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Depression, Fatigue and Sleep Quality are Associated with Quality of Life among Patients with Left Ventricular Assist Device
The 20th Annual Scientific Meeting Table. Memory and Attention based on APOE ε4 status in HF
Variables
APOE ε4 absent (N = 19)
APOE ε4 present (N = 7)
MannWhitney P-value
Memory Recall Delayed recall Attention
24.5 ± 5.2 8.8 ± 3.3 2.7 ± 0.1
22.3 ± 7.3 8.9 ± 2.4 2.7 ± 0.1
.543 .774 .541
evaluated in linear regression analyses, and there was no evidence for confounding effects. Conclusions: The APOE ε4 allele was present in nearly 1/4 of patients, which is similar to the frequency in general older US population. In this small cohort, no association between APOE ε4 and memory or attention was found. Future studies are needed to deepen our understanding of APOE ε4 genotypes and memory and attention impairment in HF.
015 Posture, Mobility, and 30-Day Hospital Readmission and Function in Older Adults with Heart Failure Theresa Floegel1,2, Cheryl DerAnanian2, Jared Dickinson2, Marianne McCarthy2, Steven P. Hooker2, Matthew Buman2; 1UNC-Chapel HIll, Raleigh, NC; 2Arizona State University, Phoenix, AZ Introduction: Session participants will be able to describe the relationship between hospital posture/ambulation and readmission status and functional outcomes at 30 days in a sample of older adults with heart failure. Background: Heart failure is the leading cause of hospitalization in older adults and has the highest 30-day readmission rate of all diagnoses. An estimated 30 to 60 percent of older adults lose some degree of physical function during the course of an acute hospital stay. Few studies have addressed the role of posture and ambulation in contributing to, or improving, physical function in older hospitalized adults. No study to date has addressed this specifically in the older heart failure population. Purpose: To investigate the predictive value of posture and ambulation during a hospital stay and patterns of ambulation during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients. Methods: This was a prospective observational study of 27 older (ages 62 + years) hospital patients admitted with a primary diagnosis of heart failure. During hospitalization, participants wore continuously two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Participants continued to wear the ankle accelerometer for 30 days after hospital discharge. Function was assessed for all patients the day after hospital discharge (Timed Up and Go test [TUG], Short Performance Physical Battery test [SPPB], hand grip strength) and again at 30 days post-discharge. Results: Mean participant age was 78.0 ± 9.8 (51.8% female) with a mean length of stay of 5.1 ± 3.9 days (median 3.9 days). Participants spent (M ± SD) 63.0 ± 19.2 percent of their hospital time lying, 30.2 ± 18.7 percent sitting, 5.3 ± 4.2 percent standing, and 1.9 ± 8.6 percent ambulating. Thirty-day post-discharge stepping (M ± SD) was 4890 ± 2285. Five patients (18.5%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower TUG time (b = .08 [95% CI .03, .14], P = .02). Higher average daily stepping during the post-discharge period was associated with improvements in SPPB scores at 30 days post-discharge (b = .001 [95% CI .00, .001], P < .001). Conclusion: In this sample of older heart failure patients, increased time lying while hospitalized was associated with decreased functional performance. Higher daily stepping in the early post-discharge period was associated with improvements in physical function at 30 days. Findings from this and similar studies should be used to inform interventions targeting patient care practices to improve mobility care and support of older adults hospitalized with medical illnesses such as heart failure.
