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Effects of an integrated approach to care in the management of hypertensive patients with heart failure
AJH–May 2003–VOL. 16, NO. 5, PART 2
consecutive inpatients with heart failure were studied between April 2001 and September 2002, 115 older than 80 years, and 65 between 65 and 80 years. We analyzed the following cardiovascular risk factors: 1) hypertension, 2) hyperlipidemia, 3) smoking and 4) diabetes. Besides, we analyzed the following comorbidities: 1) chronic obstructive pulmonary disease, 2) stroke, 3) chronic renal failure, 4) alcoholism, 5) gout, 6) peripheral vascular disease, and 7) others. An uni. and multivariate analysis was carried out using the Epidat and Statistix. By multivariate analysis, a higher percentage of hyperlipidemia: 11.3 % vs 24.6 % (OR, 2.82; 95 % CI, 1.14-6.98; p ⬍ 0.02); smoking: 16.5 % vs 42.4 % (OR, 2.62; 95 % CI, 1.23-5.60; p ⬍ 0.01); alcoholism: 0.8% vs 10.9 % (OR, 14.22; 95 % CI, 1.57-128.32; p⬍0.01); and peripheral vascular disease: 6 % vs 15 % (OR, 3.63; 95 % CI, 1.22-10.86; p ⬍ 0.02), was found in the group of patients between 65 and 80 years in comparison to the group of patients older than 80 years. In conclusion, certain cardiovascular risk factors and comorbidities are different in our population of octogenarians in comparison to a geriatric but younger group with heart failure. By multivariate analysis, a lower incidence of hyperlipidemia, smoking, alcoholism and peripheral vascular disease was observed in the oldest group. Key Words: Heart failure, octogenarians, risk factors
P-127 HEART FAILURE IN OCTOGENARIANS: ETIOLOGY AND TYPE OF DYSFUNCTION Jose M Bonorino, Juan R Mieres, Amilcar Herbas Pozo, Freddy Padilla, Leonardo Ferrer, Roberto Bagnasco, Veronica L Crosa, Manuel Vazquez Blanco, Sara Berensztein, Jorge Lerman. Cardiology, Hospital de Clinicas Jose de San Martin, Capital Federal, Buenos Aires, Argentina. The aim of this study was to analyze the etiology and type of dysfunction in octogenarians with heart failure and at the same time establish if there are differences with a geriatric but younger population. A total of 180 consecutive inpatients with heart failure were studied between April 2001 and September 2002, 115 older than 80 years, and 65 between 65 and 80 years. We analyzed the following etiologies: 1) ischemic heart disease, 2) hypertension, 3) valvular heart disease, 4) chagasic cardiomyopathy, 5) idiopathic, 6) others. We compared the presence of systolic and diastolic heart failure between both groups. An uni. and multivariate analysis was carried out using the Epidat and Statistix. The etiologic factors were: 1) ischemic heart disease: 37.3 % vs 53.4 % (OR, 4.47; 95 % CI, 0.27-0.99; p ⬍ 0.03) by univariate analysis; 2) hypertension: 58.2 % vs 43.8 % (p⫽ns); 3) valvular heart disease: 26.9 % vs 23.2 % (p⫽ns); 4) chagasic cardiomyopathy: 0% vs 2.7% (p⫽ns); 5) idiopathic: 11.3 % vs 6.8 % (p⫽ns); others: 3.4 % vs 5.4 % (p⫽ns), 6) systolic heart failure: 35.6 % vs 47.9 % (p⫽ns), 7) diastolic heart failure: 40.8 % vs 21.9 % (OR, 6.28; 95 % CI, 0.01-0.87; p ⬍ 0.01) by univariate analysis, and (OR, 0.35; 95 % CI, 0.14-0.845; p ⬍ 0.02) by multivariate analysis, in patients older than 80 years vs patients between 65 and 80 years. In conclusion, in this group of patients with heart failure there were no differences in the etiology between patients who were older or younger than 80 years old. In spite of this, octogenarians had a higher prevalence of diastolic heart failure. Key Words: Heart failure, octogenarians, etiology
POSTERS: Heart Failure/Hypertrophy
85A
