Introdução: Níveis de fator de necrose tumoral–alfa (TNF-α), N-peptídeo do pró-colágeno III (PIIINP) e metaloproteinase de matriz –1 (MMP-1), marcadores biológicos de remodelamento ventricular, estão elevados em pacientes com insuficiência cardíaca (IC), talvez refletindo elevadas pressões de enchimento. A correlação destes marcadores com variáveis clínicas e hemodinâmicas permanece pouco compreendida, particularmente no contexto ambulatorial da IC. Objetivo: Avaliar níveis séricos de marcadores biológicos de remodelamento ventricular em pacientes com IC, comparando tratamento guiado por ecocardiografia (ECO), buscando redução de pressões de enchimento, versus tratamento convencional (CLÍNICO), baseado em sinais e sintomas. Métodos: Ensaio clínico randomizado. Pacientes estáveis com IC e fração de ejeção menor do que 40% foram alocados entre os grupos de tratamento e submetidos a ecocardiograma e coletas de sangue no início do estudo e em 180 dias. TNF-α e MMP- 1 foram medidos por ELISA, e PIIINP, por radioimunoensaio. Resultados: Incluiu-se 80 pacientes, com 59 ± 15 anos e fração de ejeção de 26 ± 7%; 25% isquêmicos e 52% masculinos. Houve redução dos marcadores biológicos intragrupos, não havendo diferença entre os tratamentos. No grupo CLÍNICO, os níveis de TNF-α, MMP-1 e PIIINP apresentaram diferenças estatisticamente significativas entre os momentos basal e final (respectivamente, 3,11 ± 2,90 versus 1,24 ± 0,60 pg/mL p < 0,0003; 2,66 ± 1,00 versus 1,16 ± 0,40 ng/mL p < 0,0001; 6,12 ± 2,60 versus 3,89 ± 1,60 μg/L p < 0,0001). De maneira semelhante, tal diferença também foi observada no grupo ECO para os três marcadores (respectivamente, 3,90 ± 4,90 versus 1,40 ± 1,30 pg/mL p < 0,0001; 2,50 ± 0,90 versus 1,09 ± 0,40 ng/mL p < 0,0001; 6,09 ± 2,60 versus 3,50 ± 1,30 μg/L p<0,0001). Ao final da intervenção, no entanto, não foi observada diferença significativa dos valores de TNF-α , MMP-1 e PIIINP entre os dois grupos de tratamento (p = 0,7; p = 0,8; e p = 0,2; respectivamente). A combinação dos valores basais das variáveis biológicas gerou um escore que se associou significativamente com o comportamento final das pressões atrial direita e sistólica da artéria pulmonar. Pacientes com marcadores biológicos basais no quartil 75% mantiveram níveis superiores de pressões atrial direita (13 mmHg; p = 0,034) e sistólica de artéria pulmonar (60 mmHg; p = 0,007) ao final do seguimento. Conclusão: Independente do tratamento alocado, houve redução dos níveis de marcadores biológicos ao final do seguimento; no entanto, níveis basais mais elevados destes marcadores foram preditores de menor redução das pressões em átrio direito e sistólica da artéria pulmonar. Os dados sugerem que indicativos de intenso processo de remodelamento ventricular se associam à progressão da IC e a pressões de enchimento elevadas. / Introduction: Levels of tumor necrosis factor-alpha (TNF-α), N-terminal propeptide of type III collagen (PIIINP) and type 1 matrix metalloproteinase (MMP-1), biological markers of ventricular remodeling, are elevated in heart failure (HF) patients, perhaps reflecting elevated filling pressures. The correlation of these markers with clinical and hemodynamic variables remains poorly understood, particularly in the outpatient setting. Objective: To evaluate serum levels of ventricular remodeling biological markers in patients with HF, comparing a conventional clinically-oriented treatment (Conventional Therapy), based on clinical signs and symptoms, to an echocardiography-guided treatment (Echo-guided Therapy), aiming at a reduction in filling pressure levels. Methods: Randomized trial. Stable patients with HF and ejection fraction lower than 40% were allocated to the treatment groups and submitted to echocardiography and blood sampling at the beginning of the study and after 180 days. TNF-α