Standardized Heart Failure Research Articles

National trends in heart failure admissions in Peru: Insights on regional and demographic disparities from 2018 to 2023.

Heart failure (HF) represents a significant public health challenge, particularly in low- and middle-income countries, where demographic shifts and healthcare disparities influence disease patterns. This study aimed to analyze trends in HF admissions across Peru from 2018 to 2023. We conducted a secondary data analysis of emergency department morbidity records of patients aged ≥20 years registered in the National Superintendence of Health (SUSALUD) database. HF admissions were identified using ICD-10 codes. Age-adjusted standardized HF admission rates per 100,000 persons were estimated using the direct method. Annual percentage changes with their 95% confidence intervals (CI) were estimated using Poisson regression models. In total, 38,931 HF admissions were recorded, with the majority occurring in patients aged ≥60 years (69.2%), and 51.2% of cases were men. HF admissions showed an overall annual growth rate of 2.78% (95% CI 0.95% - 4.65%), 2.92% (95% CI 1.13% - 4.74%) for men, and 2.57% (95% CI 0.45% - 4.73%) for women. Regional disparities were evident, with the highest rates observed in the Amazon region. HF admissions declined during 2020, followed by a rebound in subsequent years. HF admissions in Peru increased from 2018 to 2023, with notable disparities by sex and region. These findings underscore the need for targeted interventions to address regional and demographic variations in HF burden.

Increased Plasma Pyruvate Kinase M2 (PK-M2) in Heart Failure: A Novel Biomarker Related to Cardiac Function and its Clinical Implications.

The purpose of this study was to investigate whether circulating pyruvate kinase M2 (PK-M2) levels are elevated in the peripheral blood and to assess their association with diagnosis and prognosis in patients with heart failure (HF). We conducted a prospective investigation involving 222 patients with HF and 103 control subjects, measuring PK-M2 concentrations using ELISA. The primary outcome, assessed over a median follow-up of 2 years (interquartile range: 776 to 926 days), was the time to the first occurrence of either rehospitalization for worsening HF or cardiovascular death. Patients with HF had higher PK-M2 levels than controls (17.4±4.1 versus 7.8±2.3 U/mL, P <0.001), and these levels correlated with HF severity (New York Heart Association cardiac function class). Patients with reduced left ventricular ejection fraction had higher PK-M2 concentrations than those with preserved ejection fraction (18.3±4.5 versus 16.7±3.6 U/mL, P <0.01). In a subset of patients with HF (n=52), PK-M2 levels significantly decreased following standardized HF treatment (mean difference, -4.3±0.5 U/mL, P <0.001). A high PK-M2 level had a 1.913-fold higher risk of the primary outcome (P=0.033) after adjusting for multiple cardiovascular risk factors, but not with cardiovascular death. Additionally, PK-M2 added incremental prognostic value beyond clinical predictors and N-terminal pro-brain natriuretic peptide (P <0.05). Elevated PK-M2 levels are associated with primary outcomes and rehospitalization for worsening heart failure in patients with HF. These findings suggest that PK-M2 is a potential biomarker for HF diagnosis and prognosis, warranting consideration for serial patient assessment.

Impact of Standardized Heart Failure Management Center Construction on the Management of Patients With Chronic Heart Failure.

Heart failure is extremely harmful to human health and social economics. The purpose of standardized heart failure management center (SHFMC) is to correct the non-standardization of heart failure treatment. SHFMC has a positive impact on the management and prognosis of patients with chronic heart failure (CHF). The SHFMC database of Jiaxing First Hospital was retrospectively analyzed. Two hundred sixty-three patients with CHF who were hospitalized in the cardiovascular medicine department of Jiaxing First Hospital in Zhejiang Province from January 2020 to December 2020 were identified as study subjects. The SHFMC opening day, July 1, 2020, was used as the dividing line around which the patients were divided into Group A (before the completion of SHFMC, n = 137) and Group B (after, n = 126). The baseline data, treatment standardization, long-term efficacy, 1-year all-cause mortality, and readmission rate of the two groups were compared. The use of angiotensin receptor enkephalinase inhibitors (ARNIs), β-blockers (β-Bs), and sodium-glucose cotransport protein 2 inhibitors (SGLT2is) increased significantly, and the long-term outcome, readmission rate, and 1-year all-cause mortality of patients improved in group B. The construction of SHFMC has been associated with consistent improvements in the standardization of CHF treatment, long-term patient outcomes, 1-year cumulative survival rates, and readmission rates.

Health-related quality of life and self-care in heart failure patients under telecare-insights from the randomized, prospective, controlled AMULET trial.

