Publications by authors named "Mariann R Piano"

61 Publications

Factors associated with phosphatidylethanol (PEth) sensitivity for detecting unhealthy alcohol use: An individual patient data meta-analysis.

Alcohol Clin Exp Res 2021 Apr 10. Epub 2021 Apr 10.

Department of Community Health Sciences, Boston University, School of Public Health, Section of General Internal Medicine, Boston University, School of Medicine and Boston Medical Center, Grayken Center on Addiction, Boston Medical Center, Boston, MA, USA.

Background: Objective measurement of alcohol consumption is important for clinical care and research. Adjusting for self-reported alcohol use, we conducted an individual participant data (IPD) meta-analysis to examine factors associated with the sensitivity of phosphatidylethanol (PEth), an alcohol metabolite, among persons self-reporting unhealthy alcohol consumption.

Methods: We identified 21 eligible studies and obtained 4073 observations from 3085 participants with Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) positive scores (≥3 for women and ≥4 for men) and PEth measurements. We conducted one-step IPD meta-analysis using mixed-effects models with random intercepts for study site. We examined the associations between demographic (sex, race/ethnicity, and age) and biologic (body mass index -- BMI, hemoglobin, HIV status, liver fibrosis, and venous versus finger-prick blood collection) variables with PEth sensitivity (PEth≥8 ng/mL), adjusting for level of alcohol use using the AUDIT-C score.

Results: One-third (31%) of participants were women, 32% were African, 28% African American, 28% White, and 12% other race/ethnicity. PEth sensitivity (i.e. ≥8 ng/mL) was 81.8%. After adjusting for AUDIT-C, we found no associations of sex, age, race/ethnicity, or method of blood collection with PEth sensitivity. In models that additionally included biologic variables, those with higher hemoglobin and indeterminate and advanced liver fibrosis had significantly higher odds of PEth sensitivity; those with higher BMI and those living with HIV had significantly lower odds of PEth sensitivity. African Americans and Africans had higher odds of PEth sensitivity compared to whites in models that included biologic variables.

Conclusions: Among people reporting unhealthy alcohol use, several biological factors (hemoglobin, BMI, liver fibrosis, and HIV status) were associated with PEth sensitivity. Race/ethnicity was associated with PEth sensitivity in some models; age, sex and method of blood collection were not. Clinicians should be aware of these factors, and researchers should consider adjusting analyses for these characteristics where possible.
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http://dx.doi.org/10.1111/acer.14611DOI Listing
April 2021

Hospital- and Patient-Level Characteristics Associated With Unplanned Readmissions and In-Patient Mortality in Men and Women With Alcoholic Cardiomyopathy.

J Stud Alcohol Drugs 2021 Mar;82(2):257-268

Center for Research Development and Scholarship, Vanderbilt University School of Nursing, Nashville, Tennessee.

Objective: The aims of the study were to (a) determine rates of early, late, and overall 30-day all-cause readmission for women and men with the diagnosis of alcoholic cardiomyopathy (ACM), (b) examine hospital- and patient-level characteristics associated with the risk of readmission and how these factors differed by sex, and (c) examine the association between sex and in-patient mortality during readmission.

Method: We conducted a multi-year cross-sectional analysis of adult (≥18 years) inpatient hospitalizations in the United States. Descriptive statistics including frequencies and percentages were used to describe the study population, stratified by sex. We then used Poisson regression with robust error variance estimation to estimate risk ratios (RRs) and 95% confidence intervals (CIs) that represented the associations between sex and likelihood of 30-day all-cause readmission and inpatient mortality.

Results: Among more than 116 million hospitalizations, there were 53,207 ACM-related hospitalizations (45,573 men and 7,634 women). Thirty-day all-cause readmission rates following an ACM-related index hospitalization were similar between men (20.3%) and women (20.5%). For men and women, cancer, hepatitis, chronic renal failure, cirrhosis, asthma, and anemia were associated with a higher risk of readmission. Although crude in-hospital mortality rates were higher among women (6.6%) than men (4.3%), there were no sex differences in mortality after adjusting for confounders (RR = 1.26, 95% CI [0.88, 1.81]).

Conclusions: Although men are more likely to be hospitalized for ACM, readmission risk is high (approximately 20%) and is similar in men and women following hospitalization for ACM. Hospital care transition programs that include a multidisciplinary approach are needed to help prevent these readmissions and associated morbidity and mortality.
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March 2021

Opportunities and challenges presented by recent pedagogical innovations in doctoral nursing education.

J Prof Nurs 2021 Jan-Feb;37(1):228-234. Epub 2020 Sep 2.

NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America.

The demand to expand the nurse scientist pipeline over the past decade has generated numerous pedagogical innovations in nursing doctoral education. A PhD nursing education summit was held at the University of Pennsylvania in October 2019 to discuss pedagogical innovations. The main pedagogical innovations discussed by Summit attendees included: 1) the expansion of both 3-year PhD programs and BSN to PhD programs; 2) changes in learning opportunities and curricula content; and 3) the role of postdoctoral fellowships. This overview examines the numerous opportunities and challenges generated by these innovations. Opportunities include producing scholars with research careers that are potentially longer than historically seen in the nursing profession, as well as the emergence of unique educational and mentoring opportunities both during and after doctoral studies. Challenges involve the impact condensed program timelines have had on both the content and delivery of curricula, as well as the research expertise and skillsets of nursing PhD program graduates. There is a need to conduct a national coordinated evaluation of PhD program using shared metrics in order to better evaluate the effect of these pedagogical innovations on the development of nurse scientists, and ultimately, the discipline.
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http://dx.doi.org/10.1016/j.profnurs.2020.09.003DOI Listing
September 2020

Parental cardiovascular health predicts time to onset of cardiovascular disease in offspring.

