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Long term trends of physical activity in heart failure patients
38
Journal of Cardiac Failure Vol. 4 No. 3 Suppl. 1 1998
142
141 Is C a r v e d i l o l a Safe and Efficacious Treatment Option for Patients with Severe Heart Failure Receiving Intermittent Inotropic T h e r a p y ? Charles W. Parrott, Patricia Hall, C h e r y l L. Quale, C a r d i o l o g y Associates of Mobile, P.C. Mobile, A1; D e b o r a h S Watts, S u s a n C h a m n e s s , Lois A. Deatherage, H e i d i K. Ross, D e b o r a h L. Lewis, M a r g a r e t E. B a c h m a n n , P r o v i d e n c e H o s p i t a l , Mobile, A1.
Although Carvedilol (C) is an effective treatment for patients with mild to moderate heart failure fflF), its safety and efficacy in patients with severe (NYHA III-IV) HF receiving intermittent thotropic therapy (IIT)is unclear. Therefore, we retrospectively analyzed 29 patients with severe heart failure receiving C in an outpatient IIT program. RESULTS: Four (14%) patients were withdrawn from C due to intolerance or worsening I-IF and 3 patients (10%) expired on target dose of C (2 sudden death; 1 embolic CVA). Of the remaining 22 patients (50% male; age 67 ± 8), 18 (82%) received miMnone and C, 1 (4%) dobutamine and C, and 3 (14%) had crossovers from dobutamine to miMnone during C titration. C was initiated at 3.125 mg and titrated to 25-50 mg bid over 10 ± 3.9 weeks. Ire- and Post-LVEF (0.21 ± 0.7 vs 0.39 ± .16, 17=.005)were measured on 10/22 patients. Ire- and Post-NYHA (3.4 ± .5 vs 2.1 ± .2, p=.0005). Minnesota Quality of Life scores on 17/22 patients were unchanged. Fifty percent required less frequent ]?IT(p=.01). CONCLUSIONS: C was tolerated by the majority of severe HF patients stabilized on IIT, although care is warranted in initiation and up-titration. Furthermore, utilization of C in this population may facilitate weaning of IIT.
Long Term Trends of Physical Activity in Heart Failure Patients Michael F. O'Toole, MD, R. A n d r e w R a u h , MD, A n n e B u m s , RN, N a n c y J. S c h w a b a u e r , RN, MSN, Elaine L. Eager, MS, V a s a n t P a d m a n a b h a n , PhD, K a r e n A. Stone, MS, Robert A. Corey, MS, W a l t e r H. Olson, PhD, a n d Dick M. Powell, MS, M i d w e s t H e a r t Research F o u n d a t i o n , IL a n d M e d t r o n i c Inc., MN.
Introduction: The ability to perform physical activities is not only reduced in heart failure (HF) patients but has also been shown to be a predictor of death. In order to correlate changes in activities of daily living to improvements in HF, a new external device was used to collect physical activity data from patients for a 4 month period after acute treatment for HF. Methods: An accelerometer based pacemaker (Exact device) was modified to sample the activity signals at 0.5 Hz and store an 80 second average for 7 days (ACT) in device memory (7560 values). 10 patients treated acutely for new or recent exacerbation of HF were enrolled into the study and 7 follow-ups were performed over a 4 month period. At each follow-up, the Exact device was applied to the skin at a pectoral location and ACT data collected for 7 days. ACT data were then processed to compute a measure of patient activities (ADL minutes/day). New York Heart Association functional class (FC) was assessed by the same observer at each follow-up. Results: 7/10 pts had an improvement in HF of at least la°1 u a,~,b~t~of~ a 1 FC. This corresponded to a o i~ ~u ' ~ eurFar[ure Fg[ ~1~0 mean ADL change of i i ~ ~ n ~ i n
~
+124%,greater and than was thesignificantly mean ADL change in 3/I0 pts with stable HF (-0.48%, p < 0.05). Furthermore, 3 pts who imao+~ ~ proved by at least 1 FC had 0 2 4 6 aw~ksl0 12 14 16 is an exacerbation of HF by at least I FC; the mean ADL change (-49%) was significantly lower (p < 0.05). Conclusions: Activities of daily living, measured over a 4 month period, increased in aII patients that had improvements in heart failure and decreased in all patients during exacerbations of heart failure.
