A Insuficiência Cardíaca (IC) é uma doença crônica e incapacitante de alta morbi-mortalidade que provoca mudanças na qualidade de vida relacionadas à saúde (QVRS). Foi realizado um estudo descritivo, correlacional tipo corte transversal com 138 pacientes com IC em seguimento ambulatorial com os objetivos de avaliar: o estado geral de saúde por meio do Medical Outcomes Survey 36 - Item Short-Form (SF-36), o impacto da IC na vida diária utilizando o Minnesota Living with Heart Failure Questionnaire (MLHFQ) e analisar as relações entre essas duas variáveis e do estado de saúde percebido e do impacto da IC com variáveis sócio-demográficas e clínicas. Os dados foram coletados por entrevistas e, posteriormente, processados e analisados por meio de estatística descritiva, teste de correlação de Pearson, teste t e ANOVA para comparação entre os grupos e análise da consistência interna dos instrumentos usados (? de Cronbach). O nível de significância foi de 0,05. Como resultados constatamos que a maioria dos pacientes era do sexo masculino, com idade média de 56 anos, casados, baixa escolaridade e aposentados com renda média mensal individual de dois salários mínimos. Clinicamente, apresentaram IC secundária à miocardiopatia Dilatada Idiopática seguida da miocardiopatia Chagásica com classe funcional (CF-NYHA) II e III, grave disfunção sistólica, ou seja, menor valor da fração de ejeção do ventrículo esquerdo (FEVE) e com outras doenças associadas. Os instrumentos apresentaram, em sua maioria, consistência interna satisfatória (0,44 a 0,88 para o SF-36 e 0,78 a 0,93 para o total do MLHFQ e suas dimensões). A avaliação dos valores do SF-36 pode variar de zero a 100 com maiores valores indicando melhor estado de saúde percebido enquanto a avaliação dos valores do MLHFQ varia de zero a 105 com maiores valores indicando maior impacto da IC na vida diária dos pacientes. Os resultados foram apresentados em média e desvio-padrão. Os componentes mais comprometidos do SF-36 foram os Aspectos físicos (36,8+41,2) e Aspectos emocionais (47,6+43,9). O MLHFQ obteve valor de 35,8 (+24,9) para o total, 13,6 (+11,5) para dimensão física e 8,3 (+6,7) para a emocional. A correlação entre os instrumentos foi de forte magnitude e todas estatisticamente significantes. O impacto da IC na vida das mulheres (41,2+24,3) foi maior que os homens (32,2+24,9). A correlação entre o MLHFQ e idade e tempo de seguimento ambulatorial apresentou-se negativa e fraca, mas estatisticamente significante apenas para o tempo. As correlações do MLHFQ total e as variáveis clínicas foram estatisticamente significantes. O impacto da IC tende a aumentar com menor FEVE e maior CF-NYHA. O estado de saúde percebido e o impacto da IC na vida diária estavam moderadamente comprometidos. Quanto pior a percepção sobre o estado geral de saúde mais os pacientes com IC sentem o impacto dessa condição crônica de saúde sobre sua vida diária. Os pacientes com IC apresentaram comprometimento no seu estado de saúde percebido e sofreram com o impacto dessa doença em suas vidas diárias afetando a qualidade de vida. Mensurar a qualidade de vida relacionada à saúde permite a identificação de aspectos relevantes percebido pelos pacientes. A utilização dessas medidas, ou seja, o estado de saúde percebido e o impacto da IC na vida diária tornam-se uma ferramenta na identificação desses aspectos. Os resultados advindos dessas medidas poderão ser usados para subsidiar a assistência à saúde desses pacientes. / Heart Failure (HF) is a chronic and debilitating condition of high morbidity and mortality that provokes changes in the health related quality of life (HRQL). A descriptive, correlational study type transversal cut with 138 outpatients with HF was performed with the objectives of assessing the general health condition by Medical Outcomes Survey 36 - Item Short-Form (SF-36), the impact of HF in daily life using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and analyzing the relations between these two variables and the perceived health condition and the impact of HF with socio-demographic and clinical variables. The data were collected through interviews and, subsequently, processed and analyzed by descriptive statistics, test on Pearson\'s correlation, t-test and ANOVA for comparison among the groups and analyses of internal