Clinical profile and management of outpatients with non-ischemic and non-hypertensive systolic heart failure: Analysis of the Polish DATA-HELP registry

Background: Although coronary artery disease and arterial hypertension are the most common etiologies underlying heart failure (HF), there are still many patients present with non-ischemic and non-hypertensive HF whose management remains very challenging. In this research study the clinical profile and applied treatment of patients with HF without coronary artery disease or hypertension versus patients with known etiology of HF (ischemic/hypertensive) were compared. Methods: Clinical data about 5563 patients with stable systolic HF were obtained from prospective multicenter DATA-HELP registry performed between October and December 2009 in ambulatory clinics in Poland, in which 500 cardiologists and 290 general practitioners participated. Results: Heart failure of non-ischemic and non-hypertensive etiology which affected 10% of all patients and was particularly frequent in younger patients, both in women: < 50 years old 42%; 50–65 years old 12%; > 65 years old 7%; and men: < 50 years old 47%; 50–65 years old 10%; > 65 years old 5%; p < 0.0001. Patients with non-ischemic and non-hypertensive HF were characterized by younger age, fewer co-morbidities, shorter duration of HF and, surprisingly, more advanced HF. Patients in this group were less likely to have received life-prolonging treatment in HF recommended by European Society of Cardiology (ESC) and more often required symptomatic management. Similarly, they were more likely to have implanted CRT-D and ICD. Conclusions: Heart failure of non-ischemic and non-hypertensive origin affects particularly young patients. These patients, despite suffering from more advanced HF are not optimally managed according to ESC guidelines

Relations between combined oral contraceptive therapy and indices of autonomic balance (baroreflex sensitivity and heart rate variability) in young healthy women

Introduction: There are structural and functional links between autonomic nervous and endocrine systems. Derivatives of estrogens and gestagens applied in combined oral contraceptives (COC) reduce the production of endogenous sex steroids, but their effect on autonomic nervous system remains unknown. Aim: To compare indices of heart rate variability (HRV) and baroreflex sensitivity (BRS) among young healthy women taking vs. non-taking COC. Material and methods: We performed a cross-sectional study in a group of 53 healthy women (age: 23±3 years, BMI: 22.3±2.8 kg/m2) taking COC for ≥ 3 months (COC-group) and in a group of 113 healthy women (age: 24±4 years, BMI: 22.0±3.1 kg/m2) not taking COC for ≥3 months (n-COC-group). All examined women were between the 4th and the 8th day of menstrual (or pill-driven) cycle lasting from 21 to 35 days. Indices of autonomic balance was assessed based on the time- and frequency- domains of heart rate variability (HRV, very low (VLF), low (LF), high (HF) frequencies and total HRV spectrum). BRS was evaluated using the sequence (BRS-Seq) and the controlled breathing (BRS-CtBr) methods. Results: There were no differences in: age, weight, height, measures of adiposity and fat distribution, the menstrual (or pill-driven) cycle day on the day of examination, heart rate and HRV parameters between the two studied groups (all p>0.1). BRS-CtBr was higher among n-COC-group as compared to COC-group (20.00±6.28 vs. 18.07±6.57 ms/mmHg,

Self-Reported Medication Adherence Measured With Morisky Medication Adherence Scales and Its Determinants in Hypertensive Patients Aged ≥60 Years: A Systematic Review and Meta-Analysis

Background: The aim of this systematic review and meta-analysis was to estimate medication adherence in hypertensive patients aged ≥60 years and to explore potential determinants of adherence with antihypertensive treatment in this age group.Methods: A systematic search of the PubMed, Scopus, and Google Scholar using the Cochrane guidelines was performed. The analysis included articles published between 1 January 2000 and 30 June 2018. The patients were considered adherent if they scored ≥6 pts. on the Morisky Medication Adherence Scale (MMAS-8) or ≥3 pts. on the Morisky Green Levine Medication Adherence Scale (MGL). If available, also odds ratios (OR) with 95% confidence intervals (95% CI) for determinants of medication adherence were recorded.Results: Thirteen studies including a total of 5,247 patients were available for the meta-analysis. The pooled percentage of adherence was 68.86% (95% CI: 57.80–79.92%). Subgroup analysis did not demonstrate a significant difference in the adherence measured with the MMAS-8 and the MGL (68.31 vs. 70.39%, P = 0.773). The adherence of patients from Western countries (Europe, United States) turned out to be significantly higher than in other patients (83.87 vs. 54.30%, P = 0.004). The significant determinants of better adherence identified in more than one study were older age, retirement/unemployment, duration of hypertension >10 years, and a lower number of prescribed drugs.Conclusion: Medication adherence in the oldest old hypertensive patients seems to be higher than in younger persons. Adherence in older persons was associated with age, socioeconomic status, and therapy-related factors

A curriculum for heart failure nurses : an expert opinion of the Section of Nursing and Medical Technicians and the Heart Failure Working Group of the Polish Cardiac Society

ABSTRACT The rates of mortality and morbidity due to heart failure (HF) are expected to significantly rise over the next 10 years owing to an ageing population and will be the highest of all rates pertaining to cardiovascular diseases. To face this rapidly progressing problem, that is, the increasing prevalence of HF and need for care of patients with this disease, an attempt was made to develop a curriculum targeted at HF nurses. The HF nurse, as a member of the therapeutic team, has to play an active role in monitoring patients’ physical and mental condition, coordinating hospital care, planning intervention after discharge from the hospital, and involving the patient and / or his or her family in self‑care, effective cooperation, and communication with the therapeutic team. The curriculum was conceived to complement the knowledge of HF and improve HF nurses’ educational skills. The proposed model of education, based on the guidelines of the European Society of Cardiology and led by trained educators, will enable clinicians to fully implement the principles of coordinated care and properly assess the effectiveness of educational interventions in patients with HF

