Quality Of Life In Heart Failure Research Articles

Sacubitril/valsartan for the treatment of non-obstructive hypertrophic cardiomyopathy: An open label randomized controlled trial (SILICOFCM).

Sacubitril/valsartan treatment reduces mortality and hospitalizations in heart failure with reduced ejection fraction but has limited application in hypertrophic cardiomyopathy (HCM). The aim of this study was to evaluate the effect of sacubitril/valsartan on peak oxygen consumption (VO2) in patients with non-obstructive HCM. This is a phase II, randomized, open-label multicentre study that enrolled adult patients with symptomatic non-obstructive HCM (New York Heart Association class I-III) who were randomly assigned (2:1) to receive sacubitril/valsartan (target dose 97/103 mg) or control for 16 weeks. The primary endpoint was a change in peak VO2. Secondary endpoints included echocardiographic measures of cardiac structure and function, natriuretic peptides and other cardiac biomarkers, and Minnesota Living with Heart Failure quality of life. Between May 2018 and October 2021, 354 patients were screened for eligibility, 115 patients (mean age 58 years, 37% female) met the study inclusion criteria and were randomly assigned to sacubitril/valsartan (n = 79) or control (n = 36). At 16 weeks, there was no significant change in peak VO2 from baseline in the sacubitril/valsartan (15.3 [4.3] vs. 15.9 [4.3] ml/kg/min, p = 0.13) or control group (p = 0.47). No clinically significant changes were found in blood pressure, cardiac structure and function, plasma biomarkers, or quality of life. In patients with HCM, a 16-week treatment with sacubitril/valsartan was well tolerated but had no effect on exercise capacity, cardiac structure, or function.

Sacubitril/valsartan for treatment of symptomatic non-obstructive hypertrophic cardiomyopathy: a randomised, controlled, phase II clinical trial (SILICOFCM)

Abstract Aim To evaluate the effect of sacubitril/valsartan on exercise capacity, cardiac structure, and function in patients with hypertrophic cardiomyopathy (HCM). Methods Phase II, randomised, open-label multicentre study enrolled adult patients with symptomatic non-obstructive HCM (NYHA class I–III) who were randomly assigned (2:1) to receive sacubitril/valsartan (target dose 97/103mg) or usual care for 16 weeks. Primary endpoint was a change in peak oxygen consumption (peak VO2). Secondary endpoints included echocardiography measures of cardiac structure and function, natriuretic peptides and other biomarkers, and Minnesota Living with Heart Failure quality of life (QoL). Results Between May 2018 and November 2021, 354 patients were screened for eligibility, 115 patients (mean age 58 years [SD 11], 37% women) met the study inclusion criteria and were randomly assigned to sacubitril/valsartan (N=79) or usual care (N=36). At 16 weeks, there was no significant change in peak VO2 from baseline in sacubitril/valsartan (15.3 [4.3] vs 15.9 [4.3] ml/kg/min, p=0.13), or usual care group (p=0.47). There was a significant reduction in ventilatory efficiency slope (30.1 [7] vs 28.4 [4.9], p=0.03), but not in the control group (p=0.09). No significant changes were found in systolic or diastolic function, cardiac structure, or plasma biomarkers. The QoL score decreased significantly in the sacubitril/valsartan by 6 points (p=0.005) but not in the usual care group (p=0.66). Conclusion In patients with hypertrophic cardiomyopathy, 16 weeks of treatment with sacubitril/valsartan was well tolerated and contributed to a significant improvement in ventilatory efficiency and quality of life but not in exercise capacity or cardiac function.

Abstract 12756: The Interplay of Self-Care Maintenance, Social Support, Depressive Symptoms and Anxiety in Predicting Quality of Life in Patients With Heart Failure

Introduction: Depressive symptoms, anxiety, and inadequate social support are predictors of quality of life (QOL) in patients with heart failure (HF), but prediction of QOL is multifaceted and mechanisms underlying association are unknown. Essential to better HF outcomes, self-care maintenance (SCM) may moderate associations among these predictors. The interplay among depressive symptoms, anxiety, social support, and SCM and their influence on QOL remains uncertain. Purpose: To determine whether (1) depressive symptoms and anxiety mediate the association of social support with QOL, and (2) SCM moderates the relationship of social support with depressive symptoms, anxiety, and QOL. Methods: We included 167 patients (61 ± 12 years old, 65% male, 47% NYHA III/IV) with HF, who completed the Patient Health Questionnaire-9 to measure depressive symptoms, Brief Symptom Inventory for anxiety, Multidimensional Scale of Perceived Social Support for social support, Self-Care of Heart Failure Index for SCM, and Minnesota Living with Heart Failure Questionnaire for QOL. A moderated mediation model was performed using PROCESS macro. Results: We found an indirect association of social support with QOL, mediated by depressive symptoms and anxiety (Figure). The beneficial impact of social support on depressive symptoms and anxiety varied with SCM, suggesting a dose-response moderation effect, which is attenuated at lower SCM scores (Figure). The indices of moderated mediation via depressive symptoms and anxiety were -.007 (95%CI: -.150, -.002) and -.005 (95%CI: -.010, -.002), respectively. There was no direct nor moderated direct effect. Conclusions: There is a pivotal interplay of SCM, depressive symptoms, anxiety, social support, and QOL in HF. Findings suggest that improvement in depressive symptoms and anxiety may improve QOL in HF. Moreover, good SCM may enhance the positive effect of social support on depressive symptoms and anxiety.