Eur J Prev Cardiol 2020 Nov 5. Epub 2020 Nov 5.

College of Nursing and Health Sciences, University of Massachusetts Boston, 100 William T Morrissey Blvd, Boston, MA 02125, USA.

Background: Cardiovascular disease (CVD) risk factors are transmitted from parents to children. We prospectively examined the association between parental cardiovascular health (CVH) and time to onset of CVD in the offspring.

Methods And Results: The study consisted of a total of 5967 offspring-mother-father trios derived from the Framingham Heart Study. Cardiovascular health score was defined using the seven American Heart Association's CVH metrics attained at ideal levels: poor (0-2), intermediate (3-4), and ideal CVH (5-7). Multivariable-adjusted Cox proportional hazards regression models, Kaplan-Meier plots, and Irwin's restricted mean were used to examine the association and sex-specific differences between parental CVH and offspring's CVD-free survival. In a total of 71 974 person-years of follow-up among the offspring, 718 incident CVD events occurred. The overall CVD incidence rate was 10 per 1000 person-years [95% confidence interval (CI) 9.3-10.7]. Offspring of mothers with ideal CVH lived 9 more years free of CVD than offspring of mothers with poor CVH (P < 0.001). Maternal poor CVH was associated with twice as high hazard of early onset of CVD compared with maternal ideal CVH (adjusted Hazard Ratio 2.09, 95% CI 1.50-2.92). No statistically significant association was observed in the hazards of CVD-free survival by paternal CVH categories.

Conclusions: We found that offspring of parents with ideal CVH had a greater CVD-free survival. Maternal CVH was a more robust predictor of offspring's CVD-free survival than paternal CVH, underscoring the need for clinical and policy interventions that involve mothers to break the intergenerational cycle of CVD-related morbidity and mortality.
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http://dx.doi.org/10.1093/eurjpc/zwaa072DOI Listing
November 2020

Pregnancy Associated Heart Failure With Preserved Ejection Fraction: Risk Factors and Maternal Morbidity.

J Card Fail 2021 Feb 1;27(2):143-152. Epub 2021 Jan 1.

Center for Research Development and Scholarship, Vanderbilt University, School of Nursing, Nashville, Tennessee.

Background: Cardiovascular conditions are leading contributors to increasing maternal morbidity and mortality. Heart failure with preserved ejection fraction (HFpEF) results in the majority of HF admissions in women, yet its impact in pregnancy is unknown. We examined the prevalence rates, risk factors and adverse pregnancy outcomes in women with HFpEF during pregnancy-related hospitalizations in the United States.

Methods And Results: We conducted a cross-sectional analysis of pregnancy-related hospitalizations from 2002 through 2014 using the National Inpatient Sample. HFpEF cases were identified using the 428.3 International Classification of Diseases, 9th edition, Clinical Modification code. Weighting variables were used to provide national estimates, unconditional survey logistic regression to generate odds ratios and 95% confidence intervals (CI) representing adjusted associations with adverse pregnancy outcomes and Joinpoint regression to estimate temporal trends. Among 58,732,977 hospitalizations, there were 3840 HFpEF cases, an overall rate of 7 cases per 100,000 pregnancy-related hospitalizations; 56% occurred postpartum, 27% during delivery, and 17% antepartum. The temporal trend for hospitalization increased throughout the timeframe by 19.4% (95% CI 13.9-25.1). HFpEF hospitalizations were more common for Black, older, or poor women. Risk factors included hypertension (chronic hypertension and hypertensive disorders of pregnancy), anemia, obesity, diabetes, renal disease and coronary atherosclerosis; all known risk factors for HFpEF. Women with HFpEF were 2.61-6.47 times more likely to experience adverse pregnancy outcomes.

Conclusions: The pregnancy-related HFpEF hospitalization prevalence has increased and is associated with adverse pregnancy outcomes. Risk factors resemble those outside pregnancy, emphasizing the need for screening and monitoring women with risk factors during pregnancy for HFpEF.
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http://dx.doi.org/10.1016/j.cardfail.2020.12.020DOI Listing
February 2021

Effects of Alcohol on the Cardiovascular System in Women.

Alcohol Res 2020 30;40(2):12. Epub 2020 Jul 30.

Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality for women. This review summarizes the relationship between alcohol consumption and common CVDs in women and highlights potential differences from men. Except for risk of hypertension, no sex-related effects of alcohol consumption on the risk for coronary heart disease and stroke have been reported, and data on the sex-related effects on risk for peripheral arterial disease are limited. For women, alcohol consumption has a J-shaped relationship with hypertension. About 1 to 2 standard drinks per day is associated with lower risk for the development of hypertension, whereas for men, the relationship is relatively linear. In the area of alcoholic cardiomyopathy, the prevalence is greater for men, but women may develop alcoholic cardiomyopathy at a lower lifetime level of alcohol consumption. Overall, data support that 1 to 2 standard drinks per day for women and men is associated with a lower risk of CVD, and higher daily amounts may increase the risk of CVD.
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http://dx.doi.org/10.35946/arcr.v40.2.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398617PMC
February 2021

Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association.

Circulation 2020 Sep 5;142(10):e131-e152. Epub 2020 Aug 5.

Cannabis, or marijuana, has potential therapeutic and medicinal properties related to multiple compounds, particularly Δ-9-tetrahydrocannabinol and cannabidiol. Over the past 25 years, attitudes toward cannabis have evolved rapidly, with expanding legalization of medical and recreational use at the state level in the United States and recreational use nationally in Canada and Uruguay. As a result, the consumption of cannabis products is increasing considerably, particularly among youth. Our understanding of the safety and efficacy of cannabis has been limited by decades of worldwide illegality and continues to be limited in the United States by the ongoing classification of cannabis as a Schedule 1 controlled substance. These shifts in cannabis use require clinicians to understand conflicting laws, health implications, and therapeutic possibilities. Cannabis may have therapeutic benefits, but few are cardiovascular in nature. Conversely, many of the concerning health implications of cannabis include cardiovascular diseases, although they may be mediated by mechanisms of delivery. This statement critically reviews the use of medicinal and recreational cannabis from a clinical but also a policy and public health perspective by evaluating its safety and efficacy profile, particularly in relationship to cardiovascular health.
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http://dx.doi.org/10.1161/CIR.0000000000000883DOI Listing
September 2020

Temporal Trends and Familial Clustering of Ideal Cardiovascular Health in Parents and Offspring Over the Life Course: An Investigation Using The Framingham Heart Study.

