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Immoderate Reduction in Blood Pressure May be Associated with Reduced Survival in Non-Hypertensive Patients with Chronic Heart Failure
S182 Journal of Cardiac Failure Vol. 12 No. 8 Suppl. 2006 1100
1102
Immoderate Reduction in Blood Pressure May be Associated with Reduced Survival in Non-Hypertensive Patients with Chronic Heart Failure NOBUYUKI SHIBA, MIKA MATSUKI, JUN TAKAHASHI, JUN WATANABE, YUTAKA KAGAYA, HIROAKI SHIMOKAWA Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
The Influence of NYHA Class on the Cost Under DPC System TAKAYUKI MATSUKI Shin-Nittetsu Muroran General Hospital, Muroran, Hokkaido, Japan
Background: Several studies suggested that reduced blood pressure (BP) might be associated with the reduction in survival of patients with chronic heart failure (CHF). This study was designed to clarify the relationship between BP and the prognosis of CHF patients. Methods: Study population was 836 patients with stage-C/D CHF and BP was collected at the entry. We performed Kaplan-Meier (KM) analysis and Cox regression analysis adjusted by age, etiology of CHF, and medication for CHF to evaluate the association between systolic BP (sBP) and the all-cause mortality. Results: The mean age of the study population was 69.3613.0 years and the mean follow-up period was 3.261.7 years. First, we conducted KM analysis including the total population, which suggested that CHF patients with lower sBP at the entry showed the higher incidence of the all-cause mortality. Second, we performed multivariate Cox analysis, which showed that higher sBP at the entry was significantly associated with the longer survival in CHF patients without hypertension (Hazard Ratio 0.984; 95% CI 0.972-0.996), however, it was not the case in patients with hypertension (0.974; 0.983-1.005). Conclusions: These results suggest that immoderate reduction in BP may be associated with reduced survival in non-hypertensive patients with CHF. Further investigation is necessary to determine the optimum goal of BP to improve the survival of those patients.
1101 Prognosis of the Heart Failure with Preserved Systolic Function does not Differ from the Heart Failure with Systolic Dysfunction UCHINO KAZUAKI1, TOMOAKI ISHIGAMI1, KENJI OSHIGE2, ICHIRO NAKAZAWA1, HIDEYUKI OGAWA1, TERUYASU SUGANO1, YOHEI YAMAKAWA1, TOSHIYUKI ISHIKAWA1, KAZUO KIMURA1, SATOSHI UMEMURA1 1 Department of Medical Science and Cardiorenal Medicine, 2Ubiquitous Preventive Medicine Background: It is unclear whether the prognosis of heart failure with preserved systolic function (HPS) is better than the heart failure with systolic dysfunction (HSD). Because, study reports about the prognosis of HPS are inconsistent. This study was performed to clarify the prognosis of HPS. Methods: First hospitalized heart failure patients at Yokohama City University Hospital from the year 2000 to 2003 were studied. Heart failure with left ventricular ejection fraction (LVEF) more than 50 % was classified as HPS. LVEF less than 35 % was classified as HSD. LVEF between 35 to 50 % were excluded. Cardiovascular events and death after discharge were surveyed. Results: Kaplan-Meier survival curve following Log Rank test failed to demonstrate the significant prognostic difference between the two groups. Conclusions: Prognosis of HPS did not differ from the prognosis of HSD.
Background: Diagnosis Procedure Combination system (DPC system) is a Japanese original "Insurance Payment" trial system. It consists of "Hospital fee" and "Procedure fee" (as a Doctor fee). So far, there is no report regarding the influence of severity of heart failure on the cost under DPC system. Purpose: The purpose of this study was to evaluate the influence of severity of heart failure according to NYHA class on the cost under DPC system. Method: One hundred sixty-nine patients in 12 hospitals were divided into four groups according to NYHA class. The cost for the treatment per one admission was evaluated. Result: The average cost for the patients with NYHA class 1 symptoms (n549) was 337439 yen and those for the patients of NYHA class 2 symptoms (n552), NYHA class 3 symptoms (n542), NYHA class 4 symptoms (n526) were 436467, 390327, 481538 yen, respectively. While the average cost was gradually increased according to the severity of heart failure, there was no significant difference among those groups. Conclusion: The severity of heart failure did not influence the cost under DPC system.
