Functional profile of patients with heart failure followed up in a referral ambulatory in southern Brazil

Abstract

Heart failure (HF) is a complex clinical syndrome, and its prevalence has been increasing in recent years. Despite advancements in pharmacological therapy, symptoms such as fatigue, dyspnea, and exercise intolerance are still likely to persist over time. Therefore, functional evaluation is crucial for treating patients with HF and improving their prognosis. This cross-sectional study aimed to identify the functional profile of patients with HF who were followed up at a referral ambulatory clinic in southern Brazil. In total, 51 patients with HF were treated in an outpatient setting. Functional capacity was assessed using the 6-min walk test, dynamometry, 30s sit-and-stand test, and manovacuometry (maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP]). The Minnesota Living with HF Questionnaire was used to assess the quality of life (QOL). The sample mostly comprised men (72.5%), with an average age of 48.2 ± 12.4 years. Cardiomyopathy (62.7%) was the most predominant etiology. A reduced left ventricular ejection fraction was prevalent in 94.1% of individuals and New York Heart Association functional class II and III HF in 62.8%. The most predominant risk factors were systemic arterial hypertension (60.8%), sedentary lifestyle (80.4%), obesity (41.2%), and smoking (41.2%). The most used medications were beta-blockers (94.1%), antihypertensives (52.9%), diuretics (100%), antiarrhythmics (64.7%), and angiotensin II blockers (68.6%). The average distance covered in 6MWT (Six Minute Walk Test) was 429.8 ± 96.7 m. The MIP and MEP reduced to 79.6% and 92.6% of the predicted distance, respectively. The right-hand grip strength (39 ± 11 kg) and left-hand grip strength (36 ± 10 kg) and the sit-and-stand test in 30s (30CST) (9.8 ± 2.3 repetitions) also decreased. HF had a moderate impact on QOL (46.6 ± 24.6 points). Individuals with HF have a reduced functional capacity in terms of respiratory and peripheral muscle strength, which moderately impacts QOL.

Keywords

Heart failure / Physical functional performance / Exercise test / Walk test / Quality of life

Acknowledgments

The authors thank the patients who agreed to participate in the study.

Funding

None.

Conflict of interest

The authors declare they have no competing interests.

Author contributions

Conceptualization: Jonathan Oviedo da Silva, Diether Villegas Calle, Roberto Sant’Anna, Maico Furlanetto, Guilherme Viganó, Vinicius Peringer, Bruna Eibel

Formal analysis: Jonathan Oviedo da Silva, Maria Eduarda da Costa, Bruna Eibel

Investigation: Jonathan Oviedo da Silva, Diether Villegas Calle

Methodology: Jonathan Oviedo da Silva, Roberto Sant’Anna, Maico Furlanetto, Guilherme Viganó, Vinicius Peringer, Bruna Eibel

Writing - original draft: Jonathan Oviedo da Silva, Maria Eduarda da Costa

Writing - review & editing: Vinicius Peringer, Bruna Eibel

Ethics approval and consent to participate

The study was approved by the human research ethics committee of the Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS, Brazil (CAAE 55002222.3.0000.5333), and all the subjects signed the informed consent forms.

Consent for publication

We obtained verbal consent from human patients to release their data and/or images in this article.

Availability of data

Data are available from the corresponding author upon reasonable request.

References

[1] ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. (2002). ATS statement: guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine, 166(1):111-117. https://doi.org/10.1164/ajrccm.166.1.at1102

[2] Boşnak Güçlü M., Barği G., Katayifçi N., & Şen F. (2021). Comparison of functional and maximal exercise capacity, respiratory and peripheral muscle strength, dyspnea, and fatigue in patients with heart failure with pacemakers and healthy controls: A cross-sectional study. Physiotherapy Theory and Practice, 37(2):295-306. https://doi.org/10.1080/09593985.2019.1630878

