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Ambulation with Femoral IABP, Pumped and Moving!
The 21st Annual Scientific Meeting
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HFSA
S111
Readmission Reduction Program report from 2009 - 2014. Obesity was classified by BMI according to the World Health Organization: Underweight (BMI <18.5 kg/m2), Normal (18.5–24.9 kg/m2), Overweight (25.0–29.9 kg/m2), Class I Obesity (30.0– 34.9 kg/m2), Class II Obesity (35.0–39.9 kg/m2), and Morbid Obesity (≥40.0 kg/m2). The primary outcome was 30-day all-cause readmission to any hospital after a HF admission. Mortality was assessed using the CMS Inpatient Quality Report on HF 30day mortality. Readmission reasons were classified by primary discharge diagnosis using Clinical Classification Software from the AHRQ. Results: The cohort BMI distribution consisted of 2.9% Underweight, 29.1% Normal, 30.3% Overweight, 19.7% Class I Obesity, 9.5% Class II Obesity, and 8.5% Morbid Obesity. Compared to Normal BMIs, those in elevated BMI groups were younger (P < .001) and had a higher prevalence of diabetes (P < .0001) and obstructive sleep apnea (P < .0001). The cohort’s 30-day all cause readmission rate was 21.3 % (n = 309) and 30-day mortality rate was 7.1% (n = 103). Compared to the 30-day all cause readmission rate in the Normal BMI group (16.8%), readmissions were more frequent among the Overweight (22.4%; P = .04), Class I Obesity (26.8%, P = .001), Class II Obesity (24.6%, P = .04), but not Morbid Obesity (18.7%, P = .6). Mortality rates were lower among the Overweight (6.1%; P = .04), Class I Obesity (5.2%, P = .02), Class II Obesity (3.6%, P = .02), but not Morbid Obesity (6.5%, P = .2) compared to the Normal BMI group (9.9%). Of the 309 readmissions, the most frequent reasons were HF (n = 107; 35%), infection (n = 32; 10%), and AKI (n = 25; 9%). The percentage of readmissions from non-HF diagnoses were similar across BMI groups: Normal (66%), Overweight (63%), Class I Obesity (62%), Class II Obesity (68%), except Morbid Obesity (83%). Conclusions: In contrast to paradoxical effects on mortality, elevated BMI increased the rate of hospitalization after a HF admission compared to a normal BMI, except in the morbidly obese.
309 Implications of Intravenous Contrast Use in Patients Admitted with Acute Decompensated Heart Failure Manova David1, Sengodan Mohan2, Sakina Sachak3, Macaulay Onuigbo2, Richard Hanna2; 1University of Alabama, Birmingham, Alabama; 2Mayo Clinic Health System, Eau Claire, Wisconsin; 3University of Wisconsin, Eau Claire, Wisconsin
308 Ambulation with Femoral IABP, Pumped and Moving! Stephen Ramsey, Jason Lucas, Katie Rattray, Peter Barrett, Arun Krishnamoorthy, Tara Hrobowski, Kelly McCants, David Dean, Amin Yehya; Piedmont Heart Institute, Atlanta, Giorgia Background: Cardiogenic shock is associated with high morbidity and mortality. Mechanical support with intra-aortic balloon pump (IABP) has been instrumental in managing patients with hemodynamic compromise. Patients with femoral IABP support lie flat in bed and are immobilized, which can lead to physical deconditioning. Studies demonstrate that with extended bedrest, patients lose up to 5% of maximal muscle torque and nearly 3% of muscle cross sectional area each week, in addition to increasing susceptibility to infections, pressure ulcers and venous thrombosis. Methods: We report a single center’s experience in 20 patients with femoral IABP in situ completing a total of 45 sessions of ambulation. An institutionally approved, unit specific guideline to determine candidacy as well as the well-defined Ramsey protocol (Fig. 1) was utilized by a multi-disciplinary team including a physical therapist (PT) and nursing staff, with supervision from advanced practice providers (APP) and physicians to complete safe ambulation. Successful ambulation was defined as walking a minimum of 10 feet in distance. Complications were defined as major (limb ischemia, arterial dissection, aortic aneurysm, balloon rupture, site infection, death) or minor (balloon migration, changes in augmentation, site hematoma not necessitating blood transfusion or vascular intervention). Results: A total of 45 successful sessions of ambulation were performed. No major or minor complications were noted. Patients ambulated an average of 377 ft. per session. Conclusion: Patient ambulation with femoral IABP done under standardized protocol and close supervision with a multidisciplinary team is safe and can help reduce physical deconditioning.
