Numerous studies associate metabolic syndrome (MetS) with poor life quality, depression, and anxiety. Aerobic exercise training has proven its value in promoting health among subjects with MetS. We ...aimed to evaluate the changes in health-related quality of life (HRQOL), motivation for physical activity, and the levels of anxiety and depression in subjects with MetS after individualized aerobic training.
A total of 140 subjects with MetS (53.2 ± 6.8 years, 55% female) were analyzed after the random assignment to the intervention (n = 84) or the control group (n = 56). Only the intervention group participated in the 8-week HR targeted aerobic training program, which consisted of exercises on a cycle ergometer for 30‑40 min/day, 5 days/week. In all study participants HRQOL, motivation for physical activity, anxiety and depression levels were evaluated by the Medical Outcomes Study 36-Item Short-Form Health Survey, the Exercise Motivations Inventory-2, and the Hospital Anxiety and Depression scale before and after 8 weeks.
After 8 weeks, self-reported physical functioning significantly increased only in the intervention group (p = 0.01). The scores of mental health-summary and role limitations due to emotional problems also improved in subjects with MetS, who participated in the aerobic training program (p < 0.001, p = 0.009, respectively). The scores for social engagement motive, enjoyment and revitalization motive, and fitness motive to exercise increased (p = 0.003, p < 0.001, p = 0.023, respectively), whereas the level of depression reduced only in the intervention group (p = 0.021).
The 8-week individualized aerobic training had a positive effect on HRQOL, motivation for physical activity, and the level of depression in subjects with MetS.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
This study sought to evaluate the relation between long-term segmental and global functional outcome after revascularisation in patients with chronic ischaemic left ventricular dysfunction (LVD) and ...baseline markers of viability: late gadolinium enhancement (LGE) transmurality and contractile reserve (CR).
Forty-two patients with chronic ischaemic LVD underwent low-dose dobutamine- (LDD) and late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) before surgical or percutaneous revascularisation. Regional and global left ventricular (LV) functions and LGE were repeatedly assessed 6 ± 1 and 35 ± 6 months after revascularisation. In total, 319 at baseline dysfunctional and successfully revascularised segments were available for statistical analysis.
The likelihood of long-term functional improvement was directly related to the presence of CR and inversely related to both the LGE and the degree of contractile dysfunction at baseline. The time course of functional improvement was protracted, with significantly more delay in segments with more extensive LGE (p = 0.005) and more severe contractile dysfunction at baseline (p = 0.002). The presence of CR was the predictor of earlier functional improvement (p < 0.0001). Using a definition of viable segment as a segment without any LGE or with any LGE and producing CR during LDD stimulation, ≥ 55% of viable segments from all dysfunctional and revascularised segments in a patient was the only independent predictor of significant improvement (≥ 5%) in the left ventricular ejection fraction (LVEF) after revascularisation, with a 72% sensitivity and an 80% specificity (AUC 0.76, p = 0.014). Reverse LV remodelling was observed in patients who had a significant amount of viable myocardium successfully revascularised.
In patients with chronic ischaemic LVD, improvement of dysfunctional but viable myocardium can be considerably delayed. Both the likelihood and the time course of functional improvement are related to the LGE, CR and the degree of contractile dysfunction at baseline. At 35 ± 6 months after revascularisation, patients with ≥55% of viable segments from all dysfunctional and revascularised segments significantly improve LVEF and experience reverse LV remodelling. A combination of LDD-CMR and LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from revascularisation.
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DOBA, GEOZS, IJS, IMTLJ, IZUM, KILJ, KISLJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, UILJ, UKNU, UL, UM, UPUK, ZAGLJ, ZRSKP
Background
MASK‐air® is an app whose aim is to reduce the global burden of allergic rhinitis (AR) and asthma. A transfer of innovative practices was performed to disseminate and implement MASK‐air® ...in European regions. The aim of the study was to examine the implementation of the MASK‐air® app in Lithuanian adults in order to investigate (i) the rate of acceptance in this population, (ii) the duration of app use and (iii) the evaluation of the app after its use.
