Adult Heart Failure Patients Research Articles

Assessing socioeconomic vulnerability and COVID-19 infection risk among NCD patients in rural Sierra Leone: a cross-sectional study

BackgroundIn Sierra Leone, non-communicable diseases (NCDs) are an increasingly important source of mortality and morbidity. However, Sierra Leonean NCD patients’ experience of direct exposure to COVID-19-related risks and indirect effects of the COVID-19 pandemic on socioeconomic determinants of health has not been described.MethodsWe conducted a cross-sectional telephone survey among adult (≥ 18 years) hypertensive, diabetic, and heart failure patients receiving treatment at the NCD clinic at Koidu Government Hospital (KGH) in rural Sierra Leone. We described patient demographics, COVID-19 related knowledge, and practice of infection prevention measures. Patients were categorized into nationally representative wealth quintiles using an asset-based wealth index and measures of social vulnerability were reported by clinical program and wealth category.ResultOf the 400 respondents, 80.5% were between 40 and 69 years old and 46.1% were male. The majority of patients (> 90%) knew utilizing masks, social distancing, isolation from positive cases, and avoiding hand shaking were effective COVID-19 prevention measures. However, only 27.3% of the population had access to adequate handwashing facilities, 25.5% had attended crowded events in the past two weeks, and only 5.8% always used face masks. Compared with the national distribution of wealth, 33.0% of our population belonged in the richest quintile, 34.8% in the second-richest quintile, and 32.2% in the bottom 3 poorest-middle quintiles. Socioeconomic vulnerability was high overall with significant disparities between wealth categories. In the 30 days before the interview, almost 60% of the poorest-middle categories experienced one barrier to essential health services, 87.4% used at least one emergency coping mechanism to cover food, housing, or health care, and 98.4% were worried about having food. In the richest category, the proportion of patients experiencing these challenges was 32.3%, 39.5% and 81.6%, respectively.ConclusionOur patients had good knowledge of COVID-19 prevention measures; however, we found substantial discrepancies between patients’ self-reported knowledge and practices. Although our population was wealthier than the national average, the NCD patients were still exposed to unacceptable levels of socioeconomic vulnerability, reflecting a high absolute poverty in Sierra Leone. Furthermore, wealth-based disparities in access to essential resources persist among NCD patients.

Diabetes mellitus impact on left ventricular assist deviceoutcomes in heart failure patients: National Inpatient Sample study.

Aim: Diabetes mellitus (DM) is a recognized risk factor for heart failure (HF), increasing the likelihood of requiring left ventricular assist device (LVAD) therapy. Objective: This retrospective cohort study aims to assess the impact of DM on LVAD patients, focusing on in-hospital mortality as the primary outcome. Methods: Utilizing the National Inpatient Sample administrative database, data from 11,506 adult HF patients who underwent LVAD implantation were analyzed. Results: Of the patients, 44.28% had diabetes. Adjusting for various factors, diabetic patients exhibited shorter hospital stays, lower admission costs and similar in-hospital mortality rates compared with non-diabetic patients. Conclusion: These findings enhance our understanding of the risks and benefits of LVAD therapy in patients with refractory HF and DM.

Relationship between Disease Knowledge and Self-care Adherence among Heart Failure Patients at King Abdulaziz University Hospital

Backgrounds: Heart failure (HF) is a progressive syndrome characterized bycomplicated therapeutic regimens and repeated hospitalizations. HF has turnedinto a global epidemic demonstrating serious mortality and morbidity. This studyaimed to assess the relationship between disease knowledge and self-careadherence among adult HF patients at King Abdulaziz University Hospital (KAUH).Methods: A cross-sectional descriptive correlational design was utilized. Patientswere recruited from outpatient clinic at KAUH in Jeddah, Saudi Arabia. Aconvenience sample of 208 HF patients. The Dutch Heart Failure Knowledge Scale(DHFS) and the European Heart Failure Self-Care Behavior Scale (EHFSCBs) wereused to measure the main study outcomes. Participants were recruited from heartfailure outpatient clinics at KAUH from January 31 – May 17, 2021. Results: 63.9%of participants were male, 49% were over 61 years old, and 30.8% of theparticipants were not educated. 55.8% of the participants had an adequate level ofknowledge about HF disease and 57.2% had a good level of self-care adherence. Themean total HF knowledge score DHFS was 8.58±3.08 out of 15 and the self-careadherence score EHFSCBs was 28.97 ±5.61out of 60. A significant positive moderatecorrelation existed between disease knowledge and self-care adherence.Conclusion: Disease knowledge was adequate in more than half of the participants,and self-care adherence was good. This study has shown a relationship betweendisease knowledge and self-care adherence, which means that a high level of HFknowledge was associated with improved self-care adherence.

EVALUATION OF RENAL DYSFUNCTION IN PATIENTS OF HEART FAILURE WITH OR WITHOUT THYROID DYSFUNCTION AND ITS PROGNOSTIC ROLE IN TERMS OF HOSPITAL STAY

Aim – To study renal dysfunction in patients of heart failure with or without thyroid dysfunction and assess its prognostic value in terms of hospital stay. A Prospective observational study Material And Methods – was conducted at MLN Medical College, Prayagraj. A total of 185 consecutive adult heart failure patients were enrolled in the study after following inclusion and exclusion criterias. Prevalence of thyroid disorders was 28.6 Result – % (6.5% hyper and 22.2% hypothyroid). Serum urea and creatinine levels of patients with thyroid dysfunction were signicantly higher as compared to those having euthyroid status (p<0.05). Heart failure patients with thyroid dysfunction had a prolonged hospital stay (p<0.05) Conclusion – Heart failure patients with thyroid dysfunction had signicant impairment in renal function tests, i.e. both serum urea and creatinine as compared to those without thyroid dysfunction and also showed a prolonged hospital stay.

