Clinical impact of compound sarcopenia in hospitalized older adult patients with heart failure

Background: Telemedicine interventions to prevent readmissions in patients with heart failure (HF) have shown inconsistent results in their effectiveness on HF-related and all-cause rehospitalization. Team-based interventions geared toward patient-centric care delivery in concert with comprehensive care coordination that enhances patient self-care may help to prevent unplanned hospitalizations in patients with HF. Objective: To evaluate the outcomes of a comprehensive care delivery system using a team-based high-touch coaching and remote patient monitoring intervention designed for older adult patients with heart failure in a community hospital setting. Design: A descriptive cross-sectional observational design was used to measure readmission rates. A one-group pretest-posttest design using the Self-care of Heart Failure Index was used to measure self-care outcomes. Correlation analysis was performed to determine relationships between the coaching and outcomes. Patients: Participants were older adult patient hospitalized with heart failure and followed for 30-days. Patients were excluded if they were unwilling to participate, non- English speaking, had end-stage renal disease, a terminal illness, debilitating neuro-psychological disorder, or lived greater than 30 miles away. Results: The 30-patients were primarily Caucasian, female with a mean age of 77.5 years. The majority of patients had medically optimized NYHA class II or III HF with an ejection fraction ≤ 40%. HF readmission rate was zero, and 6% for all cause. Patient self-care scores improved (p < .0001). Team based coaching was correlated with improvement in self-care maintenance scores (p =.009). Conclusion: A comprehensive care delivery system leveraging remote patient monitoring and health coaching significantly reduced 30-day readmission and enhanced patient self-care management. Implications: Patient centric team based care models leveraging technology should continue to be developed and implemented to transform care delivery for older adults with HF. Table 1. Change in Mean Self-Care of Heart Failure Index Scores p < .0001 p < .0001 p < .0001

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63 Systematic review of prognostic variables associated with mortality in adult patients with heart failure

10.1136/spcare-2020-pcc.83 ◽

2020 ◽

Author(s):

Sophie Hancock ◽

Anna Oriani ◽

Miriam J Johnson ◽

Una Macleod ◽

Amy Gadoud

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Adult Patients ◽

Prognostic Variables ◽

Patients With Heart Failure

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Implementing a Protocol to Improve Self-Care Behaviors in Adult Patients With Heart Failure

Journal of Doctoral Nursing Practice ◽

10.1891/2380-9418.11.1.59 ◽

2018 ◽

Vol 11 (1) ◽

pp. 59-71 ◽

Cited By ~ 1

Author(s):

Sari Capilouto ◽

Erica M. Brewer ◽

Wynne Crawford

Keyword(s):

Heart Failure ◽

Hospital Admissions ◽

Sodium Intake ◽

Self Care ◽

Heart Association ◽

Adult Patients ◽

Written Information ◽

Practice Organization ◽

Patients With Heart Failure ◽

Implementation Period

Background:Heart failure (HF) is a condition that affects millions of Americans and costs $30 billion to treat annually. HF is the cause for frequent hospitalizations. Self-care practices have been found to improve quality of life, decrease hospitalizations, and reduce treatment costs.Participants:Fifteen adult patients with a HF diagnosis ages 18 to 70 voluntarily participated in the implementation of a protocol aimed at improving self-care behaviors in patients with HF in a private cardiology practice located in a southeastern city.Methods:The project was a quality improvement design. A protocol was implemented using resources from the American Heart Association. Monitoring logs were provided to patients to record daily weights, sodium intake, blood pressure, and symptoms. Educational resources included information about medications and a list of valid HF websites. Participants were provided medication organizers and a two-liter container with which to monitor daily fluid intake. The written information and logs were compiled in red folders.Results:Of the 15 participants, there were no hospital admissions or readmissions for HF during the implementation period. Leg and ankle swelling worsened; dyspnea improved; fewer participants felt like a burden to their family; HF knowledge improved.Discussion:The findings indicate the feasibility of implementing the protocol throughout a private practice organization.

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Acute isoproterenol leads to age-dependent arrhythmogenesis in guinea pigs

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00061.2018 ◽

2018 ◽

Vol 315 (4) ◽

pp. H1051-H1062 ◽

Cited By ~ 1

Author(s):

Kathleen C. Woulfe ◽

Cortney E. Wilson ◽

Shane Nau ◽

Sarah Chau ◽

Elisabeth K. Phillips ◽

...

Keyword(s):

