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Biomedical subjects

Miles D Witham

Publications and source records attributed to Miles D Witham.

At least 19 recordsLinked to original sources
PubMed2006

Defining the nutritional status and dietary intake of older heart failure patients.

BACKGROUND: Little information exists about diet in the management of heart failure. AIMS: To describe the nutritional and biochemical status, and the dietary intake of older heart failure patients. METHODS: Stable outpatients and patients with recent hospitalisation for decompensated heart failure were recruited. Anthropometric measurements, handgrip strength, biochemical values and echocardiography were recorded. Patients kept 7-day food diaries and completed questionnaires concerning food provision. RESULTS: Forty-five patients with a mean (S.D.) age of 80.8 (6.8) years were studied and classed according to the New York Heart Association (NYHA) (11% Class I, 27% Class II and 62% Class III). Mean (S.D.) body mass index (BMI) was 27.1 (5.4) kg/m(2) with 7% of patients having a BMI<20 kg/m(2) and 56% with a BMI above 25 kg/m(2). 64% of participants failed to achieve the estimated average requirements for energy intake; 82% took more than 2 mg of sodium daily; and 18% had a potassium intake above 3500 mg/day. Only 29% of individuals did not need assistance with food shopping, whilst 58% required assistance with meal preparation. CONCLUSION: Possible targets for dietary intervention in older heart failure patients have been identified but whether such changes would be beneficial to patients is unknown.

Aged, 80 and over↗
PubMed2006

Using an individualised quality of life measure in older heart failure patients.

BACKGROUND: Existing tools purporting to measure quality of life in heart failure do not allow expression of individual needs and preferences. The Patient Generated Index is a recently introduced tool that allows individualised assessment of quality of life. METHODS: 59 patients aged 65 years and over with a clinical diagnosis of chronic heart failure were administered the Patient Generated Index at baseline, 1 week and 12 weeks, along with the Guyatt chronic heart failure questionnaire, Minnesota Living with Heart failure questionnaire and Short Form-12 tool. Changes in questionnaire scores were used to calculate reproducibility and responsiveness to change. Comparison of Patient Generated Index scores with the other questionnaires and with New York Heart Association class was used to determine construct validity. RESULTS: All four questionnaires were completed by >90% of participants. Intraclass correlation coefficients denoting reproducibility were high for the Guyatt (0.93) and Minnesota questionnaires (0.89), moderate for the Patient Generated Index (0.65) and Short Form-12 (0.59). Responsiveness to change was similar for all questionnaires, but lower than in previous studies. The Patient Generated Index correlated with New York Heart association class and correlated moderately with the other questionnaires. The most important domains nominated on the Patient Generated Index were walking, performing daily activities, feeling tired and climbing stairs. CONCLUSIONS: The Patient Generated Index can be administered successfully to older heart failure patients; usefulness is limited by suboptimal reproducibility and responsiveness. Impairment of physical function is the factor most cited by older heart failure patients affecting their quality of life.

Activities of Daily Living↗
PubMed2006

Effects of an exercise intervention for older heart failure patients on caregiver burden and emotional distress.

BACKGROUND: The impact of exercise programmes for heart failure on those close to the patient is largely unknown. We examined the effect of a hospital and home-based exercise intervention on burden, anxiety and depression of informal caregivers. DESIGN: The study was a randomized, controlled trial. Heart failure patients were randomized to a seated 12-week hospital-based exercise programme. Caregiver measures were gathered at baseline, 3 months later and 6 months following baseline. METHODS: Sixty caregivers (mean age 63.4 years, 65% female) of heart failure patients (n = 82, mean age 80.5 years, 44% female) participating in a trial of an exercise intervention were recruited. Caregiver burden, anxiety and depression were assessed. RESULTS: There were no differences in caregiver burden, depression or anxiety between the two groups of caregivers at baseline (caregiver burden, patient control 33.1 versus patient exercise 34.1; anxiety 4.1 versus 5.5; depression 2.8 versus 3.8). At 3 months there were no differences between caregivers in the two groups on outcomes. At 6-month follow-up caregivers of heart failure patients in the exercise group had burden scores that were significantly worse than the control group. There were no differences between the carers of exercise and control groups in anxiety and depression. Levels of anxiety and depression in the entire carer sample were marginally higher than reference values in a healthy non-clinical sample. CONCLUSION: The present exercise interventions for frail older patients did not benefit caregivers and was associated with an increase in caregiver burden. We suggest that future exercise interventions for heart failure patients should actively incorporate informal caregivers into research designs.

