Research Objectives Heart failure (HF) is a common condition in persons older than 65 years. Existing literature indicated that hospital readmission rates after discharge for heart failure patients are immensely high. However, previous studies showed that almost half of the early hospital readmissions could be prevented. Moreover, Angiotensin-converting enzyme (ACE) inhibitor and Angiotensin receptor blocker (ARB) are the commonly used medications for heart failure patients to control blood pressure. Nevertheless, studies indicated that these two medications could also cause the risk of hospital readmission. Little studies examined the associations of medication use and hospital readmission of heart failure patients in Taiwan. This study aims to investigate the influence factors of hospital readmissions among heart failure patients in Taiwan. Study Design We collected the data from National Health Insurance (NHI) database during the period from year 2000 to 2006. Based on the rule of Bureau of National Health Insurance in Taiwan, the 14-day readmission is considered as a poor quality indicator. We categorized readmissions into 4 groups (14-day, 30-day, 180-day and over 180-day) and evaluated each group¡¦s demographic, hospital characteristics, medical resource utilization, Charlson Comorbidity Index and medication utilizations of ACE inhibitor and ARB. We conducted descriptive analyses by using chi-square and t tests and applied multivariate logistic regression analyses to estimate the probabilities of hospital readmissions of heart failure patients. Population Studied Patients aged 50 or older with heart failure were identified based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Principle Findings Among 1920 heart failure patients, 19.9% of them were readmitted within 14 days, 7.6% were readmitted within 30 days and 26% were readmitted within 180 days. The medical resource utilizations such as average inpatients cost per patient, average outpatients cost per patient, total medical cost, average of inpatients times per patient and average of outpatients times per patient were significantly higher in patients with readmissions than those without readmission. Age, Charlson Comorbidity Index, patients who had been treated with ACE inhibitors and patients who had been treated with ARB were significantly affected the probabilities of readmissions. Conclusion The heart failure patients with readmissions had significantly higher medical resource utilizations than those without readmission. The medication uses of ACE inhibitors or ARB were significantly affected the probabilities of hospital readmissions. By understanding more about the influence factors of readmissions among heart failure patients, we may provide continue improvements of quality of care and reduce unnecessary medical costs. This study results provide useful reference for policy-makers to establish effective disease management program and appropriate health care financing arrangement in the future.

<p>Ventricular Assist Devices (VADs) are mechanical pumps used to off-load a deceased heart, primarily in late stage congestive heart failure patients. VAD employment may facilitate cardiac recovery, but most often provides time before a suitable heart transplant can be found. Lately, long term use VAD systems have been introduced as an alternative to a heart transplant.</p><p>Traditionally, design of VADs has employed either displacement based pump technologies or radial-flow pumps, also known as rotodynamic pumps. A displacement pump induces a mechanical force on a fluid contained within a defined space, hence giving it motion. Radial-flow pumps impart momentum to a fluid, most often by placing a rotating device in the fluid.</p><p>This thesis introduces a novel pumping concept, combining features from both displacement and radial-flow pumps. A first prototype, the Vivicor^TM pump, has been designed, fabricated and evaluated In Vitro, the results reported in this thesis.</p><p>The In Vitro evaluation of the Vivicor^TM pump provides evidence of a pump with mechanical self-regulation based on pump pre-load level, much like a displacement pump. The Vivicor^TM pump also displays pulsating outflow in combination with an inflow both during pump systole and diastole. The latter provides potential advantages over traditional displacement pumps as smaller cannulae or catheters can be used, facilitating miniaturization. Continuos filling throughout the pumping cycle also require less pressure to be exerted on the fluid, compared to displacement pumps, limiting the risk of mechanical damage to the pumped fluid. The In Vitro evaluation has also provided further insights on necessary design modifications in the second-generation Vivicor^TM prototype, currently planned. The Vivicor^TMpumping technology is highly interesting for further development and evaluation for use in ventricular assist applications.</p>

