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Sodium Polystyrene Sulfonate for Secondary Prevention of Hyperkalemia in Patients with Chronic Kidney and Heart Diseases on Renin-Angiotensin-Aldosterone System Blockade Therapy
The 15th Annual Scientific Meeting months), age, percent males, myocardial infarction, and comorbidities such as chronic obstructive pulmonary disease, and atrial fibrillation (all PO0.05). The two groups differed in prevalence of coronary artery disease (CAD; 64% in non-diabetics vs. 72% in diabetics, P50.005), hypertension (HTN; 64% in non-diabetics vs. 77% in diabetics, P!0.001) and sleep apnea (8% in non-diabetics vs. 13% diabetics, P50.013). Importantly, there was a statistically significant higher number of patients with HFHs in the diabetic group versus non-diabetic group. Total number of HFHs, HFH per patient, percent of patients rehospitalized, and number of 30 day readmissions were also higher in diabetic group (see Table). Diabetes remained an independent risk factor even after adjusting for CAD, HTN, and sleep apnea (odds ratio: 1.9, CI: 1.2-2.9, P50.004). Conclusion: The HF patients with diabetes are at a statistically significant higher risk of being hospitalized for HF, and a significantly greater proportion of them are rehospitalized for HF. Further studies are required to confirm this post-hoc analysis and determine if treatments to improve diabetic care could reduce the increased risk of hospitalization.
HFSA
S107
by tissue Doppler imaging showed no significant changes (7.1 6 1.1 and 7.0 6 1.1 cm/s, respectively, p5NS). E/E’ ratio showed trend of increase (10.5 6 2.7 vs.11.2 6 3.1, p50.090). In hypertensive patients (23.2%), E/E’ values were consistently higher and baseline S’ velocity was lower than in non-hypertensives.
Comparison of HFHs in Diabetics vs. Non-Diabetics
Follow-up duration (months) Number of Patients with HFH Number of HFHs Number of HFH/patient Number of patients rehospitalized 30 day HF readmissions
Diabetics (n5582)
Non-diabetics (n5396)
p value
11 6 3 42 (7%) 55 1.3 9 (1.5%) 1.0/patient
11 6 3 54 (14%) 98 1.8 19 (4.8%) 1.9/patient
0.961 0.001 NA 0.097 0.005 NA
Baseline and Changes of Echocardiographic Parameters Regarding Risk Factors Hypertension Yes (n513) vs. No (n543) LV EF (%)
Baseline Follow-up
345 Sodium Polystyrene Sulfonate for Secondary Prevention of Hyperkalemia in Patients with Chronic Kidney and Heart Diseases on Renin-AngiotensinAldosterone System Blockade Therapy Gil Chernin, Amir Gal-Oz, Idit F. Schwartz, Doron Schwartz, Donald S. Silverberg; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
s’ (cm/s)
p value Baseline Follow-up
E/E’
p value Baseline Follow-up
Purpose: Renin-angiotensin-aldosterone system blockade (RAAS-B) may benefit patients with left-ventricular dysfunction (LVD) or post myocardial-infarction (MI). Hyperkalemia, induced by RAAS-B in patients with CKD, often leads to withdraw of RAAS-B therapy. Sodium polystyrene sulfonate (SPS) is an ion-exchange resin used for the treatment of hyperkalemia. Recently, concerns regarding its safety have emerged, mainly due to its mixture with sorbitol. Here, we report of a longterm follow-up of 14 patients with CKD and heart disease on RAAS-B, with the use of low-dose daily SPS as a secondary prevention of hyperkalemia. Methods: We evaluated all the patients with CKD (non-dialysis patients) and heart disease, treated in our CKD clinic from 2000 to 2010. Of which, we detected all patients on RAAS-B therapy who were treated with daily or alternate-day low-dose SPS (sorbitol-free) after episodes of hyperkalemia. Data on hospitalizations, symptoms that may be attributed to SPS therapy and electrolyte concentration levels were obtained. Results: Fourteen patients with LVD or post-MI were treated with low-dose SPS therapy for a total of 289 months (median length of follow-up 14.5 months; range 7-47 months). None of the patients developed colonic necrosis or life-threatening events attributed to SPS use. Worsening of heart failure or fluid retention were not observerd. Marked hypocalcemia (two patients) and mild episodes of hypokalemia (two patients) were noted without acute clinical consequence. Sodium and phosphor levels remained within normal limits. Overall, SPS was well-tolerated during the follow-up without self-withdrawl of therapy by any of the patients. Conclusions: Prolonged use of low-dose SPS was relatively safe as a secondary prevention measure of hyperkalemia, induced by RAAS-B in CKD patients with heart disease. Future randomized studies are warranted to further evaluate the safety, efficacy and clinical benefits SPS as a secondary prevention measure of hyperkalemia in comparison with novel binding-resins.