Men With a Terminal Illness Relax Their Criteria for Facial Attractiveness

According to the life history paradigm, in life-threatening conditions, sexual selection criteria are relaxed in order to increase the probability of a last resort reproduction, ultimately contributing to reproductive success. This should be reflected in loosened mating preferences — a process observed in nonhuman animals. Studies investigating this aspect in humans, however, are scarce. This study explored the aesthetic preferences towards facial and nonfacial stimuli in terminally ill patients with heart failure (HF) and their healthy, same-sex peers. The aim was to examine if these two groups of men demonstrate different patterns of aesthetic judgments. Using a 7-point scale, 65 male patients with HF and 143 healthy men evaluated the perceived attractiveness of 15 photographs (five adult male faces, five adult female faces, and five nonfacial pictures). A mixed-design analysis of variance was run to assess group differences in aesthetic preferences. Compared to healthy controls, stimuli. HF patients rated the pictures using significantly higher scores, but this applied only to male and female, but not nonfacial, stimuli. We propose that lower criteria for facial attractiveness in HF patients are linked to relaxation of mate preferences as a result of a life-threatening conditions, and that this process can be an adaptive mating strategy from an ultimate, evolutionary perspective. However, other mechanisms (e.g., seeking social support) may be also responsible for the observed patterns

„W trosce o słabe serce” — model edukacji chorych hospitalizowanych z powodu dekompensacji niewydolności serca ze zmniejszoną frakcją wyrzutową

Introduction. Kompleksowa opieka nad chorymi z niewydolnością serca (KONS) is the name of a Polish programme for the coordinated care for patients with heart failure that has been proposed as a complex heart failure management solution based on European Society of Cardiology (ESC) Heart Failure recommendations. The challenge is that there are currently no available systemic solutions for educating these patients. Our project aimed to evaluate the effectiveness of a pilot model of education and telemonitoring known as ‘The Weak Heart’ for patients hospitalised due to decompensation of heart failure with reduced ejection fraction (HFrEF). Materials and methods. ‘The Weak Heart’ educational model consists of three phases: phase I — training and certification of nurses to perform the role of heart failure nurse specialists; phase II — checking the effectiveness of the model in a clinical setting; and phase III — implementation of patient education standards in cardiac centres. Data collected will be used to evaluate the impact of the programme on patients’ understanding regarding heart failure, their compliance with recommendations, and their pro-health behaviours in terms of self-care and self-control. Conclusion. ‘The Weak Heart’ programme will allow conclusions to be drawn concerning the usefulness and effectiveness of the first targeted heart failure-based patient educational model in Poland. Positive results in this pilot project could become the basis for implementing systemic changes, and introducing the model into everyday clinical practice.Introduction. Kompleksowa opieka nad chorymi z niewydolnością serca (KONS) is the name of a Polish programme for the coordinated care for patients with heart failure that has been proposed as a complex heart failure management solution based on European Society of Cardiology (ESC) Heart Failure recommendations. The challenge is that there are currently no available systemic solutions for educating these patients. Our project aimed to evaluate the effectiveness of a pilot model of education and telemonitoring known as ‘The Weak Heart’ for patients hospitalised due to decompensation of heart failure with reduced ejection fraction (HFrEF). Materials and methods. ‘The Weak Heart’ educational model consists of three phases: phase I — training and certification of nurses to perform the role of heart failure nurse specialists; phase II — checking the effectiveness of the model in a clinical setting; and phase III — implementation of patient education standards in cardiac centres. Data collected will be used to evaluate the impact of the programme on patients’ understanding regarding heart failure, their compliance with recommendations, and their pro-health behaviours in terms of self-care and self-control. Conclusion. ‘The Weak Heart’ programme will allow conclusions to be drawn concerning the usefulness and effectiveness of the first targeted heart failure-based patient educational model in Poland. Positive results in this pilot project could become the basis for implementing systemic changes, and introducing the model into everyday clinical practice

clinical profile and management of outpatients with non ischemic and non hypertensive systolic heart failure analysis of the polish data help registry

Background: Although coronary artery disease and arterial hypertension are the most common etiologies underlying heart failure (HF), there are still many patients present with non-ischemic and non-hypertensive HF whose management remains very challenging. In this research study the clinical profile and applied treatment of patients with HF without coronary artery disease or hypertension versus patients with known etiology of HF (ischemic/hypertensive) were compared. Methods: Clinical data about 5563 patients with stable systolic HF were obtained from prospective multicenter DATA-HELP registry performed between October and December 2009 in ambulatory clinics in Poland, in which 500 cardiologists and 290 general practitioners participated. Results: Heart failure of non-ischemic and non-hypertensive etiology which affected 10% of all patients and was particularly frequent in younger patients, both in women: 65 years old 7%; and men: 65 years old 5%; p < 0.0001. Patients with non-ischemic and non-hypertensive HF were characterized by younger age, fewer co-morbidities, shorter duration of HF and, surprisingly, more advanced HF. Patients in this group were less likely to have received life-prolonging treatment in HF recommended by European Society of Cardiology (ESC) and more often required symptomatic management. Similarly, they were more likely to have implanted CRT-D and ICD. Conclusions: Heart failure of non-ischemic and non-hypertensive origin affects particularly young patients. These patients, despite suffering from more advanced HF are not optimally managed according to ESC guidelines