Aged↗
PubMed2005

Predictors of exercise capacity and everyday activity in older heart failure patients.

BACKGROUND: Exercise capacity and daily activity are key outcomes for older, frail heart failure patients. Little is known about the determinants of these outcomes in this patient group. AIMS: To explore predictors of exercise capacity and daily activity in older, frail heart failure patients. METHODS: Analysis of prospectively collected data from a cohort of 82 patients aged 70 years and over, enrolled in a randomised controlled trial of exercise in heart failure patients. Pathophysiological, demographic, psychological and social factors were analysed by multivariate regression to determine predictors of exercise capacity (6-min walk distance) and daily activity (daily accelerometer counts). RESULTS: Between 49% and 55% of the variance in 6-min walk distance was explained by variables including New York Heart Association class, depression score, attitude to ageing and use of walking aids. Only 11% to 26% of the variance in accelerometer scores was explained by the model; 6-min walk distance was the only consistent predictor of daily activity. CONCLUSIONS: Physical, psychological and attitudinal variables contribute to variance of the 6-min walk. Six-minute walk distance predicts a small amount of the variance in daily activity, but the majority of variance in daily activity remains unexplained and requires further investigation.

Activities of Daily Living↗
PubMed2005

Autonomic effects of spironolactone and MR blockers in heart failure.

Neurohormonal dysfunction is an important and potentially modifiable part of the disease process of heart failure. In this review we will discuss the ways in which the autonomic system is deranged in congestive cardiac failure and the different ways we have of monitoring these abnormalities i.e.: heart rate variability, plasma norephinephrine activity, MIBG scanning, heart rate turbulence, baroreceptor function and briefly, microneurographic techniques and QT interval analysis. We will then discuss the direct effects of aldosterone and of aldosterone blockade on some of these parameters. We conclude that neurohormonal dysfunction is an important component of chronic heart failure, which is affected by aldosterone and can be modified by the use of aldosterone receptor blockade.

Aldosterone↗
PubMed2005

Family caregiving and congestive heart failure. Review and analysis.

BACKGROUND: There is increasing evidence that discharge planning and post-discharge support for CHF patients can contribute greatly to the medical management of heart failure (CHF) in the community and that the quality of the CHF patient's close personal relationships can influence outcome in CHF. However, there has been little research on the impact of CHF on the family or the role of the family in the management of the condition. In this paper, we provide a review and analysis of studies that have explicitly investigated these issues in the informal carers of CHF patients. RESULTS OF THE REVIEW: Sixteen papers were identified that examined the role and/or impact of informal caregiving for CHF patients. Our main findings were: demands specific to CHF caregiving were identified, e.g., monitoring complex medical and self-care regimen, disturbed sleep and frequent hospitalisation of patients. Relatively high levels of emotional distress were identified in CHF caregivers. Few studies explicitly investigated the role of informal carers in the management of CHF. Studies were limited in number, scope and quality. CONCLUSION: Caring for a family member with CHF can affect the well-being of those responsible for care, which may have consequences for the CHF patient's health. Further studies are needed to clarify these issues and to examine the role of informal caregivers in the management of CHF in the community.

Caregivers↗
PubMed2005

B-type natriuretic peptide is associated with mortality in older functionally impaired patients.

OBJECTIVES: To determine the predictive power of B-type natriuretic peptide (BNP) regarding death in older, functionally impaired patients with multiple comorbidity. DESIGN: Prospective cohort study. SETTING: Specialist geriatric assessment clinic and day hospital. PARTICIPANTS: Two hundred ninety-nine older, functionally impaired patients, mean age 79 at enrollment. MEASUREMENTS: Full clinical history and examination, baseline BNP, and echocardiography. Date and cause of death were ascertained from Scottish death records. Kaplan-Meier survival curves were constructed for quartiles of log (BNP), and the contribution of BNP to prediction of death was investigated. RESULTS: The follow-up period ranged from 3.9 to 5.2 years (mean 4.4 years). BNP was a powerful independent predictor of all-cause and cardiovascular mortality. BNP was a more powerful predictor than blood pressure, diabetes mellitus, smoking, echocardiographic left ventricular hypertrophy, left ventricular systolic dysfunction, or age. BNP predicted death in those with and without a previous cardiovascular event at baseline. CONCLUSION: BNP has significant predictive power for death in older, functionally impaired patients.

