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What Type of Social Support Do Heart Failure Patients Need?
S102 Journal of Cardiac Failure Vol. 17 No. 8S August 2011 (HFPEF). Data suggests that up to a third of older adults with HFPEF having TTR deposits on autopsy and up to 4% of African Americans are carriers of the V122I allele (substitution of isoleucine for valine at position 122 of the TTR gene), making it the most common amyloidogenic mutation worldwide. Contributing to difficulty in diagnosis is the requirement for an endomyocardial biopsy to confirm the presence of amyloid deposits. A non-invasive method to identify individuals with this condition is needed. Methods: SPECT imaging with technetium-99m pyrophosphate was performed in 12 subjects to date including patients with biopsy proven cardiac amyloidosis from AL disease (n55), ATTR amyloid from either V122I (n53) or wild type disease (n53) and healthy controls (n52). Scans were interpreted by a nuclear cardiologist blinded to subject assignment both qualitatively and quantitatively. Visual scoring of cardiac retention (i.e., score 0, absent cardiac uptake; score 1, mild cardiac uptake, score 2, moderate cardiac uptake; score 3, strong cardiac uptake). Semi-quantitative analyses of heart retention (heart to mediastinal ratio) was evaluated from region of interest (ROI) drawn over the heart and superior mediastinum. All images will be performed on ECAM, Siemens Camera with low energy and high resolution collimators. Results: The cohorts with ATTR amyloid all demonstrated marked uptake which differed significantly from controls, who demonstrated absent cardiac uptake and AL amyloid subjects that 80% of the time demonstrated no cardiac uptake (p50.0175, by chi-square with fisher’s exact test). Using a semi-quantitative analysis of heart retention by comparison to a region of interest (ROI), subjects with ATTR cardiac amyloid had higher heart retention than AL and controls, p50.0036 by Kruskall-Wallis.
whether improvement of emotional support leads to improvement in physical and emotional symptom status and HRQOL.
329 Factors Related to Self-Care Behavior among Outpatients with Heart Failure in Korea Jong Sun Ok1, Heejung Choi2, Kyu Hyung Ryu1, Sung Hea Kim1, Min-Seok Kim3, Jin-Oh Choi4; 1Cardiovascular Center, KonKuk University Medical Center, Seoul, Republic of Korea; 2Nursing, Konkuk Univeristy, Chungju, Republic of Korea; 3 Cardiovascular Center, Asan Medical Center, Seoul, Republic of Korea; 4Division of Cardiology, Samsung Medical Center, Seoul, Republic of Korea Background: The Korean society has become an aging society and the heart failure patients will drastically increase in the future. However, heart failure has not recognized as a chronic disease and there were no statistical results about the cost of hospitalization with heart failure and the number of patients treated heart failure in Korea. Purpose: The aims of this study are to evaluate adherence to heart failure patients’ self-care behavior and to identify associated factors with it in Korea. Methods: Target population was the outpatients of cardiac centers in three multicenter. A total of 312 patients were participated, however, the data from 298 patients were analyzed. The structured questionnaire consisted of the Korean version of the European Heart Failure Self-care Behavior Scale(EHFScBS), Duke Activity Status Index, Dutch Heart Failure Knowledge Scale, Beck Depression Inventory (BDI) short form, and Medical outcomes study (MOS) social support. Results: The score of the European heart failure self-care behavior scale(EHFScBS) ranges from 12 to 60, indicating higher score means good self-care. The mean (SD) of the EHFScBS was 40.18(6 7.62). It implies that the subjects have done self-care relatively well. One of the possible reasons may be the national health center provides the free flu shot to people aged 65 years and older every year. Another possible explanation may be the well-developed health insurance system in Korea makes easy to access to medical help. Among five selected potential affecting factors (age, activity status, heart failure knowledge, depression, and social support) to self-care behavior, social support (ß5.209, p5.001), age (ß5 .223, p5.002), and heart failure knowledge (ß5.140, p5.021) were significant. It means that those who is older, perceives to be supported, and has more knowledge on heart failure is likely to adhere to the prescribed instructions. The reasons could be the Korean culture of elderly patients living with their family members and more severe symptom of older patients. Conclusions: Considering the results of this study, nurses should focus on educating patients and their family members to improve self-care behavior adherence. Further distinctive education program according to age will be needed in the clinical fields.
Conclusion: Preliminary data suggest that SPECT scanning with Tc-99 pyrophosphate may be used to identify subjects with ATTR cardiac amyloid noninvasively.
