M. Lye

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

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.

Effect of Diuretic Withdrawal on Haemodynamic Changes Following an Angiotensin Converting Enzyme Inhibitor in Elderly Heart Failure Patients

Introduction Despite the established benefits of angiotensin converting enzyme inhibitors (ACEI) in heart failure, many patients aTe still not receiving these drugs. One reason for this is fear of first dose hypotension (FDH) in patients, particularly elderly ones, taking loop diuretics. It has been suggested that withholding diuretics for 2448h prior to ACE