Improving Nutritional Status in Chronic Heart Failure Patients: Effectiveness of a Transtheoretical Model-Based Stepwise Nutritional Management Program.

Background Chronic Heart Failure (CHF) patients have marked functional limitations causing a significant impact on Health Related Quality of Life (HRQoL) in these patients. Iron Defeciency is very common in Heart Failure patients & it is suggested that it affects HRQoL in CHF patients regardless of the Anemia status . Objective To evaluate the impact of iron deficiency (ID) on health-related quality of life (HRQoL) in chronic heart failure (CHF) patients using Minnesota Living with Heart Failure questionnaire (MLHFQ) in patients with normal hemoglobin levels . Methods From October 2018 to August 2019 ,100 patients with CHF from out- patient clinics in ASU university hospitals were subjected to history taking , examination , Echocardiography , measurement of Iron status using serum ferritin, Assessment of Health Related Quality of Life (HRQoL) using Minnesota Living with Heart Failure Questionnaire (MLHFQ) . Patients then were divided into 2 equal groups depending on their serum ferritin level & comparison of MLHFQ score between the 2 groups was done . Results The study population was divided into 2 groups: Iron Defecient (ID) (n = 50) & non Iron Defecient (non ID) (n = 50) , 61 patients were males & 39 were females. The MLHFQ scores were 66.9 ± 9.1 among ID patients vs 46.9 ± 7.3 in non ID patients (p value < 0.001) indicating worse HRQoL in ID group . The physical domain (p value < 0.001) was markedly affected than the emotional domain (p value 0.006) of the MLHFQ score . Conclusion In CHF patients , HRQoL was markedly affected among ID patients than non ID patients with physical factors more affected than the emotional factors .

chronic heart failure (CHF) is a complex and prevalent disease affecting 2% of adults in developed countries. This number increases to 6–10% in adults over the age of 65 ([3][1], [8][2]), and on diagnosis, half of all CHF patients die within 4 years ([11][3]). In addition to the significant

Background:Chronic heart failure (CHF) is a common clinical syndrome characterized by reduced exercise capacity, diminished quality of life (QoL), and unfavorable cardiovascular outcomes. Conventional cardiac rehabilitation often requires moderate-to-high-intensity exercise, which may be tolerated poorly by many CHF patients. Low-intensity mind–body interventions, such as traditional Chinese exercises (TCEs), are potentially more suitable; however, the evidence from existing studies is fragmented and sometimes inconsistent. Thus, this study aimed to conduct an umbrella review of systematic reviews (SRs) and meta-analyses (MAs) to evaluate the effectiveness of TCEs in improving exercise capacity, QoL, and cardiovascular function in patients with CHF.Methods:An umbrella review of SRs/MAs was conducted by searching English and Chinese databases without language limits and focusing on randomized controlled trials (RCTs) that assessed the additional benefit of TCEs in individuals with CHF. Methodological quality was appraised using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) checklist and the Risk of Bias in Systematic Reviews (ROBIS) instrument. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was utilized to quantify the certainty of evidence. Individual trial data were retrieved, and re-meta-analyses were performed using standard statistical procedures, with publication bias assessed via Egger's test.Results:A total of 15 SRs/MAs were included, encompassing 65 original trials. Our re-meta-analysis indicated that TCEs were associated with substantially longer 6-minute walk test (6-MWT) values, improved QoL measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), higher left ventricular ejection fraction (LVEF), reduced B-type natriuretic peptide (BNP) levels, and enhanced maximal oxygen consumption (VO2max). Baduanjin exhibited a particularly robust effect on lowering N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations, while Yijinjing yielded comparatively greater improvements in VO2max. Nonetheless, limitations such as suboptimal methodological quality and overlapping study samples require cautious interpretation.Conclusions:TCEs may serve as a beneficial adjunct to standard care for CHF, improving exercise capacity, QoL, and key cardiac markers. Large, rigorous RCTs with extended follow-up are needed to confirm the durability of TCEs and further define the role of these exercises in comprehensive CHF rehabilitation.The PROSPERO Registration:CRD420251003129 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251003129).

