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Beta-Blocker Cessation in Stable Outpatients with Heart Failure with a Preserved Ejection Fraction
S58 Journal of Cardiac Failure Vol. 25 No. 8S August 2019 dently associated with increased mortality [adjusted OR 1.39 (1.07,1.79), p-0.011] in patients hospitalized with AP. Conclusion: Our study showed that patients with AP associated with CHF have significantly higher mortality in comparison with those without CHF. While acute respiratory distress syndrome is a known complication of AP, concomitant CHF was shown to have a higher rate of respiratory failure, requiring intubation and mechanical ventilation. Volume resuscitation in patients with CHF and AP can be challenging, as there is a very fine balance to tip them from euvolemic to volume overload state. Future studies are needed to determine methods to improve volume resuscitation in these patients.
148 Severe Right Ventricular Dysfunction Predicts Failure of Intra-Aortic Balloon Pump Hemodynamic Support in Cardiogenic Shock Jana P. Lovell, M. Imran Aslam, Steven P. Schulman, Steven Hsu; Johns Hopkins University School of Medicine, Baltimore, MD Introduction: We previously showed that ischemic history and low left ventricular cardiac power index (LVCPI) predict failure of intra-aortic balloon pump (IABP) hemodynamic support in cases of acute decompensated heart failure complicated by cardiogenic shock. We hypothesized that right ventricular (RV) systolic dysfunction would further impact the adequacy and outcomes of IABP hemodynamic support. Methods: We retrospectively studied 74 patients who underwent IABP insertion for treatment of cardiogenic shock not related to acute myocardial infarction. Severity of RV systolic dysfunction, based on echocardiographic assessment, ranged from none to severe. Poor outcomes from IABP support included death or need for unplanned upgrade of mechanical circulatory support. Successful outcomes included bridge to recovery, transplant, or left ventricular assist device. Multivariable regression and Cox proportional hazard ratios were also used to study outcomes. Results: Severe RV systolic dysfunction on echocardiogram was found in 10 patients (13.5%). Severe RV dysfunction, when compared to patients with no or mild RV dysfunction, was associated with increased right atrial pressure (RAP) (20.6§6 vs. 16.2§5.9 mmHg, p=0.04) and lower RV stroke work index (3.2§2.0 vs. 5.5§3.4 g/m, p=0.046) at time of IABP placement. After 48 hours of IABP support, patients with severe RV dysfunction continued to have higher RAP (18.9§8.5 vs. 12.2§4.7 mmHg, p=0.03), as well as worsened pulmonary artery pulsatility index (1.3§0.7 vs. 2.6§2.4, p=0.048) and RAP/pulmonary capillary wedge ratio (1.1§0.7 vs. 0.7§0.3, p=0.01). Severe RV systolic dysfunction independently predicted poor outcomes (OR 8.5, p=0.01), even when adjusted for LVCPI and ischemic history. An IABP failure risk score using all 3 variables (severe RV dysfunction, LVCPI, and ischemic history) predicted 28-day outcomes with excellent discrimination (Figure 1). Conclusions: Severe RV systolic dysfunction corresponds with poor right-sided hemodynamics at baseline and following IABP support, and may predict failure of IABP hemodynamic support. Severe RV systolic dysfunction complicating cardiogenic shock likely warrants up-front consideration of biventricular support instead of IABP alone.
majority agreed that pain in HF patients was related to anxiety, depression, fatigue and unplanned hospitalization, and pain should be individually assessed and managed. More than 80% of them thought pain management practice in HF patients should be improved, 78.1% were interested in getting more information and online education module was the most preferable approach. Lack pain assessment tools, drug addiction, side effect, overuse, underuse, and contraindication with other medications were the main concerns regarding to opioid use in pain management in HF. The gaps of managing pain in HF patients included lack knowledge of opioid use, lack consideration and awareness of pain, no clinical guidelines of pain assessment and treatment, and complicated pain management with multiple chronic conditions. Conclusions: The impact of pain, individually assessment and management of pain in HF patients were well perceived by nurses, whereas improvement in pain management practice in HF patients are needed. Concerns regarding to opioid use and gaps in pain management of HF patients should be addressed.
