- Email: [email protected]
FACTORS PROTECTING OR FAVOURING FEAR IN CARDIAC HEART FAILURE PATIENTS
Oral Communications / European Journal of Internal Medicine 19S (2008) (2008), S1–S59 In univariate analysis for the identification of predictors of adverse outcome after discharge we found a significant higher hazard of death or re-hospitalization for patients with higher levels of thoracic fluid content (on the third tertile in comparison to the first) (HR 3.36; 95% CI, 1.75 to 6.46, p<0.001) and for patients with chronic HF vs patients with new-onset HF, number of previous hospital admissions due to HF, coronary heart disease, diabetes mellitus, systolic and diastolic blood pressure at admission and values of hemoglobin, albumin, B-type natriuretic peptide (BNP) and C reactive protein at admission and discharge, and cholesterol levels at discharge. Taking into account the effect of other prognostic factors that are associated with higher thoracic fluid content, in multivariate analysis, TFC maintained prognostic value (HR 3.26 CI 95% 1.50 to 6.70, p=0.001) independently of number of hospital admissions, new-onset vs chronic HF or BNP at discharge. Conclusions: The results suggest that thoracic fluid content evaluated by impedance cardiography allows the identification of patients at higher risk of adverse events and might help clinicians in planning discharge of HF patients.
FR-17 THE METABOLIC SYNDROME (METS) IN SYMPTOMATIC HEART FAILURE: PREVALENCE AND CLINICAL ASPECTS Daniela Toporan, Cristina Tanaseanu, Marius Vintila. "St. Pantelimon" Emergency Hospital, Clinic of Internal medicine and Cardiology, Bucharest, Romania Background: The association of MetS’ components in chronic heart failure (HF) elderly patients and its clinical significance has not been yet clearly established. Objective: To analyze the prevalence of MetS (diagnosed according to National Cholesterol Education Program Adult Treatment Panel III – NCEP ATP III criteria and, respectively, International Diabetes Federation – IDF criteria) in patients with symptomatic heart failure; to correlate the presence of the metabolic risk factors with the type and severity of left ventricular dysfunction. Methods: We studied the impact of MetS on 630 patients, aged >65 yrs (mean age 75 yrs), women 65%, admitted to our hospital with clinical syndrome of HF. 52% of patients had class IV NYHA (New York Heart Association) HF, 21% had class III, 15% met class II and 12% class I. All patients underwent a measurement of ejection fraction (EF) by the quantitative 2D (biplane Simpson) method and a Doppler examination of mitral inflow for a complete, systolic and diastolic, left ventricular function (LVF) evaluation. An EF >50% defined a preserved systolic LVF. HF had, as underlying disease, 51% coronary artery disease, 12% valve disease, 8% dilated cardiomiopathy and 29% arterial hypertension. The patients in atrial fibrillation and flutter were excluded. Student’s t and chi-square tests were used for statistical analyzed. Results: The prevalence of the MetS was 27,2% (171 cases) by classical ATP III criteria and 34,1% (215 patients) by applying IDF criteria (subjects are required to have central obesity – waist circumference >94 cm for males and >80 cm for females plus any two of the following: triglyceride level >150 mg/dl, HDL-cholesterol level <40 mg/dl for males and <50 mg/dl for females, blood pressure >130/80 mm Hg and blood glucose level >100 mg/dl). About 16% of cases with MetS (including 2 or 3 components)had HF class I and II NYHA,with preserved EF and diastolic dysfunction. 180 patients (84%) with MetS (including 4 or 5 components) were older, more often women, in more severe NYHA class (III and IV), with systolic (LVEF <40%) and diastolic dysfunction. Compare with patients in HF without MetS, cases with MetS had more frequently both coronary heart disease and hypertension, longer duration of diabetes, use of insulin, severe mixed dyslipidemia and higher creatinin level. The hospitalization was longer for these patients, with more ischemic heart events and with a slower regression of HF symptoms and signs under maximal conventional treatment. Conclusions: The prevalence of MetS in elderly with HF is higher according to the new IDF recommendations (approximately one third -34,1%, respect of one quarter –27,2% according to ATP III criteria). The presence of few components of MetS is associated with a stable clinical HF and with an echocardio-graphic LV diastolic dysfunction. The cluster of more metabolic risk factors encompasses by the MetS in one case seems to be a heavy burner on patients in HF, given the high risk for development a severe LV systolic and diastolic dysfunction and a more complicate evolution. Enhancing knowledge about the clinical importance of MetS is a priority future research. At present, an aggressive and uncompromising approach and management of MetS is require in order to avoid the high risk for progression to a severe form of HF