Background: The study aimed to see the effectiveness and role of ivabradine on the quality of life in chronic heart failure suffering patients. This open-label Randomized controlled Trial was conducted to assess the effect of ivabradine plus conventional medical management over conventional medical management on quality-of-life parameters among 100 patients of chronic heart failure from January 2021 to December 2021 in the Department of Pharmacology & Therapeutics in collaboration with the Department of Cardiology & Medicine, Rajshahi Medical College Hospital, Rajshahi.
 Materials and methods: According to the drug allocation study population was divided into a control group (50 patients) and an experimental group (50 patients). Minnesota Living with Heart Failure questionnaire (MLWHFQ) was used to assess the quality of life, and the resting heart rate was measured by 12-lead electrocardiography. Baseline demographic and clinical characteristics were recorded, and patients were followed up at four weeks and 12 weeks of treatment.
 Results: The comparison of mean differences of MLWHFQ score at first and second follow-up visits between the two study groups was statistically significant [t (100) = 2.43 p < 0.05 & t (100) = 6.60 p < 0.001 respectively]. According to the MLWHFQ cut-point score, it was also observed that poor baseline quality of life gradually shifted to good quality after four weeks and 12 weeks of treatment, and it was proportionately higher in the experimental group. Relations between the respondents of both study groups and their different qualities of life during the first follow-up visit (x2 = 13.69, df = 2, p < 0.05) and second follow-up visit (x2 = 22.79, df = 2, p < 0.001) were statistically significant.The comparison of the mean (±SD) heart rate between the two study groups was statistically significant (p <0.001) only during the second follow-up visit.
 Conclusion: This study concluded that adding ivabradine to conventional medical management in treating patients with chronic heart failure improves their symptoms, quality of life, and heart rate and ultimately reduces the morbidity and mortality of such patients.
 TAJ 2022; 36: No-1: 1-8

Objective To explore the effects of exercise rehabilitation nursing on exercise self-efficacy among chronic heart failure (CHF) patients. Methods From January 2015 to December 2016, we selected 82 CHF patients of Liaocheng People's Hospital of Shandong Province. All of the patients were randomly divided into observation group and control group, 41 cases in each group. Control group adapted routine health education. On this basis of intervention in control group, observation group carried out exercise rehabilitation nursing. We compared the score of Exercise Self-Efficacy Scale and the 6-minute walk distance with the 6-minute walk test of patients between two groups before and after intervention. Results Twelve months after intervention, the score of Exercise Self-Efficacy Scale was (57.09±9.47) in observation group and (49.73±8.22) in control group with a significant difference (t=3.758, P<0.01) . After intervention, the 6-minute walk distance of observation group and control group was (398.56±89.53) m and (327.95±85.37) m respectively with a significant difference (t=3.655, P<0.01) . Conclusions Comparing with single and routine health education, exercise rehabilitation nursing can improve exercise self-efficacy of CHF patients and increase the walk distance obviously. It is also conducive to enhancing patients' motor function. Key words: Health education; Chronic heart failure; Exercise self-efficacy; Rehabilitation nursing

Health-related quality of life is related to cytokine levels at 12 months in patients with chronic heart failure

A Potential Shift From Adaptive Immune Activity to Nonspecific Inflammatory Activation Associated With Higher Depression Symptoms in Chronic Heart Failure Patients

To characterize eplerenone pharmacokinetics (PK) in Japanese chronic heart failure (CHF) patients and to estimate the impact of factors that may affect eplerenone PK, population pharmacokinetic (PPK) analysis was conducted. In addition, PK of Japanese CHF and Western CHF patients from a previous clinical pharmacology study were compared in the analysis. Eplerenone PK was characterized by a 1-compartment PPK model with first-order absorption and lag time in Japanese CHF patients. The population mean of apparent oral clearance (CL/F) in Japanese CHF patients was estimated as 5.31L/h, which was similar to the mean CL/F for Western CHF patients. In the full model approach, creatinine clearance (CLcr) on CL/F and body weight on apparent central volume of distribution (Vc/F) were selected as factors that may affect PK. The effect of CLcr on CL/F predicted that CL/F would be decreased by 25% when CLcr was decreased from 80 mL/min to 50 mL/min. The effect of body weight on Vc/F predicted that Vc/F would be decreased by 18% when body weight was decreased from 80kg to 60kg. Distribution of individual CL/F estimates for Japanese CHF patients overlapped CL/F observed values for Western CHF patients, and CL/F values for Western CHF patients were contained within the distribution of CL/F estimates for Japanese CHF patients. No obvious difference between Japanese and Western subjects was detected even in the updated model by adding the data obtained from Western CHF patients and Western healthy adults to the model constructed with data from Japanese CHF patients.