150 Prognostic Implications of Atrial Fibrillation on Patients Admitted with Acute Decopensated Heart Failure and Acute Kidney Injury Haitham Mazek, Sabry Omar, Sharma Prabhakar; Texas Tech University Health Sciences Center, Lubbock, TX Introduction: Patients with acute heart failure (AHF) & acute kidney injury (AKI) have increased hospital mortality and readmissions. The impact of atrial fibrillation (AF) in these patients has not been well studied. We examined the hypothesis that the presence of AF in patients with AHF and AKI will further increase mortality and rates of readmission. Methods: Medical records of patients who were admitted with AHF and AKI between 2008 and 2010 (n=244) were reviewed. The patients were divided into two groups: patients with AHF and AKI with presence of AF (N= 66), and absence of AF (N=178). Presence of AF was confirmed using electrocardiogram on admission. AKI was defined as a rise of serum creatinine > 0.3 mg/dL above their baseline. Results: We studied 244 patients with AHF and AKI (121 male and 123 female) with a mean age of 64.12 §16.4; 27 % of patients had AF on admission. The 30 days in-hospital mortality, 90-days readmission and length of hospital stay were significantly higher in patients with AF compared to patients without AF (Table 1). In the multivariate logistic regression model the only independent predictors of mortality were left ventricular ejection fraction (odds ratio 0.963; 95 % CI 0.930 to 0.997; P = 0.032) and the use of angiotensin converting enzyme inhibitors (odds ratio 0.225; 95 % CI 0.066 to 0.763; P = 0.017). Conclusions: The presence of AF in patients with AHF and AKI is associated with increased mortality, readmission rates and length of hospital stay. Higher LVEF and the use of ACE inhibitors predicted better survival.
151 149 Pain Management in Patients with Heart Failure: A Survey of Nurses’ Perception Jie Chen, Stephen Walsh, Colleen Delaney, Xiaomei Cong; University of Connecticut, Storrs, CT Background: Over 50% of patients with heart failure (HF) report suffering from pain and pain related burdens; however, pain in HF patients has not been recognized and well treated. Few studies have comprehensively examined pain management in patients with HF from nurses’ perception. Aims: To investigate nurses’ perception of pain management in HF patients. Methods: Members of American Association of Heart Failure Nurses (AAHFN) were invited to participate in a cross-sectional online survey. Results: A total of 147 nurses responded and completed the survey. The
Beta-Blocker Cessation in Stable Outpatients with Heart Failure with a Preserved Ejection Fraction Lakshmi Nambiar, Daniel Silverman, Peter VanBuren, Martin LeWinter, Markus Meyer; University of Vermont Medical Center, Burlington, VT Background: Beta-blockers are frequently administered to patients with heart failure with a preserved ejection fraction (HFpEF), but their effectiveness is unproven. In patients with a normal left ventricular EF and hypertension (HTN) and/or coronary artery disease (CAD), there are emerging concerns that betablockers are associated with adverse outcomes, including heart failure. In view of these concerns, we discontinued or discontinued and replaced beta-blockers in a series of stable outpatients with HFpEF. Methods: Beta-blockers were discontinued in 22 patients with HF and an EF50%. NT-proBNP levels were obtained before and after beta-blocker cessation. Baseline clinical characteristics, echocardiography data, medications and beta-blocker substitutions were tabulated.
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Patient charts were reviewed for changes in symptoms and clinical events. Results: The mean age of the patients was 77§8 (§SD) years and 73% were female. HTN, CAD and atrial fibrillation were present in 95%, 50% and 41%, respectively. Baseline EF was 61§6% with evidence of left ventricular concentric remodeling and left atrial dilation. After beta-blocker cessation, NT-proBNP levels declined by -57§28% (in pg/dL: 1153§810 vs. 484§486, p<0.001). Repeat NT-proBNP levels after beta-blocker cessation remained low and none of the patients had a significant clinical event over a one-year follow-up. Conclusions: In stable HFpEF patients, beta-blocker cessation resulted in nearly uniform and sustained reductions in NTproBNP. These data suggest that beta-blocker cessation is safe and potentially beneficial in stable HFpEF patients.
