Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 299
Filter
1.
China Pharmacy ; (12): 209-216, 2022.
Article in Chinese | WPRIM | ID: wpr-913113

ABSTRACT

OBJECT IVE To evaluate the efficacy ,safety and cost-effectiveness of Qili qiangxin capsule in the treatment of chronic heart failure ,and provide reference for drug selection and evaluation in relevant institutions. METHODS Meta-analysis was performed to investigate clinical efficacy and safety of Qili qiangxin capsule combined with routine treatment (combined treatment group)versus routine treatment (routine treatment group )in the treatment of chronic heart failure. From the perspective of Chinese health care system ,a decision tree model was constructed. The time horizon of the model was 1 year. The effective rate obtained by meta-analysis was taken as the effect parameter ,and the total cost was calculated by drug cost and hospitalization cost ,to evaluate the cost-effectiveness of combined treatment versus routine treatment in the treatment of chronic heart failure. Subgroup analysis was carried out according to the course of treatment and literature quality ,and one-way sensitivity analysis and probability sensitivity analysis were adopted to check the robustness of basic analysis results. RESULTS Total of 72 literatures involving 9 575 patients were included in meta-analysis. Results of meta-analysis showed that effective rate ,left ventricular ejection fraction , N-terminal fragment of the prohomone brain-type natriuretic peptide and 6 minute walking distance in combined treatment group were all better than those of routine treatment group , while its safety was similar to routine therapy. The results of cost-effectiveness analysis showed that the cost of combined therapy was 1 867 yuan higher than that of routine therapy ,patients could get 0.016 QALYs more ,and the incremental cost-effectiveness ratio (ICER)was 117 861 yuan/QALY. If only high-quality literature were included for meta-analysis and the effectiveness parameters were obtained ,the ICERs of the combined therapy versus routine therapy were 102 162 yuan/QALY(based on all high-quality literature )and 72 354 yuan/QALY(based on high-quality literature with treatment course of 24 weeks). The results of the probability sensitivity analysis showed that taking twice China ’s per capita gross domestic product in 2020 as the willingness to pay threshold ,the probability of cost-effectiveness for Qili qiangxin capsule combined with routine therapy was 67.1% . CONCLUSIONS Compared with routine therapy ,Qili qiangxin capsule combined with routine therapy has better clinical efficacy ,equivalent safety and cost-effective.

2.
Article in Chinese | WPRIM | ID: wpr-933726

ABSTRACT

Objective:To develop an evaluation index system for community screening and referral procedure of patients with chronic heart failure.Methods:Experts in fields of medical education, health administration and various clinical specialties were selected from Shanghai through the purpose sampling method. Two rounds of expert consultation with Delphi method were conducted during October 2020 to February 2021, the contents of consultation included the importance and availability of the index system. According to the consultation results, the index system for community screening and referral procedure of patients with chronic heart failure was developed.Results:A total of 16 experts participated in the consultation, among whom 15 held senior or associate senior titles and 14 had worked for 20 years. The recovery rates of valid questionnaires of two rounds expert of consultation were 16/16. The familiarity and judgment coefficient were 0.82 and 0.90 in the first round of expert consultation, and 0.86 and 0.90 in the second round. The expert consultation coordination coefficient of the importance in the community screening and referral procedure were 0.652 and 0.462 for the first consultation; 0.741 and 0.525 for the second consultation. In the final version of the evaluation index system there were 7 first-level indicators, 15 secondary indicators and 3 conditions for screening; and 2 first-level indicators, 5 secondary indicators and 1 condition for referral.Conclusion:In this study the positivity coefficient and authority degree of experts are high; the opinions are relatively concentrated. The consultation results have a high rationality and feasibility, which would be applicable for assessment of community screening and referral procedure of patients with chronic heart failure.

3.
Article in Chinese | WPRIM | ID: wpr-940714

ABSTRACT

Chronic heart failure is a serious heart disease with dyspnea and limited activity tolerance as the main clinical manifestations. Autophagy is a self-protection mechanism in eukaryotic cells and plays an important role in the development of heart failure. Appropriately increasing the level of autophagy during the compensated stage of heart failure and timely removal of necrotic myocardial organelles and other harmful garbage can inhibit myocardial hypertrophy to a certain extent,alleviate myocardial remodeling,and delay heart failure. The theory of healthy Qi and pathogenic Qi is an important basic theory for explaining the occurrence of diseases,and struggle between healthy Qi and pathogenic Qi exists in the entire onset of chronic heart failure,which may lead to pathogenic Qi invasion and healthy Qi deficiency. The regulatory effect of autophagy on cardiomyocytes is similar to the theory of healthy Qi and pathogenic Qi in traditional Chinese medicine (TCM). Autophagy is the body's self-regulatory mechanism for healthy Qi and pathogenic Qi in a dose-effect manner,Specifically,autophagy can only protect the body's cells to a certain extent,and healthy Qi can only take effect within a certain range and degree. To protect the body from external pathogenic factors,excessive or insufficient autophagy may destroy the stability of the body's environment. In this regard,we use the theory of healthy Qi and pathogenic Qi as a starting point to clarify the function of autophagy in the development of chronic heart failure from a macro and micro perspective,and propose adjusting the balance of healthy Qi and pathogenic Qi in the body to regulate the autophagy of cardiomyocytes. The principle of prevention and treatment is expected to lay the foundation for modern research on the function of autophagy in the development of chronic heart failure in TCM,find novel therapy for chronic heart failure at different stages,and provide new insights into the diagnosis and treatment of chronic heart failure.

