The ROle of Compression StocKings in Heart Failure Patients

项目总结： 在美国，心力衰竭(HF)影响着620万患者，是#年13.4%的死亡原因 2018年的费用约为307亿美元，所有心力衰竭患者中约80%的人是65岁的老年人。临床 症状包括呼吸急促和外周水肿。利尿剂被认为可以治疗老年人的浮肿。 然而，心力衰竭患者仅限于肾功能受损的患者。周围性水肿是 与疼痛、腿部沉重、行动不便和生活质量差有关，增加了蜂窝组织炎的风险 伤口。多达44%的静脉性溃疡患者被确认为心力衰竭。长期使用压缩 在心力衰竭患者中穿丝袜有潜在的好处，如更好地控制浮肿，减少对 利尿剂、改善流动性、防止静脉疾病的进展和预防静脉溃疡。至 到目前为止，没有主要的心力衰竭指南推荐对心力衰竭患者使用加压长袜。 本R21提案的目的是研究压缩长袜在预防浮肿和 心力衰竭患者的静脉疾病。 我们的假设我们假设使用压缩长袜将防止病情发展或恶化 静脉疾病(静脉返流和静脉溃疡)，改善下肢浮肿、活动能力和 心衰患者在不增加心力衰竭恶化、住院或死亡风险的情况下的生活质量 在目标1中，我们计划将患者随机分为高度(20-30毫米汞柱)和低度(10-15毫米汞)两组。 压缩袜子3个月，并评估临床体征和心力衰竭恶化的症状， 以及需要在治疗结束时更换利尿剂治疗。 在目标2a中，我们计划评估高度压缩的袜子是否与 术后3个月静脉双功超声检查瓣膜关闭时间(静脉返流)。 在目标2b中，我们计划评估高度压缩的袜子是否与 3个月时出现静脉疾病的临床体征。 在目标3中，我们计划评估高度压缩的袜子是否与改善 3个月时的活动能力和生活质量。 这个项目的贡献是巨大的，因为浮肿和静脉疾病在患者中是非常病态的。 有心力衰竭，以及简单和预防措施，如压缩袜子，可以是安全和容易的 实施。 我们的项目是创新的，因为我们计划在心力衰竭患者身上使用压缩袜子， 医生不愿使用的东西，因为可能会出现代偿失调和液体超载。另一方面 另一方面，我们认为它可以容易地实施和预防晚期静脉疾病。

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.