{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T18:00:38Z","timestamp":1781200838814,"version":"3.54.1"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japan Society for the Promotion of Science (JSPS), KAKENHI","award":["23K09973"],"award-info":[{"award-number":["23K09973"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Heart failure (HF) restricts activities of daily living, impacting prognosis and quality of life. Dressing requires sustained upper-limb movements, postural transitions, and fine-motor tasks that may impose cardiovascular and autonomic demands, potentially informing on physiological tolerance during daily activities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This observational study compared hemodynamic, autonomic, subjective, and upper-limb sensor count (ULSC) responses during dressing across HF clinical courses to characterize recovery dynamics during daily activities and identify nursing support requirements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We compared healthy controls (HCs; n\u2009=\u200915),\n                      <jats:italic>de novo<\/jats:italic>\n                      HF (NO-HF; n\u2009=\u200912), and recurrent HF (R-HF; n\u2009=\u200912) groups. Heart rate (HR), systolic blood pressure (SBP), peripheral oxygen saturation, HR variability, Borg scale score, ULSC, dressing duration, and HR recovery (HRR) were measured at rest, during dressing, and after 20 min of recovery. Linear mixed-effects models tested group, time, and interaction. Pairwise comparisons were performed via Bonferroni adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HR increased during and immediately post-dressing across groups, with NO-HF exhibiting higher HR than R-HF. HRR varied among groups (HC vs. NO-HF: P\u2009=\u20090.108; HC vs. R-HF: P\u2009&lt;\u20090.0001; NO-HF vs. R-HF: P\u2009=\u20090.026). SBP displayed a group effect (P\u2009=\u20090.034). Peak HR responses tended to occur immediately post-dressing in HC and NO-HF, whereas R-HF descriptively showed a delayed peak around 5 min. No significant group\u2009\u00d7\u2009time interaction was observed. ULSC showed no group differences after dressing time and body size adjustments. Patients with HF had higher Borg scores than did HCs (NO-HF, P\u2009&lt;\u20090.001; R-HF, P\u2009=\u20090.028).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite being low-intensity, dressing was associated with measurable physiological and subjective HF responses. R-HF trended toward slower HR recovery; NO-HF demonstrated consistently higher HR levels and perceived exertion. Monitoring recovery responses and supporting pacing and symptom self-monitoring during daily activities may be important in HF nursing care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351501","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T17:31:39Z","timestamp":1781199099000},"page":"e0351501","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dressing-induced hemodynamic instability in patients with heart failure: Implications for nursing care"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0372-4406","authenticated-orcid":true,"given":"Tae","family":"Watanabe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimiko","family":"Tagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Kimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiro","family":"Kitagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyokazu","family":"Sekikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiko","family":"Nakano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1157-032X","authenticated-orcid":true,"given":"Sanae","family":"Oriyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"issue":"36","key":"pone.0351501.ref001","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"TA McDonagh","year":"2021","journal-title":"Eur Heart J"},{"issue":"1","key":"pone.0351501.ref002","doi-asserted-by":"crossref","first-page":"7","DOI":"10.15420\/cfr.2016:25:2","article-title":"Global public health burden of heart failure","volume":"3","author":"G Savarese","year":"2017","journal-title":"Card Fail Rev"},{"issue":"10120","key":"pone.0351501.ref003","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/S0140-6736(17)32520-5","article-title":"Temporal trends and patterns in heart failure incidence: A population-based study of 4 million individuals","volume":"391","author":"N Conrad","year":"2018","journal-title":"Lancet"},{"issue":"18","key":"pone.0351501.ref004","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1056\/NEJM199910283411804","article-title":"Heart-rate recovery immediately after exercise as a predictor of mortality","volume":"341","author":"CR Cole","year":"1999","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0351501.ref005","doi-asserted-by":"crossref","DOI":"10.1016\/j.ahj.2005.09.012","article-title":"Prognostic value of heart rate recovery in patients with heart failure","volume":"151","author":"R Arena","year":"2006","journal-title":"Am Heart J"},{"issue":"14","key":"pone.0351501.ref006","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1001\/jama.2009.454","article-title":"Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial","volume":"301","author":"CM O\u2019Connor","year":"2009","journal-title":"JAMA"},{"issue":"2","key":"pone.0351501.ref007","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1161\/CIRCHEARTFAILURE.114.001542","article-title":"Activities of daily living and outcomes in heart failure","volume":"8","author":"SM Dunlay","year":"2015","journal-title":"Circ Heart Fail"},{"issue":"9","key":"pone.0351501.ref008","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1161\/01.CIR.99.9.1173","article-title":"Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: Effects on functional capacity, quality of life, and clinical outcome","volume":"99","author":"R