The growing population of heart failure (HF) patients places a burden on the healthcare system. Patient-centered outcomes such as health-related quality of life (HRQoL) and self-care behaviors are key elements of modern HF management programs. Thus, optimized strategies to improve these outcomes are sought. To assess the effects of a new model of medical telecare on HRQoL and self-care in patients with HF (the AMULET study). The study was prospective, randomized, open-label, and controlled with two parallel groups: telecare and standard care. In the telecare group, HF nurses performed patient clinical assessments with telemedical support by a cardiologist and provided education focused on the prevention of HF exacerbation. In the standard care group, patients were followed according to standard practices in the existing healthcare system. At the baseline and at 12 months, HRQoL was assessed using the Short Form 36 (SF-36) questionnaire and the Minnesota Living with Heart Failure Questionnaire (MLwHF). The level of self-care was assessed with the 12-item standardized European Heart Failure Self-care Behavior Scale (EHFScBS-12). In the overall study group, 79% of the subjects were male, the mean age was 67 ± 14 years, and 59% of the subjects were older than 65 years of age. The majority of the subjects (70%) had a left ventricular ejection fraction below 40%. After 12 months, statistically significant increases in physical component of the SF-36 (43.3 vs. 47.4 for telecare vs. 43.4 vs. 46.6 for standard care) and mental component of SF-36 (58.4 vs. 62 for telecare vs. 60.4 vs. 64.2 for standard care) were noted, with no intergroup differences. However, patients receiving telecare showed improvement in specific domains, such as physical functioning, role-physical, bodily pain, vitality, social functioning, role-emotional, and mental health. There was a significant decrease in MLwHF (29 vs. 35.0; lower is better) at follow-up for both groups. Telecare patients had a statistically significant decrease in EHFScBS-12 (lower is better) at 12 months. AMULET outpatient telecare, which is based on nurse-led non-invasive assessments supported by specialist teleconsultations, improved the HRQoL and self-care of HF patients after an episode of acute HF.

Translating the 2021 ESC heart failure guideline recommendations in daily practice: Results from a heart failure survey. A scientific statement of the ESC Council for Cardiology Practice and the Heart Failure Association of the ESC.

Real-world data show that guidelines are insufficiently implemented, and particularly guideline-directed medical therapies (GDMT) are underused in patients with heart failure and reduced ejection fraction (HFrEF) in clinical practice. The Council for Cardiology Practice and the Heart Failure Association of the European Society of Cardiology (ESC) developed a survey aiming to (i) evaluate the perspectives of the cardiology community on the 2021 ESC heart failure (HF) guidelines, (ii) pinpoint disparities in disease management, and (iii) propose strategies to enhance adherence to HF guidelines. A 22-question survey regarding the diagnosis and treatment of HFrEF was delivered between March and June 2022. Of 457 physicians, 54% were general cardiologists, 19.4% were HF specialists, 18.9% other cardiac specialists, and 7.7% non-cardiac specialists. For diagnosis, 52.1% employed echocardiography and natriuretic peptides (NPs), 33.2% primarily used echocardiography, and 14.7% predominantly relied on NPs. The first drug class initiated in HFrEF was angiotensin-converting enzyme inhibitors/angiotensin receptor-neprilysin inhibitor (ACEi/ARNi) (91.2%), beta-blockers (BB) (73.8%), mineralocorticoid receptor antagonists (MRAs) (53.4%), and sodium-glucose cotransporter 2 (SGLT2) inhibitors (48.1%). The combination ACEi/ARNi + MRA+ BB was preferred by 39.3% of physicians, ACEi/ARNi + SGLT2 inhibitors + BB by 33.3%, and ACEi/ARNi + BB by 22.2%. The time required to initiate and optimize GDMT was estimated to be <1 month by 8.3%, 1-3 months by 52%, 3-6 months by 31.8%, and >6 months by 7.9%. Compared to general cardiologists, HF specialists/academic cardiologists reported lower estimated time-to-initiation, and more commonly preferred a parallel initiation of GDMT rather than a sequential approach. Participants generally followed diagnostic and treatment guidelines, but variations in HFrEF management across care settings or HF specialties were noted. The survey may raise awareness and promote standardized HF care.