4.
Article in Chinese | WPRIM | ID: wpr-940682

ABSTRACT

Chronic heart failure (CHF), the end stage of heart disease due to a variety of causes, features high disability rate and mortality, which has become a hot spot in cardiovascular field. As recorded in Treatise on Cold Damage(《伤寒论》), Zhenwutang is composed of Radix Aconiti Lateralis Preparata, Poria Cocos, Rhizoma Atractylodis Macrocephalae, Paeoniae Radix Alba, and Rhizoma Zingiberis Recens. With the functions of warming Yang and excreting water, it is a classical prescription for the treatment of CHF in clinical settings. By searching China National Knowledge Infrastructure (CNKI), PubMed, Wanfang Data, and VIP, we find Zhenwutang exerts therapeutic effect on CHF through multiple targets and multiple pathways. Experiments show that it alleviates CHF by antagonizing the overactivation of neuroendocrine system, inhibiting immune-inflammatory response, suppressing cardiac remodeling, restricting apoptosis, regulating autophagy, improving myocardial energy metabolism, inhibiting oxidative stress injury, protecting endothelial function, and decreasing volume load. Clinical research shows that Zhenwutang can significantly alleviate the clinical symptoms of CHF patients in a safe manner with little adverse reactions. This paper systematically summarizes the mechanisms of and clinical research on Zhenwutang in the treatment of CHF in recent years, so as to provide theoretical and experimental data for the further research and development of Zhenwutang.

5.
Article in Chinese | WPRIM | ID: wpr-940360

ABSTRACT

ObjectiveTo study the pathological process and changes of metabolites in myocardial tissue of heart failure induced by transverse aortic constriction (TAC) in rats. MethodRats were treated with TAC operation and divided into TAC-30 d group and TAC-60 d group, and sham operation group at the same period was set up as control. Echocardiography and pathological staining of myocardial tissue were performed on rats in each group. Enzyme-linked immunosorbent assay was used to determine the expression of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and adenosine triphosphate (ATP) in serum. Liquid chromatography-mass spectrometry was used to observe the changes of metabolites and related pathways in myocardial tissue, the mobile phase consisted of 25 mmol·L-1 ammonium acetate and 25 mmol·L-1 ammonia hydroxide in water (A) and acetonitrile (B) for gradient elution (0-0.5 min, 95%B; 0.5-7 min, 95%-65%B; 7-8 min, 65%-40%B; 8-9 min, 40%B; 9-9.1 min, 40%-95%B; 9.1-12 min, 95%B), electrospray ionization was used under positive and negative ion detection modes, acquisition range was m/z 70-1 050. ResultCompared with the sham-30 d group, the left ventricular internal diameter at end-systole (LVIDs) in TAC-30 d group was significantly decreased (P<0.01), and left ventricular ejection fraction (LVEF), fraction shortening (FS), left ventricular end-diastolic posterior wall thickness (LVPWd), left vebtricular end-systolic posterior wall thickness (LVPWs) were significantly increased (P<0.01), there were cardiomyocyte arrangement disorder, edema, collagen fibre hyperplasia, the content of NT-probNP was significantly increased, while the content of ATP was significantly decreased (P<0.01), and 15 metabolites with abnormal expression were involved in pyrimidine metabolic pathway, pantothenic acid and coenzyme A biosynthesis pathway. Compared with the sham-60 d group, LVEF and FS in the TAC-60 d group were significantly decreased (P<0.01), and left ventricular internal diameter at end-diastole (LVIDd), LVIDs and LVPWd were increased (P<0.05, P<0.01), the edema of myocardial cells increased obviously, myocardium fibers degenerated, coagulation necrosis appeared, and a large amount of collagen fibers were deposited, the expression of NT-proBNP increased and the expression of ATP decreased (P<0.01), there were 21 metabolites with abnormal expression, involving pyrimidine metabolic pathway, and starch and sucrose metabolic pathway. ConclusionAt 30 d after TAC, there are myocardial hypertrophy, lipid metabolism disorder, pyrimidine metabolism disorder and energy imbalance. At 60 d after TAC, there are heart failure, aggravation of lipid metabolism disorder, excessive activation of glucose metabolism, and continuous disorder of pyrimidine metabolism.

6.
Article in Chinese | WPRIM | ID: wpr-940224

ABSTRACT

Chronic heart failure is a serious heart disease with dyspnea and limited activity tolerance as the main clinical manifestations. Activation of the inflammatory system can significantly stimulate cardiac fibrosis and remodeling and promote the progression of heart failure, playing a key role in the development of the disease. Studies have confirmed that inflammation is involved in the development of different types of heart failure. "Toxic pathogen theory" is an important basic theory of traditional Chinese medicine (TCM) to explain the occurrence of diseases. We concluded the similarities between TCM toxic pathogens and inflammation in concept, disease location, etiology, syndrome differentiation, and clinical characteristics. Chronic heart failure is manifested by the toxic pathogens of turbid phlegm, stagnated blood, and accumulated fluid. Heart vessel obstruction is the main pathological factor, and the inflammatory factors produced by necrotic cardiomyocytes are the microscopic manifestations of the obstruction. Therefore, based on the "toxic pathogen theory", this study aimed to clarify the role of inflammation in the development of chronic heart failure from both macroscopic and microscopic perspectives. Moreover, this paper proposed that the stagnated blood has not been transformed into toxin in the early stage of the disease and thus the products of clearing heat and detoxification should not be used. At the development stage of the disease when the transformation tends to begin, treatment should be based on syndrome differentiation, and detoxifying Chinese medicine should be used in order to achieve the goal of "removing toxin without harming the healthy Qi". At the late stage of heart failure, toxins have been accumulated and detoxifying medicines and therapies should be applied to eliminate the toxic pathogens. This study is expected to lay a foundation for the modern research on the role of inflammation in the development of chronic heart failure with TCM theory and guide the diagnosis and treatment of this disease.

