Thesis (MPhil (Rehabilitation))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: In South Africa, rapid urbanisation and epidemiological transition have left the black urban population vulnerable to diseases of lifestyle such as chronic heart failure. This is in part due to the fact that changes in dietary patterns during urbanization play an important role in the increase of risk factors of these diseases. However, there is a lack of information on dietary choices of black urban populations. Therefore the current study evolved to describe the food choices and macro-and micronutrient intake of black, urban Sowetans, newly diagnosed with chronic heart failure, who attended the outpatient cardiac clinic at Chris Hani Baragwanath Hospital. A descriptive study methodology that made use of quantitative methods of data collection was used. Study participants comprised Sowetans with chronic heart failure who attended the Chris Hani Baragwanath Hospital outpatient cardiac clinic for the first time. Consecutive sampling followed by stratified random sampling was used to identify study participants. Participants were stratified for gender. Hundred persons participated in the study. Data was collected through the Food Frequency Questionnaire, a demographic questionnaire and measuring of height and weight. Data from the FFQ's was analysed for macro- and micronutrient intake by using the MRC "Food Finder 3‟ programme. Data were analysed by a statistician using StatSoft, Inc. (2009) STATISTICA, version 9.0. A p value of 0.05 was seen as statistically significant. The most significant clinical finding is an inadequate intake of certain micro nutrients and excessive salt consumption. Study participants continued to eat the more traditional carbohydrate foods. These staples were supplemented by highly refined carbohydrate sources, such as added sugar, sweets and chocolates, cakes, biscuits and cold drinks. Women ate significantly more maltabella (p=0.04), sweets and chocolates (p=0.01) than men, while men consumed significantly more, meat (p=0.01), milk and milk products (p=0.04), additional salt (p=0.02) and take away foods (p=0.05). Both genders had inadequate intake of Vitamin D [men 4 mcg/day (p=0.00), and women, 4 mcg/day (p=0.01)], selenium, [46 mcg/day (p=0.03) and 32 mcg/day (p=0.00)], folate [215 mcg/day (p=0.00) and 179 mcg/day (p=0.00)] and Vitamin C [71 mg/day (p=0.05) and 66 mg/day (p=0.07)]. Women had an inadequate intake of iron of 9 mg/day (P=0.00). It is recommended that dietary health promotion packages are developed and targeted specifically at this high risk community. Key words: Chronic heart failure, black, urban, food choices, macro-and micronutrients. / AFRIKAANSE OPSOMMING: Die swart stedelike bevolking in Suid Afrika gaan gebuk onder 'n al groter wordende risiko vir leefstyl siektes soos kroniese hartversaking. Dit kan gedeeltelik toegeskryf word aan veranderinge in dieet patrone as gevolg van verstedeliking en die epidemiologiese oorgang. Daar is egter nie genoeg inligting oor die voedselkeuses van swart stedelike bevolkingsgroepe nie. Die huidige studie het dus ontwikkel uit die behoefte om die voedselkeuses en mikro- en makronutrient inname van swart, stedelike Soweto inwoners wat nuut gediagnoseer is met hartversaking en die buitepasiënt kardiologie kliniek by Chris Hani Baragwanath Hospitaal bygewoon het, te bepaal. Daar was gebruik gemaak van 'n beskrywende studie metodologie wat gebruik gemaak het van kwantitatiewe metodes van data insameling. Deelnemers aan die studie het bestaan uit swart inwoners van Soweto met kroniese hartversaking wat die buitepasiënt kardiologie kliniek by Chris Hani Baragwanath Hospitaal vir die eerste keer bygewoon het. 