Review of Randomized Controlled Trials in Patients with Peripartum Cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is a rare but potentially lifethreatening disease, defined as idiopathic cardiomyopathy occurring towards the end of pregnancy or in the months following delivery, abortion or miscarriage. We aim to raise awareness of this condition and give an overview of current knowledge as well as an insight and comparison of clinical trials focusing on randomized controlled trials. Systematic literature searches were conducted using PubMed up to December 2021. Studies published involving clinical trials and interventions in women with PPCM after 1970 were selected. Randomized controlled trials have shown that the addition of Bromocriptine to standardized heart failure therapy improves outcome in terms of recovery of Left Ventricular Ejection Fraction (LVEF), symptoms and death. Bromocriptine 2.5 mg twice daily for two weeks followed by 2.5 mg once daily for six weeks had the best trend and outcome. The addition of Levosimendan to standardized heart failure therapy had no effect, whereas the addition of Selenium improved heart failure symptoms but did not reduce risk in terms of unrecovered LVEF or death. One prospective study showed potential usage of TNF-alfa inhibitors, but was never tried in a randomized clinical trial. PPCM is a rare and potentially fatal disease. New insights on pathophysiology, genetics and clinical studies, particularly randomized controlled trials, have shown that the addition of Bromocriptine has a beneficial effect in terms of improved LVEF and death. However, some clinical studies have shown promising results using anti-inflammatory pharmacological agents with an improvement in LVEF. We suggest that targeting an anti-inflammatory route may prove beneficial in patients with PPCM. However, further research is highly warranted.

EFFECT OF ALLOPURINOL TREATMENT ON CARDIAC FUNCTION AND LONG-TERM DISEASE PROGNOSIS IN PATIENTS WITH CHRONIC HEART FAILURE AND HYPERURICEMIA

Hyperuricemia (HU) is important and common comorbidity that often coexist in patients with heart failure (HF). High values of serum uric acid are associated to severe heart failure. The purpose of the present study was to evaluate a UA-lowering and prognostic effects of allopurinol in patients with chronic HF and hyperuricemia.We studied 75 patients (50 men and 25 women) with HF and increased UA levels, who have been admitted to hospital since September 2019; All patients aged 18&nbsp;years and older were eligible, provided a left ventricular ejection fraction of 45% or less was documented on echocardiography during the enrolment visit and signs and symptoms of chronic heart failure were present. Patient baseline assessment included a standardized HF history regarding HF aetiology (classified as ischemic or non-ischemic) and co-morbidities. All patients underwent a standardized clinical evaluation, including physical examination, determination of NYHA class, determination of body weight. Blood samples were drawn from an antecubital vein in the morning for the assessment of a full blood count and clinical chemistry. Echocardiographic parameters included interventricular septum thickness, left ventricular dimension, left ventricular diastolic function, posterior wall thickness, left ventricular mass index, LVEF. Hyperuricemia was defined according to World Health Organization criteria as uric acid level &gt;5.7&nbsp;mg/dl in women and &gt;7 mg/dl in men. Patients were divided into two groups: 50 patients (group 1) received allopurinol. The initial dose of in most patients was 200 mg/day and it was reduced according to their renal function or UA level. 25 patients (group 2) – controlled group. Treatment duration was 6 and 12 months.Repeated studies after 12 months showed the following results: Uric acid treatment improved the echocardiographic parameters LVEF (38.5± 3.7 and 43.4± 2.4) LV mass index, IVS, PW, stroke volume), reduced NT-proBNP, improved renal function, Improved NYHA functional class; We studied the frequency of cardiovascular events 24-30 months after the start of treatment. Of the 50 patients treated with allopurinol, 11 patients (22%) required rehospitalisation and 9 patients (36%) in the control group;

Self-care and quality of life among men with chronic heart failure.

IntroductionChronic Heart Failure (CHF) involves a complex regimen of daily self-care behaviors: pharmacological therapy, symptom monitoring and lifestyle modifications. Patients with CHF may have a reduced health related quality of life (HRQoL) due to various physical and emotional symptoms. HRQoL may be improved through the use of self-care interventions.PurposeTo assess the level of self-care and quality of life among men with chronic heart failure.MethodsThe study was conducted among 80 men diagnosed with CHF (mean age 58 years). The study was cross-sectional. A self-administered questionnaire and analysis of medical records were used to collect baseline sociodemographic and clinical data. Self-care was assessed using the standardized European Heart Failure Self-care Behavior Scale- EHFScBS-9 and quality of life was assessed using the World Health Organization Quality of Life Bref.ResultsThe Patients in NYHA class II constituted the vast majority (71.25%), mean LVEF in the study group was 43.5%, and mean disease duration was 3 years. The most common comorbidities were ischemic heart disease (72.5%), hypertension (70%) and diabetes mellitus (60%). The most commonly reported non-pharmacological treatments for NS were fluid restriction (45%), moderate physical activity (42.50%) and daily weight control (41.25%). The EHFSc-9 questionnaire score averaged 50.31 points out of 100 possible (SD = 26.52). The mean score regarding perception of QoL was 2.78 points (SD = 0.91), and 40% of patients indicating poor perception of QoL. The mean score for self-rated Analysis of the results of the individual domains of the WHOQoL BREF questionnaire showed that patients rated their QoL best in the environmental domain (M = 13.28; SD = 3.11), then in the social domain (M = 12.81; SD = 2.71), and in the psychological domain (M = 12.8; SD = 3.2). In contrast, QoL in the physical domain was rated the lowest (M = 10.44; SD = 2.85). There was no significant correlation between quality of life and self-care (p > 0.05).ConclusionsMen with CHF have unsatisfactory self-care outcomes and low quality of life scores and are dissatisfied with their health. Strategies to improve selfcare and quality of life in this group are indicated.

