- Email: [email protected]
Long-term effect of patiromer for hyperkalemia treatment in patients with chronic kidney disease, heart failure, and ejection fraction >40% on RAAS inhibitors
TagedEn654
Abstracts / Heart & Lung 47 (2018) 650 655
cardiomyopathy (including NICM), with an EF of less than or equal to 35%, ICD explanations, and other conditions with high risk of ventricular tachycardia (VT) or VF are candidates for the WCD. The sample of data was from 186 patients. However, more patients were likely candidates but may not have been considered due to lack of awareness or provider preference of the WCD. Of those patients, four received a living saving shock from the WCD. Two were ICM and two were NICM. Of the sample population, there was a much smaller group of woman than men protected with the WCD. Recognizing at risk patients for SCA can be challenging. There is considerable controversy regarding the use of the WCD in the short term for cardiomyopathy patients. The use of the WCD has shown to be lifesaving in both the ICM and NICM patients in protecting them from SCA. However, the risk assessment among patients with NICM is less straightforward that’s for patients with ICM. The WCD is a therapeutic option, listed along with implantable cardioverter defibrillators (ICDs), in the ACC/AHA/ESC Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. It is also a Class I recommendation in the International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates. Result: The PinnacleHealth CardioVascular Institute enrolled 186 patients with ischemic (N= 60, 32.3%), and nonischemic (n= 126, 67.7 %) cardiomyopathies prescribed the WCD between October 1, 2015 through September 30 2017. Clinical data, arrhythmic events, and ejection fractions were captured. The median age was 62-years-old; there were 58 female patients (31%) and 128 male patients (69%), the median ejection fraction was 25%. Four patients received appropriate WCD shock. Two patients were NICM (2%) and two patients were ICM (4%). Of the two ICM there was one VT and one VF arrest. Of the NICM they were both shocked for VF arrests. Long-term effect of patiromer for hyperkalemia treatment in patients with chronic kidney disease, heart failure, and ejection fraction >40% on RAAS inhibitors TAGEDPBERTRAM PITT, ANDREW KO, MARTHA MAYO, DAHLIA GARZA, SUSAN ARTHUR, LAINSCAK MITJATAGEDN Background: Patients with heart failure and chronic kidney disease (CKD) on RAAS inhibitors have a high risk of hyperkalemia, which can increase risk of mortality and lead to RAAS inhibitor dose reduction or discontinuation. Patiromer, a sodium-free nonabsorbed K+-binding polymer that exchanges calcium for K+, is approved for the treatment of hyperkalemia. Previously, we showed that patiromer reduced mean serum K+ over 52 weeks in a small (n=26) subgroup of patients with heart failure with reduced ejection fraction (40%) in the AMETHYST-DN study. Methods: Patients with CKD, type 2 diabetes mellitus, and hyperkalemia (baseline serum K+ >5.0 to <6.0 mEq/L) were randomized to patiromer starting doses of 8.4 33.6 g/d, divided twice daily. All patients remained on RAAS inhibitors during study treatment. Changes in mean serum K+ from baseline through 52 weeks were evaluated in the subgroup of patients with heart failure and EF >40%. Conclusion: Patiromer decreased serum K+ through 52 weeks in patients with hyperkalemia, chronic kidney disease, and heart failure with EF>40%, all of whom were taking RAAS inhibitors. These posthoc results require prospective evaluation, but suggest that patiromer allows control of hyperkalemia in heart failure patients with EF >40% on RAAS inhibitors. Result: Overall, 55 out of 306 randomized patients had heart failure with EF >40% (100% Caucasian, 75% male, 69% 65 years of age). Mean (SD) EF was 48 (7)% and mean (SD) eGFR was 41 (13) mL/min/ 1.73 m2 at baseline. All patients had hypertension (mean BP 155/ 83 mm Hg). Mean serum K+ was reduced to <5.0 mEq/L at the first post-baseline visit (day 3) through 52 weeks (Table). From baseline to 52 weeks, mean (SE) eGFR increased by 6 (3) mL/min/1.73 m2 and mean (SE) SBP/DBP decreased by 22 (3)/ 9 (2) mm Hg. Forty-two
