Adult Heart Failure Patients Research Articles

The incremental economic burden of heart failure: A population-based investigation from South Korea.

BackgroundThe prevalence of heart failure (HF) and its economic burden are increasing with age of the South Korean population. This study aimed to assess the economic impact of HF from the societal perspective.MethodsA prevalence-based, incremental cost-of-patient study was performed to estimate the cost ratio between patients with HF and those without HF based on the claims database of the national health insurance in South Korea. We defined adult HF patients as those aged ≥19 years who had at least one insurance claim record with a primary or secondary diagnosis of HF. Age- and gender-matched controls were defined using a 1:4 greedy matching method. Costs were estimated by including medical costs for insurance-covered and non-covered services, transportation costs, caregiver’s cost, and time costs of patients. The ratio of costs between patients with HF and those without HF was adjusted for age, gender, and type of universal health security program in the multivariate regression model.ResultsThe average annual per-capita cost was estimated to be $6,601 for patients with HF (n = 14,252), which is about 3.38 (95% confidence interval [CI]: 3.31–3.46) times higher than that for patients without HF (n = 1,116,882) and 1.64 (95% CI: 1.59–1.70) times higher than that for the age- and gender-matched patients without HF (n = 57,008). In the multivariate regression model, the annual per-capita total costs were 1.98-fold (95% CI: 1.94–2.02) statistically higher for patients with HF than for patients without HF after adjustment for age, gender, and type of universal health security program.ConclusionsThis study demonstrates a significant incremental burden of HF. Given that the prevalence of HF is expected to increase with an increase in the aging population, the national economic burden is expected to be substantial in the future. Thus, greater emphasis on the prevention and treatment of HF is warranted.

Ventricular Arterial Coupling: A Novel Echocardiographic Risk Factor for Disease Progression in Pediatric Dilated Cardiomyopathy.

In adult heart failure (HF) patients, a higher ventricular arterial (VA) coupling ratio measured non-invasively is associated with worse HF prognosis and response to treatment. There are no data regarding the relationship of VA coupling to outcome in pediatric dilated cardiomyopathy (DCM) patients. We investigated the association of VA coupling ratio with worse outcome (mechanical circulatory support, transplant, or death) in 48 children with DCM and 97 age-gender matched controls. Mean age at presentation was 9 ± 7 years; DCM patients had a higher arterial elastance (3.8 ± 1.7 vs 2.7 ± 0.7 respectively p = 0.001), a lower LV elastance (1.1 ± 0.65 vs 4.5 ± 1.4, respectively p = 0.001) and higher VA coupling ratio (5.0 ± 3.9 vs 0.34 ± 0.14, respectively p = 0.001). Outcome events occurred in 27/48 (56%) patients. Patients with an outcome event had a higher NYHA class (p = 0.001), lower LV elastance (0.8 ± 0.47 vs 1.6 ± 0.57, respectively p = 0.001), higher arterial elastance (4.5 ± 1.8 vs 2.9 ± 1.1, respectively p = 0.002), and a higher VA coupling ratio (7.1 ± 3.8 vs 2.2 ± 1.5, respectively p = 0.001) compared to those without. In a multivariate CART analysis, VA coupling was the top and only discriminator of poor outcome. In conclusion, a higher VA coupling ratio is associated with worse outcome in pediatric patients with DCM. VA coupling is promising as a bedside analysis tool that may provide insight into the mechanisms of HF in pediatric DCM and identify potential targets for therapy.

Bioelectrical impedance analysis in the management of heart failure in adult patients with congenital heart disease.