S33
FR-18 FACTORS PROTECTING OR FAVOURING FEAR IN CARDIAC HEART FAILURE PATIENTS I. Quiles, M. Diaz, R. Alfaro, P. Llorens, P. Wikman, J.M. Segui, A. Martinez Baltanas, P. Safont, J Merino. Emergency Unit, Alicante General Hospital, Internal Medicine Department, San Juan University Hospital, Alicante, Italy Introduction: Diseases could trigger fears provide they induced organic and psychological changes in the way of living and alter life expectancies. In this work we try to define the factors favouring or protecting cardiac heart failure patients (CHF) of suffering of fears. Methods: Descriptive study in which for evaluating fears we use a modification of P. Arranz questionnaire. The forms have been filled by a random sample of CHF patients (all of which accomplished Framingham criteria), willing to participate and admitted in the Internal Medicine wards of our hospital through the two first terms of 2007. We study 34 different factors, all probably related with fear in these patients. Statistical analysis was the percentage of each factor in the sample, and then Odds ratio was calculated with a bi variable and multivariable analysis. Results: We included 42 patients, mean age 73,6+_14,5 years, 54,8% of which were women, Many factors seem to be related in the bi variate analysis but lost their effect in the multivariate analysis (MA).The final findings were: Favouring the appearance of fears: a) unwilling loneliness: pain scale values (OR 1, 44 p< 0.03), to have dead brothers (14,2, p=0,04); b) having an incurable disease: number of children (OR 1,34, p=0,04); c) of being judged: presence of anxiety (OR 8,57 p > 0,05); d) of organic pain: being male (OR 4,9, p=0,02); e) of possible psychological adverse effects of used drugs, (OR 3,67 p=0,05); f) of possible organic adverse effects with the drugs used: number of drugs (OR 0,74 p=0,05); g) of the impossibility of being cared by their family: number of brothers (OR 1,69 p=0,01), number or previous admissions (OR 0,6 p=0,05) and the presence of anxiety (OR 16,3 p=0,004); h) the need to be institutionalized: to be male (OR 8,59 p= 0,02), Protecting for the appearance of fears: a) of loose of self control: to be practising catholic (OR 0,04, p0 0,02) and to be under benzodiacepine treatment (OR 0,029, 0= 0,0004); and b) of the possibility to suffer sanitary errors: to be practising catholic (0R 0,2 p=0,03). Comments: We find very few modifiable factors able to protect against fears
FR-19 BIOELECTRICAL IMPEDANCE ANALYSIS FOR PREDICTION OF HOSPITAL ADMISSION DUE TO CARDIAC DECOMPENSATION IN AMBULATORY HEART FAILURE: A FOLLOW-UP STUDY Daniele Torres, Gaspare Parrinello, Salvatore Paterna, Pietro Di Pasquale, Manuela Mezzero, Antonio Fatta, Karin Trapanese, Alessia Torres, Giuseppe Licata. Heart Failure Center, Department of Internal and Specialistic Medicine, University of Palermo, Italy Background: During the progression of heart failure (HF), phases of chronic compensation and acute decompensation are characterized by fluid accumulation. It is not always apparent, becoming evident only when the symptoms/signs are manifest. We evaluate the predictive value of WholeBody (WB) and Segmental (Seg) Bioelectrical Impedance Analysis (BIA), useful in hydration status evaluation, for hospital admission due to cardiac decompensation in ambulatory HF. Methods and Results: 62 patients (67.1±8.1 yr, 32 F) with %, NYHA class 2,4) referred to our Heart Failure Centre??compensated HF (LVEF 36 and followed-up for a median of 522 days. 25 healthy subjects were controls. Clinical data, BIA measurements (Resistance R, Reactance Xc) using BIA-101 pletismograph (Akern Srl) were taken at recruitment and at intervals of about 45 days. The end point was hospitalization due to cardiac decompensation. At the end of the study an expert team blinded to BIA parameters, subdivided the subjects into two groups (A group 42 stable patients; B group 14 hospitalized patients) estimating the predictive accuracy of BIA. Hospitalized patients had a statistically significant reduction (p<0,001) of