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Dose-Response Relationships between Exercise Intensity, Mood States, and Quality of Life in Heart Failure Patients
The 20th Annual Scientific Meeting shocking coil with only modifications to the generator. Methods: In an ongoing clinical trial named RECHARGE, n = 14 patients were tested to determine the agreement between a volume measurement using a standard RV lead and 3D Transthoracic echo (3D TTE). The RV lead was connected to a test device using only common ICD components, that recorded the 20kHz admittance of the RV lead in real-time. EDV was modulated by overdrive pacing at 10 and 50 bpm above baseline heart rate to reduce filling time, which reduces EDV. This procedure was repeated three times to help define the resolution of echo and the resolution of RV lead volume, which was reported as mean Coefficient of Variation (CV). The RV lead volume was calibrated to baseline TTE on a patient-by-patient basis, to ensure that variation in lead scarring, placement, and brand would not affect the volume calculation. Results: Concordance (CCC) and Individual (ICC) Correlation Coefficient between 3D TTE and RV lead volume measurement was calculated CCC = 0.97, and ICC = 0.96 (1 is perfect) over all EDVs in the study. Volume measurement using the unmodified lead in all patients showed a mean within-subject Coefficient of Variation (wCV) of 5.9% (0% is perfect repeatability), while the echo wCV was 10.2%. This implies that much of the error in volumes in the study is due to high echo variability, and that RV lead volumes are more reliable than echo. Conclusion: Statistics show excellent agreement between volume measurements made using a single RV shocking coil and 3D TTE, and imply that EDV can be measured with higher repeatability using RV shocking coils than echo in patients. Regardless of device brand, new device generators can be modified to implement this technology in new and existing patients with no additional surgery.
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over the recent decade. Differences between men and women and minority groups persist. African Americans have over twice the rate of hospitalization than Whites. Hispanics have a higher rate of hospitalization than Whites which is counter to the suggestion that there is a “Hispanic Paradox” in terms of lower rates of HF among Hispanics.
067 Dose-Response Relationships between Exercise Intensity, Mood States, and Quality of Life in Heart Failure Patients Lorraine S. Evangelista1, Marysol Cacciata1, Anna Stromberg1, Kathleen Dracup2; 1 University of California Irvine, Irvine, CA; 2University of California San Francisco, San Francisco, CA Background: The beneficial effects of exercise training on mood disorders and quality of life (QOL) in patients with heart failure (HF) remains controversial, with investigators documenting both positive and negative results. We conducted a secondary analysis to 1) compare changes in mood disorders, specifically anxiety, depression, hostility, and QOL among four groups of patients in a home-based exercise program who had varying degrees of change in their exercise capacity; and 2) determine whether there was an association between exercise capacity, mood disorders, and QOL. Methods: Seventy-one patients in the exercise arm of a clinical trial were divided into 4 groups based on changes in exercise capacity from baseline to 6 months: Group 1were patients with improvements >10% (n = 19); Group 2 were patients with improvements ≤10% (n = 16); Group 3 were patients with reductions ≤10% (n = 9); and Group 4 were patients with reductions >10% (n = 27). Results: Over time, patients in all four groups demonstrated significantly lower levels of depression and hostility (P < .001) and significantly higher levels of physical and overall QOL (P = .046). Group differences over time were noted in anxiety (P = .009), depression (P = .015), physical QOL (P < .001) and overall QOL (P = .002). Greater improvement in exercise capacity was strongly associated with lower depression scores (r = -.49, P = .01). Conclusions: An improvement in exercise capacity with exercise training was associated with a decrease in depression and anxiety and an increase in QOL in patients with HF. The controversial findings in prior clinical trials may be the result of variable changes in exercise capacity secondary to non-adherence or other clinical factors.
