药物治疗的安全性与效果评估研究

评估心衰竭患者药物治疗在心内科临床实践中的安全性和效果。方法 选择同期接受药物治疗的心衰竭患者62例,根据治疗方法不同分为观察组和对照组。结果 观察组的总安全性(93.55%)显著优于对照组的64.52%,其心动过速、呼吸困难和乏力等副作用发生率均低于对照组;观察组总有效率(96.77%)明显较对照组的67.74%高。药物治疗后,观察组患者心功能指标(如HR、DBP、SBP、LVEF、E/A、CO、CI)与对照组相比优化明显,差异均有统计学意义。同时,观察组的心衰指标NT-proBNP、PRA和醛固酮水平均明显低于对照组。结论 在心衰竭患者的药物治疗过程中,观察组以更优的安全性和有效性显示出临床优势。

急诊早期应用无创正压通气对重症心衰合并Ⅱ型呼吸衰竭患者缺氧状态和心肺功能的影响观察

分析急诊早期应用无创正压通气对重症心衰合并Ⅱ型呼吸衰竭患者缺氧状态和心肺功能的影响。方法 选择我院2022年1月-2022年12月重症心衰合并Ⅱ型呼吸衰竭患者共70例,随机分2组比对,对照组以常规治疗,观察组急诊早期应用无创正压通气。比较两组住院时间、治疗前后患者血气分析指标、心功能状况、血浆氨基末端脑钠肽前体、肺功能、总有效率。结果 观察组住院时间短于对照组,治疗后患者血气分析指标、心功能状况、血浆氨基末端脑钠肽前体、肺功能优于对照组,总有效率高于对照组,P<0.05。结论 急诊早期应用无创正压通气对重症心衰合并Ⅱ型呼吸衰竭患者缺氧状态和心肺功能改善效果确切。

体外膜肺氧合在心肺功能衰竭患者治疗期间的护理

体外膜肺氧合是治疗心功能衰竭和肺功能衰竭的有效措施。护士在体外膜肺氧合治疗过程中发挥着非常重要的作用,护理质量直接关系到体外膜肺氧合治疗的成功。

探究无创呼吸机与常规对症治疗在并发呼吸衰竭的急性心衰患者中的临床价值

探索无创呼吸机与常规对症治疗在并发呼吸衰竭的急性心衰患者中的作用。方法 对2023年1月到5月我院所收治的40例急性心衰并发呼吸衰竭患者进行研究,将其分为参照组20例(予常规对症治疗)与研究组20例(在常规对症治疗上授予无创呼吸机治疗)。比较两组的生命体征指标、并发症发生率、肺功能指标。结果 两组间的生命体征指标、并发症发生率、肺功能指标均具有显著差异(P<0.05)。结论 对急性心衰并发呼吸衰竭患者给予无创呼吸机联合常规对症治疗,能明显调整患者生命体征指标趋向正常化的同时还能改善患者的肺功能情况,降低预后并发症,有利于患者的健康恢复。

ECMO联合CRRT在严重心肺衰竭患者中的应用及护理

随着医疗条件的发展,医疗事业人员研究出了体外膜肺氧合这一治疗方法,来治疗严重心肺衰竭患者。ECMO是一种支持手段,为进一步治疗争取时间,并不能直接治疗原发病,作为国内新兴的高级生命支持技术,也逐渐为大家所知悉,这一方法是治疗急性循环系统和呼吸系统所不可缺少的,成为了走出手术室的体外循环技术。另外一种CRRT是通过长时间的不间断的传输血液来代替出现损伤的器官,并且对一些比较严重的症状比如:中毒、感染等有不同一般的效果。对于严重的心肺衰竭的患者,用这两种方法相结合能够使患者得到更好的护理。