P-128 PLASMA CARDIOTROPHIN-1, A MYOCARDIAL STRESS MARKER IN HYPERTENSIVE HEART DISEASE ? Arantxa Gonza´ lez, Begon˜ a Lo´ pez, Manuel M Sa´ nchez del Pino, Agnes Dı´az, Diego Martı´n-Raimundi, Marı´a Antonia Fortun˜ o, Lourdes Toma´ s, Elisa Lozano, Marı´a del Mar Herna´ ndez, Eloy Sa´ nchez, Manuel Serrano, Joaquı´n Barba, Ramo´ n Querejeta, Javier Dı´ez. Division of Cardiovascular Pathophysiology, School of Medicine, University of Navarra, Pamplona, Navarra, Spain; Department of Cardiology, University Clinic, University of Navarra, Pamplona, Navarra, Spain; Navarra Health System, Pamplona, Navarra, Spain; Department of Cardiology, Donostia Hospital, San Sebastia´ n, Navarra, Spain. Cardiotrophin-1 (CT-1) is a cytokine of the interleukin-6 family, essentially of cardiac origin, that can be detected in plasma. It is produced in conditions of myocardial biomechanical stress and acts as a cardiomyocyte survival factor. Provided that, in the evolution of essential hypertension (EH) three stages of cardiac affection of increasing severity can be described (absence of alterations or group 1, presence of left ventricular hypertrophy or group 2 and development of heart failure due to hypertensive myocardiopathy or group 3), we have hypothesized that circulating CT-1 could be a non invasive marker of myocardial biomechanical stress in patients with EH. In order to evaluate this hypothesis, CT-1 was determined in 71 normotensive subjects and in 106 patients with EH, who after a clinical and echocardiographic (M mode and Doppler) study were classified as follows: 36 from group 1, 39 from group 2 and 31 from group 3. CT-1 concentration was measured in plasma by a direct ELISA using a polyclonal antiserum developed by ourselves. CT-1 was increased (P⬍0.01) in the 3 groups of patients as compared with the group of normotensive subjects. This increase was progressive as higher was the degree of cardiac atteint in the different groups of patients. 50% of the patients from group 1 presented abnormally increased levels of CT-1. Within group 2, patients with concentric hypertrophy (N⫽22) did tend to present higher concentrations of CT-1 (⫹32%) than patients with eccentric hypertrophy (N⫽17). Within group 3, patients with systolic heart failure (N⫽21) did tend to present higher concentrations of CT-1 (⫹50%) than patients with diastolic heart failure (N⫽10). These data suggest that CT-1 may be an early marker of cardiac atteint in EH, since in half of the patients with no echocardiographic alterations, abnormally increased levels of CT-1 are detected. On the other hand, the levels of CT-1 are higher in hypertensives exhibiting those patterns of hypertrophy or heart failure with the worst clinical prognosis, thus suggesting that this factor is a marker of the degree of myocardial biomechanical stress associated with EH. Key Words: Cardiotrophin-1, hypertensive heart disease, heart failure
P-129 EFFECTS OF AN INTEGRATED APPROACH TO CARE IN THE MANAGEMENT OF HYPERTENSIVE PATIENTS WITH HEART FAILURE Daniela Degli Esposti, Eugenio Cosentino, Ada Dormi, Stefano Bacchelli, Domenico Maione, Maria Grazia Prandin, Vincenzo Immordino, Claudio Borghi, Ettore Ambrosioni. Internal Medicine, Bologna University - S.Orsola Hospital, Bologna, Italy. Heart failure management (HF) integrated programs, comprehensive of systematic assessment and management, and counseling and education of patients, may reduce readmission and improve quality of life of patients, but the real value of this kind of managemen still is matter of question. We assessed the effect of 1 year of specialistic and integrated program care and educational/support intervention, with outpatient management strategies focus on maintenance of patient stability, on NHYA class and
