Background and Purpose: To improve life quality, and lower mortality and rehospitalization for heart failure patients, awareness and adherence to self-care behaviors are essential. This study aims to determine the adherence level to self-care behaviors in the patients with systolic heart failure hospitalized in Alborz hospital in Karaj and Shahriar hospital, and it was conducted in 2013.Methods: In this cross-sectional study, 100 patients with at least one year experience of developing heart failure and ejection fraction below 40% were studied. They were admitted to Alborz Social Security hospital of Karaj and the Social Security Hospital Shahriar during 2012-2013. They were selected through convenience sampling. Demographic data and European heart failure Self-care Behavior questionnaires were completed through interviews. Data analysis has been done using SPSS, V.18 and independent t-test and ANOVA.Results: 84% of the subjects had moderate and 10% had poor adherence to self-care. The best adherence to self-care behaviors was related to the drug and diet regimen and the poorest to the daily weight control and exercise. There was a significant relationship between self-care behaviors and age (p=0.011), marital status (p=0.008), the number of chronic diseases (p=0.048), hypertension (p=0.038), chronic pulmonary obstruction (p=0.029), renal disease (p=0.017) and severity of the disease (p=0.032).Conclusion: Adherence to self-care behaviors in heart failure patients is not appropriate. Training and following up self-care behaviors should focus on the specific problems of aging, social support, diet and drug regimens simplification and its relation with other chronic diseases.

This study attempted to investigate the factors in sleep quality, sleep disorder, daytime sleepiness in male systolic heart failure patients. It was a cross-sectional study conducted with 100 male patients with systolic heart failure. The method of sampling method was convenience whereby data were collected by means of demographic data forms, epworth sleepiness scale, sleep disorder index and the Pittsburgh Sleep Quality Index. SPSS software was utilized to analyze the data using descriptive statistics oft-test, ANOYA and coefficient Pearson correlation. Findings indicated that 100% of heart failure patient had low sleep quality and 53% had low daytime sleepiness. Insomnia and sleep apnea were the most common sleep problems in heart failure patients. There was a statistically significant relationship between sleep quality with age (p=0.030), education (p=0.004), smoking (p=0.048), on the one hand, and sleep disorders with income (p=0.012), body mass index (p=0.028), education (p=0.019), smoking (p=0.050), chronic obstructive pulmonary disease (p=0.035), angiotensin converting enzyme inhibitors (P =0.009), and angiotensin receptor blockers (p=0.016), on the other hand. The results showed that men with systolic heart failure had low sleep quality and insomnia, sleep apnea and daytime sleepiness as their common problems. It was concluded that weight loss, smoking cessation, control and treatment of chronic respiratory diseases, control of side effects of drugs might decrease sleep problems in male heart failure patients.

Objective: Anemia is prevalent in heart failures and is an independent risk factor for adverse clinical outcomes in patients with CHF. The aim of the present study was to determine the prevalence of anemia in elderly with systolic heart failure hospitalized in Alborz Hospital of Karaj in 2009.Materials & Methods: This is a descriptive retrospective study that reviewed 154 medical records of elderly with systolic heart failure during 2002-2008. Demographic, laboratory, and echocardiography data were reviewed from medical records. Anemia was defined as a hemoglobin level below 12 g/dL in women and below 13 g/dL in men in this study. Data were analysed by descriptive statistics such as frequency distribution, mean, standard deviation and independent group test and Pearson correlation coefficient.Results: The findings indicated that prevalence of anemia in elderly with systolic heart failure was (42.9%). There was significant difference between mean level of hemoglobin in heart failure with chronic obstructive pulmonary disease (p=0.000). Level of hemoglobin significant associated with age (p=0.014) and left ventricular ejection fraction (0.022).Conclusion: This study indicated that anemia is frequent among elderly with systolic heart failure and anemia may be associated with age, LVEF and COPD. More research into the mechanisms of anemia in CHF is needed.

