Heart Failure Nurses Research Articles

0404 Heart Failure Nurses’ Perceptions of Cognitive Behavioral Therapy for Insomnia and the Feasibility of Providing it to Patients

Abstract Introduction People with heart failure (HF) often report insomnia. Despite strong evidence to support treatment with Cognitive Behavioral Therapy for Insomnia (CBT-I), few with HF have access to CBT-I programs. Access may be improved if it is offered where HF patients receive their medical care, but little is known about the feasibility of doing so. The purpose of this focus group study was to explore HF Nurses’ perceptions of: the importance of insomnia and the value of CBT-I to their patients; the feasibility of making CBT-I available in clinic settings and its delivery by HF nurses; and preferences for alternative modes of delivery. Methods We used a descriptive qualitative study design. We recruited focus group participants via electronic invitation to members of the American Association of Heart Failure Nurses and through requests to local nurse collaborators to distribute within their networks. We conducted virtual focus groups. After providing a brief description of the components of CBT-I and its efficacy in the HF population, we elicited participant perceptions of the value of providing CBT-I for HF patients in the clinic setting, facilitators and barriers to implementation, and ways to increase access to CBT-I. We audio-recorded the focus group discussions and used a professional transcription service. Two researchers coded the data and performed thematic content analysis. Results We conducted four focus groups with registered nurses and advanced practice nurses employed in HF clinics (N=23). Nurses endorsed the importance of sleep to HF patients, their interest in addressing sleep, perceived benefits of CBT-I, and the need for increased resources to address sleep in the clinic setting. They favored multiple modes of CBT-I delivery extending beyond the clinic. All nurses believed they had a role to play in addressing sleep, but differed in their views about the possibility of becoming CBT-I interventionists and the training and support needed to do so. Conclusion HF nurses recognize the importance of insomnia and support the implementation of CBT-I. Implementation studies are needed to identify effective methods of increasing access to evidence based CBT-I in the HF clinic setting, including appropriate support and training for nurses with interest in CBT-I delivery. Support (if any) R01NR01691

Personalized care of patients with heart failure: are we ready for a REWOLUTION? Insights from two international surveys on healthcare professionals' needs and patients' perceptions.

Guidelines for the management of heart failure (HF) are evolving, and increasing emphasis is placed on patient-centred care. As part of the REWOLUTION HF (REal WOrLd EdUcaTION in HF) programme, we conducted two international surveys aimed at assessing healthcare professionals' (HCPs) educational needs and patients' perspectives on the care of HF. Anonymous online questionnaires co-developed by HF experts and patients assessed HCPs' educational needs (520 respondents, mostly cardiologists, in 67 countries) and patients' perceptions on HF impact and management (98 respondents in 18 countries). Among HCPs, 62.7% prioritized rapid initiation of all guideline-mandated medications over up-titration of some medications, and 87.7% always or frequently discussed treatment goals with patients. There was good agreement between HCPs and patients on key treatment goals, except for a greater emphasis on reducing hospitalizations among HCPs. The most frequently cited barriers to the provision of guideline-recommended pharmacological therapy were treatment side effects/intolerance, complex treatment regimens, low blood pressure, cost/reimbursement issues, and low estimated glomerular filtration rate. Most patients (81.6%) reported no difficulties taking medications as prescribed, although 21.4% felt they were taking too many pills. Patients wanted more information about HF and its consequences, prognosis, and treatments (70.4%, 74.5% and 76.6%, respectively). Cardiologists were the preferred source of information about HF, followed by general practitioners and HF nurses. These surveys provide valuable insights into HCPs' needs about personalized care for patients with HF, as well as patients' perceptions, expectations and preferences. These findings will be helpful to develop patient-centred, needs-driven quality improvement programmes.

Report from the Northern Ireland Heart Failure Nurse Forum's educational meeting

This year, the Northern Ireland Heart Failure Nurse Forum relaunched with the aim of supporting, developing and promoting the essential role of heart failure specialist nurses in Northern Ireland. One of their first priorities was to host an educational meeting for their members, colleagues working in cardiac rehabilitation and cardiology nurses. This report summarises the content of the day, highlighting some topical issues in 2022.