Impact of Non-cardiac Comorbidities on Long-Term Clinical Outcomes and Health Status After Acute Heart Failure in China.

BackgroundIndividual non-cardiac comorbidities are prevalent in HF; however, few studies reported how the aggregate burden of non-cardiac comorbidities affects long-term outcomes, and it is unknown whether this burden is associated with changes in health status.AimsTo assess the association of the overall burden of non-cardiac comorbidities with clinical outcomes and quality of life (QoL) in patients hospitalized for heart failure (HF).MethodsWe prospectively enrolled patients hospitalized for HF from 52 hospitals in China. Eight key non-cardiac comorbidities [diabetes, chronic renal disease, chronic obstructive pulmonary disease (COPD), anemia, stroke, cancer, peripheral arterial disease (PAD), and liver cirrhosis] were included, and patients were categorized into four groups: none, one, two, and three or more comorbidities. We fitted Cox proportional hazards models to assess the burden of comorbidities on 1-year death and rehospitalization.ResultsOf the 4,866 patients, 25.3% had no non-cardiac comorbidity, 32.2% had one, 22.9% had two, and 19.6% had three or more in China. Compared with those without non-cardiac comorbidities, patients with three or more comorbidities had higher risks of 1-year all-cause death [heart rate, HR 1.89; 95% confidence interval (CI) 1.48–2.39] and all-rehospitalization (HR 1.35; 95%CI 1.15–1.58) after adjustment. Although all patients with HF experienced a longitudinal improvement in QoL in the 180 days after discharge, those with three or more non-cardiac comorbidities had an unadjusted 11.4 (95%CI −13.4 to −9.4) lower Kansas City Cardiomyopathy Questionnaire (KCCQ) scores than patients without comorbidities. This difference decreased to −6.4 (95%CI −8.6 to −4.2) after adjustment for covariates.ConclusionAmong patients hospitalized with HF in this study, a higher burden of non-cardiac comorbidities was significantly associated with worse health-related QoL (HRQoL), increased risks of death, and rehospitalization post-discharge. The findings highlight the need to address the management of comorbidities effectively in standardized HF care.

Heart Failure Discharge Readiness Checklist - Standardizing Care to Decrease Length of Stay and Readmissions

Background: Heart Failure (HF) is a frequent cause of 30-day readmissions, which in turn contributes to rising healthcare costs. An effective discharge process is critical to reducing readmission rates. After surveying all nine WellStar hospitals which have cardiac programs, it was determined that there was no standardized HF care pathway, which led to variations in care; specifically, variations in how hospital discharges are managed.

URIC ACID LOWERING TREATMENT OF PATIENTS WITH CHRONIC HEART FAILURE

Hyperuricemia (HU) is important and common comorbidity that often coexist in patients with heart failure (HF). High values of serum uric acid are associated to severe heart failure. The purpose of the present study was to evaluate a UA-lowering and prognostic effects of allopurinol in patients with chronic HF and hyperuricemia.We studied 75 patients with HF and increased UA levels, who have been admitted to hospital. All patients aged 18&nbsp;years and older were eligible, provided a left ventricular ejection fraction of 45% or less was documented on echocardiography during the enrolment visit and signs and symptoms of chronic heart failure were present. Patient baseline assessment included a standardized HF history regarding HF aetiology (classified as ischemic or non-ischemic) and co-morbidities. All patients underwent a standardized clinical evaluation, including physical examination, determination of NYHA class, determination of body weight. Blood samples were drawn from an antecubital vein in the morning for the assessment of a full blood count and clinical chemistry. Patients were divided in to two groups:&nbsp; 50 patients (group 1) received allopurinol. The initial dose of in most patients was 200 mg/day and it was reduced according to their renal function or UA level. 25 patients (group 2) – controlled group. Treatment duration was 6 months.Repeated studies after 3 months showed the following results: Uric acid treatment improved the echocardiographic parameters (LVEF, LV mass index, IVS, PW, stroke volume), reduced NT- proBNP, improved renal function, Improved NYHA functional class;6-minute walking test distance improved significantly in the UA- treatment group and quality of life. The QoL parameters that was improved included reduced physical limitation, improved mobility, selfcare, increased daily activities and reduced discomfort, anxiety and depression.Among patients with HF and elevated serum uric acid levels, allopurinol use was safe and strongly associated with improved outcomes.