Abstract 12817: The Mediator Role of Physical Function in the Relationship Between Caregiver Contribution to Self-Care and Caregiver Quality of Life in Heart Failure

Introduction: Caregivers of patients with heart failure (HF) commonly show reduced physical function and quality of life (QOL). Caregiver contribution to self-care maintenance (CC-SC maintenance) may result in reduced physical function, and, in turn, poor QOL. However, these relationships have not been tested in caregivers of patients with HF. Aim: To test the mediating role of physical function in the relationship of CC-SC maintenance to caregiver QOL in HF. Hypothesis: Physical function mediates the relationship between CC-SC maintenance and caregiver QOL in caregivers of patients with HF, controlling for covariates (i.e., age, marital status, relationship to patient, comorbidity, depressive symptoms, and caregiver confidence to self-efficacy). Methods: In this cross-sectional, correlational study, data on physical function (Korean Activity Status Index), CC-SC maintenance (Caregiver Contribution to Self-care Maintenance), caregiver confidence to self-care (Caregiver Confidence in Contributing to Self-care Scale), caregiver QOL (EuroQol Quality of Life Scale), depressive symptoms (Patient Health Questionnaire-9), and sociodemographic characteristics (Sociodemographic Questionnaire) were collected from 92 caregivers of patients with HF (mean age = 53.8) from 4 hospitals in South Korea. PROCESS macro for SPSS was used to test the hypothesis. Results: CC-SC maintenance was associated with caregiver QOL indirectly through the effect on physical function. Higher levels of CC-SC maintenance (p = .021) were significantly associated with poorer physical function, and poorer physical function (p < .001), but not CC-SC maintenance (p = .362), was significantly associated with poorer caregiver QOL (F = 7.021, R 2 = .435, p < .001), controlling for the covariates (standardized indirect effect = -.105, bootstrap 95% CI = -.217, -.017). Conclusions: The findings of this study supported the hypothesis. Physical function was a mediator in the relationship between CC-SC maintenance and caregiver QOL, implying that CC-SC maintenance was associated with QOL only indirectly through the effects on physical function. Healthcare providers should consider CC-SC maintenance and physical function of caregivers at the same time to improve their QOL.

The Impact of Ferric Derisomaltose on Cardiovascular and Noncardiovascular Events in Patients With Anemia, Iron Deficiency, and Heart Failure With Reduced Ejection Fraction

BackgroundIn some countries, intravenous ferric derisomaltose (FDI) is only licensed for treating iron deficiency with anemia. Accordingly, we investigated the effects of intravenous FDI in a subgroup of patients with anemia in the IRONMAN (Effectiveness of Intravenous (IV) Iron Treatment Versus Standard Care in Patients With Heart Failure and Iron Deficiency) trial. Method and ResultsIRONMAN enrolled patients with heart failure, a left ventricular ejection fraction of ≤45%, and iron deficiency (ferritin <100 µg/L or transferrin saturation of <20%), 771 (68%) of whom had anemia (hemoglobin <12 g/dL for women and <13 g/dL for men). Patients were randomized, open label, to FDI (n = 397) or usual care (n = 374) and followed for a median of 2.6 years. The primary end point, recurrent hospitalization for heart failure and cardiovascular death, occurred less frequently for those assigned to FDI (rate ratio 0.78, 95% confidence interval 0.61–1.01; P = .063). First event analysis for cardiovascular death or hospitalization for heart failure, less affected by the coronavirus disease 2019 pandemic, gave similar results (hazard ratio 0.77, 95% confidence interval 0.62–0.96; P = .022). Patients randomized to FDI reported a better Minnesota Living with Heart Failure quality of life, for overall (P = .013) and physical domain (P = .00093) scores at 4 months. ConclusionsIn patients with iron deficiency anemia and heart failure with reduced left ventricular ejection fraction, intravenous FDI improves quality of life and may decrease cardiovascular events.

Markers of Iron Metabolism and Outcomes in Patients with Heart Failure: A Systematic Review