346 Changes of Left Ventricular Function Assessed by 2D and Doppler Echocardiography in Patients Receiving Tratsuzumab Therapy Sun Hwa Lee, Won Ho Kim, Jae Ki Ko, Yun Ji Park, Lae Young Jung, Min Ju Song, Hae Eun Yun; Cardiology, Chonbuk National University Medical School, Jeonju, Korea Background: We investigated the incidence of cardiac adverse events and changes in echocardiographic parameters in breast cancer patients receiving tratsuzumab (Herceptin) therapy. Methods: 56 patients who were receiving tratsuzumab therapy were enrolled. All patients underwent 2D and Doppler echocardiography before the commencement of therapy and every 3 months thereafter. Results: Mean age was 52 6 9 (31-75) years. Tratsuzumab was used as adjuvant chemotherapy in 52 patients (92.9%). 50 patients (89.3%) had been treated with anthracyclines and 37 (66.1%) had received radiation therapy. Symptomatic CHF occurred in 1 patient (1.8%) whose LV EF declined from 52% to 26%, but it was reversible. Another one patient’s EF fell 10% without CHF symptoms. Mean baseline and follow-up EF were 59.1 6 3.7% and 58.4 6 6.1%, respectively (p5NS). S’ velocities assessed
p value
58.3 6 4.3 : 59.3 6 3.5 56.9 6 9.8 : 58.9 6 4.5 NS 6.5 6 1.1 : 7.3 6 1.0 6.8 6 0.8 : 7.0 6 1.2 NS 12.3 6 3.2 : 10.0 6 2.4 13.5 6 4.1 : 10.4 6 2.4 NS
p value NS NS
0.014* NS
0.007* 0.001*
Radiation Therapy Yes (n537) vs. No (n519) 58.7 6 4.1 : 59.8 6 4.1 57.4 6 6.9 : 60.4 6 3.4 NS 7.1 6 1.2 : 7.2 6 0.7 6.8 6 1.1 : 7.3 6 0.9 NS 10.5 6 2.6 : 10.6 6 3.1 11.0 6 3.4 : 11.4 6 2.8 NS
Use of anthracycline Yes (n550) vs. No (n56)
NS NS
NS NS
NS NS
59.0 6 3.8 : 59.2 6 2.3 58.4 6 6.3 : 58.8 6 3.6 NS 7.2 6 1.1 : 7.0 6 0.7 6.9 6 1.1 : 7.3 6 1.2 NS 10.6 6 2.6 : 10.3 6 4.3 11.2 6 3.1 : 10.8 6 3.6 NS
NS NS
NS NS
NS NS
*p!0.05 Conclusion: The incidence of tratsuzumab-induced cardiotoxicity was very low. In addition to measurement of LV EF, Doppler echocardiographic parameters should be added for surveillance of cardiac function in patients receiving tratsuzumab therapy.
347 Evaluation of an Educational Intervention, Utilizing Simulation and a Teach Back (TB) Method, To Increase Nurses’ Knowledge and Retention of Heart Failure (HF) Self-Management (SM) Principles Sarah Frewin1, Tara Mahramus1, Lyne Chamberlain2, Debra Wilson3, Daleen Penoyer4, Mary Lou Sole4; 1Cardiology, Orlando Health: ORMC, Orlando, FL; 2 Cardiology, Orlando Health: Dr. P. Phillips, Orlando, FL; 3Home Health, Orlando Health: Visiting Nurses Association, Orlando, FL; 4Nursing Research, Orlando Health, Orlando, FL Introduction: Heart failure (HF) readmissions occur frequently. Two systematic reviews on HF management supported interventions that included education and self management (SM) techniques. In 2010, nurses in acute care and home health care were assessed for their knowledge level on SM principles. The average score of the 95 participants was 13.96 (+-2.4 SD) out of 20 possible points (70%). Improving nurse knowledge on SM may enhance their abilities for discharge education of patients with HF. Hypothesis: Nurses participation in a comprehensive HF education program will increase their knowledge and retention of HF SM principles. Methods: The study used a quasi-experimental, pre-test, post-test design. Nurses who care for patients with HF from in-and out-patient areas at 4 sites within a large community hospital system were included. After taking the 20-item pre-test Nurses’ Knowledge of HF Education Principles Survey, subjects attended a 3- hour class on HF SM principles and TB. Simulation, including demonstration role-play was used to reinforce TB. Subjects completed a post-test, identical to the pre-test, and underwent competency assessment using TB with one HF SM principle after class completion. To promote retention, HF education program content will be reinforced via multimodal means. Results: A total of 158 nurses from 4 sites participated: 111 from in-patient, 35 from outpatient area, and 12 had missing demographic data. Improvement in mean scores were found from pre to post-test scores (13.0 vs. 16.1, p!.001). Only 6.3% had a passing score of 85% on the pre-test, where 42.5 % had an 85% or greater on the post-test. Teach back competency assessment scores showed that 97.8% demonstrated appropriate TB. No statistical differences were found between pre and post tests by site, licensure, certification, years on unit, and years as a nurse. A planned retesting for retention will be done 3 months after course completion. Conclusions: Based upon findings, this educational intervention has shown effectiveness in
HFSA
S107
by tissue Doppler imaging showed no significant changes (7.1 6 1.1 and 7.0 6 1.1 cm/s, respectively, p5NS). E/E’ ratio showed trend of increase (10.5 6 2.7 vs.11.2 6 3.1, p50.090). In hypertensive patients (23.2%), E/E’ values were consistently higher and baseline S’ velocity was lower than in non-hypertensives.