86A
POSTERS: Heart Failure/Hypertrophy
AJH–May 2003–VOL. 16, NO. 5, PART 2
on the number of readmissions of hypertensive patients with II-III NYHA class heart failure. Study patients were required to have clinical, radiologic or echocardiographic signs of HF. At entry in the study protocol and after 1 year we evaluated the number of hospital admission in the previous 12 months, the NYHA class and the ongoing therapy. In a 2 year period, among 164 consecutive pts with HF, we evaluated 130 subjects (79.3%) with a hystory of hypertension (68M, 62F, mean age 74 yrs), of which 87 had 1 year control. At entry, 89.6% of patients had at least 1 hospital admission because of HF and 32.9% had ⱖ 3 admission, whilst after 1 year 7.5% of patient were readmitted once and nobody had ⱖ 3 readmission. The data of NYHA class are represented in the table, with a global trend toward an improvement of NYHA class. At entry and after 1 year respectively 97% and 89% of patients received ACE-I, 1% and 4.2% AngioII-I, 32% and 83% -blockers, 93% and 87% diuretics, 29% and 29% digoxin, 26% and 25% calcium channel blockers, and 46% and 51% nitrates. Changes in NYHA Class During the Study Period by Entry NYHA Class
entry NYHA I entry NYHA II entry NYHA III end by NYHA class
end NYHA I
end NYHA II
end NYHA III
entry by NYHA class
4/4 pts (100%) 6/69 pts (8.7%) 2/14 pts (14.3%) 12/87 pts (13.8%)
59/69 pts (85.5%) 9/14 pts (64.3%) 68/87 pts (78.2%)
4/69 (5.8%) 3/14 pts (21.4%) 7 pts/87 (8%)
4 pts (4.5%) 69 pts (79.3%) 14 pts (16%) 87 pts (100%)
VO2 Kinetics in HF and N age (years) 1st group H (50–59 yrs) F N 2nd group H (60–69 yrs) F N 3rd group H (⬎70 yrs) F N
O2deficit/ VO2 ss%
s
O2deficit ml
54 ⫾ 4.6 109.7 ⫾ 4.5*
61.7 ⫾ 9**
723.3 ⫾ 305.7 102.3 ⫾ 15.2*
55 ⫾ 3.6 150.4 ⫾ 25.3
42.8 ⫾ 4.1
66 ⫾ 2.1
68.7 ⫾ 2.5** 591.7 ⫾ 223.7 114.7 ⫾ 4.5**
⌽1%
67.3 ⫾ 18.6* 134 ⫾ 37.5
76 ⫾ 5.5
58.6 ⫾ 32.1* 72.4 ⫾ 10.9* 682.4 ⫾ 271.4 120.5 ⫾ 18.1* 54.7 ⫾ 1.5
518 ⫾ 97.8
73 ⫾ 10.4
63 ⫾ 1.3
75 ⫾ 3.5 118.3 ⫾ 7.5
50 ⫾ 3.4
419 ⫾ 128.9
559 ⫾ 86.6
83 ⫾ 5.5 91 ⫾ 2.6
* p ⬍ 0.05, ** p ⬍ 0.001 vs N in each group
In addition, within each group we observed a trend toward a correlation between VO2 kinetics and clinical and some echocardiographic parameters, suggesting a capacity of the test of assessing the severity of heart failure. In conclusion, this test well discriminate HF from N, giving a potential further tool in the evaluation of heart failure and in the assessment of the grading of the severity of the disease. Key Words: VO2 kinetics, heart failure, constant load exercise
p ⬍ 0.0001 for improving trend; p ⬍ 0.05 for worsening trend
In conclusion the specific care and educational/support intervention program was effective in reducing readmission and in ameliorating quality of life of patients with HF. After the program implementation, a better utilization of drugs, in particular -blockers, in accordance with guide-lines indications, was also observed. Key Words: Heart failure, hypertension, integrated program care
