Systolic blood pressure reduction during the first 24 h in acute heart failure admission: friend or foe?

Aims: Changes in systolic blood pressure (SBP) during an admission for acute heart failure (AHF), especially those leading to hypotension, have been suggested to increase the risk for adverse outcomes. Methods and results: We analysed associations of SBP decrease during the first 24 h from randomization with serum creatinine changes at the last time-point available (72 h), using linear regression, and with 30- and 180-day outcomes, using Cox regression, in 1257 patients in the VERITAS study. After multivariable adjustment for baseline SBP, greater SBP decrease at 24 h from randomization was associated with greater creatinine increase at 72 h and greater risk for 30-day all-cause death, worsening heart failure (HF) or HF readmission. The hazard ratio (HR) for each 1 mmHg decrease in SBP at 24 h for 30-day death, worsening HF or HF rehospitalization was 1.01 [95% confidence interval (CI) 1.00–1.02; P = 0.021]. Similarly, the HR for each 1 mmHg decrease in SBP at 24 h for 180-day all-cause mortality was 1.01 (95% CI 1.00–1.03; P = 0.038). The associations between SBP decrease and outcomes did not differ by tezosentan treatment group, although tezosentan treatment was associated with a greater SBP decrease at 24 h. Conclusions: In the current post hoc analysis, SBP decrease during the first 24 h was associated with increased renal impairment and adverse outcomes at 30 and 180 days. Caution, with special attention to blood pressure monitoring, should be exercised when vasodilating agents are given to AHF patients

Predictors and associations with outcomes of length of hospital stay in patients with acute heart failure: results from VERITAS

Background: The length of hospital stay (LOS) is important in patients admitted for acute heart failure (AHF) because it prolongs an unpleasant experience for the patients and adds substantially to health care costs. Methods and Results: We examined the association between LOS and baseline characteristics, 10-day post-discharge HF readmission, and 90-day post-discharge mortality in 1347 patients with AHF enrolled in the VERITAS program. Longer LOS was associated with greater HF severity and disease burden at baseline; however, most of the variability of LOS could not be explained by these factors. LOS was associated with a higher HF risk of both HF readmission (odds ratio for 1-day increase: 1.08; 95% confidence interval [CI] 1.01–1.16; P = .019) and 90-day mortality (hazard ratio for 1-day increase: 1.05; 95% CI 1.02–1.07; P < .001), although these associations are partially explained by concurrent end-organ damage and worsening heart failure during the first days of admission. Conclusions: In patients who have been admitted for AHF, longer length of hospital stay is associated with a higher rate of short-term mortality. Clinical Trial Registration: VERITAS-1 and -2: Clinicaltrials.gov identifiers NCT00525707 and NCT00524433

Measuring Dispositional Flow: Validity and reliability of the Dispositional Flow State Scale 2, Italian version

Objective The aim of this study is to evaluate the psychometric properties of the Italian version of the Dispositional Flow Scale-2 (DFS-2), for use with Italian adults, young adults and adolescents. Method In accordance with the guidelines for test adaptation, the scale has been translated with the method of back translation. The understanding of the item has been checked according to the latest standards on the culturally sensitive translation. The scale thus produced was administered to 843 individuals (of which 60.69% female), between the ages of 15 and 74. The sample is balanced between workers and students. The main activities defined by the subjects allow the sample to be divided into three categories: students, workers, athletes (professionals and semi-professionals). Results The confirmatory factor analysis, conducted using the Maximum Likelihood Estimator (MLM), showed acceptable fit indexes. Reliability and validity have been verified, and structural invariance has been verified on 6 categories of Flow experience and for 3 subsamples with different with different fields of action. Correlational analysis shows significant high values between the nine dimensions. Conclusions Our data confirmed the validity and reliability of the Italian DFS-2 in measuring Flow experiences. The scale is reliable for use with Italian adults, young adults and adolescents. The Italian version of the scale is suitable for the evaluation of the subjective tendency to experience Flow trait characteristic in different contest, as sport, study and work

Dispositional flow scale 2: validity and reliability of the Italian version and discussion of the applications to different samples

The purpose of this paper was to present the validation process of the Italian Version of the Dispositional Flow Scale-2 (DFS-2; Jackson & Eklund, 2002). The scales developed by the authors convey Csikszentmihaly\u2019s idea of flow as a componential construct that can be measured as a state or as a trait. Namely DFS-2 is designed to assess flow both as a general trait (tendency to experience flow in a variety of activities) and a domain-specific trait (tendency to experience it in particular tasks). Following the guidelines for test adaptation, the scale was translated with the method of back translation; particular efforts were devoted to avoid cultural and context biases. The 36 item thus obtained were used in a first pretest (n = 100), following which specific terms included in some items were modified. Subsequently we conducted a second pretest (n = 100) that allowed us to identify the 36 final items. The scale was administered to 843 individuals (60.69% females), between 15 and 74 years. The sample was balanced between workers and students. The main activities described by the subjects led to divide the sample into three categories: students, workers, and sports practitioners (professionals and semi-professionals). The confirmatory factor analysis made using the MLM, showed acceptable fit indices. Reliability and validity were verified and structural invariance was verified on 6 areas described by participants as source of flow (sports, socio-relational, experiential, intellectual/study, work, art and creative activities). Correlation analysis showed significant high values between the nine dimensions considered as components of Flow. The findings of this study provided strong support for the validity and reliability of the DFS-2 in assessing flow experiences for Italian adults, young adults and adolescents. The Italian version of the scale proved suitable for the evaluation of subjective tendency to experiencing flow as a trait characteristic not only in sports but also, and with equal success, in other areas such as study and work. The results are discussed with reference to procedural and cultural issues. The scale revealed to be a useful tool for evaluating well-being of individuals in several research fields of psychology, that can be conveniently included in a battery of tests due to its conciseness. It can certainly be a fruitful resource in cross-cultural researches, and its validity supports existing data in the literature about the invariance of the construct of flow across languages and cultures