Nurses’ knowledge of heart failure assessment and management: A cross-sectional survey

BackgroundNurses’ knowledge of heart failure (HF) is highly variable, ranging from expert to poor, potentially leading to inadequate self-care. Objectives(1) document the knowledge variation of HF assessment and management among specialist and generalist nurses; (2) determine factors that may be associated with nurses’ knowledge; and (3) describe nurses’ views of knowledge deficits and ways to improve nurses’ knowledge to better meet the needs educational interventions. MethodMembers of the American Association of Heart Failure Nurses and Registered Nurses were invited to participate in a cross-sectional survey. Independent samples t-test, chi-square, and linear regression were used for quantitative analysis. Text analysis was applied to analyze the themes of qualitative comments. ResultsA total of 918 nurses completed the survey. Specialist nurses had higher scores than generalist nurses with statistically significant F-test for diet, fluid, signs/symptoms, medication, and exercise. Both specialist and generalist nurses were least knowledgeable about dry weight, asymptomatic hypotension, and transient dizziness. Being a specialist nurse was associated with higher level of knowledge scores. Years of experience and race were significant factors associated with knowledge scores in generalist nurses. Confidence level and race were significant predictors for specialist nurses. Three themes emerged regarding the cause of nurses’ insufficient knowledge and several approaches were provided. ConclusionsSpecialist nurses are not only knowledgeable, but their knowledge levels are less variable compared to generalist nurses. There is a need to identify additional factors that may potentially influence nurses’ knowledge, contributing to the effectiveness of interventions.

Abstract 12373: Process Evaluation of a Vanguard Phase of a Trial for a Smartphone- App Based Model Of Care

Background: Home-based monitoring and timely intervention of patients with acute coronary syndrome (ACS) and heart failure (HF) can improve patient outcomes. TeleClinical Care (TCC-Cardiac) is a smartphone app-based model of care designed to improve community-based care. We conducted a process evaluation within a multi-centre RCT to elucidate barriers and facilitators to implementation. Methods Patients were enrolled during their hospital stay and provided with an app and Bluetooth observation monitors. Patients were encouraged to engage with the app regularly (i.e. exercise program, record their observations). Data were monitored by a dedicated Remote Monitoring Solution team (RMS), and information was made available to the care team. Interviews were conducted with patients at 6 months, and with 3 RMS members, 2 HF nurses and 1 cardiologist. Results Of the 35 enrolled patients, 27 (77%) had a diagnosis of ACS and 8 (23%) of HF. Patient engagement with the app was good overall, with adherence tailing off over time, demonstrated by median (IQI) patient self-BP recordings of 93.3% (90-100%) at 1-month compared to 70% (43-90%) at 6-months. Older patients had higher levels of adoption (>50%), with a median age amongst high adopters of 67-years (IQI 40-82) compared to 63-years (IQI 50-87) for medium adopters (50-70%) and 44-years (IQI 33-53) amongst low adopters (<50%) (p=0.0184) (Fig 1). Interviews revealed good acceptance of Telehealth and remote monitoring. Higher motivation and health and tech literacy facilitated adherence. 21% of participants meeting inclusion criteria but not enrolled did not possess a smartphone. GPs did not engage. Other health professionals identified the time requirements of supporting less tech-literate patients and responding to alerts as potential barriers to adoption. However, most valued the potential for early detection and prevention of deterioration of this cohort of patients. Conclusion TCC-cardiac was generally considered an acceptable and viable model of care by patients and health professionals. Adherence was best amongst older patients with the highest potential to benefit. Designing strategies to overcome barriers to adherence in younger patients and GPs, combined with adequate tech support is recommended.