and MMP-1 were measured by ELISA, and PIIINP, by radioimmunoassay. Results: Eighty patients at 59 ± 15 years and a mean ejection fraction of 26 ± 7% were included; 25% were ischemic and 52%, males. There was a reduction in intragroup biological markers, without difference between treatments. TNF-α, MMP-1 and PIIINP levels were statistically different between baseline and final in patients allocated to Conventional Therapy (respectively, 3.11 ± 2.90 versus 1.24 ± 0.60 pg/mL p < 0.0003; 2.66 ± 1.00 versus 1.16 ± 0.40 ng/mL p < 0.0001; 6.12 ± 2.60 versus 3.89 ± 1.60 μg/L, p < 0.0001). Similarly, such a difference was also observed in the Echo-guided Therapy for the 3 markers (respectively, 3.90 ± 4.90 versus 1.40 ± 1.30 pg/mL p < 0.0001; 2.50 ± 0.90 versus 1.09 ± 0.40 ng/mL p < 0.0001; 6.09 ± 2.60 versus 3.50 ± 1.30 mg/L p<0.0001). By the completion of the intervention, however, no significant difference was observed in the values of TNF-α, MMP- 1 and PIIINP between the 2 treatment groups (p = 0.7; p = 0.8; and p = 0.2; respectively). A composite score incorporating baseline biological marker levels was statistically associated to final right-sided pressure levels (right atrial pressure and pulmonary artery systolic pressure). Patients with baseline biological marker levels over percentile 75 maintained higher right atrial (13 mmHg; p = 0.034) and pulmonary artery systolic pressures (60 mmHg; p = 0.007) at the end of protocol. Conclusion: Regardless of allocated treatment group, biological marker levels were lower at the end of the follow-up; however, higher baseline levels of these markers were predictive of lower reductions in right atrial pressure and pulmonary artery systolic pressure. The data obtained suggest that indicators of an intense remodeling process are associated with elevated filling pressures and progression of HF.

Master of Science / Department of Kinesiology / Timothy I. Musch / Chronic heart failure (CHF) reduces nitric oxide (NO) bioavailability and impairs skeletal muscle vascular control during exercise. Reduction of nitrite (NO[subscript]2-) to NO may impact exercise-induced hyperemia particularly in muscles with pathologically-reduced O[subscript]2 delivery. We tested the hypothesis that NO[subscript]2- infusion would increase exercising skeletal muscle blood flow (BF) and vascular conductance (VC) in CHF rats with a preferential effect in muscles composed primarily of type IIb+IId/x fibers. CHF (coronary artery ligation) was induced in adult male, Sprague-Dawley rats. Following a >21 day recovery, mean arterial pressure (MAP, carotid artery catheter) and skeletal muscle BF (radiolabelled microspheres) were measured during treadmill exercise (20 m•min[superscript]-1, 5% incline) with and without NO[subscript]2- infusion. The myocardial infarct size (35 ± 3%) indicated moderate CHF. NO[subscript]2- infusion increased total hindlimb skeletal muscle VC (CHF: 0.85 ± 0.09, CHF+NO[subscript]2-: 0.93 ± 0.09 ml•min[superscript]-1•100g[superscript]-1•mmHg[superscript]-1, p<0.05) without changing MAP (CHF: 123 ± 4 mmHg, CHF+NO[subscript]2-: 120 ± 4 mmHg, p=0.17). Total hindlimb skeletal muscle BF was not significantly different (CHF: 102 ± 7, CHF+NO[subscript]2-: 109 ± 7 ml•min[superscript]-1•100g[superscript]-1, p>0.05). BF increased in 6 (~21%) and VC in 8 (~29%) of the 28 individual muscles and muscle parts. Muscles and muscle portions exhibiting greater BF and VC following NO[subscript]2- infusion were comprised of ≥63% type IIb+IId/x muscle fibers. These data demonstrate that NO[subscript]2- infusion can augment skeletal muscle vascular control during exercise in CHF rats. Given the targeted effects shown herein, a NO[subscript]2[superscript]--based therapy may provide an attractive “needs-based” approach for treatment of the vascular dysfunction in CHF.