on sacubitril/valsartan at the Spectrum Health advanced HF clinic. Epidemiological, pharmacological, clinical, and echocardiographic information was collected. Ejection fraction (EF), functional class, and hospitalizations were compared prior and 6 months after initiation of sacubitril/valsartan. Statistical significance was considered if p<0.05. Results: Our patients were predominantly male (74.1%) and young (57.4§13.7 years) with a median duration of HF of 21 months. Non-ischemic cardiomyopathy was present in 58% of patients. At the time of initiation of sacubitril/valsartan, 82.7% were receiving ACEi or ARB, 98.1% beta-blocker, 55.8% aldosterone antagonist, 11.5% hydralazine or isosorbide, and 69% had an ICD or CRT device. Follow up after the initiation of sacubitril/valsartan was 17§10 months. Of this cohort 48 patients (27%) discontinued sacubitril/valsartan mainly due to side effects. During the follow-up period, 3 patients (1.7%) were listed and 1 patient (0.6%) received a heart transplant, 10 patients (5.6%) received a LVAD, 1 patient (0.6%) selected for VAD, and 10 patients (5.6%) died. Of the 177 patients, 162 patients received sacubitril/valsartan for at least 6 months and among these patients the frequency of HF hospitalizations decreased after sacubitril/valsartan from 41 to 18 (p<0.001). The distribution of patients according to NYHA-FC I, II, III and IV at the time of initiation of sacubitril/valsartan was 7.4%, 52.1%, 36.5%, and 4% respectively, which improved significantly after 6 months of treatment to 22.3%, 50%, 25%, and 2.7% respectively (p<0.001). The left ventricular EF improved after sacubitril/valsartan from 24§9% to 32§12%. (p<0.0001). Conclusion: At our advanced HF clinic, patients who received sacubitril/valsartan for at least 6 months had an improvement in functional capacity, left ventricular ejection fraction and decreased rate of hospitalizations. One in every four patients discontinued sacubitril/valsartan and 14.1% of patients reached the combined outcome of death/LVAD/heart transplant/list transplant/VAD selected, underlining the importance of close follow up in this population.
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Incidence, Trends and Predictors of Palliative Care Consultation among Patients Admitted for LVAD Implantation in the United States Olakanmi O. Olagoke1, Olisa Ezegwu1, Ayokunle A. Olagoke2, Yasmeen Golzar1; 1 John H Stroger Jr. Hospital of Cook County, Chicago, IL; 2University of Illinois at Chicago, Chicago, IL
Feasibility of Outpatient Cardiac Rehabilitation Implementation among VAD Recipients at an Urban Tertiary Care Center Rebecca Pinnelas, Alex Reyentovich, Jonathan Whiteson, John Bostrom, Greg Sweeney, Alicia Pierre, Francois Haas, Stuart Katz, John Dodson; New York University, New York, NY
Aim: Left ventricular assist devices (LVAD) have become an important part of advanced heart failure management either as a bridge to transplantation or destination therapy. Patients with advanced heart failure have a poor prognosis and may benefit from palliative care (PC) services. However, there is scarce data regarding the incidence, trends, and predictors of palliative care consultation among patients undergoing LVAD implantation. The main objective of this study is to assess the incidence, trends, and predictors of PC referral in LVAD recipients using the Nationwide Inpatient Sample (NIS) database from 2010 till 2014. Methods: We conducted a weighted analysis on patients who underwent LVAD implantation during their index hospitalization in the 2010 - 2014 NIS data. We compared those who had palliative care referral with those who did not. We further examined the trend in palliative care utilization. Adjusted odds ratio (aOR) was calculated to identify patients’ demographic, social and hospital characteristics associated with PC consult using multivariable logistic regression analysis. Results: A total of 13,825 admissions (mean age: 57.02+13.4 years, 23.3% female) who had LVAD implantation were identified. Also, 559 (4.2%) had PC during the hospital stay. PC referral increased in the time frame from 14 per 1000 LVAD implantations in 2010 to 55 per 1000 in 2014 (P=0.001). Age75years (aOR 1.61), higher median household income (aOR 1.746), female (aOR 1.43), cardiac arrest (aOR 1.46) were associated with higher PC referral. PC referral was also higher in private owned hospitals when compared to governmentowned hospitals (aOR 2.4). Midwest had higher PC referrals compared with Northeast region (aOR 1.768). Mortality was significantly higher among those who had PC referral (aOR 10.76) Conclusion: There was an increase in trends for in-hospital PC referral in LVAD admissions over the 5-year study period. However, the overall rate of PC referrals during the index hospitalization remains low. Significant mortality among patients with PC referral may reflect the erroneous belief that palliative care consultation is only indicated among those with a higher likelihood of dying after the procedure.
