Background The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure trial tested the hypothesis that continuous positive airway pressure (CPAP) would...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa051001

Continuous positive airway pressure for central sleep apnea and heart failure.

A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain.

Health measurement scales

A lack of clarity exists about the definition and adequate approach for evaluating responsiveness. An overview is presented of different categories of definitions and methods used for calculating responsiveness identified through a literature search. Twenty-five definitions and 31 measures were found. When applied to a general and a disease-specific quality of life questionnaire large variation in results was observed, partly explained by different goals of existing methods. Four major issues are considered to claim the usefulness of an evaluative health-related quality of life (HRQL) instrument. Their relation with responsiveness is discussed. The confusion about responsiveness arises mostly from a lack of distinction between cross-sectional and longitudinal validity and from a lack of distinction between responsiveness defined as the effect of treatment and responsiveness defined as the correlation of changes in the instrument with changes in other measures. All measures of what is currently called responsiveness can be looked at as measures of longitudinal validity or as measures of treatment effect. The latter ones tell us little about how well the instrument serves its purpose and are only of use in interpreting score changes. We therefore argue that the concept of responsiveness can be rejected as a separate measurement property of an evaluative instrument.

On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation.

Background: Multimodal analgesia programs have been shown to decrease hospital stay, but it not clear which functions are restored after surgery. The objective of this study is to evaluate the impact of epidural anesthesia and analgesia on functional exercise capacity and health-related quality of life. Methods: Sixty-four patients undergoing elective colonic resection were randomized to either patient-controlled analgesia with morphine or thoracic epidural analgesia with bupivacaine and fentanyl (epidural group). All patients in both groups received similar perioperative care and were offered the same amount of postoperative oral nutrition and assistance with mobilization. Primary outcome was functional exercise capacity as measured by the 6-min walking test, and secondary outcome was health-related quality of life, as measured by the SF-36 health survey. These were assessed before surgery and at 3 and 6 weeks after hospital discharge. Other variables measured in hospital included pain and fatigue visual analogue scale, bowel function, time out of bed, nutritional intake, complication rate, readiness for discharge, and length of hospital stay. Results: Although the 6-min walking test and the SF-36 physical health component decreased in both groups at 3 and 6 weeks after surgery, the patient-controlled analgesia group experienced a significantly greater decrease at both times (P < 0.01). Patients in the epidural group had lower postoperative pain and fatigue scores, which allowed them to mobilize to a greater extent (P < 0.05) and eat more (P < 0.05). Length of hospital stay and incidence of complications were similar in both groups, although patients in the epidural group were ready to be discharged earlier. Conclusions: The superior quality of pain relief provided by epidural analgesia had a positive impact on out-of-bed mobilization, bowel function, and intake of food, with long-lasting effects on exercise capacity and health-related quality of life.

Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial.

Objective—To examine the reproducibility and responsiveness to change of a six minute walk test and a quality of life measure in elderly patients with heart failure.
Design—Longitudinal within patient study.
Subjects—60 patients with heart failure (mean age 82 years) attending a geriatric outpatient clinic, 45 of whom underwent a repeat assessment three to eight weeks later.
Main outcome measures—Subjects underwent a standardised six minute walk test and completed the chronic heart failure questionnaire (CHQ), a heart failure specific quality of life questionnaire. Intraclass correlation coefficients (ICC) were calculated using a random effects one way analysis of variance as a measure of reproducibility. Guyatt's responsiveness coefficient and effect sizes were calculated as measures of responsiveness to change.
Results—24 patients reported no major change in cardiac status, while seven had deteriorated and 14 had improved between the two clinic visits. Reproducibility was satisfactory (ICC > 0.75) for the six minute walk test, for the total CHQ score, and for the dyspnoea, fatigue, and emotion domains of the CHQ. Effect sizes for all measures were large (> 0.8), and responsiveness coefficients were very satisfactory (> 0.7). Effect sizes for detecting deterioration were greater than those for detecting improvement.
Conclusions—Quality of life assessment and a six minute walk test are reproducible and responsive measures of cardiac status in frail, very elderly patients with heart failure.

Keywords: six minute walk;  elderly people;  heart failure;  quality of life

https://heart.bmj.com/content/heartjnl/80/4/377.full.pdf

Reproducibility and responsiveness of quality of life assessment and six minute walk test in elderly heart failure patients

We are an aging population. It is estimated that 20% of people in Europe will be over 65 years of age in the year 2000. The proportion of the population over 80 years, the so-called “old old”, is increasing most rapidly. Life expectancy at all ages is also increasing. At 65 years life expectancy ranges from 14.9 to 18.9 years and at 80 years from 6.9 to 9.1 years for men and women, respectively. Cardiovascular disease is the most frequent single cause of death in persons over 65 years of age1, and most importantly it is responsible for considerable morbidity and a large burden of disability, particularly in the community.

Cardiovascular pathologies such as hypertension and cerebrovascular disease, and heart diseases such as coronary artery disease, arrhythmias, and heart failure, increase in incidence with increasing age.w1 The aging process itself also effects the cardiovascular system. It is difficult to differentiate “normal” aging, which is inevitable, from age related pathology, which is potentially preventable or treatable.w2 Age related changes are most likely to be seen in the “old old” who have escaped cardiovascular pathology earlier in life. This group demonstrates the dual processes, often interacting, of biological aging of the cardiovascular system and age related pathology. This combination modifies the pathophysiology of disease such that knowledge of that condition and treatment thereof, derived from studies in “young old” (65–75 years) are not readily applicable to the “old old”. Older patients differ from “trial” patients of any age by virtue of their other comorbidities and multiple drug usage, which are invariably exclusion criteria for entering treatment studies.

### Cardiac

https://heart.bmj.com/content/heartjnl/84/5/560.full.pdf

Heart disease in the elderly.

/pdf/neurohormonal-effects-of-an-angiotensin-converting-enzyme-3xdmh3g1u4.pdf

Neurohormonal Effects of an Angiotensin Converting Enzyme Inhibitor in Elderly Heart Failure Patients

Iconographies supplémentaires de l'article : Does stopping diuretics prevent first dose hypotension in older heart failure patients commencing ACE inhibitor therapy?

M. Lye

Papers

Reproducibility and responsiveness of quality of life assessment and six minute walk test in elderly heart failure patients

Heart disease in the elderly.

Neurohormonal Effects of an Angiotensin Converting Enzyme Inhibitor in Elderly Heart Failure Patients

Iconographies supplémentaires de l'article : Does stopping diuretics prevent first dose hypotension in older heart failure patients commencing ACE inhibitor therapy?

Does stopping diuretics prevent first dose hypotension in older heart failure patients commencing ACE inhibitor therapy