330 328 What Type of Social Support Do Heart Failure Patients Need? Seongkum Heo1, Debra K. Moser2, Terry A. Lennie2; 1College of Nursing, University of Arkansas for Medical Science, Little Rock, AR; 2College of Nursing, University of Kentucky, Lexington, KY Background: Patients with heart failure (HF) commonly have a high physical and emotional symptom burden along with poor health-related quality of life (HRQOL). Social support may contribute to improvement of symptoms and HRQOL, but there are multiple ways to operationalize social support. The purpose of this study was to determine what type of social support was associated with symptoms and HRQOL. Methods: Patients (N 5 75, 72 years old, 67% male, 99% New York Heart Association [NYHA] class II/III) provided data on physical symptom status, depression, social support (family and health care provider relationships, instrumental support, social networks, and emotional support), and HRQOL. Family relationship assessed cohesive and conflicting relationships among family members. Health care provider relationship assessed patients’ trust in their physicians or nurses. Instrument support assessed visible, practical support in managing diet, symptom, house tasks, and financial situation. Social networks assessed the magnitude of social network using number of significant other contacting regularly. Emotional support assessed patients’ perceptions on invisible, emotional support from family, friends, and significant other. Demographic and clinical characteristics were also collected. Multiple regression was used to analyze the data. Results: Among family and health care provider relationships, instrumental support, social networks, and emotional support, only emotional support was significantly related to symptom status (F 5 11.19, p 5 .001), depression (F 5 15.78, p ! .001), and HRQOL (F 5 4.28, p 5 .042). Conclusion: Invisible, emotional support was more important than visible and practical support and simple relationship. Further studies are needed to determine how to improve emotional support effectively, and
Frequency of Improvement in Ventricular Function Allows Many Patients To Defer Defibrillator Implantation Bethany A. Austin1, Nicole R. Bianco2, Steven J. Szymkiewicz2, Sanjeev Aggarwal1, Andrew C. Kao1; 1Saint Luke’s Mid-America Heart and Vascular Institute, Saint Luke’s Hospital, Kansas City, MO; 2Zoll Corporation, Pittsburgh, PA Background: Little data exists about the rate of recovery in left ventricular ejection fraction (LVEF) in recent onset dilated cardiomyopathy (DCM). We sought to determine the frequency of LVEF improvement after maximal medical therapy. Methods: The Wearable defibrillator use In heart Failure registry (WIF) examined the use of a wearable defibrillator vest (WDV) in patients who are not candidates for defibrillator (ICD) implantation from 7/07-5/10 in accordance with ACC/AHA guidelines. Deaths were determined by physician report and the Social Security Death Index. Results: After exclusion of patients listed for transplant/on inotropes/LVEF O35%, 69 pts (32% female, 44% ischemic, mean age 58.4 6 12.5 yrs) in WIF were followed for a mean of 80 6 62 days, at which time their LVEF was re-evaluated. Mean LVEF was 24 6 8% at baseline and 38 6 14% at the end of study. The 30% of patients with a final LVEF O 35% (group 1) discontinued WDV use, whereas the 70% of patients with a final LVEF ! 35% (group 2) were referred for ICD implantation. LVEF was similar at baseline between groups (26 6 8% vs 23 6 8%, p5NS), but group 1 had a significantly higher LVEF at the end of study (49 6 9% vs 31 6 12%, p! 0.0001) (Figure). There was no difference in NYHA class at baseline (2.5 6 0.8 vs 2.4 6 0.8; p5NS) or at the end of study (1.6 6 0.8 vs 2.0 6 0.8; p5NS) between groups. No deaths were observed during the study. There was no significant difference in the rate of beta blocker use (100% vs 96%; p5NS) or ACE/ARB use (86% vs 88%; p5NS) between groups. Prior revascularization, diabetes and smoking were also not significantly different between groups. Conclusions: In this small, nonrandomized DCM population, 30% of patients improved their LVEF to O35% after 80 days of medical therapy and were able to defer ICD placement. These preliminary findings reinforce the importance of maximizing medical therapy prior to referral for ICD placement in accordance with ACC/AHA guidelines and merit validation in a larger cohort.
whether improvement of emotional support leads to improvement in physical and emotional symptom status and HRQOL.
329 Factors Related to Self-Care Behavior among Outpatients with Heart Failure in Korea Jong Sun Ok1, Heejung Choi2, Kyu Hyung Ryu1, Sung Hea Kim1, Min-Seok Kim3, Jin-Oh Choi4; 1Cardiovascular Center, KonKuk University Medical Center, Seoul, Republic of Korea; 2Nursing, Konkuk Univeristy, Chungju, Republic of Korea; 3 Cardiovascular Center, Asan Medical Center, Seoul, Republic of Korea; 4Division of Cardiology, Samsung Medical Center, Seoul, Republic of Korea Background: The Korean society has become an aging society and the heart failure patients will drastically increase in the future. However, heart failure has not recognized as a chronic disease and there were no statistical results about the cost of hospitalization with heart failure and the number of patients treated heart failure in Korea. Purpose: The aims of this study are to evaluate adherence to heart failure patients’ self-care behavior and to identify associated factors with it in Korea. Methods: Target population was the outpatients of cardiac centers in three multicenter. A total of 312 patients were participated, however, the data from 298 patients were analyzed. The structured questionnaire consisted of the Korean version of the European Heart Failure Self-care Behavior Scale(EHFScBS), Duke Activity Status Index, Dutch Heart Failure Knowledge Scale, Beck Depression Inventory (BDI) short form, and Medical outcomes study (MOS) social support. Results: The score of the European heart failure self-care behavior scale(EHFScBS) ranges from 12 to 60, indicating higher score means good self-care. The mean (SD) of the EHFScBS was 40.18(6 7.62). It implies that the subjects have done self-care relatively well. One of the possible reasons may be the national health center provides the free flu shot to people aged 65 years and older every year. Another possible explanation may be the well-developed health insurance system in Korea makes easy to access to medical help. Among five selected potential affecting factors (age, activity status, heart failure knowledge, depression, and social support) to self-care behavior, social support (ß5.209, p5.001), age (ß5 .223, p5.002), and heart failure knowledge (ß5.140, p5.021) were significant. It means that those who is older, perceives to be supported, and has more knowledge on heart failure is likely to adhere to the prescribed instructions. The reasons could be the Korean culture of elderly patients living with their family members and more severe symptom of older patients. Conclusions: Considering the results of this study, nurses should focus on educating patients and their family members to improve self-care behavior adherence. Further distinctive education program according to age will be needed in the clinical fields.