Objective To evaluate the effect of nursing intervention on the quality of life of patients with heart failure based on the transtheoretical model （ TTM）.Methods Totals of 100 heart failure patients were divided into the control group and the intervention group , 50 cases each .The control group was treated with conventional health education .The intervention group was treated with the nursing intervention based on TTM . We evaluated the quality of life in the time of before intervention , 1 month and 3 months after the intervention , respectively , by the Minnesota living with heart failure questionnaire （ MLHFQ） , and compared the differences . Results 1 month and 3 months after discharge , 2 cases were died and 5 cases were lost during the follow-up in＆amp;nbsp;the intervention group , and 43 cases finished the investigation .3 cases were died and 7 cases were lost during the follow-up in the control group , and 40 cases finished the investigation .Before the intervention , 1 month and 3 months after the intervention, the total score of MLHFQ were （40.14 ±17.59）, （59.98 ±17.44）, （52.28 ±16.46） in the intervention group, and （38.45 ±16.00）, （45.25 ±14.80）, （41.30 ±14.40） in the control group .Before the intervention , there was no statistically difference between the two groups （ P〈0.05）.After the intervention for 1month and 3 months, the differences were significant （ t =3.29, 3.22, respectively;P〈0.05）.Conclusions Comparing with the conventional healthy education , the method based on TTM is one of the most effective ways , which can improve the quality of life of patients with heart failure . Thus, it is worthy of getting widely promoted in hospital . Key words: Heart failure; Quality of life; Transtheoretical model

Previous studies show that the rise in skin blood flow and cutaneous vascular conductance during heat stress is substantially attenuated in chronic heart failure (CHF) patients. The mechanisms responsible for this finding are not clear. In particular, little is known regarding the responses of skin sympathetic nerve activity (SSNA) that control the skin blood flow during heat stress in CHF patients. We examined the effects of a modest heat stress to test the hypothesis that SSNA responses could be attenuated in CHF. We assessed SSNA (microneurography) from the peroneal nerve and skin blood flow (forearm laser Doppler) in 9 patients with stable class II-III CHF and in matched healthy subjects during passive whole-body heating with a water-perfused suit. Whole-body heating induced similar increases in internal temperature (≈0.6 °C) in both groups. Whole-body heat stress evoked similar SSNA activation in CHF patients (Δ891±110 U/min) and the control subjects (Δ787±84 U/min; P=0.66), whereas the elevation in forearm cutaneous vascular conductance in patients with CHF was significantly lower than that in healthy control subjects (Δ131±29% vs. Δ623±131%; P=0.001). The present data show that SSNA activation during a modest whole-body heat stress is not attenuated in CHF. Thus, the attenuated skin vasodilator response in CHF patients is not attributable to a reduction in total activity of sympathetic outflow to skin.