Doctor of Philosophy / Department of Anatomy and Physiology / Timothy I. Musch / Matching local muscle O[subscript]2-supply to O[subscript]2-demand during the prodigious exercise-induced metabolic challenge is achieved through coordinated mechanisms of vascular control. The unique sensitivity of ATP-sensitive potassium (K[subscript]ATP) channels to cell metabolism indicates the potential to match energetic demand to peripheral O[subscript]2 transport. The aim of this dissertation was to determine the magnitude and kinetics of the K[subscript]ATP channel contribution to vascular control during exercise in health and heart failure. It was hypothesized that K[subscript]ATP channel inhibition via glibenclamide would, in healthy rats, 1) reduce exercising skeletal muscle blood flow and vascular conductance 2) speed the fall of microvascular O[subscript]2 driving pressure (PO[subscript]2mv; set by the O[subscript]2 delivery-O[subscript]2 utilization ratio) during muscle contractions and 3) in heart failure rats, augment the PO[subscript]2mv undershoot and delay the time to reach the contracting steady-state. A total of 55 male Sprague-Dawley rats were used under control and glibenclamide conditions (5 mg kg[superscript]-1). Hindlimb muscle blood flow (radiolabelled microspheres) was determined at rest (n = 6) or during treadmill exercise (n = 6-8; 20, 40 and 60 m min[superscript]-1, 5% incline). Spinotrapezius muscle PO[subscript]2mv (phosphorescence quenching) was measured in 16 heart failure (coronary artery ligation) and 12 healthy rats and during 180 s of 1-Hz twitch contractions (~6 V). The major effects of glibenclamide were, in healthy rats, 1) a reduction in exercising hindlimb skeletal muscle blood flow with the greatest effect in predominantly oxidative muscle fiber types and at higher running speeds 2) an increased prevalence of the undershoot of PO[subscript]2mv steady-state and doubled time to reach the steady-state and 3) in heart failure rats, a reduced baseline PO[subscript]2mv, an augmented undershoot of the steady-state and time to reach steady-state and a reduction in the mean PO[subscript]2mv during contractions. These data suggest that the K[subscript]ATP channel contributes substantially to exercise-induced hyperemia and may contribute to the slowing of VO[subscript]2 kinetics given the spatial and temporal effects of glibenclamide. The K[subscript]ATP channel-mediated protection against a severe O[subscript]2-delivery to O[subscript]2-utilization mismatch at the onset of contractions raises serious concerns for sulphonylurea treatment in diabetes which is likely to cause perturbations of [metabolite] and compromise exercise tolerance.