Background: heart failure (HF) is a major cause of morbidity and mortality worldwide. Additionally, Worsening Renal Function (WRF) during hospitalization has a significant effect on re-hospitalization and mortality in such patients.Objectives: The present study aimed to determine the prevalence and prognostic significance of WRF complicating acute HF in patients enrolled into Rajaie Acute systolic heart failure (RASHF) registry.Patients and Methods: RASHF registry is a single-center, prospective, observational, hospital-based study of systolic HF patients with Left Ventricular Ejection Fraction (LVEF) £ 35% admitted with acute decompensation. The patients were enrolled for 10 months from March 2012 to February 2013. The primary endpoint of the study was WRF. In addition, the secondary endpoints were in-hospital mortality and death within 3 months after discharge.Results: This study was performed on 230 patients (82% male). About one thirds of the patients (29.1%) developed WRF. Although some characteristics of the patients with WRF, including etiology of HF, NYHA functional class, and presence of risk factors, were similar to those of other patients, they were older, had more congestive symptoms, and had higher baseline creatinine levels. The incidence of in-hospital mortality was 9.6%. Length of hospital stay (14 days versus 8 days, P<0.001), in-hospital mortality (23.9% versus 4.9%, P<0.001), and death during 3 months after discharge (19.4% versus 13.4%, P<0.001) were higher among the patients with WRF.Conclusions: WRF was quite common in the patients with Acute heart failure (AHF) and was associated with higher in-hospital mortality and decrease in early survival after discharge.

Background: Bendopnea, defined as dyspnea while bending, can be observed in patients with heart failure (HF). In this study, we investigated the frequency of this symptom in patients with systolic HF and its association with echocardiographic parameters. Methods: In this study, patients with left ventricular ejection fraction (LVEF) ≤, 45% and decompensated HF referred to our clinics were prospectively recruited. All the patients were examined by cardiologists for collecting data on the presence of bendopnea and baseline characteristics. They also underwent electrocardiographic and echocardiographic examinations. All findings were compared between the patients with or without bendopnea. Results: A total of 120 patients at a mean age of 65. 19±, 12. 62 years were evaluated, and 74. 8% were men. Bendopnea was observed in 44. 2% of the patients. The etiology of HF was ischemic in most patients (81. 9%), and the functional class of most patients (85. 9%) was III or IV. The mortality rate at the 6-month follow-up was comparable between the patients with or without bendopnea (6. 1% vs 9. 5%,P=0. 507). The waist circumference (odds ratio [OR], 1. 037, 95% confidence interval [CI], 1. 005 to 1. 070,P=0. 023), paroxysmal nocturnal dyspnea (OR, 0. 338, 95% CI, 0. 132 to 0. 866,P=0. 024), and right atrial size (OR, 1. 084, 95% CI, 1. 002 to 1. 172,P=0. 044) were associated with bendopnea. Conclusion: Bendopnea can be frequently found among patients with systolic HF. This phenomenon is associated with obesity and baseline symptoms of patients and right atrial size upon echocardiographic examinations. It can help clinicians with the risk stratification of HF patients.

Background & objective: Depression associate with increase severity of illness, length of hospitalization and mortality in heart failure patient's .The aim of this study was to investigate the frequency and related factors of depression in male systolic heart failure patients.Materials & Methods: This is a cross sectional study that was conducted on 100 male patients with systolic heart failure in Alborz of Karaj and Shahriar Social Security Hospitals in 2010. Sampling method in this study was Convenience sampling. Data collected by demographic data form, MLHFQ (Minnesota Living with heart failure Questionnaire), (CES-D) Center for Epidemiologic Studies Depression Scale. Data was analyzed by SPSS software version 18 and using descriptive statistics, t-test, ANOVA and coefficient Pearson correlation.Results: The findings indicated that mean score of depression was 20.3±12. 47% had severe and 16% had mild to moderate depression. Depression significant associated with age (p=0.002), education (p<0.001), economic status (p=0.002), smoking (p=0.034), hemoglobin level (p=0.004), left ventricular ejection fraction (p=0.012), use of digoxin (p=0.019), angiotensin receptor blocker (ARB) (p=0.005), aldacton (p=0.005) and quality of life (p<0.001).Conclusion: Depression was common among men with systolic heart failure and had negative impact on quality of life. Nurses by screening and assessment symptoms of depression and refer patients for counseling and treatment can help to improve quality of life in heart failure patient.