1103 Relationship Between Performance Measure for Activities of Daily Living (PMADL) and Muscle Strength in Patients with Chronic Heart Failure (CHF) YUKO SHIMIZU1, SUMIO YAMADA1, MAKOTO SUZUKI2, KOTARO IWATSU1, HIROKO MIYOSHI1, HIDEO IZAWA3, TOYOAKI MUROHARA3 1 Program in Physical and Occupational Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan, 2Department of Rehabilitation Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan, 3Department of Integrated Molecular Medicine, Graduate School of Medicine, Nagoya University, Nagoya, Japan Purpose: The disability in daily activities in CHF patients reflects weakening in skeletal muscle strength. This study aimed to research the relationship between the scores in PMADL items which was developed as performance measure in daily activities and skeletal muscle strength. Methods: Forty-five outpatients (58.5613.3 years of age, mean6SD) at Nagoya University Hospital were enrolled in this study. Twenty items in PMADL for CHF patients were selected from basic 55 ADL items by principle component analysis. Each of 20 item has the rating of 4 (very easy) to 1 (very difficult). PMADL was taken by personal interview and grip and isometric knee extension strength measured by grip dynamometer and by hand held dynamometer. Spearman rank method was computed. Results: Correlations ranged from 0.06 to 0.68 between all the items. The grip strength moderately or highly correlated with 5 items of PMADL (r50.58 to 0.68; p!0.01), knee strength with 8 items (r50.54 to 0.66; p!0.01), and grip and knee strength with 4 items. Little correlation was found with 8 items. Conclusion: The findings in this study will contribute clinical usage of the PMADL to assess one’s real performance in activity of daily living in CHF patients.
1104 Effect of Cycle Ergometer Training on Peripheral Muscle Oxygen Uptake for Patients with LVAS YUSUKE HANAFUSA1, SHIGERU MAKITA1, TOSHIYUKI TAKAGI1, SHUNEI KYO2 1 Department of Rehabilitation Medicine, Saitama Medical University Hospital, 2 Department of Cardiovascular Surgery, Saitama Medical University Hospital Purpose: The left ventricular assist system (LVAS) has been used as severe heart failure treatment. That pump output does not increase according to exercise intensity, but it is experienced that exercise capacities of those patients are improved by exercise training. Therefore, in this study, we analyzed oxygen uptake of peripheral muscle before and after training for patients with LVAS. Method: The subjects were 6 patients with LVAS (aged 39.7 yr, 4 males and 2 females). The average training period was 3.3 months. Before and after the training, cardiopulmonary exercise test (CPX) was performed for determination of peakVO2 and aerobic threshold (AT). The change in total hemoglobin (delta (d) cHb) and tissue oxygen index (dTOI) in rectus femoris was measured by Near-infrared spectroscopy. Cycle ergometer training was carried out 3 times weekly for 30 min at the intensity of AT. Result: AT, peakVO2 showed the significant increase after training, respectively (p!0.05). dTOI showed the significant decrease at AT after training (p!0.05), but
1102
Immoderate Reduction in Blood Pressure May be Associated with Reduced Survival in Non-Hypertensive Patients with Chronic Heart Failure NOBUYUKI SHIBA, MIKA MATSUKI, JUN TAKAHASHI, JUN WATANABE, YUTAKA KAGAYA, HIROAKI SHIMOKAWA Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
The Influence of NYHA Class on the Cost Under DPC System TAKAYUKI MATSUKI Shin-Nittetsu Muroran General Hospital, Muroran, Hokkaido, Japan
Background: Several studies suggested that reduced blood pressure (BP) might be associated with the reduction in survival of patients with chronic heart failure (CHF). This study was designed to clarify the relationship between BP and the prognosis of CHF patients. Methods: Study population was 836 patients with stage-C/D CHF and BP was collected at the entry. We performed Kaplan-Meier (KM) analysis and Cox regression analysis adjusted by age, etiology of CHF, and medication for CHF to evaluate the association between systolic BP (sBP) and the all-cause mortality. Results: The mean age of the study population was 69.3613.0 years and the mean follow-up period was 3.261.7 years. First, we conducted KM analysis including the total population, which suggested that CHF patients with lower sBP at the entry showed the higher incidence of the all-cause mortality. Second, we performed multivariate Cox analysis, which showed that higher sBP at the entry was significantly associated with the longer survival in CHF patients without hypertension (Hazard Ratio 0.984; 95% CI 0.972-0.996), however, it was not the case in patients with hypertension (0.974; 0.983-1.005). Conclusions: These results suggest that immoderate reduction in BP may be associated with reduced survival in non-hypertensive patients with CHF. Further investigation is necessary to determine the optimum goal of BP to improve the survival of those patients.
