A Pilot Randomized Placebo Controlled Trial of Inhaled Beclomethasone after Community-Acquired Respiratory Viral (CARV) Infection in Lung Transplant Recipients (LTR)

Abstracts distributed among the primary VAD education providers (VEPs) at ACTION sites. Results: Seventeen centers replied, the majority of respondents were VAD coordinators (71%). The majority of VEPs train >100 providers/staff yearly (53%) and devote >6 hours/month on education (75%). There was significant variability in the effectiveness of VAD education programs, competence of care providers, patient/family discharge preparation and ongoing competence assessment among centers. The majority of respondents felt that the existing, educational materials and resources were insufficient for pediatric VAD patients/families and care providers, leading centers to center specific VAD education resources (figure). Conclusion: Pediatric VEPs currently spend a significant amount of time educating patients and patient care providers on VAD management and care. The existing VAD educational materials and resources are insufficient and have led programs to create highly variable education/discharge protocols and center specific educational materials. The rapid growth of the field of pediatric VAD has created the urgent need for pediatric specific, high quality VAD educational materials and protocols.

472 Lung Transplant Clinicians’ Perceptions of Pocket PATH Synergy, an Interactive Health Technology (IHT) to Monitor Patients Remotely A.J. Devito Dabbs,1 T. Irizarry,1 M. Alrawashdeh,1 J.M. Pilewski,2 M. Morrell,2 J. D'Cunha,2 and M. Dew.2 1University of Pittsburgh School of Nursing, Pittsburgh, PA; and the 2University of Pittsburgh School of Medicine, Pittsburgh, PA. Purpose: PocketPATH Synergy (PPS) is an IHT that combines customized smartphone software (PocketPATH: Personal Assistant for Tracking Health) with PocketPATH Link, a clinician website, to share data collected through the smartphone app between lung transplant recipients (LTR) and the transplant team. The success of PPS depends on clinicians’ adoption of the website. Before possible full-scale deployment, our aims were to assess clinicians’ intention to use the website, their actual use, and perceptions regarding its usability and acceptability. Methods: All 22 members of the lung transplant team (including surgeons, pulmonologists, nurses) were invited to participate. Responders were oriented to the website and asked about their intention to use the website. After the website was deployed, clinicians were followed prospectively as they monitored data from 27 LTRs uploaded in real-time to the website over a 2-month period. Clinicians were instructed to view the website at will. At the end of the 2-months, clinicians were sent an online survey including the Perceived Ease of Use and Usefulness scales and open-ended questions related to acceptability of the website (benefits and barriers). Results: 18/22 (88%) agreed to use the website (physicians 11, nurses 7). Over the 2 months, 2/11 (18%) of physicians logged in at least once and 4/18 (22%) of professionals (all nurses) met the threshold of weekly logins. 15/18 (83%) completed the post-survey regardless of whether they logged-in to the website. Over 85% agreed that the website was useful and easy to use. The most commonly cited benefits were to: monitor patients between visits (92%) and identify potential problems early (83%). The most common barriers were: too busy to use the website (83%), interruption

S199 of workflow (75%), forgot log-in (50%), and inconvenient to log-on to another website besides the electronic health record (EHR) (33%). Conclusion: Clinicians’ intention to use, perceived usability and acceptability of the website were favorable, but actual use was low. Future work should integrate data into the EHR and use of the website into clinicians’ workflow. Data suggest that as barriers are resolved, assessment of how PPS impacts clinical management will be a crucial next step. Funding: NR010711 473 Pre-Lung Transplant Waitlist Mortality Rate Reduction Using Remote Video Monitoring Technology M. Zubrinic,1 N. Marks,2 L. Brzozowski,3 J. Qiu,3 D. Lin,3 K. Wang,3 J. De Romana,1 L. Singer,4 and S. Keshavjee.1 1Department of Surgery, University Health Network, Toronto, ON, Canada; 2Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada; 3 Techna Institute & University Health Network, Toronto, ON, Canada; and the 4Division of Respirology, Department of Medicine, University Health Network, Toronto, ON, Canada. Purpose: Lung transplant (LTx) candidates often have multiple medical comorbidities along with end stage lung disease. As their lung disease progresses, they experience increased symptom burden and increasing hypoxia and oxygen requirements, increasing the risk of delirium. This poses an increased safety risk, especially if they become disconnected from their supplemental oxygen supply. The use of remote video monitoring (RVM) has been shown to improve safety and prevent adverse events in various hospitalized patient populations. However, it has not been previously evaluated for the pre-LTx patient population. Our objective was to investigate the feasibility of RVM in this population. Methods: We conducted a feasibility pilot from 07-2016 to 12-2017. Rapidly deteriorating pre-LTx patients that were admitted to hospital and requiring high flow oxygen support were observed with RVM. Consent was obtained from all patients and/or family. Mortality rate and adverse event incident reports were assessed prior to and post implementation of RVM. A satisfaction survey was also administered to patients, family and healthcare providers. Results: Fifty-three consecutive patients admitted to hospital while on the LTx waitlist were included in the pilot. The average length of time monitored was 136 hours (range 18 - 715). The mortality rate of LTx candidates was reduced from 21% to 6% post implementation of RVM. Reporting of adverse events causing severe patient harm was also reduced. Overall, patients, families and healthcare providers provided positive feedback on the reassurance and overall performance provided of the RVM program. Conclusion: Our findings suggest that RVM in hospitalized end stage lung disease patients listed for LTx is feasible and enhances patient safety and satisfaction.

