P6134Understanding non-attendance to an inner city tertiary centre heart failure clinic: a pilot project

Abstract Background Tackling health inequalities is a priority in heart failure (HF). We do not fully understand why some patients do not attend their hospital HF clinic appointments. Currently when a patient DNAs (does not attend) they are offered a repeat appointment often months later or are discharged from the service with a request to the primary care physician to re-refer. Non-attendance represents a missed opportunity to improve patients' health. Purpose The purpose of this pilot was to look at the demographics and patient factors that contribute to non-attendance. The aim is to understand and personalise our DNA policy to reduce health inequality, improve outcomes, and reduce inefficiencies in our service. Methods The last consecutive 45 patients who DNAd HF clinic were identified and for each, a patient who did attend the same clinic date (Attender), was chosen at random (random.org). The demographics were obtained (age, ethnicity, contact details) and medical notes reviewed (LVEF%, co-morbidities). The patient address was scored for its Index of Multiple Deprivation (IMD) – a UK government dataset measuring relative deprivation by ranking 32,844 neighbourhoods nationally using 37 indicators across 7 domains of deprivation where neighbourhood 1 is the most deprived nationally. Patients were phoned up to three times to establish the patient's mode, duration and cost of their last journey to clinic and, for those patients who DNAd, to ascertain the reason for non-attendance. Results Demographic and medical history was obtained for all patients. It was not possible to contact 2/45 of the Attenders, and 13/45 of the DNA patients. There was no significant difference in age, gender, number of comorbidities, LVEF%, travel time, or travel cost between DNAs and attenders. The mean one-way journey time was 53.4 mins (range 15–210 mins) and the mean return journey cost was GBP ≤10.95 (range ≤0–≤80). Common reasons for non-attendance were not receiving appointment details, forgetting appointments, being unwell on the day and difficulties with travel. The IMD score for the patients who DNAd was significantly lower confirming these patients lived in more deprived areas (9436±5863 vs. 15414±7801, p<0.001) with 71% of DNA patient's addresses in the bottom third most deprived neighbourhoods nationally. Figure 1 Conclusions There was a significant difference in deprivation score between patients who attended and DNAd their clinics. In addition, we found that all patients were travelling up to an hour each way to attend clinic, and that the cost of travel may be a barrier to attendance, even in a healthcare system that is free at the point of delivery. Despite calling three times, we were unable to speak to 29% of patients who DNAd and 4% of the patients who attended their appointments. Work is ongoing to reduce our DNA rates and personalise our response in this deprived population, with the aim of improving engagement and health inequality.

Download Full-text

The effect of left ventricle ischemia severity on cardiac performance appeared on ejection fraction using radioactive TC 99m MIBI in comparison with echocardiography

Journal of Physics Conference Series ◽

10.1088/1742-6596/2114/1/012006 ◽

2021 ◽

Vol 2114 (1) ◽

pp. 012006

Author(s):

M K Mohammed ◽

S I Essa

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Mean Value ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Systolic Volume ◽

End Diastolic Volume ◽

Significant Difference ◽

End Systolic Volume ◽

The Mean

Abstract Ischemic heart disease is a major causes of heart failure. Heart failure patients have predominantly left ventricular dysfunction (systolic or diastolic dysfunction, or both). Acute heart failure is most commonly caused by reduced myocardial contractility, and increased LV stiffness. We performed echocardiography and gated SPECT with Tc99m MIBI within 263 patients and 166 normal individuals. Left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF) were measured. For all degrees of ischemia, there was a significant difference between ejection fraction values measured by SPECT and echocardiography, and there were no significant differences among end systolic volume and end diastolic volume value calculated by two methods for all cases. The mean value for EDV (ECHO)/EDV (SPECT) was 1.07 ± 0.31 for degree (1, 2); in the degree 3 the mean value was 1.02 ± 0.08, and 1.005 ± 0.07 for degree 4. The mean value for ESV (ECHO)/ESV (SPECT) was 1.08 ± 0.34 for degree (1, 2); while 1.03 ± 0.12, 1.021 ± 0.128 for degree 3 and 4 respectively. This study was showed a good relation between left ventricular size and ejection fraction measured by SPECT with Tc99m, and echocardiography.