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Rationale: In the breast cancer setting, anti-cancer therapies, including Doxorubicin (DOX) and Trastuzumab (TRZ), are associated with an increased risk of cardiotoxicity. There is a need to develop prophylactic cardioprotective agents to mitigate the cardiotoxic side effects of these common anti-cancer drugs. Objective: To investigate whether the anti-oxidant, N-acetylcysteine amide (NACA), can attenuate the drug-induced heart failure caused by DOX+TRZ in a murine model. Methods: A total of 100 female mice received one of the following drug regimens: i) saline; ii) NACA; iii) DOX; iv) TRZ; v) DOX+TRZ; vi) NACA+DOX; vii) NACA+TRZ; and viii) NACA+DOX+TRZ. Serial echocardiography was performed over a 10-day study period, after which the mice were euthanized for histological and biochemical analyses. Results: In mice receiving DOX, left ventricular ejection fraction (LVEF) decreased from 73±4% to 43±2% at day 10. In mice receiving DOX+TRZ, LVEF decreased from 72±3% to 32±2% at day 10. Prophylactic administration of NACA to mice receiving DOX or DOX+TRZ was cardio-protective with an LVEF of 62±3% and 55±3% at day 10, respectively. Histological and biochemical analyses demonstrated loss of cellular integrity, increased oxidative stress (OS), and increased cardiac apoptosis in mice treated with DOX+TRZ which was attenuated by the prophylactic administration of NACA. Conclusion: NACA attenuates the cardiotoxic side effects of DOX+TRZ in a murine model of chemotherapy induced cardiac dysfunction by decreasing OS and apoptosis. / October 2015

Bakgrund: Hjärtsvikt är en allvarlig sjukdom som drabbar många äldre personer. Olika orsaker gör att hjärtats förmåga att tillförse kroppen med tillräcklig mängd blod minskat. Sjukdomen är kronisk och de drabbade tvingas ofta leva med flera fysiska och psykiska symtom. Att drabbas av en kronisk sjukdom kan på flera sätt vara omskakande för många och påverka livskvaliten. Syfte: Syftet med litteraturstudien var att belysa hur äldre personer med hjärtsvikt upplever livskvalitet. Metod: En allmän litteraturstudie baserad på nio artiklar med kvalitativ ansats. Resultat: Fyra huvudkategorier identifierades där upplevelsen av hjärtsvikt baseras på: Förlust av tidigare förmågor; Betydelsen av stöd och att vara beroende av andra; Att bli begränsad i sin vardag; Det kunde varit värre. Slutsats: Upplevelsen av livskvalitet påverkas såväl av den fysiska begränsning som uppstår genom sjukdomens olika symtom som av personens sociala stöd och inställning till livet. Genom en god förståelse för hur äldre personer med hjärtsvikt upplever livskvalitet ökar sjuksköterskans möjlighet att stötta dessa personer och hjälpa till att bevara en god livskvalitet trots sjukdomen. / Background: Heart failure is a serious condition that affects many elderly people. Different causes reduce the heart's ability to provide the body with enough blood. The disease is chronic and the patients are often forced to live with multiple physical and psychological symptoms. To suffer from a chronic illness can in many ways be shattering for many and affect quality of life. Aim: The aim of this study was to illuminate how older people with heart failure experience quality of life. Method: A literature review based on nine articles with qualitative approach. Results: Four main categories were identified where the experience of heart failure based on: Loss of previous abilities; The importance of support and being dependent; To be limited in their everyday lives; It could have been worse. Conclusion: The experience of quality of life is affected by both the psychological limitation caused by the disease different symptoms, the person's social support and approach to life. Through a good understanding of how older people with heart failure experiences the quality of life gives the nurse the opportunity to support these people and help to preserve a good quality of life despite the disease.