016 Depression, Fatigue and Sleep Quality are Associated with Quality of Life among Patients with Left Ventricular Assist Device Martha A. Abshire, Cheryl Dennison Himmelfarb; Johns Hopkins University, Baltimore, MD Introduction: Functional status and quality of life (QOL) have been demonstrated to improve significantly from pre-implant through the first year of LVAD support. However, little is known about the home-dwelling LVAD patient experience in the stage of chronic care after adaptation to implantation. Poor sleep quality, fatigue and depression are associated with worse outcomes among heart failure patients, but few studies have examined these variables in the LVAD population. Hypothesis: The purpose of this study was to examine the relationships between sleep, fatigue, depression and QOL among LVAD patients. We hypothesized that poor sleep quality, high levels of fatigue and high levels of depression would be associated with lower QOL among LVAD patients. Methods: Using a descriptive, observational study design and collected cross-sectional data from a convenience sample of LVAD patients receiving treatment at an established LVAD outpatient clinic. IRB approval was obtained. Patients attending a clinic visit at any
•
HFSA
S7
time after the first outpatient clinic appointment were eligible to participate. To be included, patients also had to speak/read English and be >21 years of age. Patients were screened using the Montreal Cognitive Assessment and were ineligible with a score less than 17 (severe cognitive impairment). Written consent was obtained. Patients completed the following self-report surveys on the day of an LVAD clinic appointment: PSQI, MAF, PHQ-9 and KCCQ-12. Individual clinical characteristics were obtained through chart review. Descriptive statistics and correlation analytics were performed. Results: This sample of 22 LVAD patients was primarily male (68%), black (59%), and married (57%) with a mean age of 58.5 ± 9.7 years. Most were bridge to transplant (59%), supported for a mean of 21.6 ± 24.9 months and a median of 13.8 months. Participants self-reported low levels of depression (mean 3.05 ± 4.24), moderate sleep quality (6.25 ± 3.8) and low fatigue (mean 12 ± 15.8). QOL was reported at high levels (mean 71.24 ± 16), consistent with 12–24 month LVAD outcomes. High levels of sleep disturbances were the greatest contributor to decreased sleep quality. Low symptom frequency enhanced QOL scores. Depression, fatigue and sleep quality were all significantly correlated with QOL in the expected direction (P < .002, P < .02, P < .01, respectively) using Spearman’s correlation. Conclusions: This preliminary data suggests that LVAD patients in the chronic stage of management experience good QOL, but may need support to improve factors affecting QOL. Clinical assessment of depression and sleep quality in patients with increased symptom severity is suggested. Interventions to improve emotional adjustment, depression and sleep may further improve QOL.
Variables
APOE ε4 absent (N = 19)
APOE ε4 present (N = 7)
MannWhitney P-value
Memory Recall Delayed recall Attention
24.5 ± 5.2 8.8 ± 3.3 2.7 ± 0.1
22.3 ± 7.3 8.9 ± 2.4 2.7 ± 0.1
.543 .774 .541
evaluated in linear regression analyses, and there was no evidence for confounding effects. Conclusions: The APOE ε4 allele was present in nearly 1/4 of patients, which is similar to the frequency in general older US population. In this small cohort, no association between APOE ε4 and memory or attention was found. Future studies are needed to deepen our understanding of APOE ε4 genotypes and memory and attention impairment in HF.