'n Opeenvolgende steekproef, gevolg deur gestratifiseerde steekproefneming was gebruik om die studie deelnemers te identifiseer. Deelnemers was gestratifiseer volgens geslag. Eenhonderd pesone het aan die studie deelgeneem. Data is ingesamel deur gebruik te maak van die Voedsel Frekwensie Vraelys, a demografiese vraelys en die meet van lengte en gewig. Data van die Voedsel Frekwensie Vraelyste was ge-analiseer vir mikro-en makronutrient inname met die MRC ”Food Finder 3” program. Data is ge-analiseer deur 'n statistikus met die „StatSoft, Inc. (2009) STATISTICA, version 9.0‟. 'n P waarde van 0.05 is gesien as statisties beduidend. Mees beduidendste kliniese bevinding was die ontoereikende inname van sekere mikro-nutriënte en die verhoogde inname van sout. Studie deelnemers het nog steeds die meer tradisionele koolhidraat voedsels geëet. Hierdie stapel voedsels was aangevul deur hoogs verfynde bronne van koolhidrate, soos ekstra suiker, lekkergoed en sjokolade, koek, koekies en koeldrank. Die vrouens het beduidend meer maltabella (p=0.01), lekkergoed en sjokolade (p=0.01) geëet as mans, terwyl mans beduidend meer vleis (p=0.01), melk en melkprodukte (p=0.04), bygevoegde sout (p=0.02) en wegneem kosse (p=0.05) ingeneem het. Beide geslagte het ontoereikende innames van vitamiene D [mans 4 mcg/dag (p=0.00), en vrouens, 4 mcg/dag (p=0.01)], selenium [46 mcg/dag (p=0.03) en 32 mcg/dag (p=0.00)], foliensuur [215 mcg/dag (p=0.00) en 179 mcg/dag (p=0.00)] en vitamiene C [71 mg/dag (p=0.05) en 66 mg/dag (p=0.07)]. Vrouens het 'n ontoereikende inname van yster van 9 mg/dag (p=0.00) gehad. Daar word aanbeveel dat gesonde voedingsprogramme ontwikkel word, spesifiek gemik op hierdie bevolkingsgroep. Sleutelwoorde: Kroniese hartversaking, swart, verstedeliking, voedselkeuses, makro- en mikronutriënte.

Yu Sau Fung. / "October 2004." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (p. 389-460) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Congestive heart failure (CHF) affects an estimated 5.1 million Americans over the age of 20. The purpose of this quantitative study was to determine whether there is a difference in the Quality of Life (QOL) for Congestive heart failure patients receiving care through telehealth compared to patients receiving face-to-face care (usual care). Guiding this project was the Self-Care Model of Chronic Illness because the primary outcome of the self-care model is illness stability, well-being, and quality of life. Seventy-seven veterans with Heart Failure (HF) from the Washington D.C. Veterans Affairs Medical Center (VAMC) participated in the project. Forty reported they were receiving telehealth and 37 reported that they were receiving face-to-face care. The average participant age was 67 years with a range of 44 to 93 years. Seventy-five of the participants were male and 2 were female. Sixty-four participants were Black and 12 were White. The Minnesota Living with Heart Failure (MLHF) questionnaire average score for the telehealth group was 49.4 (SD = 28.7) and the face-to-face care group was 37 (SD = 27.9). With equal variance assumed, there was no significant difference between MLHF scores in the telehealth group compared to the usual care group (t = -1.91, p > .05). Thus, opportunities for using telehealth without negatively affecting patient outcomes, such as QOL, are plausible. It can be concluded that providing services using home telehealth for HF patients may produce outcomes that are equivalent to those receiving traditional services.