(76%) patients reported 1 adverse event (AE); hypomagnesemia (9.1%) was the most common AE (none severe). Three patients had serum K+ <3.5 mEq/L. TagedPEn
Implementation challenges of conducting a heart failure palliative care intervention pilot trial in the deep south TAGEDPRACHEL WELLS, NICHOLAS J. DIONNE-ODOM J, SALPY PAMBOUKIAN, JOSE TALLAJ, ANDRES AZUERO, KONA KEEBLER, DEBORAH EJEM, ELIZABETH KVALE, KEITH SWETZ, KAREN STEINHAUSER, REAGAN DURANT, ALAN KONO, MARIE BAKITASTAGEDN Background: We translated and tested ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends Comprehensive Heart care for Patients and Caregivers), an early heart failure (HF) palliative care (PC) telehealth intervention, to determine implementation and access challenges in medically-underserved/rural HF patient and caregiver dyads Methods: ENABLE CHF-PC was piloted in North- and Southeast U.S. sites (4/1/14-8/31/15). Eligibility criteria included: Class III/IV or Stage C/D HF and age 50 years. Intervention components were in-person PC consultation, nurse coach phone sessions (patients: 6 sessions; caregivers: 4 sessions), monthly phone check-ins. Measures included quality of life (QOL), physical/mental health, symptom, and burden outcomes at baseline, 12, and 24 weeks. Feasibility determined by intervention and measurement completion. Conclusion: Lessons learned from pilot-testing ENABLE CHF-PC facilitated refinement of strategies to recruit and retain literacy-challenged advanced HF dyads, which have been incorporated in an ongoing efficacy trial of ENABLE CHF-PC. Result: Patients (n = 61; NE = 32; SE = 29) and caregivers (n = 48; NE =29; SE =19) were enrolled. HF patients were 70.6 years, NYHA Class IIIa/b (70.5%), mostly male (50.8%), and white (80.3%); caregivers were 64.9 years, mostly female (81.3%), and white (83.3%). Intervention sessions averaged 50 minutes per patient and 46 minutes per caregiver. There were between-site differences in completing pc consultation (NE = 44% vs. SE = 20%), patient sessions (NE = 94% vs. SE = 41 %) and measurements (NE = 72% vs. SE = 38%, P = .008). Additional challenges in the SE were recruitment/retention, participants' comprehension of non-hospice palliative care, keeping appointments for
Abstracts / Heart & Lung 47 (2018) 650 655
cardiomyopathy (including NICM), with an EF of less than or equal to 35%, ICD explanations, and other conditions with high risk of ventricular tachycardia (VT) or VF are candidates for the WCD. The sample of data was from 186 patients. However, more patients were likely candidates but may not have been considered due to lack of awareness or provider preference of the WCD. Of those patients, four received a living saving shock from the WCD. Two were ICM and two were NICM. Of the sample population, there was a much smaller group of woman than men protected with the WCD. Recognizing at risk patients for SCA can be challenging. There is considerable controversy regarding the use of the WCD in the short term for cardiomyopathy patients. The use of the WCD has shown to be lifesaving in both the ICM and NICM patients in protecting them from SCA. However, the risk assessment among patients with NICM is less straightforward that’s for patients with ICM. The WCD is a therapeutic option, listed along with implantable cardioverter defibrillators (ICDs), in the ACC/AHA/ESC Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. It is also a Class I recommendation in the International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates. Result: The PinnacleHealth CardioVascular Institute enrolled 186 patients with ischemic (N= 60, 32.3%), and nonischemic (n= 126, 67.7 %) cardiomyopathies prescribed the WCD between October 1, 2015 through September 30 2017. Clinical data, arrhythmic events, and ejection fractions were captured. The median age was 62-years-old; there were 58 female patients (31%) and 128 male patients (69%), the median ejection fraction was 25%. Four patients received appropriate WCD shock. Two patients were NICM (2%) and two patients were ICM (4%). Of the two ICM there was one VT and one VF arrest. Of the NICM they were both shocked for VF arrests. Long-term effect of patiromer for hyperkalemia treatment in patients with chronic kidney