Self-care among men with chronic heart failure - need for educational interventions?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart failure (HF) is one of the biggest problems in cardiology and public health. The long-term risk of developing HF symptoms in a person aged 55 years is 33% for men. Self-care is a key element of therapeutic process of patients with HF. Purpose To assess the level of self-care among men with chronic heart failure. Methods The study was conducted among 80 men diagnosed with chronic heart failure (mean age 58 years). A self-administered questionnaire and analysis of medical records were used to collect baseline sociodemographic and clinical data. Self-care was assessed using the standardized European Heart Failure Self-care Behavior Scale- EHFScBS-9. Results Patients in NYHA class II constituted the vast majority (71.25%), mean LVEF in the study group was 43.5%, and mean disease duration was 3 years. The most common comorbidities were ischemic heart disease (72.5%), hypertension (70%) and diabetes mellitus (60%). The most commonly reported non-pharmacological treatments for NS were fluid restriction (45%), moderate physical activity (42.50%) and daily weight control (41.25%). The EHFSc-9 questionnaire score averaged 50.31 points out of 100 possible (SD = 26.52). Conclusions Patients with HF have unsatisfactory self-care outcomes. There is a need to implement interventions based on patient-tailored health education.

Utilizing The Electronic Medical Record To Assess Optimal Medical Therapy In Heart Failure Patients

<h3>Intro</h3> As healthcare payment models continue to shift from fee-for-service to pay-for-performance, adequate tools to measure & manage population health will be critical. Heart failure (HF) remains a prevalent & costly chronic condition that has been difficult to manage on a population basis. Guideline-directed optimal medical therapy (OMT) improves HF outcomes, but significant limitations exist in assessing & improving physician/patient compliance with guideline-directed therapy in real world clinical practice. <h3>Hypothesis</h3> Creating an objective scoring system for HF OMT & integrating it into the EMR can benchmark current medical therapy in HF patients & identify gaps in guideline-directed care. <h3>Methods</h3> A small committee within a 100-physician cardiology practice worked to adapt a proposed HF OMT score published in a JACC:HF editorial to meet updated guidelines & specific practice goals. The different guideline-directed HF medications were assigned scores to be combined to a total HF OMT score for a specific patient. The score was integrated into EMR to calculate prospectively for all patient encounters in which there was a history of LVEF less than or equal to 40% or diagnosis of systolic heart failure without LVEF. The treating physician/APP was not alerted to the calculated score in order to truly assess the baseline use of OMT in HF pts. Results: The HF OMT score was calculated for 1,201 pts at the time of a physician/APP encounter over a one-month period. The average score for all visits was 2.8. Evaluation by medication class & dose reveals significant underutilization of MRA and SGLT2i in HF patients in our practice. <h3>Conclusion</h3> Active management & optimization of guideline driven OMT in HF pts across a population will be critical to improving outcomes & succeeding in the evolving pay-for-performance environment. Long term use of a standardized HF OMT score can identify gaps in care for specific medications, by specific physician/APPs, or related to specific patient factors (race/ethnicity, insurance status, gender). Additionally this score can be used to measure the success of future interventions targeting improved compliance with guideline-directed therapy.

Disease Management in Skilled Nursing Facilities Improves Outcomes for Patients With a Primary Diagnosis of Heart Failure.