7.
Article in Chinese | WPRIM | ID: wpr-940127

ABSTRACT

Chronic heart failure is a serious heart disease with dyspnea and limited activity tolerance as the main clinical manifestations. Activation of the inflammatory system can significantly stimulate cardiac fibrosis and remodeling and promote the progression of heart failure, playing a key role in the development of the disease. Studies have confirmed that inflammation is involved in the development of different types of heart failure. "Toxic pathogen theory" is an important basic theory of traditional Chinese medicine (TCM) to explain the occurrence of diseases. We concluded the similarities between TCM toxic pathogens and inflammation in concept, disease location, etiology, syndrome differentiation, and clinical characteristics. Chronic heart failure is manifested by the toxic pathogens of turbid phlegm, stagnated blood, and accumulated fluid. Heart vessel obstruction is the main pathological factor, and the inflammatory factors produced by necrotic cardiomyocytes are the microscopic manifestations of the obstruction. Therefore, based on the "toxic pathogen theory", this study aimed to clarify the role of inflammation in the development of chronic heart failure from both macroscopic and microscopic perspectives. Moreover, this paper proposed that the stagnated blood has not been transformed into toxin in the early stage of the disease and thus the products of clearing heat and detoxification should not be used. At the development stage of the disease when the transformation tends to begin, treatment should be based on syndrome differentiation, and detoxifying Chinese medicine should be used in order to achieve the goal of "removing toxin without harming the healthy Qi". At the late stage of heart failure, toxins have been accumulated and detoxifying medicines and therapies should be applied to eliminate the toxic pathogens. This study is expected to lay a foundation for the modern research on the role of inflammation in the development of chronic heart failure with TCM theory and guide the diagnosis and treatment of this disease.

8.
Article in Chinese | WPRIM | ID: wpr-936453

ABSTRACT

Objective To investigate the prevalence of chronic heart failure in the adult hospitalized population and to analyze the related disease burden. Methods A total of 326 chronic heart failure samples from adult inpatients in Yanliang District, Xi'an City from 2019 to 2021 were selected for analysis. The three-year epidemic situation was described and analyzed, and the information on the disease burden (hospitalization and cost, quality of life) caused by heart failure was collected, and the disease burden was preliminarily analyzed. The study used the Chinese version of the Minnesota heart failure quality of life questionnaire (Minnesota lving with heart failure questionnaire, MLHFQ) to measure the quality of life of patients during hospitalization. Results Among the patients in this study, there were 196 male patients (60.12%) and 130 female patients (39.88%), with an average age of (57.14±13.64) years, and the highest incidence was in the age group of 60-69 years. The highest proportion of cardiac function grades I to IV is grade III, and the lowest is grade I; coronary atherosclerotic heart disease is the first cause, followed by hypertensive heart disease, cardiomyopathy and rheumatism. Sexual heart valve. In addition, the patients' primary disease duration was on average (7.14±3.05) years. 26.99% of patients had blood pressure exceeding the standard during hospitalization. The average length of hospitalization of the subjects was (12.97±4.52) d, and there were significant differences in the length of hospitalization between patients with different age groups, different cardiac function grades, different primary diseases, and different primary disease durations (all P<0.05). The median medical expenses of the subjects during hospitalization were 31 373.70 (15 250.65, 47 005.15) yuan. The quality of life scores of the patients with heart failure in this study were (44.65±14.47), (35.91±12.58) in the physical domain, and (53.66±19.81) in the emotional domain. And the quality of life of male patients is lower; the quality of life of heart failure caused by dilated cardiomyopathy and hypertension is lower; the level of cardiac function increases, and the quality of life score decreases. Conclusion In recent years, the elderly inpatients with chronic heart failure in Yanliang District, Xi'an City, the middle-aged, the high-level cardiac function, the patients with cardiomyopathy and hypertensive heart disease, and the patients with the normal course of the primary disease have longer hospitalization time and higher medical expenses. Male patients, patients with heart failure caused by dilated cardiomyopathy and hypertension, and patients with higher cardiac function grades have lower quality of life.