A Prognostic Model Based on Clinical Biomarkers for Heart Failure in Adult Patients Following Allogeneic Hematopoietic Stem Cell Transplantation

Heart failure (HF) is an uncommon but serious cardiovascular complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Unfortunately, knowledge about early mortality prognostic factors in patients with HF after allo-HSCT is limited, and an easy-to-use prognostic model is not available. This study aimed to develop and validate a clinical-biomarker prognostic model capable of predicting HF mortality following allo-HSCT that uses a combination of variables readily available in clinical practice. To investigate this issue, we conducted a retrospective analysis at our center with 154 HF patients who underwent allo-HSCT between 2008 and 2021. The patients were separated according to the time of transplantation, with 100 patients composing the derivation cohort and the other 54 patients composing the external validation cohort. We first calculated the univariable association for each variable with 2-month mortality in the derivation cohort. We then included the variables with a P value <.1 in univariate analysis as candidate predictors in the multivariate analysis using a backward stepwise logistic regression model. Variables remaining in the final model were identified as independent prognostic factors. To predict the prognosis of HF, a scoring system was established, and scores were assigned to the prognostic factors based on the regression coefficient. Finally, 4 strongly significant independent prognostic factors for 2-month mortality from HF were identified using multivariable logistic regression methods with stepwise variable selection: pulmonary infection (P=.005), grade III to IV acute graft-versus-host disease (severe aGVHD; P=.033), lactate dehydrogenase (LDH) >426 U/L (P=.049), and brain natriuretic peptide (BNP) >1799 pg/mL (P=.026). A risk grading model termed the BLIPS score (for BNP, LDH, cardiac troponin I, pulmonary infection, and severe aGVHD) was constructed according to the regression coefficients. The validated internal C-statistic was .870 (95% confidence interval [CI], .798 to .942), and the external C-statistic was .882 (95% CI, .791-.973). According to the calibration plots, the model-predicted probability correlated well with the actual observed frequencies. The clinical use of the prognostic model, according to decision curve analysis, could benefit HF patients. The BLIPS model in our study can serve to identify HF patients at higher risk for mortality early, which might aid designing timely targeted therapies and eventually improving patients' survival and prognosis.

Predictions of Adherence to Treatment in Patients Referred to the Heart Failure Clinic of Shahid Rajaee Hospital in Tehran

Background: The objective of this study was to identify the level of treatment adherence and also sought to explore several demographic, clinical, comorbidities, and self-care behavior factors that may affect adherence among patients with heart failure (HF). Materials and Methods: This single-center cross-sectional, questionnaire-based study was conducted on 500 adult HF patients referred to the clinic of Rajaie Cardiovascular, Medical, and Research Center, in Tehran, Iran, from February to July 2022. The level of treatment adherence was assessment through Modanloo’s questionnaire. An unadjusted and adjusted binary logistic regression model was used to check the effect of different factors on the patients’ adherence level. Results: Among 474 responders, 51.7% had “good” adherence to treatment. According to the results, age &gt;54 years (odds ratio [OR]: 0.967, 95% confidence interval [CI]: 0.946–0.988, P = 0.002), mitral valve regurgitation (OR: 0.597, 95% CI: 0.362–0.982, P = 0.042) and HF duration (OR: 0.486, 95% CI: 0.274–0.862, P = 0.014) were found as independent variables associated with “poor” treatment adherence. However, higher educational level (OR: 3.313, 95% CI: 2.632–4.067, P &lt; 0.001), New York Heart Association class I (OR: 3.231, 95% CI: 1.587–4.661, P = 0.002), ejection fraction (EF) &gt;40% (OR: 1.023, 95% CI: 1.005–1.041, P = 0.013), HF with preserved EF (OR: 2.728, 95% CI: 1.387–5.365, P = 0.004), familiar with social media (OR: 3.792, 95% CI: 1.777–4.268, P &lt; 0.001) and high awareness of HF (OR: 2.385, 95% CI: 1.072–3.044, P = 0.006) were significant positive predictors for good adherence to treatment. Conclusion: Adherence to the treatment regimen has improved compared to previous studies, but is still suboptimal, particularly with respect to awareness of HF. Therefore, improving the awareness of patients as well as encouraging and supporting them for self-care behaviors can have a positive effect on treatment adherence.

Adherence to Self-Care Recommendations and Associated Factors among Adult Heart Failure Patients in West Gojjam Zone Public Hospitals, Northwest Ethiopia.