consistency of the used instruments (Cronbach\'s ). The level of significance was 0,05. It was found that the most patients were men, average age 56 years old, married, low rate of literacy and retired with two minimum wages as individual monthly minimum revenue. Clinically, they presented HF secondary to Idiopathic Dilated myocardiopathy followed by Chagas\' myocardiopathy with functional class (CF-NYHA) II and III, serious systolic dysfunction, in other words, decreased value of left ventricular ejection fraction (LVEF) and with other related diseases. The instruments presented, mostly, satisfactory internal consistency (0,44 to 0,88 for SF-36 and 0,78 to 0,93 for the total MLHFQ and its dimensions). The assessment of the values of SF-36 may vary from zero to 100 with increased values indicating better perceived health condition and the MLHFQ assessment varies from zero to 105 with increased values indicating greater impact on daily patient\'s life. The results were presented in means and standard deviation. The most impaired components of SF-36 were the physical (36,8+41,2) and emotional (47,6+43,9) aspects. The MLHFQ achieved the value 35,8 (+24,9) for the total; 13,6 (+11,5) for the physical dimension and 8,3 (+6,7) for the emotional dimension. The correlation among instruments had a strong importance and all were statistically significant. The impact of HF on women\'s lives (41,2+24,3) was more severe than on men\'s (32,2+24,9). The correlation among the MLHFQ, the age and time in an outpatient clinic was presented as negative and weak, but statistically significant only for the time. The total and clinical variables correlations of MLHFQ were statistically significant. The impact of HF tends to increase with decreased LVEF and increased CF-NYHA. The general perceived health condition and the impact of HF on daily life were reasonably impaired. The more the perception on the general health condition the more the patients with HF feel the impact of this chronic health condition on their daily life. It is more common in young women patients with decreased time in outpatient clinic and whose condition was more severe related to the systolic dysfunction and to the symptoms. These patients need greater attention from the health team during the outpatient clinical care, especially in the onset of the medical assistance.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2016-04-19T12:30:49Z No. of bitstreams: 1 Ysabely de Aguiar Pontes Pamplona.pdf: 2372319 bytes, checksum: 6ecd5cfeb943df20c4248a8c73344a04 (MD5) / Made available in DSpace on 2016-04-19T12:30:49Z (GMT). No. of bitstreams: 1 Ysabely de Aguiar Pontes Pamplona.pdf: 2372319 bytes, checksum: 6ecd5cfeb943df20c4248a8c73344a04 (MD5) Previous issue date: 2016-03-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Although there are robust evidence on the effects of exposure to air pollution on cardiovascular disease, little has been studied about the modification of this relationship induced by age and sex. This study aims to evaluate the relationship between air pollution and hospital admissions for Congestive Heart Failure (CHF) in adults and elderly in the city of São Paulo, stratified by sex, exploiting gaps structures for the 2000-2013 period. This is an ecological time series study, which uses hospital admissions information obtained from the Brazilian Unified Database Health (DATASUS), information on the daily levels of PM10, SO2, O3, NO2, CO, minimum temperature and average relative humidity were obtained from the Environmental Agency of the State of São Paulo (CETESB). A descriptive analysis was performed and calculated the Pearson correlation coefficient. To assess the relationship between exposure to pollutants and the outcomes of interest was used linear polynomial models with generalized Poisson regression exploring lags structures of up to 7 days. The models were adjusted for short and long term, and weather variables seasonality. The significance level was 5%. Results showed that contaminants were directly correlated (p <0.001), and inversely correlated with weather variables (p < 0.001), except O3, which was directly correlated with temperature (p <0.001). For the increase of one interquartile (7.63¿g/m3) in the SO2 level among adults (45-60 years) was related to the increase in hospital