This thesis describes the management of patients treated with mechanical circulatory support devices for short- or long-term use. Twenty-four patients suffering from postcardiotomy heart failure were treated with a minimally invasive axial flow pump. The device was effective in unloading the failing left ventricle and in maintaining an adequate systemic circulation. The principles of perioperative monitoring, and pharmacological therapy are outlined. The pump was also used as an alternative to the heart-lung machine in conjunction with coronary artery bypass surgery. Together with a short-acting β-blocker, esmolol, the heart was decompressed and heart motion was reduced, facilitating bypass surgery on the beating heart. The anesthesiological considerations using this method are described. An implantable left ventricular assist device was used as a bridge to heart transplantation in 10 patients. We were interested in assessing the possibility to establish such a treatment program at a non-transplanting center. A multidisciplinary approach was enabled thanks to the organization of our Heart Center and due the close collaboration with our transplant center at Lund University. As one of the first centers in Europe, we established a well-functioning program with good results. Nine out of 10 of the bridge patients, with treatment times varying between 53 to 873 days, survived pump treatment and were eventually transplanted. The device proved to be powerful enough to support the failing heart and enable rehabilitation of the patients. Outpatient management became simpler when using the electrical device with belt-worn batteries. The uncertain durability and the high risk of device-related complications are shortcomings that limit its potential for more permanent treatment of heart failure. A new generation of small implantable axial blood flow pumps has therefore been developed. The principles of these pumps are based on the first generation axial flow pumps evaluated in this thesis. After several years of basic research and experimental studies, the first human implants have been performed. In the thesis, the hemodynamic effects of such a novel axial flow pump have been evaluated in an acute heart failure model. This technology holds great promise, both as a bridge to heart transplantation, and as a permanent circulatory support system. / On the day of the public defence the status of the article IV was: Submitted for publication.

Heart failure (HF) affects an estimated 5.8 million Americans, accounting for near 250,000 deaths each year. With shortages in available donor hearts, mechanical circulatory support (MCS) has emerged as a life-saving treatment for advanced stage HF. With growth in MCS use, a clinical and developmental need has emerged for a standard characterization and evaluation platform that may be utilized for inter-device comparison and system training. The goal of this research was to harness SynCardia's total artificial heart (TAH) to meet this need. We first sought to characterize the TAH in modern physiological terms - i.e. hemodynamics and pressure-volume loops. We then developed a model of HF using the TAH and mock circulatory system operating in a reduced output mode. We demonstrated that MCS devices could be incorporated and evaluated within the HF model. Finally, we characterized the operational envelope of SynCardia's Freedom (portable), Driver operating against varying loading conditions. Our results describe the hemodynamic envelope of the TAH. Uniquely, the TAH was found not to operate with time-varying elastance, to be insensitive to variations in afterload up to at least 135 mmHg mean aortic pressure, and exhibit Starling-like behavior. After transitioning the setup to mimic heart failure conditions, left atrial pressure and left ventricular pressure were noted to be elevated, aortic flow was reduced, sensitivity to afterload was increased, and Starling-like behavior was blunted, consistent with human heart failure. The system was then configured to allow ready addition of ventricular assist devices, which upon placement in the flow circuit resulted in restoration of hemodynamics to normal. Lastly, we demonstrated that the Freedom Driver is capable of overcoming systolic pressures of 200 mmHg as an upper driving limit. Understanding the physiology and hemodynamics of MCS devices is vital for proper use, future device development, and operator training. Characterization of the TAH affords insight into the functional parameters that govern artificial heart behavior providing perspective on differences compared to the human heart. The use of the system as a heart failure model has the potential to serve as a valuable research and teaching tool to foster safe MCS device use.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 6 uppsatser.

