- Email: [email protected]
283
S142
Abstracts
derived using Kaplan Meier analysis and compared by log rank analysis. Results: The mean age of the 272 women was 52 yrs. 75% had dilated cardiomyopathy and 25% CAD. Follow-up averaged 930 days. HFSS for the whole cohort averaged 8.56⫾1.1 and VO2 13.9⫾5.1 ml/kg/ min. The number of patients in the low (14), medium (10 –14) and high (10 ml/kg/min) risk VO2 strata were 112, 96 and 64 respectively. For the HFSS, 178 patients were low (8.1), 71 medium (8.1⫺7.19) and 23 in high risk (⬍7.19) strata. Survival curves for VO2 (p⬍0.01)and HFSS (p⬍0.001) demonstrated significant differences (see figures). Conclusion: VO2 and HFSS are excellent parameters to predict survival in women with CHF.
The Journal of Heart and Lung Transplantation February 2006
serman formula, which adjusts for gender and age effects. Cox regression analyses were performed to model the predictive value of significant variables. Results: Women had significantly lower PVO2 (14.0⫾4.9 vs 16.6⫾7.1 ml/kg/min; p⬍0.0001) but higher PP-PVO2 (54.5⫾15.9 vs 48.1⫾17.4%; p⬍0.0001) than men. We evaluated the effects of gender, age, PP-PVO2, race, LVEF, BMI, peak respiratory exchange ratio (RER), and -blocker use on transplant-free survival and found that only PP-PVO2, gender, and peak RER significantly predicted survival. Despite controlling for gender effects with PP-PVO2, female gender remains a significant predictor of survival. Cox Regression Model Variable
p Value
Odds Ratio
Confidence Interval
PP-PVO2 Gender Peak RER
⬍0.0001 ⬍0.01 ⬍0.02
0.96 0.50 8.20
0.948–0.973 0.297–0.842 1.398–48.125
Conclusion: PP-PVO2 is a powerful predictor of outcomes in ambulatory HF patients. However, despite correcting for gender, PP-PVO2 does not negate the survival benefit conferred by the female gender. Further evaluation of the utility of PP-PVO2 values in women HF patients is warranted. 284 FACTORS ASSOCIATED WITH NON-COMPLETION OF CARDIAC REHABILITATION IN HEART FAILURE PATIENTS S.V. Pamboukian,1 B. Sanderson,1 A. Lazaryan,1 V. Bittner,1 1 Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL
283 PRECENT-PREDICTED PEAK OXYGEN CONSUMPTION PREDICTS SURVIVAL IN AMBULATORY HEART FAILURE PATIENTS, BUT DOES NOT NEGATE GENDER EFFECTS ON SURVIVAL S. Elmariah,1 L.R. Goldberg,2 M.T. Allen,2 A. Kao,3 1Department of Medicine, Lankenau Hospital, Wynnewood, PA; 2Department of Medicine, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA; 3Department of Medicine, Division of Cardiology, Mid-America Heart Institute, Kansas City, MO Background: Peak oxygen consumption (PVO2) is a powerful predictor of outcomes in heart failure (HF) patients. As PVO2 is affected by both age and gender, its applicability to younger patients and women is uncertain. Percent-predicted peak VO2 (PP-PVO2) has been studied primarily in men being evaluated for cardiac transplantation but was found to add little prognostic significance to PVO2. Thus, we examined the predictive value of PP-PVO2 in a large, diverse group of ambulatory HF patients. Methods: 594 ambulatory HF patients (mean age 52⫾12 yrs; 28% women; 21% blacks; mean LVEF 26⫾12%) underwent symptomlimited exercise tests with breath-by-breath expired gas analyses using ramped treadmill protocols. PP-PVO2 was calculated using the Was-