admissions for CHF of 5.32% (CI95%: 5.29-5.36) for women and 7.75% (CI95%: 7.53-7.96) for men in the first two days after exposure. In the group of elderly (60 years old) this increase raised admissions for CHF in 6.69% (CI95%: 6.62-6.75) for women and 5.83% (CI95%: 5.75¿5.90) for men in the first two days after exposure. For PM10 in relation to adults (45-60 years) an increase of 24.28¿g/m3 increased hospitalizations for ICC in 11.38% (CI95%: 10.68-12.09) for women and 4.08% (CI95%: 4.04-4.12) for men in the first three days after exposure. In the group of elderly (60 years old) there was an increase of 6.92% (CI95%: 6.86-6.98) for women and 5.97% (CI95%: 5.90-6 04) for men in the first two days after exposure in hospitalizations for ICC. The adverse effects of SO2 on CHF admissions in adult were higher men than in women. However, in the elderly group the adverse effects of SO2 on CHF admissions were higher in the women's groups. As for PM10, women seem to be more susceptible than men due to the adverse effects of PM10 on admissions for CHF, especially in the younger age group. It is concluded that the effect of air pollutants in admissions for CHF differ by age and sex. / Apesar de haver evidências robustas sobre os efeitos da exposição à poluição do ar sobre as doenças cardiovasculares, pouco tem sido estudado sobre a modificação desta relação induzida pela faixa etária e pelo sexo. Este estudo tem por objetivo avaliar a relação entre poluição do ar e internações por Insuficiência Cardíaca Congestiva (ICC), em adultos e idosos, na cidade de São Paulo, estratificado por sexo, explorando estruturas de defasagens, para o período de 2000 a 2013. Este é um estudo ecológico de séries temporais, que utiliza informações de internações hospitalares obtidas junto ao banco de dados do Sistema Único de Saúde (DATASUS), as informações sobre os níveis diários de PM10, SO2, O3, NO2, CO, temperatura mínima e umidade relativa média foram obtidos junto a Agência Ambiental do Estado de São Paulo (CETESB). Foi realizada a análise descritiva e calculado o coeficiente de correlação de Pearson. Para se avaliar a relação entre exposição a poluentes e os desfechos de interesse foi utilizado modelos polinomiais lineares generalizados de regressão de Poisson explorando estruturas de defasagens de até 7 dias. Os modelos foram ajustados para sazonalidade de curta e longa duração e pelas variáveis meteorológicas. O nível de significância foi de 5%. Os poluentes estavam diretamente correlacionados entre si (p<0,001) e inversamente correlacionada com variáveis meteorológicas (p<0,001), com exceção do O3, que foi diretamente correlacionada com a temperatura (p< 0,001). Para o aumento de um interquartil (7,63¿g/m3) no nível de SO2, entre os adultos (45-60 anos) esteve relacionado com o aumento nas admissões hospitalares por Insuficiência Cardíaca Congestiva de 5,32% (IC95%: 5,29 - 5,36) para mulheres e 7,75% (IC95%: 7,53 - 7,96) para os homens nos dois primeiros dias após a exposição. No grupo de idosos (60 ou mais anos de idade) esse aumento elevou as admissões por ICC em 6,69 % (IC95%: 6,62 - 6,75) para mulheres e 5,83 % (IC95%: 5,75 - 5, 90) para os homens nos dois primeiros dias após a exposição. Para PM10 em relação aos adultos (45-60 anos) um aumento de 24,28¿g/m3 elevou as internações por Insuficiência Cardíaca Congestiva em 11,38% (IC95%: 10,68 - 12,09) para mulheres e 4,08% (IC95 %: 4,04 - 4,12) para os homens nos três primeiros dias após a exposição. No grupo de idosos (60 ou mais anos de idade) observou-se um aumento de 6,92 % (IC95%: 6,86 - 6,98) para mulheres e 5,97% (IC95%: 5,90 - 6,04) para os homens nos dois primeiros dias após a exposição nas internações por Insuficiência Cardíaca Congestiva. Os efeitos adversos de SO2 sobre admissões de Insuficiência Cardíaca Congestiva foram maiores em homens adultos do que nas mulheres. No entanto, no grupo de idosos os efeitos adversos de SO2 sobre admissões de Insuficiência Cardíaca Congestiva foram maiores nos grupos de mulheres. Já para o PM10, as mulheres parecem ser mais suscetíveis do que os homens, devido aos efeitos adversos do PM10 sobre admissões por Insuficiência Cardíaca Congestiva, principalmente no grupo etário mais jovem. Conclui-se que o efeito dos poluentes do ar nas admissões por ICC diferem por faixa etária e sexo.