Self-care practices are an important part of heart failure patient management and essential to control symptoms of the disease and its exacerbation. However, poor adherence to these self-care behaviors could be associated with an increase in hospitalization, morbidity, and mortality. Even if it is an important part of management for heart failure patients, yet information is not adequate in the study area about adherence to self-care recommendations and associated factors among heart failure patients. To assess self-care recommendation adherence and associated factors among heart failure patients in West Gojjam Zone public hospitals. Institutional-based cross-sectional study was conducted on 304 selected heart failure patients attending follow-up at public hospitals in West Gojjam Zone from March 16 to April 16, 2021. Consecutive sampling technique based on patient arrival with proportional allocation to each hospital was employed to select the study participants. Data were collected through face-to-face interview and reviewing patients' medical records. Data were entered into EpiData version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Binary logistic regression model was fitted to assess the association between adherence to self-care recommendations and associated factors. P value < 0.05 with 95% confidence interval (CI) was considered to declare a statistically significant association in multivariable logistic regression. In this study, 304 patients participated with a response rate of 97.4%. Only 32.9% of them had good adherence to self-care recommendations. Having good knowledge on heart failure (adjusted odds ratio (AOR) = 4.6; 95% CI: 1.82, 11.86), no depression (AOR = 6.1; 95% CI: 1.92, 19.37), having strong social support (AOR = 3.57; 95% CI: 1.56-8.33), age 30-49 years (AOR = 3.37; 95% CI: 1.14, 9.89), and college and above level of education (AOR = 6.17; 95% CI: 1.22, 31.25) were factors significantly associated with good adherence to self-care recommendations. This study showed that most of the heart failure patients had poor adherence to self-care recommendations. Policymakers and other stakeholders should develop and implement appropriate strategies to increase patients' adherence level to self-care recommendations by emphasizing on addressing identified factors.

Development and Validation of a Prognostic Model Based on Clinical Biomarkers for Heart Failure in Adult Patients Following Allogeneic Hematopoietic Stem Cell Transplantation

Introduction: Heart failure (HF) is an uncommon but one of the most serious types of cardiovascular complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the prognostic factors of HF after allo-HSCT remain unknown, and there is currently no prognostic model for HF after allo-HSCT. In this study, we investigated the clinical features and prognosis of patients with HF after allo-HSCT. A prognostic model based on clinical biomarkers, which combined variables that are readily available in clinical practice, that is capable of predicting 2-month mortality of HF patients after allo-HSCT was developed and validated. Methods: In our retrospective study, 154 patients with HF after allo-HSCT from 2008 to 2021 were identified. One hundred patients were assigned to the derivation cohort and the remaining 54 patients were assigned to the external validation cohort according to the time of transplantation. We first calculated the univariable association of each variable with 2-month mortality in the derivation cohort. Second, the variables with p values less than 0.1 in the univariate analysis were further included as candidate predictors in the multivariate analysis using a backward stepwise logistic regression model. The variables that remained in the final model based on the outcomes of the multivariate analysis in the derivation cohort were identified as independent prognostic factors. A scoring system to predict the prognosis of HF after allo-HSCT was also established, and scores were assigned to the prognostic factors based on the regression coefficient. Results: Using multivariable logistic regression methods with stepwise variable selection, four highly significant independent prognostic factors for the two-month mortality of HF were identified: pulmonary infection (p=0.005; odds ratio [OR], 6.89; 95% confidence interval [CI], 1.93-29.13), Grades III to IV acute graft-versus-host disease (severe aGVHD) (p=0.033; odds ratio [OR], 3.62; 95% confidence interval [CI], 1.15-12.69), lactate dehydrogenase (LDH)>426 U/L (p=0.049; odds ratio [OR], 3.02; 95% confidence interval [CI], 1.00-9.32) and brain natriuretic peptide (BNP)>1799 pg/ml (p=0.026; odds ratio [OR], 3.44; 95% confidence interval [CI], 1.16-10.56). We also included cardiac troponin I (cTNI) (p=0.069; odds ratio [OR], 2.93, 95% confidence interval [CI], 0.94-29.13) in our final 5-predictor prognostic model. A risk grading model termed the BLIPS score (BNP, LDH, cardiac troponin I, pulmonary infection, severe aGVHD) was constructed according to the regression coefficients. BNP level>1799 pg/mL, LDH level>426 U/L, cTNI level>100 pg/ml, and severe aGVHD were each assigned one point, and pulmonary infection was assigned two points. The points scored for each of these five factors were added to yield the overall risk score, which ranged from zero to six. Patients were stratified into a low-risk group (0-2 points), an intermediate-risk group (3-4 points) and a high-risk group (5-6 points). The validated internal c-statistic was 0.870 (95% CI, 0.798-0.942), and the external c-statistic was 0.882 (95% CI, 0.791-0.973). According to the calibration plots, the model-predicted probabilities showed a good correlation with the actual observed frequencies. Decision curve analysis indicated that the clinical implementation of the prognostic model could benefit HF patients. The Kaplan‒Meier estimations of overall survival revealed good separation between these risk groups. We generated a risk heatmap for the BLIPS model to visualize the risk estimates derived from the individual prognostic factor profile. Conclusions: Patients who develop HF after allo-HSCT have a poor prognosis. An integrated prognostic model based on clinical biomarkers (BLIPS) was developed and externally validated, and this is the first straightforward scoring model that incorporates clinical and laboratory risk factors to evaluate the 2-month mortality of patients with HF after receiving allo-HSCT to treat hematological malignancies. This model can be effectively utilized to help improve the survival and prognosis of HF patients by accelerating the early identification of patients at a high risk of mortality and contributing to the appropriate implementation of urgent medical support. Disclosures: No relevant conflicts of interest to declare.