bioelectrical data before hospitalization (A: Seg R 60,5±8,6, Seg Xc 5,2±3,7, Seg PA 0,43±0,05, WB R 512.7+56.8, WB Xc 44,3±5,8,; B: Seg R 40,2±7,7 Seg Xc 3,1±2,9 Seg PA 0,23±0,02 WB R 438.1+53.4 WB Xc 34±8,7 Ohm) and significantly lower LV ejection fraction and serum sodium level, higher C-reactive protein and a reduced compliance to medical recommendations. In a multivariate analysis BIA was the most significant independent predictor for hospitalization (p=.012). Conclusion: BIA is low-cost, easy, non-invasive, rapid method to predict hospital admission due to HF exacerbation among ambulatory patients. It may be prospectively a useful tool in monitoring HF: the earlier evaluation of
FR-17 THE METABOLIC SYNDROME (METS) IN SYMPTOMATIC HEART FAILURE: PREVALENCE AND CLINICAL ASPECTS Daniela Toporan, Cristina Tanaseanu, Marius Vintila. "St. Pantelimon" Emergency Hospital, Clinic of Internal medicine and Cardiology, Bucharest, Romania Background: The association of MetS’ components in chronic heart failure (HF) elderly patients and its clinical significance has not been yet clearly established. Objective: To analyze the prevalence of MetS (diagnosed according to National Cholesterol Education Program Adult Treatment Panel III – NCEP ATP III criteria and, respectively, International Diabetes Federation – IDF criteria) in patients with symptomatic heart failure; to correlate the presence of the metabolic risk factors with the type and severity of left ventricular dysfunction. Methods: We studied the impact of MetS on 630 patients, aged >65 yrs (mean age 75 yrs), women 65%, admitted to our hospital with clinical syndrome of HF. 52% of patients had class IV NYHA (New York Heart Association) HF, 21% had class III, 15% met class II and 12% class I. All patients underwent a measurement of ejection fraction (EF) by the quantitative 2D (biplane Simpson) method and a Doppler examination of mitral inflow for a complete, systolic and diastolic, left ventricular function (LVF) evaluation. An EF >50% defined a preserved systolic LVF. HF had, as underlying disease, 51% coronary artery disease, 12% valve disease, 8% dilated cardiomiopathy and 29% arterial hypertension. The patients in atrial fibrillation and flutter were excluded. Student’s t and chi-square tests were used for statistical analyzed. Results: The prevalence of the MetS was 27,2% (171 cases) by classical ATP III criteria and 34,1% (215 patients) by applying IDF criteria (subjects are required to have central obesity – waist circumference >94 cm for males and >80 cm for females plus any two of the following: triglyceride level >150 mg/dl, HDL-cholesterol level <40 mg/dl for males and <50 mg/dl for females, blood pressure >130/80 mm Hg and blood glucose level >100 mg/dl). About 16% of cases with MetS (including 2 or 3 components)had HF class I and II NYHA,with preserved EF and diastolic dysfunction. 180 patients (84%) with MetS (including 4 or 5 components) were older, more often women, in more severe NYHA class (III and IV), with systolic (LVEF <40%) and diastolic dysfunction. Compare with patients in HF without MetS, cases with MetS had more frequently both coronary heart disease and hypertension, longer duration of diabetes, use of insulin, severe mixed dyslipidemia and higher creatinin level. The hospitalization was longer for these patients, with more ischemic heart events and with a slower regression of HF symptoms and signs under maximal conventional treatment. Conclusions: The prevalence of MetS in elderly with HF is higher according to the new IDF recommendations (approximately one third -34,1%, respect of one quarter –27,2% according to ATP III criteria). The presence of few components of MetS is associated with a stable clinical HF and with an echocardio-graphic LV diastolic dysfunction. The cluster of more metabolic risk factors encompasses by the MetS in one case seems to be a heavy burner on patients in HF, given the high risk for development a severe LV systolic and diastolic dysfunction and a more complicate evolution. Enhancing knowledge about the clinical importance of MetS is a priority future research. At present, an aggressive and uncompromising approach and management of MetS is require in order to avoid the high risk for progression to a severe form of HF
S33