474 A Pilot Randomized Placebo Controlled Trial of Inhaled Beclomethasone after Community-Acquired Respiratory Viral (CARV) Infection in Lung Transplant Recipients (LTR) K.B. Bain,1 K.A. Fester,1 J. Iuppa,2 K. Bakos,1 B. Mittler,3 K. Richardson,3 P. Aguilar,3 J. Alexander-Brett,3 D. Byers,3 H. Kulkarni,3 E. Trulock,3 C. Witt,3 R. Yusen,3 V. Puri,4 D. Kreisel,4 and R. Hachem.3 1Pharmacy, Barnes Jewish Hospital, Saint Louis, MO; 2 Pharmacy, University of Rochester Medical Center, Rochester, NY;

S200

The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019

3 Pulmonary & Critical Care, Washington University, Saint Louis, MO; and the 4Surgery, Washington University, Saint Louis, MO . Purpose: CARV infections are associated with an increased risk of CLAD development and progression. Inhaled corticosteroids are used to treat airway inflammation, but there is a dearth of data regarding their use in lung transplantation. This study aimed to examine the effect of inhaled beclomethasone on the development and progression of CLAD after CARV. Methods: Single-center, double blind, pilot, randomized, placebo controlled trial of inhaled beclomethasone in adult LTR diagnosed with a CARV between Jan 2017 and Dec 2017. Patients were randomized in a 1:1 ratio stratified by BOS stage (BOS 0/0p vs 1/2) within 7 days of CARV. Study drug was continued for 6 months. The primary endpoint was freedom from new or progressive CLAD (defined as a 15% decline in pre CARV FEV1). Secondary endpoints included all-cause mortality and development of new DSA post-CARV. Results: 7 patients were randomized to inhaled beclomethasone and 8 to placebo. Baseline demographics were well matched between groups including gender, age at LTR, time from LTR to CARV, upper vs lower CARV, BOS stage, and DSA at the time of study enrollment (Table 1). There was no difference in freedom from CLAD or CLAD progression between the 2 groups (Figure 1). No patients died or developed new DSA during the study period. Conclusion: Inhaled beclomethasone was not associated with a lower incidence of new or progressive CLAD after CARV when compared to placebo. However, this study had limited power and sample size. Additional studies are necessary to assess the potential benefit of inhaled corticosteroids in LTR after CARV.

475 Effects of INR Variability and Time in the Therapeutic Range on the Rates of Gastrointestinal Bleeding in Patients Supported by Left Ventricular Assist Devices A. Mardis,1 M. Freiter,2 B. Mierzejewski,2 and M. Adams.3 1Department of Pharmacy, Palmetto Health, Columbia, SC; 2College of Pharmacy, University of South Carolina, Columbia, SC; and the 3Department of Family and Preventive Medicine, University of South Carolina College of Medicine, Columbia, SC. Purpose: Patients supported with left ventricular assist devices (LVADs) require chronic anticoagulation with warfarin to prevent thrombus formation within the device. While a goal INR range of 2 to 3 is generally accepted as appropriate, higher time in the therapeutic range (TTR) has been associated with improved outcomes. This analysis aimed to also determine the impact of INR variability on gastrointestinal bleeding (GIB) events. Methods: This was a retrospective, longitudinal cohort study at a single center from January 2015 to December 2017. Standard INR goal was 2 to 3 but could be adjusted on a patient-specific basis. GIB was defined per the standard INTERMACS definition. INR TTR was calculated using the Rosendaal method, and coefficient of variation (CV) was calculated as a ratio of standard deviation to the mean. For the primary analysis, patients who experienced a GIB were compared to those who had not. Results: Baseline characteristics were similar between the two groups (Table 1). Of the 87 subjects analyzed in the study, 23 (26.4%) experienced a GIB (average time to bleed 363 days) with 9 patients developing a second GIB. The overall TTR for the population was 65.0%, and the overall CV was 27.3%. Patients who had a GIB had a lower mean TTR than those who did not bleed (58.8% vs 67.2%, p=0.03). For those that bled, the TTR in the 30 days prior to the GIB event (50.4%) was lower than the overall TTR (p=0.032). Patients who experienced a GIB also had significantly more variability in their INR values than those who did not bleed (31.2% vs 25.8%, p=0.035) (Table 2). Conclusion: Both increased INR variability and decreased TTR are associated with increased rates of GIB in patients supported by LVADs. This is the first study to explore whether more INR variation puts patients with LVADs at greater risk of developing a GIB. Further prospective studies are warranted to further test this hypothesis.

476 Appropriate Management of Drug Interactions Results in Safe Use of Hepatitis C Therapies in Heart Transplant Recipients K. Boyle, R.E. Fowler, A. Pollack, C. Edmonds, J. Gray, J. Lindenfeld and K. Schlendorf. Vanderbilt University Medical Center, Nashville, TN.