Introduction:: Heart failure (HF) is associated with poor health-related quality of life (HRQoL). In Taiwan, the medical resources and health-care insurance program for HF patients differs from those available in the West. This study sought to test whether there is any change in knowledge, self-care behaviour and HRQoL during 1-year of follow-up under the Taiwan national health-care insurance programme and education by cardiologists at an outpatient clinic. Materials and Methods:: 141 HF patients with New York Heart Association (NYHA) class II or III were enrolled at the outpatient clinic three months after stabilisation. Questionnaires on knowledge, self-care, and HRQoL were administered at baseline and after one year. At the end of the study, 36 (26%) patients were lost to follow-up leaving 105 patients in the study. Results:: Overall, there was improvement in knowledge, self-care, and HRQoL (p<0.0001) of patients with HF (Class II and III combined) after one year of follow up. Subgroup analysis showed that the improvement of HRQoL was significant only in class III patients. Compared to class II patients at baseline, class III patients had poorer knowledge (p=0.03) and HRQoL (p<0.0001), however exhibited significant improvements in knowledge (p=0.02) and HRQoL (p=0.001). Multivariate analysis showed that functional class (p<0.001) and education level (p=0.03) were independent parameters correlated with the improvement in HRQoL. Compared to class II patients, class III patients had better HRQoL at 1-year and this was significantly associated with better self-care (p<0.0001). Conclusion: In patients with stable HF followed under the Taiwan national health-care insurance by cardiologists at an outpatient clinic, HRQoL improved modestly but more significantly in the NYHA class III subgroup. In the future, it should be tested whether the interventions specific for self-care behaviour in class III patients may yield substantial improvement in HRQoL.

Objectives There is little information available regarding local vasomotor regulating processes in chronic heart failure. In this study, we tested the hypothesis that chronic heart failure impaired the endothelial function, and long term captopril treatment might reverse endothelial activity through tissue endothelin (ET) pathway.Methods Forty Spraque-Dawley rats were divided into 4 groups including 15 rats in each of the sham-operated with or without captopril-treated groups and 5 rats in each of large infarcted with or without captopril-treated groups.Results Concentration-response curves obtained in aortic rings without endothelium revealed no difference in nitroprusside-induced relaxation. With endothelium, rightward shifting was noted only in the untreated large infarct group during acetylcholine-induced relaxation. As compared to the non-treated group, plasma ET-1 concentrations were lower in the captopril-treated with or without large infarct groups. However, endothelin-like immunoreactivity in endothelial cells and cytoplasma of smooth muscle cells of the media of the aorta were lower only in the non-treated large infarct group.Conclusions Endothelial function was impaired in the chronic heart failure model. Coverting enzyme inhibitor might improve endothelial function through the Local endothelin pathway.