Patients admitted with Acute Decompensated Heart Failure (ADHF) are exposed to intravenous contrast agents for various clinical indications. Given the hemodynamic changes that occur during ADHF, it is not clear that the use of intravenous contrast will have any adverse outcome in this group of patients. Hence this quality improvement project designed to see the outcomes of intravenous contrast use in patients with ADHF. Hypothesis: The use of intravenous contrast agents in patients with acute decompensated heart failure can have worse outcome. Methods: All adult patients (>18 years) admitted with primary diagnosis of acute decompensated heart failure (ADHF) during 2013 was included. Patients on hemodialysis, sepsis, terminal cancer and patients who had surgical procedure during the hospital stay were excluded. The included patients were grouped into patients who received contrast and who did not receive intravenous contrast. Primary endpoint was all cause mortality, length of hospital stay and 30-day readmission to hospital. Data was analyzed using IBM SPSS Version 20 software. Results: Of the 338 patients with diagnosis of ADHF, 228 patients met the inclusion criteria. The included patients were divided into contrast received group (n = 65) and non-contrast group (n = 163). The all cause in-hospital mortality was 7.6% in contrast group and 6.7% (P value 0.801) in non-contrast group. There is no significant difference in overall length of stay (P value 0.626) and 30-day readmission (P value 0.661) between these groups. Within contrast received group, patients received contrast for coronary angiogram had lengthy hospital day (5 days and 3.5 days, P value 0.047) The subgroup analysis on elderly patients (age > 80 years) the length of stay was significantly higher in contrast received group (P value 0.044). Conclusions: The use of intravenous contrast agents in patients with acute decompensated heart failure may increase length of stay in elderly patients.
310 Shared-Care for Adult Cardiac Transplant Patients: A Single Center Experience Fayez S. Raza1, Charles Howard1, Kristen M. Tecson2, Sandra A. Carey1, Aayla K. Jamil1, Joost Felius1, Shelley A. Hall1; 1Baylor University Medical Center, Dallas, Texas; 2 Baylor Heart & Vascular Institute, Dallas, Texas Introduction: To mitigate the persistent shortage of donor hearts, the United Network for Organ Sharing (UNOS) lists candidates according to needs (level 1a, 1B, 2) and has divided the country into geographical regions. Differences in expected waiting time prompt many patients to seek listing at multiple centers. Here we describe patients who were transplanted at our center but whose postoperative care was “shared” with another geographically separate cardiac transplant center. Methods: From May 2015 to July 2016, 25 patients underwent cardiac transplantation at our hospital (region 4) under a shared care agreement with 9 different other centers (regions 3, 7, 8, 9, 10, and 11).
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HFSA
S111
Readmission Reduction Program report from 2009 - 2014. Obesity was classified by BMI according to the World Health Organization: Underweight (BMI <18.5 kg/m2), Normal (18.5–24.9 kg/m2), Overweight (25.0–29.9 kg/m2), Class I Obesity (30.0– 34.9 kg/m2), Class II Obesity (35.0–39.9 kg/m2), and Morbid Obesity (≥40.0 kg/m2). The primary outcome was 30-day all-cause readmission to any hospital after a HF admission. Mortality was assessed using the CMS Inpatient Quality Report on HF 30day mortality. Readmission reasons were classified by primary discharge diagnosis using Clinical Classification Software from the AHRQ. Results: The cohort BMI distribution consisted of 2.9% Underweight, 29.1% Normal, 30.3% Overweight, 19.7% Class I Obesity, 9.5% Class II Obesity, and 8.5% Morbid Obesity. Compared to Normal BMIs, those in elevated BMI groups were younger (P < .001) and had a higher prevalence of diabetes (P < .0001) and obstructive sleep apnea (P < .0001). The cohort’s 30-day all cause readmission rate was 21.3 % (n = 309) and 30-day mortality rate was 7.1% (n = 103). Compared to the 30-day all cause readmission rate in the Normal BMI group (16.8%), readmissions were more frequent among the Overweight (22.4%; P = .04), Class I Obesity (26.8%, P = .001), Class II Obesity (24.6%, P = .04), but not Morbid Obesity (18.7%, P = .6). Mortality rates were lower among the Overweight (6.1%; P = .04), Class I Obesity (5.2%, P = .02), Class II Obesity (3.6%, P = .02), but not Morbid Obesity (6.5%, P = .2) compared to the Normal BMI group (9.9%). Of the 309 readmissions, the most frequent reasons were HF (n = 107; 35%), infection (n = 32; 10%), and AKI (n = 25; 9%). The percentage of readmissions from non-HF diagnoses were similar across BMI groups: Normal (66%), Overweight (63%), Class I Obesity (62%), Class II Obesity (68%), except Morbid Obesity (83%). Conclusions: In contrast to paradoxical effects on mortality, elevated BMI increased the rate of hospitalization after a HF admission compared to a normal BMI, except in the morbidly obese.