[3] Bretan O., Elias Silva J., Ribeiro O.R., & Corrente J.E. (2013). Risk of falling among elderly persons living in the community: Assessment by the timed up and go test. Brazilian Journal of Otorhinolaryngology, 79(1):18-21. https://doi.org/10.5935/1808-8694.20130004

[4] Cahalin L.P., & Arena R.A. (2015). Breathing exercises and inspiratory muscle training in heart failure. Heart Failure Clinics, 11(1):149-172. https://doi.org/10.1016/j.hfc.2014.09.002

[5] Carluccio E, Dini F.L., Bitto R., Ciccarelli M., Correale M., D’Agostino A., et al. Benefit from sacubitril/valsartan is associated with hemodynamic improvement in heart failure with reduced ejection fraction: An echocardiographic study. Int J Cardiol. 2022; 350:62-68. https://doi.org/10.1016/j.ijcard.2022.01.004

[6] Carvalho T., Milani M., Ferraz A.S., Silveira A.D., Herdy A.H., Hossri C.A.C., et al. (2020). Diretriz brasileira de reabilitação cardiovascular-2020. Arquivos Brasileiros de Cardiologia, 114(5):943-987. https://doi.org/10.36660/abc.20200407

[7] Carvalho V.O., Guimarães G.V., Carrara D., Bacal F., & Bocchi E.A. (2009). Validação da versão em português do minnesota living with heart failure questionnaire. Arquivos Brasileiros de Cardiologia, 93(1):39-44. https://doi.org/10.1590/S0066-782X2009000700008

[8] Dall’Ago P., Chiappa G.R., Guths H., Stein R., & Ribeiro J.P. (2006). Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: A randomized trial. Journal of the American College of Cardiology, 47(4):757-763. https://doi.org/10.1016/j.jacc.2005.09.052

[9] De Decco L., Andrade M., Da R., Coelho Barbosa S., Faria De Carvalho A.C., et al. (2021). Cardiorespiratory Profile of Patients with Heart Failure with Intermediate Ejection Fraction Resumo. Vol. 6. Available from: https://revista. unifeso.edu.br/index.php/jopic/article/view/2857.[2024 Jul 15]

[10] Di Naso F.C., Pereira J.S., Beatricci S.Z., Bianchi R.G., Dias A.S., & Monteiro M.B. (2011). A classe da NYHA tem relação com a condição funcional e qualidade de vida na insuficiência cardíaca. Fisioterapia e Pesquisa, 18(2):157-163. https://doi.org/10.1590/S1809-29502011000200010

[11] Fernandes D.F.A., Fernandes G.C., Rivera Mazza M., Knijnik M.L., Soares Fernandes G., Telis de Vilela A., et al. (2019). Insuficiência cardíaca no brasil subdesenvolvido: Análise de tendência de dez anos. Arquivos Brasileiros de Cardiologia, 114(2):222-231. https://doi.org/10.36660/abc.20180321

[12] Fuentes-Abolafio I.J., Stubbs B., Pérez-Belmonte L.M., Bernal- López M.R., Gómez-Huelgas R., & Cuesta-Vargas A.I. (2020). Physical functional performance and prognosis in patients with heart failure: A systematic review and meta-analysis. BMC Cardiovascular Disorders, 20(1):512. https://doi.org/10.1186/s12872-020-01725-5

[13] García-Olmos L., Batlle M., Aguilar R., Porro C., Carmona M., Alberquilla A., et al. (2019). Disability and quality of life in heart failure patients: A cross-sectional study. Family Practice, 36(6):693-698. https://doi.org/10.1093/fampra/cmz017

[14] Herdy A.H., Ritt L.E.F., Stein R., Araújo C.G.S., Milani M., Meneghelo R.S., et al. (2016). Cardiopulmonary exercise test: Fundamentals, applicability and interpretation. Arquivos Brasileiros de Cardiologia, 107(5):467-481. https://doi.org/10.5935/abc.20160171