The recognition of fluid retention is critical in treating heart failure (HF). Bioelectrical impedance analysis (BIA) is a well-known noninvasive method; however, data on its role in managing patients with congenital heart disease (CHD) are limited. Here, we aimed to clarify the correlation between BIA and HF severity as well as the prognostic value of BIA in adult patients with CHD. This prospective single-center study included 170 patients with CHD admitted between 2013 and 2015. We evaluated BIA parameters (intra- and extracellular water, protein, and mineral levels, edema index [EI, extracellular water-to-total body water ratio]), laboratory values, and HF-related admission prevalence. Patients with New York Heart Association (NYHA) functional classes III-IV had a higher EI than those with NYHA classes I-II (mean±SD, 0.398±0.011 vs 0.384±0.017, P<.001). EI was significantly correlated with brain natriuretic peptide level (r=0.51, P<.001). During the mean follow-up period of 7.1months, Kaplan-Meier analysis showed that a discharge EI>0.386, the median value in the present study, was significantly associated with a future increased risk of HF-related admission (HR=4.15, 95% CI=1.70－11.58, P<.001). A body weight reduction during hospitalization was also related to EI reduction. EI determined using BIA could be a useful marker for HF severity that could predict future HF-related admissions in adult patients with CHD.

PCV26 - Estimating The Incremental Resource Utilization And Economic Cost Attributable To Heart Failure In South Korea

Owing to the increasing age of the Korean population, the prevalence of heart failure (HF) and its economic burden are also increasing. This study aimed to assess the economic impact of HF from the restricted societal perspective. A prevalence-based, incremental cost-of-patient study was performed to estimate the incremental resource use and costs for all-causes among adult HF patients compared to those without HF. We defined adult HF patients as those aged ≥19 years who had at least one insurance claim record with a primary or a secondary diagnosis of HF (ICD-10 codes of I11.0, I13.0, I13.2, I50.x) from the 2014 Health Insurance Review and Assessment Service-National Patients Sample (HIRA-NPS) claims data. The average annual per-capita cost was estimated to be $6,978, $2,097, and $4,176 for HF patients (n=14,252 patients), non-matched controls (n=1,116,882), and age- and gender-matched controls (n=57,008), respectively. The incremental cost per case of HF compared to that of matched controls was $2,802, which is about 1.70 times higher. In the multiple regression model, the mean expenditure was 1.4-fold higher for patients with HF than for matched controls. Simple conclusions as to whether the estimated economic burden of HF is large or small are not easy to make. However, the strong correlation between aging and the incidence of HF validates that the prevalence of this chronic condition will continue to increase, resulting in an enduring societal burden. Thus, greater emphasis on the prevention and treatment of HF is.

The use of sacubitril/valsartan in anthracycline-induced cardiomyopathy: A mini case series

Sacubitril/valsartan has been shown to significantly reduce cardiovascular mortality and hospitalizations due to heart failure in adult patients with reduced ejection fraction when compared to enalapril. To the best of our knowledge, the combination of sacubitril (neprilysin inhibitor) and valsartan (angiotensin receptor blocker) has not been evaluated in patients with chemotherapy-induced cardiomyopathy, as these patients were excluded from the recent pivotal trial, PARADIGM-HF. However, current guidelines for the evaluation and management of cardiovascular complications of cancer therapy, published by the Canadian Cardiovascular Society, direct clinicians to the Canadian Cardiovascular Society Heart Failure Guidelines for the management of cancer patients who develop clinical heart failure or an asymptomatic decline in left ventricular ejection fraction (e.g. >10% reduction from baseline or left ventricular ejection fraction <53%), which could include the use of sacubitril/valsartan. Retrospective descriptive comparative case study of two patients treated with sacubitril/valsartan. We present data from two patients who experienced anthracycline-induced cardiomyopathy and were successfully managed with sacubitril/valsartan after suboptimal responses to traditional evidence-based heart failure therapies. Both patients demonstrated some recovery of function and normalization of N-terminal pro B-type natriuretic peptide levels. Sacubitril/valsartan was well tolerated with minimal side effects. To date, neither patient has required hospitalization or additional clinic interventions for heart failure. While further large scale studies are required to determine a comprehensive safety and efficacy profile, we report two cases of anthracycline-induced cardiomyopathy survivors managed with sacubitril/valsartan with minimal side effects and no hospitalizations.