Effects of sacubitril valsartan on renal function in adults with heart failure: a systematic review and meta analysis of randomised controlled trials

Abstract Background Sacubitril/valsartan (S/V) may have beneficial effects on renal outcomes in patients with heart failure (HF) receiving angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Purpose To systematically evaluate the effects of sacubitril/valsartan on renal function in adults with HF. Methods Five databases were searched for randomised controlled trials (RCTs) comparing S/V (LCZ696) vs. ACEI or ARB in adult HF patients until January 2022. Doubling serum creatinine levels was the primary outcome. Acute kidney injury (AKI)&amp;gt;50% decline of estimated glomerular filtration rate (eGFR), and hyperkalaemia (serum K+ &amp;gt;5.5 mmol/L) were secondary outcomes. Inverse variance random-effects meta-analyses were used, and effects of S/V on outcomes were described with relative risks (RR) and their 95% confidence intervals (CI). Subgroup analyses by type of HF (chronic vs. acute), and LVEF (&amp;lt;40% vs &amp;gt;40%) were performed. We used the RoB 2.0 tool for risk of bias assessments of RCTs. GRADE methods were used to rate the certainty of evidence (CoE). Results Eight RCTs (n=15859) were included; four in chronic HF and four in acute HF. Mean age was 66.2 (SD 5.5) years-old, and 34.1% were female. The median follow-up across RCTs was 36 weeks. In comparison to ACEI/ARB, S/V was associated with lower risk of doubling serum creatinine (RR 0.77; 95% CI 0.72–0.83; I2=0%; moderate CoE). S/V did not reduce the risk of AKI (RR 0.88; 95% CI 0.72–1.08; I2=0%; low CoE), &amp;gt;50% decline of eGFR (RR 0.65; 95% CI 0.37–1.17; I2=45%; very low CoE), and hyperkalaemia (RR 1.01; 95% CI 0.81–1.25; I2=44%; very low CoE). Two RCTs had high risk of bias and two had some concerns of bias. Subgroup analyses were consistent with main analyses for the primary outcome. Conclusions In adults with heart failure, S/V reduced doubling creatinine compared to ACEI/ARB, but did not reduce risks of AKI, &amp;gt;50% decline in eGFR or hyperkalaemia. Subgroup analyses by type of HF and LVEF were consistent with main analyses. Funding Acknowledgement Type of funding sources: None.

S178 A Systematic Review of the Gut Microbiota Profile in Patients With Heart Failure

Introduction: The “gut-heart axis” could explain the role of the human gut microbiota in the pathogenesis of heart failure (HF) by activation of host inflammation induced by a state of gut dysbiosis. This systematic review characterized the gut microbiota profile in HF patients compared to healthy subjects. Methods: Peer-reviewed human studies published in Ovid MEDLINE, Ovid EMBASE, SCOPUS, and the Cochrane Library up to April 18, 2022, were searched. Studies comparing the gut microbiota profile in adult HF patients and healthy controls (HCs) were eligible for inclusion. The alpha diversity (microbial richness and diversity), beta diversity (dissimilarity in microbiota composition between two groups), and the relative abundance of gut microbiota taxa were compared in adult HF patients and HCs. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of included studies. Results: A total of nine studies, including 317 HF patients and 510 HCs, were included in this systematic review. Decreased gut microbiota richness and similar microbial diversity and significantly different gut microbiota composition were observed between HF patients and HCs. HF patients had a greater abundance of Actinobacteria, Proteobacteria, and Synergistetes phyla; Enterococcus, Escherichia, Klebsiella, Lactobacillus, Ruminococcus, Streptococcus, and Veilonella genera; and Ruminococcus gnavus, Streptococcus sp., and Veilonella sp. Species compared to HCs. Decreased abundance of Firmicutes phylum; Blautia, Eubacterium, Faecalibacterium, Lachnospiraceae FCS020, and Sutterella genera; and Dorea longicatena, Eubacterium rectale, Faecalibacterium prausnitzii, Oscillibacter sp., and Sutterella wadsworthensis species were noted in HF patients. Conclusion: The gut microbiota diversity, richness, and composition in HF patients are significantly different from HCs. Overall, short-chain fatty acids-producing gut microbiota was depleted in HF patients.

Adherence to Self-Care Behaviors and Associated Factors among Adult Heart Failure Patients Attending Chronic Follow-Up Care at Jimma University Medical Center, Southwest Ethiopia

Background: Optimal outcomes and quality of life in patients with heart failure (HF) depend on effective self-care activities. However, patients may experience difficulties, and their performance may be inconsistent. Aim: To determine the level of adherence to self-care behaviors and associated factors among adult HF patients attending chronic follow-up care at Jimma University Medical Center (JUMC). Methods: A cross-sectional study was conducted between August and September 2021. Data were collected through face-to-face interviews and by reviewing patients’ medical records. The collected data were analyzed using SPSS version 25 and the findings were presented in frequency, percentage, mean (SD), and median (IQR). Multivariate logistic regression was performed to determine factors associated with adherence to self-care behaviors. Odds ratios with 95% confidence intervals and p-values were used to report the findings. Results: Out of 266 HF patients, 50.0% had good adherence towards self-care behavior recommendations. The highest following recommendation was taking medication as prescribed (75.5%), followed by a dietary recommendation of a low-salt diet (45.2%). Participants who could not read and write (adjusted odds ratio (AOR) = 0.30 (95% confidence interval (CI) 0.13, 0.71), P = 0.006), had an illness duration greater than or equal to ten years (AOR = 0.31 (95% CI 0.12, 0.82), P = 0.02), in the NYHA class II HF (AOR = 0.33 (95% CI 0.15, 0.73), P = 0.007) were negatively associated with good adherence to self-care behavior recommendations. Conclusion: In this study, only half of the respondents had good adherence to self-care behaviors. Lower educational level, longer illness duration, and NYHA class II HF were predictors of poor adherence to self-care. Therefore, nurses should devise strategies to counsel or educate the HF patients on self-care practice recommendations, particularly patients with a lower education level and who lived longer with HF.