Activities of Daily Living↗
PubMed2004

Age is not a significant risk factor for failed trial of beta-blocker therapy in older patients with chronic heart failure.

OBJECTIVES: To evaluate how well older heart failure patients tolerate beta-blockers in everyday clinical practice. DESIGN: Retrospective casenote analysis. SETTING: Specialist heart failure clinic in a large teaching hospital. PARTICIPANTS: 226 patients with a clinical diagnosis of heart failure and evidence of left ventricular systolic dysfunction. MEASUREMENTS: Data on age, sex, comorbid illness, other medications, duration of beta-blocker therapy, side-effects and reasons for discontinuation. RESULTS: Patients aged 75 years and over had a higher level of comorbid disease and worse New York Heart Association status. Despite this, 60.4% of those aged 75 or over had been tried on a beta-blocker (versus 69% of those aged <75), and of those tried, 80% of those aged 75 or over were still taking a beta-blocker at the time of survey (versus 86% of those aged <75). Forty-seven percent of those aged 75 or over had at least one side-effect recorded (versus 48% of those aged <75). Significant risk factors for failing a trial of beta-blocker therapy were worse New York Heart Association status and worse left ventricular function, but importantly not age. CONCLUSIONS: A high proportion of older heart failure patients tolerate beta-blockers. Side-effects and failure rates are comparable to younger patients. Left ventricular function and worse New York Heart Association class, rather than age, predict low tolerability of therapy. Further studies are warranted to evaluate whether frail patients with heart failure can improve their quality of life by taking beta-blockers.

Adrenergic beta-Antagonists↗
PubMed2004

Tolerability of spironolactone in patients with chronic heart failure -- a cautionary message.

AIM: To assess how well heart failure patients tolerate spironolactone in routine clinical practice. DESIGN: Retrospective analysis of 226 patients attending a specialist heart failure clinic. RESULTS: One hundred and thirty of 226 (57.5%) patients tried spironolactone at least once. Forty-four of 130 (33.8%) discontinued spironolactone due to side-effects after a mean of 11.1 months; 59/141 (41.8%) trials of spironolactone resulted in at least one side-effect; therapy was stopped in 30/141 (21.3%) trials due to raised potassium or creatinine. Significant risk factors for raised potassium/creatinine were age and baseline potassium level. CONCLUSIONS: Potentially serious side-effects are common despite appropriate use of spironolactone.

Age Factors↗
PubMed2003

Exercise training as a therapy for chronic heart failure: can older people benefit?

Despite recent advances in pharmacological therapy, chronic heart failure remains a major cause of morbidity and mortality in older people. Studies of exercise training in younger, carefully selected patients with heart failure have shown improvements in symptoms and exercise capacity and in many pathophysiological aspects of heart failure, including skeletal myopathy, ergoreceptor function, heart rate variability, endothelial function, and cytokine expression. Data on mortality and hospitalization are lacking, and effects on everyday activity, depression, and quality of life are unclear. Exercise therapy for patients with heart failure appears to be safe and has the potential to improve function and quality of life in older people with heart failure. To realize these potential benefits, exercise programs that are suitable for older, frail people need to be established and tested in an older, frail, unselected population with comorbidities.

Aged↗
PubMed2002

Occult transfixation of the sigmoid colon by suprapubic catheter.

PRESENTATION: A 75-year old man with severe cerebrovascular disease underwent a routine change of suprapubic catheter three months after first insertion. One day after the catheter was changed, he passed faeculent material in the catheter and became unwell with abdominal pain. The catheter tip was visible per rectum. OUTCOME: A CT scan confirmed that the suprapubic catheter had passed into the sigmoid colon. He underwent laparotomy and repair of a colovesical fistula and sigmoid perforation. He made an uncomplicated recovery. CONCLUSION: Damage to the bowel is a rare but recognized complication of suprapubic catheter insertion. Our patient illustrates that the injury may not become apparent until a change of catheter, and clinicians should bear in mind the possibility of occult bowel damage if patients become unwell after a change of suprapubic catheter.

Aged↗