309 Implications of Intravenous Contrast Use in Patients Admitted with Acute Decompensated Heart Failure Manova David1, Sengodan Mohan2, Sakina Sachak3, Macaulay Onuigbo2, Richard Hanna2; 1University of Alabama, Birmingham, Alabama; 2Mayo Clinic Health System, Eau Claire, Wisconsin; 3University of Wisconsin, Eau Claire, Wisconsin
308 Ambulation with Femoral IABP, Pumped and Moving! Stephen Ramsey, Jason Lucas, Katie Rattray, Peter Barrett, Arun Krishnamoorthy, Tara Hrobowski, Kelly McCants, David Dean, Amin Yehya; Piedmont Heart Institute, Atlanta, Giorgia Background: Cardiogenic shock is associated with high morbidity and mortality. Mechanical support with intra-aortic balloon pump (IABP) has been instrumental in managing patients with hemodynamic compromise. Patients with femoral IABP support lie flat in bed and are immobilized, which can lead to physical deconditioning. Studies demonstrate that with extended bedrest, patients lose up to 5% of maximal muscle torque and nearly 3% of muscle cross sectional area each week, in addition to increasing susceptibility to infections, pressure ulcers and venous thrombosis. Methods: We report a single center’s experience in 20 patients with femoral IABP in situ completing a total of 45 sessions of ambulation. An institutionally approved, unit specific guideline to determine candidacy as well as the well-defined Ramsey protocol (Fig. 1) was utilized by a multi-disciplinary team including a physical therapist (PT) and nursing staff, with supervision from advanced practice providers (APP) and physicians to complete safe ambulation. Successful ambulation was defined as walking a minimum of 10 feet in distance. Complications were defined as major (limb ischemia, arterial dissection, aortic aneurysm, balloon rupture, site infection, death) or minor (balloon migration, changes in augmentation, site hematoma not necessitating blood transfusion or vascular intervention). Results: A total of 45 successful sessions of ambulation were performed. No major or minor complications were noted. Patients ambulated an average of 377 ft. per session. Conclusion: Patient ambulation with femoral IABP done under standardized protocol and close supervision with a multidisciplinary team is safe and can help reduce physical deconditioning.
Patients admitted with Acute Decompensated Heart Failure (ADHF) are exposed to intravenous contrast agents for various clinical indications. Given the hemodynamic changes that occur during ADHF, it is not clear that the use of intravenous contrast will have any adverse outcome in this group of patients. Hence this quality improvement project designed to see the outcomes of intravenous contrast use in patients with ADHF. Hypothesis: The use of intravenous contrast agents in patients with acute decompensated heart failure can have worse outcome. Methods: All adult patients (>18 years) admitted with primary diagnosis of acute decompensated heart failure (ADHF) during 2013 was included. Patients on hemodialysis, sepsis, terminal cancer and patients who had surgical procedure during the hospital stay were excluded. The included patients were grouped into patients who received contrast and who did not receive intravenous contrast. Primary endpoint was all cause mortality, length of hospital stay and 30-day readmission to hospital. Data was analyzed using IBM SPSS Version 20 software. Results: Of the 338 patients with diagnosis of ADHF, 228 patients met the inclusion criteria. The included patients were divided into contrast received group (n = 65) and non-contrast group (n = 163). The all cause in-hospital mortality was 7.6% in contrast group and 6.7% (P value 0.801) in non-contrast group. There is no significant difference in overall length of stay (P value 0.626) and 30-day readmission (P value 0.661) between these groups. Within contrast received group, patients received contrast for coronary angiogram had lengthy hospital day (5 days and 3.5 days, P value 0.047) The subgroup analysis on elderly patients (age > 80 years) the length of stay was significantly higher in contrast received group (P value 0.044). Conclusions: The use of intravenous contrast agents in patients with acute decompensated heart failure may increase length of stay in elderly patients.
310 Shared-Care for Adult Cardiac Transplant Patients: A Single Center Experience Fayez S. Raza1, Charles Howard1, Kristen M. Tecson2, Sandra A. Carey1, Aayla K. Jamil1, Joost Felius1, Shelley A. Hall1; 1Baylor University Medical Center, Dallas, Texas; 2 Baylor Heart & Vascular Institute, Dallas, Texas Introduction: To mitigate the persistent shortage of donor hearts, the United Network for Organ Sharing (UNOS) lists candidates according to needs (level 1a, 1B, 2) and has divided the country into geographical regions. Differences in expected waiting time prompt many patients to seek listing at multiple centers. Here we describe patients who were transplanted at our center but whose postoperative care was “shared” with another geographically separate cardiac transplant center. Methods: From May 2015 to July 2016, 25 patients underwent cardiac transplantation at our hospital (region 4) under a shared care agreement with 9 different other centers (regions 3, 7, 8, 9, 10, and 11).