Download Full-text

Abstract P232: Screening Past B-Type Natriuretic Peptide (BNP) Values to Identify Candidates for Treatment of Systolic Dysfunction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap232 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Parisa Gholami ◽

Shoutzu Lin ◽

Paul Heidenreich

Keyword(s):

Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Significant Difference ◽

The Mean

Background: BNP testing is now common though it is not clear if the test results are used to improve patient care. A high BNP may be an indicator that the left ventricular ejection fraction (LVEF) is low (<40%) such that the patient will benefit from life-prolonging therapy. Objective: To determine how often clinicians obtained a measure of LVEF (echocardiography, nuclear) following a high BNP value when the left ventricular ejection fraction (LVEF) was not known to be low (<40%). Methods and Results: We reviewed the medical records of 296 consecutive patients (inpatient or outpatient) with a BNP values of at least 200 pg/ml at a single medical center (tertiary hospital with 8 community clinics). A prior diagnosis of heart failure was made in 65%, while 42% had diabetes, 79% had hypertension, 59% had ischemic heart disease and 31% had chronic lung disease. The mean age was 73 ± 12 years, 75% were white, 10% black, 15% other and the mean BNP was 810 ± 814 pg/ml. The LVEF was known to be < 40% in 84 patients (28%, mean BNP value of 1094 ± 969 pg/ml). Of the remaining 212 patients without a known low LVEF, 161 (76%) had a prior LVEF >=40% ( mean BNP value of 673 ± 635 pg/ml), and 51 (24%) had no prior LVEF documented (mean BNP 775 ± 926 pg/ml). Following the high BNP, a measure of LVEF was obtained (including outside studies documented by the primary care provider) within 6 months in only 53% (113 of 212) of those with an LVEF not known to be low. Of those with a follow-up echocardiogram, the LVEF was <40% in 18/113 (16%) and >=40% in 95/113 (84%). There was no significant difference in mean initial BNP values between those with a follow-up LVEF <40% (872 ± 940pg/ml), >=40% (704 ± 737 pg/ml), or not done (661 ± 649 pg/ml, p=0.5). Conclusions: Follow-up measures of LVEF did not occur in almost 50% of patients with a high BNP where the information may have led to institution of life-prolonging therapy. Of those that did have a follow-up study a new diagnosis of depressesd LVEF was noted in 16%. Screening of existing BNP and LVEF data and may be an efficient strategy to identify patients that may benefit from life-prolonging therapy for heart failure.

Download Full-text

Abstract 321: Impact Of Chronic Kidney Disease On Heart Failure Outcomes In A Minority Cohort

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.321 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

TAOPHEEQ MUSTAPHA ◽

VARIJA BHOGIREDDY ◽

HARTMAN MADU ◽

ADU BOACHIE ◽

ABDUL OSENI ◽

...