Cost-Effectiveness of Ventricular Assist Device Destination Therapy for Advanced Heart Failure in Duchenne Muscular Dystrophy

Destination ventricular assist device therapy (DT-VAD) is well accepted in select adults with medically refractory heart failure (HF) who are not transplant candidates; however, its use in younger patients with progressive diseases is unclear. We sought to evaluate the cost-effectiveness of DT-VAD in Duchenne muscular dystrophy (DMD) patients with advanced HF. We created a Markov-state transition model (5-year horizon) to compare survival, costs, and quality of life (QOL) between medical management and DT-VAD in DMD with advanced HF. Model input parameters were derived from the literature. We used sensitivity analyses to explore uncertainty around model assumptions. DT-VAD had higher costs ($435,602 vs. $125,696), survival (3.13 vs. 0.60years), and quality-adjusted survival (1.99 vs. 0.26years) than medical management. The incremental cost-effectiveness ratio (ICER) for DT-VAD was $179,086 per quality-adjusted life year (QALY). In sensitivity analyses that were widely varied to account for uncertainty in model assumptions, the DT-VAD strategy generally remained more costly and effective than medical management. Only when VAD implantation costs were <$113,142 did the DT-VAD strategy fall below the $100,000/QALY willingness-to-pay threshold commonly considered to be "cost-effective." In this exploratory analysis, DT-VAD for patients with DMD and advanced HF exceeded societal expectations for cost-effectiveness but had an ICER similar to the accepted practice of DT-VAD in adult HF patients. While more experience and research in this population is needed, our analysis suggests that DT-VAD for advanced HF in DMD should not be dismissed solely based on cost.

Comparison of the effects of adaptive servo-ventilation and biphasic positive airway pressure in the treatment of adult heart failure patients complicated with complex sleep apnes syndrome

Objective To compare the therapeutic outcomes of adaptive servo-ventilation (ASV) and biphasic positive airway pressure(BiPAP) in the treatment of adult chronic heart failure(CHF) patients complicated with complex sleep apnes syndrome(SAS). Methods 34 adult CHF patients complicated with complex SAS were selected and divided into ASV group and BiPAP group according to random number table method, 17cases in each group.The clinical efficacy, polysomonograph(PSG) data and heart function during treatment were compared. Results The total effective rate of the ASV group was 88.2%(15/17), which was higher than 58.8%(10/17) of the BiPAP group(χ2=7.777, P<0.01). Compared with the BiPAP group, the sleeping efficacy, SpO2 and LVEF significantly increased in the ASV group (t=4.951, P<0.01; t=-5.743, P<0.01), while the AHI and CAI were significantly decreased in the ASV group (t=14.893, P<0.01; t=18.384, P<0.01). Compared with pre-treatment, the heart function parameters of the two groups after treatment were improved.Compared with the BiPAP group after treatment, the LVEF and 6min walking distance were significantly prolonged in the ASV group (t=-6.552, P<0.01; t=-6.720, P<0.01). Conclusion Compared with BiPAP, ASA showed better effect in the treatment of CHF patients complicated with complex SAS.It can improve the sleeping efficacy and respiratory disorder, decrease the AHI and CAI, and enhance the heart function, which is worth to be recommended into clinical application. Key words: Ventilators, mechanical; Sleep apnes syndromes; Heart failure; Controlled clinical trial

Association Between Medication Adherence and the Outcomes of Heart Failure.

Previous studies of heart failure patients demonstrated an association between cardiovascular medication adherence and hospitalizations or a composite end point of hospitalization and death. Few studies have assessed the impact of treatment adherence within large general medical populations that distinguish the health outcomes of emergency department visits, hospitalization, and death. To determine the association of incremental cardiovascular medication adherence on emergency department visits, hospitalization, and death in adult heart failure patients in Indiana. Retrospective cohort study conducted using electronic health record data from the statewide Indiana Network for Patient Care between 2004 and 2009. Patients were at least 18 years of age with a diagnosis of heart failure and prescribed at least one cardiovascular medication for heart failure. Adherence was measured as the proportion of days covered (PDC) using pharmacy transaction data. Clinical end points included emergency department visits, hospital admissions, length of hospital stay, and mortality. Generalized linear models were used to determine the effect of a 10% increase in PDC on clinical end points adjusting for age, sex, race, Charlson Comorbidity Index, and medications. Electronic health records were available for 55,312 patients (mean age ± standard deviation 68 ± 16 yrs; 54% women; 65% white). Mean PDC for all heart failure medications was 63% ± 23%. For every 10% increase in PDC, emergency department visits decreased 11% (rate ratio [RR] 0.89, 95% confidence interval [CI] 0.89-0.89), hospital admissions decreased 6% (RR 0.94, 95% CI 0.94-0.94), total length of hospital stay decreased 1% (RR 0.99, 95% CI 0.99-1.00), and all-cause mortality decreased 9% (odds ratio 0.91; 95% CI 0.90-0.92). Incremental medication adherence was associated with reductions in emergency department visits, hospital admissions, length of hospital stay, and all-cause mortality.