Methods
In a longitudinal study, Lithuanian adults with AR and/or asthma were recruited by allergists. They were informed about how to use MASK‐air® and were followed closely. They were reviewed after one to 3 months to evaluate satisfaction and were asked to continue using the app.
Results
Among the 149 patients recruited (37.2 ± 10.4 years), 52.4% had rhinitis alone, 42.9% had rhinitis, asthma and/or conjunctivitis multimorbidity, and 2.7% isolated asthma. According to the MASK‐air® baseline questionnaire, 88.3% of patients considered that their symptoms were troublesome. Data were available for 102 (68.4%) patients. The duration of app usage in patients ranged from 1 to 680 days (median, 25–75 percentile: 54, 23.2–151 days). Forty‐two (41.1% of patients who were reviewed) patients agreed to share their opinion on MASK‐air®. Most users of the app were satisfied, from 46.5% thinking their allergy was treated more successfully to 90.4% recommending this app to other allergy sufferers.
Discussion
When recommended by physicians, MASK‐air® was used for a longer period of time.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
The aim of the study was to evaluate the relationship between MetS components and arterial stiffness in concert with left ventricular diastolic dysfunction (LVDD) in patients with high ...risk of cardiovascular disease.
Methods
A study was carried among 436 subjects (aged 53,8 ± 6, 37,2% men) without overt atherosclerotic disease and systolic LV dysfunction. The average of observations was 4,4 years. According to the MetS components (pathologically increased waist circumference — W, increased triglyceride — T, increased fasting plasma glucose — G, low high-density lipoprotein level-H, arterial hypertension — B) patients were divided into the metabolic phenotypes. Arterial stiffness parameters (carotid to femoral pulse wave velocity (cfPW), aortic augmentation index (AIxHR75) were assessed by applanation tonometry. Cardioankle vascular index (CAVI) was calculated using the VaSera VS-1000. Impaired relaxation was described as E/A < 1,0 and E/e’ mean < 13. Participants were considered as having pseudonorma/ restrictive LVDD if the E/e’mean ratio was ≥ 13. In case of E/A>1,0 and e’ septal ≥ 8cm/s and e’ lateral ≥ 10cm/s diastolic function was interpreted as normal.
Results
Most of study subjects had LVDD at the first visit (n = 358, n = 171 with relaxation abnormalities and n = 187 with pseudonormalisation). In presented cohort the most common metabolic phenotypes were: WTGHB (n = 70), WGB (n = 66), WTGB (n = 61), WTB (n = 46), WTHB (n = 30), WGHB (n = 27). During the observation period we found significant changes of LV diastolic function distribution between metabolic phenotypes (p< 0,001). All patients with WGHB phenotype at first visit had LVDD comparing with other groups. We found significant differences of arterial markers between first and follow up visits- in women (cfPWV 8,70 vs 8,94m/s, p < 0,001), in man (CAVI 8,05 vs 8,45, p < 0,001) and in whol cohort (AIxHR75 23,1 vs 24,1, p>0,001).
Conclusion
Metabolic phenotype is closely associated with the development of LVDD. Some metabolic phenotypes promote early arterial aging.
Aim
To evaluate the relation between arterial stiffness and left ventricular diastolic dysfunction (LVDD) in metabolic syndrome (MetS) patients during more than 3 years observation period (average ...was 3,8 years).
Methods
This longitudinal study enrolled 573 subjects (aged 53,4 ± 6 years, 63% female, 76% hypertensive) from the Lithuanian High Cardiovascular Risk Primary Prevention Programme1, without overt atherosclerotic disease and systolic LV dysfunction. Arterial stiffness parameters (carotid-to-femoral pulse wave velocity(cfPWV), augmentation index (AIxHR75), mean aortic pressure(mAP), central pulse pressure(cPP) were assessed by applanation tonometry. Diastolic function (LVDF) was defined according to the 2016 ESC Guidelines for diagnosis and treatment of acute and chronic heart failure.
