The ROle of Compression StocKings in Heart Failure Patients

压力袜对心力衰竭患者的作用

• 批准号: 10574068
• 负责人: Rafael S. Cires-Drouet
• 金额: $ 17.3万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10574068
• 关键词: Accident and Emergency department; Adverse event; Affect; Bilateral; Body Weight; Brain natriuretic peptide; Cardiomyopathies; Catheters; Cellulitis; Cessation of life; Chronic; Cities; Classification; Clinical; Compression Stocking; Creatinine; Deterioration; Disease; Diuretics; Documentation; Edema; Enrollment; Femur; Fluid overload; Guidelines; Heart; Heart Atrium; Heart failure; Hospitalization; Intervention; Kansas; Knee; Leg; Lower Extremity; Medical; New York; Obstruction; Pain; Patients; Peripheral; Physical Performance; Physicians; Pilot Projects; Prevention; Preventive measure; Pulmonary artery structure; Quality of life; Questionnaires; Randomized; Recommendation; Reflux; Renal function; Risk; Role; SF-36; Safety; Saphenous Vein; Serum; Shortness of Breath; Signs and Symptoms; Structure of popliteal vein; Symptoms; Telemedicine; Testing; Time; United States; Varicose Ulcer; Venous; Venous Insufficiency; Visit; compression therapy; cost; dosage; human old age (65+); improved; improved mobility; innovation; millisecond; pressure; prevent; ultrasound; wound

Project Summary: Heart failure (HF) affects 6.2 million patients in the United States and was responsible of 13.4% of deaths in 2018 costing about 30.7 billion USD in 2012, and about 80% of all the patients with HF are >65 years old. Clinical manifestations include shortness of breath and peripheral edema. Diuretics are indicated to treat edema in patients with HF, however, its use is limited in patients with compromised kidney function. Peripheral edema is associated with pain, heavy legs, limited mobility, and poor quality of life, increasing the risk of cellulitis, and wounds. Heart failure was identified in up to 44% of patients with venous ulcers. The chronic use of compression stockings in HF patients has potential benefits such as a better control of the edema, decreasing the need for diuretics, improving mobility, prevention of progression of venous disease, and prevention of venous ulcers. To date, no major HF guidelines recommend in favor or against compression stockings in HF patients. The objective of this R21 proposal is to study the role of the compression stockings in preventing edema and venous disease in heart failure patients. Our hypothesis We hypothesize that the use of compression stockings will prevent developing or worsening venous disease (venous reflux, and venous ulcers), improving the edema of the lower extremities, mobility, and quality of life in HF patients without increasing the risk of HF deterioration, hospitalization, or death In Aim 1 we are planning to randomize patients to high degree (20-30 mmHg) vs. low degree (10-15 mmHg) compression stockings for 3 months and evaluate for clinical sign and symptoms of deterioration of heart failure, as well as need to change in diuretic therapy at the end of the therapy. In Aim 2a we are planning to evaluate if high degree compression stockings are associated with a difference in time of valve closure (venous reflux) by venous duplex ultrasound at 3 months. In Aim 2b we are planning to evaluate if high degree compression stockings are associated with a difference in clinical signs of venous disease at 3 months. In Aim 3 we are planning to evaluate if high degree compression stockings are associated with improvement in mobility and quality of life at 3 months. The contribution with this project is significant as edema and venous disease are very morbid condition in patients with heart failure, and a simple and preventive measure such as compression stockings, could be safe and easily implemented. Our project is innovative as we are planning to use compression stockings in patients with heart failure, something that physicians are reluctant to use due to possible decompensation and fluid overload. On the other hand, we consider that it could be easily implemented and prevent advanced venous disease.

项目摘要： 心力衰竭（HF）在美国影响620万患者，造成13.4％的死亡 2018年在2012年耗资约3007亿美元，所有HF患者中约有80％的年龄较高65岁。临床 表现包括呼吸急促和周围水肿。利尿剂被指出治疗水肿 但是，HF患者在肾功能受损的患者中使用限制。外围水肿是 与疼痛，腿部沉重，活动能力有限和生活质量相关，增加了蜂窝炎的风险， 伤口。在多达44％的静脉溃疡患者中发现了心力衰竭。长期使用压缩 HF患者的长袜具有潜在的好处，例如更好地控制水肿，减少了对 利尿剂，改善活动能力，预防静脉疾病进展以及预防静脉溃疡。到 日期，没有主要的HF指南建议您有利或反对HF患者的压缩袜。 该R21提案的目的是研究压缩袜在防止水肿和 心力衰竭患者的静脉疾病。 我们假设我们假设压缩袜的使用将阻止发展或恶化 静脉疾病（静脉反流和静脉溃疡），改善下肢，活动性和 HF患者的生活质量而不增加HF恶化，住院或死亡的风险 在AIM 1中，我们计划将患者与低度（20-30 mmHg）相比（10-15 mmHg）随机随机。 压缩管袜3个月，评估心力衰竭恶化的临床体征和症状， 以及在治疗结束时需要改变利尿治疗的需要。 在AIM 2A中，我们计划评估高度压缩袜是否与 3个月时，静脉双链体超声检查阀门闭合时间（静脉反流）。 在AIM 2B中，我们计划评估高度压缩袜是否与 3个月时静脉疾病的临床体征。 在AIM 3中，我们计划评估高度压缩袜是否与改进相关 3个月的流动性和生活质量。 该项目的贡献很大，因为水肿和静脉疾病是患者病态非常病态的 通过心力衰竭以及一种简单而预防的措施，例如压缩袜，可以安全且容易 实施的。 我们的项目具有创新性，因为我们计划在心力衰竭的患者中使用压缩袜， 由于可能的代偿性和流体超负荷，医生不愿使用的东西。另一方面 手，我们认为它可以轻松实施并预防晚期静脉疾病。