Better Preparation and Training Determine Home Care Workers' Self-Efficacy in Contributing to Heart Failure Self-Care.

Identify determinants of home care workers' (HCW) self-efficacy in contributing to heart failure (HF) self-care. Secondary analysis of a survey (n = 328) examining characteristics of HCWs caring for adults with HF in New York. Self-efficacy assessed using Caregiver Self-Efficacy in Contributing to Self-Care Scale. Standardized scores range 0-100; ≥ 70 points indicate adequate self-efficacy. Characteristics determined by self-efficacy (low vs. adequate). Prevalence ratios with 95% confidence intervals (PR [95% CI]) were estimated using multivariable Poisson regression with robust standard errors. Home care workers with adequate self-efficacy had at least some prior HF training (55% vs. 17%, p < .001) and greater job satisfaction (90% vs. 77%, p = .003). Significant determinants for adequate self-efficacy were employment length (1.02 [1.00-1.03], p = .027), preparation for caregiving (3.10 [2.42-3.96], p < .001), and HF training (1.48 [1.20-1.84], p < .001). Home care agencies and policy-makers can target caregiving preparation and HF training to improve HCWs' confidence in caring for adult HF patients.

Adherence to self-care recommendations and associated factors among adult heart failure patients in public hospitals, Addis Ababa, Ethiopia, 2021: cross-sectional study

BackgroundAdherence to self-care recommendations in heart failure (HF) patients is essential to improve the patients’ quality of life, prevent hospital admission, and reduce mortality and morbidity. Nevertheless, poor adherence to self-care recommendations remains to be an extensive problem for HF patients. Thus, the aim was to assess adherence to self-care recommendations and associated factors among HF patients in public hospitals, Addis Ababa, Ethiopia, 2021.MethodsAn institutional-based cross-sectional study was conducted among adult HF patients from February 15 to April 15, 2021, in five public hospitals, in Addis Ababa, Ethiopia. A total of 294 adult HF patients completed an interviewer-administered questionnaire in the Amharic language. The Revised HF Compliance Questionnaire was used to measure the adherence to self-care recommendations of HF patients. Data was collected using the Revised HF Compliance Questionnaire, the Japanese heart failure knowledge scale, the multidimensional scale of perceived social support, and the chronic diseases self-efficacy scale. Study participants were selected through a systematic random sampling technique. Data were entered into Epi-info version 7.1 and then exported to SPSS Version 25 for analysis. Descriptive and logistic regression analyses were performed and the statistical significance of associations between the variables was determined using ORs with 95% CI and p-values < 0.05.ResultsAdherence to self-care recommendations among adult HF patients in public hospitals, in Addis Ababa, Ethiopia was 32.70%. Being female (AOR 4.66, 95% CI 1.58–13.67), patients who had high family monthly income (AOR 10.32, 95% CI 2.00–5.13), NYHA class III (AOR: 7.01, 95% CI 2.18–22.57) and class IV (AOR: 6.30, 95% CI 1.01–39.22), who had good self-efficacy (AOR 7.63, 95% CI 2.64–21.97), and who had good knowledge about HF (AOR 3.95, 95% CI 1.56–9.95) were more likely to have good adherence to self-care recommendations, p-value < 0.05.ConclusionThis study revealed that 32.70% of adult HF patients had good adherence to self-care recommendations. Factors associated with adherence to self-care recommendations of adult HF patients are sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF. Therefore, interventions focused on sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF are required to improve adherence to self-care recommendations of adult HF patients.

GAMBARAN ABNORMALITAS ELEKTROKARDIOGRAM PADA PASIEN GAGAL JANTUNG DEWASA DI RSUD DR. M. HAULUSSY KOTA AMBON TAHUN 2019-2021

Heart failure is one of the cardiovascular spectrum and a major cause of morbidity and mortality worldwide. Electrocardiogram (ECG) is a supporting examination in diagnosing heart failure. This study aims to determine the description of ECG abnormalities in adult heart failure patients in RSUD DR. M. Haulussy Ambon City in 2019-2021. This research is a descriptive study with a cross sectional design and 126 samples were selected using a simple random sampling technique. The results showed that the most ECG abnormalities were T inverted 37.3%, pathological Q 31%, prolonged QT interval 25.4%, LVH 23.8%, atrial fibrillation 19.8%, poor R wave 13.5%. , ST depression 12.7%, AV block grade 1 10.3%, ventricular extra systole/premature ventricular contraction 9.5%, ST elevation 8.7%, sinus tachycardia 6.3%, left atrial enlargement 5.6% , sinus bradycardia 4%, complete RBBB 4%, atrial extra systole/premature atrial contraction 3.2, complete LBBB 2.4%, incomplete LBBB 2.4%, AV block grade 2 type 1 1.6%, microvoltage 1, 6%, RVH 0.8%, and supraventricular tachycardy 0.8%.&#x0D;

