Objective To cluster the symptoms of patients with chronic heart failure (CHF) through the cluster analysis, and to explore the relationships among symptom clusters of CHF, patients’ self-care behaviors and sleep quality, as well as the pathways influencing sleep quality of CHF patients. Methods A convenience sampling approach was used to provide a questionnaire survey to CHF patients who were being followed up with between January and December 2021. The Pittsburgh Sleep Quality Index, Memorial Symptom Assessment Scale-Heart Failure, European Heart Failure Self- care Behavior Scale and a self-created questionnaire on sociodemographic and clinical data characteristics were all included in the survey. Results A total of 304 CHF patients were included. Among them, there were 178 males and 126 females; the average age was (61.31±14.00) years; the average sleep quality score was (8.17±4.51) points, while the average overall self-care behavior score was (21.28±3.80) points. According to the cluster analysis of the symptoms of CHF patients, the patients’ symptoms were separated into clusters related to exhaustion, disease perception, and a single symptom of dry mouth. The sleep quality score was positively correlated with the following factors: age, number of comorbidities, overall score of symptom assessment, fatigue symptom cluster score, and illness perception symptom cluster score (P<0.05). There was no significant correlation between the self-care behavior score and sleep quality (P>0.05). However, sleep quality scores were negatively correlated with body mass index and education level, respectively (P<0.05). Age, gender, score of illness perception symptom cluster, and fatigue symptom cluster all had direct effects on sleep quality of 0.014, 0.206, 0.487, and 0.165 (P<0.05), respectively, according to path analysis. Self-care behavior also had a direct influence of 0.018 (P=0.686). Conclusions CHF patients have somewhat high levels of self-care behaviors, but they have poor sleep quality. They still have a lot of symptoms after being released. Sleep quality is significantly impacted by the patients’ age, body mass index, educational attainment, number of comorbidities, symptom ratings, fatigue symptom clusters, and disease perception symptom clusters. While the route effects of the patients’ self-care actions are not statistically significant, the age, gender, disease perception, and fatigue symptom cluster scores of CHF patients have a direct impact on the quality of their sleep. By managing the same clusters of symptoms, nursing staff can help patients with CHF feel better. They can also help patients sleep better by adopting practical measures.
Objective To assess the effectiveness and safety of meglumine adenosine cyclophosphate (MAC) for chronic heart failure. Methods The databases such as Cochrane Central Register of Controlled Trials (Issue 3, 2011), MEDLINE (1950 to March 2011), EMbase (1980 to March 2011), CNKI (1995 to March 2011), and VIP (1989 to March 2011) were searched, and the relevant journals and conference proceedings were also manually retrieved. Then the studies were screened according to predefined inclusion and exclusion criteria, and their quality was evaluated. Meta-analyses were performed by using RevMan 5.0 software. Results Seventeen randomized controlled trials (RCTs) involving 1 281 patients were included. All of the included RCTs were Grade C in methodological quality. The results of meta-analyses showed that MAC plus routine treatment was superior to routine treatment in improving the left ventricular ejection fraction (WMD=5.75, 95%CI 3.61 to 7.89), stroke volume (SV) (WMD=5.55, 95%CI 3.71 to 7.38), E/A (WMD=0.09, 95%CI 0.05 to 0.14) and 6 min walk test (WMD=43.52, 95%CI 21.00 to 66.04). But MAC plus routine treatment was similar to routine treatment in regulating cardiac index (CO) (WMD=0.20, 95%CI –0.31 to 0.71) and heart rate (WMD=0.64, 95%CI –7.49 to 8.77). No significant adverse effects or allergic reactions were reported. Conclusion The current evidence shows that MAC may improve the left ventricular ejection fraction, stroke volume, E/A and 6 min walk test. Due to a high risk of selection bias and detection bias in the included studies, the evidence is insufficient to determine the effectiveness of MCA. Further large-scale trials are required to define the role of MAC in the treatment of chronic heart failure.
Objective To evaluate the diagnostic value of brain natriuretic peptide (BNP) for cardiac dyspnea.Methods Plasma BNP levels were measured by radioimmunoassay in dyspnea patients with chronic heart failure (CHF) (n=52) or without CHF (n=30) and normal control group (n=28).Results The BNP level in dyspnea patients with CHF was significantly higher than that of dyspnea patients without CHF and normal control group [(649.80±141.72) pg/mL vs (59.08±18.60) pg/mL and (65.20±16.32) pg/mL，respectively,Plt;0.05].There was no significant difference of BNP level between dyspnea patients without CHF and normal group (Pgt;0.05).The plasma BNP level elevated with the worsening of heart failure (NYHA Classiffication).The BNP level in dyspnea patients with CHF was negatively correlated with left ventricle ejection fraction (r=－0.673，Plt;0.001).The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) is 0.91(0.88-0.98，Plt;0.001) with a sensitivity of 87.2% and a specificity of 86.8% at the cutoff value of 206 pg/mL.Conclusion Measurement of plasma BNP is a rapid diagnostic method for cardiac dyspnea.