Congestive heart failure (CHF) is a growing epidemic that affects more than 50% of the world's population. CHF is a preventable disease, but prevention requires a healthy lifestyle from a young age. Most patients already diagnosed with CHF receive advice and strict instructions for care to prevent further cardiac injury. This quantitative descriptive research study was designed to address walking and jogging as the best exercises for patients diagnosed with CHF and in patients diagnosed with other cardiac problems. The results revealed that walking is the best exercise to improve patients' resting heart rate and overall cardiac function. This study also indicated that cardiac rehabilitation (CR) improved both blood pressure and heart rate, but the findings showed that CR improved heart rate most effectively. The Levine conservation model served as the foundation of the research. The Levine conservation model ensures the safety and the wholeness of a patient by protecting the interaction and adaptations of the patient's health care plan and environment through conserving and balancing energy. The social change plan for this research study is to give health care teams who care for patients with CHF or cardiac problems guidance to educate patients about CR. Increasing CR education among all health care teams could help improve many patients' quality of life, and the autonomy and empowerment given to patients may subsequently increase patients' cooperation with the treatment plan.

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.

Abstract not available

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.

Previous research on quality of life (QOL) and its relation to BNP levels in heart failure (HF) has been widely studied. However, the impact of physicians' knowledge of BNP levels at time of clinic visit on QOL and hospital length of stay (LOS) has yet to be fully investigated. The purpose of this study were to determine if physicians' knowledge of BNP levels affected a change in QOL scores at 90 days and reduce hospital length of stay among heart failure patients. QOL data from HF clinic patients (N = 108, 67.5 ± 12.3, 56% male, ejection fraction 26.5 ± 8.2) were analyzed. QOL was measured at time of clinic visit (T1) and at 90 days (T2) using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). An independent t-test was utilized to compare the two groups. Findings: Both groups were comparable regarding demographic and baseline characteristics. There was no significant association observed between the experimental and control group at 90 days, although the data indicated a decrease in the mean QOL scores at 90 days (37.46 ± 28.67) as compared to the mean QOL scores at baseline (46.87 ± 29.63) for both groups. Because the QOL scale is reversed, this indicated that there was a positive change in QOL scores during the 90 day time interval. Hospital LOS was similar for both groups (mean=3 days). BNP levels were significantly correlated with both baseline QOL scores (r=.25, p=.01) and physical subscale scores (r=.24, p=.01). Mortality was higher in the control when compared to the experimental group (t=1.99, df=90, p=.04). Conclusion: While physicians' awareness of BNP levels had not shown a significant change in QOL at 90 days, patients' QOL might already have been quite positive. Chronic HF patients may have adapted to their disease and have adjusted their perception of their QOL. Therefore, QOL may be a stable construct at this time. Findings may have been different on newly diagnosed HF patients since they may not have adapted to their health condition.