HFRenDs: an inaugural conference of heart failure, renal and diabetes specialist nurses

Journal of Kidney CareVol. 7, No. 6 Association of Nephrology NurseshFRenDs: an inaugural conference of heart failure, renal and diabetes specialist nursesMarissa DaintonMarissa DaintonEmail: E-mail Address: [email protected]Education Committee Member, Association of Nephrology Nurses UKSearch for more papers by this authorMarissa DaintonPublished Online:22 Nov 2022https://doi.org/10.12968/jokc.2022.7.6.298AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular disease in chronic kidney disease. Circulation. 2021; 143(11):1157–1172. https://doi.org/10.1161/circulationaha.120.050686 Google ScholarUK Renal Registry. 24th Annual report. 2022. https://ukkidney.org/audit-research/annual-report/24th-annual-report-data-31122020 (accessed 4 October 2022) Google Scholar FiguresReferencesRelatedDetails 2 November 2022Volume 7Issue 6ISSN (print): 2397-9534ISSN (online): 2397-9542 Metrics History Published online 22 November 2022 Published in print 2 November 2022 Information© MA Healthcare LimitedKeywordsheart failurerenaldiabetesspecialist nursesPDF download

Stronger together: heart failure, renal and diabetes

Coming together as a triumvirate of nursing specialties within the cardio-metabolic field, the British Society for Heart Failure Nurse Forum, the Association of Nephrology Nurses and the Diabetes Specialist Nurse Forum UK unanimously agreed that we are ‘stronger together’ and that a combined voice would be of great benefit—both in terms of managing clinical complexity, and in tackling professional issues. This report summarises the inaugural meeting held in July 2022 of the ‘heart failure, renal and diabetes’ group that was duly formed.

Nurse-Provided Lung and Inferior Vena Cava Assessment in Patients With Heart Failure

BackgroundResidual congestion detected using handheld ultrasound may be associated with increased risk of readmission and death after hospitalization for acute decompensated heart failure (ADHF). However, effective application necessitates routine use by nonexperts delivering clinical care. ObjectivesThe objective of this study was to determine the ability of heart failure (HF) nurses to deliver a predischarge lung and inferior vena cava (IVC) assessment (LUICA) to predict 90-day outcomes. MethodsIn this multisite, prospective, observational study, HF nurses scanned 240 patients with ADHF (median age: 77 years; 56% men) using a 9-zone LUICA protocol. Obtained images were reviewed by independent nurses who were blinded to clinical characteristics and outcomes. Based on a B-line cut-off of 10, patients were dichotomized as congested (n = 115) or not congested (n = 125). ResultsCongested patients were more likely to have previous cardiac operations, long-standing HF (>6 months), and renal impairment. At 90 days, HF readmission or mortality occurred in 42 congested patients (37%) compared with 18 noncongested patients (14%). Pulmonary congestion increased at 30-day (OR: 3.86; 95% CI: 1.65-8.99; P < 0.01) and 90-day (OR: 3.42; 95% CI: 1.82-6.4; P < 0.01) HF readmission or mortality risk and 90-day mortality (OR: 5.18; 95% CI: 1.44-18.69; P < 0.01). Pulmonary congestion increased the 90-day odds of HF readmission and/or death by 3.3- to 4.2-fold (P < 0.01), independent of demographics, HF characteristics, comorbidities, and event risk score. Over 90 days, days alive out of hospital were fewer (78.3 ± 21.4 days vs 85.5 ± 12.4 days; P < 0.01) in congested patients. ConclusionsLUICA can be a powerful tool for detection of predischarge residual congestion. HF nurses can obtain images and provide diagnostic reports that are predictive of ADHF outcomes.

How do Heart Failure Caregivers gain information and support for their role? The contribution of specialist nurses.