J Am Heart Assoc 2020 06 3;9(12):e016292. Epub 2020 Jun 3.

College of Nursing and Health Sciences University of Massachusetts Boston Boston MA.

Background Evidence suggests familial aggregation and intergenerational associations for individual cardiovascular health (CVH) metrics. Over a 53-year life course, we examined trends and association of CVH between parents and their offspring at similar mean ages. Methods and Results We conducted a series of cross-sectional analyses of the FHS (Framingham Heart Study). Parent-offspring pairs were assessed at exams where their mean age distributions were similar. Ideal CVH was defined using 5 CVH metrics: blood pressure (<120/<80 mm Hg), fasting blood glucose (<100 mg/dL), blood cholesterol (<200 mg/dL), body mass index (<25 kg/m), and non-smoking. Joinpoint regression and Chi-squared test were used to assess linear trend; proportional-odds regression was used to examine the association between parents and offspring CVH. A total of 2637 parents were paired with 3119 biological offspring throughout 6 exam cycles. Similar patterns of declining ideal CVH with advancing age were observed in parents and offspring. Small proportions of parents (4%) and offspring (17%) achieved 5 CVH metrics at ideal levels (-trend <0.001). Offspring of parents with poor CVH had more than twice the odds of having poor CVH (pooled odds ratio, 2.59; 95% CI, 1.98-3.40). Over time, elevated glucose levels and obesity doubled among the offspring and were the main drivers for declining ideal CVH trends. Conclusions Parental CVH was positively associated with offspring CVH. However, intergenerational CVH gains from declining smoking rates, cholesterol, and blood pressure were offset by rising offspring obesity and elevated glucose levels. This suggests an intergenerational phenotypic shift of risk factors and the need for a family-centered approach to cardiovascular care.
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http://dx.doi.org/10.1161/JAHA.120.016292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429037PMC
June 2020

Tetrahydrobiopterin Restores Microvascular Dysfunction in Young Adult Binge Drinkers.

Alcohol Clin Exp Res 2020 02 26;44(2):407-414. Epub 2019 Dec 26.

From the, Department of Physical Therapy, (C-LH, SAP), University of Illinois at Chicago, Chicago, Illinois.

Background: Repeated binge drinking is associated with reduced microvascular function. However, microvascular responses to pathophysiological stimulus such as high pressure as well as potential mechanisms that underlie binge-induced microvascular dysfunction are unknown. Therefore, using an ex vivo experimental model, we examined microvascular responses following a brief period of high intraluminal pressure in isolated arterioles from young adults who have a history of repeated binge drinking. In addition, we examined whether the application of the endothelial nitric oxide synthase cofactor, tetrahydrobiopterin, would restore microvascular function in response to flow and high intraluminal pressure in young adult binge drinkers.

Methods: Isolated subcutaneous adipose arterioles were obtained from young adult binge drinkers (BD; n = 14), moderate drinkers (MODs; n = 10), and alcohol abstainers (ABs; n = 12; mean age: 23.7 ± 0.5 years; and body mass index: 23.4 ± 0.4 kg/m ). Arteriolar flow-induced dilation (FID, pressure gradient: ∆10 to 100 cm H O) was measured before and after acute high intraluminal pressure with and without tetrahydrobiopterin.

Results: Before high pressure, FID at Δ60 and Δ100 cm H O pressure gradient in BDs was 14% lower and 18% lower, respectively, than ABs (p < 0.05), while MODs and ABs had similar FID across all pressure gradients (p ≥ 0.2). After high pressure, FID in BDs was further reduced by 10% (p < 0.0005) and this impairment was ameliorated by the treatment of tetrahydrobiopterin (4 to 26% higher, p < 0.005). In contrast, FID after high pressure did not change in MODs and ABs (p ≥ 0.5).

Conclusions: Microvascular dysfunction in young adult binge drinkers may be exacerbated with acute pathophysiological stimulus. These binge-induced dysfunctions may be reversed by tetrahydrobiopterin, which suggests a role of oxidative stress and/or uncoupled endothelial nitric oxide synthase in binge drinking.
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http://dx.doi.org/10.1111/acer.14254DOI Listing
February 2020

The effects of repeated binge drinking on arterial stiffness and urinary norepinephrine levels in young adults.

J Hypertens 2020 01;38(1):111-117

Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois School of Nursing, Vanderbilt University, Nashville, Tennessee Department of Biobehavioral Health Science Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, Illinois, USA Department of Physical Education and Health, Physiotherapy Course at University of Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, Chicago, Illinois, USA.

Objectives: The aim of this study was to investigate the effect of repeated binge drinking and moderate alcohol consumption in young adults on arterial stiffness and sympathetic activity.

Methods: We enrolled 49 healthy young adults, free of cardiovascular diseases (25 men; age: 23.5 ± 0.4 years; BMI: 23.4 ± 0.4 kg/m; mean ± S.E). Individuals included were those with a history of repeated binge drinking (>2 years duration; n = 20), drank at moderate levels (MODs, >5 years duration; n = 16) and abstained from alcohol (last 2-3 years; n = 13). Arterial stiffness was assessed using carotid to femoral pulse wave velocity (cfPWV) and sympathetic activity was assessed using 24-h urinary norepinephrine levels. Also measured was aortic SBP and augmentation index (AIx), a measure of wave reflection.