舒适护理干预对老年慢性心衰患者负面情绪及生活质量的影响

分析老年慢性心衰竭患者接受舒适护理干预后情绪、生活质量优化情况。方法:选择我院2019年6月1日~2020年12月31日收治的64例老年慢性心衰竭患者进行慢性心衰竭舒适护理研究,采用数字随机法分为对照组(慢性心衰竭常规护理)与研究组(慢性心衰竭舒适护理),每组各32例慢性心衰竭患者,观察患者接受护理后舒适感受、情绪状况、生活质量。结果:(1)护理后,对照组慢性心衰竭患者舒适感受评分低于研究组慢性心衰竭患者,P<0.05;(2)护理后,对照组慢性心衰竭患者稳定例数低于研究组慢性心衰竭患者稳定例数,P<0.05;(3)护理后,对照组慢性心衰竭患者生活质量低于研究组慢性心衰竭患者,P<0.05。结论:慢性心衰竭患者年龄大,在治疗期间耐受程度差,对于慢性心衰竭治疗及护理工作抵触情绪较强,应用舒适护理干预措施,可以通过多种护理措施让慢性心衰竭患者获得舒适体验感,改善其负面情绪与生活质量。

Quality of life and palliative care needs of elderly patients with advanced heart failure

Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure （HF）. Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Patients who were aged 65 or over, diagnosed with HF of New York Heart Association Class III or IV symptoms, and mentally sound were eligible to the study. The Edmonton Symptom Assessment Scale, the overall quality of life single item scale, and the McQill Quality of Life Questionnaire （MQoL）, were used for measurement. Multi- ple regression analysis was performed to determine factors for predicting quality of life. Results A convenience sample of 112 patients was recruited. Their age was 81.5 ± 8.5 years. The three most distressing symptoms reported by the patients were tiredness （5.96 ± 2.78）, drowsiness （5.47± 2.93）, and shortness of breath （5.34 ± 2.96）. Their mean overall quality of life single item scale score was 4.72 ± 2.06 out of 10. The mean MQoL physical subscale score was the lowest （4.20 ± 1.767）, whereas their mean psychological subscale was the highest （7.14 ±2.39）. However, in a multivariate analysis model, quality of life was significantly associated with existential wellbeing, physical wellbeing, psychological wellbeing and educational level. Conclusions The findings highlight that spiritual concerns are significant palliative care needs among elderly patients with advanced HF, in addition to symptom management. This is in line with the argument that palliative care that places great emphasis on holistic care should be integrated to the care of this group of patients.

High sensitivity C-reactive protein and cardfiac resynchronization therapy in patients with advanced heart failure

Background The data on the prognostic values of high sensitivity C-reactive protein （hsCRP） levels in patients with advanced symp-tomatic heart failure （HF） receiving cardiac resynchronization therapy （CRT） are scarce. The aim of present study was to investigate the association of serum hsCRP levels with left ventricle reverse remodeling after six months of CRT as well as long-term outcome. Methods A total of 232 CRT patients were included. The assessment of hsCRP values, clinical status and echocardiographic data were performed at baseline and after six months of CRT. Long-term follow-up included all-cause mortality and hospitalizations for HF. Results During the mean follow-up periods of 31.3 ± 31.5 months, elevated hsCRP （〉3 mg/L） prior to CRT was associated with a significant 2.39-fold increase （P=0.006） in the risk of death or HF hospitalizations. At 6-month follow-up, patients who responded to CRT showed significant reductions or maintained low in hsCRP levels （–0.5 ± 4.1 mg/L reduction） compared with non-responders （1.7 ± 6.1 mg/L increase, P=0.018）. Com-pared with patients in whom 6-month hsCRP levels were reduced or remained low, patients in whom 6-month hsCRP levels were increased or maintained high experienced a significantly higher risk of subsequent death or HF hospitalizations （Log-rank P〈0.001）. The echocardio-graphic improvement was also better among patients in whom 6-month hsCRP levels were reduced or remained low compared to those in whom 6-month hsCRP levels were raised or maintained high. Conclusions Our findings demonstrated that measurement of baseline and follow-up hsCRP levels may be useful as prognostic markers for timely potential risk stratification and subsequent appropriate treatment strategies in patients with advanced HF undergoing CRT.

Atrial fibrillation may be a hidden factor for the development of cognitive impairment in patients with heart failure

To the editor We read the article entitled Cognitive impairment in heart failure patients＇ by Leto, et al. with great interest. In this review, they demonstrated pathophysiological determinants of cognitive impairment in heart failure （HF） population.