Use of dietary sodium intervention effect on neurohormonal and fluid overload in heart failure patients: Review of select research based literature

AimThis literature review analyzed ten articles investigating the effects of low dietary sodium intake on neurohormonal and fluid overload on heart failure (HF). BackgroundRecommendations for low dietary sodium to HF patients has been debated in the past one to two decades. MethodsThis report presents a literature review of interventional studies from 2006 to 2015 investigating adult HF patients. ResultsThe results of the neurohormonal outcome variables seem to be the primary consideration for recommending a low sodium diet to patients with HF. Most of articles in this review reported that 2.6–3 g/day of dietary sodium is effective for decreased BNP, renin, and aldosterone (neurohormonal) plasma levels in patients with HF. ConclusionsWe have to provide the reason, effect, and amount of dietary sodium when providing dietary sodium recommendations to patients.

Predicting cardiogenic pulmonary edema in heart failure patients by using an N-terminal pro-b-type natriuretic peptide (NT-pro BNP) -based score

BackgroundCardiogenic pulmonary edema (CPE) is a life-threatening emergency necessitating aggressive management. We conducted this study to test the hypothesis that a combination of N-terminal pro-b-type natriuretic peptide (NT-pro-BNP) and some relevant clinical factors may provide better predictability for CPE in heart failure (HF) patients. MethodsThis retrospective study enrolled adult HF patients hospitalized during January 2011 to December 2013. After determining the independent predictors for the occurrence of CPE, a novel NT-pro BNP-based diagnostic score for predicting CPE was established. ResultsA total of 269 patients (mean age, 74.5 ± 13.6 years; female, 53.9%) were enrolled, and categorized into CPE group (n = 80, 29.7%) and non-CPE group (n = 189, 70.3%). Several factors such as “Serum NT-pro-BNP level > 6980 mg/dl,” “systemic blood pressure > 170 mm Hg,” “heart rate > 120 bpm,” “with rales in breathing sound,” “with jugular vein engorgement,” “with NYHA Fc III/IV,” “with chronic lung disease” and “with angiotensin converting enzyme inhibitors/angiotensin receptor blocker” were found to be associated with the existence of CPE. A novel NT-pro BNP based scoring system containing these risk factors was proposed and proven excellent in predicting CPE. ConclusionsThe NT-pro-BNP scoring system could predict CPE in HF patients.

Design and Rationale of Gulf Documentation of Ambulatory Sick Patients with Heart Failure (Gulf DYSPNEA) Registry.

Aim:The aim of this study is to describe the clinical characteristics of ambulatory patients with chronic heart failure (HF) in the Arabian Gulf and to examine several aspects including types of HF, causes, and adherence to management guidelines.Methods:Gulf documentation of ambulatory sick patients with HF (Gulf DYSPNEA) registry is a multicenter, cross-sectional study, recruiting adult ambulatory HF patients from 24 hospitals in five Arabian Gulf countries. Consecutive patients are recruited prospectively from participating clinics with no follow-up data collection. Recruitment started on November 07, 2016 and will stop when 3,500 patients are enrolled in this study. Collected data explore demographics, baseline patient characteristics, symptoms, previous medical history, comorbidities, physical signs, presenting electrocardiogram, echocardiographic findings, types of HF, and management.Conclusion:This registry is expected to provide useful data on several important aspects and features of ambulatory patients with chronic HF in Arabian Gulf countries. The trial registration number is “ClinicalTrials.gov number, NCT02793180”.

Management of acute heart failure in adult patients with congenital heart disease.