Results: Binge drinkers and MODs had higher cfPWV than alcohol abstainers (0.6 and 0.5 m/s, respectively; P ≤ 0.04). In addition, binge drinkers had higher urinary norepinephrine levels than MODs and alcohol abstainers (P < 0.05). Higher cfPWV were correlated with higher norepinephrine levels (r = 0.35. P = 0.02). Aortic SBP (P = 0.2) and AIx (P = 0.96) were similar among binge drinkers, MODs and alcohol abstainers.

Conclusion: Our findings suggest that repeated exposure to alcohol, regardless of drinking pattern, may increase aortic arterial stiffness in healthy young adults. In addition, sympathetic activation, reflected by increased 24-h urinary norepinephrine levels, may contribute to alcohol-induced arterial stiffening in young adults.
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http://dx.doi.org/10.1097/HJH.0000000000002223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239610PMC
January 2020

Contemporary Appraisal of Sex Differences in Prevalence, Correlates, and Outcomes of Alcoholic Cardiomyopathy.

Alcohol Alcohol 2019 Jul;54(4):386-395

Center for Research Development and Scholarship, Vanderbilt School of Nursing, Nashville, TN, USA.

Aims: The aims of this study were to: examine differences in alcoholic cardiomyopathy (ACM) prevalence, temporal trends and the distribution of socio-demographic factors and comorbidities by sex; and investigate differences in selected inpatient outcomes between women and men with ACM.

Methods: We used the 2002-2014 Nationwide Inpatient Sample databases. Overall and sex-specific rates of ACM were estimated across sociodemographic, clinical, and hospital characteristics. Joinpoint regression was used to estimate temporal trends (annual percent change [APC]) of ACM-related hospitalization by sex and race/ethnicity. Adjusted odds ratios (AOR) representing associations between sex and selected ACM outcomes were calculated using survey logistic regression.

Results: The rate of ACM among all inpatient men and women was 128 per 100,000 and 17 per 100,000 hospitalizations, respectively. Among women, the rate of ACM remained unchanged during the study period, while for men, there was 1.2% annual reduction from 2002-2010 (APC -1.3, 95% CI: -1.7, -0.8). Women with ACM were more likely than men with ACM to experience depression (AOR=2.24, 95% CI: 2.06-2.43) and anxiety (AOR=1.94, 95% CI: 1.75-2.15), while men with ACM were 21% and 24% more likely than women with ACM to experience 'any heart failure (HF)' and HF with reduced ejection fraction respectively. One in 1,471 hospitalizations were related to ACM with a male-to-female ratio of 8:1.

Conclusion: Individuals with ACM are at increased likelihood of adverse outcomes. Women with ACM are at increased risk of depression and anxiety, while men are at increased risk of HF.
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http://dx.doi.org/10.1093/alcalc/agz050DOI Listing
July 2019

Ethanol Induced Oxidative Stress in the Vasculature: Friend or Foe.

Curr Hypertens Rev 2020 ;16(3):181-191

Center for Research Development and Scholarship, Vanderbilt University School of Nursing, Nashville, TN 37240, United States.

Oxidative stress is implicated in the etiology of many ethanol-induced pathologies. Oxidative stress has been shown to contribute to the development of endothelial dysfunction and cardiovascular disease, such as hypertension. This review details mechanisms of vascular function, the role of oxidative stress in vascular biology and how ethanol consumption may alter endothelial and smooth muscle cell function as well as microvascular function. Also reviewed are data from human investigations that have examined the association between alcohol consumption and changes in blood pressure and increased risk for hypertension.
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http://dx.doi.org/10.2174/1573402115666190325124622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239609PMC
January 2020

Perceived Stress Among Patients With Heart Failure Who Have Low Socioeconomic Status: A Mixed-Methods Study.

J Cardiovasc Nurs 2019 May/Jun;34(3):E1-E8

Carolyn Dickens, PhD, APRN Clinical Assistant Professor, Department of Medicine, College of Medicine, University of Illinois at Chicago. Victoria Vaughan Dickson, PhD, RN FAHA, FAAN Associate Professor and Director, Pless Center for Research, Rory Meyers College of Nursing, New York, New York. Mariann R. Piano, PhD, RN, FAHA, FAAN Nancy and Hilliard Travis Professor of Nursing Senior and Associate Dean for Research, Vanderbilt University School of Nursing, Nashville, Tennessee.

Background: Patient populations with low socioeconomic status (SES) experience psychological stress because of social determinants of health. Social determinants of health contribute to self-care-especially among patients with heart failure (HF).

Objective: We sought to describe the influence of stress and social determinants of health on self-care in patients with HF who have low SES.

Methods: In this mixed-methods, concurrent embedded study, participants (N = 35) were recruited from 2 urban hospitals in Chicago if they had low SES and were readmitted within 120 days of an exacerbation of HF. We conducted semistructured interviews to collect qualitative data about stressors associated with patients' living circumstances, strategies patients used to foster self-care, family dynamics, and coping strategies patients used to decrease stress. We measured psychological stress (Perceived Stress Scale [PSS-10]), and self-care (Self-care of Heart Failure Index). Content analysis was used to analyze the qualitative data, and descriptive statistics were used to describe the sample. In the final analytic phase, the qualitative and quantitative data were integrated.

Results: Self-care was poor: 91.5% of participants had Self-care of Heart Failure Index subscale scores lower than 70. Perceived stress was high: 34% of participants had PSS-10 scores of 20 or higher. Several social determinants of health emerged as affecting self-care: financial stress, family personal health, past impactful deaths, and a recent stressful event (eg, child's death). Participants lived in areas with high crime and violence, and participants described many stressful events. However, among participants whose PSS-10 scores were lower than 20 (indicating lower stress), there was discordance among the description of factors impacting self-care and their PSS-10 score.