Comparison of HFHs in Diabetics vs. Non-Diabetics
Follow-up duration (months) Number of Patients with HFH Number of HFHs Number of HFH/patient Number of patients rehospitalized 30 day HF readmissions
Diabetics (n5582)
Non-diabetics (n5396)
p value
11 6 3 42 (7%) 55 1.3 9 (1.5%) 1.0/patient
11 6 3 54 (14%) 98 1.8 19 (4.8%) 1.9/patient
0.961 0.001 NA 0.097 0.005 NA
Baseline and Changes of Echocardiographic Parameters Regarding Risk Factors Hypertension Yes (n513) vs. No (n543) LV EF (%)
Baseline Follow-up
345 Sodium Polystyrene Sulfonate for Secondary Prevention of Hyperkalemia in Patients with Chronic Kidney and Heart Diseases on Renin-AngiotensinAldosterone System Blockade Therapy Gil Chernin, Amir Gal-Oz, Idit F. Schwartz, Doron Schwartz, Donald S. Silverberg; Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
s’ (cm/s)
p value Baseline Follow-up
E/E’
p value Baseline Follow-up
Purpose: Renin-angiotensin-aldosterone system blockade (RAAS-B) may benefit patients with left-ventricular dysfunction (LVD) or post myocardial-infarction (MI). Hyperkalemia, induced by RAAS-B in patients with CKD, often leads to withdraw of RAAS-B therapy. Sodium polystyrene sulfonate (SPS) is an ion-exchange resin used for the treatment of hyperkalemia. Recently, concerns regarding its safety have emerged, mainly due to its mixture with sorbitol. Here, we report of a longterm follow-up of 14 patients with CKD and heart disease on RAAS-B, with the use of low-dose daily SPS as a secondary prevention of hyperkalemia. Methods: We evaluated all the patients with CKD (non-dialysis patients) and heart disease, treated in our CKD clinic from 2000 to 2010. Of which, we detected all patients on RAAS-B therapy who were treated with daily or alternate-day low-dose SPS (sorbitol-free) after episodes of hyperkalemia. Data on hospitalizations, symptoms that may be attributed to SPS therapy and electrolyte concentration levels were obtained. Results: Fourteen patients with LVD or post-MI were treated with low-dose SPS therapy for a total of 289 months (median length of follow-up 14.5 months; range 7-47 months). None of the patients developed colonic necrosis or life-threatening events attributed to SPS use. Worsening of heart failure or fluid retention were not observerd. Marked hypocalcemia (two patients) and mild episodes of hypokalemia (two patients) were noted without acute clinical consequence. Sodium and phosphor levels remained within normal limits. Overall, SPS was well-tolerated during the follow-up without self-withdrawl of therapy by any of the patients. Conclusions: Prolonged use of low-dose SPS was relatively safe as a secondary prevention measure of hyperkalemia, induced by RAAS-B in CKD patients with heart disease. Future randomized studies are warranted to further evaluate the safety, efficacy and clinical benefits SPS as a secondary prevention measure of hyperkalemia in comparison with novel binding-resins.