066 National Trends in Age-Adjusted Heart Failure Hospitalizations From 2002 to 2013 by Gender and Ethnicity Boback Ziaeian, Gregg C. Fonarow; UCLA, Los Angeles, CA Background: The burden of heart failure (HF) is projected to increase significantly secondly to an aging national demographic. National HF hospitalization rates have not been age-adjusted by single-year of life previously. Single year age-adjustment removes the residual bias related to differences in age distributions between gender and ethnic subgroups over time in calculating hospitalization rates. Methods: The National Inpatient Sample (NIS) was used to estimate the number of national HF hospitalizations for adults per year of life by subgroup. The NIS provides a 20% sample of nationally representative billing data to estimate hospitalization care utilization and cost data available through the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP). ICD-9 codes were used to identify a primary HF related discharge. Missing ethnicity data was imputed to account for unclassified race using multinomial logistic models in STATA 13.1. U.S. Census estimates between 2002 and 2013 were used to normalize hospitalization rates to the 2000 U.S. standard population. Crude and adjusted rates of hospitalization were calculated using the direct standardization method for national and relevant sub-groups. Results: The national ageadjusted HF hospitalization rate decreased from 526.86 to 364.66 per 100,000 between 2002 and 2013, a 30.7% decrease. The male age-adjusted HF hospitalization rate decreased from 581.69 to 431.4, a 25.8% decrease. The female age-adjusted HF hospitalization rate decreased from 486.2 to 310.99, a 36.0% decrease. The White ageadjusted HF hospitalization rate decreased from 448.29 to 315.47 a 29.65 decrease. The African American age-adjusted HF hospitalization rate decreased from 1,048.31 to 740.99, a 29.3% decrease. The Hispanic age-adjusted HF hospitalization rate decreased from 649.53 to 337.47, a 48.0% decrease. The Asian age-adjusted HF hospitalization rate decreased from 342.84 to 181.09, a 47.2% decrease. Conclusions: National age-adjusted rates of hospitalization for HF have decreased dramatically
068 Selection for Advanced Heart Failure Therapy is Associated with Better Patient Activation before Selection Sandra A. Carey1, Kyle Bass1, Kristen M. Tecson2, Megan C. Reynolds3, Aayla K. Jamil4, Catherine A. Baxter1, Joost Felius4, Ann Marie Warren1, Shelley A. Hall1; 1Baylor University Medical Center, Dallas, TX; 2Baylor Heart and Vascular Institute, Dallas, TX; 3Baylor Institute for Rehabilitation, Dallas, TX; 4Baylor Simmons Transplant Institute, Dallas, TX Introduction: The selection process for advanced heart failure therapy takes into account many factors, including the expected ability of the patient to self-manage and the requirement of a designated primary caregiver. Having the necessary information, motivation, and skills to live with a condition is captured in the concept of activation. Objective: To compare activation between patients who were selected and patients who were not selected for advanced heart failure therapy, and to determine whether patient activation was associated with anxiety, depression, and caregiver activation. Methods: Patients who were referred for advanced therapy completed the Patient Activation Measure (PAM) and the Hospital Anxiety and Depression Scale (HADS) prior to receiving a decision regarding selection for advanced therapy. Their caregivers completed a
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over the recent decade. Differences between men and women and minority groups persist. African Americans have over twice the rate of hospitalization than Whites. Hispanics have a higher rate of hospitalization than Whites which is counter to the suggestion that there is a “Hispanic Paradox” in terms of lower rates of HF among Hispanics.
067 Dose-Response Relationships between Exercise Intensity, Mood States, and Quality of Life in Heart Failure Patients Lorraine S. Evangelista1, Marysol Cacciata1, Anna Stromberg1, Kathleen Dracup2; 1 University of California Irvine, Irvine, CA; 2University of California San Francisco, San Francisco, CA Background: The beneficial effects of exercise training on mood disorders and quality of life (QOL) in patients with heart failure (HF) remains controversial, with investigators documenting both positive and negative results. We conducted a secondary analysis to 1) compare changes in mood disorders, specifically anxiety, depression, hostility, and QOL among four groups of patients in a home-based exercise program who had varying degrees of change in their exercise capacity; and 2) determine whether there was an association between exercise capacity, mood disorders, and QOL. Methods: Seventy-one patients in the exercise arm of a clinical trial were divided into 4 groups based on changes in exercise capacity from baseline to 6 months: Group 1were patients with improvements >10% (n = 19); Group 2 were patients with improvements ≤10% (n = 16); Group 3 were patients with reductions ≤10% (n = 9); and Group 4 were patients with reductions >10% (n = 27). Results: Over time, patients in all four groups demonstrated significantly lower levels of depression and hostility (P < .001) and significantly higher levels of physical and overall QOL (P = .046). Group differences over time were noted in anxiety (P = .009), depression (P = .015), physical QOL (P < .001) and overall QOL (P = .002). Greater improvement in exercise capacity was strongly associated with lower depression scores (r = -.49, P = .01). Conclusions: An improvement in exercise capacity with exercise training was associated with a decrease in depression and anxiety and an increase in QOL in patients with HF. The controversial findings in prior clinical trials may be the result of variable changes in exercise capacity secondary to non-adherence or other clinical factors.