Skilled nursing facilities (SNFs) are common destinations after hospitalization for patients with heart failure (HF). Our objective was to determine if patients in SNFs with a primary hospital discharge diagnosis of HF benefit from an HF disease management program (HF-DMP). This is a subgroup analysis of multisite, physician and practice blocked, cluster-randomized controlled trial of HF-DMP vs usual care for patients in SNF with an HF diagnosis. The HF-DMP standardized SNF HF care using HF practice guidelines and performance measures and was delivered by an HF nurse advocate. Patients with a primary hospital discharge diagnosis of HF discharged to SNF. Composite outcome of all-cause hospitalization, emergency department visits, and mortality were evaluated at 30 and 60days post SNF admission. Linear mixed models accounted for patient clustering at the physician level. Of 671 individuals enrolled in the main study, 125 had a primary hospital discharge diagnosis of HF (50 HF-DMP; 75 usual care). Mean age was 79 ± 10years, 53% women, and mean ejection fraction 46% ± 15%. At 60days post SNF admission, the rate of the composite outcome was lower in the HF-DMP group (30%) compared with usual care (52%) (P= .02). The rate of the composite outcome at 30days for the HF-DMP group was 18% vs 31% in the usual care group (P= .11). Patients with a primary hospital discharge diagnosis of HF who received HF-DMP while cared for in an SNF had lower rates of the composite outcome at 60days. Standardized HF management during SNF stays may be important for patients with a primary discharge diagnosis of HF.

Abstract 11358: A Standardized Heart Failure Bundle to Provide Better Patient Care and Reduce Readmissions

In adults, heart failure (HF) is associated with increased morbidity and mortality, with projected health care costs of 70 billion by 2030. Evidence-based care identifies that early evaluation and management improves lives and is cost-effective. Streamlining strategies to facilitate care delivery can assist heart failure patients in sustaining their complex lifestyles and behavioral modifications while preventing readmissions. Utilizing a standardized heart failure bundle with evidence-based heart failure care across health systems can provide better care and reduce the 30-day readmission rate. An interdisciplinary team identified a shared need and worked together to set the patient up for success providing a seamless transition of care from inpatient to outpatient. A literature review of evidence-based heart failure care was completed. An Information Systems (IS) team was engaged in creating an HF dashboard to measure interventions and show a return of investments. A Physician Champion was brought into the team to lead the group. A nurse coordinates the initiative while ensuring all aspects are met before discharge. The bundle includes standardized patient education, pharmacy medication reconciliation (MR) before discharge, medication counseling, and HF clinic visit within 10-days of discharge.The Standardized HF bundle begins with identifying heart failure admissions utilizing a readmissions risk report. Next, ensuring medication reconciliation is completed before discharge, as well as medication counseling. A self-management tool engaged patients in care as well. Finally, ensuring the patient has a follow-up appointment within 14 days of discharge. Process metrics evaluated include scheduling and completing follow-up (F/U) appointments and completing medication reconciliation by pharmacy. Before the HF bundle, 72% of F/U appointments were scheduled, and 34.3% were completed in March 2020. MR was 55%. After the HF bundle’s implementation, 95.9% of f/U appointments were scheduled, and 69.2% were completed in March 2021. In addition, mr was 77%. The Outcomes data includes HF readmission rates. The HF readmission rates were 30.4% in early 2020. After the implementation of the HF bundle, the HF readmission rate is 18.5%.

Absence of exercise capacity improvement after in-hospital short-term cardiac rehabilitation is associated with long-term clinical outcome in heart failure patients

Abstract Background Previous studies suggest Cardiac rehabilitation (CR) improve exercise capacity and decline mortality in heart failure (HF) patients. However, some studies show there are HF patients who do not improve exercise capacity by CR and these patients have a higher risk of adverse events in long-term clinical outcome. We investigated whether absence of exercise capacity improvement after in-hospital short-term CR also has adverse effect in long-term clinical outcome. Methods In this retrospective study, 130 HF patients who underwent two weeks in-hospital CR after received standardized HF treatment between July 2014 and August 2020 were included. Improvement in exercise capacity was assessed by change in peak oxygen consumption (delta-Peak VO2) measured at 1st and 14th day of CR by cardiopulmonary test. The median delta-PeakVO2 was 1.3 ml·kg-1·min-1. Patients were classified as responder if they demonstrated delta-PeakVO2 ≥1.3 ml·kg-1·min-1 and as non-responder if they demonstrated delta-PeakVO2 &amp;lt;1.3ml·kg-1·min-1. MeanΩ follow-up was 1236 days. The primary outcome was all-cause death. Result 63 patients (48.4%) were classified as non-responder. Non-responders were older (75.5±10.6 vs 70.8±11.0, P=0.01) and lower estimated glomerular filtration rate (eGFR) (49.7±19.4 vs 57.9±19.2) and lower albumin (3.5±0.5 vs 3.7±0.3 g/dL, P=0.04) than responders. Transtricuspid pressure gradient (TRPG) measured by transthoracic echocardiography was also higher in non-responders (28.5±10.9 vs 22.7±6.3). Predictor of non-responders were TRPG (OR = 1.1, 95% CI 1.02–1.26) and albumin (OR =0.04, 95% CI: 0.003–0.40). In multivariate analysis including delta-PeakVO2 &amp;lt;1.3 ml·kg-1·min-1 (non-responder), age &amp;gt;75, male gender, PeakVO2 at 1st day of CR, body mass index (BMI), left ventricular ejection fraction measured by transthoracic echocardiography, medication of β-blockers showed that delta-PeakVO2 &amp;lt;1.3 ml·kg-1·min-1 (HR =2.8, 95% CI 1.0–7.5), age&amp;gt;75 (HR11.2, 95% CI 2.1–60.1), BMI (HR =0.8, 95% CI 0.6–0.96) were associated with all-cause death. Conclusion The absence of exercise capacity improvement after in-hospital short-term CR was the risk of all-cause death. Especially, the HF patients with higher TRPG and lower albumin have a higher probability of becoming a non-responder. Funding Acknowledgement Type of funding sources: None.