Self-care and caregivers' contribution to self-care are vital for chronic heart failure (CHF) patients. Family resilience and mutuality are known protective factors for self-care. However, little is known about how family resilience and mutuality contribute to self-care among heart failure patient-caregiver dyads. This study aims to examine actor and partner effects of family resilience on self-care through mutuality among CHF patients and caregiver dyads. In the cross-sectional study, 220 CHF patient-caregiver dyads (n = 440 participants) were enrolled. Family resilience, mutuality, self-care, and self-care contribution to CHF were assessed by self-report questionnaires. The Actor-Partner Interdependence Mediation Model analysis was used to identify the direct and indirect effects of family resilience on self-care through mutuality in CHF patient-caregiver dyads. Actor effects showed that caregivers' family resilience had a direct effect on their own self-care contribution [direct actor effect, B = 0.385; 95% confidence interval (CI), 0.263-0.506]. Caregivers' mutuality (indirect actor effect, B = 0.057; 95% CI, 0.004-0.111) and CHF patients' mutuality (indirect actor effect, B = 0.04; 95% CI, 0.010-0.103) mediated caregivers' family resilience and self-care contribution. Partner effect showed that caregivers' family resilience predicted CHF patients' self-care behaviour (direct partner effect, B = -0.334; 95% CI, -0.406 to -0.251). Chronic heart failure patients' family resilience had indirect effects on caregivers' contribution to self-care via patients' mutuality (indirect partner effect, B = 0.019; 95% CI, 0.001-0.066) and caregivers' mutuality (indirect partner effect, B = 0.025, 95% CI, 0.001-0.058). The results demonstrated a reciprocal influence on self-care between CHF patients and their caregivers. Family resilience within these dyads has impacted not only their own self-care but also those of their caregivers, with mutuality playing a mediating role. These results provided empirical support for improving the patients' self-care behaviour and caregivers' contribution at the dyadic level. Chinese Clinical Trial Registry: ChiCTR2200064561.

Studies report relation between quality of life and outcome. However, less is known about how various aspects of quality of life relates to mortality and admissions for heart failure. Method Mortality was examined in 7001 patients with completed Minnesota Living with Heart Failure Questionnaire (MLWHFQ) at the first visit to specialised hospital outpatient clinics included in our registry. A subset of 4264 patients with a second MLWHFQ at a late follow-up visit was assessed for the number of admissions and days in hospital for reason of heart failure during a six months period prior to the late visit. Results In multivariate Cox proportional hazard regression model for time to death after the first visit with a median 19 months follow-up and 1001 deaths, the MLWHFQ score for the subset of the “physical domain” (question 2 to 9) was a significant independent predictor for mortality (P=0.002) adjusted for gender, NYHA-class, blood pressure, s-sodium, stroke, obstructive lung disease, eGFR, anemia, age, daily dose diuretic, and ischemic cause for heart failure. The total MLWHFQ score and the Minnesota “emotional domain” (question 17–21) were not significant variables when the MLWHFQ “physical domain” was entered in the analysis. The number of admissions for heart failure and the number of days in hospital for these admissions in a six months period prior to the late visit were analysed by linear regression for related variables. The total MLWHFQ score at the late visit was highly significant for the number of admissions in the six months period (p&lt;0.001) adjusted for the daily dose diuretic, NYHA functional class and proBNP. The MLWHFQ “physical domain” and the MLWHFQ “emotional domain” were not significant variables when the total score was entered. The number of days in hospital was related to the daily dose diuretic, NYHA functional class, proBNP, and in addition anaemia at the late visit again with the MLWHFQ total score being a significant predictor (=0.001) Conclusions Disease specific quality of life measured with MLWHFQ “physical domain” was a highly significant predictor for mortality after the first visit. The late total MLWHFQ score was a better predictor for heart failure related admissions and days in hospital than the subset domains in multivariate analysis. Acknowledgement/Funding None