Iron deficiency (ID) in conjunction with heart failure (HF) poses a challenge for clinicians and is associated with worse HF outcomes. Treatment of ID with IV iron supplementation for patients with HF has demonstrated benefits in quality of life (QoL) and HF-related hospitalizations. The aim of this systematic review was to summarize the evidence linking iron metabolism biomarkers with outcomes in patients with HF to assist in the optimal use of these biomarkers for patient selection. A systematic review of observational studies in English from 2010 to 2022 was conducted using PubMed, with keywords of "Heart Failure" and respective iron metabolism biomarkers ("Ferritin", "Hepcidin", "TSAT", "Serum Iron", and "Soluble Transferrin Receptor"). Studies pertaining to HF patients, with available quantitative data on serum iron metabolism biomarkers, and report of specific outcomes (mortality, hospitalization rates, functional capacity, QoL, and cardiovascular events) were included, irrespective of left ventricular ejection fraction (LVEF) or other HF characteristics. Clinical trials of iron supplementation and anemia treatment were removed. This systematic review was conducive to formal assessment of risk of bias via Newcastle-Ottawa Scale. Results were synthesized based on their respective adverse outcomes and iron metabolism biomarker(s). Initial and updated searches identified 508 unique titles once duplicates were removed. The final analysis included 26 studies: 58% focused on reduced LVEF; age range was 53-79 years; males composed 41-100% of the reported population. Statistically significant associations of ID were observed with all-cause mortality, HF hospitalization rates, functional capacity, and QoL. Increased risk for cerebrovascular events and acute renal injury have also been reported, but these findings were not consistent. Varying definitions of ID were utilized among the studies; however, most studies employed the current European Society of Cardiology criteria: serum ferritin < 100 ng/mL or the combination of ferritin between 100-299 ng/mL and transferrin saturation (TSAT) < 20%. Despite several iron metabolism biomarkers demonstrating strong association with several outcomes, TSAT better predicted all-cause mortality, as well as long-term risk for HF hospitalizations. Low ferritin was associated with short-term risk for HF hospitalizations, worsening functional capacity, poor QoL, and development of acute renal injury in acute HF. Elevated soluble transferrin receptor (sTfR) levels were associated with worse functional capacity and QoL. Finally, low serum iron was significantly associated with increased risk for cardiovascular events. Considering the lack of consistency among the iron metabolism biomarkers for association with adverse outcomes, it is important to incorporate additional biomarker data, beyond ferritin and TSAT, when assessing for ID in HF patients. These inconsistent associations question how best to define ID to ensure proper treatment. Further research, potentially tailored to specific HF phenotypes, is required to optimize patient selection for iron supplementation therapy and appropriate targets for iron stores replenishment.

The Effects of Post-Acute Care in Patients with Heart Failure in Taiwan: A Single Center Experience.

The National Health Insurance Administration in Taiwan has promoted the heart failure post-acute care (HF-PAC) program as a means to provide proactive integrated care within the optimal treatment timeframe to enhance functional recovery after acute decompensated heart failure (HF). The aim of this program was to reduce HF readmission rates, improved medication prescription rates, and improve the quality of life in HF patients. Patients who had a reduced left ventricular ejection fraction (LVEF) of ≤ 40% were included and followed up for 6 months after discharge. They underwent cardiac rehabilitation and physiological, and nutritional status evaluations. The main clinical outcomes of the HF-PAC program were guideline-directed medical therapy prescription rate and 6-month readmission rate. A total of 122 patients were recruited from June 2018 to December 2020 at a medical center in southern Taiwan. The patients' activities of daily living, nutritional status, quality of life and LVEF were significantly improved during the HF-PAC program. More than 95% of the patients received guideline-directed medical prescriptions at the end of the HF-PAC program. The cardiovascular-related 6-month re-admission rate after the HF-PAC program ended was 27.7%, and it could be predicted by the New York Health Association functional class [hazard ratio (HR) 95% confidence interval (95% CI) = 4.12 (1.36-12.46)], value of the Mini Nutritional Assessment - Short Form [HR (95% CI) = 0.46 (0.31-0.68)] and LVEF [HR (95% CI) = 0.95 (0.91-0.99)]. By incorporating multidisciplinary healthcare teams, the HF-PAC program improves the guideline- directed medical therapy prescription rate, thus improving patients' cardiac function, physical activity recovery, the quality of life, and also reduces their readmission rate.

Smernice za dijagnostiku i tretman srčane insuficijencije - pregled noviteta

Heart failure (HF) is a global health problem nowadays, with a high prevalence and incidence rate, as like as a high mortality rate. Quality of life is also very important for patients and their families, and it is often affected in HF. This article is not only about a definition and different types of HF, it is more about modern diagnostic and therapeutic approaches to HF patients according to the latest ESC guidelines for the diagnosis and treatment of acute and chronic HF. There are many different factors contributing to poor quality of life in HF. The last ESC HF guidelines have recognized the importance of multidiciplinar approach to HF patients, such as treatment of cardiovascular and non-cardiovascular comorbidities.

Effect of coenzyme Q10 on cardiac function and survival in heart failure: an overview of systematic reviews and meta-analyses.

Heart failure (HF) is associated with a deficiency in blood levels of coenzyme Q10 (CoQ10), and its supplementation has been proposed. The aim of this systematic review was to synthesise the available evidence on the effects of CoQ10 on cardiac function and quality of life in HF. A systematic search of Medline, Scopus, Web of Science and the Cochrane Library was conducted from inception until March 2023. Meta-analyses measuring the effect of CoQ10 on cardiac function [i.e., ejection fraction (EF), cardiac output (CO), cardiac index (CI), stroke volume (SV)], quality of life [i.e., mortality, exercise capacity, and New York Heart Association (NYHA) classification], and CoQ10 levels in HF were included. Ten meta-analyses met the inclusion criteria. CoQ10 had an effect on EF in 6 of the 9 studies, with an increase of 1.77% (0.10, 3.44) to 3.81% (1.22, 6.40), while it had an effect on CO, CI and SV in one of the two studies. Moreover, CoQ10 did not improve exercise capacity and only one study showed an effect on NYHA classification, while there was a risk ratio (RR) of 0.69 (0.50, 0.95) to 0.58 (0.35, 0.95) in favour of CoQ10 for mortality and a RR of 0.62 (0.49, 0.78) for hospitalisations. Finally, CoQ10 levels were found to increase by 1.40 μg mL-1 in all studies. CoQ10 showed a possible beneficial effect on heart function, which was associated with a reduction in mortality and hospitalisations. However, more research is needed into the conditions that may optimise CoQ10 therapy.