Results
In presented cohort most of study subjects had LVDD at first visit (n = 418, n = 325 impaired relaxation, n = 92 pseudonormalisation, n = 1 restrictive LVDD). During the observation LVDF didn’t change in 337 (GR1 ), deteriorated in 110 (GR2), improved in 126 (GR0) participants. We found significant alterations of arterial and diastolic function parameters(mean): cfPWV 8,55 ± 1,4 vs 8,7 ± 1,6 m/s; AIxHR75 22,8 ± 10,4 vs 24,3 ± 10,8%; mAP 105,3 ± 10,4 vs 101,5±14,8 mmHg; cPP 42,6 ± 9,9 vs 43,3 ± 10,6 mmHg; E/A ratio 1 ± 0,3 vs 0,93 ± 0,2; E/e’mean ratio 10,4 ± 3,5 vs 9,4 ± 2,9; E/e’septal 11,9 ± 4,1 vs 10, 9 ± 3,2; MMI105 ± 22,7 vs 99 ± 24,1 (p< 0,05 for all). Significant correlations were found between initial arterial indices and alterations of LVDF: in GR1 with E/Aratio (rcfPWV = –0.176); in GR0 with E/e’mean (rcfPWV = –0.163, r
mAP
= –0.171). To clarify the relation between LVDD and arterial stiffness the conditional inference trees analysis was used. Only cfPWV, mAP, heart rate and BMI were significant for presence of LVDD.
Conclusion
Carotid-to-femoral PWV, the biomarker of vascular damage, is significant determinant of LV diastolic dysfunction in MetS patients. Arterial stiffness is a possible causal link to development of LV diastolic dysfunction.
Pacientu itraukties irankiai yra naudingi viešajam interesui, siekiant gerinti sveikatos priežiuros kokybe ir ivertinti pacientu poreikius bei prioritetus, nes padeda nustatyti esamas kliutis. ...Siekiant išsiaiškinti pacientu itraukties irankiu naudojima ir aktualuma kitose valstybese, buvo atlikta bibliometrine analize, kuri parode temos pletojimasi mokslineje literaturoje ir leido identifikuoti svarbiausius integravimo procesus. Vilniaus universiteto ligonines Santaros kliniku informacineje sistemoje buvo idiegti pacientu itraukties irankiai ir ateityje planuojama atlikti bandomaji tyrima su realiais pacientais, ivertinti rezultatus ir pasiulyti, kaip ši sistema galetu buti integruota i Lietuvos e. sveikatos sistema. Reikšminiai žodžiai: elektroniniai sveikatos irašai, kokybe, pacientu itraukties irankiai, e. sveikata, bibliometrine analize. Patient-reported measures are useful in the public interest to improve the quality of care and to assess patients' needs and priorities by helping to identify existing barriers. A bibliometric analysis was carried out to investigate the use and relevance of patient-reported measures in other countries, which showed the growth of the topic in the scientific literature and allowed the identification of the most important integration processes. Patient-reported measures have been implemented in the information system of Vilnius University Hospital Santaros Clinics and a pilot study with real patients is planned for the future to evaluate the results and propose how this system could be integrated into the Lithuanian eHealth system. Keywords: electronic health records, quality, patient-reported measures, eHealth, bibliometric analysis.
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IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UL, UM, UPUK
The relationship between longitudinal clinical congestion pattern and heart failure outcome is uncertain. This study was designed to assess the prevalence of congestion over time and to investigate ...its impact on outcome in chronic heart failure.