P-130 CONSTANT LOAD EXERCISE VO2 KINETICS STUDY IN THE EVALUATION OF HEART FAILURE Domenico Maione, Daniela Degli Esposti, Eugenio Cosentino, Ada Dormi, Stefano Bacchelli, Maddalena Veronesi, Olga Baraldi, Claudio Borghi, Ettore Ambrosioni. Internal Medicine, University of Bologna - S.orsola Hospital, Bologna, Italy. VO2 kinetics is assumed to represent the kinetics of oxidative resynthesis of ATP. Conditions, such as heart failure, which limit O2 transport, result in modifications of VO2 kinetics, better shown during constant load exercise. To evaluate heart failure patients we used a constant load exercise, personalized by 80% of anaerobic threshold, determined by a previous incremental test. With this test, patients can perform exercise without going over the anaerobic threshold and avoiding the complexity of supra-threshold VO2 kinetics. We tested this personalized protocol on 11 heart failure patients (HF) (6M, 5F), NYHA class II-III), compared with 13 normal subjects (N) (3M, 10 F), subdivided into 3 groups of age. An incremental test, to achieve the watts and the O2 peak of the anaerobic threshold was firstly performed; then 80% of this exercise is used in 4 square wave exercises. To obviate the influence of inertia of the ergometer flywheel at start of exercise, the flywheel was driven at 60 rpm during rest by an electric motor, which was turned off at the start of exercise. This consented an optimal evaluation of the first phase of VO2 kinetics (1), studied, by itself and together with the 2nd phase (2), by mathematical models superimposed on breath-by-breath data. The examined parameters were: the % of increment of O2 in 1 respect to basal, the time constant of 2 (), the O2 deficit, the % of the O2 deficit/steady state VO2. The results are represented in the table.
P-131 RELATIONSHIP OF ANTIHYPERTENSIVE TREATMENT WITH HEART FAILURE HOSPITALIZATION IN HYPERTENSIVE PATIENTS Javier Sobrino, Jaume Plana, Angela Felip, Monica Domenech, Maria J Adrian. Internal Medicine, Fundacio Estudi HTA Hospitals Comarcals Catalunya, Barcelona, Spain. The World Health Organization/International Society of Hypertension on 1999, recommended to start pharmacological treatment with anyone of 6 groups of antihypertensive treatments. However, preliminary results of ALLHAT study, seems to refute that, due to one of this six therapeutics groups, seems to be relationship to produce heart failure. Objective: To determinate if any pharmacological group of antihypertensive treatments is relationated with development of heart failure. Material and Methods: Multicenter case– control study. For one side, we analyzed as case-patients, all hypertensive patients hospitalized for heart failure during 1997-2000 in community hospitals of Catalonia and, on the other side, we considered as a control patients, all hypertensive patients hospitalized at the same time, for any complication relationed with hypertension (stroke, myocardial ischemia or infarction) but without heart failure. Results: We analyzed 596 hypertensive patients that required hospitalization for heart failure (case group) and 716 hypertensive patients that hospitalized for several vascular diseases relationated with hypertension (control group). The two groups are significantly different for previously hospitalized antihypertensive therapy , for diuretics 68.6% in case group vs 36,8% in control group, OR 3.75 (CI of 95% 2.98-4.37; p ⬍ 0,001), for beta blockers 3.4% in case group vs 9.8% in control group, OR 0.32 (CI of 95% 0.19-0.53; p ⬍ 0.001), for calcium antagonists 13.6% in case group vs 19.1% in control group, OR 0.66 (CI of 95% 0.49-0.90; p ⫽ 0.08), for ACE inhibitors 46.1% in case group vs 37.6% in control group, OR 1.41 (CI of 95% 1.13-1.76; p ⫽ 0.002), for angiotensin receptor blockers 8.2% in case group vs 6.3% in control group, OR 1.33 (CI of 95% 0.87-2.03; p ⫽ 0.17), and for alpha blockers 4.5% in case group vs 3.9% in control group, OR 1.16 (CI of 95% 0.67-2.0; p ⫽ 0.57). Conclusion: The use of alpha-blockers as antihypertensive treatment seems not to increase the risk for hospitalization due to heart failure in hypertensive patients treated with this pharmacological group. Key Words: Heart failure, alpha blockers