1101 Prognosis of the Heart Failure with Preserved Systolic Function does not Differ from the Heart Failure with Systolic Dysfunction UCHINO KAZUAKI1, TOMOAKI ISHIGAMI1, KENJI OSHIGE2, ICHIRO NAKAZAWA1, HIDEYUKI OGAWA1, TERUYASU SUGANO1, YOHEI YAMAKAWA1, TOSHIYUKI ISHIKAWA1, KAZUO KIMURA1, SATOSHI UMEMURA1 1 Department of Medical Science and Cardiorenal Medicine, 2Ubiquitous Preventive Medicine Background: It is unclear whether the prognosis of heart failure with preserved systolic function (HPS) is better than the heart failure with systolic dysfunction (HSD). Because, study reports about the prognosis of HPS are inconsistent. This study was performed to clarify the prognosis of HPS. Methods: First hospitalized heart failure patients at Yokohama City University Hospital from the year 2000 to 2003 were studied. Heart failure with left ventricular ejection fraction (LVEF) more than 50 % was classified as HPS. LVEF less than 35 % was classified as HSD. LVEF between 35 to 50 % were excluded. Cardiovascular events and death after discharge were surveyed. Results: Kaplan-Meier survival curve following Log Rank test failed to demonstrate the significant prognostic difference between the two groups. Conclusions: Prognosis of HPS did not differ from the prognosis of HSD.
Background: Diagnosis Procedure Combination system (DPC system) is a Japanese original "Insurance Payment" trial system. It consists of "Hospital fee" and "Procedure fee" (as a Doctor fee). So far, there is no report regarding the influence of severity of heart failure on the cost under DPC system. Purpose: The purpose of this study was to evaluate the influence of severity of heart failure according to NYHA class on the cost under DPC system. Method: One hundred sixty-nine patients in 12 hospitals were divided into four groups according to NYHA class. The cost for the treatment per one admission was evaluated. Result: The average cost for the patients with NYHA class 1 symptoms (n549) was 337439 yen and those for the patients of NYHA class 2 symptoms (n552), NYHA class 3 symptoms (n542), NYHA class 4 symptoms (n526) were 436467, 390327, 481538 yen, respectively. While the average cost was gradually increased according to the severity of heart failure, there was no significant difference among those groups. Conclusion: The severity of heart failure did not influence the cost under DPC system.
1103 Relationship Between Performance Measure for Activities of Daily Living (PMADL) and Muscle Strength in Patients with Chronic Heart Failure (CHF) YUKO SHIMIZU1, SUMIO YAMADA1, MAKOTO SUZUKI2, KOTARO IWATSU1, HIROKO MIYOSHI1, HIDEO IZAWA3, TOYOAKI MUROHARA3 1 Program in Physical and Occupational Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan, 2Department of Rehabilitation Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan, 3Department of Integrated Molecular Medicine, Graduate School of Medicine, Nagoya University, Nagoya, Japan Purpose: The disability in daily activities in CHF patients reflects weakening in skeletal muscle strength. This study aimed to research the relationship between the scores in PMADL items which was developed as performance measure in daily activities and skeletal muscle strength. Methods: Forty-five outpatients (58.5613.3 years of age, mean6SD) at Nagoya University Hospital were enrolled in this study. Twenty items in PMADL for CHF patients were selected from basic 55 ADL items by principle component analysis. Each of 20 item has the rating of 4 (very easy) to 1 (very difficult). PMADL was taken by personal interview and grip and isometric knee extension strength measured by grip dynamometer and by hand held dynamometer. Spearman rank method was computed. Results: Correlations ranged from 0.06 to 0.68 between all the items. The grip strength moderately or highly correlated with 5 items of PMADL (r50.58 to 0.68; p!0.01), knee strength with 8 items (r50.54 to 0.66; p!0.01), and grip and knee strength with 4 items. Little correlation was found with 8 items. Conclusion: The findings in this study will contribute clinical usage of the PMADL to assess one’s real performance in activity of daily living in CHF patients.
1104 Effect of Cycle Ergometer Training on Peripheral Muscle Oxygen Uptake for Patients with LVAS YUSUKE HANAFUSA1, SHIGERU MAKITA1, TOSHIYUKI TAKAGI1, SHUNEI KYO2 1 Department of Rehabilitation Medicine, Saitama Medical University Hospital, 2 Department of Cardiovascular Surgery, Saitama Medical University Hospital Purpose: The left ventricular assist system (LVAS) has been used as severe heart failure treatment. That pump output does not increase according to exercise intensity, but it is experienced that exercise capacities of those patients are improved by exercise training. Therefore, in this study, we analyzed oxygen uptake of peripheral muscle before and after training for patients with LVAS. Method: The subjects were 6 patients with LVAS (aged 39.7 yr, 4 males and 2 females). The average training period was 3.3 months. Before and after the training, cardiopulmonary exercise test (CPX) was performed for determination of peakVO2 and aerobic threshold (AT). The change in total hemoglobin (delta (d) cHb) and tissue oxygen index (dTOI) in rectus femoris was measured by Near-infrared spectroscopy. Cycle ergometer training was carried out 3 times weekly for 30 min at the intensity of AT. Result: AT, peakVO2 showed the significant increase after training, respectively (p!0.05). dTOI showed the significant decrease at AT after training (p!0.05), but