Abstract Funding Acknowledgements Type of funding sources: None. Background Current evidence shows caregivers of people with Heart Failure are susceptible to a deterioration of their own health as a consequence of carrying a high degree of burden as a result of this role (McIlfatrick et al 2018, McHorney et al 2021). This level of burden appears to be a consequence of a limited understanding of heart failure symptoms and complex medication management, further perpetuated by being unsure of where to ask for help (Boyd et al 2004, Exley et al 2005). The empirical evidence further suggests caregivers of people with Heart Failure experience a reduced quality of life, lack understanding of the Heart Failure trajectory (Etemadifar et al 2015, Fitzsimmons et al 2019), do not have adequate support networks (Shahrbabaki et al 2016) and require help and guidance with the care needs of the person with Heart Failure (Tavakoli et al 2018, Hayashi et al 2021). Purpose The aim of this study was to explore the support and information needs of caregivers of people with Heart Failure, in particular to explore the support provided by specialist Heart Failure Nurses. Methods A qualitative interview study was designed following the approach detailed by Brinkmann and Kvale (2015). A thematic analysis of the transcripts was conducted using the Braun and Clark’s Thematic Analysis approach (Braun and Clarke 2012). Coding of the interview transcripts was undertaken by two researchers (HW and SS), agreement reached and subsequent discussion and refinement by the Public/Patient Involvement (PPI) group of two heart failure nurse specialists and an ex-caregiver. Results Thematic analysis identified 4 themes: Taking on the role of caregiver; Getting to grips with being a caregiver; Impact on own health and wellbeing; Need for information and Support. This presentation will focus on the data that was a thread through each of the themes relating to the role of the Heart Failure Specialist Nurse in providing information and support. Whilst the specialist nurse was universally seen as informative and someone who actually valued caregiver input, consultants and general practitioners lacked consistency and failed to include the caregiver. Conclusions Caregivers in this study felt they were lacking information and knowledge about Heart Failure and consequently felt ill-equipped to deliver and manage care. Needs identified within our study reflect earlier work demonstrating the key role played by specialist nurses in supporting and informing caregivers of people with Heart Failure.

Use of metolazone in the community setting for heart failure decompensation: is it worthwhile?

Background/Aims There are more than 900 000 people living with heart failure in the UK. The risk of hospitalisation for heart failure is even higher in patients with underlying chronic kidney disease with diuretic resistance. Prescribers can be apprehensive about prescribing metolazone for use in the community setting because of a perceived risk of renal function deterioration and electrolyte imbalance. This study explores issues around the safety of metolazone use in the community setting, aiming to demonstrate whether this is useful for the prevention of hospitalisation. Methods Data were collected retrospectively on patients who had been newly initiated on metolazone by the authors' London-based specialist heart failure service to treat decompensation during the 3-year period from June 2017 to June 2020. The renal function, incidence of hypokalaemia and hospital admissions of included patients (n=23) were analysed. Results Overall, 65% of patients did not require hospitalisation following initiation of metolazone. Most patients did experience a decline in estimated glomerular filtration rate, with an average decline of 21%, although only one patient experienced a severe decline. Of the three patients who experienced hypokalaemia, all were treated with oral potassium and did not require hospitalisation. Conclusions Metolazone requires good support and follow up from heart failure nurses or other heart failure specialists, but can be safe and effective in the community setting. In patients with heart failure and diuretic resistance, the risks of avoiding metolazone may be higher than the risks of administering it.

Quality of work-life among advanced practice nurses who manage care for patients with heart failure: The effect of resilience during the Covid-19 pandemic

Background Clinician burnout, stress and job dissatisfaction among Advance Practice Registered Nurses (APRNS) may have impacted work-related quality of life (WRQoL) during the COVID-19 pandemic. No studies describe burnout and resilience in APRNs who manage care for patients with HF.Objectives Among APRNs who manage care for patients with HF, study aims included: 1) Describe burnout and WRQoL levels; 2) Determine the relationship between burnout and WRQoL; 3) Examine whether resilience moderates the association between WRQoL and burnout.Methods: An online survey of American Association of Heart Failure Nurses and the Heart Failure Society of America APRN members were queried. Inclusion criteria: APRN's who practiced in ambulatory or inpatient cardiology settings at least 8 h weekly. Outcomes measured: Burnout, WRQoL, and resilience.Results Participants’ (N = 101) mean age was 50 (±10) years and 93% identified as female. APRNs worked more than 42 h weekly and reported moderate levels of resilience, high levels of personal (M = 51.7, norm-referenced mean: 35.9) and work-related burnout (M = 50.1, norm-referenced mean: 33.0). Correlations between high levels of burnout and low WRQoL (r range: -0.74 — -0.39 -, p<.001) were found. Burnout moderated the relationships among resilience and WRQoL.Conclusion APRNs had high levels of burnout during the COVID-19 pandemic. Patient-related burnout was not high. Level of burnout influenced the relationships among resilience and WRQoL suggesting that burnout is from workplace and personal sources, and that level of resilience could not overcome the effect of burnout. Interventions are needed regarding systems changes to uplift and support our workforce.

Developing a core outcome set for patient-reported symptom monitoring to reduce hospital admissions for patients with heart failure.