Purpose: To determine factors associated with non completion of outpatient cardiac rehabilitation (CR) in a population of heart failure (HF) patients. Methods: Data from HF patients (systolic or diastolic) in an academic medical center CR program were analyzed. Groups were categorized as completers (C) and non-completers (NC) based on discharge status. Reasons for non completion were categorized as medical or non-medical. Baseline characteristics were compared: age, race, gender, insurance status, employment status, left ventricular ejection fraction, cardiac risk factors, body mass index, 6 minute walk test, self-reported physical activity (total met hours), history of low physical activity, NYHA class, Beck Depression Inventory-II (BDI-II, depressive symptom score ⬎ 13), SF (short form)-36 physical and mental components. Results: Of 266 patients, C⫽130, NC⫽136. Of NC, 47% dropped out for medical reasons. NC had lower self reported physical activity (history and current), shorter 6 minute walk distance, and higher BDI-II score. In multiple logistic regression analysis, odds ratio for non completion was 2.57 (95% CI: 1.13– 6.05) for low physical activity, 2.32 (1.16 – 4.32) for BDI-II ⬎ 13, and 0.41 (0.18 – 0.94) for those with high baseline cholesterol. Conclusion: HF patients may need targeted interventions in CR that address their high-acuity needs while retaining them in therapy. This requires further prospective study. Variable Family history of CVD Smoking Hypertension High Cholesterol History of low physical activity BMI (kg/m2 mean ⫾ SD) 6 minute walk (ft mean ⫾ SD) Total met hours (hrs mean ⫾ SD) BDI-II (mean score ⫾ SD) SF 36 physical (mean score ⫾ SD) SF 36 mental (mean score ⫾ SD)
Completer 50.0% 11.5% 76.9% 83.1% 69.2% 31.2 ⫾ 7.7 1138 ⫾ 391 6.8 ⫾ 13.2 11 ⫾ 8 30.2 ⫾ 8.2 46 ⫾ 11
Non-completer 60.3% 17.7% 85.3% 73.5% 86.8% 32.8 ⫾ 8.8 994 ⫾ 354 3.3 ⫾ 9.8 15 ⫾ 10 29.5 ⫾ 9.4 44.3 ⫾ 11.5
p-value 0.09 0.16 0.08 0.06 ⬍0.01 0.12 ⬍0.01 0.02 ⬍0.01 NS NS
Abstracts
derived using Kaplan Meier analysis and compared by log rank analysis. Results: The mean age of the 272 women was 52 yrs. 75% had dilated cardiomyopathy and 25% CAD. Follow-up averaged 930 days. HFSS for the whole cohort averaged 8.56⫾1.1 and VO2 13.9⫾5.1 ml/kg/ min. The number of patients in the low (14), medium (10 –14) and high (10 ml/kg/min) risk VO2 strata were 112, 96 and 64 respectively. For the HFSS, 178 patients were low (8.1), 71 medium (8.1⫺7.19) and 23 in high risk (⬍7.19) strata. Survival curves for VO2 (p⬍0.01)and HFSS (p⬍0.001) demonstrated significant differences (see figures). Conclusion: VO2 and HFSS are excellent parameters to predict survival in women with CHF.