Performance of a HeartLogicTM Based Care Path in the Management of a Real-World Chronic Heart Failure Population

AimEarly detection of impending fluid retention and timely adjustment of (medical) therapy can prevent heart failure related hospitalizations. The multisensory cardiac implantable electronic device (CIED) based algorithm HeartLogicTM aims to alert in case of impending fluid retention. The aim of the current analysis is to evaluate the performance of the HeartLogicTM guided heart failure care path in a real-world heart failure population and to investigate whether the height of the index and the duration of the alert state are indicative of the degree of fluid retention.MethodsConsecutive adult heart failure patients with a CIED and an activated HeartLogicTM algorithm were eligible for inclusion. Patients were followed up according to the hospital's heart failure care path. The device technician reviewed alerts for a technical CIED checkup. Afterwards, the heart failure nurse contacted the patient to identify impending fluid retention. An alert was either true positive or false positive. Without an alert a patient was true negative or false negative.ResultsAmong 107 patients, [82 male, 70 (IQR 60–77) years, left ventricular ejection fraction 37 ± 11%] 130 HeartLogicTM alerts were available for analysis. Median follow up was 14 months [IQR 8–23]. The sensitivity to detect impending fluid retention was 79%, the specificity 88%. The positive predictive was value 71% and the negative predictive value 91%. The unexplained alert rate was 0.23 alerts/patient year and the false negative rate 0.17 alerts/patient year. True positive alerts [42 days (IQR 28–63)] lasted longer than false positive alerts [28 days (IQR 21–44)], p = 0.02. The maximal HeartLogicTM index was higher in true positive alerts [26 (IQR 21–34)] compared to false positive alerts [19 (IQR 17–24)], p < 0.01. Patients with higher HeartLogicTM indexes required more intense treatment (index height in outpatient setting 25 [IQR 20–32], day clinic treatment 28 [IQR 24–36] and hospitalized patients 45 [IQR 35–58], respectively), p < 0.01.ConclusionThe CIED-based HeartLogicTM algorithm facilitates early detection of impending fluid retention and thereby enables clinical action to prevent this at early stage. The current analysis illustrates that higher and persistent alerts are indicative for true positive alerts and higher index values are indicative for more severe fluid retention.

Healthcare Disparities In Heart Failure Patients And Use Of Sodium Glucose Co-Transport Inhibitors (SGLT2-i)

Introduction Co-existence of heart failure (HF) and diabetes presents myriad of challenges in patientcare which are further complicated by socioeconomic disparities that disproportionately affect patients of color. To understand and address the unique challenges faced by socioeconomically disadvantaged HF-patient population in the Bronx county of New York City, we sought to phenotype the burden of diabetes, and understand any disparities including the use of SGLT2-i. Methods Consecutive adult(18years and older) HF patients [reduced and preserved left-ventricular ejection fraction (LVEF)] seen in the advanced-HF clinics were included in the analysis. Patients were categorized based on race/ethnicity and compared for baseline characteristics and associated outcomes including worsening HF event, all-cause hospitalization in the previous 1-year, and medication adverse-events. Results Of the 1218 HF-patients [n=556 non-Hispanic-Black (nH-Black), n=485 Hispanic, n=177 non-Hispanic-White (nH-White)]; 541(44.4%) had type-2 diabetes-mellitus (44.1% nH-Black, 47.0% Hispanic, 38.4% nH-White, p=0.14). In the HF-DM cohort, substantial proportion (20.9%) had poorly controlled diabetes (HgA1c 9% or higher) that did not vary with race/ethnicity. The median-household-income based on residential address was significantly lower for nH-Black $41,500 (33,490-58,392) and Hispanic $37,804 (29,579-54,278) cohorts compared to nH-White $65,399 (52,091-92,232) cohort. Overall use of SGLT2-i was low (5.7% overall, 0.9% in HF-NoDM and 11.7% HF-DM). On further analysis of HF-DM patients based on SGLT2-i use, patients on SGLT2-i were younger [62(54-69)vs.66(58-75)years], more nH-White (22.2%vs.11.3%); but were also more likely to have HF with reduced ejection fraction (HFrEF)(69.8%vs.54.2%), more poorly controlled DM (31.8%vs.19.5%) and higher median HgA1c levels[7.9(6.9-9.2)vs.7.0(6.3-8.4)%], all p<0.05. Based on race/ethnicity, while the three groups had statistically similar rates of worsening HF events (30.9% nH-Black, 26.0% Hispanic, 24.3% nH-White, p=0.104), the rate of all-cause hospitalization was higher in nH-Black(38.9% nH-Black, 32.2% Hispanic, 31.2% nH-White, p=0.040) . Using logistic-regression model, nH-Black had higher Odds-ratio (OR)=1.46(1.01-2.11), p=0.043 when compared to nH-White for all-cause hospitalization adjusted for age, gender, DM, hypertension, ischemic-cardiomyopathy and LVEF. However, this association was substantially attenuated (p=0.14) when the model was adjusted for median-household-income. Conclusion These findings highlight the complex relationships between income inequality, social determinants of health (including language barriers) and observed racial/ethnic differences in HF and diabetes. Co-existence of heart failure (HF) and diabetes presents myriad of challenges in patientcare which are further complicated by socioeconomic disparities that disproportionately affect patients of color. To understand and address the unique challenges faced by socioeconomically disadvantaged HF-patient population in the Bronx county of New York City, we sought to phenotype the burden of diabetes, and understand any disparities including the use of SGLT2-i. Consecutive adult(18years and older) HF patients [reduced and preserved left-ventricular ejection fraction (LVEF)] seen in the advanced-HF clinics were included in the analysis. Patients were categorized based on race/ethnicity and compared for baseline characteristics and associated outcomes including worsening HF event, all-cause hospitalization in the previous 1-year, and medication adverse-events. Of the 1218 HF-patients [n=556 non-Hispanic-Black (nH-Black), n=485 Hispanic, n=177 non-Hispanic-White (nH-White)]; 541(44.4%) had type-2 diabetes-mellitus (44.1% nH-Black, 47.0% Hispanic, 38.4% nH-White, p=0.14). In the HF-DM cohort, substantial proportion (20.9%) had poorly controlled diabetes (HgA1c 9% or higher) that did not vary with race/ethnicity. The median-household-income based on residential address was significantly lower for nH-Black $41,500 (33,490-58,392) and Hispanic $37,804 (29,579-54,278) cohorts compared to nH-White $65,399 (52,091-92,232) cohort. Overall use of SGLT2-i was low (5.7% overall, 0.9% in HF-NoDM and 11.7% HF-DM). On further analysis of HF-DM patients based on SGLT2-i use, patients on SGLT2-i were younger [62(54-69)vs.66(58-75)years], more nH-White (22.2%vs.11.3%); but were also more likely to have HF with reduced ejection fraction (HFrEF)(69.8%vs.54.2%), more poorly controlled DM (31.8%vs.19.5%) and higher median HgA1c levels[7.9(6.9-9.2)vs.7.0(6.3-8.4)%], all p<0.05. Based on race/ethnicity, while the three groups had statistically similar rates of worsening HF events (30.9% nH-Black, 26.0% Hispanic, 24.3% nH-White, p=0.104), the rate of all-cause hospitalization was higher in nH-Black(38.9% nH-Black, 32.2% Hispanic, 31.2% nH-White, p=0.040) . Using logistic-regression model, nH-Black had higher Odds-ratio (OR)=1.46(1.01-2.11), p=0.043 when compared to nH-White for all-cause hospitalization adjusted for age, gender, DM, hypertension, ischemic-cardiomyopathy and LVEF. However, this association was substantially attenuated (p=0.14) when the model was adjusted for median-household-income. These findings highlight the complex relationships between income inequality, social determinants of health (including language barriers) and observed racial/ethnic differences in HF and diabetes.