abstract: ABSTRACT The population of older adults in the United States is growing disproportionately, with corresponding medical, social and economic implications. The number of Americans 65 years and older constitutes 13.7% of the U.S. population, and is expected to grow to 21% by 2040. As the adults age, they are at risk for developing chronic illness and disability. According to the Centers for Disease Control and Prevention, 5.7 million Americans have heart failure, and almost 80% of these are 65 years and older. The prevalence of heart failure will increase with the increase in aging population, thus increasing the costs associated with heart failure from 34.7 billion dollars in 2010 to 77.7 billion dollars by 2020. Of all cardiovascular hospitalizations, 28.9% are due to heart failure, and almost 60,000 deaths are accounted for heart failure. Marked disparities in heart failure persist within and between population subgroups. Living with heart failure is challenging for older adults, because being a chronic condition, the responsibility of day to day management of heart failure principally rests with patient. Approaches to improve self-management are targeted at adherence, compliance, and physiologic variables, little attention has been paid to personal and social contextual resources of older adults, crucial for decision making, and purposeful participation in goal attainment, representing a critical area for intervention. Several strategies based on empowerment perspective are focused on outcomes; paying less attention to the process. To address these gaps between research and practice, this feasibility study was guided by a tested theory, the Theory of Health Empowerment, to optimize self-management, functional health and well-being in older adults with heart failure. The study sample included older adults with heart failure attending senior centers. Specific aims of this feasibility study were to: (a) examine the feasibility of the Health Empowerment Intervention in older adults with heart failure, (b) evaluate the effect of the health empowerment intervention on self-management, functional health, and well-being among older adults with heart failure. The Health Empowerment Intervention was delivered focusing on strategies to identify and building upon self-capacity, and supportive social network, informed decision making and goal setting, and purposefully participating in the attainment of personal health goals for well-being. Study was feasible and significantly increased personal growth, and purposeful participation in the attainment of personal health goals. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2017

目的：本研究以真武湯及其加減方對慢性充血性心力衰竭作用的系統文獻研究，用Meta 分析法評價其臨床療效和安全性。 方法： 以“心力衰竭"或“心衰"或“心悸"或"喘證"或"水腫"或"胸痹"和“真武湯 為中文檢索主題詞 “heart failure" 、"zhenwu"為英文檢索詞，在中國科技期刊資料庫（ V I P ） 、中國期刊全文資料庫（ CNKI) 、萬方資料庫、中國生物醫學文獻資料庫（ CBM ） 、PubMed 、The Cochrane Library 和EMbase 的資料庫檢索近五年文獻。(2011年至2015年12月），並手工檢索相關雜誌，獲取真武湯及其加減方治療慢性充血性心力衰竭的臨床隨機對照試驗的文獻。對文獻的研究質量進行評價，並選取Jadad 評分l分及以上、資料恰當的研究，採用RevMan 5.3 軟件進行Meta 分析，用倒漏斗圖檢測是否存在發表偏倚。 結果：納入的54個研究中（4422名患者），均為單中心的開放對照試驗。這些研究對治療後的臨床療效有效率、心功能療效、6分鐘步行試驗等指標進行了評價，選取研究分組及干預措施相近、評價指標一致的研究，按同一評價指標和療效判定標準者嘗試合併, Meta 分析提示治療組改善優於對照組： (1 ) 9 個研究根據2002版的《中藥新藥臨床研究指導原則〉以臨床療效的總有效率為評價指標，其合併效應量0R=4.09, 95%CI(2.66, 6.29), Z=6.42(P<0.00001 ），兩名且比較有統計學意義，提示治療組在臨床療效總有效率上優於對照組。（ 2) 7 個研究參考2002 版的《中藥新藥臨床研究指導原則〉以心功能療效的有效率為評價指標，其合併效應量OR二3 .6 2, 95%CI(2.23, 5.88), Z=5.20(P<0.00001) ，比較有統計學意義，提示治療組在慢性心寰的心功能療效方面優於常規西藥組。（ 3) 5 個研究根據2002 版的〈中藥新藥臨床研究指導原則〉以中醫證候療效為評價指標， 其合併效應量OR=S.24, 95%CI(2.90,9.47), Z二5.4 (P<0.00001) ，兩名且比較有統計學意義，提示治療組的中醫證候療效優於對照組。（ 4 )5 個研究以6 分鐘步行試驗為評價指標，MD=41.66, 95%CI(38.57, 44.74), Z=26.45(P<0.00001) ，兩組比較有統計學意義，提示治療組對慢性心力衰竭患者6 分鐘步行試驗的改善情況優於對照組。有15 個研究提及不良反應，其中1 2 個未出現不良反應，剩餘3 個研究，治療組不良反應的病例數並不多於對照組，對症處理後緩解，或自行緩解。描述隨訪的2個研究中，發生病情惡化和猝死的為其他原因引起。故無足夠證據說明真武湯及其加減方的不良反應，其安全性有待進一步研究。 結論：真武湯及其加減方在短期內有提高CHF 患者臨床療效的總有效率、心功能療效、中醫證候療效， 改善6 分鐘步行試驗等指標的趨勢，但對於遠期復發率、病死率及安全性， 評價證據不足，有待進一步驗證。

No description available.

