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Background: Coronary artery disease (CAD) confers increased risks of premature mortality, non-fatal morbidity, and significant impairment in functional status and health-related quality of life. Routine administration of electronic patient-reported outcome measures (PROMs) and its real time delivery to care providers is known to have the potential to inform routine cardiac care and to improve quality of care and patient outcomes. This study describes a user-centered development and evaluation of the Alberta Provincial Project for Outcomes Assessment (APPROACH) electronic Patient Reported Outcomes Measurement (e-PROM) system. This e-PROM system is an electronic system for the administration of PROMs to patients with CAD and the delivery of the summarized information to their care providers to facilitate patient-physician communication and shared decision-making. This electronic platform was designed to be accessible via web-based and hand-held devices. Heuristic and user acceptance evaluation were conducted with patients and attending care providers. Results: The APPROACH e-PROM system was co-developed with patients and care providers, research investigators, informaticians and information technology experts. Five PROMs were selected for inclusion in the online platform after consultations with patient partners, care providers, and PROMs experts: the Seattle Angina Questionnaire, Patient Health Questionnaire, EuroQOL, and Medical Outcomes Study Social Support Survey, and Self-Care of Coronary Heart Disease Inventory. The heuristic evaluation was completed by four design experts who examined the usability of the prototype interfaces. User acceptance testing was completed with 13 patients and 10 cardiologists who evaluated prototype user interfaces of the e-PROM system. Conclusion: Both patients and physicians found the APPROACH e-PROM system to be easy to use, understandable, and acceptable. The APPROACH e-PROM system provides a user-informed electronic platform designed to incorporate PROMs into the delivery of individualized cardiac care for persons with CAD. [ABSTRACT FROM AUTHOR]

Introduction: Preeclampsia and gestational diabetes mellitus share risk factors such as obesity and increased maternal age, which have become more prevalent in recent decades. We examined changes in the prevalence of preeclampsia and gestational diabetes between 2005 and 2018 in Denmark and Alberta, Canada, and investigated whether the observed trends can be explained by changes in maternal age, parity, multiple pregnancy, comorbidity, and body mass index (BMI) over time. Material and methods: This study was a register‐based cohort study conducted using data from the Danish National Health Registers and the provincial health registers of Alberta, Canada. We included in the study cohort all pregnancies in 2005–2018 resulting in live‐born infants and used binomial regression to estimate mean annual increases in the prevalence of preeclampsia and gestational diabetes in the two populations across the study period, adjusted for maternal characteristics. Results: The study cohorts included 846 127 (Denmark) and 706 728 (Alberta) pregnancies. The prevalence of preeclampsia increased over the study period in Denmark (2.5% to 2.9%) and Alberta (1.7% to 2.5%), with mean annual increases of 0.03 (95% confidence interval [CI] 0.02–0.04) and 0.06 (95% CI 0.05–0.07) percentage points, respectively. The prevalence of gestational diabetes also increased in Denmark (1.9% to 4.6%) and Alberta (3.9% to 9.2%), with average annual increases of 0.20 (95% CI 0.19–0.21) and 0.44 (95% CI 0.42–0.45) percentage points. Changes in the distributions of maternal age and BMI contributed to increases in the prevalence of both conditions but could not explain them entirely. Conclusions: The prevalence of both preeclampsia and gestational diabetes increased significantly from 2005 to 2018, which portends future increases in chronic disease rates among affected women. Increasing demand for long‐term follow up and care will amplify the existing pressure on healthcare systems. [ABSTRACT FROM AUTHOR]

How well anthropometric indices such as body mass index (BMI), waist circumference, waist-stature ratio, and waist index correlate with direct measures of body composition (lean body mass, body fat) in men and women with chronic heart failure (CHF) has not been reported. Body composition was assessed by dual-energy x-ray absorptiometry in 140 patients with CHF. Age-adjusted Pearson correlations between each index and measures of body composition for men and women were calculated. Diagnostic accuracy of detecting obesity or high central fat was also examined. In men, all of the anthropometric indices except waist index were just as strongly correlated with lean body mass (correlation coefficients varied between 0.56 for waist-stature ratio to 0.74 for BMI) as with percentage of body fat (correlation coefficients varied between 0.72 for BMI to 0.79 for waist circumference). In women, all 4 anthropometric measures were unable to significantly differentiate between body fat and lean body mass. The positive likelihood ratios for the detection of obesity varied between 2.26 for waist circumference and 3.42 for BMI, waist-stature ratio, and waist index. Anthropometric indices do not accurately reflect body composition in patients with CHF, especially in women. When accurate assessment of body composition is required, direct measurements should be obtained.

BackgroundWe examined the validity of leg-to-leg bioelectrical impedance analysis (BIA) and near-infrared interactance (NIR) to assess body composition in chronic heart failure (CHF) patients.Methods and resultsA total of 140 patients with CHF were enrolled in this cross-sectional study between June 2008 and July 2009. Dual energy x-ray absorptiometry (DEXA) served as the reference standard. A priori, desired precision levels were set at ± 3.5% body fat and ± 3.5 kg lean body mass. Mean age was 63, 74% were male, and 90% were Caucasian. BIA- and NIR-ascertained percent body fat and lean body mass were highly correlated to DEXA. Mean differences and limits of agreement for NIR were -0.3% ± 5.1% for percent body fat and 2.9 kg ± 4.3 kg for lean body mass. Mean difference and limits of agreement for BIA percent body fat was 0.8% ± 5.8%. BIA lean body mass showed poor agreement with DEXA because of variable limits of agreement across the range of measurement (Pitman's test P < .0001).ConclusionsIn patients with CHF, both NIR and BIA accurately measure body fat. However, both methods were imprecise. NIR overestimated lean body mass and BIA was not useful to assess this parameter. Further study is required, including examination of the utility of these field methods in serially assessing body composition.

ObjectiveTo explore the covariate-adjusted associations between body composition (percent body fat and lean body mass) and prognostic factors for mortality in patients with chronic heart failure (CHF) (nutritional status, N-terminal pro-B-type natriuretic peptide [NT-proBNP], quality of life, exercise capacity, and C-reactive protein).Patients and methodsBetween June 2008 and July 2009, we directly measured body composition using dual energy x-ray absorptiometry in 140 patients with systolic and/or diastolic heart failure. We compared body composition and CHF prognostic factors across body fat reference ranges and body mass index (BMI) categories. Multiple linear regression models were created to examine the independent associations between body composition and CHF prognostic factors; we contrasted these with models that used BMI.ResultsUse of BMI misclassified body fat status in 51 patients (41%). Body mass index was correlated with both lean body mass (r=0.72) and percent body fat (r=0.67). Lean body mass significantly increased with increasing BMI but not with percent body fat. Body mass index was significantly associated with lower NT-proBNP and lower exercise capacity. In contrast, higher percent body fat was associated with a higher serum prealbumin level, lower exercise capacity, and increased C-reactive protein level; lean body mass was inversely associated with NT-proBNP and positively associated with hand-grip strength.ConclusionWhen BMI is divided into fat and lean mass components, a higher lean body mass and/or lower fat mass is independently associated with factors that are prognostically advantageous in CHF. Body mass index may not be a good indicator of adiposity and may in fact be a better surrogate for lean body mass in this population.