Predictors of Cardiac-Specific Quality of Life among Patients with Heart Failure: Effects of Psychosocial Variables

Predictors of Cardiac-Specific Quality of Life among Patients with Heart Failure: Effects of Psychosocial Variables

The 9th Annual Scientific Meeting • HFSA S177 326 328 Brain Natriuretic Peptide Is a Predictor of Thirty Day Hospital Admission in Patients Enro...

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The 9th Annual Scientific Meeting



HFSA

S177

326

328

Brain Natriuretic Peptide Is a Predictor of Thirty Day Hospital Admission in Patients Enrolled in a Collaborative Care Heart Failure Treatment Program Miguel Gambetta1, Dawn Nelson1, Patrick Dunn1, Ross Arena2; 1Heart Center, Community Hospital, Munster, IN; 2Departments of Physical Therapy and Physiology, Virginia Commonwealth University, Richmond, VA

Total Bilirrubin Can Predict Long Term Survival in Patients with Dilated Cardiomyopathy Ricardo M. Rocha1, Elias P. Gouvea1, Denilson C. Albuquerque1, Roberto Esporcatte1, Francisco M. Albanesi Filho1; 1Cardiology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

Introduction: The Community Hospital in Munster, Indiana developed a collaborative care outpatient heart failure (HF) treatment program. This program is staffed by a cardiologist, an advanced practice nurse and a team of registered nurses. The program included HF education, an infusion clinic and tele-management. A primary goal of this program is to address sings/symptoms of HF decomposition and prevent the need for hospital admission. We have previously demonstrated this program is successful in significantly reducing the need for inpatient care, although a number of subjects in our cohort were still hospitalized within 30 days of program enrollment. The purpose of the present study is to examine the ability of baseline variables, collected during program enrollment, to predict short-term hospitalization. Methods: 1,404 (856 male/ 548 female) subjects enrolled in the collaborative care program were included in this analysis. Mean age of the group was 77.11 (⫾8.9) years. All subjects received outpatient care as previously described. Heart Rate, blood pressure, respiratory rate and brain natriuretic peptide (BNP) were collected upon program enrollment. Subjects were tracked for inpatient hospital admissions for 30 days following initiation of the collaborative care program. Results: Seventy-five subjects (5.3%) were hospitalized within the 30-day tracking period. Multivariate Cox regression analysis revealed BNP was the only significant predictor of 30-day hospitalization (p ⬍ 0.01). Receiver operating characteristic curve analysis revealed a BNP threshold of ⬍/ⱖ 651 pg/ml produced a sensitivity and specificity of 62% and 60% respectively. The hazard ratio for this BNP threshold value was 2.4 (95% CI ⫽ 1.5-3.8), p ⬍ 0.001. Conclusion: The results of the present study further illustrate the clinical value of BNP in the HF population. Specifically, in a group of HF patients demonstrating signs/symptoms of acute documentation and being aggressively treated on an out-patient basis, BNP appears useful in identifying those individuals at higher risk for hospitalization.

Background: There are few studies in chronic heart failure correlating mortality and liver dysfunction. Hypothesis: Evaluate the influence of the hepatic laboratory profile (specially total bilirrubin) at the moment of the diagnosis of dilated cardiomyopathy (DCM) and its correlation with cumulative survival of these patients. Methods: Patients were included if they had baseline total bilirrubin levels and evolved to death. From a population of 450 consecutive patients with DCM, 98 patients were selected from Jan/1987 to Dec/1997. They were 65.3% male, aged 21 to 68 y (mean ⫽ 50.4), 31.6% in NYHA funcional class (FC) III and 68.4% in FC IV. We divided the population in two groups: group 1 (G1)(total bilirrubin ⬍ ⫽ 2 mg/dl) and group 2 (G2)(total bilirrubin ⬎ 2 mg/dl). Survival analysis using Kaplan Meier curve. Results: G1 was composed of 39 (39.8%) patients [26 patients (66.7%) in NYHA FC III and 13 (33.3%) in FC IV]. In these group, death was due to pulmonary embolism (PE) in 12 patients (30.8%) and due to worsening heart failure (WHF) in 27 patients (69.2%). G2 was composed of 59 (60.2%) patients [5 patients (8.5%) in NYHA FC III and 54 (91.5%) in FC IV]. In these group, only 7 patients (11.9%) died due to PE and 52 patients (88.1%) due to WHF. Table below shows cumulative survival in both groups (p ⬍ 0.001 for comparisons between groups 1 and 2). Conclusions: Patients with total bilirrubin ⬎ 2.0mg/dl at the time of DCM diagnosis were in worse NYHA FC, had more cases of WHF and a reduced cumulative survival curve. These findings define an important, easy and cheap marker that can predicts long term survival in patients with dilated cardiomyopathy. Cumulative Survival

12 months 24 months 36 months

Group 1 n ⫽ 39

Group 2 n ⫽ 59

78% 68% 61%

66% 58% 50%

P ⬍ 0.001 for comparisons between groups 1 and 2.