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

African American ◽

Kidney Disease ◽

Prognostic Impact ◽

Mortality And Morbidity ◽

Ckd Stage ◽

Significant Difference ◽

The Mean ◽

The Impact

BACKGROUND: Heart failure (HF) and Chronic kidney disease (CKD) are major public health problems that often co-exist with a resultant high mortality and morbidity. Most of the studies evaluating their reciprocal prognostic impact have focused on mortality in majority populations. There is limited literature on the impact of CKD on HF morbidities in ethnic minorities. AIMS: Our study seeks to compare HF outcomes in patients with or without CKD in an African-American predominant cohort. METHODS: We obtained data from the NGH at Meharry Heart Failure Cohort; a comprehensive retrospective HF database comprised of patient care data (HF admissions, non-HF admissions, and emergency room visits) were assessed from January 2006 to December 2008. The study group consist of 306 subjects with a mean age of 65±15 years. 81% were African-American (AA), 19% Caucasian and 48.5% are females. Following the NKF KDOQI guidelines, 5 stages of CKD were outlined based on GFR. RESULTS: The overall prevalence of CKD in this population is 54.2%. CKD stage 1 was most prevalent with 45.8%, prevalence for stages 2-5 are 21.6%, 18.3%, 9.5% and 4.9% respectively. The comparison of the mean of ER visits, non HF hospitalizations and HF hospitalizations between normal and CKD patients was done using independent t-test and showed no significant difference in the mean number of ER visits (p=0.564), or HF hospitalizations(p=0.235). However, there is a statistically significant difference in the mean number of non -HF hospitalizations between normal and CKD patients (p=0.031). CONCLUSION: This study shows that the prevalence of CKD in this minority -predominant HF cohort is similar to prior studies in majority populations. However, only the non-HF hospitalizations were significantly increased in the CKD group. Future prospective studies will be needed to define the implications of this in the management of HF patients with CKD.

Download Full-text

The Relationship Between N-Terminal Pro-Brain Natriuretic Peptide Level and Myocardial Performance Index and Their Prognostic Importances in Patients With Acute Myocardial Infarction in Short Term Follow-up

Şehir Tıp Dergisi ◽

10.37609/cmj.1434 ◽

2020 ◽

Vol 1 (1) ◽

pp. 12-17

Author(s):

Mehmet Küçükosmanoğlu ◽

Cihan Örem

Keyword(s):

Heart Failure ◽

Prognostic Significance ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ejection Time ◽

Ventricular Ejection Fraction ◽

Significant Difference ◽

The Mean ◽

The Relationship

Introduction: MPI is an echocardiographic parameter that exibit the left ventricular functions globally. NT-proBNP is an important both diagnostic and prognostic factor in heart failure. In this study, we aimed to investigate the prognostic significance of serum NT-proBNP levels and MPI in patients with STEMI. Method: Totally 104 patients with a diagnosis of STEMI were included in the study. Patients followed for 30-days and questioned for presence of symptoms of heart failure (HF) and cardiac death. Patients were invited for outpatient control after 30-days and were divided into two groups: (HF (+) group) and (HF (-) group). Results: Totally 104 patients with STEMI were hospitalized in the coronary intensive care unit. Of those patients, 17 were female (16%), 87 were male (84%), and the mean age of the patients was 58.9±10.8 years. During the 30-day follow-up, 28 (27%) of 104 patients developed HF. The mean age, hypertension ratio and anterior STEMI rate were significantly higher in the HF (+) group compared to the HF (-) group. Ejection time (ET) and left ventricular ejection fraction (LVEF) were significantly lower and MPI was significantly higher in the HF (+) group. When the values on day first and sixth were compared, NT-ProBNP levels were decreased in both groups. There was no significant difference between the two groups in terms of the change in MPI values on the first and sixth days. Multiple regression analysis showed that the presence of anterior MI, first day NT-proBNP level and LVEF were independently associated with development of HF and death. Conclusion: In our study, NT-proBNP levels were found to be positively associated with MPI in patients with acute STEMI. It was concluded that the level of NT-proBNP detected especially on the 1st day was more valuable than MPI in determining HF development and prognosis after STEMI.

Download Full-text

Ca-125, A Biomarker in Acute-Decompensated Heart Failure. Preliminary Study.

Internal Medicine ◽

10.2478/inmed-2018-0017 ◽

2018 ◽

Vol 15 (3) ◽

pp. 7-16

Author(s):

M. Ababei ◽

A. Câmpeanu ◽

D. Nistorescu ◽

O. Zaharia ◽

P Portelli ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Acute Decompensated Heart Failure ◽