[15] Hwang R., Morris N.R., Mandrusiak A., Mudge A., Suna J., Adsett J., et al. (2016). Timed up and go test: A reliable and valid test in patients with chronic heart failure. Journal of Cardiac Failure, 22(8):646-650. https://doi.org/10.1016/j.cardfail.2015.09.018

[16] Jones C.J., Rikli R.E., & Beam W.C. (1999). A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Research Quarterly for Exercise and Sport, 70(2):113-119. https://doi.org/10.1080/02701367.1999.10608028

[17] Mathiowetz V., Kashman N., Volland G., Weber K., Dowe M., & Rogers S. (1985). Grip and pinch strength: Normative data for adults. Archives of Physical Medicine and Rehabilitation, 66(2):69-74.

[18] Novaes R.D., Miranda A.S., Silva J.O., Tavares B.V.F., & Dourado V.Z. (2009). Reference equations for predicting handgrip strength in middle-aged and elderly Brazilians. Psysiotherapy and Research, 16(3):217-222. https://doi.org/10.1590/S1809-29502009000300005

[19] Oliveira M.F., Zanussi G., Sprovieri B., Lobo D.M.L., Mastrocolla L.E., Umeda I.I.K., et al. (2016). Alternatives to aerobic exercise prescription in patients with chronic heart failure. Arquivos Brasileiros de Cardiologia, 106(2):97-104. https://doi.org/10.5935/abc.20160014

[20] Paz L.F.A., Medeiros C.A., Martins S.M., Bezerra S.M.M.S., Oliveira Junior W., & Silva M.B.A. (2019). Quality of life related to health for heart failure patients. Revista Brasileira de Enfermagem, 72(Suppl 2):140-146. https://doi.org/10.1590/0034-7167-2018-0368

[21] Podsiadlo D., & Richardson S. (1991). The timed “Up and Go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2):142-148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x

[22] Poffo M.R., Assis A.V., Fracasso M., Londero Filho O.M., Alves S.M.M., Bald A.P., et al. (2017). Profile of patients hospitalized for heart failure in tertiary care hospital. International Journal of Cardiovascular Sciences, 30(3):189-198. https://doi.org/10.5935/2359-4802.20170044

[23] Rohde L.E.P., Montera M.W., Bocchi E.A., Clausell N.O., Albuquerque D.C., Rassi S., et al. (2018). Brazilian Guideline for Chronic and Acute Heart Failure. Arquivos Brasileiros de Cardiologia, 111(3):436-539. https://doi.org/10.5935/abc.20180190

[24] Santos T.A.B., Santos P.M., Wassmuth T., Mazzo D.M., Costa B.M., & Moleta J.F.K. (2022). The use of ultrasonography as a tool to evaluate the quadriceps muscle in patients with chronic obstructive pulmonary disease: A systematic review. Research, Society and Development, 11(1):e19911124728. https://doi.org/10.33448/rsd-v11i1.24728

[25] Silva T.M., Chagas P.S., Nogueira E.N., & Boone D.K. (2022). Avaliação da perda de massa muscular em pacientes críticos: Utilizando a ultrassonografia como ferramenta. Brazilian Journal of Development, 8(12):78589-78598. https://doi.org/10.34117/bjdv8n12-117

[26] Suzuki T., Palus S., & Springer J. (2018). Skeletal muscle wasting in chronic heart failure. ESC Heart Failure, 5(6):1099-1107. https://doi.org/10.1002/ehf2.12387

[27] Vieira L., Rocha L.P.B., Mathur S., Santana L., Melo P.F., Silva V.Z.M., et al. (2019). Reliability of skeletal muscle ultrasound in critically ill trauma patients. Revista Brasileira de Terapia Intensiva, 31(4):464-473. https://doi.org/10.5935/0103-507X.20190072

[28] Xavier S.O., & Ferretti-Rebustini R.E.L. (2019). Clinical characteristics of heart failure associated with functional dependence on admission in hospitalized elderly patients. Latin American Journal of Nusring. 27:e3137. https://doi.org/10.1590/1518-8345.2869-3137