Symptom clusters and quality of life among patients with advanced heart failure

Objectives To identify symptom clusters among patients with advanced heart failure （HF） and the independent relationships with their quality of life （QoL）. Methods This is the secondary data analysis of a cross-sectional study which interviewed 119 patients with advanced HF in the geriatric unit of a regional hospital in Hong Kong. The symptom profile and QoL were assessed by using the Edmonton Symptom Assessment Scale （ESAS） and the McGill QoL Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Hier- archical regression analysis was used to examine the independent relationships with their QoL, after adjusting the effects of age, gender, and comorbidities. Results The patients were at an advanced age （82.9± 6.5 years）. Three distinct symptom clusters were identified： they were the distress cluster （including shortness of breath, anxiety, and depression）, the decondition cluster （fatigue, drowsiness, nausea, and reduced appetite）, and the discomfort cluster （pain, and sense of generalized discomfort）. These three symptom clusters accounted for 63.25% of variance of the patients＇ symptom experience. The small to moderate correlations between these symptom clusters indicated that they were rather independent of one another. After adjusting the age, gender and comorbidities, the distress （β = -0.635, P 〈 0.001）, the decondition （β = -0.148, P = 0.01）, and the discomfort （β = -0.258, P 〈 0.001） symptom clusters independently predicted their QoL. Conclusions This study identified the distinctive symptom clusters among patients with advanced HF. The results shed light on the need to develop palliative care interventions for optimizing the symptom control for this life-limiting disease.

Drug therapy for heart failure in older patients —what do they want？

Chronic heart failure （CHF） is predominantly seen in older patients, and therefore real life medicine often requires the extrapolation of findings from trials conducted in much younger populations. Prescribing patterns and potential benefits in the elderly are heavily influenced by polypharmacy and co-morbid pathologies. Increasing longevity may become less relevant in the frail elderly, whereas improving quality of life （QoL） often becomes priority; the onus being on improving wellbeing, maintaining independence for longer, and delaying institution- alisation. Specific studies evaluating elderly patients with CHF are lacking and little is known regarding the tolerability and side-effect profile of evidence based drug therapies in this population. There has been recent interest on the impact of heart rate in patients with symptomatic CHF. Ivabradine, with selective heart rate lowering capabilities, is of benefit in patients with CHF and left ventricular systolic dysfunction in sinus rhythm, resulting in reduction of heart failure hospitalisation and cardiovascular death. This manuscript will focus on CHF and the older patient and will discuss the impact of heart rate, drug therapies and tolerability. It will also highlight the tmmet need for specific studies that focus on patient-centred study end points rather than mortality targets that characterise most therapeutic trials. An on-going study evalu- ating the impact of ivabradine on QoL that presents a unique opportunity to evaluate the tolerability and impact of an established therapy on a wide range of real life, older patients with CHF will be discussed.

Cognitive impairment in heart failure patients

Cognitive damage in heart failure （HF） involves different domains thus interfering with the ability for single patient to self-care and to cope with treatment regimens, modifying symptoms and health behaviours. Many cerebral and functional changes were detected in brain imaging, involving areas of both grey and white matter deputed to cognition. Although various instruments are available to explore cognition, no consensus was obtained on better tools to be used in HF population. Reduction in cerebral blood flow, decreased cardiac output, altera-tions of cerebrovascular reactivity and modification of blood pressure levels are the main features involved in the etiopathogenetic mecha-nisms of cognitive deficit. Several cardiac variables, laboratory parameters, demographic and clinical elements were studied for their possible relation with cognition and should be properly evaluated to define patients at increased risk of impairment. The present review gathers avail-able data pointing out assured information and discussing possible areas of research development.

Differences in the predictive value of red cell distribution width for the mortality of patients with heart failure due to various heart diseases

Background Increased red blood cell distribution width （RDW） is associated with adverse outcomes in patients with heart failure （HF）. The objective of this study was to compare the differences in the predictive value of RDW in patients with HF due to different causes. Methods We retrospectively investigated 1,021 HF patients from October 2009 to December 2011 at Fuwai Hospital （Beijing, China）. HF in these patients was caused by three diseases; coronary heart disease （CHD）, dilated cardiomyopathy （DCM） and valvular heart disease （VHD）. Patients were followed-up for 21 ~ 9 months. Results The RDW, mortality and survival duration were significantly different among the three groups. Kaplan-Meier analysis showed that the cumulative survival decreased significantly with increased RDW in patients with HF caused by CHD and DCM, but not in those with HF patients caused by VHD. In a multivariable model, RDW was identified as an independent predictor for the mortality of HF patients with CHD （P 〈 0.001, HR 1.315, 95% CI 1.122-1.543）. The group with higher N-terminal pro-brain natriuretic peptide （NT-proBNP） and higher RDW than median had the lowest cumulative survival in patients with HF due to CHD, but not in patients with HF due to DCM. Conclusions RDW is a prognostic indicator for patients with HF caused by CHD and DCM; thus, RDW adds important information to NT-proBNP in CHD caused HF patients.