Background: Over the past decade, a growing number of patients with advanced heart failure (HF) have undergone ventricular assist device (VAD) implantation, including some ineligible for transplant. Cardiac rehabilitation (CR) may improve functional capacity and symptoms among VAD recipients, but feasibility of completing a full 12-week outpatient CR program among VAD recipients has not been characterized. We therefore sought to determine the prevalence and predictors of early CR cessation in VAD recipients referred to outpatient CR in an urban center. Methods: We prospectively enrolled all eligible 18 VAD recipients who were referred to outpatient CR between 2013-2016 at NYU Langone Rusk Rehabilitation from 4 New York City VAD centers in an IRB-approved observational study. The primary feasibility outcome was completion of CR (all 36 scheduled sessions). We reviewed demographic data, comorbidities, number of CR sessions attended, and physiologic data from baseline cardiopulmonary exercise testing (CPET) in patients who completed and did not complete CR. We used two-sample t-tests and chi-squared test for
153 The Use of Sacubitril/Valsartan in an Advanced Heart Failure Clinic is Associated with Decreased Heart Failure Hospitalizations, Improved Left Ventricular Ejection Fraction and Functional Class Chelsea Meloche1, Pranay Pandrangi2, Jessica Parker3, Morgan Maley3, Beth Twydell3, Stephanie Mueller3, Ryan Grayburn3, Milena Jani3, Renzo Y. LoyagaRendon3; 1Michigan State University College of Human Medicine, Marquette, MI; 2 Spectrum Health/Michigan State University, Grand Rapids, MI; 3Spectrum Health, Grand Rapids, MI Introduction: Sacubitril/valsartan has demonstrated improvement in survival in patients with heart failure (HF) and reduced ejection fraction. However, the population studied in the PARADIGM trial may not reflect the patients managed with optimal medical therapy at an advanced heart failure clinic in North America. Our objective was to evaluate the clinical characteristics and outcomes of patients who were initiated on sacubitril/valsartan and followed by Spectrum Health advanced HF clinic. Methods: This retrospective study included 177 patients who were initiated
Table. Characteristics of Vad Recipients Enrolled in Cardiac Rehabilitation.
148 Severe Right Ventricular Dysfunction Predicts Failure of Intra-Aortic Balloon Pump Hemodynamic Support in Cardiogenic Shock Jana P. Lovell, M. Imran Aslam, Steven P. Schulman, Steven Hsu; Johns Hopkins University School of Medicine, Baltimore, MD Introduction: We previously showed that ischemic history and low left ventricular cardiac power index (LVCPI) predict failure of intra-aortic balloon pump (IABP) hemodynamic support in cases of acute decompensated heart failure complicated by cardiogenic shock. We hypothesized that right ventricular (RV) systolic dysfunction would further impact the adequacy and outcomes of IABP hemodynamic support. Methods: We retrospectively studied 74 patients who underwent IABP insertion for treatment of cardiogenic shock not related to acute myocardial infarction. Severity of RV systolic dysfunction, based on echocardiographic assessment, ranged from none to severe. Poor outcomes from IABP support included death or need for unplanned upgrade of mechanical circulatory support. Successful outcomes included bridge to recovery, transplant, or left ventricular assist device. Multivariable regression and Cox proportional hazard ratios were also used to study outcomes. Results: Severe RV systolic dysfunction on echocardiogram was found in 10 patients (13.5%). Severe RV dysfunction, when compared to patients with no or mild RV dysfunction, was associated with increased right atrial pressure (RAP) (20.6§6 vs. 16.2§5.9 mmHg, p=0.04) and lower RV stroke work index (3.2§2.0 vs. 5.5§3.4 g/m, p=0.046) at time of IABP placement. After 48 hours of IABP support, patients with severe RV dysfunction continued to have higher RAP (18.9§8.5 vs. 12.2§4.7 mmHg, p=0.03), as well as worsened pulmonary artery pulsatility index (1.3§0.7 vs. 2.6§2.4, p=0.048) and RAP/pulmonary capillary wedge ratio (1.1§0.7 vs. 0.7§0.3, p=0.01). Severe RV systolic dysfunction independently predicted poor outcomes (OR 8.5, p=0.01), even when adjusted for LVCPI and ischemic history. An IABP failure risk score using all 3 variables (severe RV dysfunction, LVCPI, and ischemic history) predicted 28-day outcomes with excellent discrimination (Figure 1). Conclusions: Severe RV systolic dysfunction corresponds with poor right-sided hemodynamics at baseline and following IABP support, and may predict failure of IABP hemodynamic support. Severe RV systolic dysfunction complicating cardiogenic shock likely warrants up-front consideration of biventricular support instead of IABP alone.