Heart Failure ◽

Sudden Death ◽

Guinea Pigs ◽

Pediatric Patients ◽

Left Ventricular ◽

Adult Patients ◽

Adrenergic Stimulation ◽

Premature Ventricular Contractions ◽

Age Related ◽

Patients With Heart Failure

Sudden cardiac death from ventricular arrhythmias is more common in adult patients with with heart failure compared with pediatric patients with heart failure. We identified age-specific differences in arrhythmogenesis using a guinea pig model of acute β-adrenergic stimulation. Young and adult guinea pigs were exposed to the β-adrenergic agonist isoproterenol (ISO; 0.7 mg/kg) for 30 min in the absence or presence of flecainide (20 mg/kg), an antiarrhythmic that blocks Na+ and ryanodine channels. Implanted cardiac monitors (Reveal LINQ, Medtronic) were used to monitor heart rhythm. Alterations in phosphorylation and oxidation of ryanodine receptor 2 (RyR2) were measured in left ventricular tissue. There were age-specific differences in arrhythmogenesis and sudden death associated with acute β-adrenergic stimulation in guinea pigs. Young and adult guinea pigs developed arrhythmias in response to ISO; however, adult animals developed significantly more premature ventricular contractions and experienced higher arrhythmia-related mortality than young guinea pigs treated with ISO. Although there were no significant differences in the phosphorylation of left ventricular RyR2 between young and adult guinea pigs, adult guinea pigs exposed to acute ISO had significantly more oxidation of RyR2. Flecainide treatment significantly improved survival and decreased the number of premature ventricular contractions in young and adult animals in association with lower RyR2 oxidation. Adult guinea pigs had a greater propensity to develop arrhythmias and suffer sudden death than young guinea pigs when acutely exposed to ISO. This was associated with higher oxidation of RyR2. The incidence of sudden death can be rescued with flecainide treatment, which decreases RyR2 oxidation. NEW & NOTEWORTHY Clinically, adult patients with heart failure are more likely to develop arrhythmias and sudden death than pediatric patients with heart failure. In the present study, older guinea pigs also showed a greater propensity to arrhythmias and sudden death than young guinea pigs when acutely exposed to isoproterenol. Although there are well-described age-related cardiac structural changes that predispose patients to arrhythmogenesis, the present data suggest contributions from dynamic changes in cellular signaling also play an important role in arrhythmogenesis.

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Stem cell therapy for CHD: towards translation

Cardiology in the Young ◽

10.1017/s1047951115000840 ◽

2015 ◽

Vol 25 (S2) ◽

pp. 58-66 ◽

Cited By ~ 7

Author(s):

Brody Wehman ◽

Osama T. Siddiqui ◽

Rachana Mishra ◽

Sudhish Sharma ◽

Sunjay Kaushal

Keyword(s):

Heart Failure ◽

Stem Cell ◽

Cell Therapy ◽

Stem Cell Therapy ◽

Adult Patients ◽

Molecular Medicine ◽

Clinical Experiences ◽

Patients With Heart Failure ◽

Clinical Models ◽

Methodological Considerations

AbstractStem cell therapy has the optimistic goal of regenerating the myocardium as defined by re-growth of lost or destroyed myocardium. As applied to patients with heart failure, many confuse or limit the regenerative definition to just improving myocardial function and/or decreasing myocardial scar formation, which may not be the most important clinical outcome to achieve in this promising field of molecular medicine. Many different stem cell-based therapies have been tested and have demonstrated a safe and feasible profile in adult patients with heart failure, but with varied efficacious end points reported. Although not achieved as of yet, the encompassing goal to regenerate the heart is still believed to be within reach using these cell-based therapies in adult patients with heart failure, as the first-generation therapies are now being tested in different phases of clinical trials. Similar efforts to foster the translation of stem cell therapy to children with heart failure have, however, been limited. In this review, we aim to summarise the findings from pre-clinical models and clinical experiences to date that have focussed on the evaluation of stem cell therapy in children with heart failure. Finally, we present methodological considerations pertinent to the design of a stem cell-based trial for children with heart failure, as they represent a population of patients with very different sets of issues when compared with adult patients. As has been taught by many learned clinicians, children are not small adults!

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477 Mechanisms and clinical impact of mitral regurgitation reduction in patients with heart failure undergoing cardiac resynchronization therapy

European Journal of Echocardiography ◽

10.1016/s1525-2167(05)80227-6 ◽

2005 ◽

Vol 6 ◽

pp. S61-S61

Keyword(s):

Heart Failure ◽

Mitral Regurgitation ◽

Cardiac Resynchronization Therapy ◽

Clinical Impact ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Patients With Heart Failure

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Abstract 17157: Clinical Impact of Digoxin Discontinuation at Hospital Discharge in Patients With Heart Failure With Reduced Ejection Fraction

Circulation ◽

10.1161/circ.138.suppl_1.17157 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Fahad Lodhi ◽

Awais Malik ◽

Syed Z Qamer ◽

Cherinne Arundel ◽

Helen Sheriff ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Hospital Discharge ◽

Propensity Scores ◽

Clinical Impact ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

African America ◽

Discharge From Hospital

Introduction: Digoxin use is associated with a lower risk of hospital admission and readmission in patients with heart failure with reduced ejection fraction (HFrEF). Moreover, PROVED and RADIANCE trials have shown that digoxin discontinuation is associated with lower ejection fraction (EF), higher heart rate, and worse heart failure (HF) symptoms in chronic HFrEF patients. Despite these results, digoxin use has declined over recent years. In this study, we examined the clinical impact of digoxin discontinuation at hospital discharge in elderly patients with HFrEF. Hypothesis: Digoxin discontinuation at hospital discharge will increase mortality and heart failure readmission in HFrEF patients. Methods: Of 10,625 patients hospitalized with HFrEF (EF≤40%) in Medicare-linked OPTIMIZE-HF registry, 3,225 were receiving digoxin prior to admission but it was discontinued in 655 of these patients at the time of discharge. Propensity scores for digoxin discontinuation, estimated for each of the 3,225 patients, were used to match 616 pairs of patients (digoxin continued vs. discontinued) balanced on 60 baseline characteristics including age (mean 76 years), EF (mean 26%), gender (31% females) and race (15% African America) among others. Results: Among 1,232 matched patients, digoxin discontinuation was associated with a higher risk of all-cause mortality at 30-days (12% vs. 8%; HR 1.45; 95% CI 1.01-2.07; p=0.044) and 6-months (HR 1.32; p=0.009) but not at 1-year (HR 1.18; p=0.07). Digoxin discontinuation was also associated with increased combined heart failure readmission/all-cause mortality at 4-years of follow up (HR 1.16; 95% CI 1.03-1.30; p=0.017). Conclusions: In patients with HFrEF receiving digoxin prior to admission, digoxin discontinuation at discharge from hospital is associated with increased short-term all-cause mortality and long-term heart failure readmission/all-cause mortality.

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