In patients with chronic heart failure, there have been no gender differences in the impact of self behavior on patient-reported outcomes

Abstract Background Poor self-care behaviour is associated with a higher risk in heart failure (HF). Gender is a determinant of patient-reported outcomes (PROMs) such as health-realted quality of life (QoL) in HF. Female gender is consistently associated with worse QoL. Whether gender may influence the effect of self-care on PROMS is not known. Purpose Describe the effect of self-care on QoL according to gender in a real world cohort of HF patients. Methods 1120 patients with chronic HF were analysed. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care (inverted and standardised: higher scores indicate better self-care). To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). General linear models (GLM) were constructed to explore the interaction between gender and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores. To determine the impact of global self-care and its dimensions, multivariate linear regressions models to predict QoL were constructed stratified according to gender. All models were adjusted by determinants of HF severity. Results Mean age was 72±11 years, 43% were women and mean LVEF was 45±17%. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value&amp;lt;0.0001). Unadjusted MLHFQ scores were consistenly higher in women compared to men (49±23 vs. 43±24; p-value&amp;lt;0.001). In adjusted GLM, female gender (F=4.8; p-value=0.028) and poor global self-care (F=12.6; p-value&amp;lt;0.001) were independent predictors of higher adjusted scores in MLHFQ, indicating worse global QoL. As shown in Figure 1, the interaction term gender by poor self-care was not significantly associated with MLHFQ scores in adjusted GLM (F=0.018; p-value=0.893): the gap between women and men in terms of QoL was observed in both self-care strata and the effect of self care on QoL was observed in both genders. Multivariate linear regresion models (Table 1) stratified according to female gender (panel A) or male gender (panel B) showed that higher scores in the EHFScBS-9 were associated with lower scores in the MLHFQ in women and men. This effect (Table 1) was equally seen in both genders for global QoL and was driven by global self-care, consulting behaviour, and in a lesser extent by autonomy-baseda dherence. The physical dimension of QoL was not affected by self-care in either women or men except for consulting behaviour. Conclusions Self-care is an independent predictor of health-related QoL in HF, regardless of the level of disease severity. Global self-care, autonomy-based adherence and consulting behaviour were particularly associated with global QoL and emotional and social dimensions of QoL in women and men. In both genders, the effect of self-care on QoL was driven by its effect on emotional and social dimensions. Provider-based adherence did not influence QoL. Funding Acknowledgement Type of funding sources: None.

In heart failure, self-care behavior is an independent determinant of health-related quality of life, regardless of the severity of this patients

Abstract Background Poor self-care behaviour is associated with a higher risk of readmission and mortality in patients with heart failure (HF). The interplay between self-care and patient-reported outcomes such as health-related quality of life (QoL) has not been fully established. Purpose To describe the association between self-care and QoL in real-world cohort of HF patients. Methods We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic HF. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care. Scores were inverted and standardized (higher scores indicate better selfcare). To assess QoL, we used the Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). Written informed consent, complete clinical and psychosocial information of patients were obtained at baseline. To determine the impact of global self-care and its dimensions (autonomy-based adherence, consulting behaviour and provider-based adherence), multivariate linear regressions models (backwards stepwise methods) to predict QoL were constructed. The multivariate parametric and non-parametric associations between EHFSCBS-9 scoresand the β estimated risk of impairment of QoL (defined as MLHFQ scores ≥ median values) were explored using General Additive Models (GAM). All models were adjusted by age, sex and prognostic factors such as LVEF, NYHA, NT-proBNP levels and recent hospitalization among other well-known determinants of HF severity. Results A total of 484 patients (43%) were women, mean age was 72±11 years, and mean LVEF was 45±17%. Mean MLHFQ scores were 45±24. Mean EHFSCBS-9 scores were 69±28. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value&amp;lt;0.0001). As shown in Table 1, self-care behaviour and its 3 domains were independent predictors of QoL in 7 out of the 16 associations explored. These models confirmed a weak linear relationship between EHFSCBS-9 scores and MLHFQ scores particularly between global selfcare and consulting behaviour dimension with global, emotional and social dimensions of QoL. Interestingly, when QoL was dichotomized as impaired/preserved QoL, GAM showed a significant non-parametric “U-shape” relationship (p-value&amp;lt;0.05) between EHFScBS-9 scores and the risk of impairment in QoL (Figure 1). Conclusions We have shown that self-care behaviour is an independent predictor of health related QoL in HF regardless the level of disease severity. Global self-care and consulting behaviour were particularly and significantly associated with global QoL and emotional and social dimensions of QoL. Interestingly the relationship between self-care scores and the risk of impaired global QoL was non-linear showing a “U-shape” association pointing out that patients with extreme levels of self-care were more likely to experience impairments in QoL. Funding Acknowledgement Type of funding sources: None.