Anticoagulation in elderly patients at high risk of atrial fibrillation without documented arrhythmias

Recent studies have suggested that patients with high CHA2DS2VASc-score [Congestive Heart failure, hyperten- sion, Age ≥ 75 years （doubled）, Diabetes, Stroke （doubled）, Vascular disease, Age 65-74 years, Sex category （female sex）] thromboembolic complications occurred irrespective of the presence of atrial fibrillation （AF） and anticoagulant therapy may be initiated irrespective of documented AF.

Self-care among older Chinese people with chronic heart failure： the roles of cognitive and psychosocial characteristics

Chronic heart failure （CHF） is a complex clinical syndrome resulting from inefficient myocardial pumping, and is characterised by a typical progressively deteriorating trajectory punctuated by serious episodes of acute disease decompensation.High prevalence of hospital admission has been reported.[2] However, around 40% of hospital admissions was avoidable if patients demonstrate consistent self-care.

Precipitating factors leading to decompensation of chronic heart failure in the elderly patient in South-American community hospital

Background Exacerbations of heart failure appear frequently associated with precipitating factors not directly related to the evolution of cardiac disease. There still a paucity of data on the proportional distribution of precipitating factors specifically in elderly patients. The aim of this study was to examine prospectively the precipitating factors leading to hospitalization in elderly patients with heart failure in our community hospital. Methods We evaluate elderly patients who need admissions for decompensate heart failure. All patients were reviewed daily by the study investigators at the first 24 h and closely followed-up. Decompensation was defined as the worsening in clinical NYHA class associated with the need for an increase in medical treatment （at minimum intravenously diuretics）. Results We included 102 patients （mean age 79 ± 12 years）. Precipitating factors were identified in 88.5%. The decompensation was sudden in 35% of the cases. Noncompliance with diet was identified in 52% of the patients, lack of adherence to the prescribed medications amounted to 30%. Others precipitating factors were infections （29%）, arrhythmias （25%）, acute coronary ischemia （22%）, and uncontrolled hypertension （15%）, miscellaneous causes were detected in 18% of the cases （progression of renal disease 60%, anemia 30% and iatrogenic factors 10%）. Concomitant cause was not recognizable in 11.5%. Conclusions Large proportion heart failure hospitalizations are associated with preventable precipitating factors. Knowledge of potential precipitating factors may help to optimize treatment and provide guidance for patients with heart failure. The presence of potential precipitating factors should be routinely evaluated in patients presenting chronic heart failure.

Type D personality negatively associated with self-care in Chinese heart failure patients

Background Little is known about the association between type D personality and self-care behaviors in heart failure （HF） patients. We examined the effect of type D personality on self-care behaviors and self-efficacy among Chinese HF patients. Methods A cross-sectional study with a convenience sample was conducted. All participants completed the questionnaires of the self-care of HF index （V6） and type D personality scale. Demographic and clinical variables were obtained from medical records and patient interviews. The me- thods used for data analysis included descriptive analysis, independent-sample t-test, Z2 test, and multiple linear regression. Results A total of 127 HF patients were included and 61.4% of them were male. The average age for this study sample was 64.9± 12.34 years. The majority of the participants were in a New York Heart Association class III or IV （87%）, and the average length of living with HF was 38.24 ± 41.1 months. A total of 33.1% of the participants were identified as having type D personality. No significant differences were determined in the demographic and clinical variables between type D and non-type D patients, except for the mean age and the length of living with HF. Type D patients were younger and had a shorter time of living with HF than their non-type D counterparts. Multiple regression demonstrated significant associations between type D personality and self-care maintenance and self-efficacy after adjusting the demographic and clinical factors. However, type D personality was not significantly associated with self-care management behaviors. Conclusions Type D personality was negatively related to self-care maintenance and self-efficacy in Chinese HF patients. Future study is warranted to develop a tailored intervention to improve engagement in self-care behaviors in HF patients with type D personality.

Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure

Background The neutrophil-to-lymphocyte （N/L） ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide （NT-proBNP） in elderly patients with chronic heart failure （CHF）. We sought to make this comparison. Methods A total of 1355 elderly patients with CHF were analyzed. A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation （AF）. Cox regression analysis was used to assess the multivariable rela- tionship between the N/L ratio, NT-proBNP level, and subsequent major cardiovascular events （MCE）. Results In the multiple logistic regression analysis, the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio （OR）： 1.079, 95% confi- dence interval （CI）： 1.027-1.134, P = 0.003]. The median follow-up period was 18 months. In a multivariable model using tertiles of both variables, the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio （HR）： 1.407, 95% CI： 1.098-1.802, P = 0.007] compared with the lowest tertile. Similarly, the highest NT-proBNP tertile was also significantly associated with MCE （HR： 1.461, 95% CI： 1.104-1.934, P- 0.008）. Conclusions In elderly patients with CHF, the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP. The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.

Mitral peak early diastolic filling velocity to deceleration time ratio as a predictor of prognosis in patients with chronic heart failure and preserved or reduced ejection fraction

Objective Doppler derived mitral peak early diastolic filling velocity to deceleration time ratio （E/DT） has been proposed as parameter for predicting prognosis in general population. This study prospectively investigates the incremental prognostic value of E/DT over clinical, conven- tional eehocardiographic and mitral-Doppler variables in patients hospitalized for decompensated heart failure （HF）. Methods We analyzed 95 HF patients （mean age 64.8 ± 12.2 years） hospitalized at our institution from January 2010 to March 2012. The primary end-point was cardiac death or hospitalization, whichever occurred first. Cox regression analysis was performed to identify significant predictors of outcomes. Results During follow-up （median 37.7 months） 13 patients died and 44 were hospitalized for a cardiac event. At univariable analysis, New York Heart Association （NYHA） functional class, furosemide dosage, lateral tricuspidal annular plane systolic excursion, deceleration lime and E/DT were predictive of outcome. At multivariable analysis, E/DT was the only predictor of prognosis （hazard ratio = 1.02, P = 0.018）, giving incremental prognostic information to clinical and other echocardio-graphic measures （global chi-square from 15.4 to 25.2; P = 0.032）. Conclusions FJDT gives independent and incremental prognostic information in HF patients.

Brain natriuretic peptide is a potent vasodilator in aged human microcircula- tion and shows a blunted response in heart failure patients

Background Brain natriuretic peptide （BNP） is normally present in low levels in the circulation, but it is elevated in parallel with the degree of congestion in heart failure subjects （CHF）. BNP has natriuretic effects and is a potent vasodilator. It is suggested that BNP could be a therapeutic alternative in CHF. However, we postulated that the high levels of circulating BNP in CHF may downregulate the response of microvascular natriuretic receptors. This was tested by comparing 15 CHF patients （BNP 〉 3000 ng/L） with 10 matched, healthy controls. Methods Cutaneous microvascular blood flow in the forearm was measured by laser Doppler Flowmetry. Local heating （＋44°C, 10 min） was used to evoke a maximum local dilator response. Results Non-invasive iontophoretic administration of either BNP or acetylcholine （ACh）, a known endothelium-dependent dilator, elicited an increase in local flow. The nitric oxide synthase inhibitor, l-N-Arginine- methyl-ester （L-NAME）, blocked the BNP response （in controls）. Interestingly, responses to BNP in CHF patients were reduced to about one third of those seen in healthy controls （increase in flow： 251% in CHF vs. 908% in controls; P 〈 0.001）. In contrast, the vasodilator responses to ACh and to local heating were only somewhat attenuated in CHF patients. Thus, dilator capacity and nitric oxide signalling were not af- fected to the same extent as BNP-mediated dilation, indicating a specific downregulation of the latter response. Conclusions The findings show for the first time that microvascular responses to BNP are markedly reduced in CHF patients. This is consistent with the hypothesis of BNP receptor function is downregulated in CHF.