disease, heart failure, and ejection fraction >40% on RAAS inhibitors TAGEDPBERTRAM PITT, ANDREW KO, MARTHA MAYO, DAHLIA GARZA, SUSAN ARTHUR, LAINSCAK MITJATAGEDN Background: Patients with heart failure and chronic kidney disease (CKD) on RAAS inhibitors have a high risk of hyperkalemia, which can increase risk of mortality and lead to RAAS inhibitor dose reduction or discontinuation. Patiromer, a sodium-free nonabsorbed K+-binding polymer that exchanges calcium for K+, is approved for the treatment of hyperkalemia. Previously, we showed that patiromer reduced mean serum K+ over 52 weeks in a small (n=26) subgroup of patients with heart failure with reduced ejection fraction (40%) in the AMETHYST-DN study. Methods: Patients with CKD, type 2 diabetes mellitus, and hyperkalemia (baseline serum K+ >5.0 to <6.0 mEq/L) were randomized to patiromer starting doses of 8.4 33.6 g/d, divided twice daily. All patients remained on RAAS inhibitors during study treatment. Changes in mean serum K+ from baseline through 52 weeks were evaluated in the subgroup of patients with heart failure and EF >40%. Conclusion: Patiromer decreased serum K+ through 52 weeks in patients with hyperkalemia, chronic kidney disease, and heart failure with EF>40%, all of whom were taking RAAS inhibitors. These posthoc results require prospective evaluation, but suggest that patiromer allows control of hyperkalemia in heart failure patients with EF >40% on RAAS inhibitors. Result: Overall, 55 out of 306 randomized patients had heart failure with EF >40% (100% Caucasian, 75% male, 69% 65 years of age). Mean (SD) EF was 48 (7)% and mean (SD) eGFR was 41 (13) mL/min/ 1.73 m2 at baseline. All patients had hypertension (mean BP 155/ 83 mm Hg). Mean serum K+ was reduced to <5.0 mEq/L at the first post-baseline visit (day 3) through 52 weeks (Table). From baseline to 52 weeks, mean (SE) eGFR increased by 6 (3) mL/min/1.73 m2 and mean (SE) SBP/DBP decreased by 22 (3)/ 9 (2) mm Hg. Forty-two
(76%) patients reported 1 adverse event (AE); hypomagnesemia (9.1%) was the most common AE (none severe). Three patients had serum K+ <3.5 mEq/L. TagedPEn
Implementation challenges of conducting a heart failure palliative care intervention pilot trial in the deep south TAGEDPRACHEL WELLS, NICHOLAS J. DIONNE-ODOM J, SALPY PAMBOUKIAN, JOSE TALLAJ, ANDRES AZUERO, KONA KEEBLER, DEBORAH EJEM, ELIZABETH KVALE, KEITH SWETZ, KAREN STEINHAUSER, REAGAN DURANT, ALAN KONO, MARIE BAKITASTAGEDN Background: We translated and tested ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends Comprehensive Heart care for Patients and Caregivers), an early heart failure (HF) palliative care (PC) telehealth intervention, to determine implementation and access challenges in medically-underserved/rural HF patient and caregiver dyads Methods: ENABLE CHF-PC was piloted in North- and Southeast U.S. sites (4/1/14-8/31/15). Eligibility criteria included: Class III/IV or Stage C/D HF and age 50 years. Intervention components were in-person PC consultation, nurse coach phone sessions (patients: 6 sessions; caregivers: 4 sessions), monthly phone check-ins. Measures included quality of life (QOL), physical/mental health, symptom, and burden outcomes at baseline, 12, and 24 weeks. Feasibility determined by intervention and measurement completion. Conclusion: Lessons learned from pilot-testing ENABLE CHF-PC facilitated refinement of strategies to recruit and retain literacy-challenged advanced HF dyads, which have been incorporated in an ongoing efficacy trial of ENABLE CHF-PC. Result: Patients (n = 61; NE = 32; SE = 29) and caregivers (n = 48; NE =29; SE =19) were enrolled. HF patients were 70.6 years, NYHA Class IIIa/b (70.5%), mostly male (50.8%), and white (80.3%); caregivers were 64.9 years, mostly female (81.3%), and white (83.3%). Intervention sessions averaged 50 minutes per patient and 46 minutes per caregiver. There were between-site differences in completing pc consultation (NE = 44% vs. SE = 20%), patient sessions (NE = 94% vs. SE = 41 %) and measurements (NE = 72% vs. SE = 38%, P = .008). Additional challenges in the SE were recruitment/retention, participants' comprehension of non-hospice palliative care, keeping appointments for