majority agreed that pain in HF patients was related to anxiety, depression, fatigue and unplanned hospitalization, and pain should be individually assessed and managed. More than 80% of them thought pain management practice in HF patients should be improved, 78.1% were interested in getting more information and online education module was the most preferable approach. Lack pain assessment tools, drug addiction, side effect, overuse, underuse, and contraindication with other medications were the main concerns regarding to opioid use in pain management in HF. The gaps of managing pain in HF patients included lack knowledge of opioid use, lack consideration and awareness of pain, no clinical guidelines of pain assessment and treatment, and complicated pain management with multiple chronic conditions. Conclusions: The impact of pain, individually assessment and management of pain in HF patients were well perceived by nurses, whereas improvement in pain management practice in HF patients are needed. Concerns regarding to opioid use and gaps in pain management of HF patients should be addressed.
150 Prognostic Implications of Atrial Fibrillation on Patients Admitted with Acute Decopensated Heart Failure and Acute Kidney Injury Haitham Mazek, Sabry Omar, Sharma Prabhakar; Texas Tech University Health Sciences Center, Lubbock, TX Introduction: Patients with acute heart failure (AHF) & acute kidney injury (AKI) have increased hospital mortality and readmissions. The impact of atrial fibrillation (AF) in these patients has not been well studied. We examined the hypothesis that the presence of AF in patients with AHF and AKI will further increase mortality and rates of readmission. Methods: Medical records of patients who were admitted with AHF and AKI between 2008 and 2010 (n=244) were reviewed. The patients were divided into two groups: patients with AHF and AKI with presence of AF (N= 66), and absence of AF (N=178). Presence of AF was confirmed using electrocardiogram on admission. AKI was defined as a rise of serum creatinine > 0.3 mg/dL above their baseline. Results: We studied 244 patients with AHF and AKI (121 male and 123 female) with a mean age of 64.12 §16.4; 27 % of patients had AF on admission. The 30 days in-hospital mortality, 90-days readmission and length of hospital stay were significantly higher in patients with AF compared to patients without AF (Table 1). In the multivariate logistic regression model the only independent predictors of mortality were left ventricular ejection fraction (odds ratio 0.963; 95 % CI 0.930 to 0.997; P = 0.032) and the use of angiotensin converting enzyme inhibitors (odds ratio 0.225; 95 % CI 0.066 to 0.763; P = 0.017). Conclusions: The presence of AF in patients with AHF and AKI is associated with increased mortality, readmission rates and length of hospital stay. Higher LVEF and the use of ACE inhibitors predicted better survival.
151 149 Pain Management in Patients with Heart Failure: A Survey of Nurses’ Perception Jie Chen, Stephen Walsh, Colleen Delaney, Xiaomei Cong; University of Connecticut, Storrs, CT Background: Over 50% of patients with heart failure (HF) report suffering from pain and pain related burdens; however, pain in HF patients has not been recognized and well treated. Few studies have comprehensively examined pain management in patients with HF from nurses’ perception. Aims: To investigate nurses’ perception of pain management in HF patients. Methods: Members of American Association of Heart Failure Nurses (AAHFN) were invited to participate in a cross-sectional online survey. Results: A total of 147 nurses responded and completed the survey. The
Beta-Blocker Cessation in Stable Outpatients with Heart Failure with a Preserved Ejection Fraction Lakshmi Nambiar, Daniel Silverman, Peter VanBuren, Martin LeWinter, Markus Meyer; University of Vermont Medical Center, Burlington, VT Background: Beta-blockers are frequently administered to patients with heart failure with a preserved ejection fraction (HFpEF), but their effectiveness is unproven. In patients with a normal left ventricular EF and hypertension (HTN) and/or coronary artery disease (CAD), there are emerging concerns that betablockers are associated with adverse outcomes, including heart failure. In view of these concerns, we discontinued or discontinued and replaced beta-blockers in a series of stable outpatients with HFpEF. Methods: Beta-blockers were discontinued in 22 patients with HF and an EF50%. NT-proBNP levels were obtained before and after beta-blocker cessation. Baseline clinical characteristics, echocardiography data, medications and beta-blocker substitutions were tabulated.