In patients with heart failure (HF), hospitalization rates are increasing, particularly for non-HF causes and over half may be avoidable. Self-monitoring of symptoms plays a key part in the early identification of deterioration. Our objective was to develop expert consensus for a core outcome set (COS) of symptoms to be monitored by patients, using validated single-item patient-reported outcome measures (PROMs), focused on the key priority of reducing admissions in HF. A rigorous COS development process incorporating systematic review, modified e-Delphi and nominal group technique (NGT) methods. Participants included 24 HF patients, 4 carers, 29 HF nurses, and 9 doctors. In three Delphi and NGT rounds, participants rated potential outcomes on their importance before a HF or a non-HF admission using a 5-point Likert scale. Opinion change between rounds was assessed and a two-thirds threshold was used for outcome selection.Item generation using systematic review identified 100 validated single-item PROMs covering 34 symptoms or signs, relevant to admission for people with HF. De-duplication and formal consensus processes, resulted in a COS comprising eight symptoms and signs; shortness of breath, arm or leg swelling, abdomen bloating, palpitations, weight gain, chest pain, anxiety, and overall health. In the NGT, a numerical rating scale was selected as the optimal approach to symptom monitoring. Recognition of a range of HF-specific and general symptoms, alongside comorbidities, is an important consideration for admission prevention. Further work is needed to validate and integrate the COS in routine care with the aim of facilitating faster identification of clinical deterioration.

Quality Of Work-Life Among Advanced Practice Nurses Who Care For Patients With Heart Failure: The Effect Of Resilience During The Covid-19 Pandemic

IntroductionHeart failure (HF) prevalence continues to rise while therapeutic options expand in complexity. Advanced Practice Registered Nurses (APRNs; Nurse Practitioners & Clinical Nurse Specialists) manage high burden, complex care of patients with HF. During the COVID-19 pandemic, clinician burnout, stress and job dissatisfaction have likely impacted quality of life (WR-QoL). No studies describe burnout and resilience in APRNs who provide care to individuals with HF.AimsAmong APRNs who work with patients with HF, three aims include: 1) Describe the level of burnout and WR-QoL; 2) Determine the relationship between burnout and QOWL variables; 3) Examine whether resilience moderates the association between WR-QoL and burnout.MethodsThis descriptive correlational study employed an online survey in October, 2020 to APRNs who were members of the American Association of Heart Failure Nurses and the HFSA. Inclusion criteria: APRN's who practiced in cardiology clinics, advanced HF clinics, inpatient cardiology units, or HF home care programs, at least 8 hours weekly. Exclusion criteria: Exclusively pediatric, administrative, educational, or research-focused APRNs. Outcomes measured: Burnout (Copenhagen Burnout Inventory), WR-QoL (Work-Related QoL Scale), and Resilience (Brief Resilience Scale). Institutional review board approval and written consents were obtained.ResultsParticipant (N=101) mean age was 50 (±10) years, 93% identified as female, 96% White, and 70% were master's prepared. Mean weekly worked hours were more than 42 and the majority of APRNs (n=75) represented community and academic health centers. APRNs reported high levels of personal (M= 51.7, norm-referenced mean: 35.9) and work-related burnout (M=50.1, norm-referenced mean: 33.0) with significant correlations between high levels of burnout and low WR-QoL (r range: -.74 — -.39 -, p<.001). APRNs who reported medium or high resilience showed negative relationships between burnout and general well-being (r = -.64, -.76, respectively, p<.001), while the low resilience group showed no relationship. Additionally, APRNs who reported no/low or work-related burnout showed a positive relationship between resilience and general well-being (r = .57, p<.001), while the moderate and severe burnout groups did not.ConclusionWe found that the positive effect of resilience on general well-being decreased as work-related burnout went up, indicating the moderating role of work-related burnout. The unanticipated finding that the negative burnout-QOWL relationship was stronger with higher resilience requires more exploration. It is especially critical now, given the emphasis on supporting clinician well-being and preventing burnout, for us to better understand the role of resilience and burnout in well-being.

Sleeve Gastrectomy Reduces BMI and Pill Count in Patients With LVAD.