FR-18 FACTORS PROTECTING OR FAVOURING FEAR IN CARDIAC HEART FAILURE PATIENTS I. Quiles, M. Diaz, R. Alfaro, P. Llorens, P. Wikman, J.M. Segui, A. Martinez Baltanas, P. Safont, J Merino. Emergency Unit, Alicante General Hospital, Internal Medicine Department, San Juan University Hospital, Alicante, Italy Introduction: Diseases could trigger fears provide they induced organic and psychological changes in the way of living and alter life expectancies. In this work we try to define the factors favouring or protecting cardiac heart failure patients (CHF) of suffering of fears. Methods: Descriptive study in which for evaluating fears we use a modification of P. Arranz questionnaire. The forms have been filled by a random sample of CHF patients (all of which accomplished Framingham criteria), willing to participate and admitted in the Internal Medicine wards of our hospital through the two first terms of 2007. We study 34 different factors, all probably related with fear in these patients. Statistical analysis was the percentage of each factor in the sample, and then Odds ratio was calculated with a bi variable and multivariable analysis. Results: We included 42 patients, mean age 73,6+_14,5 years, 54,8% of which were women, Many factors seem to be related in the bi variate analysis but lost their effect in the multivariate analysis (MA).The final findings were: Favouring the appearance of fears: a) unwilling loneliness: pain scale values (OR 1, 44 p< 0.03), to have dead brothers (14,2, p=0,04); b) having an incurable disease: number of children (OR 1,34, p=0,04); c) of being judged: presence of anxiety (OR 8,57 p > 0,05); d) of organic pain: being male (OR 4,9, p=0,02); e) of possible psychological adverse effects of used drugs, (OR 3,67 p=0,05); f) of possible organic adverse effects with the drugs used: number of drugs (OR 0,74 p=0,05); g) of the impossibility of being cared by their family: number of brothers (OR 1,69 p=0,01), number or previous admissions (OR 0,6 p=0,05) and the presence of anxiety (OR 16,3 p=0,004); h) the need to be institutionalized: to be male (OR 8,59 p= 0,02), Protecting for the appearance of fears: a) of loose of self control: to be practising catholic (OR 0,04, p0 0,02) and to be under benzodiacepine treatment (OR 0,029, 0= 0,0004); and b) of the possibility to suffer sanitary errors: to be practising catholic (0R 0,2 p=0,03). Comments: We find very few modifiable factors able to protect against fears
FR-19 BIOELECTRICAL IMPEDANCE ANALYSIS FOR PREDICTION OF HOSPITAL ADMISSION DUE TO CARDIAC DECOMPENSATION IN AMBULATORY HEART FAILURE: A FOLLOW-UP STUDY Daniele Torres, Gaspare Parrinello, Salvatore Paterna, Pietro Di Pasquale, Manuela Mezzero, Antonio Fatta, Karin Trapanese, Alessia Torres, Giuseppe Licata. Heart Failure Center, Department of Internal and Specialistic Medicine, University of Palermo, Italy Background: During the progression of heart failure (HF), phases of chronic compensation and acute decompensation are characterized by fluid accumulation. It is not always apparent, becoming evident only when the symptoms/signs are manifest. We evaluate the predictive value of WholeBody (WB) and Segmental (Seg) Bioelectrical Impedance Analysis (BIA), useful in hydration status evaluation, for hospital admission due to cardiac decompensation in ambulatory HF. Methods and Results: 62 patients (67.1±8.1 yr, 32 F) with %, NYHA class 2,4) referred to our Heart Failure Centre??compensated HF (LVEF 36 and followed-up for a median of 522 days. 25 healthy subjects were controls. Clinical data, BIA measurements (Resistance R, Reactance Xc) using BIA-101 pletismograph (Akern Srl) were taken at recruitment and at intervals of about 45 days. The end point was hospitalization due to cardiac decompensation. At the end of the study an expert team blinded to BIA parameters, subdivided the subjects into two groups (A group 42 stable patients; B group 14 hospitalized patients) estimating the predictive accuracy of BIA. Hospitalized patients had a statistically significant reduction (p<0,001) of bioelectrical data before hospitalization (A: Seg R 60,5±8,6, Seg Xc 5,2±3,7, Seg PA 0,43±0,05, WB R 512.7+56.8, WB Xc 44,3±5,8,; B: Seg R 40,2±7,7 Seg Xc 3,1±2,9 Seg PA 0,23±0,02 WB R 438.1+53.4 WB Xc 34±8,7 Ohm) and significantly lower LV ejection fraction and serum sodium level, higher C-reactive protein and a reduced compliance to medical recommendations. In a multivariate analysis BIA was the most significant independent predictor for hospitalization (p=.012). Conclusion: BIA is low-cost, easy, non-invasive, rapid method to predict hospital admission due to HF exacerbation among ambulatory patients. It may be prospectively a useful tool in monitoring HF: the earlier evaluation of