9.
Frontiers of Medicine ; (4): 295-305, 2022.
Article in English | WPRIM | ID: wpr-929184

ABSTRACT

The association among plasma trimethylamine-N-oxide (TMAO), FMO3 polymorphisms, and chronic heart failure (CHF) remains to be elucidated. TMAO is a microbiota-dependent metabolite from dietary choline and carnitine. A prospective study was performed including 955 consecutively diagnosed CHF patients with reduced ejection fraction, with the longest follow-up of 7 years. The concentrations of plasma TMAO and its precursors, namely, choline and carnitine, were determined by liquid chromatography-mass spectrometry, and the FMO3 E158K polymorphisms (rs2266782) were genotyped. The top tertile of plasma TMAO was associated with a significant increment in hazard ratio (HR) for the composite outcome of cardiovascular death or heart transplantation (HR = 1.47, 95% CI = 1.13-1.91, P = 0.004) compared with the lowest tertile. After adjustments of the potential confounders, higher TMAO could still be used to predict the risk of the primary endpoint (adjusted HR = 1.33, 95% CI = 1.01-1.74, P = 0.039). This result was also obtained after further adjustment for carnitine (adjusted HR = 1.33, 95% CI = 1.01-1.74, P = 0.039). The FMO3 rs2266782 polymorphism was associated with the plasma TMAO concentrations in our cohort, and lower TMAO levels were found in the AA-genotype. Thus, higher plasma TMAO levels indicated increased risk of the composite outcome of cardiovascular death or heart transplantation independent of potential confounders, and the FMO3 AA-genotype in rs2266782 was related to lower plasma TMAO levels.


Subject(s)
Carnitine , Choline/metabolism , Chronic Disease , Heart Failure/genetics , Humans , Methylamines , Oxygenases , Prospective Studies
10.
Article in English | WPRIM | ID: wpr-928948

ABSTRACT

OBJECTIVE@#To explore the effect of Shenmai Injection (SMI) on the long-term prognosis of patients with chronic heart failure (CHF).@*METHODS@#The Hospital Information System was used to extract data of CHF patients, and the retrospective cohort study was conducted for analysis. In non-exposed group, standardized Western medicine treatment and Chinese patent medicine or decoction were applied without combination of SMI while in the exposed group, SMI were applied for more than 7 days. Evaluation indicators are followed with New York Heart Association functional classification (NYHA classification), left ventricular ejection fraction (LVEF), N-terminal brain natriuretic peptide precursor (NT-ProBNP), cardiogenic death and heart failure (HF) readmission. Statistical analysis includes Kaplan-Meier analysis and Cox regression which are used to explore the relationship between SMI and outcome events.@*RESULTS@#A total of 1,211 eligible CHF patients were involved and finally 1,047 patients were followed up successfully. After treatment, the cases of NYHA classification decline in the exposed and non-exposed groups accounted for 64.30% and 43.45%, respectively; the improvement values of LVEF were 8.89% and 7.91%, respectively; the improvement values of NT-ProBNP were 909 pg/mL and 735 pg/mL, respectively. After exposure on SMI, the rates of cardiogenic death and HF readmission reduced from 15.43% to 10.18% and 38.93% to 32.37%. According to Kaplan-Meier analysis, the log-rank P value of SMI and cardiogenic death was 0.014, while the counterpart of SMI and HF readmission was 0.025. Cox regression analysis indicated that for cardiogenic death, age, cardiomyopathy, diabetes, and NYHA classification were risk factors while β-blockers, aldosterone receptor antagonists, Chinese patent medicine/decoction and SMI were protective factors. Likewise, for HF readmission, age, cardiomyopathy, and NYHA classification were risk factors while SMI was a protective factor.@*CONCLUSION@#Combination with SMI on the standardized Western medicine treatment can effectively reduce cardiogenic mortality and readmission rate in CHF patients, and thereby improve the long-term prognosis.


Subject(s)
Biomarkers , Drug Combinations , Drugs, Chinese Herbal , Follow-Up Studies , Heart Failure/drug therapy , Humans , Natriuretic Peptide, Brain , Peptide Fragments , Prognosis , Retrospective Studies , Stroke Volume , Ventricular Function, Left
11.
Article in English | WPRIM | ID: wpr-928937

ABSTRACT

OBJECTIVE@#To confirm the improvement of cardiac function and quality of life (QOL) in patients with chronic heart failure (CHF) via Chinese medicine (CM) Qishen Taohong Granule (, QTG).@*METHODS@#This study was a single-center, prospective, randomized, controlled clinical trial. Seventy-six patients from 27 to 84 years old diagnosed with CHF New York Heart Association (NYHA) class II or III in stage C were enrolled and randomly assigned at a 1:1 ratio to receive QTG or trimetazidine (TMZ), in addition to their standard medications for the treatment of CHF. The study period was 4 weeks. The primary outcomes included cardiac function evaluated by NYHA classification and left ventricular ejection fraction (LVEF), as well as QOL evaluated by CHF Integrated Chinese and Western Medicine Survival Scale (CHFQLS). The secondary outcomes included 6-min walking test (6MWT), CM syndrome score, symptom and sign scores and N-terminal pro-B-type natriuretic peptide (NT-proBNP). All indices were measured at baseline and the end of the trial.@*RESULTS@#At the 4-week follow-up period, the effective rate according to NYHA classification in the QTG group was better than that in the TMZ group (74.29% vs. 54.29%, P<0.05). But there was no significant difference in post-treatment level of LVEF between the two groups (P>0.05). The CHFQLS scores improved by 13.82±6.04 vs. 7.49±2.28 in the QTG and TMZ groups, respectively (P<0.05). Subgroup analysis of the CHFQLS results showed that physiological function, role limitation and vitality were significantly higher in the QTG group than in the TMZ group (15.76±7.85 vs. 7.40±3.36, P<0.05; 16.00±8.35 vs. 10.53±4.64, P<0.05; 15.31±8.09 vs. 7.89±4.60, P<0.05). Compared with TMZ group, treatment with QTG also demonstrated superior performance with respect to 6MWT, CM syndrome, shortness of breath, fatigue, gasping, general edema and NT-proBNP level. No significant adverse reactions or adverse cardiac events occurred during treatment in either group.@*CONCLUSION@#In addition to conventional treatments, the use of QTG as an adjuvant therapy significantly improved cardiac function and QOL in patients with CHF class II or III in stage C. [Registration No. ChiCTR1900022036 (retrospectively registered)].