consecutive inpatients with heart failure were studied between April 2001 and September 2002, 115 older than 80 years, and 65 between 65 and 80 years. We analyzed the following cardiovascular risk factors: 1) hypertension, 2) hyperlipidemia, 3) smoking and 4) diabetes. Besides, we analyzed the following comorbidities: 1) chronic obstructive pulmonary disease, 2) stroke, 3) chronic renal failure, 4) alcoholism, 5) gout, 6) peripheral vascular disease, and 7) others. An uni. and multivariate analysis was carried out using the Epidat and Statistix. By multivariate analysis, a higher percentage of hyperlipidemia: 11.3 % vs 24.6 % (OR, 2.82; 95 % CI, 1.14-6.98; p ⬍ 0.02); smoking: 16.5 % vs 42.4 % (OR, 2.62; 95 % CI, 1.23-5.60; p ⬍ 0.01); alcoholism: 0.8% vs 10.9 % (OR, 14.22; 95 % CI, 1.57-128.32; p⬍0.01); and peripheral vascular disease: 6 % vs 15 % (OR, 3.63; 95 % CI, 1.22-10.86; p ⬍ 0.02), was found in the group of patients between 65 and 80 years in comparison to the group of patients older than 80 years. In conclusion, certain cardiovascular risk factors and comorbidities are different in our population of octogenarians in comparison to a geriatric but younger group with heart failure. By multivariate analysis, a lower incidence of hyperlipidemia, smoking, alcoholism and peripheral vascular disease was observed in the oldest group. Key Words: Heart failure, octogenarians, risk factors
P-127 HEART FAILURE IN OCTOGENARIANS: ETIOLOGY AND TYPE OF DYSFUNCTION Jose M Bonorino, Juan R Mieres, Amilcar Herbas Pozo, Freddy Padilla, Leonardo Ferrer, Roberto Bagnasco, Veronica L Crosa, Manuel Vazquez Blanco, Sara Berensztein, Jorge Lerman. Cardiology, Hospital de Clinicas Jose de San Martin, Capital Federal, Buenos Aires, Argentina. The aim of this study was to analyze the etiology and type of dysfunction in octogenarians with heart failure and at the same time establish if there are differences with a geriatric but younger population. A total of 180 consecutive inpatients with heart failure were studied between April 2001 and September 2002, 115 older than 80 years, and 65 between 65 and 80 years. We analyzed the following etiologies: 1) ischemic heart disease, 2) hypertension, 3) valvular heart disease, 4) chagasic cardiomyopathy, 5) idiopathic, 6) others. We compared the presence of systolic and diastolic heart failure between both groups. An uni. and multivariate analysis was carried out using the Epidat and Statistix. The etiologic factors were: 1) ischemic heart disease: 37.3 % vs 53.4 % (OR, 4.47; 95 % CI, 0.27-0.99; p ⬍ 0.03) by univariate analysis; 2) hypertension: 58.2 % vs 43.8 % (p⫽ns); 3) valvular heart disease: 26.9 % vs 23.2 % (p⫽ns); 4) chagasic cardiomyopathy: 0% vs 2.7% (p⫽ns); 5) idiopathic: 11.3 % vs 6.8 % (p⫽ns); others: 3.4 % vs 5.4 % (p⫽ns), 6) systolic heart failure: 35.6 % vs 47.9 % (p⫽ns), 7) diastolic heart failure: 40.8 % vs 21.9 % (OR, 6.28; 95 % CI, 0.01-0.87; p ⬍ 0.01) by univariate analysis, and (OR, 0.35; 95 % CI, 0.14-0.845; p ⬍ 0.02) by multivariate analysis, in patients older than 80 years vs patients between 65 and 80 years. In conclusion, in this group of patients with heart failure there were no differences in the etiology between patients who were older or younger than 80 years old. In spite of this, octogenarians had a higher prevalence of diastolic heart failure. Key Words: Heart failure, octogenarians, etiology
POSTERS: Heart Failure/Hypertrophy
85A