Sleeve Gastrectomy Reduces BMI and Pill Count in Patients With LVAD.

Perceptions of changes in practice patterns and patient care among heart failure nurses during the COVID-19 pandemic

BackgroundThe Coronavirus (COVID-19) had a profound impact on the delivery of care in both hospital and outpatient settings across the United States. Patients with heart failure (HF) and healthcare providers had to abruptly adapt. ObjectiveTo describe how the COVID-19 pandemic affected practice patterns of HF nurses. MethodsPracticing HF nurses completed a cross-sectional, anonymous, web-based survey of perceptions of HF practice. Analyses involved descriptive and comparative statistics. ResultsOf 171 nurses who completed surveys, outpatient HF visits decreased and 63.2% added telehealth visits. Despite spending about 29 min educating patients during visits, 27.5% of nurses perceived that the pandemic decreased patients’ abilities to provide optimal self-care. Nurses reported decreased ability to collect objective data (62.4%; n = 78), although subjective assessment stayed the same (41.6%; n = 52). ConclusionNurses’ practice patterns provided insight into patient care changes made during COVID-19. Most core components of HF management were retained, but methods of delivery during the pandemic differed.

Introduction of specialized heart failure nurses in primary care and its impact on readmissions.

Heart failure (HF) has a 2% prevalence in the population and is a major cause of morbidity and mortality. Multiple efforts have been made worldwide to improve quality of care and decrease unplanned readmissions for HF patients, one of which has been the introduction of specialist HF nurses (HFN) in primary health care. The present evidence on the benefits of HFN is contradicting. This study aims to evaluate the impact of a quality improvement intervention, availability of a HFN in Swedish primary care, on hospital readmissions. All patients over the age of 65 with a HF diagnosis and with complete information on availability of a HFN were included in this retrospective register-based study. Using propensity score matching (PSM) techniques, two comparable groups of 128 patients each were created according to the exposure status, availability or no availability of a HFN. The rate of readmission was compared between the groups. Using PSM, 256 patients were matched, 128 in the HFN group and 128 in the no-HFN group. A total of 50% and 46.09% of patients in the HFN and no-HFN groups were readmitted, respectively. Mean number of readmissions per patient was 1.19 (SD 0.61) in the HFN group and 1.10 (SD 0.44) in the no-HFN group. Patients in the HFN had 17.6% higher odds of being readmitted during the study period, OR: 1.176 (CI: 0.716-1.932), and 3.8% lower odds of being readmitted within 30 days, OR: 0.962 (CI: 0.528-1.750). Availability of a HFN in primary care was not significantly associated with reduced readmissions for the patients included in this study. Further investigations are warranted looking at the impacts of availability and access to a HFN in primary care on readmissions and other patient outcomes.

A novel heart failure care pathway developed during the pandemic.

Mark Green, Heart Failure Nurse Specialist, Portsmouth Hospitals University NHS Trust (Mark.Green@porthosp.nhs.uk) was runner up in the Cardiovascular Nurse of the Year category of the BJN Awards 2021.

Efficacy and feasibility of heart failure nurses to deliver a lungs and inferior vena cava ultrasound assessment (LUICA) protocol and prediction of outcomes

Abstract Background/Introduction Congestion is the main cause for hospital admission and readmission in heart failure (HF), with almost half being discharged with symptoms that suggest residual congestion. Novel non-invasive assessments (eg. lung ultrasound; [LUS], and Inferior Vena Cava [IVC]) may be used to assess congestion. A LUs and IvC Assessment (LUICA) delivered by HF nurses before discharge, could detect residual congestion, optimise diuresis and guide post discharge treatment. Purpose To determine the ability of HF nurses to successfully learn a LUICA protocol, obtain interpretable images, provide diagnostic reports and predict outcomes. Methods A teaching program focused on quantification of congestion by counting B-lines and reporting estimated right atrial pressure (e-RAP) from IVC congestion. LUICA readings were dichotomised based on lung congestion (≥10 vs &amp;lt;10 B-lines), the presence of lung pathology (consolidation, atelectasis, effusion) and IVC congestion (e-RAP &amp;gt;3mmHg vs 3mmHg). LUICA (8 lung zones + 2 IVC zones) was added to pre-discharge review (4 days post-admission) by HF nurses in 108 hospitalised pts (72±13 years; 58% male) with acute HF, fluid overload, and a variety of lung pathology. Images were assessed for quality (good, usable, measurable or not measurable) and interpreted by a LUICA expert and HF nurses, blinded to admission diagnosis. The predictive value of LUICA readings for patient outcomes (readmission or mortality) was expressed as risk ratio. Results The quality at the majority of the images was assessed as good or usable (expert: 82/107, nurses: 66/107, p=0.02). Readmission was predicted by both experts and nurses (picture 1). Conclusions HF nurses can be adequately trained in a 10 Zone LUICA and successfully obtain interpretable images. The predictive power of their interpretation is similar to experts. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The University of MelbourneBaker Heart &amp; Diabetes Institute Readmission risk ratio based on LUICA