Heart failure is an increasing reason for hospitalization and the leading cause of death in patients with adult congenital heart disease (ACHD). Recently, the European Society of Cardiology and the American Heart Association published consensus documents on the management of chronic heart failure in ACHD patients. However, little data and/or guidelines are available for the management of (sub)acute heart failure. The ACHD population is heterogeneous by definition and often has complex underlying anatomy, which could pose a challenge to the physician confronted with the ACHD patient in (sub)acute heart failure. Recognizing the underlying anatomy and awareness of the possible complications related would result in better treatment, avoid unnecessary delays, and improve outcomes of the ACHD patient with (sub)acute heart failure. This review focuses on the management of (sub)acute heart failure in ACHD with specific attention to lesion-specific issues.

Body composition, appetite-related hormones, adipocytokines, and heart failure in adult patients with congenital heart disease: A preliminary study.

To assess body composition and relationships among body composition, appetite-related hormones, adipocytokines, and heart failure (HF) in adult patients with congenital heart disease (CHD). This prospective study enrolled 46 consecutive adult patients with CHD and 12 age-matched healthy controls. The patients and control subjects were divided into four groups: 13 patients with Fontan circulation (group A), 16 patients with cyanosis (group B), 17 patients who previously underwent biventricular repair (group C), and 12 age-matched healthy controls. Body composition was measured using InBody730, and levels of appetite-related hormones (ghrelin and leptin) and adipocytokines (leptin, interleukin-6, and tumor necrosis factor-α) were determined. Relationships of these measurements between severe HF, defined as New York Heart Association functional class III-IV and/or recent repeated unscheduled hospitalizations due to HF, were examined using univariate logistic analysis. Mean patient age was 32.1 ± 7.4 years. The skeletal muscle mass was significantly decreased in groups A and B compared with that in controls. Interestingly, ghrelin levels in groups A and B were also significantly lower than those in controls. Univariate logistic analysis revealed that ghrelin level, percent body fat, and pulse oximetric oxygen saturation were significantly associated with severe HF. Patients with Fontan circulation and those with cyanosis might be at a risk of sarcopenia. Despite the decreased skeletal muscle mass and increased body fat, ghrelin levels in these patients were decreased. These changes might have a negative impact on HF in these patients.

A Nurse Led Clinic’s contribution to Patient Education and Promoting Self-care in Heart Failure Patients: A Systematic Review

Introduction: Heart failure (HF) is a medical condition whereby the heart’s efficency is compromised. Typical symptoms include breathlessness, tiredness and ankle swelling and signs of increased heart rate, lung congestion or raised jugular venous pressure. It is confirmed by the presence of a structural or functional abnormality of the heart on echocardiograph. HF significantly affects the patient’s quality of life (QoL). HF is a major problem for society affecting 1-2% of adults in developed countries (Mosterd and Hoes 2007), in excess of 90,000 people in Ireland are affected (Corry et al. 2015). Background: The incidence and prevalence as well as high hospital admission rates, increase the cost of and burden of HF. Chronic disease management programmes developed nurse-led clinics and collaboration of the multi-disciplinary team (MDT) to improve HF guideline implementation and outcomes. Educating patients on the self-care skills and knowledge necessary to control symptoms and avoid hospitalisation, which include daily weight, symptom monitoring and seeking timely medical care for deterioration is vital. Self-care is the decisions and choice of behaviours by the individual in order to maintain life, healthy functioning and well-being (Reigel and Carlson 2002, Jaarsma et al. 2003). Cowie et al (2014) examined Acute HF in Europe and the USA recommending: Optimising care accross institutions, improving patient education/ support, providing equitable care, enhancing end of life care, and increasing HF prevention. Aim: To examine the evidence for the role of the nurse-led clinic in patient education on the outcomes of Self-Care and QoL for HF patients. Methodology: A search of the databases CINHAL, PubMed, Science Direct and Medline was conducted. Search criteria: Adult HF patients aged over 18years, attending Nurse-led HF clinics/ nurse managed HF care programmes, English language only, No geographical limit, Published 2006-2016. Inclusion Criteria: Original Research, Interventions delivered through nurse led clinics, patient education, self-care skills, health assessment, and referral to MDT. Grey literature- online reports x 2 and small unpublished local population study. Results: Sixty eight studies were identified spanning 12 countries, various components of disease management programmes such as goal setting & motivational interviewing, educational and self-care needs, barriers and facilitators. Characteristics included all classes of HF, group or individualised programmes. Themes identified included: learning needs; knowledge, symptom recognition, barriers to learning, self-care skills, role of social/ caregiver support and a therapeutic nurse/patient/relationship. Conclusion: The patient’s need to be connected is highlighted by the review. Quantitative measures of self-care tools and patient satisfaction are augmented by patient reported outcomes and rich qualitative data. Cognitive impairment and depression may interfere with learning, decision-making and perception of symptoms.. The evidence supports the need for individualised patient educational plans and management strategies. Lifestyle changes may include controlling or modifiying risk factors (Dickstein et al. 2008). Adherence to guidelines and supporting patient autonomy are also important. Patients must learn and understand the relevant self-care behaviour required (Stromberg 2005, McMurray et al. 2012), gain the necessary skills to act on deteriorating symptoms and ways of increasing activity adjusted to functional capacity and energy conservation. Through education adapted to patient’s needs and goals, Self-Care is promoted and quality of life is improved. Further research is needed into other factors that affect QoL screening and the use of nursing taxonomies.