P-128 PLASMA CARDIOTROPHIN-1, A MYOCARDIAL STRESS MARKER IN HYPERTENSIVE HEART DISEASE ? Arantxa Gonza´ lez, Begon˜ a Lo´ pez, Manuel M Sa´ nchez del Pino, Agnes Dı´az, Diego Martı´n-Raimundi, Marı´a Antonia Fortun˜ o, Lourdes Toma´ s, Elisa Lozano, Marı´a del Mar Herna´ ndez, Eloy Sa´ nchez, Manuel Serrano, Joaquı´n Barba, Ramo´ n Querejeta, Javier Dı´ez. Division of Cardiovascular Pathophysiology, School of Medicine, University of Navarra, Pamplona, Navarra, Spain; Department of Cardiology, University Clinic, University of Navarra, Pamplona, Navarra, Spain; Navarra Health System, Pamplona, Navarra, Spain; Department of Cardiology, Donostia Hospital, San Sebastia´ n, Navarra, Spain. Cardiotrophin-1 (CT-1) is a cytokine of the interleukin-6 family, essentially of cardiac origin, that can be detected in plasma. It is produced in conditions of myocardial biomechanical stress and acts as a cardiomyocyte survival factor. Provided that, in the evolution of essential hypertension (EH) three stages of cardiac affection of increasing severity can be described (absence of alterations or group 1, presence of left ventricular hypertrophy or group 2 and development of heart failure due to hypertensive myocardiopathy or group 3), we have hypothesized that circulating CT-1 could be a non invasive marker of myocardial biomechanical stress in patients with EH. In order to evaluate this hypothesis, CT-1 was determined in 71 normotensive subjects and in 106 patients with EH, who after a clinical and echocardiographic (M mode and Doppler) study were classified as follows: 36 from group 1, 39 from group 2 and 31 from group 3. CT-1 concentration was measured in plasma by a direct ELISA using a polyclonal antiserum developed by ourselves. CT-1 was increased (P⬍0.01) in the 3 groups of patients as compared with the group of normotensive subjects. This increase was progressive as higher was the degree of cardiac atteint in the different groups of patients. 50% of the patients from group 1 presented abnormally increased levels of CT-1. Within group 2, patients with concentric hypertrophy (N⫽22) did tend to present higher concentrations of CT-1 (⫹32%) than patients with eccentric hypertrophy (N⫽17). Within group 3, patients with systolic heart failure (N⫽21) did tend to present higher concentrations of CT-1 (⫹50%) than patients with diastolic heart failure (N⫽10). These data suggest that CT-1 may be an early marker of cardiac atteint in EH, since in half of the patients with no echocardiographic alterations, abnormally increased levels of CT-1 are detected. On the other hand, the levels of CT-1 are higher in hypertensives exhibiting those patterns of hypertrophy or heart failure with the worst clinical prognosis, thus suggesting that this factor is a marker of the degree of myocardial biomechanical stress associated with EH. Key Words: Cardiotrophin-1, hypertensive heart disease, heart failure
P-129 EFFECTS OF AN INTEGRATED APPROACH TO CARE IN THE MANAGEMENT OF HYPERTENSIVE PATIENTS WITH HEART FAILURE Daniela Degli Esposti, Eugenio Cosentino, Ada Dormi, Stefano Bacchelli, Domenico Maione, Maria Grazia Prandin, Vincenzo Immordino, Claudio Borghi, Ettore Ambrosioni. Internal Medicine, Bologna University - S.Orsola Hospital, Bologna, Italy. Heart failure management (HF) integrated programs, comprehensive of systematic assessment and management, and counseling and education of patients, may reduce readmission and improve quality of life of patients, but the real value of this kind of managemen still is matter of question. We assessed the effect of 1 year of specialistic and integrated program care and educational/support intervention, with outpatient management strategies focus on maintenance of patient stability, on NHYA class and