The impact of self-care behaviour on health-related quality of life across functional dependency phenotipes: insights from a real-world cohort of 1120 patients with chronic heart failure

Abstract Background Poor self-care is associated with higher risk in heart failure (HF). Self-care may influence patient-reported outcomes (PROMs) such as health-realted quality of life (QoL). Functional and instrumental autonomy are determinants of QoL. Literature has shown instrumental and/or functional dependency are associated with worse QoL. Purpose Describe the effect of self-care on QoL across to different levels of dependency and explore the potencial interaction between self-care and autonomy. Methods 1120 patients with chronic HF from DAMOCLES study were analyzed. We used modified European Heart Failure Self-care Behavior Scale 9-item version (EHFSCBS-9) to measure self-care, scores were inverted. To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ). Functional dependency for basic activities of daily living (BADL) was evaluated using Barthel index (BI). Dependency for instrumental activities (IA) was evaluated using Lawton and Brody questionnaire (LBQ). Regarding dependency, patients were grouped in 3 phenotypes: independent (normal BI and LBQ, phenotype 1), dependency for IA (abnormal LBQ, phenotype 2) and dependency for BADL and IA (abnormal BI ± abnormal LBT, phenotype 3). General linear models (GLM) were constructed to explore interaction between dependency phenotypes and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores and to obtain the estimated marginal means of QoL scores across phenotypes and levels of self-care. All models were adjusted by determinants of HF severity. Results Mean age was 72±11 years, 43% were women and mean LVEF was 45±17%. Mean MLHFQ scores were 45±24. Mean EHFSCBS-9 scores were 69±28. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value &amp;lt;0.0001). Unadjusted MLHFQ scores were consistenly higher in the phenotype 3 (51.5±21.3) compared to phenotype 2 (41.8±25.4, p-value&amp;lt;0.001) or phenotype 1 (41.6±25.6, p-value &amp;lt;0.001). In adjusted GLM, poor global self-care (F=15.7; p-value &amp;lt;0.001) was an independent predictor of higher adjusted scores in MLHFQ. Interaction term dependency phenotypes by poor self-care was not significantly associated with MLHFQ scores (F=0.297; p-value = 0.743; Figure 1): the gap in terms of QoL between self-care strata was observed across dependency phenotypes. Estimated adjusted marginal means of MLHFQ scores stratified according to dependency phenotypes and levels of self-care are displayed in Table 1. In phenotypes 2 or 3, MLHFQ scores were lower in patients with preserved self-care. In phenotype 1 differences in QoL across self-care strata were present but not significant. Conclusions Self-care behaviour is an independent predictor of health-related QoL in HF regardless of the level of patient's autonomy. Better self-care was associated with better QoL particularly in patients with dependendecy to IA and/or BADL. Impact of self-care on QoL was attenuated in patients with normal autonomy. Funding Acknowledgement Type of funding sources: None.

Quality of life in patients with heart failure and improved ejection fraction: one year changes and prognostic implication

Abstract Background Inconsistent and controversial results have been reported about the association of quality of life (QoL) and left ventricular ejection fraction (LVEF) in patients with heart failure (HF). The 2021 universal definition of HF specifically describes the criteria for the patients with HF and improved LVEF (HFimpEF): HF with a baseline LVEF ≤40%, a ≥10 point increase from baseline LVEF, and a second measurement of LVEF &amp;gt;40%. Purpose 1) To assess whether patients with HF and reduced LVEF (HFrEF) at first visit in an outpatient HF Clinic that fulfil the HFimpEF criteria one year later presented a higher improvement in QoL assessed by the Minnesota Living With Heart Failure Questionnaire (MLWHFQ) than those patients that did not fulfil HFimpEF criteria. 2) To assess the prognostic role of QoL on outcomes in HFimpEF patients. Methods In a prospective registry of real-life HF outpatients LVEF and QoL evaluated by MLWHFQ were assessed at first visit at the HF Clinic and at one year of follow-up. Results From August 2001 to August 2021, baseline and one year LVEF and MLWFQ scores were available in 1040 patients with an initial LVEF ≤40%. Table 1 shows baseline demographic and clinical characteristics of patients. In summary, mean age was 65.2±11.7 years, 75.9% of the patients were men, the main aetiology was ischaemic heart disease (52.9%) and patients were mostly in New York heart Association (NHYA) class II (71.1%) and III (21.6%). Baseline LVEF was 28.5% ± 7.3 and baseline MLWHFQ score was 30.2±19.5. At one year, mean LVEF increased to 38.0±12.2 while MLWHFQ scores improved to 17.4±16.0. There were 361 patients that fulfilled the HFimpEF criteria (34.7%). These patients significantly and markedly improved both LVEF (from 28.7±6.6 to 50.9±7.6, p&amp;lt;0.001) and QoL (from 32.9±20.6 to 16.9±16.0, p&amp;lt;0.001). Although in patients that did not fulfil the criteria of HFimpEF both LVEF (from 28.4±7.6 to 31.1±7.9, p&amp;lt;0.001) and QoL (from 28.7±18.8 to 17.6±15.9, p&amp;lt;0.001) also significantly improved, the improvement in QoL was significantly higher in HFimpEF patients (−16.0±23.8 vs. −11.1±20.3, p=0.001), taking into account that baseline MLWHFQ score was worse in HFimpEF patients (p=0.001). However, at one year QoL was similar when both groups were compared (p=0.50). MLWHFQ score at one year proved to be superior to QoL improvement (using a cut-off of at least 5 points) from the prognostic point of view. Conclusions QoL improved both in patients with and without HFimpEF criteria, and QoL perception at one year was similar in both groups, suggesting the influence of other factors other than LVEF in QoL perception. QoL at one year revealed to be superior to QoL changes from baseline from the prognostic point of view. Funding Acknowledgement Type of funding sources: None.