Clinically Important Differences Are Useful for Interpreting Patient-Reported Outcomes Measurement Information System (PROMIS) Measures After Left Ventricular Assist Device (LVAD) Implantation: Findings from the Mechanical Circulatory Support: Measures of Adjustment and Quality of Life (MCS A-QOL) Study

<h3>Purpose</h3> Interpreting patient-reported outcomes is enhanced by estimating clinically important differences, i.e., clinically significant score differences likely to have implications for patient treatment or care. <h3>Methods</h3> Adult heart failure patients at 12 U.S. sites enrolled in MCS A-QOL (<i>n</i>=648). Post-LVAD implant they completed 12 PROMIS physical, mental and social health measures. Other measures were: Kansas City Cardiomyopathy Questionnaire (KCCQ-12), EuroQOL (EQ-5D-3L), and NYHA Functional Classification. Clinically important differences were estimated by mean PROMIS score differences between distinct, clinically relevant categories for multiple indicators. Tukey-Kramer method adjusted for multiple comparisons. Cohen's <i>d</i> effect sizes were calculated. Minimally important differences (MIDs) were estimated by significant (adjusted <i>p</i><0.05) differences between adjacent, minimally different categories, e.g., NYHA I vs. II. <h3>Results</h3> Mean age was 58 years and the majority were male (78%), Non-Hispanic White (68%), with dilated cardiomyopathy (55%), long-term implant strategy (57%) and NYHA Class I-II (54%). Large (4-10 points) clinically important differences were detected in nearly all pairwise comparisons for all PROMIS measures (see Table for Fatigue results). MIDs for four PROMIS measures were: Fatigue (3 to 5 points; see Table), Physical Function (2 to 3 points), Ability to Participate in Social Roles and Activities (3 points), and Satisfaction with Social Roles and Activities (3 to 5 points). <h3>Conclusion</h3> Patients with an LVAD, their caregivers and their clinicians should find it useful to be able to interpret the meaning of their PROMIS scores. MIDs are especially useful for power calculations when designing new studies.