Left Ventricular ◽

Left Ventricular Filling ◽

Ca 125 ◽

Oxidative Stress Marker ◽

Significant Difference ◽

The Mean ◽

Ventricular Filling

AbstractBackground. CA-125 is a tumor antigen expressed on the surface of ovarian cells, used to monitor the treatment of ovarian cancer (normal upper limit is 35U/mL), but it seems also to have a role as biomarker in heart failure (HF).Aim. To determine CA-125 changes in acute-decompensated HF (ADHF) patients.Method. The study group included 110 patients (mean age 72±10 years, 63% men) with ADHF caused by ischemic cardiomyopathy. The subjects were clinically, ecocardiographically and biologically (NT-proBNP, PCR, serum uric acid (sUA), CA-125) evaluated.Results. CA-125 at admission was 53±33 U/mL and decreased at discharge to 34±17 U/mL, without any difference between males and females. The mean level of CA-125 was significantly higher in patients with pleural effusion.There was a significant difference between NT-proBNP at admission in obese versus normoponderal patients, which was maintained at discharge. In the same time, the CA-125 did not show significant differences between obese and normoponderal subjects at admission and discharge. The mean level of CA-125 was significantly higher for subjects with reduced ejection fraction and with elevated left ventricular filling pressures versus subjects with preserved ejection fraction and normal left ventricular filling pressures.The CA-125 correlated with LVEF (R=-0.221, p=0.02), with NT-proBNP (R=0.371, p<0.001), with the inflammation marker - PCR (R=0.284, p=0.003) and oxidative stress marker - sUA (R=0.234, p=0.015).Conclusions. The wide availability of CA-125, its relatively low cost, its correlation with known prognostic markers in HF and the additional information provided make it a valuable biomarker that can be used in monitoring ADHF patients.

Download Full-text

Abstract 18183: Short-term Impact of Defibrillation Testing on Heart Failure Admission

Circulation ◽

10.1161/circ.132.suppl_3.18183 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Baris Akdemir ◽

Balaji Krishnan ◽

Venkatakrishna Tholakanahalli ◽

David Benditt ◽

Jian-Ming Li

Keyword(s):

Heart Failure ◽

Retrospective Study ◽

Short Term ◽

Primary Endpoints ◽

Significant Difference ◽

Heart Failure Admission ◽

The Mean ◽

Demographic Features ◽

Long Term Mortality

Introduction: SIMPLE trial showed that defibrillation testing (DT) is safe but does not improve shock efficacy or mortality. However, impact of DT on heart failure (HF) admission at 30 days is unclear. Objectives: The aim of this study was to compare mortality and HF admission of ICD recipients who underwent DT (DT+) compared with those who did not (DT-). Methods: In this retrospective study, we analyzed consecutive patients who received an ICD ( new implant or generator change ) with DT+ and DT- between January 2008 and May 2014 from our ICD registry. Primary endpoints were death ( 30 days and 1 year ) and HF admission ( 30 days) . Results: Of the 501 patients, 311 patients (62,1%) were in DT+ group vs 190 (37,9%) were in DT- group. The mean ages in DT+ and DT- were 66 ± 10 and 70 ± 10 respectively (p<0.0001). DT- group had more generator change than DT+ group ( 61,1% versus 30,9%, p < 0.0001). Other demographic features were not significantly different between two groups (Table 1). No significant difference in mortality was found between two groups at 30 days and 1 year. HF admission at 30 days was significantly higher in DT+ group than in DT- group ( 17,4 % versus 4,7%, p < 0.0001) (Table 2). Conclusion: No short-term and long-term mortality were associated with DT, but DT was associated with increased HF admission at 30 days. Future prospective studies are needed to prove this association.