Aims: heart failure is a major risk factor for erectile dysfunction. This study seeks to investigate the incidence and factors associated with erectile dysfunction in patients with systolic heart failure.Methods: This is a cross sectional study that was conducted on 100 male patients with systolic heart failure in 2009. Convenience sampling was used to gather the required data. Data collection instruments included a demographic data form, IIEF-5 (The International Index of Erectile Function, a 5-item version), MLHFQ (Minnesota Living with heart failure), and CES-D (Center for Epidemiologic Studies Depression Scale). The data was analyzed by SPSS software and using descriptive statistics, t-test, ANOVA and Pearson correlation coefficient.Results: The findings indicated that the mean score of erectile dysfunction was 14.02±6.26 and 80% of male patients with systolic heart failure suffered from erectile dysfunction. There was a significant relationship between erectile dysfunction and age (p<0.001), education (p=0.019), occupation (p=0.002), hemoglobin level (p=0.003), left ventricular ejection fraction (p=0.030), cholesterol level (p=0.001), renal dysfunction (p=0.009), use of digoxin (p=0.014), angiotensin converting enzyme inhibitors (P<0.001), beta blocker (p=0.001), diuretics (p=0.035), depression (p<0.001), and quality of life (p<0.001).Conclusion: Erectile dysfunction is the most common problem in patients with systolic heart failure and is associated with age, medical conditions, co-morbidity, medicinal treatments and psychological disorders. In patients with heart failure, erectile dysfunction has a negative impact on quality of life.

Background: To study the occurrence of left ventricular (LV) diastolic asynchrony in patients with systolic heart failure (HF) and its relationship to diastolic function regardless of QRS duration.Recent work has demonstrated that intraventricular asynchrony is a common finding in patients with systolic heart failure. Little attention has been paid to diastolic asynchrony in patients with systolic heart failure. We have therefore decided to determine the extent to which patients with systolic heart failure have evidence of diastolic asynchrony and whether or not diastolic asynchrony is correlated with diastolic dysfunction. Patients and Methods: Tissue Doppler echocardiography was performed in 50 HF patients (LV EF=23 ± 8%). Diastolic and systolic asynchrony was determined by tissue synchronization imaging using a 6 basal, 6 mid-segmental model. systolic and diastolic asynchrony were assessed by the maximal difference in time to peak systolic and early diastolic velocities between any two of 12 LV segments, and the standard deviation of time to peak systolic and early diastolic velocities of the 12 LV segments.Results: The mean ± SD maximal difference in time to peak systolic velocity (controls: 17.2± 9.6 ms versus narrow QRS: 66.7±38.0 ms versus wide QRS: 76.5±34.6 ms, both P<0.05 versus controls) and in standard deviation of time to peak systolic velocity of 12 LV segments (controls: 15±6.1 ms versus narrow QRS: 25.9± 15.3 ms versus wide QRS: 28.6±14.4ms, both P<0.05 versus controls) was prolonged in both the narrow and wide QRS groups compared with normal controls. Similarly, the maximal difference in time to peak diastolic velocity (controls: 39±16.8 ms versus narrow QRS: 73.1± 58ms versus wide QRS: 108.5±168 ms, both P<0.05 versus controls) and in standard deviation of time to peak early diastolic velocity of 12 LV segments (controls: 15.3±5.8ms versus narrow QRS: 25.1±.13.8ms versus wide QRS: 25.5±14.9ms, both P<0.05 versus controls) was prolonged in both the narrow and wide QRS groups. The respective prevalence of systolic and diastolic asynchrony was 31.4% and 20%, in the narrow QRS group, and 40% and 28.6%, in the wide QRS group re­spectively. Stepwise multiple regression analysis showed that low ejection fraction and low mitral annular early diastolic velocity were independent predictors of both systolic and diastolic asynchrony. QRS complex duration was found to correlate only with diastolic asynchrony.Conclusions: LV systolic and diastolic mechanical asynchrony is common in patients with HF regardless of QRS duration. Selection for cardiac resynchronization treatment should also be based on information about systolic and diastolic synchronicity.