Problems Experienced by Heart Failure Patients the First Month After Discharge from a Heart Failure Related Hospitalization

S86 Journal of Cardiac Failure Vol. 23 No. 8S August 2017 with cognitive impairment may inaccurately reflect their ability to manage independently. We hypothesized that older cognitively impaired patients who had an abnormal mini-cog, self report on IADLs would not be reliable. Methods: Setting: Cardiology service at an academic medical center. Population: Patients >60 yo who were living in the community with abnormal MiniCog and their primary caregivers. Design: Convenience sample of consecutive eligible patients seen for geriatrics heart failure comanagement and willing to undergo cognitive and IADL testing with their primary caregivers available to report their assessment of IADLs. Measures: We assessed IADLs using the ALSAR-R2 instrument. IADLs were reported and graded separately by both the patient and a family member most familiar with the patient. The availability of resources for each IADL was also assessed for and graded separately by both the patient and a family member/caregiver. Participant patients also underwent cognitive testing with the Montreal Cognitive Assessment (MoCA). Results: A total of 30 patients met our inclusion criteria. MoCA was missing for one patient and was excluded from the analytic sample. The average age was 76 years old, and 55% were men. The MoCA and difference between caregiver and patient ALSAR correlated with a r2 = −0.58 and P < .05 by Wilcoxon Signed Rank Test for small samples based on W score. Conclusions: Degree of discordance between ALSAR-R2 report by patient from caregiver appears to correlate with severity of cognitive impairment based on MoCA. A larger sample is needed to confirm this finding. Discussion: If discordant reporting of ALSAR by patient and caregiver predicts cognitive impairment it may also indicate loss of insight that could further relate to caregiver burden and ability of a patient or their caregiver to follow an after-hospital care plan. This area deserves further study.

sociation HF Class II (53%). Problems identified as being the highest priority during the first month were (1) HF symptoms (e.g., fatigue, shortness of breath); (2) dietary regimen adherence (e.g., maintaining a low sodium diet); and (3) daily activities (e.g., activity intolerance, sleep disturbances). Other high priority problems reported included: mood (e.g., depressed), difficulty adhering to the treatment regimen (e.g., smoking cessation, monitoring daily weights, exercise), and resource difficulties (e.g., decreased finances). Conclusions: During the first month after hospital discharge, HF patients experience a variety of problems that may impact physical and psychological well-being. Interventions which target these issues may be beneficial in preventing hospital readmission.

236 Utilizing a Multi-modal Skin Cancer Education Program with Heart Transplant Recipients to Increase Knowledge and Sun Protection Practices Anna Sorensen, Lisa Norsen, Elizabeth Palermo, Martens John, Leway Chen; URMC, Rochester, NY Background: Immunosuppressant medications significantly increase the risk of developing skin cancers after transplantation. Skin cancers pose problems for transplant patients including: financial burden, impaired quality of life, pain and discomfort from treatments and procedures, and even death. Fortunately, a majority of skin cancers can be prevented or can be detected early and treated successfully. Prevention and early detection of skin cancer requires vigilant screening and strict sun protection behaviors which are often achieved with focused patient education. Skin cancer education in the post-transplant group is inadequate, but with focus and consistency may be a viable approach to addressing the problem. Methods: Twenty five post heart transplant patients who were scheduled to be seen for routine post-transplant care at a single center transplant center between October 26, 2016 and November 15, 2017 were asked to take part in a multi-modal skin cancer education program. The program included a Skin Cancer Sun Knowledge questionnaire, a 7 min video, one to one self-skin exam teach and teach back and an assurance of a dermatology follow up. The participants were asked to take the SCSK questionnaire immediately after the video and SSE teach and asked again to take it in one month and mail it back to the PC. Results: We noted a significant increase in knowledge between Pretest and Posttest 1 (P < .01) and pretest and Posttest 2 (P < .01). We also noted an increase in sun protective behavior in the following areas: wear sunscreen daily (P < .01) Pretest and Posttest 1, (P < .01), Pretest and Posttest 2; SSE (P < .01) Pretest and Posttest 1, (P < .03) Pretest and Posttest 2, and follow up with a dermatologist (P < .01) Pretest and Posttest 1, (P < .01) Pretest and Posttest 2. Conclusions: This data suggests that a multi-modal intensive skin cancer education program may be effective at increasing knowledge and sun protective behavior in the post heart transplant population.

Table 1. Results: Knowledge scores.

235 Problems Experienced by Heart Failure Patients the First Month After Discharge from a Heart Failure Related Hospitalization Lucinda J. Graven1, Joan Grant Keltner2, Kelly Fuller1; 1Florida State University, Tallahassee, FL; 2University of Alabama at Birmingham, Birmingham, AL Background: Thirty-day readmission rates remain high for HF patients despite concentrated efforts to address this issue. Problems experienced in the first month after hospital discharge may increase risk for readmission. Knowledge of frequent HFrelated problems experienced during the first month after hospital discharge could provide insight for intervention development. Purpose: To identify the highest priority problems experienced by HF patients the first month after discharge from a HF-related hospitalization. Methods: This study was part of a randomized controlled trial that examined the effectiveness of a coping partnership intervention on HF self-care, depression, and healthcare utilization. Patients with HF (n = 25) who were assigned to the intervention group participated in this study. Participants received 1 home visit, followed by weekly telephone calls for the first month post discharge. A card sorting activity was used to help participants identify their highest priority problems from a set of 8 cards which identified common HF-related problems in the areas of HF symptoms, dietary and treatment regimen, interpersonal and social issues, daily activities, mood, resource difficulties, and other. Descriptive statistics were used to analyze demographic and clinical data. Content and quantitative data analysis were used to identify the highest priority problems experienced by participants. Problems were independently analyzed and coded by two content experts, with differences discussed until consensus was reached on the final list of problems. Results: Overall, participants were unmarried (68%), African American (42%), women (42%), with New York Heart As-

Table 2. Results: Knowledge significance.

Table 3. Results: Behavior.