Conclusions: Social determinants of health negatively impact the ability of low-SES patients to manage their HF symptoms and adhere to a medication and dietary regimen. It is important that healthcare providers assess patients' stressors so appropriate referral to services can occur.
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http://dx.doi.org/10.1097/JCN.0000000000000562DOI Listing
September 2020

Relationship between cardiovascular risk factors and binge drinking among college students in South Korea.

J Ethn Subst Abuse 2020 Jan-Mar;19(1):119-132. Epub 2018 Jul 31.

Vanderbilt University, Nashville, Tennessee.

This study determined cardiovascular risk among Korean college students with a history of binge drinking. Variables included alcohol consumption, cardiovascular risk factors (increased blood pressure, body mass index, lipid values) and markers (high-sensitivity C-reactive protein, fibrinogen), and 10-year Framingham risk scores. Korean college student binge drinkers had higher triglyceride levels and higher ratios of triglyceride to high-density lipoprotein cholesterol than did abstainers. Average number of drinks on one occasion was correlated with higher body mass index, triglyceride level, ratio of triglyceride to high-density lipoprotein cholesterol, and 10-year Framingham risk score. The findings indicate that binge drinking may be associated with premature cardiovascular disease risk.
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http://dx.doi.org/10.1080/15332640.2018.1484311DOI Listing
July 2018

Effects of Repeated Binge Drinking on Blood Pressure Levels and Other Cardiovascular Health Metrics in Young Adults: National Health and Nutrition Examination Survey, 2011-2014.

J Am Heart Assoc 2018 06 27;7(13). Epub 2018 Jun 27.

Department of Physical Therapy, University of Illinois at Chicago, IL.

Background: Binge drinking prevalence rates are highest in young adults; however, little is known about the effects of binge drinking on blood pressure (BP) and other cardiovascular health metrics in individuals between 18 and 45 years of age. The aim of this study was to determine the effects of regular binge drinking on BP, lipid and glucose levels and to determine if there were differences in these associations between men and women.

Methods And Results: We analyzed data from NHANES (the US National Health and Nutrition Examination Survey) for men and women 18 to 45 years old who were non-binge drinkers, binge drank 1 to 12 times, or binge drank >12 times in the past year. After controlling for diet and physical activity, both categories of men binge drinkers compared with non-binge drinkers had higher systolic BP (121.8 and 119.0 mm Hg versus 117.5 mm Hg) and total cholesterol (215.5 and 217.9 mg/dL versus 207.8 mg/dL) values. There were no effects of binge drinking on systolic BP or total cholesterol in women. Binge drinking in men and women was associated with higher high-density lipoprotein-cholesterol values. The effects of binge drinking on glucose parameters in men and women were variable.

Conclusions: Compared with young adult women, repeated binge drinking in men was associated with an elevated systolic BP, and greater frequency of binge drinking in men was associated with a more unfavorable lipid profile. In young adults with elevated systolic BP, practitioners should consider the possible role of binge drinking and address the importance of reducing alcohol intake as an important cardiovascular risk reduction strategy.
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http://dx.doi.org/10.1161/JAHA.118.008733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064923PMC
June 2018

Alcoholic Cardiomyopathy: Is it Time for Genetic Testing?

Authors:
Mariann R Piano

J Am Coll Cardiol 2018 05;71(20):2303-2305

Center for Research Development and Scholarship, Vanderbilt University School of Nursing, Nashville, Tennessee. Electronic address:

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http://dx.doi.org/10.1016/j.jacc.2018.03.463DOI Listing
May 2018

Cardiovascular Nursing Science Priorities: A Statement From the American Heart Association Council on Cardiovascular and Stroke Nursing.

J Cardiovasc Nurs 2018 Jul/Aug;33(4):E11-E20

Mariann R. Piano, PhD, RN, FAAN, FAHA Senior Associate Dean for Research and Nancy and Hilliard Travis Chair in Nursing Center for Research, Development and Scholarship, Vanderbilt University School of Nursing, Nashville, Tennessee. Nancy T. Artinian, PhD, RN, FAAN, FAHA Professor, Michigan State University College of Nursing, East Lansing. Holli A. DeVon, PhD, RN, FAAN, FAHA Professor and Department Head, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago. Susan T. Pressler, PhD, RN, FAAN, FAHA Professor and Sally Rehard Chair, Center for Enhancing Quality of Life in Chronic Illness, University of Indiana School of Nursing, Indianapolis. Kathleen T. Hickey, EdD, RN, FNP-BC, ANP-BC, FAAN, FAHA Professor of Nursing, Columbia University School of Nursing, New York, New York. Deborah A. Chyun, PhD, RN, FAAN, FAHA Professor and Dean, University of Connecticut School of Nursing, Storrs, Connecticut.

Background: The American Heart Association's (AHA) Council on Cardiovascular and Stroke Nursing (CVSN) plays a critical role in advancing the mission of the AHA in the discovery of new scientific knowledge. The aim was to identify priority research topics that would promote and improve cardiovascular (CV) health, provide direction for the education of future nurse scientists, and serve as a resource and catalyst for federal and organizational funding priorities.

Methods: A Qualtrics survey, which included 3 questions about priorities for CVSN nurse researchers, was sent to the CVSN Leadership Committee and all CVSN Fellows of the AHA (n = 208). Responses to the questions were reviewed for word repetitions, patterns, and concepts and were then organized into thematic areas. The thematic areas were reviewed within small groups at the November (2016) in-person CVSN leadership meeting.

Results: Seventy-three surveys were completed. Five thematic areas were identified and included (1) developing and testing interventions, (2) assessment and monitoring, (3) precision CV nursing care, (4) translational and implementation science, and (5) big data. Topic areas noted were stroke, research methods, prevention of stroke and CV disease, self-management, and care and health disparities.