Mechanical circulatory support (MCS) is a viable therapy for end stage heart failure. However, despite clinical success, the ability to compare MCS devices in vitro and perform training scenarios is extremely limited. Comparative studies are limited as different devices cannot be interchanged in a patient due to the surgical nature of implant. Further, training and failure scenarios cannot be performed on patients with devices as this would subject a patient to a failure mode. A need exists for a readily available mock system that can perform comparative testing and training scenarios with MCS devices. Previously, our group has fabricated a well characterized mock circulation system consisting of a SynCardia temporary Total Artificial Heart (TAH) and Donovan Mock Circulation tank (DMC tank). Further, utilizing this system with the TAH operating in reduced output mode, a heart failure model was developed. In the present study, three ventricular assist devices (VADs) were independently attached to the heart failure model to compare device performances over a range of preloads and afterloads. In addition, specific clinical scenarios were created with the system to analyze how VAD-displayed waveforms from the system correlate with clinical scenarios. Finally, each VAD was powered off while attached to the heart failure model to compare fluid flow through the VAD in a pump-failure scenario. We demonstrated that this system can successfully be utilized to compare MCS devices (i.e. ventricular assist devices) and for successful training of patients and clinicians.

The most recognized risk associated with the HeartMate II is thrombosis. In the presence of developing clot, the HeartMate II Display Monitor and System Controller senses a decrease in pump flow and is accompanied by audible and visual alarms when flow rates drop below a certain threshold; however, when flow is completely inhibited, the Display Monitor and System Controller both fail to indicate that flow has reduced to zero and does not produce any corresponding alarms. To test the efficacy of the HeartMate II alarms, the Donavan Mock was used to simulate the hemodynamics of a typical heart failure patient. The hemodynamics were then improved by the addition of the HeartMate II LVAS. Partially occluding the inflow and outflow of the HeartMate II did display changes in flow and presented with alarms when appropriate; however, complete occlusions of the device failed to produce any alarms or accurate changes in flow.

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Low levels of physical activity (PA) are a significant predictor of early death among recipients of implantable cardioverter defibrillators (ICDs). Regular, moderate PA is associated with improved quality of life (QOL), reduced arrhythmia burden, and improved health outcomes in ICD recipients yet many do not engage in PA and the reasons for lack of engagement are unclear. The purpose of this descriptive, cross-sectional study was to examine health beliefs related to PA and QOL in adults living with ICDs. The Health Belief Model provided the theoretical framework for this study. A convenience sample of 107 adult, ICD recipients (26 females and 81 males) were recruited from five cardiology clinic settings within the same private practice. Seventy-seven percent completed the study tasks (N=81). Subjects completed a Demographic Data Questionnaire, Self-Efficacy Expectations after ICD Scale, Exercise Self-Efficacy Scale, Health Belief Questionnaire, Incidental and Planned Exercise Questionnaire and Quality of Life Medical Outcomes Survey-SF36®. Clinical data was collected from the medical record. Mean age of the subjects was 70.23 yrs. ± 11.76 yrs. The majority were male (71.6 percent) and 77.8 percent were White, non-Hispanic. Most were insured by Medicare (79 percent), were retired (50 percent) and reported incomes less than 20,000 dollars/year (39 percent). Over 98 percent were diagnosed with heart failure and almost 40 percent reported their physical activity had decreased since having an ICD implanted. There were no differences in health beliefs and QOL scores between subjects who had an ICD as a primary or secondary prevention of sudden cardiac death. Predictors of PA participation in this population were Self-Efficacy for Exercise (SEE) beliefs, Self-Efficacy ICD (SEICD) beliefs, age and NYHA Class. Almost 33 percent of variance in PA participation can be explained by SEE (b = 2.407, β = .390, t = 3.911, p<.01); SEICD (b =2.304, β = .215, t = 2.149, p<.05); age (b = -.394, β = -.234, t =-2.277, p<.05); and NYHA Class (b = -6.373, β =-.198, t = -1.998, p =<.05). Findings indicate the strength of self-confidence in influencing healthy behavior. Findings support the need for more research in identifying barriers and predictors of PA participation in adult, ICD recipients.