Current drugs used to treat Congestive Heart Failure target the renin-angiotensin and adrenergic systems. Studies showed increased mortality rates in patients treated with a combination of these medications. Angiotensin-AT1 and ?2-Adrenergic receptors were shown to form receptor heteromers. Blockade of one receptor in the complex can affect the signal transmitted by the other; suggesting that ligand-based therapy is not as selective as we might think. Modulating receptor trafficking after synthesis might prove to be a valid therapeutic strategy. Unfortunately, little is known about receptor assembly and transport from Endoplasmic Reticulum to Plasma Membrane. The objectives of this study are to identify the proteins that participate in the assembly of AT1R-?2AR heteromer and the regulators of the anterograde trafficking of G-Protein Coupled Receptors. This thesis introduces the role of important targets in those poorly understood processes. The identification of such targets could lead to developing better drugs with fewer adverse effects.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

Introdução: O benefício da restrição hidrossalina em pacientes internados por insuficiência cardíaca (IC) descompensada não está bem estabelecido. Objetivo: Comparar o efeito de uma dieta com restrição hídrica de 800 ml e 800 mg de sódio adicional/dia (grupo intervenção: GI) com uma dieta sem restrição hidrossalina (grupo controle: GC) na redução do peso e na estabilidade clínica em três dias em pacientes internados por IC aguda descompensada. Delineamento: Ensaio clínico randomizado que incluiu pacientes adultos com IC aguda descompensada, disfunção sistólica e admissão hospitalar k 36 horas. Avaliou-se diariamente o estado congestivo por meio do Escore Clínico de Congestão (ECC); a sensação de sede por meio da escala visual analógica (escala 0-10), até k sete dias de internação. As readmissões foram avaliadas em 30 dias. Resultados: Incluídos 75 pctes (GI: 38; GC: 37), predominantemente homens com fração de ejeção média de 26±8,7%, 22% com etiologia isquêmica. Os grupos não foram diferentes nas características basais. O delta do peso (GI: -4,42±2,85 e GC: -4,67±5,6/ P=0,82) e o delta do ECC (GI: - 4,03±3,3 e GC: - 3,44±3,35/ P=0,47) no terceiro dia não foram diferentes entre os grupos. A sede foi significativamente maior no GI durante o período do estudo (P=0,002). Readmissão em 30 dias foi semelhante entre o GI 11(28,9%) e GC 7 (18,9%), (P=0,41). Conclusão: A intervenção agressiva de restrição hidrossalina não teve impacto na redução do peso e na estabilidade clínica em três dias. Além disso, foi responsável por significativo aumento da sensação de sede. / Introduction: The benefits of fluid and sodium restriction in patients hospitalized with acute decompensated heart failure (HF) are unclear. Objective: To compare the effects of a fluid-restricted (800 mL/day) and sodium additional-restricted (800 mg/day) diet (intervention group, IG) versus a diet with no such restrictions (control group, CG) on weight loss and clinical stability over a 3-day period in patients hospitalized with acute decompensated HF. Methods: Randomized clinical trial of adult patients with acute decompensated HF, systolic dysfunction, and a length of stay k36 hours. Congestion was assessed daily by means of a clinical congestion score (CCS). Perceived thirst was assessed with a 10-point visual analog scale. Patients were followed until the 7th hospital day. Readmissions were assessed at 30 days. Results: Seventy-five patients were enrolled (38 allocated to intervention, 37 to the control group). Most were male; ischemic heart disease was the predominant cause of HF (22%), and the mean ejection fraction was 26±8.7%. Both groups were homogeneous in terms of baseline characteristics. There were no between-group differences in weight loss (IG, -4.42±2.85 kg; CG, -4.67±5.6 kg; P=0.82) or change in CCS (IG, -4.03±3.3; CG, -3.44±3.35; P=0.47) at 3 days. Thirst was significantly worse in the IG during the study period (P=0.002). There were no between-group differences in the readmission rate at 30 days (IG, 11 patients [28.9%]; CG, 7 patients [18.9%]; P=0.41). Conclusion: Aggressive fluid and additional sodium restriction had no impact on weight loss or clinical stability at 3 days, and was associated with a significant increase in perceived thirst.