Subject(s)
Adult , Aged , Aged, 80 and over , Chronic Disease , Double-Blind Method , Heart Failure/drug therapy , Humans , Middle Aged , Natriuretic Peptide, Brain , Peptide Fragments , Prospective Studies , Quality of Life , Stroke Volume , Ventricular Function, Left
12.
Clinics ; 77: 100056, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1394300

ABSTRACT

Abstract Objective: As a greater proportion of patients survived their initial cardiac insult, Chronic Heart Failure (CHF) is becoming a major cause of worldwide morbidity and mortality. However, the mechanism underlying the inflammation in patients with CHF has not yet been elaborated. This study aims to explore the associations between inflammation and CHF patients, and the predictive performance of inflammatory indicators in identifying patients with CHF. Methods: A matched case-control study was conducted by recruiting 385 patients who were diagnosed with CHF from January 2018 to December 2019 in The First Affiliated Hospital of Chongqing Medical University. Each CHF patient was matched against one control subject without CHF on the criteria of age, sex, Body Mass Index (BMI), smoking status, and comorbidities. The clinical data and systemic inflammatory indicators were compared between the two groups, independent risk factors of CHF were identified by multivariate regression analysis, and the predictive values of systemic inflammatory indicators for CHF were analyzed by Receiver Operating Characteristic (ROC) curve analysis. Results: After processed in the univariate and multivariate regression analysis models, three systemic inflammatory indicators (hs-CRP [high sensitivity C Reactive Protein], LMR [lymphocyte-to-monocyte ratio], and Monocyte-to-High-density-lipoprotein Ratio [MHR]) were considered as independent predictors of CHF, among which the hs-CRP exhibited the best predictive performance (AUC = 0.752, 95%CI 0.717‒0.786, p < 0.001), followed by LMR (AUC = 0.711, 95% CI 0.675‒0.747, p < 0.001) and MHR (AUC = 0.673, 95% CI 0.635‒0.710, p < 0.001). The three-indicator combination showed an improved diagnostic performance (AUC = 0.757, 95% CI 0.724‒0.791, p < 0.001). In addition, the results of subgroup comparisons demonstrated that hs-CRP and MHR were associated with the severity of CHF (p < 0.001). Conclusions: The systemic inflammatory indicators such as hs-CRP, LMR, and MHR were independently correlated with the attack of CHF and might be the complementary markers of the diagnosis of CHF. HIGHLIGHTS Two novel inflammation-related markers, LMR and MHR are associated with Chronic Heart Failure (CHF). LMR and MHR were first proposed to be the predictors of a diagnosis of CHF in this study, which suggested that inflammation was associated with CHF, and anti-inflammation therapy might be a potential target for future therapeutic interventions. Compared with special inflammatory indicators such as TNF or IL-1, LMR and MHR are routinely measured in clinical practice and less time-consuming, which makes them suitable for popularization.

13.
Arch. cardiol. Méx ; 91(2): 190-195, abr.-jun. 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1248784

ABSTRACT

Resumen Objetivo: La insuficiencia cardiaca (IC) es un síndrome clínico caracterizado por disminución en la capacidad funcional. Los programas de rehabilitación cardiaca y prevención secundaria (PRHCyPS) han mostrado mejorar la calidad de vida y tolerancia al esfuerzo en este grupo de pacientes, pero sus efectos son dependientes del volumen. Nuestro objetivo es evaluar el grado de correlación del volumen de entrenamiento medido en equivalentes metabólicos (MET)-min/semana con el porcentaje de ganancia de consumo pico de oxígeno (VO2p) (MET-carga) posterior a un PRHCyPS en pacientes con IC. Método: Estudio cuasiexperimental que evaluó la ganancia de VO2p (MET-carga) en 31 pacientes posterior a un PRHCyPS, antes y después de una prueba de ejercicio convencional, que consistió en 30 min de entrenamiento dinámico al 70% frecuencia cardíaca de reserva (FCR) durante seis semanas, así como entrenamiento de kinesioterapia e intervención interdisciplinaria. Se calculó el volumen de entrenamiento de cada paciente en MET-min/semana (método de Kaminsky). Se midió el índice de correlación con Rho de Spearman y se consideró significancia estocástica con valor de p < 0.05. Resultados: El 70.6% fueron de sexo masculino, promedio de edad 61.5 ± 8.9 años, con fracción de expulsión del ventrículo izquierdo promedio de 38 ± 4.6%; el 96.8% de la IC fue de origen isquémico; un 55.9, un 29.4 y un 5.9% en clase funcional según la New York Heart Association I, II y III, respectivamente. Con un volumen de entrenamiento promedio de 504.34 ± 164 MET-min/semana. La mayor correlación se obtuvo en las poblaciones de alto riesgo, con una Rho: 0.486 (p = 0.008) por VO2p-carga. Conclusiones: Si bien existe una ganancia sustancial en tolerancia al esfuerzo medido por VO2p-carga, no obtuvimos suficiente grado de correlación entre el volumen de entrenamiento aplicado y la ganancia obtenida.