Survival in patients with class III idiopathic pulmonary arterial hypertension treated with first line oral bosentan compared with an historical cohort of patients started on intravenous epoprostenol.

BACKGROUND: The oral dual endothelin receptor antagonist bosentan improves exercise capacity and delays clinical worsening in patients with pulmonary arterial hypertension, but its use could delay starting intravenous epoprostenol, a life saving treatment. METHODS: Survival in patients with functional class III idiopathic pulmonary arterial hypertension (PAH) treated with bosentan in clinical trials was compared with historical data from similar patients treated with epoprostenol in the clinic. Statistical methods were used to adjust for possible underlying differences between the two groups. RESULTS: Baseline factors for the 139 patients treated with bosentan and the 346 treated with epoprostenol suggested that the epoprostenol cohort had more severe disease-that is, a lower cardiac index (2.01 v 2.39 l/min/m2) and higher pressures and resistance. Kaplan-Meier survival estimates after 1 and 2 years were 97% and 91%, respectively, in the bosentan cohort and 91% and 84% in the epoprostenol cohort. Cox regression analyses adjusting for differences in baseline factors showed a greater probability of death in the epoprostenol cohort (hazard ratio 2.2 (95% confidence interval 1.2 to 4.0) in the model adjusted for haemodynamics). Alternative regression analyses and analyses to adjust for different data collection dates gave consistently similar results. When matched cohorts of 83 patients each were selected, survival estimates were similar. In the bosentan cohort 87% and 75% of patients followed for 1 and 2 years, respectively, remained on monotherapy. CONCLUSIONS: No evidence was found to suggest that initial treatment with oral bosentan, followed by or with the addition of other treatment if needed, adversely affected the long term outcome compared with initial intravenous epoprostenol in patients with class III idiopathic PAH

Survival with first-line bosentan in patients with primary pulmonary hypertension.

The efficacy and safety of combining bosentan, an orally active dual endothelin receptor antagonist and epoprostenol, a continuously infused prostaglandin, in the treatment of pulmonary arterial hypertension (PAH) was investigated. In this double-blind, placebo-controlled prospective study, 33 patients with PAH started epoprostenol treatment (2 ng.kg(-1)min(-1) starting dose, up to 14+/-2 ng.kg(-1)min(-1) at week 16) and were randomised for 16 weeks in a 2:1 ratio to bosentan (62.5 mg b.i.d for 4 weeks then 125 mg b.i.d) or placebo. Haemodynamics, exercise capacity and functional class improved in both groups at week 16. In the combination treatment group, there was a trend for a greater (although nonsignificant) improvement in all measured haemodynamic parameters. There were four withdrawals in the bosentan/epoprostenol group (two deaths due to cardiopulmonary failure, one clinical worsening, and one adverse event) and one withdrawal in the placebo/epoprostenol group (adverse event). This study showed a trend but no statistical significance towards haemodynamics or clinical improvement due to the combination of bosentan and epoprostenol therapy in patients with pulmonary arterial hypertension. Several cases of early and late major complications were reported. Additional information is needed to evaluate the risk/benefit ratio of combined bosentan-epoprostenol therapy in pulmonary arterial hypertension

Systolic blood pressure reduction during the first 24 h in acute heart failure admission: friend or foe?

AIMS: Changes in systolic blood pressure (SBP) during an admission for acute heart failure (AHF), especially those leading to hypotension, have been suggested to increase the risk for adverse outcomes. METHODS AND RESULTS: We analysed associations of SBP decrease during the first 24 h from randomization with serum creatinine changes at the last time-point available (72 h), using linear regression, and with 30- and 180-day outcomes, using Cox regression, in 1257 patients in the VERITAS study. After multivariable adjustment for baseline SBP, greater SBP decrease at 24 h from randomization was associated with greater creatinine increase at 72 h and greater risk for 30-day all-cause death, worsening heart failure (HF) or HF readmission. The hazard ratio (HR) for each 1 mmHg decrease in SBP at 24 h for 30-day death, worsening HF or HF rehospitalization was 1.01 [95% confidence interval (CI) 1.00-1.02; P = 0.021]. Similarly, the HR for each 1 mmHg decrease in SBP at 24 h for 180-day all-cause mortality was 1.01 (95% CI 1.00-1.03; P = 0.038). The associations between SBP decrease and outcomes did not differ by tezosentan treatment group, although tezosentan treatment was associated with a greater SBP decrease at 24 h. CONCLUSIONS: In the current post hoc analysis, SBP decrease during the first 24 h was associated with increased renal impairment and adverse outcomes at 30 and 180 days. Caution, with special attention to blood pressure monitoring, should be exercised when vasodilating agents are given to AHF patients