Intermittent inotropic therapy with levosimendan vs. milrinone in advanced heart failure patients.

AimsRoutine, intermittent inotropic therapy (IIT) is still applied in advanced heart failure (HF) patients either as a bridge to definitive treatment or as a mean to improve quality of life (QOL), despite limited evidence to support its' use. Given recent reports of improved QOL and reduced HF hospitalization, with levosimendan compared with placebo in advanced HF patients, we aimed to assess the effects of switching a small group of milrinone‐treated patients to levosimendan. This was performed as part of a protocol for changing our ambulatory HF clinic milrinone‐based IIT to levosimendan.Methods and resultsSingle‐centre study of consecutive ambulatory advanced HF patients that received ≥4 cycles of once‐weekly milrinone IIT at our HF outpatient clinic, who were switched to levosimendan IIT. All patients had left ventricular ejection fraction ≤35%, elevated B‐natriuretic peptide (BNP), and were in New York Heart Association Classes III–IV despite maximally tolerated guideline directed medical therapy. Patients were evaluated using BNP levels, echocardiography, cardio‐pulmonary exercise test, and HF QOL questionnaire before and after 4 weeks of levosimendan IIT. The cohort included 11 patients, 10 (91%) were male and the mean age was 76 ± 12 years. After 4 weeks of levosimendan therapy, maximal O2 consumption improved in 8/9 (89%) by a mean of 2.28 mL/kg [95% CI −0.22–3.38, P = 0.05]. BNP levels decreased in 9/11 (82%) levosimendan treated patients, from a median of 1015 ng/L [261–1035] to 719 ng/L [294–739], (P < 0.01). QOL as measure by the EQ‐5D‐5L questionnaire improved in 8/11 (82%) patients after levosimendan IIT, by a median of two points [95% CO −4.14–0.37, P = 0.09]. On echocardiography, peak systolic annular velocity (S') increased after levosimendan IIT by an average of 3 cm/s [95% CI 0.16–2.10, P = 0.03].ConclusionsIn this small‐scale study of ambulatory advanced HF patients, we observed improvements in right ventricular systolic function, maximal O2 consumption, and BNP after switching from milrinone to levosimendan based IIT.

Anxiety and depression moderate the relationship between quality of life and self-care in patients with heart failure

The purpose of this study was to determine perceptions of heart failure quality of life and its relationship to self-care as moderated by anxiety and depression. Older adults (n = 85) were surveyed using Kansas City Cardiomyopathy Questionnaire-12, Self-Care of Heart Failure Index V6.2, and Patient Reported Outcomes Measurement Information System Anxiety and Depression Short Forms 4a. As quality of life and anxiety or depression scores increased jointly, their self-care management scores decreased (p < 0.001). However, higher heart failure quality of life, and lower anxiety and depression scores showed an increase in self-care management. Our findings highlight the need for nursing interventions and research targeting heart failure symptom recognition among older adults. Identification of anxiety and depression in older adults with heart failure may be an important first step for improving self-care management for this population.

Effects of WeChat platform-based health management on health and self-management effectiveness of patients with severe chronic heart failure.