Abstract Objective: Heart failure is a clinical syndrome characterized by a decrease in functional capacity. Cardiac rehabilitation and secondary prevention (CR&SP) programs have been shown to improve quality of life and excercise tolerance in this group of patients, but their effects depends on training volume. Our objective is to evaluate the level of correlation of the training volume measured in metabolic equivalents (MET)-min/week with the percentage of peak oxygen consumption (VO2p) gain (estimated MET) after a CR&SP in patients with chronic heart failure. Method: Quasi-experimental study that evaluated the gain of VO2p (estimated MET) in 31 patients after a CR&SP, prior and post-exercise test, which consisted of 30 min of dynamic training at 70% heart rate reserve (HRR) for 6 weeks, with strenght training and interdisciplinary intervention. The training volume of each patient was calculated in MET-min/week (Kaminsky's method). Spearman's Rho correlation index was measured and stochastic significance was considered whith a value of p < 0.05. Results: 70.6% were male, average age 61.5 years ± 8.9, with left ventricular ejection fraction average of 38 ± 4.6%; 96.8% of the heart failure had an ischemic origin; 55.9, 29.4 and 5.9% in New York Heart Association funstional class I, II and III, respectively. With an average training volume of 504.34 ± 164 MET-min/week. The best correlation was obtained in high-risk population with Rhol: 0.486 (p = 0.008) meassured by estimated VO2p. Conclusions: Although there is a substantial gain in excersise tolerance measured by estimated VO2p, we did not obtain a sufficient level of correlation between the volume of training applied and the gain obtained.

14.
Article in Chinese | WPRIM | ID: wpr-877104

ABSTRACT

Objective To investigate the health literacy level and its influencing factors of patients with chronic heart failure (CHF) in Shaanxi, and to analyze the mediating effect of income level on health literacy. Methods From June 2019 to June 2020, 236 patients with CHF who were hospitalized in the Department of Cardiovascular Medicine of Xi'an North Hospital were enrolled in the study. The demographic and clinical characteristics questionnaire, and the heart failure-specific health literacy scale (HFS-HL) were used to collect data. The health literacy levels of patients with different characteristics were analyzed and compared. Logistic regression was used to analyze the factors affecting health literacy levels, Pearson correlation analysis was used to analyze the correlation between income level and health literacy, and Bootstrap test was used to analyze the mediating effect between income level and health literacy. Results Each dimension score and total score of HFS-HL scale of patients with different age, gender, place of residence, education level, family income per capita and NYHA cardiac function classification showed significant difference (P<0.05). Age, education level, family income per capita level and NYHA cardiac function classification were the influencing factors of CHF patients' health literacy (P<0.05). The level of family income per capita was significantly positively correlated with functional health literacy, interactive health literacy, critical health literacy and overall health literacy (P<0.05). The mediating effect value of family income per capita level was 0.134 (95% CI: 0.113-0.158), and the mediating effect was statistically significant (P<0.05). Conclusion The overall health literacy level of CHF patients in Shaanxi needs to be improved. The health literacy interventions for the elderly and people with low level of education, low family income, and poor heart function should be strengthened. At the same time, attention should be paid to the mediating effect of income level.

15.
China Pharmacy ; (12): 736-742, 2021.
Article in Chinese | WPRIM | ID: wpr-875657

ABSTRACT

OBJECTIVE:To systematically evaluate the effectiveness and safety of Shenfu qiangxin pills combined with chemical medicine conventional therapy in the treatment of chronic heart failure ,and to provide evidence-based reference for clinical drug use. METHODS :Retrieved from CNKI ,Wanfang database ,VIP,Google Scholar ,PubMed,the Cochrane Library and Embase database ,RCTs about Shengfu qiangxin pills combined with chemical medicine conventional therapy (trial group ) versus chemical medicine conventional treatment (control group )were collected during the inception to May 12th,2020. After literature screening and data extraction ,the quality of the literatures was evaluated with risk bias assessment tool recommended by Cochrane 5.1.0 system evaluator manual. Meta-analysis and sensitivity analysis were performed by using Stata 14.0 software. RESULTS:A total of 7 RCTs were included ,involving 596 patients. Meta-analysis results showed that the total response rate of trial group was significantly higher than that of control group [OR =4.14,95%CI(2.15,7.97),P<0.000 01];the results of sub-group analysis according to the different criteria for determining the efficacy showed that the total response rates of trial group determined by Lee integral method and cardiac function grading method were sig nificantly higher than that of the control group (P<0.05). After treatment ,N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of trial group was significantly lower than that of control group [OR =-1.33,95%CI(-1.55, qq.com -1.11),P<0.000 01]. Results of sub-group analysis accor- ding to cardiac failure type showed that NT-proBNP level of patients with chronic heart failure in trial group was lower than control group (P<0.001). The level of left ventricular ejection fraction (LVEF)in trial group after treatment [WMD =5.76,95%CI (5.05,6.47),P<0.000 01] was significantly higher than control group ;after treatment ,the level of B-type natriuretic peptide [SMD=-1.61,95%CI(-2.58,-0.54),P<0.000 01],left ventricular end-diastolic diameter (LVEDD)level [WMD = -6.06,95%CI(-6.84,-5.27),P<0.000 01],left ventricular end-systolic diameter level [WMD =-0.52,95%CI(-5.70,-4.33), P<0.000 01] were significantly lower than control group. There was no statistically significant difference in the incidence of ADR between 2 groups(P>0.05). Results of sensitivity analysis showed that when NT-proBNP ,LVEF level ,LVEDD level after treatment were used as indicators ,there was no significant difference in the analysis results after eliminating heterogeneity source , compared with before elimination. CONCLUSIONS :Shenfu qiangxin pills combined with chemical medicine conventional treatment has good efficacy and safety.