Background: Patients with heart failure are a common patient group in many caring facilities. Previous research shows that the number of heart failure patients may increase in the future and that nurses do not have enough knowledge of how to treat patients with heart failure. Aim: To describe patients’ experiences of living with heart failure. Method: A literature study with descriptive synthesis. Result: Patients with heart failure may experience a change in life. These changes are limitations in performing physical activities which may result in increased stress on relatives and friends. Patients can feel that they are a burden as they become more dependent on others. Heart failure causes patients to experience anxiety and fear in their lives. Despite adverse consequences of heart failure, patients can accept the situation and thereby experience well-being. Conclusion: lack of knowledge, bodily and emotional changes were the root cause of patients experiencing a change in life due to heart failure. Nurses can help patients deal with the new life through support and good information. They should be perceptive to patients' experiences and can therefore promote patient’s well-being. / Bakgrund: Patienter som lever med hjärtsvikt är en patientgrupp som förekommer inom flertalet vårdverksamheter. Tidigare forskning visar att antalet hjärtsviktspatienter kan komma att öka framöver och att sjuksköterskor inte har tillräcklig kunskap om hur de ska vårda patienter som lever med hjärtsvikt. Syfte: Att beskriva patienters upplevelser av att leva med hjärtsvikt. Metod: En litteraturstudie med beskrivande syntes. Resultat: Patienter som lever med hjärtsvikt kan uppleva förändringar i vardagen. Dessa förändringar är begränsningar av att utföra fysiska aktiviteter vilket kan resultera i ökad påfrestning för närstående och vänner. Patienter kan uppleva att de är en börda då de blir mer beroende av andra. Hjärtsvikt leder till att patienter kan uppleva oro och rädsla i vardagen. Trots negativa konsekvenser av hjärtsvikt kan patienter acceptera situationen och genom detta uppleva välbefinnande. Slutsats: Kunskapsbrist, kroppsliga- och emotionella förändringar var grundorsaken till att patienter upplever en förlorad kontroll över vardagen orsakat av hjärtsvikt. Sjuksköterskor kan hjälpa patienter att hantera den nya vardagen genom stöd och god information. De bör vara lyhörda till patienters upplevelser och kan därmed främja patienters välbefinnande.

INTRODUÇÃO: A insuficiência cardíaca (IC) constitui hoje um dos maiores problemas de saúde pública em todo o mundo, com números crescentes em qualquer análise epidemiológica. Além de representar grande demanda aos serviços de saúde, é responsável por prejuízo na qualidade de vida das pessoas. Alterações do sono têm sido descritas como freqüentes e comuns entre os pacientes com IC, e também é um dos sintomas de mais incômodo para esta população. OBJETIVO: Descrever o padrão de sono em pacientes com IC e analisar associações do padrão de sono com as seguintes variáveis: sexo, idade, fadiga, fadiga ao esforço, atividade física, classe funcional, terapia medicamentosa, dispnéia e índice de massa corporal. MÉTODO: Estudo transversal descritivo, com uma amostra não probabilística de 400 pacientes ambulatoriais (idade média 57,8 anos, DP=11,6; 64,8% eram homens; escolaridade média de 6,1 anos, DP=3,9; 82,5% em classe funcional II ou III) em tratamento de insuficiência cardíaca em um hospital de ensino. Os dados foram coletados por meio de entrevista em que os participantes responderam a um conjunto de instrumentos contendo: dados de demográficos e da insuficiência cardíaca; e avaliação do padrão de sono (Pittsburg Sleep Quality Index PSQI); de fadiga (Dutch Fatigue Scale DUFS), fadiga ao esforço (Dutch Exertion Fatigue