Conclusion: Five thematic areas and 24 topic areas were identified as priorities for CV nursing research. These findings can provide a guide for CV nurse scientists and for federal and foundational funders to use in developing funding initiatives. We believe additional research and discovery in these thematic areas will help reduce the rising global burden of CV disease.
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http://dx.doi.org/10.1097/JCN.0000000000000489DOI Listing
November 2019

Nursing research in heart failure care: a position statement of the american association of heart failure nurses (AAHFN).

Heart Lung 2018 Mar - Apr;47(2):169-175. Epub 2018 Feb 15.

Cleveland Clinic Health System, Cleveland, USA.

Background: Heart Failure (HF) is a public health problem globally affecting approximately 6 million in the United States.

Objectives: A tailored position statement was developed by the American Association of Heart Failure Nurses (AAHFN) and their Research Consortium to assist researchers, funding institutions and policymakers with improving HF clinical advancements and outcomes.

Methods: A comprehensive review was conducted using multiple search terms in various combinations to describe gaps in HF nursing science. Based on gaps described in the literature, the AAHFN made recommendations for future areas of research in HF.

Results: Nursing has made positive contributions through disease management interventions, however, quality, rigorous research is needed to improve the lives of patients and families while advancing nursing science.

Conclusions: Advancing HF science is critical to managing and improving patient outcomes while promoting the nursing profession. Based on this review, the AAHFN is putting forth a call to action for research designs that promote validity, sustainability, and funding of future nursing research.
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http://dx.doi.org/10.1016/j.hrtlng.2018.01.003DOI Listing
December 2018

Heart Failure in Pregnant Women: A Concern Across the Pregnancy Continuum.

Circ Heart Fail 2018 01;11(1):e004005

From the College of Nursing, Department of Women, Children, and Family Health Science (M.F.M., B.L.M., K.L.L.) and Division of Cardiology, Department of Medicine (J.E.B.), University of Illinois at Chicago; School of Nursing, Vanderbilt University, Nashville, TN (M.R.P.); and Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX (J.L.S.).

Background: Heart failure (HF) is a leading cause of maternal morbidity and mortality in the United States, but prevalence, correlates, and outcomes of HF-related hospitalization during antepartum, delivery, and postpartum periods remain unknown. The objective was to examine HF prevalence, correlates, and outcomes among pregnancy-related hospitalizations among women 13 to 49 years of age.

Methods And Results: We used the 2001 to 2011 Nationwide Inpatient Sample. Rates of HF were calculated by patient and hospital characteristics. Survey logistic regression was used to estimate adjusted odds ratios representing the association between HF and each outcome, stratified by antepartum, delivery, and postpartum periods. Joinpoint regression was used to describe temporal trends in HF and in-hospital mortality. Over 50 million pregnancy-related hospitalizations were analyzed. The overall rate of HF was 112 cases per 100 000 pregnancy-related hospitalizations. Although postpartum encounters represented only 1.5% of pregnancy-related hospitalizations, ≈60% of HF cases occurred postpartum, followed by delivery (27.3%) and antepartum (13.2%). Among postpartum hospitalizations, there was a significant 7.1% (95% confidence interval, 4.4-9.8) annual increase in HF from 2001 to 2006, followed by a steady rate through 2011. HF rates among antepartum hospitalizations increased on average 4.9% (95% confidence interval, 3.0-6.8) annually from 2001 to 2011. Women with a diagnosis of HF were more likely to experience adverse maternal outcomes, as reflected by outcome-specific adjusted odds ratios during antepartum (2.7-25), delivery (6-195), and postpartum (1.5-6.6) periods.

Conclusions: HF is associated with increased risk of maternal mortality and morbidities. During hospitalization, high-risk mothers need to be identified and surveillance programs developed before discharge.
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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.117.004005DOI Listing
January 2018

MicroRNA-21 Contributes to Reduced Microvascular Function in Binge Drinking Young Adults.

Alcohol Clin Exp Res 2018 Feb 27;42(2):278-285. Epub 2017 Dec 27.

Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois.

Background: Binge drinking is associated with increased risk for cardiovascular (CV) disease. MicroRNA-21 (miR21) is up-regulated in the setting of excessive alcohol consumption and CV disease. Therefore, the goal of this study was to examine the vasodilatory responses to flow and acetylcholine (ACh) in the absence and presence of an anti-miR21 inhibitor in the microcirculation of young adult repeated binge drinkers (BDs).

Methods: Gluteal subcutaneous adipose tissue biopsies were obtained from young adults (18 to 30 years, n = 35 vessels from BDs and n = 28 vessels from abstainers). Resistance arteries (RAs) were isolated, incubated with anti-miR21 or a negative control (NC) to miR21 (12 hours; 50 nM), and lumen diameters measured with video microscopy. miR21 of adipose tissues was determined by quantitative polymerase chain reaction.

Results: Flow-induced dilation and ACh-induced dilation (AChID) were reduced in BDs as compared to abstainers. The miR21 inhibitor but not the NC abrogated these effects in BDs, but did not affect vasodilation in abstainers. Nitric oxide synthase inhibition with L-NAME reduced vasodilation in abstainers but not in BDs. In BDs, vasodilation was reduced by L-NAME in the presence of anti-miR21 but not the NC. Scavenging the reactive oxygen species, hydrogen peroxide with polyethylene glycol catalase reduced dilation in BDs but did not affect the restored dilation by the miR21 inhibitor. Maximum dilation to papaverine (endothelium independent) was similar between groups and unaffected by pharmacological inhibition. Finally, vascular endogenous miR21 was increased in BDs compared to abstainers.