16.
Article in Chinese | WPRIM | ID: wpr-908170

ABSTRACT

Objective:To apply the best evidence of evidence-based volume management in patients with chronic heart failure to clinical practice and evaluate its effect.Methods:From February 2018 to May 2019, according to the clinical evidence practice application mode of Joanna Briggs Institute (JBI), and the best evidence obtained in the previous study, we constructed audit indicators. And then perfomed clinical audits for the patients with chronic heart failure in the department of cardiology of Shandong Provincial Hospital affiliated to Shandong First Medical University. The obstacle factors were analyzed, and the action strategies were formulated. The cognition of the medical staff on the volume management, and the fasting body mass monitoring rate, the volume management target compliance rate, the time to dry body mass, average hospitalization day of the patients′, number of negative events related to volume management were compared before and after the application of the best evidence.Results:After the implementation of the reform, Indicator 8-14 and Indicator 20 of the 20 audit indicators implementation rate had been improved, and the difference was statistically significant ( χ 2 values were 6.668-97.000, P<0.05); the volume management target compliance rate increased from (34.24±30.33)% to (61.28±16.10)%, the difference was statistically significant ( t value was 30.21, P<0.001); the time to dry body mass decreased from (10.89±3.46) days to (5.48±1.58) days, the difference was statistically significant ( t value was 13.97, P<0.001); compared with the negative events related to the access control, the number of acute left heart failure cases decreased from 7 to 2 ( χ2 value was 4.194, P=0.041). Conclusion:Evidence-based volume management of patients with chronic heart failure can improve clinical nursing practice, shorten the time for patients to reach dry body mass, and reduce the average hospitalization day. Quality review still needs to continue to improve the quality of nursing.

17.
Article in Chinese | WPRIM | ID: wpr-908164

ABSTRACT

With the development of human centered medical nursing model, empowerment as a new and effective nursing intervention model has been widely concerned. In this paper, from the overview of empowerment theory, the influencing factors of the implementation of empowerment theory in patients with chronic heart failure and the strategies to improve the implementation effect of empowerment theory for patients with chronic heart failure. The purpose of this review is to provide reference for the implementation of empowerment theory for patients with chronic heart failure in China.

18.
Article in Chinese | WPRIM | ID: wpr-906497

ABSTRACT

Objective:To explore the mechanism of the prescription consisting Aconiti Lateralis Radix Praeparata and Epimedii Folium in the treatment of chronic heart failure (CHF) based on network pharmacology,followed by verification in H9c2 myocardial cells with hypoxia-reoxygenation injury <italic>in vitro</italic> and in zebrafish with vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor Ⅱ (VRI) -induced vascular insufficiency. Method:The active ingredients in Aconiti Lateralis Radix Praeparata and Epimedii Folium were searched from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP),the corresponding target genes from the Universal Protein Resource (UniProt), and the CHF-related targets from Online Mendelian Inheritance in Man (OMIM) and GeneCards. Both the active ingredient-potential target network and the active ingredient-CHF-related target network were generated using Cytoscape 3.6.1, followed by the protein-protein interaction (PPI) network construction and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) enrichment analysis based on MetaScape. H9c2 myocardial cells exposed to hypoxia-reoxygenation were selected for determining the proliferation-promoting effect by methyl thiazolyl tetrazolium (MTT) assay. The protein expression of B-cell lymphoma-2(Bcl-2), Bcl-2-associated X protein(Bax),cysteinyl aspartate-specific protease-3(Caspase-3), protein kinase B(PKB/Akt),phosphorylated protein kinase B(p-Akt),phosphorylated extracellular signal-regulated kinases 1/2 (p-ERK1/2),extracellular signal-regulated kinase 1/2 (ERK1/2), and poly adenosine diphosphate ribose polymerase(PARP)was detected by Western blotting. The efficacy of the prescription in promoting angiogenesis was verified in a zebrafish model of VRI-induced vascular injury. Result:There were 28 active ingredients for the prescription, 209 corresponding targets, 1 296 CHF-related targets, and 94 common gene targets shared by the prescription and CHF. PPI network clustering suggested that Aconiti Lateralis Radix Praeparata and Epimedii Folium alleviated CHF by interfering with cell differentiation and metabolism and angiogenesis. GO analysis revealed that CHF relief was achieved via the intervention in such biological processes as cell migration,vascular development, and angiogenesis. Pharmacodynamic experiments verified that Epimedii Folium (10 mg·L<sup>-1</sup>) alone and the prescription (10 mg·L<sup>-1</sup>)both enhanced the proliferation of H9c2 myocardial cells under the hypoxia-reoxygenation condition (<italic>P</italic><0.05),while the latter also increased the expression of Bcl-2,Bcl-2/Bax, and PARP (<italic>P</italic><0.05) and reduced the expression of Caspase-3, Akt, and ERK (<italic>P</italic><0.05). The prescription at the concentrations of 0.3 and 0.1 g·L<sup>-1</sup> promoted angiogenesis (<italic>P</italic><0.05). Conclusion:Aconiti Lateralis Radix Praeparata and Epimedii Folium exert the therapeutic effect against CHF via multiple ingredients,multiple targets, and multiple channels. Such combination promotes the proliferation of H9c2 myocardial cells under hypoxic condition and protects zebrafish from vascular injury by up-regulating the expression of Bcl-2 and PARP,increasing Bcl-2/Bax ratio,and down-regulating the expression of Caspase-3,Akt, and ERK.