M.Cur. / The intra-aortic balloon pump is a volume displacement device that is used to provide partial support to the left ventricle. The IABP is an effective and general used circulatory support device. The nursing of a patient on IABP therapy requires demonstration of specific clinical competence by the critical care nurse. Clinical competence is defined as the ability of the critical care nurse to integrate his/her knowledge, skills and values and to demonstrate it during nursing of a patient on IABP with the aim to promote the patient's health. The aim of this research had been to evaluate the clinical competence of the critical care nurse during the nursing of a patient on IABP, and to make recommendations according to that regarding education, the practice and research. The relationship between the components of clinical competence namely knowledge, skills and values that were set as aim, were also established. A quantitative, contextual, descriptive, correlational research design had been used in the study to compile a self-developed evaluation instrument that had been used to evaluate the clinical competence of the critical care nurse. The evaluation instrument consisted of a questionnaire that evaluated the knowledge of the critical care nurse, a check list that evaluated the skills of the critical care nurse and a semantic differential scale that evaluated the values of the critical care nurse during the nursing of a patient on IABP therapy. After the data was analyzed, it appeared that critical care nurses don't possess the necessary knowledge and skills to nurse patients on IABP, and as such are not clinically competent to nurse patients on IABP. iii Recommendations were made regarding education, the practice and research in order to improve the clinical competence of critical care nurses during the nursing of a patient on IABP therapy

Ventricular assist devices are used in patients with heart failure refractory to standard management. Though left ventricular assist devices are more often used, patients with severe right ventricular dysfunction may also be treated with mechanical support. This case presents a patient with mixed cardiogenic and septic shock requiring placement of a percutaneous right ventricular assist device. A 38-year-old obese male with a medical history of alcoholism presented to the hospital with a complaint of dyspnea. He was found to have volume overload and was given intravenous diuretics. However, he had progressive renal insufficiency, hypotension requiring vasopressor support, and worsening respiratory status requiring mechanical ventilation. An echocardiogram showed a severely enlarged right ventricle, reduced RV function, normal RV wall thickness, moderate to severe tricuspid regurgitation, a severely dilated right atrium, ventricular septal flattening, and mild pulmonary hypertension. Left ventricular ejection fraction was 65-70%, LV diastolic function was normal, and there were no other significant valvular abnormalities. Troponin levels, ECG, and CT pulmonary angiography were unrevealing. Right heart catheterization showed a right atrial pressure of 29 mmHg (2 – 6 mmHg), right ventricular pressures of 50/24 mmHg (15-25/0-8 mmHg), pulmonary artery pressures of 56/35/43 mmHg (15-25/8-15/10-20 mmHg), a pulmonary capillary wedge pressure of 22 mmHg (6-12 mmHg), and a Prognostic Impact of Pulmonary Artery Pulsatility Index (PAPi) score of 0.3 to 0.6 (>1). Cardiac chamber oxygen saturations did not demonstrate intracardiac shunting. A right-sided mechanical circulatory support device was placed. The hospital course was complicated by sepsis due to pneumonia and presumed central line-associated bloodstream infection requiring antibiotic therapy, anemia secondary to device-related hemolysis requiring blood transfusions, renal failure requiring renal replacement therapy, and candidemia requiring antifungal therapy. Due to concern for device-associated infection, his central lines were replaced. The mechanical circulatory support device was able to be removed after ten days. Subsequent cardiac imaging did not reveal any other structural abnormalities, and a definitive cause for the right heart failure was not determined. Etiologies of right-sided heart failure include left-sided heart failure, pulmonary hypertension, chronic pulmonary disease, myocardial infarction, pulmonary embolism, myocarditis, valvular dysfunction, and congenital anomalies. Mechanical circulatory support may be used to support cardiac function, to allow the ventricular function to improve. Potential complications of mechanical circulatory support include infection, hemolysis, bleeding, device migration, and malfunction. RVAD therapy should be considered for patients with isolated right ventricular failure refractory to less invasive therapy.