346 Changes of Left Ventricular Function Assessed by 2D and Doppler Echocardiography in Patients Receiving Tratsuzumab Therapy Sun Hwa Lee, Won Ho Kim, Jae Ki Ko, Yun Ji Park, Lae Young Jung, Min Ju Song, Hae Eun Yun; Cardiology, Chonbuk National University Medical School, Jeonju, Korea Background: We investigated the incidence of cardiac adverse events and changes in echocardiographic parameters in breast cancer patients receiving tratsuzumab (Herceptin) therapy. Methods: 56 patients who were receiving tratsuzumab therapy were enrolled. All patients underwent 2D and Doppler echocardiography before the commencement of therapy and every 3 months thereafter. Results: Mean age was 52 6 9 (31-75) years. Tratsuzumab was used as adjuvant chemotherapy in 52 patients (92.9%). 50 patients (89.3%) had been treated with anthracyclines and 37 (66.1%) had received radiation therapy. Symptomatic CHF occurred in 1 patient (1.8%) whose LV EF declined from 52% to 26%, but it was reversible. Another one patient’s EF fell 10% without CHF symptoms. Mean baseline and follow-up EF were 59.1 6 3.7% and 58.4 6 6.1%, respectively (p5NS). S’ velocities assessed
p value
58.3 6 4.3 : 59.3 6 3.5 56.9 6 9.8 : 58.9 6 4.5 NS 6.5 6 1.1 : 7.3 6 1.0 6.8 6 0.8 : 7.0 6 1.2 NS 12.3 6 3.2 : 10.0 6 2.4 13.5 6 4.1 : 10.4 6 2.4 NS
p value NS NS
0.014* NS
0.007* 0.001*
Radiation Therapy Yes (n537) vs. No (n519) 58.7 6 4.1 : 59.8 6 4.1 57.4 6 6.9 : 60.4 6 3.4 NS 7.1 6 1.2 : 7.2 6 0.7 6.8 6 1.1 : 7.3 6 0.9 NS 10.5 6 2.6 : 10.6 6 3.1 11.0 6 3.4 : 11.4 6 2.8 NS
Use of anthracycline Yes (n550) vs. No (n56)
NS NS
NS NS
NS NS
59.0 6 3.8 : 59.2 6 2.3 58.4 6 6.3 : 58.8 6 3.6 NS 7.2 6 1.1 : 7.0 6 0.7 6.9 6 1.1 : 7.3 6 1.2 NS 10.6 6 2.6 : 10.3 6 4.3 11.2 6 3.1 : 10.8 6 3.6 NS
NS NS
NS NS
NS NS
*p!0.05 Conclusion: The incidence of tratsuzumab-induced cardiotoxicity was very low. In addition to measurement of LV EF, Doppler echocardiographic parameters should be added for surveillance of cardiac function in patients receiving tratsuzumab therapy.
347 Evaluation of an Educational Intervention, Utilizing Simulation and a Teach Back (TB) Method, To Increase Nurses’ Knowledge and Retention of Heart Failure (HF) Self-Management (SM) Principles Sarah Frewin1, Tara Mahramus1, Lyne Chamberlain2, Debra Wilson3, Daleen Penoyer4, Mary Lou Sole4; 1Cardiology, Orlando Health: ORMC, Orlando, FL; 2 Cardiology, Orlando Health: Dr. P. Phillips, Orlando, FL; 3Home Health, Orlando Health: Visiting Nurses Association, Orlando, FL; 4Nursing Research, Orlando Health, Orlando, FL Introduction: Heart failure (HF) readmissions occur frequently. Two systematic reviews on HF management supported interventions that included education and self management (SM) techniques. In 2010, nurses in acute care and home health care were assessed for their knowledge level on SM principles. The average score of the 95 participants was 13.96 (+-2.4 SD) out of 20 possible points (70%). Improving nurse knowledge on SM may enhance their abilities for discharge education of patients with HF. Hypothesis: Nurses participation in a comprehensive HF education program will increase their knowledge and retention of HF SM principles. Methods: The study used a quasi-experimental, pre-test, post-test design. Nurses who care for patients with HF from in-and out-patient areas at 4 sites within a large community hospital system were included. After taking the 20-item pre-test Nurses’ Knowledge of HF Education Principles Survey, subjects attended a 3- hour class on HF SM principles and TB. Simulation, including demonstration role-play was used to reinforce TB. Subjects completed a post-test, identical to the pre-test, and underwent competency assessment using TB with one HF SM principle after class completion. To promote retention, HF education program content will be reinforced via multimodal means. Results: A total of 158 nurses from 4 sites participated: 111 from in-patient, 35 from outpatient area, and 12 had missing demographic data. Improvement in mean scores were found from pre to post-test scores (13.0 vs. 16.1, p!.001). Only 6.3% had a passing score of 85% on the pre-test, where 42.5 % had an 85% or greater on the post-test. Teach back competency assessment scores showed that 97.8% demonstrated appropriate TB. No statistical differences were found between pre and post tests by site, licensure, certification, years on unit, and years as a nurse. A planned retesting for retention will be done 3 months after course completion. Conclusions: Based upon findings, this educational intervention has shown effectiveness in