Scale), atividade física (International Physical Activity Questionnaire) e dados sobre dispnéia, tabagismo e terapia medicamentosa. Os instrumentos mostraram boa consistência interna na amostra deste estudo (no PSQI = 0,73; na DUFS = 0,90 e na DEFS = 0,92). Testes não paramétricos foram aplicados para analisar a associação do padrão de sono com variáveis selecionadas e um modelo de regressão logística foi ajustado para investigar os preditores de maus dormidores. RESULTADOS: O escore total médio no PSQI foi 8,70 (DP = 4,39); a prevalência de maus dormidores (PSQI > 5) foi de 68,5%; e 46,5% classificou o sono como ruim ou muito ruim. Escores mais elevados no PSQI ou categoria de mau dormidor foram associados com: sexo feminino (p=0,009); não empregados (p=0,013), fadiga (p=0,000), fadiga ao esforço (p=0,000), dispnéia (p=0,000) e classes funcionais mais elevadas da IC (p=0,000). Dispnéia (OR = 3,23; IC95%1,72 6,07) e fadiga (OR = 3,45; IC95%1,82 6,49) associaram-se independentemente à categoria de mau dormidor. CONCLUSÕES: A proporção de maus dormidores entre os pacientes com IC está entre as mais altas nas doenças crônicas. Dispnéia e fadiga, sintomas comuns nessa enfermidade, aumentam significativamente a chance de ser mau dormidor. Portanto, o padrão do sono dos pacientes com IC deve ser rotineiramente avaliado. / INTRODUCTION: Heart failure (HF) is one of the largest public health problems worldwide, with increasing numbers in any epidemiological analysis. Besides representing a large demand for health services, it is responsible for poor quality of life. Sleep disorders have been described as frequent and common among patients with HF, as well as one of the most troublesome symptoms for this population. OBJECTIVE: To describe sleep patterns in patients with HF and examine associations of sleep pattern with the following variables: gender, age, fatigue, fatigue on exertion, physical activity, functional class, drug therapy, dyspnea, body mass index, and smoking habits. METHODS: A cross sectional study, with a non-probability sample of 400 outpatients (mean age 57.8 years (SD = 11.6), 64.8% men, mean schooling = 6.1 years (SD = 3.9); 82.5% in functional class II or III) under treatment of HF in an academic hospital. Data were collected by interviews in which participants answered a set of tools including: demographic and heart failure data; and assessment of the sleep pattern (PSQI Pittsburgh Sleep Quality Index), fatigue ( Dutch Fatigue Scale - DUFS), fatigue on exertion (Dutch Exertion Fatigue Scale), physical activity (International Physical Activity Questionnaire), and data on dyspnea, smoking habits and drug treatment. Reliability coefficients of the tools in this study were adequate ( PSQI = 0.73; DUFS = 0.90; DEFS = 0.92). Nonparametric tests were applied to analyze the association of sleep patterns with selected variables, and a logistic regression model was adjusted to investigate predictors of poor sleepers. RESULTS: The mean PSQI total score was 8.70 (SD 4.39), the prevalence of poor sleepers (PSQI> 5) was 68.5% and 46.5% rated sleep as poor or very poor. Higher PSQI scores or poor sleeper category was associated with: female gender (p = 0.009), unemployement (p = 0.013), fatigue (p = 0.000), fatigue on exertion (p = 0.000), dyspnea (p = 0.000) and higher HF functional class (p = 0.000). Dyspnea (OR=3.23; CI 95% 1.72 to 6.07) and fatigue (OR= 3.45; CI 95% 1.82 to 6.49) were independently associated with the poor sleeper category. CONCLUSIONS: The proportion of poor sleepers among patients with HF is among the highest rates in chronic diseases. Dyspnea and fatigue, commom symptoms in this illness, increase significantly the likelihood of being a poor sleeper. Therefore, the sleep pattern of HF patients has to be routinely assessed.

