{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:31:05Z","timestamp":1760239865571,"version":"build-2065373602"},"reference-count":43,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T00:00:00Z","timestamp":1546560000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","award":["PI08\/ 90944"],"award-info":[{"award-number":["PI08\/ 90944"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: current algorithms for the detection of heart failure (HF) and chronic obstructive pulmonary disease (COPD) exacerbations have poor performance. Methods: this study was designed as a prospective longitudinal trial. Physiological parameters were evaluated at rest and effort (walking) in patients who were in the exacerbation or stable phases of HF or COPD. Parameters with relevant discriminatory power (sensitivity (Sn) or specificity (Sp) \u2265 80%, and Youden index \u2265 0.2) were integrated into diagnostic algorithms. Results: the study included 127 patients (COPD: 56, HF: 54, both: 17). The best algorithm for COPD included: oxygen saturation (SaO2) decrease \u2265 2% in minutes 1 to 3 of effort, end-of-effort heart rate (HR) increase \u2265 10 beats\/min and walking distance decrease \u2265 35 m (presence of one criterion showed Sn: 0.90 (95%, CI(confidence interval): 0.75\u20130.97), Sp: 0.89 (95%, CI: 0.72\u20130.96), and area under the curve (AUC): 0.92 (95%, CI: 0.85\u20130.995)); and for HF: SaO2 decrease \u2265 2% in the mean-of-effort, HR increase \u2265 10 beats\/min in the mean-of-effort, and walking distance decrease \u2265 40 m (presence of one criterion showed Sn: 0.85 (95%, CI: 0.69\u20130.93), Sp: 0.75 (95%, CI: 0.57\u20130.87) and AUC 0.84 (95%, CI: 0.74\u20130.94)). Conclusions: effort situations improve the validity of physiological parameters for detection of HF and COPD exacerbation episodes.<\/jats:p>","DOI":"10.3390\/jcm8010042","type":"journal-article","created":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T11:34:26Z","timestamp":1546601666000},"page":"42","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Effort Oxygen Saturation and Effort Heart Rate to Detect Exacerbations of Chronic Obstructive Pulmonary Disease or Congestive Heart Failure"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5333-3317","authenticated-orcid":false,"given":"C\u00e9sar","family":"G\u00e1lvez-Barr\u00f3n","sequence":"first","affiliation":[{"name":"Clinical Research Unit, Consorci Sanitari del Garraf, Sant Pere de Ribes, PC 08810 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe","family":"Villar-\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, IIS Fundaci\u00f3n Jim\u00e9nez D\u00edaz, CIBERES, UAM, PC 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7356-4307","authenticated-orcid":false,"given":"Jes\u00fas","family":"Ribas","sequence":"additional","affiliation":[{"name":"Servei de Pneumologia, Hospital Universitari de Bellvitge, IDIBELL, L\u2019Hospitalet de Llobregat, PC 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3587-298X","authenticated-orcid":false,"given":"Francesc","family":"Formiga","sequence":"additional","affiliation":[{"name":"Geriatric Unit. Internal Medicine Department, IDIBELL, Unversitat de Barcelona, Hospital Universitari de Bellvitge, L\u2019Hospitalet de Llobregat, PC 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Chivite","sequence":"additional","affiliation":[{"name":"Geriatric Unit. Internal Medicine Department, IDIBELL, Unversitat de Barcelona, Hospital Universitari de Bellvitge, L\u2019Hospitalet de Llobregat, PC 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5330-9971","authenticated-orcid":false,"given":"Ram\u00f3n","family":"Boixeda","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital de Matar\u00f3-Consorci Sanitari del Maresme, PC 08304 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian","family":"Iborra","sequence":"additional","affiliation":[{"name":"Cardiology Department, IIS Fundaci\u00f3n Jim\u00e9nez D\u00edaz, PC 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9678-2654","authenticated-orcid":false,"given":"Alejandro","family":"Rodr\u00edguez-Molinero","sequence":"additional","affiliation":[{"name":"Clinical Research Unit, Consorci Sanitari del Garraf, Sant Pere de Ribes, PC 08810 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,1,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.2105\/AJPH.86.10.1388","article-title":"Decreasing disability in the 21st century: The future effects of controlling six fatal and nonfatal conditions","volume":"86","author":"Boult","year":"1996","journal-title":"Am. J. Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"121S","DOI":"10.1378\/chest.121.5_suppl.121S","article-title":"COPD: Epidemiology, prevalence, morbidity and mortality, and disease heterogeneity","volume":"121","author":"Mannino","year":"2002","journal-title":"Chest"},{"key":"ref_3","first-page":"2","article-title":"Epidemiology of heart failure in Spain and the importance of adhering to clinical practice guidelines","volume":"6","year":"2006","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1513\/pats.200701-003FM","article-title":"Exacerbations of chronic obstructive pulmonary disease","volume":"4","author":"Anzueto","year":"2007","journal-title":"Proc. Am. Thorac. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.cardfail.2010.08.010","article-title":"Hospitalization epidemic in patients with heart failure: Risk factors, risk prediction, knowledge gaps, and future directions","volume":"17","author":"Giamouzis","year":"2011","journal-title":"J. Card. Fail."