The role of Midkine in Children with Dilated Cardiomyopathy

Introduction: While current medical therapies benefit adult heart failure (HF) patients, these therapies do not confer the same improvement in survival in children with HF. This difference suggests that the underlying cellular mechanisms in failing myocytes are uniquely regulated. We have found that serum circulating factors are important in cardiomyocyte remodelling in pediatric patients with Dilated Cardiomyopathy (DCM). In our preliminary results, we identified a specific heparin-binding growth factor, midkine (MDK), which is highly upregulated in the serum of pediatric DCM patients. The objective of this study is to investigate the relation between serum MDK levels and clinical outcome, and to define the effect of MDK in modulating pathologic responses. Methods and results: Our current serum bank contains 5 non-failing (NF) and 44 DCM samples from individual patients. The level of serum (circulating) MDK was determined in the banked serum from pediatric DCM patients by ELISA, and correlated with the patient’s clinical outcome. Our results show that MDK levels in serum was elevated in pediatric DCM patients who died or were transplanted in comparison with pediatric DCM patients who are clinically stable. The contribution of serum MDK to primary cardiomyocytes was investigated by treating neonatal rat ventricular myocytes (NRVMs) with human recombinant MDK for 72 hours. Our results show an increase in the expression of genes associated with pathologic remodelling in MDK-treated NRVMs. In addition, there is an increase in cell area and ANF expression in MDK-treated NRVMs compared to NF serum-treated cells. In our unique mouse model of pediatric cardiac pathologic growth (isoproterenol infusion –30mg/kg/day), MDK treatment (3mg/kg/week) resulted in increased heart/body weight. Conclusions: Our results suggest that MDK is detrimental to cardiac function. This finding combined with increased circulating MDK in end-stage pediatric DCM patients, suggests an important regulatory role for MDK in pediatric HF.

PD3-5 - Ventricular Assist Device Treatment for Pediatric Patients

Continuous-flow ventricular assist devices (CF-VAD) have been widely used in end-stage heart failure in adult patients for both bridge to transplantation and destination therapy. Technology improvement has enabled miniaturization of the CF-VAD, which may greatly benefit the pediatric patients with sufficient body size in advanced heart failure. There are still, however, challenging situations for CF-VAD implantation, such as in single ventricle physiology, anatomically abnormal heart, small children and infants. Limited number of reports of CF-VAD for systemic ventricular failure of Fontan circulation were published. There is, so far, no agreed consensus as for the timing of CF-VAD implantation in such a situation. Successful CF-VAD experiences in (congenitally corrected) transposition of great arteries have been also reported. Berlin Heart EXCOR pediatric is an only device which is suitable for small children and infants. There are more than 1800 implantations reported worldwide. One year overall survival rate is 73%. Dilated cardiomyopathy is the major cause of its use, comprising 53%, and 21% for congenital heart disease. EXCOR pediatric was approved in 2015 in Japan. 28 implants were performed including trial cases. Fifteen patients underwent heart transplantation, 3 weaned from the VAD and 10 on-going support, which means there is no death. Clinical trial of pediatric Jarvik is just about being started with great expectations.