Indiana University-Purdue University Indianapolis (IUPUI) / The number of patients with chronic heart failure (HF) is at an all-time high and the incidence is expected to increase as our population ages. HF patients experience impaired cognition, exertional shortness of breath, and persistent fatigue; therefore, family members are needed to assist with their care at home. Although existing literature suggests that HF caregivers experience negative physical, mental, and social outcomes, there is a lack of studies guided by a conceptual model to determine factors associated with these outcomes. The purpose of this study was to determine factors associated with HF caregiver depressive symptoms, life changes, and quality of life guided by a conceptual model derived from Lazarus and colleagues’ transactional approach to stress. Psychometric properties of a new HF caregiver-specific quality of life (HFCQL) scale were also determined. Using a descriptive design, a convenience sample of 100 HF caregivers was interviewed by telephone using established measures along with the new HFCQL scale. The 16-item HFCQL scale, which measures physical, psychological, social, and spiritual well-being demonstrated evidence of internal consistency reliability (alpha = .89); 2-week test-retest reliability (ICC = .83); construct validity, as evaluated with factor analysis (loadings > .32) and hierarchical multiple regression (59% variance, p < .001); and criterion validity, as shown with significant (p < .001) correlations with the Bakas Caregiving Outcomes Scale (r = .73), SF-36 general and mental health (r = .45; .59), and a single overall QOL item (r = .71). Using hierarchical multiple regression, the model constructs accounted for 35% variance of depressive symptoms, 46% variance of life changes, and 59% variance of HFCQL (p < .001). Factors significantly associated with these outcomes included caregiving task difficulty, uncertainty, social support, and threat appraisal. Support for the conceptual model was provided, and potential areas for intervention development were identified. The new HFCQL scale showed potential as a quality outcome measure in HF caregivers, and might be used to screen HF caregivers for poor quality of life. Further research using the proposed conceptual model and the HFCQL scale is warranted. Tamilyn Bakas, DNS, RN, Chair

Akut hjärtsvikt definieras som en debut eller försämring av hjärtsvikt. Hjärtsvikt är ett allvarligt tillstånd där hjärtat inte upprätthåller adekvat hjärtminutvolym för att möta kroppens metaboliska behov vilket leder till trötthet och försämrad livskvalitet. Symtom som relaterar till systemisk vätskeansamling är vanliga vid akut hjärtsvikt. Vätskeansamling och hypoperfusion ökar morbiditet och mortalitet. Patienter med akut hjärtsvikt behöver således snabba och effektiva behandlingar, men också långtidsbehandling efter utskrivning. Avsvällande/vattendrivande behandling är hörnstenen i den terapeutiska behandlingen och loopdiuretika anses som det mest effektiva och snabbverkande läkemedlet. I dagsläget är empagliflozin ett rekommenderat läkemedel för behandling av kronisk hjärtsvikt med nedsatt ejektionsfraktion, då empagliflozins diuretiska egenskap kan stärka effekten av loopdiuretika.   Syftet med detta examensarbete var att beskriva effekter hos empagliflozin vid behandling av akut hjärtsvikt som en litteraturstudie. En sökning av randomiserade kliniska prövningar gjordes i PubMed där nio artiklar valdes ut för att ingå i detta examenarbete. Resultatet av de granskade artiklarna visade att empagliflozin som tilläggsbehandling till loopdiuretika ökade urinutsöndring hos patienterna. Resultatet visade också en statistiskt signifikant minskning av NT-proBNP i studierna vars behandlingstid var 5, 7, 15 och 30 dagar jämfört med placebo. Vidare minskade empagliflozin också plasmavolymen och mängden urinsyran i plasman. Två av studierna rapporterade en statistiskt signifikant ökning i andel röda blodkroppar i behandlingsgruppen. Insättning av empagliflozin, hos kliniskt stabila sjukhusvårdade patienterna i studien EMPULSE, gav en statistiskt signifikant klinisk nytta definierat som ett hierarkiskt kompositmått av död oavsett orsak, antal hjärtsviktsepisoder, tid till första hjärtsviktsepisod och klinisk meningsfull förbättring i KCCQ-TSS med vinstratio 1,36. Vidare gav empagliflozin en positiv effekt på viktminskning, ökad diuretisk respons, ödemlindring och ökad livskvalitet under 90 dagars behandling. Hos patienter som fick empagliflozin sänktes eGFR något till en början men återställdes senare. Det fanns dock inte någon statistiskt signifikant skillnad i eGFR mellan grupperna. En av studierna visade på en signifikant minskning av biomarkörer hos patienter som fick empagliflozin vilket gav en njurfunktionsskyddande effekt mot akut njurskada.  Slutsatsen var att empagliflozin gav gynnsamma effekter såsom till exempel avsvällande/vätskedrivande effekt och klinisk fördel hos patienter med såväl akut de novo som med dekompenserad kronisk hjärtsvikt vilket betydde att läkemedlet var både säkert och effektivt. I framtiden behöver effekterna dock styrkas genom ytterligare studier med större antal deltagare och under längre behandlingstid efter sjukhusutskrivning.