Conclusions: Endogenous miR21 is increased in RAs of young BDs, leading to reduced flow and AChID in the microcirculation.
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http://dx.doi.org/10.1111/acer.13565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286284PMC
February 2018

The pedunculopontine tegmentum controls renal sympathetic nerve activity and cardiorespiratory activities in nembutal-anesthetized rats.

PLoS One 2017 9;12(11):e0187956. Epub 2017 Nov 9.

Center for Narcolepsy, Sleep, and Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America.

Elevated renal sympathetic nerve activity (RSNA) accompanies a variety of complex disorders, including obstructive sleep apnea, heart failure, and chronic kidney disease. Understanding pathophysiologic renal mechanisms is important for determining why hypertension is both a common sequelae and a predisposing factor of these disorders. The role of the brainstem in regulating RSNA remains incompletely understood. The pedunculopontine tegmentum (PPT) is known for regulating behaviors including alertness, locomotion, and rapid eye movement sleep. Activation of PPT neurons in anesthetized rats was previously found to increase splanchnic sympathetic nerve activity and blood pressure, in addition to altering breathing. The present study is the first investigation of the PPT and its potential role in regulating RSNA. Microinjections of DL-homocysteic acid (DLH) were used to probe the PPT in 100-μm increments in Nembutal-anesthetized rats to identify effective sites, defined as locations where changes in RSNA could be evoked. A total of 239 DLH microinjections were made in 18 rats, which identified 20 effective sites (each confirmed by the ability to evoke a repeatable sympathoexcitatory response). Peak increases in RSNA occurred within 10-20 seconds of PPT activation, with RSNA increasing by 104.5 ± 68.4% (mean ± standard deviation) from baseline. Mean arterial pressure remained significantly elevated for 30 seconds, increasing from 101.6 ± 18.6 mmHg to 135.9 ± 36.4 mmHg. DLH microinjections also increased respiratory rate and minute ventilation. The effective sites were found throughout the rostal-caudal extent of the PPT with most located in the dorsal regions of the nucleus. The majority of PPT locations tested with DLH microinjections did not alter RSNA (179 sites), suggesting that the neurons that confer renal sympathoexcitatory functions comprise a small component of the PPT. The study also underscores the importance of further investigation to determine whether sympathoexcitatory PPT neurons contribute to adverse renal and cardiovascular consequences of diseases such as obstructive sleep apnea and heart failure.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187956PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679551PMC
December 2017

Alcohol's Effects on the Cardiovascular System.

Authors:
Mariann R Piano

Alcohol Res 2017 ;38(2):219-241

Mariann R. Piano, Ph.D., is a Professor in and Department Head of the Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois.

Alcohol use has complex effects on cardiovascular (CV) health. The associations between drinking and CV diseases such as hypertension, coronary heart disease, stroke, peripheral arterial disease, and cardiomyopathy have been studied extensively and are outlined in this review. Although many behavioral, genetic, and biologic variants influence the interconnection between alcohol use and CV disease, dose and pattern of alcohol consumption seem to modulate this most. Low-to-moderate alcohol use may mitigate certain mechanisms such as risk and hemostatic factors affecting atherosclerosis and inflammation, pathophysiologic processes integral to most CV disease. But any positive aspects of drinking must be weighed against serious physiological effects, including mitochondrial dysfunction and changes in circulation, inflammatory response, oxidative stress, and programmed cell death, as well as anatomical damage to the CV system, especially the heart itself. Both the negative and positive effects of alcohol use on particular CV conditions are presented here. The review concludes by suggesting several promising avenues for future research related to alcohol use and CV disease. These include using direct biomarkers of alcohol to confirm self-report of alcohol consumption levels; studying potential mediation of various genetic, socioeconomic, and racial and ethnic factors that may affect alcohol use and CV disease; reviewing alcohol-medication interactions in cardiac patients; and examining CV effects of alcohol use in young adults and in older adults.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513687PMC
May 2018

Binge Drinking Episodes in Young Adults: How Should We Measure Them in a Research Setting?

J Stud Alcohol Drugs 2017 07;78(4):502-511

Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois.

Objective: Worldwide, consequences of binge drinking are a major health and policy concern. This article reviews contemporary binge drinking definitions as well as different questionnaires and biomarkers that have been used in research settings to examine binge drinking behavior among young adults.

Method: A review of electronic databases was conducted for binge drinking definitions, questionnaires, and biomarkers for the measurement of binge drinking in young adults (18-30 years).

Results: Binge drinking is often defined as four or more drinks for females and five or more drinks for males on an occasion or in one sitting within a designated time frame (2 weeks vs. past 30 days). Several tools and questionnaires are available to identify young adult repeated binge drinkers. Biomarkers have been used to corroborate self-reported alcohol consumption, of which direct biomarkers such as phosphatidylethanol may be useful in confirming recent heavy drinking.

Conclusions: It is important to measure binge drinking along a continuum and to use questions that allow for assessment of intensity, frequency, duration, and daily versus weekend consumption patterns. Open-ended questions that allow for intensity (number of drinks) and frequency can be used to determine dose-response relationships with respect to specific outcome measures. Direct alcohol biomarkers reflecting alcohol consumption over a period of several days are useful in conjunction with questionnaire data for identifying young adult binge drinkers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551655PMC
http://dx.doi.org/10.15288/jsad.2017.78.502DOI Listing
July 2017

Cardiovascular Consequences of Binge Drinking: An Integrative Review with Implications for Advocacy, Policy, and Research.

Alcohol Clin Exp Res 2017 03 13;41(3):487-496. Epub 2017 Feb 13.

Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois.