86A
POSTERS: Heart Failure/Hypertrophy
AJH–May 2003–VOL. 16, NO. 5, PART 2
on the number of readmissions of hypertensive patients with II-III NYHA class heart failure. Study patients were required to have clinical, radiologic or echocardiographic signs of HF. At entry in the study protocol and after 1 year we evaluated the number of hospital admission in the previous 12 months, the NYHA class and the ongoing therapy. In a 2 year period, among 164 consecutive pts with HF, we evaluated 130 subjects (79.3%) with a hystory of hypertension (68M, 62F, mean age 74 yrs), of which 87 had 1 year control. At entry, 89.6% of patients had at least 1 hospital admission because of HF and 32.9% had ⱖ 3 admission, whilst after 1 year 7.5% of patient were readmitted once and nobody had ⱖ 3 readmission. The data of NYHA class are represented in the table, with a global trend toward an improvement of NYHA class. At entry and after 1 year respectively 97% and 89% of patients received ACE-I, 1% and 4.2% AngioII-I, 32% and 83% -blockers, 93% and 87% diuretics, 29% and 29% digoxin, 26% and 25% calcium channel blockers, and 46% and 51% nitrates. Changes in NYHA Class During the Study Period by Entry NYHA Class
entry NYHA I entry NYHA II entry NYHA III end by NYHA class
end NYHA I
end NYHA II
end NYHA III
entry by NYHA class
4/4 pts (100%) 6/69 pts (8.7%) 2/14 pts (14.3%) 12/87 pts (13.8%)
59/69 pts (85.5%) 9/14 pts (64.3%) 68/87 pts (78.2%)
4/69 (5.8%) 3/14 pts (21.4%) 7 pts/87 (8%)
4 pts (4.5%) 69 pts (79.3%) 14 pts (16%) 87 pts (100%)
VO2 Kinetics in HF and N age (years) 1st group H (50–59 yrs) F N 2nd group H (60–69 yrs) F N 3rd group H (⬎70 yrs) F N
O2deficit/ VO2 ss%
s
O2deficit ml
54 ⫾ 4.6 109.7 ⫾ 4.5*
61.7 ⫾ 9**
723.3 ⫾ 305.7 102.3 ⫾ 15.2*
55 ⫾ 3.6 150.4 ⫾ 25.3
42.8 ⫾ 4.1
66 ⫾ 2.1
68.7 ⫾ 2.5** 591.7 ⫾ 223.7 114.7 ⫾ 4.5**
⌽1%
67.3 ⫾ 18.6* 134 ⫾ 37.5
76 ⫾ 5.5
58.6 ⫾ 32.1* 72.4 ⫾ 10.9* 682.4 ⫾ 271.4 120.5 ⫾ 18.1* 54.7 ⫾ 1.5
518 ⫾ 97.8
73 ⫾ 10.4
63 ⫾ 1.3
75 ⫾ 3.5 118.3 ⫾ 7.5
50 ⫾ 3.4
419 ⫾ 128.9
559 ⫾ 86.6
83 ⫾ 5.5 91 ⫾ 2.6
* p ⬍ 0.05, ** p ⬍ 0.001 vs N in each group
In addition, within each group we observed a trend toward a correlation between VO2 kinetics and clinical and some echocardiographic parameters, suggesting a capacity of the test of assessing the severity of heart failure. In conclusion, this test well discriminate HF from N, giving a potential further tool in the evaluation of heart failure and in the assessment of the grading of the severity of the disease. Key Words: VO2 kinetics, heart failure, constant load exercise
p ⬍ 0.0001 for improving trend; p ⬍ 0.05 for worsening trend
In conclusion the specific care and educational/support intervention program was effective in reducing readmission and in ameliorating quality of life of patients with HF. After the program implementation, a better utilization of drugs, in particular -blockers, in accordance with guide-lines indications, was also observed. Key Words: Heart failure, hypertension, integrated program care
P-130 CONSTANT LOAD EXERCISE VO2 KINETICS STUDY IN THE EVALUATION OF HEART FAILURE Domenico Maione, Daniela Degli Esposti, Eugenio Cosentino, Ada Dormi, Stefano Bacchelli, Maddalena Veronesi, Olga Baraldi, Claudio Borghi, Ettore Ambrosioni. Internal Medicine, University of Bologna - S.orsola Hospital, Bologna, Italy. VO2 kinetics is assumed to represent the kinetics of oxidative resynthesis of ATP. Conditions, such as heart failure, which limit O2 transport, result in modifications of VO2 kinetics, better shown during constant load exercise. To evaluate heart failure patients we used a constant