A PERIOPERATIVE MULTI-DISCIPLINARY TEAM EFFORT IN IMPROVING HEART AND MULTIORGAN TRANSPLANT SURVIVAL WHEN COMPARED TO THE NATIONAL STANDARDS

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Coordinated patient-centered care is a focus of quality measures and is associated with improved patient outcomes. A structured multidisciplinary curriculum may include morning rounds, comprehensive workflows, and follow-up care. The extent to which these protocols are implemented varies across healthcare setups. Here, we summarize how a tertiary care center’s perioperative multi-disciplinary approach improved outcomes in organ transplant patients, which are one of the most challenging surgical cohorts of patients in the field of medicine. METHODS: This study was conducted in a tertiary care academic medical center. Permission was obtained from the System Quality & Patient Safety and Quality Operations departments for the use of data. A multidisciplinary approach was used, and several interventions were planned and implemented. The Policy and Procedure manual was reviewed and updated. A multi-disciplinary team comprising surgeons, intensivists, heart failure group, nurses, and respiratory therapists was constituted. Detailed workflows with pre-operative, intraoperative, and post-operative care were established. Fast track extubation and early mobilization protocols were set in place. Early morning rounds with nurses, the heart failure team, attending physicians, pharmacists, and cardiac rehabilitation technicians were conducted to discuss the status and mobilization plan for each patient. RESULTS: 1-year patient survival for heart transplants was 93.44% when compared to the national benchmark of 91.67%. 1-year primary VAD implant survival was at 96.8% when compared to national survival of 84.6%. The recent Scientific Registry of Transplant Recipients (SRTR) report demonstrated that the survival trend at our center improved further for multi-organ transplants. 5 heart-lung transplants had a 100% survival when compared to 83% national survival. 19 heart-kidney had 95% survival when compared to 88% national survival. 100% survival was noticed amongst 15 heart-liver transplants when compared to the 88% national benchmark. CONCLUSIONS: Our results highlight the invaluable role of a patient-centered interprofessional team in improving patient outcomes. Transplant patients have time-sensitive needs. A proactive multimodal approach can facilitate early detection and optimal management of complications and therefore speed up the recovery process in post-surgical patients. CLINICAL IMPLICATIONS: A perioperative multidisciplinary team approach can improve patient morbidity and mortality in complex organ transplant patients. This approach can be augmented by implementing standardized protocols to maintain adequate patient care thereby decreasing the length of hospital stay and healthcare costs. While the multidisciplinary rounds are becoming a common practice, not all institutions have processes and procedures in place to help maintain continued care after surgery. DISCLOSURES: No relevant relationships by Sahar Fatima, source=Web Response No relevant relationships by Gaurav Gheewala, source=Web Response No relevant relationships by FAISAL MASUD, source=Web Response No relevant relationships by Ariba Naz, source=Web Response No relevant relationships by Iqbal Ratnani, source=Web Response