The 23rd Annual Scientific Meeting HFSA
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Patient charts were reviewed for changes in symptoms and clinical events. Results: The mean age of the patients was 77§8 (§SD) years and 73% were female. HTN, CAD and atrial fibrillation were present in 95%, 50% and 41%, respectively. Baseline EF was 61§6% with evidence of left ventricular concentric remodeling and left atrial dilation. After beta-blocker cessation, NT-proBNP levels declined by -57§28% (in pg/dL: 1153§810 vs. 484§486, p<0.001). Repeat NT-proBNP levels after beta-blocker cessation remained low and none of the patients had a significant clinical event over a one-year follow-up. Conclusions: In stable HFpEF patients, beta-blocker cessation resulted in nearly uniform and sustained reductions in NTproBNP. These data suggest that beta-blocker cessation is safe and potentially beneficial in stable HFpEF patients.
on sacubitril/valsartan at the Spectrum Health advanced HF clinic. Epidemiological, pharmacological, clinical, and echocardiographic information was collected. Ejection fraction (EF), functional class, and hospitalizations were compared prior and 6 months after initiation of sacubitril/valsartan. Statistical significance was considered if p<0.05. Results: Our patients were predominantly male (74.1%) and young (57.4§13.7 years) with a median duration of HF of 21 months. Non-ischemic cardiomyopathy was present in 58% of patients. At the time of initiation of sacubitril/valsartan, 82.7% were receiving ACEi or ARB, 98.1% beta-blocker, 55.8% aldosterone antagonist, 11.5% hydralazine or isosorbide, and 69% had an ICD or CRT device. Follow up after the initiation of sacubitril/valsartan was 17§10 months. Of this cohort 48 patients (27%) discontinued sacubitril/valsartan mainly due to side effects. During the follow-up period, 3 patients (1.7%) were listed and 1 patient (0.6%) received a heart transplant, 10 patients (5.6%) received a LVAD, 1 patient (0.6%) selected for VAD, and 10 patients (5.6%) died. Of the 177 patients, 162 patients received sacubitril/valsartan for at least 6 months and among these patients the frequency of HF hospitalizations decreased after sacubitril/valsartan from 41 to 18 (p<0.001). The distribution of patients according to NYHA-FC I, II, III and IV at the time of initiation of sacubitril/valsartan was 7.4%, 52.1%, 36.5%, and 4% respectively, which improved significantly after 6 months of treatment to 22.3%, 50%, 25%, and 2.7% respectively (p<0.001). The left ventricular EF improved after sacubitril/valsartan from 24§9% to 32§12%. (p<0.0001). Conclusion: At our advanced HF clinic, patients who received sacubitril/valsartan for at least 6 months had an improvement in functional capacity, left ventricular ejection fraction and decreased rate of hospitalizations. One in every four patients discontinued sacubitril/valsartan and 14.1% of patients reached the combined outcome of death/LVAD/heart transplant/list transplant/VAD selected, underlining the importance of close follow up in this population.