Download Full-text

A Study on the intraocular pressure of the affected and unaffected eyes in patients with isolated cranial nerve palsies

Acta Medica ◽

10.32552/0.actamedica.422 ◽

2020 ◽

Vol 51 (1) ◽

pp. 15-20

Author(s):

Özlem Dikmetaş ◽

Bogomil Voykov

Keyword(s):

Intraocular Pressure ◽

Cranial Nerve ◽

Nerve Palsy ◽

Sixth Nerve Palsy ◽

Tertiary Centre ◽

Cranial Nerve Palsies ◽

Significant Difference ◽

History Of ◽

The Mean ◽

Sixth Nerve

Objective: The role of elevated intraocular pressure (IOP) in the incidence and progression of glaucoma is well known. However, the exact mechanisms of IOP regulation are still unclear. Central IOP control has been suggested, but the autonomic pathway through which it acts is not known. The aim of this study was to investigate if isolated cranial nerve (CN) palsies of the third, fourth and sixth nerves are associated with an IOP difference between the affected and the unaffected eyes. Materials and Methods: This was a retrospective study including patients diagnosed with a third, fourth and sixth nerve palsy at a single tertiary centre. We included only patients with an isolated unilateral palsy. Patients with a history of strabismus, orbital disease or neurosurgical cases were excluded. Results: The charts of 1712 patients were reviewed. Third, fourth and sixth nerve palsies were found in 469 patients, 314 patients and 929 patients, respectively. Of all patients, 190 (10.6%) were eligible for inclusion in the study. A third nerve, fourth nerve or sixth nerve palsy was present in 85 (44.7%), 65 (34.2%) and 40 (21.1%) patients, respectively. The mean IOP of the affected eyes and the unaffected eyes was not statistically significant different: 14.1 ± 3.1 mmHg vs. 14.6 ± 2.7 mmHg in the CN3 group (p=0.087); 13.6 ± 2.6 mmHg vs. 13.7 ± 2.3 mmHg in the CN4 group (p=0.69); and 14.3 ± 2.7 mmHg vs. 14.9 ± 3.3 mmHg in the CN6 group (p=0.089). There was no statistically significant difference between the mean IOP differences of the affected and unaffected eyes among the three groups (p=0.47). Conclusion: Our study demonstrated no difference in IOP between affected and unaffected eyes in patients with an isolated cranial nerve palsy. These findings are the first and important for ophthalmology practice.

Download Full-text

The Effect of Teaching Palliative Care on the Self-Efficacy of Elderly Patients with Chronic Heart Failure

Revista del Cuerpo Médico del HNAAA ◽

10.35434/rcmhnaaa.2019.123.530 ◽

2020 ◽

Vol 12 (3) ◽

pp. 201-207

Author(s):

Mahnaz Modanloo ◽

Ameneh Tazikeh-Lemeski ◽

Shohreh Kolagari

Keyword(s):

Heart Failure ◽

Palliative Care ◽

Chronic Heart Failure ◽

Self Efficacy ◽

Intervention Group ◽

Control Group ◽

Significant Difference ◽

The Mean ◽

And Control

ABSTRACTObjetive: Determine the effect of teaching palliative care on the self-efficacy of elderly with Chronic Heart Failure. Material and Methods: This single-blind randomized clinical trial was done on patients with Chronic Heart Failure attending to the heart clinics of Golestan University of Medical Sciences in 2018. 48 eligible patients with class-III were selected via convenience sampling. Patients allocated into control and intervention group randomly (n=32). Palliative care training was done for intervention group for six weeks. Data was gathered through the Cardiac Self-Efficacy Scale (CSES) on three time points (before, immediately, and one month after intervention). Data were analyzed in SPSS-18 using independent t-test, chi-squared, Fisher's exact, and repeated-measures ANOVA with corrected Bonferroni post-hoc test. Results: Finding showed that before intervention the mean scores of self-efficacy in intervention and control group was 23.95±8.34 and 24.11±9.41, respectively. Immediate and one month after intervention it was 26.30±8.30 vs. 28.95±8.53 in intervention group and 24.68±9.32 vs. 25.53±10.39 in control group. In intervention group there was no significant difference between the mean scores of before with immediate and one month after intervention. However, there was a significant difference between the two time follow up in both intervention (p<0.0001) and control (p<0.003) groups. Conclusion: Although the education of palliative care has increased the ability to care in elderly, it seems that self-managing in complex conditions is required follow-up over time.