BACKGROUNDEpidemiological studies have found that the prevalence of chronic heart failure in China is 0.9%, the number of people affected is more than 4 million, and the 5-year survival rate is even lower than that of malignant tumors.AIMTo determine the impact of WeChat platform-based health management on severe chronic heart failure patients’ health and self-management efficacy.METHODSA total of 120 patients suffering from chronic heart failure with cardiac function grade III-IV, under the classification of the New York Heart Association, were admitted to our hospital in May 2017. In January 2020, they were divided into two groups: A control group (with routine nursing intervention) and an observation group (with WeChat platform-based health management intervention). Changes in cardiac function, 6-min walking distance (6MWD), high-sensitivity cardiac troponin (hs-cTnT), and N-terminal pro B-type natriuretic peptide (NT-proBNP) were detected in both groups. The Self-Care Ability Scale (ESCA) score, Minnesota Living with Heart Failure Questionnaire score, and compliance score were used to evaluate self-management ability, quality of life, and compliance of the two groups. During a follow-up period of 12 mo, the occurrence of cardiovascular adverse events in both the groups was counted.RESULTSThe left ventricular ejection fraction, stroke output, and 6MWD increased, and the hs-cTnT and NT-proBNP decreased in both the groups, as compared to those before the intervention. Further, cardiac function during the 6MWD, hs-cTnT, and NT-proBNP improved significantly in the observation group after intervention (P < 0.05). The scores of self-care responsibility, self-concept, self-care skills, and self-care health knowledge in the observation group were higher than those of the control group before intervention, and their ESCA scores were significantly improved after intervention (P < 0.05). The Minnesota heart failure quality of life (LiHFe) scores of physical restriction, disease symptoms, psychological emotion, social relations, and other items were decreased compared to those of the control group before intervention, and the LiHFe scores of the observation group were significantly improved compared to those of the control group (P < 0.05). With intervention, the compliance scores of rational diet, regular medication, healthy behavior, and timely reexamination were increased, thereby leading to the compliance scores of the observation group being significantly improved compared to those of the control group (P < 0.05). During the 12 mo follow-up, the incidence rates of acute myocardial infarction and cardiogenic rehospitalization in the observation group were lower than those of the control group, and the hospitalization time in the observation group was shorter than that of the control group, but there was no significant difference between the two groups (P > 0.05).CONCLUSIONWeChat platform-based health management can improve the self-care ability and compliance of patients with severe chronic heart failure, improve the cardiac function and related indexes, reduce the occurrence of cardiovascular adverse events, and enable the avoidance of rehospitalization.

Effect of Spiritual Care Program on Quality of Life in Patients with Heart Failure

Background: Heart failure (HF) is the common result of most of heart disorders. Quality of life (QoL) of these patients is severely impaired and needs continuous care. One of the nursing cares which may affect QoL of these patients is spiritual care.Aim: The current study aimed to determine effect of spiritual care program on QoL in HF patients.Method: This randomized controlled trial was performed at Rajaie Cardiovascular Medical and Research Center in Tehran in August 2020 .84patients were selected through convenient sampling and were randomly assigned to two groups using block balanced randomization. Iranian Heart Failure Quality of Life (IHF-QoL) questionnaire and Parsian and Dunning spirituality questionnaire were complemented before and after finishing 1-month follow-up by two groups. Intervention was carried out for experimental group in two1.5-hours virtual educational sessions as well as 1-month follow-up 3 times a week for 1-hour per session via what’s-App. At the end, the data related to 74 patients was analyzed SPSS software version 22. Significance level was considered at P < 0.05.Results: The groups were homogenous in terms of demographic characteristics. Dimensions of QoL in mental limitations (p <0.001) and self-care (p <0.01) in experimental group was significant comparing to control group, so that the spiritual care program increased the total score of QoL significantly (p <0.01).Implications for Practice: Results of the study showed that spiritual care program has a great role in improving the total QoL score and can be considered as a part of the holistic care program.

TRANSITIONING FROM TYVASO TO LIQ861 IN PULMONARY ARTERIAL HYPERTENSION: A CASE STUDY

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: LIQ861 (Liquidia Technologies) is an investigational, dry-powder formulation of treprostinil designed using PRINT® technology to enhance deep-lung drug deposition and achieve higher dose levels over current nebulized prostacyclin therapies for pulmonary arterial hypertension (PAH) in 1-2 breaths per capsule. INSPIRE (Investigation of the Safety and Pharmacology of Dry Powder Inhalation of Treprostinil) is a Phase 3, open-label, multicenter study of the long-term safety and tolerability of LIQ861. This case evaluates the clinical impact of transitioning treprostinil administration from a Tyvaso® nebulized device to LIQ861 with a dry-powder inhaler. METHODS: A 42-year-old male with ALK1 mutation PAH (functional class [FC] II) and hereditary hemorrhagic telangiectasia was referred to a PAH comprehensive care center for evaluation. Diagnostic hemodynamics were consistent with precapillary PAH. The patient did not tolerate sildenafil or tadalafil due to worsening nosebleeds or macitentan due to fluid retention, and could only tolerate inhaled treprostinil using a Tyvaso® device. He initially titrated to 6 breaths QID but then decreased to 3 breaths QID due to worsening cough. He remained stable in FC II, with an N-terminal pro-brain natriuretic peptide (NT-proBNP) of 30 pg/ml and a 6-minute walk distance (6MWD) of 542 m with no desaturation. He was considered stable to enroll in the INSPIRE study. Assessments at baseline included pulmonary artery pressure of 71/34 mm Hg, mean pulmonary artery pressure of 46 mm Hg, wedge pressure of 13 mm Hg, and pulmonary vascular resistance of 4.6 Wood units. The ESC/ERS risk score was assessed as low with a 6MWD of 558 m, FC II, and NT-proBNP of 62 pg/ml. The total score of the Minnesota Living with Heart Failure Quality of Life (MLWHF) questionnaire was 70. RESULTS: The patient initiated LIQ861 at 26.5 mcg QID. The dose was increased to 53 mcg QID after 4 weeks but reduced to 26.5 mcg QID after 1 week due to worsening cough. An increase to 53 mcg QID was attempted again at Week 8 but immediately decreased to 26.5 mcg QID due to severe cough and desaturation while on oxygen. The dose remained stable at 26.5 mcg QID through Month 12 with no notable adverse events. Assessments at Month 12 showed a risk score maintained as low, including FC II, a 6MWD of 569 m, and NT-proBNP of 124 pg/ml. The MLWHF total score was stable at 69. The patient remained stable on the same dose throughout the duration of the study (2 months), continued to tolerate the same dose a year later, and maintained his low ESC/ERS risk status. CONCLUSIONS: Transition from monotherapy with Tyvaso® to LIQ861 in this patient was well-tolerated and the patient remained stable during the study. CLINICAL IMPLICATIONS: In low-risk PAH patients monotherapy with inhaled prostacyclin LIQ861 is well-tolerated and maintains clinical status. DISCLOSURES: Speaker relationship with Actelion Please note: $5001 - $20000 by Sandeep Sahay, source=Web Response, value=honoraria Speaker relationship with United Therapeutics Please note: $5001 - $20000 by Sandeep Sahay, source=Web Response, value=honoraria speaker relationship with Bayer Please note: $5001 - $20000 by Sandeep Sahay, source=Web Response, value=honoraria My spouse/partner as a Speaker relationship with BTG Please note: $5001 - $20000 by Sandeep Sahay, source=Web Response, value=honoraria brief interview relationship with Liquidia Technologies Please note: $1-$1000 Added 05/26/2020 by Sandeep Sahay, source=Web Response, value=Honoraria