Submitted by Maike Costa (maiksebas@gmail.com) on 2016-12-12T14:36:03Z No. of bitstreams: 1 arquivototal.pdf: 1487202 bytes, checksum: 3fa44bc5395ec1dfecbfee4fabb72a9c (MD5) / Made available in DSpace on 2016-12-12T14:36:03Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1487202 bytes, checksum: 3fa44bc5395ec1dfecbfee4fabb72a9c (MD5) Previous issue date: 2016-02-29 / Heart failure (HF) is a chronical and progressive syndrome caused by the heart’s inability to pump enough blood to meet the organism’s metabolic and tissue necessities. Patients with HF present a series of symptoms such as dyspnea, orthopnea, fatigue, edema, and ascites, among others that compromise the functional capability, affecting the health-related quality of life (HRQOL). The objective of this investigation was to evaluate the health-related quality of life in heart failure patients. This is a descriptive study, of transversal cut, and quantitative approach, conducted in two public facilities of the city of João Pessoa - PB. The non-probabilistic sample was, for convenience, constituted by 84 outpatients. To evaluate the HRQOL, an instrument of socio-demographical depiction manufactured by the researcher responsible for the experiment was used, as well as the Minnesota Living Heart Failure Questionnaire (MLHFQ). The data was processed by the statistical program Statistical Package for Social Science. A descriptive analysis was generated for all variables. To evaluate the correlation between socio-demographical and clinical variables with the HRQOL scores, it was used the Pearson correlation coefficient test. The internal consistency of the instrument, evaluated by Cronbach’s alpha, was considered good (α = 0.90). The participants average age was 58.82±12.78 (53.6%), they were mostly female (67.8%), married or living in a domestic partnership (58.3%), retired (56.0%), and had a complete/incomplete basic education level (72.6%). The clinical profile revealed that the most frequent comorbidity was systemic arterial hypertension (63.1%), and the most distinct HF etiology was non-ischemic (72.6%). Most participants (44%) were in the functional class I, according to the New York Heart Association criteria, and had an average left ventricular ejection fraction (LVEF) of 50±14.6%. The HRQOL measure showed an average score of 33.13±19.66, with the physical dimension being the most hurt. In the inferential analysis, it was found significant negative correlation between age and HRQOL (r= -0.378; p=0.01). The results of this study reveal a slighter influence of HF in the HRQOL. It was noticed that the age factor impacts the HRQOL perception. The patients’ good HRQOL can be explained by the fact that the majority of them present no symptomology, or only symptoms initiated by physical effort. It is important to stress the value of ensuring outpatient care with a qualified multi-professional team, in order to prevent the decompensation of the disease, and to preserve the patients’ good HRQOL. / A insuficiência cardíaca (IC) é uma síndrome crônica, progressiva, caracterizada pela incapacidade do coração em bombear sangue o suficiente para atender as necessidades metabólicas e teciduais do organismo. Os pacientes com IC apresentam uma série de sintomas como dispneia, ortopneia, fadiga, edema, ascite, entre outros que comprometem a capacidade funcional, afetando a percepção da qualidade de vida relacionada à saúde (QVRS). O objetivo delineado para a investigação consistiu em avaliar a qualidade de vida relaciona à saúde de pacientes com insuficiência cardíaca. Trata-se de um estudo descritivo, de corte transversal, com abordagem quantitativa, realizado em duas instituições públicas do município de João Pessoa - PB. A amostra não probabilística, por conveniência foi constituída de 84 pacientes em seguimento ambulatorial. Utilizou-se um instrumento para caracterização sociodemográfica e clínica elaborado pelo pesquisador responsável e o questionário Minnesota Living Heart Failure Questionnaire (MLHFQ) para avaliar a QVRS. Os dados foram processados pelo programa estatístico Statistical Package for Social Science. Realizou-se análise descritiva para todas variáveis. Para avaliar a correlação das variáveis sociodemográfica e clínica com os escores de QVRS, foi utilizado o teste de correlação de Pearson. A consistência interna do instrumento avaliada através do alfa de Cronbach foi considerada boa (α = 0,90). Os participantes apresentaram idade média de 58,82±12,78, (53,6%) era do sexo feminino, (67,8%) casados ou viviam em união estável e (58,3%) aposentados, (56,0%) com ensino fundamental incompleto/completo, (72,6%). O perfil clínico revelou que a comorbidade mais frequente foi à hipertensão arterial sistêmica (63,1%), a etiologia da IC mais evidenciada foi a não isquêmica (72,6%). A maioria dos participantes (44%) encontrava-se em classe funcional I segundo os critérios da New York Heart Association e com média de fração de ejeção do ventrículo esquerdo (FEVE) de 50±14,6%. A medida da QVRS evidenciou escore médio de 33,13±19,66, sendo a dimensão física a mais prejudicada. Na análise inferencial, foi encontrada correlação negativa significante entre idade e QVRS (r= -0,378; p=0,01). Os achados deste estudo evidenciam uma menor influencia da IC na QVRS. Constatou-se que a idade influência na percepção da QVRS. A boa QVRS dos pacientes pode ser explicada pelo fato da maioria se encontrar sem sintomatologia ou com sintomas desencadeados a partir de esforços. Ressalta-se a importância de assegurar atendimento ambulatorial por equipe multiprofissional qualificada, a fim de prevenir a descompensação da doença e preservar a boa QVRS dos pacientes.