A total of 588 patients with chronic heart failure older than 60 years of age with New York Heart Association (NYHA) functional class ≥II from the TIME-CHF study were included. The endpoints for this study were survival and hospitalization-free heart failure survival. Orthopnea, NYHA ≥III, paroxysmal nocturnal dyspnea, hepatomegaly, peripheral pitting edema, jugular venous distension, and rales were repeatedly investigated and related to outcomes. These congestion-related signs and symptoms were used to design a 7-item Clinical Congestion Index.
Sixty-one percent of patients had a Clinical Congestion Index ≥3 at baseline, which decreased to 18% at month 18. During the median interquartile range follow-up of 27.2 14.3-39.8 months, 17%, 27%, and 47% of patients with baseline Clinical Congestion Index of 0, 1-2, and ≥3 at inclusion, respectively, died (P <.001). Clinical Congestion Index was identified as an independent predictor of mortality at all visits (P <.05) except month 6 and reduced hospitalization-free heart failure survival (P <.05). Successful decongestion was related to better outcome as compared to persistent congestion or partial decongestion (log-rank P <0.001).
The extent of congestion as assessed by means of clinical signs and symptoms decreased over time with intensified treatment, but it remained present or relapsed in a substantial number of patients with heart failure and was associated with poor outcome. This highlights the importance of appropriate decongestion in chronic heart failure.
Abstract
Background and Aims
Patient feedback, including collection of patient-reported experience (PREMs) and outcome measures (PROMs), is an essential component of patient-centered care ...implementation. We performed a pilot study of an integrated electronic approach to collect PROMs and PREMs in patients with kidney diseases across all age groups. In addition, we aimed to explore potential associations between PREMs and PROMs.
Method
92 parents of children with kidney disease and 134 adult patients followed in nephrology outpatient clinic at a single university hospital consented to receive automated surveys to their emails. The group consisted of patients (and parents of children) with kidney diseases that require long-term management, including chronic kidney disease, post-kidney transplantation, glomerular diseases and rare kidney diseases. Surveys consisted of an originally created PREM questionnaire and well established generic PROM questionnaires (age-dependent PedsQL for parents as proxies and EQ-5D for adults). PREM questionnaires consisted of 12 questions with 5-point Likert scale answers, encompassing experiences throughout all patient journey (including primary, secondary and tertiary care, and social/rehabilitation services). Higher scores in PREM questionnaire and in EQ-5D indicated worse experiences or worse PROMs evaluation (except for overall health), while higher score in PedsQL indicated better PROMs assessment. Surveys were generated and sent using REDCap system with the entire process integrated into hospital‘s electronic medical record system.
Results
48 (52%) parents and 60 (45%) adult patients completed both questionnaires. In adult patients, median completion times of PREM and PROM surveys were 5.0 and 2.2 minutes, respectively. Among parents, median PREM survey filling time was 1.7 minutes and PROM surveys filling time ranged between 2.7 and 3.8 minutes. Adult patients, who evaluated their mobility worse, reported experiencing more problems throughout diagnosis establishment process (r = 0.3, p = 0.049) and better experiences in rehabilitation (r = −0.37, p = 0.015). Worse self-care evaluation and reporting more pain/anxiety correlated with better experiences in psychological support (r = −0.3, p = 0.049 and r = −0.34, p = 0.026). Worse overall health self-evaluation associated with worse experiences in diagnosis establishment process (r = −0.37, p = 0.035). Parents evaluating their childrens` physical health as worse reported more negative experiences in diagnosis establishment process (r = −0.31, p = 0.028), more technical difficulties in the healthcare process (r = −0.47, p = 0.001) and worse information provision (r = −0.31, p = 0.031). Similar associations with PREMs were observed with social and global PROMs domains (all p<0.05).
Conclusion
Electronic integrated collection of PREMs and PROMs in patients with chronic kidney disorders is feasible but attempts to promote higher patient engagement are needed. Observed associations between PROMs and PREMs point towards potential benefits of long-term integrated patient feedback collection for targeted healthcare services quality improvement.
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