066 National Trends in Age-Adjusted Heart Failure Hospitalizations From 2002 to 2013 by Gender and Ethnicity Boback Ziaeian, Gregg C. Fonarow; UCLA, Los Angeles, CA Background: The burden of heart failure (HF) is projected to increase significantly secondly to an aging national demographic. National HF hospitalization rates have not been age-adjusted by single-year of life previously. Single year age-adjustment removes the residual bias related to differences in age distributions between gender and ethnic subgroups over time in calculating hospitalization rates. Methods: The National Inpatient Sample (NIS) was used to estimate the number of national HF hospitalizations for adults per year of life by subgroup. The NIS provides a 20% sample of nationally representative billing data to estimate hospitalization care utilization and cost data available through the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP). ICD-9 codes were used to identify a primary HF related discharge. Missing ethnicity data was imputed to account for unclassified race using multinomial logistic models in STATA 13.1. U.S. Census estimates between 2002 and 2013 were used to normalize hospitalization rates to the 2000 U.S. standard population. Crude and adjusted rates of hospitalization were calculated using the direct standardization method for national and relevant sub-groups. Results: The national ageadjusted HF hospitalization rate decreased from 526.86 to 364.66 per 100,000 between 2002 and 2013, a 30.7% decrease. The male age-adjusted HF hospitalization rate decreased from 581.69 to 431.4, a 25.8% decrease. The female age-adjusted HF hospitalization rate decreased from 486.2 to 310.99, a 36.0% decrease. The White ageadjusted HF hospitalization rate decreased from 448.29 to 315.47 a 29.65 decrease. The African American age-adjusted HF hospitalization rate decreased from 1,048.31 to 740.99, a 29.3% decrease. The Hispanic age-adjusted HF hospitalization rate decreased from 649.53 to 337.47, a 48.0% decrease. The Asian age-adjusted HF hospitalization rate decreased from 342.84 to 181.09, a 47.2% decrease. Conclusions: National age-adjusted rates of hospitalization for HF have decreased dramatically
068 Selection for Advanced Heart Failure Therapy is Associated with Better Patient Activation before Selection Sandra A. Carey1, Kyle Bass1, Kristen M. Tecson2, Megan C. Reynolds3, Aayla K. Jamil4, Catherine A. Baxter1, Joost Felius4, Ann Marie Warren1, Shelley A. Hall1; 1Baylor University Medical Center, Dallas, TX; 2Baylor Heart and Vascular Institute, Dallas, TX; 3Baylor Institute for Rehabilitation, Dallas, TX; 4Baylor Simmons Transplant Institute, Dallas, TX Introduction: The selection process for advanced heart failure therapy takes into account many factors, including the expected ability of the patient to self-manage and the requirement of a designated primary caregiver. Having the necessary information, motivation, and skills to live with a condition is captured in the concept of activation. Objective: To compare activation between patients who were selected and patients who were not selected for advanced heart failure therapy, and to determine whether patient activation was associated with anxiety, depression, and caregiver activation. Methods: Patients who were referred for advanced therapy completed the Patient Activation Measure (PAM) and the Hospital Anxiety and Depression Scale (HADS) prior to receiving a decision regarding selection for advanced therapy. Their caregivers completed a