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Similarities in Hospitalization Rates on Systolic Heart Failure Patients with Atrial Fibrillation Compared to Normal Sinus Rhythm Alan B. Miller1, Jun R. Chiong1, Binu Jacob1, Hector P. Sanchez1, Robert F. Percy1; 1Internal Medicine-Division of Cardiology, University of Florida, Jacksonville, FL

Predictors of Cardiac-Specific Quality of Life among Patients with Heart Failure: Effects of Psychosocial Variables Eva R. Serber1, Emily A. Kuhl1, Cyndie M. Williams2, Samuel F. Sears1, Juan M. Aranda, Jr.2, Eileen M. Handberg2; 1Department of Clinical & Health Psychology, University of Florida, Gainesville, FL; 2Department of Cardiovascular Medicine, University of Florida, Gainesville, FL

The prevalence of heart failure and atrial fibrillation is increasing in the aging U.S. population, and both conditions result in significant morbidity and mortality. Despite the extensive amount of research and literature that has been written about each of these disorders separately, little is known about the prognosis of patients in whom they coexist. It is generally accepted that patients with atrial fibrillation who have systolic dysfunction and symptomatic heart failure have worse outcomes than patients who have maintained sinus rhythm. This includes symptomatic status, physical work capacity, hospitalizations and survival rates for decompensation of heart failure. Methods: We evaluated patients in our outpatient data base system with atrial fibrillation and systolic heart failure (ejection fraction ⬍ 40%) and compared them to patients with sinus rhythm to determine if comorbidities, background therapy, symptomatic status determined by New York Heart Association functional class, and hospitalizations were different. Results: From our database of 172 patients, 44 (26%) had atrial fibrillation. There was no difference in age, gender, comorbidities of diabetes, hypertension, hyperlipidemia, or etiology of heart failure (63% ischemic etiology with atrial fibrillation versus 52% with normal sinus rhythm, p ⫽ NS). New York Heart Association (NYHA) functional class was also similar when evaluating patients with advanced heart failure (class III/IV): 64% with atrial fibrillation compared to 61% with sinus rhythm. Treatment was identical with angiotensin converting enzyme inhibitors/angiotensin receptor blockers and beta blockers except for a slightly higher incidence of digitalis therapy in the atrial fibrillation patients. The mean heart rate was similar for both groups (75 beats per minute). When analyzing admissions for the past one year, rates were not significantly different between the two groups (1.68 average admissions for atrial fibrillation patients versus 1.38 for sinus rhythm, p ⫽ 0.381). Conclusions: In a multi-disciplinary outpatient heart failure clinic, patients with atrial fibrillation who are appropriately treated with well-controlled heart rates have similar rates of hospitalizations compared to patients with normal sinus rhythm. Patients with atrial fibrillation also had similarities in comorbidities, etiology of heart failure and symptomatic NYHA functional class.

Background: The experience of HF is known to impact biopsychosocial outcomes. This study examined age ejection fraction, and psychosocial variables (i.e., depression, trait anxiety) in predicting cardiac-specific quality of life (CS-QOL) among a population of medically ill (e.g., NYHA Class 3 & 4) HF patients who were randomized to either an at-home exercise regimen or usual care. Hypothesis: It is hypothesized that factors of a biopsychosocial model at hospital discharge will each uniquely contribute to the variance in CS-QOL at 12-weeks post-discharge. Methods: Participants were enrolled in this study during an index hospitalization for medical optimization. Fifty-five HF patients were randomized to at-home exercise (n ⫽ 28) or usual care (n ⫽ 27). The sample was predominantly male (78%) and married (58.2%, N ⫽ 32) with a mean age of 58 years (SD ⫽ 12 years). Measures included the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Center for Epidemiological Studies-Depression (CES-D), and the State-Trait Anxiety Inventory (STAI). Repeated measures were available in 41 subjects at 12 weeks. Results: A hierarchical multiple regression analysis examined age, group assignment, cardiac variables (i.e., ejection fraction), and psychosocial variables (i.e., depression and trait anxiety) collected at hospital discharge, as the independent variables. CS-QOL (MLHFQ) at 12 weeks following discharge was the dependent variable. Age and ejection fraction significantly predicted quality of life (F[27, 2] ⫽ 3.74, p ⫽ .04, Adjusted R2 ⫽ .16), but group assignment did not significantly add to the model (F[27, 2] ⫽ 2.54, p ⫽ .08, R2 Change ⫽ .01). Notably, the psychosocial variables significantly accounted for an additional 32% of the variance in CS-QOL (F[27, 2]⫽6.99, p ⬍ .01, Adjusted R2 ⫽ .51). In the full model, the only significant unique predictor of CS-QOL was depression, in that more depressive symptoms predicted worse CS-QOL (p ⬍ .001, β ⫽ .59). Conclusion: In a biopsychosocial predictor model, depression scores uniquely influenced CS-QOL, above and beyond scores of anxiety, age, and ejection fraction in patients treated for decompensated HF. Further, group assignment did not appear to be important in the prediction of QOL. Addressing depression beforehand or during an exercise regimen may be necessary in order to optimize benefit.