Download Full-text

The effect of using smartphone applications on self-care in patients with heart failure

Nursing Practice Today ◽

10.18502/npt.v7i4.4041 ◽

2020 ◽

Author(s):

Nahid Kiyarosta ◽

Tahereh Najafi Ghezeljeh ◽

Farah Naghashzadeh ◽

Mahshid Feizi ◽

Shima Haghani

Keyword(s):

Heart Failure ◽

Health Care Providers ◽

Intervention Group ◽

Self Care ◽

Smartphone Application ◽

Care Providers ◽

Smartphone Applications ◽

Significant Difference ◽

Patients With Heart Failure ◽

The Mean

Background & Aim: Due to the chronic nature of heart failure, it is necessary to observe and maintain self-care behaviors accordingly. Tele-monitoring using smartphone applications can be effective in this regard. This study aimed to determine the effect of using smartphone applications on self-care behaviors in patients with heart failure. Methods & Materials: This randomized controlled clinical trial was conducted between August and March in 2018. Using consecutive sampling, 120 patients were selected and were allocated to the two groups by a random quadruple block approach. The participants in both groups completed the European heart failure self-care questionnaire before and after the intervention. Patients in both groups received routine hospital care; however, patients in the intervention group used an Android smartphone application for three months daily as well. Via the application, there were ongoing interactions between patients and researchers, depending on the needs of patients and their conditions. The data were analyzed using SPSS V.16 software. Results: There was a statistically significant difference between groups in terms of the mean score of self-care after the intervention where the mean score in the intervention group was lower (p<0.001), which indicates better self-care. Based on the results, the intervention effect was reported at 0.787. Conclusion: The findings of this study showed that using a smartphone application can improve self-care in patients with heart failure. Therefore, it is recommended to health care providers to use this mobile application to care and monitor remote patients with HF.

Download Full-text

Transendocardial CD34+ Cell Therapy does not Increase the Risk of Ventricular Arrhythmias in Patients with Chronic Heart Failure

Cell Transplantation ◽

10.1177/0963689719840351 ◽

2019 ◽

Vol 28 (7) ◽

pp. 856-863 ◽

Cited By ~ 1

Author(s):

Gregor Poglajen ◽

Gregor Zemljič ◽

Andraž Cerar ◽

Sabina Frljak ◽

Martina Jaklič ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Cell Therapy ◽

Ventricular Arrhythmias ◽

Serum Bilirubin ◽

Inclusion Criteria ◽

Significant Difference ◽

Before And After ◽

The Mean ◽

Average Serum

Ventricular arrhythmias (VA) are of major concern in the field of cell therapy, potentially limiting its safety and efficacy. We sought to investigate the effects of CD34+ cell therapy on VA burden in patients with chronic heart failure (CHF). We performed registry data analysis of patients with CHF and implanted ICD/CRT devices treated with transendocardial CD 34+ cell therapy. Demographic, echocardiographic, and biochemical parameters were analyzed. Device records were reviewed and the number and type of VA 1 year prior to and 1 year after cell therapy were analyzed. All patients underwent electroanatomical mapping, and myocardial scar was defined as unipolar voltage (UV) <8.3 mV and linear local shortening (LLS) <6%. Of 209 patients screened, 48 met inclusion criteria. The mean age of the patients was 52 years and 88% were male. Nonischemic and ischemic cardiomyopathy were present in 55% and 45% of patients. The average serum creatinine was 91±26 µmol/L, serum bilirubin 18±9 µmol/L, NT-proBNP 1767 (468, 2446) pg/mL, LVEF 27±9% and 6’ walk test 442±123 m. The average scar burden in patients with nonischemic and ischemic DCM was 58±15% and 51±25% (P=0.48). No significant difference in VA burden was observed before and after cell therapy (48% vs. 44%; P=0.68). ICD activation occurred in 19% and 27% of patients before and after cell therapy (P=0.33). According to our results, transendocardial CD34+ cell therapy does not appear to increase the risk of VA in chronic heart failure patients.

Download Full-text