143
144
Prevalence of Autoantibodies in Patients with Acute Cardiomyopathy Rene' J. Alvarez, Jr, N o r e e n Fertig, Timothy M. Wright, Dennis M. M c N a m a r a , for the IMAC Investigators, USA
L o n g T e r m Outcome of Functional Class III and IV Congestive Heart Failure Patients Treated with Intermittent Outpatient Inotropes R. A n d r e w R a u h , MD, FACC, N a n c y J. S c h w a b a u e r , RN, MS, C a t h e r i n e J. M a r t i n RN, BSN
Autoantibodies have been described in patients with myocarditis and dilated cardiomyopathies(IDCM)which may be involved in their pathogenesis. However, the presence of autoantibodies in patients with new onset IDCM has not been clearly established. The IMAC trial,is a multi-center clinical study which is evaluating the role of immanomodulatorytherapy in patients with acute IDCM. Patients must have an LVEF <40%, symptoms for
70.
=
1 10
~ •
-~ ~
o
z
0 Figure 1. Hep 2 Positivity
Patients
with
NYHA
Functional
Class (FC) III (CHF) have poor long term outcomes w i t h high m o r t a l i t y rates and frequent hospitalizations (HOSP). Outpatient intermittent inotropes (IMI) have been offered as a possible means of controlling patients with advanced CHF. The long term Outcome of patients treated with IMI is unknown. The two-year outcome of 128 consecutive patients treated with IMI was reviewed. The patient population was 65% male with mean age of 71 y e a r s and mean ejection fraction of 25.5±11.5%. Most patients had coronary artery disease (73%) with 42% having undergone revascularization. Fifty-five percent had a history of hypertension and 45% h a d diabetes mellitus. At the end of two years, 46% had expired. Seventy percent of the patients h a d one or less HOSP. Only 8% of HOSP w e r e for CHF. The mean length of stay (LOS) was 3.68 days. There was improvement in the NYHA FC. and IV c o n g e s t i v e h e a r t failure
C h a n g e in N H Y A FC
NYHA FC 2 3 4 Pre i0 77 41 Post* 70 34 17 *p<.05 post vs pre Conclusion: IMI in CHF patients improves NYHA PC, minimizes HOSP for CHF, results in short LOS, and has comparable survival rates to historical controls treated with standard therapy.
Journal of Cardiac Failure Vol. 4 No. 3 Suppl. 1 1998
142
141 Is C a r v e d i l o l a Safe and Efficacious Treatment Option for Patients with Severe Heart Failure Receiving Intermittent Inotropic T h e r a p y ? Charles W. Parrott, Patricia Hall, C h e r y l L. Quale, C a r d i o l o g y Associates of Mobile, P.C. Mobile, A1; D e b o r a h S Watts, S u s a n C h a m n e s s , Lois A. Deatherage, H e i d i K. Ross, D e b o r a h L. Lewis, M a r g a r e t E. B a c h m a n n , P r o v i d e n c e H o s p i t a l , Mobile, A1.
Although Carvedilol (C) is an effective treatment for patients with mild to moderate heart failure fflF), its safety and efficacy in patients with severe (NYHA III-IV) HF receiving intermittent thotropic therapy (IIT)is unclear. Therefore, we retrospectively analyzed 29 patients with severe heart failure receiving C in an outpatient IIT program. RESULTS: Four (14%) patients were withdrawn from C due to intolerance or worsening I-IF and 3 patients (10%) expired on target dose of C (2 sudden death; 1 embolic CVA). Of the remaining 22 patients (50% male; age 67 ± 8), 18 (82%) received miMnone and C, 1 (4%) dobutamine and C, and 3 (14%) had crossovers from dobutamine to miMnone during C titration. C was initiated at 3.125 mg and titrated to 25-50 mg bid over 10 ± 3.9 weeks. Ire- and Post-LVEF (0.21 ± 0.7 vs 0.39 ± .16, 17=.005)were measured on 10/22 patients. Ire- and Post-NYHA (3.4 ± .5 vs 2.1 ± .2, p=.0005). Minnesota Quality of Life scores on 17/22 patients were unchanged. Fifty percent required less frequent ]?IT(p=.01). CONCLUSIONS: C was tolerated by the majority of severe HF patients stabilized on IIT, although care is warranted in initiation and up-titration. Furthermore, utilization of C in this population may facilitate weaning of IIT.