ENHANCED REMOTE MONITORING FOR HEART FAILURE PATIENTS: DOES THE HEARTLOGIC ALGORITHM AUGMENT OUR TELEMONITORING PLATFORM

BACKGROUND Remote monitoring programs for heart failure (HF) patients have been designed to identify changes in clinical status and notify clinicians of patient-reported symptoms to detect impending decompensation with a view to intervening before hospitalization is required. A nurse-led, mobile app-based system, Medly, has shown improvement in quality of life (QoL), reduction in HF-related length of stay and biomarkers (Ware et al, 2020). This platform has been routinely used at our institution since 2016 as the local standard of care for remote monitoring. In the MultiSENSE study, implantable electronic devices (Boston Scientific) with special physiological sensors that generated a HeartLogic™ index predicted impending HF decompensation days to weeks before changes occur to weight or clinical symptoms (Boehmer et al 2017). Herein we describe our initial experience using data from HeartLogic™-enabled devices in the addition to our remote monitoring platform. METHODS AND RESULTS In a large HF Clinic based at a quaternary academic cardiac center in Toronto, Ontario, between July 2020 and May 2021, patients monitored remotely through Medly were screened for HeartLogic™ enabled ICD or CRT. They were approached to consent to enhanced monitoring by activating the device sensor and provided with a remote communicator for daily transmissions. They were encouraged to continue to use Medly as usual. A multidisciplinary group: HF Cardiologist, Electrophysiologist, HF Nurse Practitioner, and Medly Nurse met at weekly intervals to review remote monitoring data from Medly and implanted devices. Abnormal findings were shared with the patient's Cardiologist prior to making recommendations on the patient's further management. Results: Twenty-eight patients were enrolled from August 2020 onwards. Of the 28, 11 lived over one hour's distance away from the clinic, 5 ∼1 hour away, the rest lived less than 1 hour away. The median length of monitoring time was 3.25 months. There were 368 Medly alerts and 12 HeartLogic™ alerts, 11 of these alerts were congruent with Medly, one was not but was still clinically relevant. There were 10 therapeutic interventions after review of the HeartLogic™ alerts primarily involving medication adjustments. There were 5 hospitalizations in this cohort, none for HF. CONCLUSION The use of implantable technologies with physiological sensors is feasible and can complement existing remote monitoring programs. The combination of data, physiologic and patient-reported and multi-disciplinary review can facilitate providing more equitable HF care across the province particularly to those living in remote settings. Remote monitoring programs for heart failure (HF) patients have been designed to identify changes in clinical status and notify clinicians of patient-reported symptoms to detect impending decompensation with a view to intervening before hospitalization is required. A nurse-led, mobile app-based system, Medly, has shown improvement in quality of life (QoL), reduction in HF-related length of stay and biomarkers (Ware et al, 2020). This platform has been routinely used at our institution since 2016 as the local standard of care for remote monitoring. In the MultiSENSE study, implantable electronic devices (Boston Scientific) with special physiological sensors that generated a HeartLogic™ index predicted impending HF decompensation days to weeks before changes occur to weight or clinical symptoms (Boehmer et al 2017). Herein we describe our initial experience using data from HeartLogic™-enabled devices in the addition to our remote monitoring platform. In a large HF Clinic based at a quaternary academic cardiac center in Toronto, Ontario, between July 2020 and May 2021, patients monitored remotely through Medly were screened for HeartLogic™ enabled ICD or CRT. They were approached to consent to enhanced monitoring by activating the device sensor and provided with a remote communicator for daily transmissions. They were encouraged to continue to use Medly as usual. A multidisciplinary group: HF Cardiologist, Electrophysiologist, HF Nurse Practitioner, and Medly Nurse met at weekly intervals to review remote monitoring data from Medly and implanted devices. Abnormal findings were shared with the patient's Cardiologist prior to making recommendations on the patient's further management. Results: Twenty-eight patients were enrolled from August 2020 onwards. Of the 28, 11 lived over one hour's distance away from the clinic, 5 ∼1 hour away, the rest lived less than 1 hour away. The median length of monitoring time was 3.25 months. There were 368 Medly alerts and 12 HeartLogic™ alerts, 11 of these alerts were congruent with Medly, one was not but was still clinically relevant. There were 10 therapeutic interventions after review of the HeartLogic™ alerts primarily involving medication adjustments. There were 5 hospitalizations in this cohort, none for HF. The use of implantable technologies with physiological sensors is feasible and can complement existing remote monitoring programs. The combination of data, physiologic and patient-reported and multi-disciplinary review can facilitate providing more equitable HF care across the province particularly to those living in remote settings.