Belardinelli","year":"1999","journal-title":"Circulation"},{"issue":"2","key":"pone.0351501.ref009","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ejheart.2005.03.008","article-title":"Predictors of exercise capacity and everyday activity in older heart failure patients","volume":"8","author":"MD Witham","year":"2006","journal-title":"Eur J Heart Fail"},{"issue":"16","key":"pone.0351501.ref010","doi-asserted-by":"crossref","DOI":"10.1161\/CIR.0000000000000483","article-title":"Prioritizing functional capacity as a principal end point for therapies oriented to older adults with cardiovascular disease: A scientific statement for healthcare professionals from the american heart association","volume":"135","author":"DE Forman","year":"2017","journal-title":"Circulation"},{"issue":"10","key":"pone.0351501.ref011","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/j.cardfail.2011.05.013","article-title":"Functional mitral regurgitation: A link to pulmonary hypertension in heart failure with preserved ejection fraction","volume":"17","author":"S Mar\u00e9chaux","year":"2011","journal-title":"J Card Fail"},{"issue":"11","key":"pone.0351501.ref012","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.120.007503","article-title":"How patients with heart failure perform daily life activities: An innate energy-saving strategy","volume":"13","author":"M Mapelli","year":"2020","journal-title":"Circ Heart Fail"},{"issue":"3","key":"pone.0351501.ref013","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1136\/heart.87.3.235","article-title":"Health related quality of life in patients with congestive heart failure: Comparison with other chronic diseases and relation to functional variables","volume":"87","author":"J Juenger","year":"2002","journal-title":"Heart"},{"issue":"1","key":"pone.0351501.ref014","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.cardfail.2007.09.008","article-title":"Ethnic differences in quality of life in persons with heart failure","volume":"14","author":"B Riegel","year":"2008","journal-title":"J Card Fail"},{"issue":"1","key":"pone.0351501.ref015","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1161\/CIRCHEARTFAILURE.114.001615","article-title":"Exercise training in patients with heart failure and preserved ejection fraction: Meta-analysis of randomized control trials","volume":"8","author":"A Pandey","year":"2015","journal-title":"Circ Heart Fail"},{"issue":"17","key":"pone.0351501.ref016","first-page":"298","article-title":"De novo acute heart failure and acutely decompensated chronic heart failure","volume":"112","author":"A Hummel","year":"2015","journal-title":"Dtsch Arztebl Int"},{"key":"pone.0351501.ref017","article-title":"Clinical characteristics of de novo heart failure and acute decompensated chronic heart failure: Are they distinctive phenotypes that contribute to different outcomes?","volume":"7","author":"WM Raffaello","year":"2020","journal-title":"Card Fail Rev"},{"issue":"11","key":"pone.0351501.ref018","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1161\/CIRCRESAHA.114.302589","article-title":"The autonomic nervous system and heart failure","volume":"114","author":"VG Florea","year":"2014","journal-title":"Circ Res"},{"issue":"1","key":"pone.0351501.ref019","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s10286-010-0089-z","article-title":"Changes in autonomic balance in patients with decompensated chronic heart failure","volume":"21","author":"A Rydlewska","year":"2011","journal-title":"Clin Auton Res"},{"issue":"6","key":"pone.0351501.ref020","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1161\/CIRCHEARTFAILURE.111.966366","article-title":"Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction","volume":"5","author":"SM Dunlay","year":"2012","journal-title":"Circ Heart Fail"},{"issue":"2","key":"pone.0351501.ref021","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.hrtlng.2012.09.006","article-title":"Caring for heart transplant recipients: The lived experience of primary caregivers","volume":"42","author":"MLA Sadala","year":"2013","journal-title":"Heart Lung"},{"issue":"5","key":"pone.0351501.ref022","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1002\/ejhf.1474","article-title":"Novel potassium binders as enabling therapy in heart failure","volume":"21","author":"J Butler","year":"2019","journal-title":"Eur J Heart Fail"},{"issue":"2","key":"pone.0351501.ref023","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"F Faul","year":"2007","journal-title":"Behav Res Methods"},{"key":"pone.0351501.ref024","volume-title":"Statistical power analysis for the behavioral sciences","author":"J Cohen","year":"1988","edition":"2"},{"key":"pone.0351501.ref025","doi-asserted-by":"crossref","first-page":"863","DOI":"10.3389\/fpsyg.2013.00863","article-title":"Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t-tests and ANOVAs","volume":"4","author":"D Lakens","year":"2013","journal-title":"Front Psychol"},{"issue":"1","key":"pone.0351501.ref026","article-title":"Sample Size Justification","volume":"8","author":"D Lakens","year":"2022","journal-title":"Collabra: Psychology"},{"key":"pone.0351501.ref027","doi-asserted-by":"crossref","first-page":"785501","DOI":"10.3389\/fphys.2021.785501","article-title":"The impact of cardiac rehabilitation on activities of daily life in elderly patients with heart failure","volume":"12","author":"M Paneroni","year":"2022","journal-title":"Front Physiol"},{"issue":"9","key":"pone.0351501.ref028","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1016\/j.healun.2022.06.011","article-title":"The effect of COVID-19 on transplant function and development of CLAD in lung transplant patients: A multicenter experience","volume":"41","author":"E Roosma","year":"2022","journal-title":"J Heart Lung Transplant"},{"issue":"14","key":"pone.0351501.ref029","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1001\/archinte.159.14.1599","article-title":"Furosemide