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.
ObjectivesTo analyze the application value of 6-minute walking test (6MWT) in the clinical evaluation of chronic heart failure (CHF).MethodsPubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were searched online to collect randomized controlled trials (RCTs) of 6-minute walking distance (6MWD) as the CHF evaluation index. Two reviewers independently screened literature, extracted data, and then analyzed data by using SPSS 17.0 statistical software. The 6MWD with symptom, quality of life, exercise tolerance (ETT), left ventricular ejection fraction (LVEF), peak oxygen consumption (pVO2) were analyzed by Kappa consistency test, and the possible influencing factors of 6MWD were analyzed by logistic regression.ResultsA total of 158 RCTs involving 17 853 patients were included. The results of statistical analysis showed that: 6MWD was consistent with the improvement of symptoms, quality of life, ETT, LVEF and pVO2 (Kappa>0.4). Baseline 6MWD (OR=2.91, 95%CI 1.278 to 6.634,P=0.011) and NYHA Ⅲ-Ⅳ ratio (OR=2.59, 95%CI 1.091 to 6.138, P=0.031) were the independent influencing factors for 6MWD improvement separately.ConclusionsThe 6MWT is an objective and reliable indicator of CHF evaluation.
ObjectiveTo investigate the role of mindfulness-based stress reduction in improving anxiety and depression in elderly patients with chronic heart failure.MethodsFrom August 2016 to August 2018, a total of 196 elderly patients with chronic heart failure were randomly divided into the treatment group and the control group, with 98 cases in each group. The control group received routine care. The treatment group received routine care plus mindfulness-based stress reduction in two 60-minute sessions a week for 8 weeks. The level of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) was detected by electrochemiluminescence immunoassay, and left ventricular ejection fraction (LVEF) was measured by echocardiography before intervention and at week 8 of intervention; the effective rate was calculated. Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and General Well-Being scale (GWB) were used to assess the degree of anxiety, depression, and well-being of patients before intervention and at week 8 of intervention.ResultsThe serum NT-proBNP levels at week 8 of intervention in the two groups were lower than those before intervention, and the LVEFs were higher than those before intervention (P<0.05). The treatment group showed significant changes when compared with the control group (P<0.05). The effective rate of the treatment group was higher than that of the control group (89.80% vs. 69.39%, P<0.05). Before intervention, the SAS scores in the treatment group and the control group were 56.61±8.25 and 55.98±6.32, respectively, the SDS scores were 59.98±7.21 and 58.86±6.17, respectively, and the GWB scores were 53.19±12.38 and 54.06±10.93, respectively; at week 8 of intervention, the SAS scores in the treatment group and the control group were 40.56±8.17 and 46.25±5.43, respectively, the SDS scores were 42.85±5.77 and 48.34±8.01, respectively, and the GWB scores were 76.17±9.63 and 68.58±13.30, respectively. At week 8 of intervention, the SAS and SDS scores of the two groups were both lower than those before intervention, and the GWB scores were higher than those before intervention (P<0.05). The treatment group showed significant changes when compared with the control group (P<0.05).ConclusionMindfulness-based stress reduction can improve the anxiety and depression of elderly patients with chronic heart failure, improve their well-being and promote the recovery of heart function.
Objective To access the efficacy and safety of different doses of metoprolol for patients with chronic heart failure. Methods We searched databases such as MEDLINE, EMbase, The Cochrane Library, CBM and CMCC. The search was conducted in March 2006. Randomised controlled trials, systematic reviews, and current guidelines of chronic heart failure were reviewed. The efficacy and safety of the high-dose (≥100 mg/d) and low-dose metoprolol (lt;100 mg/d) were compared. Results Only one small-scale, short-term randomised trial met our inclusion criteria. This found that metoprolol 100 mg/d was more effective than 25 mg/d and 50 mg/d. A sub-group analysis of MERIT-HF recommended individualized titration for drug administration. Most guidelines suggested that the administration of metoprolol CR/XL for chronic left ventricular systolic dysfunction should be performed by titrating up to 200 mg/d or the maximum tolerance dose. Patients receiving 100 mg/d might have more adverse events than those receiving a lower dose than this. However, in the long-term, it’s the benefits of high-dose treatment outweighed its risks. Race-related differences in tolerance or dose-related adverse effects were not found. Conclusion We couldn’t determine an optimal dose based on the existing evidence, but a target dose of metoprolol CR/XL 200 mg/d is safe and effective. We are unable to draw any conclusions about the relationship between dose and adverse effects.