Long Term Trends of Physical Activity in Heart Failure Patients Michael F. O'Toole, MD, R. A n d r e w R a u h , MD, A n n e B u m s , RN, N a n c y J. S c h w a b a u e r , RN, MSN, Elaine L. Eager, MS, V a s a n t P a d m a n a b h a n , PhD, K a r e n A. Stone, MS, Robert A. Corey, MS, W a l t e r H. Olson, PhD, a n d Dick M. Powell, MS, M i d w e s t H e a r t Research F o u n d a t i o n , IL a n d M e d t r o n i c Inc., MN.
Introduction: The ability to perform physical activities is not only reduced in heart failure (HF) patients but has also been shown to be a predictor of death. In order to correlate changes in activities of daily living to improvements in HF, a new external device was used to collect physical activity data from patients for a 4 month period after acute treatment for HF. Methods: An accelerometer based pacemaker (Exact device) was modified to sample the activity signals at 0.5 Hz and store an 80 second average for 7 days (ACT) in device memory (7560 values). 10 patients treated acutely for new or recent exacerbation of HF were enrolled into the study and 7 follow-ups were performed over a 4 month period. At each follow-up, the Exact device was applied to the skin at a pectoral location and ACT data collected for 7 days. ACT data were then processed to compute a measure of patient activities (ADL minutes/day). New York Heart Association functional class (FC) was assessed by the same observer at each follow-up. Results: 7/10 pts had an improvement in HF of at least la°1 u a,~,b~t~of~ a 1 FC. This corresponded to a o i~ ~u ' ~ eurFar[ure Fg[ ~1~0 mean ADL change of i i ~ ~ n ~ i n
~
+124%,greater and than was thesignificantly mean ADL change in 3/I0 pts with stable HF (-0.48%, p < 0.05). Furthermore, 3 pts who imao+~ ~ proved by at least 1 FC had 0 2 4 6 aw~ksl0 12 14 16 is an exacerbation of HF by at least I FC; the mean ADL change (-49%) was significantly lower (p < 0.05). Conclusions: Activities of daily living, measured over a 4 month period, increased in aII patients that had improvements in heart failure and decreased in all patients during exacerbations of heart failure.
143
144
Prevalence of Autoantibodies in Patients with Acute Cardiomyopathy Rene' J. Alvarez, Jr, N o r e e n Fertig, Timothy M. Wright, Dennis M. M c N a m a r a , for the IMAC Investigators, USA
L o n g T e r m Outcome of Functional Class III and IV Congestive Heart Failure Patients Treated with Intermittent Outpatient Inotropes R. A n d r e w R a u h , MD, FACC, N a n c y J. S c h w a b a u e r , RN, MS, C a t h e r i n e J. M a r t i n RN, BSN
Autoantibodies have been described in patients with myocarditis and dilated cardiomyopathies(IDCM)which may be involved in their pathogenesis. However, the presence of autoantibodies in patients with new onset IDCM has not been clearly established. The IMAC trial,is a multi-center clinical study which is evaluating the role of immanomodulatorytherapy in patients with acute IDCM. Patients must have an LVEF <40%, symptoms for
70.
=
1 10
~ •
-~ ~
o
z
0 Figure 1. Hep 2 Positivity
Patients
with
NYHA
Functional
Class (FC) III (CHF) have poor long term outcomes w i t h high m o r t a l i t y rates and frequent hospitalizations (HOSP). Outpatient intermittent inotropes (IMI) have been offered as a possible means of controlling patients with advanced CHF. The long term Outcome of patients treated with IMI is unknown. The two-year outcome of 128 consecutive patients treated with IMI was reviewed. The patient population was 65% male with mean age of 71 y e a r s and mean ejection fraction of 25.5±11.5%. Most patients had coronary artery disease (73%) with 42% having undergone revascularization. Fifty-five percent had a history of hypertension and 45% h a d diabetes mellitus. At the end of two years, 46% had expired. Seventy percent of the patients h a d one or less HOSP. Only 8% of HOSP w e r e for CHF. The mean length of stay (LOS) was 3.68 days. There was improvement in the NYHA FC. and IV c o n g e s t i v e h e a r t failure
C h a n g e in N H Y A FC
NYHA FC 2 3 4 Pre i0 77 41 Post* 70 34 17 *p<.05 post vs pre Conclusion: IMI in CHF patients improves NYHA PC, minimizes HOSP for CHF, results in short LOS, and has comparable survival rates to historical controls treated with standard therapy.