P003. An Evidence Based Quality Improvement Project of the Impact of a Nurse Practitioner Led Heart Failure, Self-Care Focused, Patient Education on Healthcare Related Quality of Life

<h3>Background</h3> Heart failure (HF) is a progressive and debilitating disease with high morbidity and mortality rates. HF affects both physical and psychosocial health with over 75% of HF patients experiencing frailty and 10-40% of HF patients having difficulty preforming activities of daily living. These limitations heavily impact healthcare related quality of life (HRQOL). Patient education has been shown to improve HF outcomes, but it remains poorly utilized. <h3>Objective</h3> This evidence-based quality improvement project aims to show that a HF education packet with nurse practitioner (NP) led reinforcement can improve HRQOL. <h3>Methods</h3> This project uses a comparison prospective design that assesses pre and post intervention scores on the Kansas City Cardiomyopathy Questionnaire 12 (KCCQ-12). Participants had chronic heart failure and were selected from HF clinic referrals. A HF packet with educational materials focused on self-care education with reinforcement provided by NPs in the HF clinic was given to participants. Data on demographics, comorbidities, time since onset of HF, quantity of follow ups, and time between initial and post visit was collected. A KCCQ-12 was given at their initial visit and at a 3-6 month post initial visit. <h3>Results</h3> 12 participants were enrolled. KCCQ-12 domains and HRQOL metrics, including physical limitation (MD = 21.92, SD = 32.4, p = .039), quality of life (QOL) (MD = 20, SD = 26.8, p = .025), and overall summary score (MD = 14.67, SD = 18.2, p = .018). had a statistically significant improvement. Social limitations (MD = 8.08, SD = 31.1, p = NS) and symptom frequency (MD = 8.25, SD = 14.8, p = NS) had a trend towards improvement, but did not reach statistical significance. Within the reduced HF subgroup (N = 9) physical limitations (MD = 27.67, SD = 35.1, p = .038) and overall summary score (MD = 17.89, SD = 20.1, p = .028) significantly improved. Uniquely, symptom frequency (MD = 12.11, SD = 11.1, p = .011) significantly improved in the reduced HF subgroup. There was no statistically significant improvement in the preserved HF subgroup (N = 3) in any of the KCCQ-12 domains. There were no HF hospitalizations during the 3-6 month follow-up. <h3>Conclusion</h3> This project shows that a guideline driven patient education intervention that focuses on self-care via a HF packet with NP follow up to reinforce education improved overall HF HRQOL. Improvement in the KCCQ-12 overall summary score indicates improved HF outcomes such as reduced HF hospitalizations and mortality. Creating a standardized HF education packet that is readily available and can guide patients and clinicians in their HF education discussion may increase rate of HF patient education in clinics, although this study did not measure this specifically. Further studies, with larger participant base, are needed to confirm efficacy of this type of intervention in patients with HF with preserved ejection fraction. In addition, Studies with longer duration would be beneficial to assess impact on mortality.

Reorganization of heart failure management and improved outcome – the 4D HF Project

Objectives Heart failure (HF) management is suboptimal in Sweden despite available evidence-based guidelines. To improve HF treatment, a comprehensive HF management program (4D project) was implemented in the Stockholm County (>2.1 million inhabitants). Design. A standardized care program centralized at five hospital-based HF clinics was implemented in 2014–2017. We registered from 2012 to 2017: (1) numbers of referrals and visits to HF clinics, (2) numbers of hospital admitted patients per million inhabitants, (3) dispensed HF medications after admission, and (4) covariate-adjusted 1-year all-cause mortality or HF readmission. Results. Yearly visits to the five HF outpatient clinics increased 3.4 times from 3,372 to 11,527. Dispensed HF drug prescriptions increased, in particular, for readmitted patients, compared to 2012 (p<.0001). Total number of hospital admitted HF patients as well as new-onset or readmitted HF patients decreased by 16, 13, and 20%, respectively (p < .0001). The combined 1-year mortality or HF readmission over the period was 48% (n = 17,124/35,880) and improved per year (HR 0.98 [0.97–0.99], p < .001) from 2012. Conclusion. A comprehensive standardized care HF management program including expanded HF clinics was associated with improved evidence-based medication, reduced HF hospitalization, and improvement of the combined outcome of 1-year mortality or HF readmission in Stockholm.