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Incidence, Trends and Predictors of Palliative Care Consultation among Patients Admitted for LVAD Implantation in the United States Olakanmi O. Olagoke1, Olisa Ezegwu1, Ayokunle A. Olagoke2, Yasmeen Golzar1; 1 John H Stroger Jr. Hospital of Cook County, Chicago, IL; 2University of Illinois at Chicago, Chicago, IL
Feasibility of Outpatient Cardiac Rehabilitation Implementation among VAD Recipients at an Urban Tertiary Care Center Rebecca Pinnelas, Alex Reyentovich, Jonathan Whiteson, John Bostrom, Greg Sweeney, Alicia Pierre, Francois Haas, Stuart Katz, John Dodson; New York University, New York, NY
Aim: Left ventricular assist devices (LVAD) have become an important part of advanced heart failure management either as a bridge to transplantation or destination therapy. Patients with advanced heart failure have a poor prognosis and may benefit from palliative care (PC) services. However, there is scarce data regarding the incidence, trends, and predictors of palliative care consultation among patients undergoing LVAD implantation. The main objective of this study is to assess the incidence, trends, and predictors of PC referral in LVAD recipients using the Nationwide Inpatient Sample (NIS) database from 2010 till 2014. Methods: We conducted a weighted analysis on patients who underwent LVAD implantation during their index hospitalization in the 2010 - 2014 NIS data. We compared those who had palliative care referral with those who did not. We further examined the trend in palliative care utilization. Adjusted odds ratio (aOR) was calculated to identify patients’ demographic, social and hospital characteristics associated with PC consult using multivariable logistic regression analysis. Results: A total of 13,825 admissions (mean age: 57.02+13.4 years, 23.3% female) who had LVAD implantation were identified. Also, 559 (4.2%) had PC during the hospital stay. PC referral increased in the time frame from 14 per 1000 LVAD implantations in 2010 to 55 per 1000 in 2014 (P=0.001). Age75years (aOR 1.61), higher median household income (aOR 1.746), female (aOR 1.43), cardiac arrest (aOR 1.46) were associated with higher PC referral. PC referral was also higher in private owned hospitals when compared to governmentowned hospitals (aOR 2.4). Midwest had higher PC referrals compared with Northeast region (aOR 1.768). Mortality was significantly higher among those who had PC referral (aOR 10.76) Conclusion: There was an increase in trends for in-hospital PC referral in LVAD admissions over the 5-year study period. However, the overall rate of PC referrals during the index hospitalization remains low. Significant mortality among patients with PC referral may reflect the erroneous belief that palliative care consultation is only indicated among those with a higher likelihood of dying after the procedure.
Background: Over the past decade, a growing number of patients with advanced heart failure (HF) have undergone ventricular assist device (VAD) implantation, including some ineligible for transplant. Cardiac rehabilitation (CR) may improve functional capacity and symptoms among VAD recipients, but feasibility of completing a full 12-week outpatient CR program among VAD recipients has not been characterized. We therefore sought to determine the prevalence and predictors of early CR cessation in VAD recipients referred to outpatient CR in an urban center. Methods: We prospectively enrolled all eligible 18 VAD recipients who were referred to outpatient CR between 2013-2016 at NYU Langone Rusk Rehabilitation from 4 New York City VAD centers in an IRB-approved observational study. The primary feasibility outcome was completion of CR (all 36 scheduled sessions). We reviewed demographic data, comorbidities, number of CR sessions attended, and physiologic data from baseline cardiopulmonary exercise testing (CPET) in patients who completed and did not complete CR. We used two-sample t-tests and chi-squared test for
153 The Use of Sacubitril/Valsartan in an Advanced Heart Failure Clinic is Associated with Decreased Heart Failure Hospitalizations, Improved Left Ventricular Ejection Fraction and Functional Class Chelsea Meloche1, Pranay Pandrangi2, Jessica Parker3, Morgan Maley3, Beth Twydell3, Stephanie Mueller3, Ryan Grayburn3, Milena Jani3, Renzo Y. LoyagaRendon3; 1Michigan State University College of Human Medicine, Marquette, MI; 2 Spectrum Health/Michigan State University, Grand Rapids, MI; 3Spectrum Health, Grand Rapids, MI Introduction: Sacubitril/valsartan has demonstrated improvement in survival in patients with heart failure (HF) and reduced ejection fraction. However, the population studied in the PARADIGM trial may not reflect the patients managed with optimal medical therapy at an advanced heart failure clinic in North America. Our objective was to evaluate the clinical characteristics and outcomes of patients who were initiated on sacubitril/valsartan and followed by Spectrum Health advanced HF clinic. Methods: This retrospective study included 177 patients who were initiated
Table. Characteristics of Vad Recipients Enrolled in Cardiac Rehabilitation.