load exercise, personalized by 80% of anaerobic threshold, determined by a previous incremental test. With this test, patients can perform exercise without going over the anaerobic threshold and avoiding the complexity of supra-threshold VO2 kinetics. We tested this personalized protocol on 11 heart failure patients (HF) (6M, 5F), NYHA class II-III), compared with 13 normal subjects (N) (3M, 10 F), subdivided into 3 groups of age. An incremental test, to achieve the watts and the O2 peak of the anaerobic threshold was firstly performed; then 80% of this exercise is used in 4 square wave exercises. To obviate the influence of inertia of the ergometer flywheel at start of exercise, the flywheel was driven at 60 rpm during rest by an electric motor, which was turned off at the start of exercise. This consented an optimal evaluation of the first phase of VO2 kinetics (1), studied, by itself and together with the 2nd phase (2), by mathematical models superimposed on breath-by-breath data. The examined parameters were: the % of increment of O2 in 1 respect to basal, the time constant of 2 (), the O2 deficit, the % of the O2 deficit/steady state VO2. The results are represented in the table.
P-131 RELATIONSHIP OF ANTIHYPERTENSIVE TREATMENT WITH HEART FAILURE HOSPITALIZATION IN HYPERTENSIVE PATIENTS Javier Sobrino, Jaume Plana, Angela Felip, Monica Domenech, Maria J Adrian. Internal Medicine, Fundacio Estudi HTA Hospitals Comarcals Catalunya, Barcelona, Spain. The World Health Organization/International Society of Hypertension on 1999, recommended to start pharmacological treatment with anyone of 6 groups of antihypertensive treatments. However, preliminary results of ALLHAT study, seems to refute that, due to one of this six therapeutics groups, seems to be relationship to produce heart failure. Objective: To determinate if any pharmacological group of antihypertensive treatments is relationated with development of heart failure. Material and Methods: Multicenter case– control study. For one side, we analyzed as case-patients, all hypertensive patients hospitalized for heart failure during 1997-2000 in community hospitals of Catalonia and, on the other side, we considered as a control patients, all hypertensive patients hospitalized at the same time, for any complication relationed with hypertension (stroke, myocardial ischemia or infarction) but without heart failure. Results: We analyzed 596 hypertensive patients that required hospitalization for heart failure (case group) and 716 hypertensive patients that hospitalized for several vascular diseases relationated with hypertension (control group). The two groups are significantly different for previously hospitalized antihypertensive therapy , for diuretics 68.6% in case group vs 36,8% in control group, OR 3.75 (CI of 95% 2.98-4.37; p ⬍ 0,001), for beta blockers 3.4% in case group vs 9.8% in control group, OR 0.32 (CI of 95% 0.19-0.53; p ⬍ 0.001), for calcium antagonists 13.6% in case group vs 19.1% in control group, OR 0.66 (CI of 95% 0.49-0.90; p ⫽ 0.08), for ACE inhibitors 46.1% in case group vs 37.6% in control group, OR 1.41 (CI of 95% 1.13-1.76; p ⫽ 0.002), for angiotensin receptor blockers 8.2% in case group vs 6.3% in control group, OR 1.33 (CI of 95% 0.87-2.03; p ⫽ 0.17), and for alpha blockers 4.5% in case group vs 3.9% in control group, OR 1.16 (CI of 95% 0.67-2.0; p ⫽ 0.57). Conclusion: The use of alpha-blockers as antihypertensive treatment seems not to increase the risk for hospitalization due to heart failure in hypertensive patients treated with this pharmacological group. Key Words: Heart failure, alpha blockers