Background: Exercise training is a cornerstone of cardiac rehabilitation in chronic heart failure (CHF), yet the optimal training modality remains debated. High-intensity interval training (HIIT) has demonstrated superior physiological adaptations compared to moderate-intensity continuous training (MICT) in various cardiovascular populations, but evidence regarding its efficacy and safety specifically in CHF patients with diverse functional severity remains limited and inconsistent. Methods: This prospective cohort study enrolled 194 stable CHF patients (left ventricular ejection fraction ≤45%; NYHA class II–III) at a university-affiliated cardiac rehabilitation center between March 2020 and November 2023. Patients self-selected into a 12-week supervised HIIT program (n = 98; 4×4-minute intervals at 85–95% peak heart rate) or a matched-duration MICT program (n = 96; continuous exercise at 60–70% peak heart rate), performed three times weekly. Primary outcome was change in peak oxygen consumption (peak VO₂) assessed via cardiopulmonary exercise testing. Secondary outcomes included six-minute walk distance (6MWD), left ventricular ejection fraction (LVEF), Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores, and adverse event rates. Results: The HIIT group demonstrated significantly greater improvement in peak VO₂ compared to MICT (+3.4 ± 1.8 vs. +1.6 ± 1.4 mL/kg/min; p &lt; 0.001). Six-minute walk distance increased by 52.8 ± 28.4 m in the HIIT group versus 31.2 ± 22.6 m in MICT (p &lt; 0.001). LVEF improved by 3.8 ± 2.6% in HIIT versus 1.9 ± 2.2% in MICT (p &lt; 0.001). MLHFQ scores decreased by 12.4 ± 8.6 versus 7.2 ± 6.8 points (p &lt; 0.001). No significant difference in serious adverse event rates was observed between groups (3.1% vs. 2.1%; p = 0.684). Conclusion: A 12-week supervised HIIT program produces superior improvements in cardiorespiratory fitness, functional capacity, ventricular function, and quality of life compared to MICT in stable CHF patients, with a comparable safety profile. These findings support the integration of structured HIIT protocols into heart failure rehabilitation programs under appropriate clinical supervision.

This paper reports the application of neural networks for the numerical analysis of steady-state axisymmetric flow through an indefinitely long corrugated tube. Meshless global radial basis function networks (RBFNs) are employed to represent all dependent variables in the governing differential equations. For a better quality of approximation, the networks used here are constructed based on the integration process rather than the usual differentiation process. Multiple spaces of network weights for each variable are converted into the single space of nodal variable values, resulting in the square system of&#13;\nequations with usual size. The governing equations are discretized in the strong form by point collocation and the resultant nonlinear system is solved with trust-region methods. The corrugated tube flow of a Newtonian fluid, power-law fluid and Oldroyd-B fluid are considered. With relatively low numbers of data points, flow resistance predictions obtained are in good agreement with the benchmark solutions.

Aim. To investigate the obesity paradox by studying the impact of overweight and abdominal obesity on the prognosis in chronic heart failure (CHF) patients with moderately reduced or preserved left ventricular ejection fraction (LVEF) by five-year follow-up results. Materials and methods. A prospective, open, parallel-group study included 314 CHF patients with moderately reduced or preserved LVEF, average age was 65.3 ± 11.2 years. Group 1 – 66 patients with normal weight; Group 2 – 67 overweight patients; Group 3 – 90 patients with I degree abdominal obesity; Group 4 – 91 subjects with II–III degrees of obesity. Adverse cardiovascular events (CVEs) were studied as a cumulative endpoint, cardiovascular death, and rehospitalization due to decompensated CHF. Results. It has been found that excess body weight (overweight and I–III degrees of abdominal obesity) did not affect the prevalence and spectrum of adverse CVEs in CHF patients with moderately reduced and preserved LVEF. In overweight patients, compared to I degree obesity group, the incidence of cumulative end point (by 15.4 %; χ2 = 3.95, p &lt; 0.05) and cases of re-hospitalization (by 19.0 %; χ2 = 5.6, p &lt; 0.05) were more often observed. Concomitant overweight was associated with an increased risk for faster onset of the cumulative end point (HR 1.46, 95 % CI 1.1–2.2, p &lt; 0.05) and re-hospitalization (HR 1.53, 95 % CI 1.1–2.4, p &lt; 0.05). Conclusions. The presence of excess body weight (overweight and I–III degrees of abdominal obesity) did not affect the prevalence and spectrum of adverse CVEs in CHF patients with moderately reduced and preserved LVEF during the five-year follow-up. In the presence of overweight, in comparison with I degree abdominal obesity, the incidence of cumulative end point and re-hospitalization due to the disease decompensation were more often observed, which could be evidence for the existence of the obesity paradox. The most adverse effect on the prognosis in CHF patients with moderately reduced and preserved LVEF caused by concomitant overweight, in the presence of which, there was a significant increase in the risk for more faster onset of cumulative end point and re-hospitalization due to decompensation of the disease.