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"447","DOI":"10.2165\/00019053-200826060-00001","article-title":"Economic burden of heart failure in the elderly","volume":"26","author":"Liao","year":"2008","journal-title":"Pharmacoeconomics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2389","DOI":"10.1161\/01.CIR.0000139841.42454.78","article-title":"Continuous autonomic assessment in patients with symptomatic heart failure: Prognostic value of heart rate variability measured by an implanted cardiac resynchronization device","volume":"110","author":"Adamson","year":"2004","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1109\/TBME.2015.2463283","article-title":"Early Warning of Acute Decompensation in Heart Failure Patients Using a Noncontact Measure of Stability Index","volume":"63","author":"Javed","year":"2016","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.recesp.2012.02.022","article-title":"Pulse oximetry in the diagnosis of acute heart failure","volume":"65","author":"Masip","year":"2012","journal-title":"Rev. Esp. Cardiol. (Engl. Ed.)"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1093\/eurjhf\/hfp033","article-title":"Predicting hospitalization due to worsening heart failure using daily weight measurement: Analysis of the Trans-European Network-Home-Care Management System (TEN-HMS) study","volume":"11","author":"Zhang","year":"2009","journal-title":"Eur. J. Heart Fail"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.cardfail.2012.01.009","article-title":"Design and performance of a multisensor heart failure monitoring algorithm: Results from the multisensor monitoring in congestive heart failure (MUSIC) study","volume":"18","author":"Anand","year":"2012","journal-title":"J. Card. Fail."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Al Rajeh, A.M., and Hurst, J.R. (2016). Monitoring of Physiological Parameters to Predict Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review. J. Clin. Med., 5.","DOI":"10.3390\/jcm5120108"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Hurst, J.R., Donaldson, G.C., Quint, J.K., Goldring, J.J.P., Patel, A.R.C., and Wedzicha, J.A. (2010). Domiciliary pulse-oximetry at exacerbation of chronic obstructive pulmonary disease: Prospective pilot study. BMC Pulm. Med., 10.","DOI":"10.1186\/1471-2466-10-52"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/1465-9921-13-44","article-title":"Prediction and course of symptoms and lung function around an exacerbation in Chronic Obstructive Pulmonary Disease","volume":"13","author":"Hop","year":"2012","journal-title":"Respir. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1258\/jtt.2011.110607","article-title":"Moving prediction of exacerbation in chronic obstructive pulmonary disease for patients in telecare","volume":"18","author":"Jensen","year":"2012","journal-title":"J. Telemed. Telecare"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1378\/chest.11-2728","article-title":"Monitoring breathing rate at home allows early identification of COPD exacerbations","volume":"142","author":"Guerrero","year":"2012","journal-title":"Chest"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Mart\u00edn-Lesende, I., Orru\u00f1o, E., Bilbao, A., Vergara, I., Cairo, M.C., Bay\u00f3n, J.C., Reviriego, E., Romo, M.I., Larra\u00f1aga, J., and Asua, J. (2013). Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial). BMC Health Serv. Res., 13.","DOI":"10.1186\/1472-6963-13-118"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1016\/j.rmed.2009.03.017","article-title":"Remote daily real-time monitoring in patients with COPD\u2014A feasibility study using a novel device","volume":"103","author":"Sund","year":"2009","journal-title":"Respir. Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Hardinge, M., Rutter, H., Velardo, C., Shah, S.A., Williams, V., Tarassenko, L., and Farmer, A. (2015). Using a mobile health application to support self-management in chronic obstructive pulmonary disease: A six-month cohort study. BMC Med. Inform. Decis. Mak., 15.","DOI":"10.1186\/s12911-015-0171-5"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/03091902.2015.1105317","article-title":"Prediction of exacerbation onset in chronic obstructive pulmonary disease patients","volume":"40","author":"Riis","year":"2016","journal-title":"J. Med. Eng. Technol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.artmed.2014.12.003","article-title":"Predicting the risk of exacerbation in patients with chronic obstructive pulmonary disease using home telehealth measurement data","volume":"63","author":"Mohktar","year":"2015","journal-title":"Artif. Intell. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1093\/eurjhf\/hfs186","article-title":"Can individualized weight monitoring using the HeartPhone algorithm improve sensitivity for clinical deterioration of heart failure?","volume":"15","author":"Ledwidge","year":"2013","journal-title":"Eur. J. Heart Fail."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.2196\/jmir.7207","article-title":"Exacerbations in Chronic Obstructive Pulmonary Disease: Identification and Prediction Using a Digital Health System","volume":"19","author":"Shah","year":"2017","journal-title":"J. Med. Internet Res."},{"key":"ref_24","first-page":"735","article-title":"Feasibility of Automated Heart Failure Decompensation Detection Using Remote Patient Monitoring: Results from the Decompensation Detection Study","volume":"3","author":"Gilliam","year":"2012","journal-title":"J. Innov. Cardiac. Rhythm. Manag."