ObjectiveTo overview of systematic reviews (SRs) of Yiqi Fumai (YQFM) injection in the treatment of chronic heart failure (CHF). MethodsThe PubMed, Cochrane Library, EMbase, Web of Science, CNKI, CBM and WanFang Data databases were electronically searched to collect SRs of YQFM injection in the treatment of CHF from January 1, 2007 to October 31, 2022. Two reviewers independently screened literature, extracted data and assessed methodological quality, risk of bias, report quality and evidence quality by using AMSTAR-2, ROBIS scale, PRISMA, and GRADE system. ResultsA total of 7 SRs were included. The evaluation results showed that the quality of all SRs was low, a few SRs were assessed as having a low risk of bias, and all SRs were relatively completely reported. A total of 46 results were extracted from the included SRs, including 3 with moderate quality evidence, 12 with low quality evidence and 31 with very low quality evidence. ConclusionYQFM may be an effective and safe treatment, but current evidence quality is low.
Objective To survey the prevalence of coexisting chronic obstructive pulmonary disease ( COPD) and chronic heart failure in Chengdu communities. Methods A cross-sectional study was performed in the population aged over 40 years in eight communities of Chengdu city. The subjects were selected by stratified cluster random sampling. Using the same protocol and questionnaire, all participants underwent medical history taking, physical examination and spirometry. Results Of 354 participating patients with a diagnosis of COPD, 74 ( 20. 90% ) cases were complicated with chronic heart failure. The prevalence of chronic heart failure in COPD in male was significantly higher than that in female ( 22. 69%vs. 18. 12% , P lt; 0. 05) . The major causes of chronic heart failure were hypertension ( 31. 64% ) , ischaemic heart disease ( 18. 93% ) , chronic pulonary heart disease ( 17. 51% ) and diabetes ( 11. 86% ) .Conclusions The prevalence of coexisting COPD and chronic heart failure in Chengdu city is significantly higher than the average level of the whole country, which warrant more attention in prevention and treatment of COPD in communities.
The fundamental reason why the organic lesions of chronic heart failure are difficult to reverse is ventricular remodeling. Myocardial fibrosis (MF) is an important pathological basis of ventricular remodeling. Its development process involves complex biological mechanisms and neuroendocrine system. Extracellular signal-regulated kinase (ERK) pathway is a classic pathway for the treatment of tumors. It is found that the inhibition of the ERK pathway can also slow down the progressive aggravation of MF. Therefore, exploring the mechanism of ERK pathway in MF may provide a new idea for the prevention and treatment of chronic heart failure. In this paper, the mechanism of ERK pathway in the occurrence and development of MF and its inhibition drugs were described, in order to provide evidence for the prevention and treatment of MF in chronic heart failure based on this pathway.
ObjectiveTo systematically review the association of body mass index (BMI) and mortality in chronic heart failure (CHF) pationts.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect cohort studies about the association of BMI and mortality in CHF patients from inception to June, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 20 cohort studies involving 91 572 CHF patients were included. The results of meta-analysis showed that, compared to patients with normal weight, underweight individuals were associated with higher mortality (HR=1.48, 95%CI 1.36 to 1.62, P<0.001), whereas overweight (HR=0.86, 95%CI 0.78 to 0.94, P=0.002) and obese (HR=0.78, 95%CI 0.68 to 0.90, P=0.001) patients were associated with lower mortality.ConclusionCurrent evidence shows that underweight is associated with a higher risk of all-cause mortality among patients with CHF, whereas overweight and obese are associated with lower risk of all-cause mortality. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To systematically evaluate the prognostic prediction model for chronic heart failure patients in China, and provide reference for the construction, application, and promotion of related prognostic prediction models. Methods A comprehensive search was conducted on the studies related to prognostic prediction model for Chinese patients with chronic heart failure published in The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, VIP, Wanfang, and the China Biological Medicine databases from inception to March 31, 2023. Two researchers strictly followed the inclusion and exclusion criteria to independently screen literature and extract data, and used the prediction model risk of bias assessment tool (PROBAST) to evaluate the quality of the models. Results A total of 25 studies were enrolled, including 123 prognostic prediction models for chronic heart failure patients. The area under the receiver operating characteristic curve (AUC) of the models ranged from 0.690 to 0.959. Twenty-two studies mostly used random splitting and Bootstrap for internal model validation, with an AUC range of 0.620-0.932. Seven studies conducted external validation of the model, with an AUC range of 0.720-0.874. The overall bias risk of all models was high, and the overall applicability was low. The main predictive factors included in the models were the N-terminal pro-brain natriuretic peptide, age, left ventricular ejection fraction, New York Heart Association heart function grading, and body mass index. Conclusion The quality of modeling methodology for predicting the prognosis of chronic heart failure patients in China is poor, and the predictive performance of different models varies greatly. For developed models, external validation and clinical application research should be vigorously carried out. For model development research, it is necessary to comprehensively consider various predictive factors related to disease prognosis before modeling. During modeling, large sample and prospective studies should be conducted strictly in accordance with the PROBAST standard, and the research results should be comprehensively reported using multivariate prediction model reporting guidelines to develop high-quality predictive models with strong scalability.