19.
Article in Chinese | WPRIM | ID: wpr-905081

ABSTRACT

Objective:To systematically evaluate the efficacy and safety of modified Buyang Huanwu Tang in the treatment of chronic heart failure. Method:CNKI database,Wanfang database,VIP database,Pubmed,MEDLINE,EMBASE and Cochrane database were retrieved systematically. The literature retrieval period is from no limit to December 2019,with "Buyang Huanwu Tang" and "chronic heart failure" "heart failure" as the key words for full-text retrieval of Chinese and English databases. Literatures of randomized controlled trials(RCTs) for chronic heart failure were included, and the data were extracted. Cochrane system evaluation method was used to score the quality of literature. Stata 14.0 was applied in Meta-analysis on the retrieval results. TSA0.9 was applied in test sequential analysis. Sensitivity analysis was made to explain heterogeneity,and funnel chart was used to evaluate publication bias. Result:A total of 2 037 patients were included in 21 RCT studies. The article quality risk assessment was generally unclear risk of bias. The results of meta-analysis showed that the left ventricular ejection fraction (LVEF) in the experimental group was significantly higher than that in the control group,with statistically significant differences [MD=0.901,95% CI (0.772,1.029),P<0.01],the left ventricular end diastolic diameter (LVEDd) in the experimental group was significantly lower than that in the control group,with statistically significant differences [OR=-0.650,95% CI=(-0.854,-0.446),P<0.01],BNP in the experimental group was significantly lower than that in the control group,with statistically significant differences [MD=-1.212,95% CI=(-1.359,-1.066),P<0.01],6-minute walk test (6MWT) in the experimental group was significantly higher than that in the control group,with statistically significant differences [MD=0.797, 95% CI=(0.447,1.146),P<0.01],and the effective rate in the experimental group was significantly improved,with statistically significant differences [OR=1.840,95% CI=(1.680,2.016),P<0.01]. Conclusion:Modified Buyang Huanwu Tang combined with conventional western medicine treatment of chronic heart failure is more effective than single administration of western medicine treatment,and can improve clinical efficacy, effectively improve the LVEF of patients with chronic heart failure,reduce the LVEDd reduces plasma BNP levels,prolong the 6-minute walking distance,and reduce the incidence of adverse reactions.

20.
Article in Chinese | WPRIM | ID: wpr-905059

ABSTRACT

Objective:To observe the clinical efficacy of Xiao Qinglongtang on chronic heart failure with cold phlegm in lung, and explore its mechanism of action. Method:A total of 87 patients with definite chronic heart failure were divided into observation group and control group by random number table method.The two groups received routine western medicine at the same time. Forty-two cases in observation group were treated with Xiao Qinglongtang based on western medicine, and 45 cases in control group received the same dose of placebo. Both groups were treated for 4 weeks, and then their cardiac function, traditional Chinese medicine (TCM) syndrome score and efficacy were compared before and after treatment. Left ventricular ejection fraction (LVEF) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured in both groups before and after treatment. The changes of standard deviation of NN intervals (SDNN), square root of the mean squared differences of successive NN intervals (RMSSD), high frequency (HF) and low frequency (LF) that reflect autonomic nerve function indexes in heart rate variability (HRV) after treatment were compared between two groups. The changes of inflammatory indicators such as interleukin-6 (IL-6) and highly sensitive C reaction protein (hs-CRP) were detected. Result:After treatment, the total effective rate for cardiac function in observation group was higher than that in control group (P<0.05). The TCM symptom scores were improved after treatment in both groups (P<0.05), and the total effective rate in observation group was higher than that in control group (P<0.01). After treatment, LVEF levels significantly increased (P<0.01) and NT-proBNP levels significantly decreased (P<0.01) in both groups, and the effect in observation group was more obvious (P<0.01). After treatment, SDNN, RMSD, HF and LF indicators in HRV were all higher than those before treatment in both groups (P<0.01), and the improvement in observation group was more significant than that in control group (P<0.01). The levels of IL-6 and hs-CRP decreased after treatment in both groups (P<0.01), and the level of observation group was significantly lower than that of control group (P<0.01). Conclusion:Xiao Qinglongtang has certain clinical efficacy in treating chronic heart failure with cold phlegm in lung as it can improve the clinical symptoms of patients, regulate autonomic nervous balance, and inhibit inflammatory factors, providing new clinical ideas to treat chronic heart failure in TCM.

SELECTION OF CITATIONS
SEARCH DETAIL