Worldwide, binge drinking is a major public health problem. The popularized health risks associated with binge drinking include physical injury and motor vehicle crashes; less attention has been given to the negative effects on the cardiovascular (CV) system. The primary aims of this review were to provide a summary of the adverse effects of binge drinking on the risk and development of CV disease and to review potential pathophysiologic mechanisms. Using specific inclusion criteria, an integrative review was conducted that included data from human experimental, prospective cross-sectional, and cohort epidemiological studies that examined the association between binge drinking and CV conditions such as hypertension (HTN), myocardial infarction (MI), stroke, and arrhythmias. Studies were identified that examined the relationship between binge drinking and CV outcomes. Collectively, findings support that binge drinking is associated with a higher risk of pre-HTN, HTN, MI, and stroke in middle-aged and older adults. Binge drinking may also have adverse CV effects in young adults (aged 18 to 30). Mechanisms remain incompletely understood; however, available evidence suggests that binge drinking may induce oxidative stress and vascular injury and be proatherogenic. Public health messages regarding binge drinking need to include the effects of binge drinking on the CV system.
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http://dx.doi.org/10.1111/acer.13329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318786PMC
March 2017

From the trenches: please send help.

Nurs Outlook 2015 Jul-Aug;63(4):388-9. Epub 2015 May 16.

Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL.

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http://dx.doi.org/10.1016/j.outlook.2015.05.001DOI Listing
December 2015

Is it time to re-examine the pipeline for advanced practice nursing practice?

Nurs Outlook 2015 Jul-Aug;63(4):386-7. Epub 2015 May 16.

Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL.

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http://dx.doi.org/10.1016/j.outlook.2015.05.002DOI Listing
December 2015

Phosphatidylethanol Levels Are Elevated and Correlate Strongly with AUDIT Scores in Young Adult Binge Drinkers.

Alcohol Alcohol 2015 Sep 7;50(5):519-25. Epub 2015 Jun 7.

Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA.

Aims: To compare levels of phosphatidylethanol (PEth) to self-reported alcohol intake among young adult binge drinkers (18-30 years).

Methods: Abstainers (n = 23), moderate (n = 22), and binge drinkers (n = 58) completed an alcohol consumption questionnaire and the AUDIT. PEth was measured in whole blood and dried blood spots via high-performance liquid chromatography with tandem mass spectrometry. Also measured was mean corpuscular volume (MCV) and gamma glutamyl transpeptidase (GGT).

Results: Most subjects were female (65%) and Caucasian (73%). Among binge drinkers, past-month average number of binge episodes was 7.2 ± 4; average duration of binge drinking behavior was 4.3 ± 3 years. AUDIT scores and PEth levels (ng/ml) in whole blood or dried blood spots were significantly (P < 0.001) greater in binge drinkers (13 ± 4, 186 ± 170, and 65 ± 53, respectively) compared to moderate drinkers (6 ± 3, 24 ± 29, and 11 ± 13, respectively) and abstainers (0.6 ± 0.89, 0, and 0, respectively). No differences were found in MCV and GGT among groups. There were significant correlations between whole blood and dried blood spot PEth levels and AUDIT scores (Spearman's r = 0.745 and 0.738, P < 0.0001, respectively), and whole blood and dried blood spot PEth levels were significantly correlated (0.899, P < 0.0001).

Conclusions: PEth levels measured in whole blood and dried blood spots were significantly greater in binge drinkers compared to abstainers and moderate drinkers, and these levels were positively correlated with AUDIT scores.
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http://dx.doi.org/10.1093/alcalc/agv049DOI Listing
September 2015

Measurement of Dyspnea in Ambulatory African Americans With Heart Failure and a Preserved or Reduced Ejection Fraction.

J Cardiovasc Nurs 2016 Jan-Feb;31(1):13-21

Karen M. Vuckovic, PhD, RN, ACNS Assistant Clinical Professor, College of Nursing, Department of Biobehavioral Health Science, University of Illinois at Chicago. Holli A. DeVon, PhD, RN Associate Professor, College of Nursing, Department of Biobehavioral Health Science, University of Illinois at Chicago. Mariann R. Piano, PhD, RN Professor, College of Nursing, Department of Biobehavioral Health Science, University of Illinois at Chicago.

Background: Dyspnea is a burdensome and disabling heart failure (HF) symptom. Few studies examining dyspnea in HF have included African Americans (AAs), despite their developing HF at a younger age and having the highest mortality rates.

Objective: The purpose of this cross-sectional study was to examine dyspnea in AA patients with HF and a preserved ejection fraction (HFpEF) compared with those with a reduced ejection fraction (HFrEF), before and after the 6-minute walk test (6MWT).

Methods: A convenience sample of ambulatory AA patients (HFrEF, n = 26; HFpEF, n = 19) 50 years or older was recruited from an urban HF clinic. The Borg Scale and a visual analog scale (VAS) were used to measure dyspnea intensity before and after the 6MWT. Activity limitations related to dyspnea were described using the modified Medical Research Council Dyspnea Scale. Group comparisons were analyzed using repeated-measures analysis of variance and χ 2tests. Convergent validity was determined between the Borg and VAS using Bland-Altman plots.

Results: No significant differences were found in age, gender, and comorbidities between HF groups. Most HFpEF patients reported dyspnea at baseline (Borg, 63%; VAS, 73%) and after the 6MWT (Borg, 78%; VAS, 79%). In the HFrEF group, the prevalence of baseline dyspnea was greater when measured with the VAS (Borg, 34%; VAS, 80%) but was similar between instruments after the 6MWT (Borg, 64%; VAS, 77%). Both groups reported a similar change in dyspnea intensity during and after the 6MWT. The Bland-Altman plots indicated moderate agreement at each time point. Most patients described walking hurriedly or uphill as dyspnea-provoking on the Modified Respiratory Council Dyspnea Scale.

Conclusions: The prevalence of dyspnea at baseline and after the 6MWT was high for both groups, but intensity varied with the dyspnea instrument used.
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http://dx.doi.org/10.1097/JCN.0000000000000205DOI Listing
October 2016