Ivabradine Use in a Pediatric Heart Transplant Recipient with Refractory Atrial Tachycardia

<h3>Introduction</h3> Ivabradine, an oral I_f channel antagonist, has been used in pediatric and adult heart failure patients for heart rate control, and in adult heart transplant (HT) recipients with sinus tachycardia secondary to cardiac graft denervation. There are little data describing the use of ivabradine in pediatric HT patients. We describe the use of ivabradine in a pediatric HT recipient with refractory ectopic atrial tachycardia (EAT) causing hemodynamic instability. <h3>Case Report</h3> A 3 year old male underwent HT for restrictive cardiomyopathy. Post-transplant course was complicated by pulmonary hypertensive crisis and cardiac arrest, followed by the development of EAT at a rate of >200 bpm and periods of atrial flutter 2 weeks post-transplant. Steroids were started for suspected clinical rejection, but endomyocardial biopsy was reassuring (ACR grade 1R/1A, pAMR0). Hypotension was noted when EAT rate was >170 bpm. Patient was refractory to esmolol, sotalol, and amiodarone. He underwent EP study with ablation of a posterolateral atrial focus, with recurrence of EAT several hours later. Given ongoing hemodynamic instability with EAT, repeat ablation was performed 1 week later with termination of EAT. However, periodic EAT recurred 3 weeks later and he was again symptomatic with recurrent emesis with rates >170 bpm. Ivabradine 0.05 mg/kg twice daily was initiated. After a single dose, the duration and frequency of EAT periods decreased. Rhythm was mostly sinus (SR) with a rate of 90-100 bpm with premature atrial contractions (PACs), few atrial couplets and blocked PACs. No hypotension, bradycardia, or hemodynamic instability was noted. He was discharged home and dose was up-titrated as an outpatient to 0.2 mg/kg twice daily. Six weeks later, a 72 hour Holter monitor showed predominately SR with short bursts of EAT with variable AV conduction, atrial ectopy overall making up <10% of beats, and rare premature ventricular contractions (PVCs). All subsequent clinic ECGs with follow up to 3 months demonstrated SR. Repeat Holter 3 months after initiation of ivabradine showed SR with rare, isolated PACs and PVCs with no EAT. <h3>Summary</h3> Ivabradine can be considered for EAT treatment in pediatric patients post-HT, with no identified side effects.

Pulmonary artery sensor system pressure monitoring to improve heart failure outcomes (PASSPORT-HF): rationale and design of the PASSPORT-HF multicenter randomized clinical trial

BackgroundRemote monitoring of patients with New York Heart Association (NYHA) functional class III heart failure (HF) using daily transmission of pulmonary artery (PA) pressure values has shown a reduction in HF-related hospitalizations and improved quality of life in patients.ObjectivesPASSPORT-HF is a prospective, randomized, open, multicenter trial evaluating the effects of a hemodynamic-guided, HF nurse-led care approach using the CardioMEMS™ HF-System on clinical end points.Methods and resultsThe PASSPORT-HF trial has been commissioned by the German Federal Joint Committee (G-BA) to ascertain the efficacy of PA pressure-guided remote care in the German health-care system. PASSPORT-HF includes adult HF patients in NYHA functional class III, who experienced an HF-related hospitalization within the last 12 months. Patients with reduced ejection fraction must be on stable guideline-directed pharmacotherapy. Patients will be randomized centrally 1:1 to implantation of a CardioMEMS™ sensor or control. All patients will receive post-discharge support facilitated by trained HF nurses providing structured telephone-based care. The trial will enroll 554 patients at about 50 study sites. The primary end point is a composite of the number of unplanned HF-related rehospitalizations or all-cause death after 12 months of follow-up, and all events will be adjudicated centrally. Secondary end points include device/system-related complications, components of the primary end point, days alive and out of hospital, disease-specific and generic health-related quality of life including their sub-scales, and laboratory parameters of organ damage and disease progression.ConclusionsPASSPORT-HF will define the efficacy of implementing hemodynamic monitoring as a novel disease management tool in routine outpatient care.Trial registrationClinicalTrials.gov; NCT04398654, 13-MAY-2020.Graphical abstract

Abstract 13174: Female Sex is Not Associated With Subsequent Heart Failure in Adult Patients Treated With Anthracyclines

Introduction and Hypothesis: Female sex has long been considered a risk factor for anthracycline-associated cardiotoxicity, based largely on data in childhood cancer survivors. However, preclinical experiments suggest that female sex hormones present in adulthood may protect against doxorubicin cardiotoxicity. We therefore hypothesized that female sex would be associated with a decreased odds of heart failure in adult patients treated with anthracyclines. Methods: We conducted a retrospective cohort study of 871 adult patients (44% women and 56% men) at our medical center with no prior history of heart failure who were treated with anthracyclines for non-hormone-dependent malignancies including lymphoma, leukemia, and sarcoma. Patients who expired during the study period were excluded. The presence or absence of heart failure within five years of initiation of anthracyclines was assessed using ICD-9/10 codes. Logistic regression models were used to assess odds ratios based on self-reported sex and other covariates, adjusting for age. Results: Baseline characteristics were similar in men and women, including age, total cumulative anthracycline dose, and prevalence of cardiovascular comorbidities such as hypertension, diabetes, and coronary artery disease. The odds of heart failure increased modestly with age (OR: 1.02; 95% CI: 1.01 to 1.03, p = 0.001). In an age-adjusted model, female sex was not associated with subsequent heart failure (OR: 1.03, 95% CI 0.72 to 1.47, p = 0.88), including after stratification by age ≤ 50 years or &gt; 50 years as a surrogate for menopausal status. Conclusions: In this retrospective cohort study, female sex was not associated with heart failure in adult patients treated with anthracyclines for non-hormone-dependent tumors. These findings diverge from prior reports suggesting an increased risk of cardiotoxicity in women. Future studies will assess the competing risks of cancer and cardiovascular disease/death in men versus women treated with anthracyclines.