Abstract P480: The Distinct Role of Occupational Therapy in Addressing the Self-care Management Needs of Patients With Heart Failure

Introduction: Hospitalizations for heart failure (HF) are the highest single Medicare expenditure. This cost primarily results from readmissions linked to failed self-care. Evidence suggests that effective self-care routines are equivalent to medication in preventing HF exacerbation and hospitalization. Occupational therapists (OT) are well suited to address HF self-care needs by facilitating self-efficacy and adapting patients’ routines, roles and habits. A recent study determined that OT is the only hospital spending category associated with lower HF readmission rates. Hypothesis: Occupational therapy has a significant role in addressing the self-care management needs of patients with HF throughout the continuum of care. Methods: The OT department launched a HF self-care management program as part of process improvement initiatives at an AHA-recognized teaching hospital. An assessment battery was developed which included the following: The Self-Care of Heart Failure Index (SCHFI) v.6.2, Minnesota Living With Heart Failure Questionnaire, Patient Health Questionnaire-9, and the Montreal Cognitive Assessment. Administration of the OT HF assessment battery to a pilot group of 12 inpatients revealed factors that affect patient adoption and adherence to beneficial self-care management routines. Based on assessment battery data, an outpatient OT program was established. Eleven outpatients were enrolled and completed 3-6 hours of OT treatment. The SCHFI was administered at program evaluation and completion to measure self-care maintenance and confidence. To expand service access, a telehealth self-care program was introduced and a single patient case study was assessed to determine the feasibility and effectiveness of the virtual format. Results: Assessment battery data enabled the development of outpatient treatment modules focusing on symptom monitoring, medication management, low sodium diet, activity tolerance and psychosocial strategies. All outpatients who completed the modules demonstrated improved self-care maintenance (ranging from 16-53 points) and half demonstrated improved self-care confidence (ranging from 6-39 points). The patient assessed after completing the telehealth program demonstrated improved self-care maintenance (70 points) and self-care confidence (28 points). Conclusions: In conclusion, OT has a significant role in addressing the self-care management needs of patients with HF throughout the continuum of care. The utilization of a standardized OT HF assessment battery is effective in determining the needs of this population and for guiding the implementation of targeted individualized treatment. Outpatient and telehealth delivery of OT programming is effective in improving self-care for people with HF.

A Simple Pediatric Heart Failure Symptom Score for Children Hospitalized with Acute Decompensated Heart Failure

Purpose Currently there are no simple tools to evaluate heart failure (HF) symptoms in children hospitalized with acute decompensated heart failure (ADHF). We sought to describe our institutional experience developing a simple, standardized symptom score (HFSS) to capture HF symptom severity in hospitalized children. Methods From 2015 to 2018, all children hospitalized with ADHF at a single center were assigned a daily HFSS, a mandatory element for EPIC note completion. The score includes 3 domains: feeding intolerance, respiratory failure, and inactivity rated on an ordinal severity scale: 0 (no symptoms), 1 (mild), 2 (moderate), 3 severe, 4 (life-threatening) (table 1). Results The HFSS was recorded daily by the on-call HF cardiologist typically taking several seconds to calculate. The HFSS was iteratively modified in response to feedback from the cardiologists, dietitians and physical therapy to make it robust across all age groups and HF syndromes [(HF with reduce ejection fraction (HFrEF), HF with preserved EF (HFpEF), cardiomyopathy, and CHD (including 1- and 2-circulations)]. Figure 1 summarizes the HFSS trajectory of a 13 y/o boy hospitalized with ADHF who underwent LVAD implantation and eventually transplant. Conclusion This simple standardized pediatric HF symptom tool may be a useful way to quantify and track HF symptoms in children hospitalized with ADHF across a range of HF syndromes. Although the tool may be useful across the age and HF severity spectrum, its utility may be greatest in smaller and/or sedated children where direct patient-reported outcome measures are difficult to ascertain.