The Journal of Heart and Lung Transplantation February 2006
serman formula, which adjusts for gender and age effects. Cox regression analyses were performed to model the predictive value of significant variables. Results: Women had significantly lower PVO2 (14.0⫾4.9 vs 16.6⫾7.1 ml/kg/min; p⬍0.0001) but higher PP-PVO2 (54.5⫾15.9 vs 48.1⫾17.4%; p⬍0.0001) than men. We evaluated the effects of gender, age, PP-PVO2, race, LVEF, BMI, peak respiratory exchange ratio (RER), and -blocker use on transplant-free survival and found that only PP-PVO2, gender, and peak RER significantly predicted survival. Despite controlling for gender effects with PP-PVO2, female gender remains a significant predictor of survival. Cox Regression Model Variable
p Value
Odds Ratio
Confidence Interval
PP-PVO2 Gender Peak RER
⬍0.0001 ⬍0.01 ⬍0.02
0.96 0.50 8.20
0.948–0.973 0.297–0.842 1.398–48.125
Conclusion: PP-PVO2 is a powerful predictor of outcomes in ambulatory HF patients. However, despite correcting for gender, PP-PVO2 does not negate the survival benefit conferred by the female gender. Further evaluation of the utility of PP-PVO2 values in women HF patients is warranted. 284 FACTORS ASSOCIATED WITH NON-COMPLETION OF CARDIAC REHABILITATION IN HEART FAILURE PATIENTS S.V. Pamboukian,1 B. Sanderson,1 A. Lazaryan,1 V. Bittner,1 1 Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL
283 PRECENT-PREDICTED PEAK OXYGEN CONSUMPTION PREDICTS SURVIVAL IN AMBULATORY HEART FAILURE PATIENTS, BUT DOES NOT NEGATE GENDER EFFECTS ON SURVIVAL S. Elmariah,1 L.R. Goldberg,2 M.T. Allen,2 A. Kao,3 1Department of Medicine, Lankenau Hospital, Wynnewood, PA; 2Department of Medicine, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA; 3Department of Medicine, Division of Cardiology, Mid-America Heart Institute, Kansas City, MO Background: Peak oxygen consumption (PVO2) is a powerful predictor of outcomes in heart failure (HF) patients. As PVO2 is affected by both age and gender, its applicability to younger patients and women is uncertain. Percent-predicted peak VO2 (PP-PVO2) has been studied primarily in men being evaluated for cardiac transplantation but was found to add little prognostic significance to PVO2. Thus, we examined the predictive value of PP-PVO2 in a large, diverse group of ambulatory HF patients. Methods: 594 ambulatory HF patients (mean age 52⫾12 yrs; 28% women; 21% blacks; mean LVEF 26⫾12%) underwent symptomlimited exercise tests with breath-by-breath expired gas analyses using ramped treadmill protocols. PP-PVO2 was calculated using the Was-
Purpose: To determine factors associated with non completion of outpatient cardiac rehabilitation (CR) in a population of heart failure (HF) patients. Methods: Data from HF patients (systolic or diastolic) in an academic medical center CR program were analyzed. Groups were categorized as completers (C) and non-completers (NC) based on discharge status. Reasons for non completion were categorized as medical or non-medical. Baseline characteristics were compared: age, race, gender, insurance status, employment status, left ventricular ejection fraction, cardiac risk factors, body mass index, 6 minute walk test, self-reported physical activity (total met hours), history of low physical activity, NYHA class, Beck Depression Inventory-II (BDI-II, depressive symptom score ⬎ 13), SF (short form)-36 physical and mental components. Results: Of 266 patients, C⫽130, NC⫽136. Of NC, 47% dropped out for medical reasons. NC had lower self reported physical activity (history and current), shorter 6 minute walk distance, and higher BDI-II score. In multiple logistic regression analysis, odds ratio for non completion was 2.57 (95% CI: 1.13– 6.05) for low physical activity, 2.32 (1.16 – 4.32) for BDI-II ⬎ 13, and 0.41 (0.18 – 0.94) for those with high baseline cholesterol. Conclusion: HF patients may need targeted interventions in CR that address their high-acuity needs while retaining them in therapy. This requires further prospective study. Variable Family history of CVD Smoking Hypertension High Cholesterol History of low physical activity BMI (kg/m2 mean ⫾ SD) 6 minute walk (ft mean ⫾ SD) Total met hours (hrs mean ⫾ SD) BDI-II (mean score ⫾ SD) SF 36 physical (mean score ⫾ SD) SF 36 mental (mean score ⫾ SD)
Completer 50.0% 11.5% 76.9% 83.1% 69.2% 31.2 ⫾ 7.7 1138 ⫾ 391 6.8 ⫾ 13.2 11 ⫾ 8 30.2 ⫾ 8.2 46 ⫾ 11
Non-completer 60.3% 17.7% 85.3% 73.5% 86.8% 32.8 ⫾ 8.8 994 ⫾ 354 3.3 ⫾ 9.8 15 ⫾ 10 29.5 ⫾ 9.4 44.3 ⫾ 11.5
p-value 0.09 0.16 0.08 0.06 ⬍0.01 0.12 ⬍0.01 0.02 ⬍0.01 NS NS