ObjectiveTo evaluate the effect of statins on amino-terminal brain natriuretic peptide (NT-proBNP), grade of New York Heart Association (NYHA), and ejection fraction (EF) in patients with chronic heart failure (CHF) using marginal structural model. MethodsA total of 297 patients with CHF from two medical centers in Shanxi province were sequentially enrolled from January 2018 to December 2020. The medical records were collected. Confounding factors were analyzed by t-test, Chi-square test and logistic regression. The random forest algorithm was used to estimate the weight of inverse probability. The marginal structural model was applied to evaluate the effects of statins. ResultsUsing logistic regression to exclude the influence of baseline confounders, the results showed that statins had no significant effect on the level of NT-proBNP in patients with CHF. The marginal structural model which excluded the influence of baseline confounders, time-dependent confounders and treatment conversion factors showed that statins significantly reduced NT-proBNP (OR=0.699, 95%CI 0.528 to 0.926, P=0.012). Statins had no significant effects on NYHA and EF. ConclusionStatins can effectively reduce the level of NT-proBNP in patients with CHF.
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 analyze the substitution mechanism of surrogate endpoints for traditional Chinese medicine (TCM) clinical efficacy evaluation of chronic heart failure (CHF). Methods To obtain data from the occurrence of surrogate endpoints and cardiogenic death of patients with CHF in 7 hospitals. The causal relationship between surrogate endpoints and cardiogenic mortality was inferred by the Bayesian network model, and the interaction among surrogate endpoints was analyzed by non-conditional logistic regression model. Results A total of 2 961 patients with CHF were included. The results of Bayesian network causal inference showed that cardiogenic mortality had a causal relationship with the surrogate endpoints including NYHA classification (P=0.46), amino-terminal pro-B-type natriuretic peptide (NT-proBNP) (P=0.24), left ventricular ejaculation fraction (LVEF) (P=0.19), and hemoglobin (HB) (P=0.11); non-conditional logistic regression analysis showed that NYHA classification had interaction with NT-proBNP, LVEF, and HB prior to and after adjusting confounders. Conclusions The substitution capability of surrogate endpoints for TCM clinical efficacy evaluation of CHF for cardiogenic mortality are NYHA classification, NT-proBNP, LVEF, and HB in turn, and there is a multiplicative interaction between the main surrogate endpoint NYHA classification and the secondary surrogate endpoints including NT-proBNP, LVEF, and HB, suggesting that when the two surrogate endpoints with interaction exist at the same time, it can enhance the substitution capability of surrogate endpoints for cardiogenic mortality.
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.
ObjectivesTo systematically review the efficacy and safety of ivabradine (IVA) for patients with chronic heart failure (CHF).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of IVA for patients with CHF from inception to April, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed using Stata 12.0 software.ResultsA total of 22 RCTs involving 2 010 patients were included. The results of meta-analysis showed that, compared with control group, IVA group could decrease heart rate (HR) (WMD=−10.58, 95%CI −12.47 to −8.69, P=0.000) and N-terminal probrain natriuretic peptide (NT-proBNP) (WMD=−457.87, 95%CI −842.63 to −73.11, P=0.020). IVA group was superior in 6 minutes’ walk distance (6MWD) (WMD=40.49, 95%CI 27.83 to 53.15, P=0.000), left ventricular ejection fraction (LVEF) (WMD=5.11, 95%CI 3.74 to 6.48, P=0.000), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic dimension (LVEDd), left ventricular end-systolic dimension (LVESd) and incidence of endpoint events with significant difference. However, the total effective rate, the incidence of adverse reactions and blood pressures were similar between two groups.ConclusionCurrent evidence shows that IVA could significantly reduce HR, improve cardiac function and exercise tolerance in CHF patients with no significant increase of adverse events. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
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.