withdrawal improves postprandial hypotension in elderly patients with heart failure and preserved left ventricular systolic function","volume":"159","author":"DJ van Kraaij","year":"1999","journal-title":"Arch Intern Med"},{"issue":"2","key":"pone.0351501.ref030","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afae022","article-title":"Prevalence of postprandial hypotension in older adults: A systematic review and meta-analysis","volume":"53","author":"L Huang","year":"2024","journal-title":"Age Ageing"},{"issue":"2","key":"pone.0351501.ref031","article-title":"Mucopolysaccharidosis Type VI with recurrent chest infection","volume":"15","author":"A Numan","year":"2023","journal-title":"Cureus"},{"key":"pone.0351501.ref032","year":"2020"},{"issue":"1","key":"pone.0351501.ref033","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s00421-008-0870-z","article-title":"Heart rate recovery and prognosis in heart failure patients","volume":"105","author":"V Kubrychtova","year":"2009","journal-title":"Eur J Appl Physiol"},{"key":"pone.0351501.ref034","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","article-title":"Heart rate variability: standards of measurement, physiological interpretation and clinical use","volume":"93","author":"Task Force of the European Society of Cardiology, Task Force of the North American Society of Pacing and Electrophysiology","year":"1996","journal-title":"Circulation"},{"issue":"15","key":"pone.0351501.ref035","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1161\/01.CIR.98.15.1510","article-title":"Prospective study of heart rate variability and mortality in chronic heart failure: Results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart)","volume":"98","author":"J Nolan","year":"1998","journal-title":"Circulation"},{"issue":"4","key":"pone.0351501.ref036","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1161\/01.CIR.0000047275.25795.17","article-title":"Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients","volume":"107","author":"MT La Rovere","year":"2003","journal-title":"Circulation"},{"issue":"1","key":"pone.0351501.ref037","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.amjcard.2003.09.013","article-title":"Measures of heart period variability as predictors of mortality in hospitalized patients with decompensated congestive heart failure","volume":"93","author":"D Aronson","year":"2004","journal-title":"Am J Cardiol"},{"issue":"5","key":"pone.0351501.ref038","article-title":"Heart rate recovery and risk of cardiovascular events and all-cause mortality: A meta-analysis of prospective cohort studies","volume":"6","author":"S Qiu","year":"2017","journal-title":"J Am Heart Assoc"},{"issue":"8","key":"pone.0351501.ref039","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.118.004969","article-title":"Chronotropic incompetence in chronic heart failure","volume":"11","author":"A Zweerink","year":"2018","journal-title":"Circ Heart Fail"},{"key":"pone.0351501.ref040","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1111\/sms.12604","article-title":"Central and peripheral hemodynamics in exercising humans: Leg vs arm exercise","author":"JAL Calbet","year":"2015","journal-title":"Scand J Med Sci Sports"},{"issue":"1","key":"pone.0351501.ref041","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1590\/S1413-35552012005000140","article-title":"Cardiac autonomic responses during upper versus lower limb resistance exercise in healthy elderly men","volume":"18","author":"HG Machado-Vidotti","year":"2014","journal-title":"Braz J Phys Ther"},{"issue":"3","key":"pone.0351501.ref042","first-page":"401","article-title":"Arm vs. combined leg and arm exercise: Blood pressure responses and ratings of perceived exertion at the same indirectly determined heart rate","volume":"8","author":"A Di Blasio","year":"2009","journal-title":"J Sports Sci Med"},{"issue":"3","key":"pone.0351501.ref043","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1249\/JES.0000000000000190","article-title":"Arterial baroreflex resetting during exercise in humans: Underlying signaling mechanisms","volume":"47","author":"PB Raven","year":"2019","journal-title":"Exerc Sport Sci Rev"},{"key":"pone.0351501.ref044","doi-asserted-by":"crossref","first-page":"461","DOI":"10.3389\/fnins.2017.00461","article-title":"Resetting of the baroreflex control of sympathetic vasomotor activity during natural behaviors: Description and conceptual model of central mechanisms","volume":"11","author":"RAL Dampney","year":"2017","journal-title":"Front Neurosci"},{"key":"pone.0351501.ref045","doi-asserted-by":"crossref","first-page":"26","DOI":"10.3389\/fphys.2013.00026","article-title":"The LF\/HF ratio does not accurately measure cardiac sympatho-vagal balance","volume":"4","author":"GE Billman","year":"2013","journal-title":"Front Physiol"},{"key":"pone.0351501.ref046","doi-asserted-by":"crossref","first-page":"301","DOI":"10.3389\/fphys.2017.00301","article-title":"Cardiac autonomic responses during exercise and post-exercise recovery using heart rate variability and systolic time intervals-A review","volume":"8","author":"S Michael","year":"2017","journal-title":"Front Physiol"},{"issue":"3","key":"pone.0351501.ref047","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1056\/NEJMoa2026141","article-title":"Physical rehabilitation for older patients hospitalized for heart failure","volume":"385","author":"DW Kitzman","year":"2021","journal-title":"N Engl J Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351501","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T17:31:48Z","timestamp":1781199108000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351501"}},"subtitle":[],"editor":[{"given":"Satoshi","family":"Higuchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":47,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0351501","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]}}}