Management of Heart Failure in a Rural Community.

In rural Western New York, hospitalizations of patients over 65 years of age with heart failure (HF) exceed state and national levels, demonstrating a need for improved management of older adult HF patients in rural communities. The aim of this project was to implement an evidence-based practice (EBP) guideline for HF management at a certified home health agency (CHHA). The objective was to increase CHHA interdisciplinary staff knowledge and to implement an EBP HF guideline to improve care and reduce hospital readmission rates. This quality improvement project used a quantitative descriptive study design, with a convenience sample of 60 CHHA interdisciplinary staff. A series of four 30-minute educational sessions were provided to the staff regarding the EBP HF guideline. Data were collected using pre- and posteducation testing to assess knowledge. A 3-month evaluation was completed to assess implementation along with readmission data pre- and postimplementation. Of the 60 interdisciplinary staff who received the EBP HF guideline education, 17 participants completed both the pretest and posttest. Results demonstrated a statistically significant increase in knowledge from the pretest (Md = 60.00%) to the posttest (Md = 80.00%) (p = .001). In the 3-month follow-up survey, 66% of the staff reported using the EBP HF guideline on "most" or "all" older adult HF patients. The organization had a 4.32% reduction in all-cause 30-day rehospitalizations from 11.39% to 7.07% following the implementation of the EBP HF guideline.

Systematic review of provider involvement in heart failure self-care interventions.

Heart failure is a global concern impacting patient outcomes. Self-care interventions improve self-care behaviors in heart failure patients. The impact of direct provider involvement on patient self-care outcomes is unknown in research. The purpose is to review self-care interventions for adults with heart failure and describe direct provider involvement versus no direct provider involvement on patient self-care behaviors. Review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were independently selected, grounded in the population, intervention, comparison, and outcome (PICO) question, and predetermined inclusion/exclusion criteria, including self-care interventions, adult heart failure patients, self-care behavior measurement, and 10-year publication. Quality assessment of studies was conducted. There was a lack of data and quality studies to answer the PICO question. Comparison of variables that impact self-care behaviors is problematic because the interventions are heterogeneous, which limits interpretation of results. There were minimal studies with direct provider involvement. None of the studies conceptually addressed direct provider involvement. The involvement of providers, health systems, and patients in pragmatic research can impact the integration of research, policy, and practice. Strategies to decrease threats to internal validity need to be addressed as research is translated into practice.

P4381Predictors of in-hospital mortality among hospitalised adult heart failure patients in the Philippines

P4381Predictors of in-hospital mortality among hospitalised adult heart failure patients in the Philippines

Pediatric and adult dilated cardiomyopathy represent distinct pathological entities.

Pediatric dilated cardiomyopathy (DCM) is the most common indication for heart transplantation in children. Despite similar genetic etiologies, medications routinely used in adult heart failure patients do not improve outcomes in the pediatric population. The mechanistic basis for these observations is unknown. We hypothesized that pediatric and adult DCM comprise distinct pathological entities, in that children do not undergo adverse remodeling, the target of adult heart failure therapies. To test this hypothesis, we examined LV specimens obtained from pediatric and adult donor controls and DCM patients. Consistent with the established pathophysiology of adult heart failure, adults with DCM displayed marked cardiomyocyte hypertrophy and myocardial fibrosis compared with donor controls. In contrast, pediatric DCM specimens demonstrated minimal cardiomyocyte hypertrophy and myocardial fibrosis compared with both age-matched controls and adults with DCM. Strikingly, RNA sequencing uncovered divergent gene expression profiles in pediatric and adult patients, including enrichment of transcripts associated with adverse remodeling and innate immune activation in adult DCM specimens. Collectively, these findings reveal that pediatric and adult DCM represent distinct pathological entities, provide a mechanistic basis to explain why children fail to respond to adult heart failure therapies, and suggest the need to develop new approaches for pediatric DCM.