Made available in DSpace on 2016-12-06T17:06:56Z (GMT). No. of bitstreams: 1 Christiani Bonin.pdf: 1561817 bytes, checksum: 0924b403c8874d34e7acbaa08e6d6cd1 (MD5) Previous issue date: 2013-06-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A educação do paciente sobre a percepção da sua doença surge como uma tendência de buscar alternativas para incrementar o conhecimento do paciente sobre a sua doença. Ainda que não haja estudos de avaliação das necessidades de informação dos pacientes com insuficiência cardíaca participantes de programas de reabilitação, constata-se a carência de ferramentas capazes de avaliar as necessidades educacionais destes pacientes. Objetivos: Desenvolver um questionário para avaliar o conhecimento sobre a doença em pacientes portadores de insuficiência cardíaca participantes de programas de reabilitação cardiopulmonar e metabólica e avaliar a clareza e a confiabilidade do questionário. Métodos: O instrumento foi construído através da análise da literatura específica da área de insuficiência cardíaca para posterior apresentação dos itens a uma equipe multidisciplinar da área da saúde com experiência em reabilitação cardíaca, que responderam a validação de clareza e conteúdo do instrumento. Posteriormente foi gerada a versão testada em um estudo-piloto. O instrumento denominado Questionário de conhecimento da doença para pacientes com insuficiência cardíaca foi testado em 96 pacientes com insuficiência cardíaca classes funcionais I III, com média de idade de 60,22±11,6 anos e participantes de programas de reabilitação cardíaca. A reprodutibilidade foi obtida através do coeficiente de correlação intraclasse, utilizando-se das situações do método de teste-reteste, considerando um valor superior a 0,8. A consistência interna foi obtida pelo Alpha de Cronbach e a validade do construto através da análise fatorial exploratória. Foi realizada a análise comparando os escores totais do instrumento em função das características da população e entre os grupos de reabilitação cardíaca público e privado. Resultados: A versão final apresentou 19 questões dispostas em áreas de importância para a educação do paciente. O instrumento proposto apresentou um índice de clareza de 8,94±0,83 e tempo médio de preenchimento de 15,3±1,6 minutos. O coeficiente de correlação intraclasse foi de 0,856 e o Alpha de Cronbach confirmou um valor de 0,749. A análise fatorial indicou cinco fatores, abrangendo uma diversidade de itens, revelando a heterogeneidade de elementos envolvidos na insuficiência cardíaca. Quando comparados os escores finais com as características da população do estudo, confirmou-se que pacientes participantes de instituições públicas apresentaram menores níveis de conhecimento sobre a doença, visto que pacientes com baixa escolaridade e baixa renda demonstraram escores finais baixos, quando comparados a sujeitos com renda e escolaridade superiores. Conclusão: O estudo demonstrou que o instrumento apresentou índices satisfatórios de clareza e validade adequados, podendo ser utilizado em programas de reabilitação cardíaca. Salienta-se a necessidade da elaboração de estudos em profundidade no que concerne às estratégias educacionais destes pacientes.