Objective To explore the effect of motivational interviewing (MI) on medication compliance and self-management behaviors of patients with chronic heart failure (CHF). Methods Between April 2013 and May 2015, 200 cases of CHF were randomly divided into control group (n=98) and MI group (n=102). Patients in the control group received routine nursing measures only. On the basis of routine nursing measures, patients in the MI group received MI program throughout the whole process inside and outside the hospital. The main contents of MI were medication compliance and self-management, to find the existing problems in patients’ daily living and make solutions with the patients. At the time of admission and 6 months after discharge, the Compliance Scale for Drug Treatment of Hypertension and the Self-management Scale for Patients with Heart Failure were conducted to asses the medication compliance and self-management behaviors of the two groups. Results Six months after discharge, the compliance level in the MI group was improved than that on admission with a significant difference (P<0.05), while the medication compliance in the control group was not improved significantly compared with that on admission (P>0.05). In the aspect of self-management, there was no significant difference in the control group between 6 months after discharge and on admission time (P>0.05); while the scores of diet management, drug management, symptom management, and psychological and social adjustment in the MI group (12.9±2.5, 16.1±2.8, 17.3±3.1, 17.0±2.4, respectively) were higer than those on admission (9.9±1.9, 13.3±2.7, 13.7±2.6, 12.8±2.2, respectively), with statistically significant differences (P<0.05). Conclusion MI can prompt CHF patients to improve medication compliance and the ability of self-management, and adopt a more healthy lifestyle.
Objective To assess the correlation between central sleep apnea (CSA) and serum leptin (LEP) levels in patients with chronic heart failure. Methods The level of serum LEP and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured by forward-looking method in patients with chronic heart failure who underwent polysomnography during hospitalization from December 2015 to April 2017 in Department of Cardiology and Respiratory Medicine, Renmin Hospital of Wuhan University. And its correlation with CSA was analyzed. Patients were divided into three groups according to the left ventricular ejection fraction (LVEF), and then according to the presence or absence of CSA into CSA group and without SDB group. Results Of the 71 patients with heart failure, 31 had LVEF≥45%, 19 were between 35% and 45% and 21 were≤35% ; 32 of whom were CSA and 39 had no SDB. The lEP concentrations in the LVEF subgroup of CSA groups were significantly lower than those in the control group without SDB, with significantly higher levels of NT-proBNP. Logistic regression showed that CSA was associated with logarithmic LEP (lnLEP) (OR=0.047, 0.030, 0.021, P<0.05). In severe heart failure (LVEF≤35%) group, high NT-proBNP was the risk of CSA (OR=5.942, P=0.045) and the incidence of CSA was as high as 71.4%, which was significantly higher than other groups. However, after adjustment for confounding factors such as age, sex and body mass index (BMI), the correlation no longer existed (OR=6.432, P=0.105). Moreover, CSA with severe cardiac insufficiency had lower LEP than those without SDB. After adjustment for confounding factors such as age, sex and BMI, CSA and lnLEP remained significantly correlated (OR=0.013, P=0.002). Meanwhile, linear correlation analysis also showed that NT-proBNP was negatively correlated with lnLEP (R=–0.751, P<0.001). After adjusting for age, sex, and BMI, this relationship still existed (R=–0.607, P=0.004). Conclusion Decreased levels of leptin and elevated NT-proBNP in patients with chronic heart failure may indicate the presence of CSA.