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1053\/euhj.1998.1473","article-title":"Cardiac and peripheral responses to exercise in patients with chronic heart failure","volume":"20","author":"Logeart","year":"1999","journal-title":"Eur. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1378\/chest.124.3.863","article-title":"High-frequency modulation of heart rate variability during exercise in patients with COPD","volume":"124","author":"Bartels","year":"2003","journal-title":"Chest"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"160","DOI":"10.3109\/15412555.2011.647130","article-title":"Cardiac autonomic function and cardiovascular response to exercise in patients with chronic obstructive pulmonary disease","volume":"9","author":"Kohler","year":"2012","journal-title":"COPD J. Chronic Obstr. Pulm. Dis."},{"key":"ref_28","unstructured":"Dolgin, M., and New York Heart Association (1994). Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels\/The Criteria Committee of the New York Heart Association, Little, Brown. [9th ed.]."},{"key":"ref_29","first-page":"1665","article-title":"Standardised questionnaire on respiratory symptoms: A statement prepared and approved by the MRC Committee on the Aetiology of Chronic Bronchitis (MRC breathlessness score)","volume":"2","author":"Fletcher","year":"1960","journal-title":"BMJ"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1249\/00005768-198205000-00012","article-title":"Psychophysical bases of perceived exertion","volume":"14","author":"Borg","year":"1982","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_31","unstructured":"Gordis, L. (2014). Epidemiology, Elsevier Saunders. [5th ed.]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","article-title":"Index for rating diagnostic tests","volume":"3","author":"Youden","year":"1950","journal-title":"Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/0304-3959(90)90018-9","article-title":"The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: Development, initial validation, and preliminary investigation for ratio scale properties","volume":"41","author":"Bieri","year":"1990","journal-title":"Pain"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/00002508-199803000-00005","article-title":"Evaluation of the Faces Pain Scale for use with the elderly","volume":"14","author":"Herr","year":"1998","journal-title":"Clin. J. Pain"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1177\/1357633X14562733","article-title":"Changes in telemonitored physiological variables and symptoms prior to exacerbations of chronic obstructive pulmonary disease","volume":"21","author":"Burton","year":"2015","journal-title":"J. Telemed. Telecare"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Alahmari, A.D., Patel, A.R.C., Kowlessar, B.S., Mackay, A.J., Singh, R., Wedzicha, J.A., and Donaldson, G.C. (2014). Daily activity during stability and exacerbation of chronic obstructive pulmonary disease. BMC Pulm. Med., 14.","DOI":"10.1186\/1471-2466-14-98"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Collins, S.P., Thorn, M., Nowak, R.M., Levy, P.D., Fermann, G.J., Hiestand, B.C., Cowart, T.D., Venuti, R.P., Hiatt, W.R., and Foo, S. (2017). Feasibility of Serial 6-min Walk Tests in Patients with Acute Heart Failure. J. Clin. Med., 6.","DOI":"10.3390\/jcm6090084"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.hrtlng.2017.04.001","article-title":"Six-minute walk distance predicts 30-day readmission after acute heart failure hospitalization","volume":"46","author":"McCabe","year":"2017","journal-title":"Heart Lung"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1536\/ihj.13-224","article-title":"Six-minute walk distance is an independent predictor of hospital readmission in patients with chronic heart failure","volume":"55","author":"Tabata","year":"2014","journal-title":"Int. Heart J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"505969","DOI":"10.1155\/2014\/505969","article-title":"The long-term prognostic significance of 6-minute walk test distance in patients with chronic heart failure","volume":"2014","author":"Ingle","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1155\/2015\/280187","article-title":"Six minute walk distance is a predictor of survival in patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation","volume":"22","author":"Dajczman","year":"2015","journal-title":"Can. Respir. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/jep.12629","article-title":"Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: A systematic review","volume":"23","author":"Bohannon","year":"2017","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1183\/09031936.00150314","article-title":"An official European Respiratory Society\/American Thoracic Society technical standard: Field walking tests in chronic respiratory disease","volume":"44","author":"Holland","year":"2014","journal-title":"Eur. Respir. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/1\/42\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:23:29Z","timestamp":1760185409000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/1\/42"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,4]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1]]}},"alternative-id":["jcm8010042"],"URL":"https:\/\/doi.org\/10.3390\/jcm8010042","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2019,1,4]]}}}