Influences of Race and Sex on Self-Care for Persons with Heart Failure and Diabetes

Introduction Persons with both diabetes (DM) and heart failure (HF) have complex self-care. Self-efficacy and knowledge influence a patient's ability to manage these chronic conditions. In other populations, differences between race and gender have been reported in areas of disease specific knowledge, self-efficacy, and self-care. Greater understanding of differences by race and gender is significant for improving HF-DM self-care and quality of life (QOL). The purpose of this study was to examine HF-DM knowledge, self-care, efficacy, and QOL in racial groups (White, Black) and by sex (men/women) in order to inform culturally congruent care. Hypothesis There are differences in self-care and antecedents of self-efficacy, knowledge, and outcomes of QOL by race and sex. Methods In a secondary analysis, baseline data were examined from 134 persons with HF-DM participating in a trial to improve co-morbid self-care. Participants were 69% Black, and 66% men. Mean age was 57.4 ± 10.6 years. Variables and measures included demographics, clinical factors (HF severity, years with HF, and DM), HF knowledge (AHFKQ), social support (ESSI), self-care efficacy and behavior (SCHFI); HF and DM QOL (MLWHF, ADDQOL), and health status (EQVAS). DM variables were self-care (SCSDA), knowledge (MDKT), and self-efficacy (PDSMS). Group comparison tests were performed using chi squares, t-tests, and non-parametric Mann Whitney tests. Results Black participants had higher body mass index (BMI) (p=.04), higher PDSMS (p=.009) and SCSDA foot care scores (p=.04), and lower MDKT (p=.001), ESSI (p=.05), and ADDQOL scores (p=.03) than white participants. Men were diagnosed with HF longer than DM (p=.02), had higher EQVAS (p=.006) and lower SCHFI confidence (p=.05) and foot care scores (p=.005). Women had lower severity of HF (p=.006) and had lived with HF longer than men (p=.02). Conclusions Results revealed differences in self-care, self-care antecedents, and QOL by race and sex. Implications include HF-DM education and social support interventions to improve overall QOL and self-care in Blacks. More focus on DM self-efficacy and foot care is warranted for men, as well as greater attention to longer term HF symptoms and QOL for women. Culturally relevant care and sex-based interventions are needed to address self-care needs for those with co-morbid conditions.

Severity of heart failure and health-related quality of life in beta-thalassemia patients: a cross-sectional study.

Cardiovascular complications account for a substantial increase in morbidity and mortality in beta-thalassemia patients. Many patients have structural heart disease, and some of them present with symptomatic heart failure (HF). Quality of life (QOL) of beta-thalassemia patients is lower than that of the general population. The aimof our studywasto explore the relationship between HF stages and QOL in beta-thalassemia patients. Seventy-three consecutive adult beta-thalassemia patients took part in this cross-sectional study. Stages of HF, classified with increasing severity as A, B, and C, were determined based on ACC/AHA guidelines. QOL was assessed using the SF-36 questionnaire. Fifteen patients had stage C HF, twenty-eight had stage B HF, and the remaining were considered stage A patients, as beta thalassemia is a predisposing factor for HF. All QOL domains except for bodily pain were significantly lower in stage C patients than in stage A patients. Stage C patients had significantly lower QOL scores for physical functioning, role physical, and social functioning domains than stage B patients. Stage B patients' QOL differed from stage A patients only in the vitality domain. In the multiple regression analysis which took several demographic and clinical factors into account, stage of HF was the most important factor associated with QOL, and negatively and significantly related to five QOL domains, namely physical functioning, role physical, general health, social functioning, and vitality. In conclusion,QOL is negatively affected by the severity of heart failure in beta-thalassemia patients.