015 Posture, Mobility, and 30-Day Hospital Readmission and Function in Older Adults with Heart Failure Theresa Floegel1,2, Cheryl DerAnanian2, Jared Dickinson2, Marianne McCarthy2, Steven P. Hooker2, Matthew Buman2; 1UNC-Chapel HIll, Raleigh, NC; 2Arizona State University, Phoenix, AZ Introduction: Session participants will be able to describe the relationship between hospital posture/ambulation and readmission status and functional outcomes at 30 days in a sample of older adults with heart failure. Background: Heart failure is the leading cause of hospitalization in older adults and has the highest 30-day readmission rate of all diagnoses. An estimated 30 to 60 percent of older adults lose some degree of physical function during the course of an acute hospital stay. Few studies have addressed the role of posture and ambulation in contributing to, or improving, physical function in older hospitalized adults. No study to date has addressed this specifically in the older heart failure population. Purpose: To investigate the predictive value of posture and ambulation during a hospital stay and patterns of ambulation during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients. Methods: This was a prospective observational study of 27 older (ages 62 + years) hospital patients admitted with a primary diagnosis of heart failure. During hospitalization, participants wore continuously two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Participants continued to wear the ankle accelerometer for 30 days after hospital discharge. Function was assessed for all patients the day after hospital discharge (Timed Up and Go test [TUG], Short Performance Physical Battery test [SPPB], hand grip strength) and again at 30 days post-discharge. Results: Mean participant age was 78.0 ± 9.8 (51.8% female) with a mean length of stay of 5.1 ± 3.9 days (median 3.9 days). Participants spent (M ± SD) 63.0 ± 19.2 percent of their hospital time lying, 30.2 ± 18.7 percent sitting, 5.3 ± 4.2 percent standing, and 1.9 ± 8.6 percent ambulating. Thirty-day post-discharge stepping (M ± SD) was 4890 ± 2285. Five patients (18.5%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower TUG time (b = .08 [95% CI .03, .14], P = .02). Higher average daily stepping during the post-discharge period was associated with improvements in SPPB scores at 30 days post-discharge (b = .001 [95% CI .00, .001], P < .001). Conclusion: In this sample of older heart failure patients, increased time lying while hospitalized was associated with decreased functional performance. Higher daily stepping in the early post-discharge period was associated with improvements in physical function at 30 days. Findings from this and similar studies should be used to inform interventions targeting patient care practices to improve mobility care and support of older adults hospitalized with medical illnesses such as heart failure.
016 Depression, Fatigue and Sleep Quality are Associated with Quality of Life among Patients with Left Ventricular Assist Device Martha A. Abshire, Cheryl Dennison Himmelfarb; Johns Hopkins University, Baltimore, MD Introduction: Functional status and quality of life (QOL) have been demonstrated to improve significantly from pre-implant through the first year of LVAD support. However, little is known about the home-dwelling LVAD patient experience in the stage of chronic care after adaptation to implantation. Poor sleep quality, fatigue and depression are associated with worse outcomes among heart failure patients, but few studies have examined these variables in the LVAD population. Hypothesis: The purpose of this study was to examine the relationships between sleep, fatigue, depression and QOL among LVAD patients. We hypothesized that poor sleep quality, high levels of fatigue and high levels of depression would be associated with lower QOL among LVAD patients. Methods: Using a descriptive, observational study design and collected cross-sectional data from a convenience sample of LVAD patients receiving treatment at an established LVAD outpatient clinic. IRB approval was obtained. Patients attending a clinic visit at any
•
HFSA
S7
time after the first outpatient clinic appointment were eligible to participate. To be included, patients also had to speak/read English and be >21 years of age. Patients were screened using the Montreal Cognitive Assessment and were ineligible with a score less than 17 (severe cognitive impairment). Written consent was obtained. Patients completed the following self-report surveys on the day of an LVAD clinic appointment: PSQI, MAF, PHQ-9 and KCCQ-12. Individual clinical characteristics were obtained through chart review. Descriptive statistics and correlation analytics were performed. Results: This sample of 22 LVAD patients was primarily male (68%), black (59%), and married (57%) with a mean age of 58.5 ± 9.7 years. Most were bridge to transplant (59%), supported for a mean of 21.6 ± 24.9 months and a median of 13.8 months. Participants self-reported low levels of depression (mean 3.05 ± 4.24), moderate sleep quality (6.25 ± 3.8) and low fatigue (mean 12 ± 15.8). QOL was reported at high levels (mean 71.24 ± 16), consistent with 12–24 month LVAD outcomes. High levels of sleep disturbances were the greatest contributor to decreased sleep quality. Low symptom frequency enhanced QOL scores. Depression, fatigue and sleep quality were all significantly correlated with QOL in the expected direction (P < .002, P < .02, P < .01, respectively) using Spearman’s correlation. Conclusions: This preliminary data suggests that LVAD patients in the chronic stage of management experience good QOL, but may need support to improve factors affecting QOL. Clinical assessment of depression and sleep quality in patients with increased symptom severity is suggested. Interventions to improve emotional adjustment, depression and sleep may further improve QOL.