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Incidence, Trends and Predictors of Palliative Care Consultation among Patients Admitted for LVAD Implantation in the United States
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.
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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.