Conclusion: Preliminary data suggest that SPECT scanning with Tc-99 pyrophosphate may be used to identify subjects with ATTR cardiac amyloid noninvasively.
330 328 What Type of Social Support Do Heart Failure Patients Need? Seongkum Heo1, Debra K. Moser2, Terry A. Lennie2; 1College of Nursing, University of Arkansas for Medical Science, Little Rock, AR; 2College of Nursing, University of Kentucky, Lexington, KY Background: Patients with heart failure (HF) commonly have a high physical and emotional symptom burden along with poor health-related quality of life (HRQOL). Social support may contribute to improvement of symptoms and HRQOL, but there are multiple ways to operationalize social support. The purpose of this study was to determine what type of social support was associated with symptoms and HRQOL. Methods: Patients (N 5 75, 72 years old, 67% male, 99% New York Heart Association [NYHA] class II/III) provided data on physical symptom status, depression, social support (family and health care provider relationships, instrumental support, social networks, and emotional support), and HRQOL. Family relationship assessed cohesive and conflicting relationships among family members. Health care provider relationship assessed patients’ trust in their physicians or nurses. Instrument support assessed visible, practical support in managing diet, symptom, house tasks, and financial situation. Social networks assessed the magnitude of social network using number of significant other contacting regularly. Emotional support assessed patients’ perceptions on invisible, emotional support from family, friends, and significant other. Demographic and clinical characteristics were also collected. Multiple regression was used to analyze the data. Results: Among family and health care provider relationships, instrumental support, social networks, and emotional support, only emotional support was significantly related to symptom status (F 5 11.19, p 5 .001), depression (F 5 15.78, p ! .001), and HRQOL (F 5 4.28, p 5 .042). Conclusion: Invisible, emotional support was more important than visible and practical support and simple relationship. Further studies are needed to determine how to improve emotional support effectively, and
Frequency of Improvement in Ventricular Function Allows Many Patients To Defer Defibrillator Implantation Bethany A. Austin1, Nicole R. Bianco2, Steven J. Szymkiewicz2, Sanjeev Aggarwal1, Andrew C. Kao1; 1Saint Luke’s Mid-America Heart and Vascular Institute, Saint Luke’s Hospital, Kansas City, MO; 2Zoll Corporation, Pittsburgh, PA Background: Little data exists about the rate of recovery in left ventricular ejection fraction (LVEF) in recent onset dilated cardiomyopathy (DCM). We sought to determine the frequency of LVEF improvement after maximal medical therapy. Methods: The Wearable defibrillator use In heart Failure registry (WIF) examined the use of a wearable defibrillator vest (WDV) in patients who are not candidates for defibrillator (ICD) implantation from 7/07-5/10 in accordance with ACC/AHA guidelines. Deaths were determined by physician report and the Social Security Death Index. Results: After exclusion of patients listed for transplant/on inotropes/LVEF O35%, 69 pts (32% female, 44% ischemic, mean age 58.4 6 12.5 yrs) in WIF were followed for a mean of 80 6 62 days, at which time their LVEF was re-evaluated. Mean LVEF was 24 6 8% at baseline and 38 6 14% at the end of study. The 30% of patients with a final LVEF O 35% (group 1) discontinued WDV use, whereas the 70% of patients with a final LVEF ! 35% (group 2) were referred for ICD implantation. LVEF was similar at baseline between groups (26 6 8% vs 23 6 8%, p5NS), but group 1 had a significantly higher LVEF at the end of study (49 6 9% vs 31 6 12%, p! 0.0001) (Figure). There was no difference in NYHA class at baseline (2.5 6 0.8 vs 2.4 6 0.8; p5NS) or at the end of study (1.6 6 0.8 vs 2.0 6 0.8; p5NS) between groups. No deaths were observed during the study. There was no significant difference in the rate of beta blocker use (100% vs 96%; p5NS) or ACE/ARB use (86% vs 88%; p5NS) between groups. Prior revascularization, diabetes and smoking were also not significantly different between groups. Conclusions: In this small, nonrandomized DCM population, 30% of patients improved their LVEF to O35% after 80 days of medical therapy and were able to defer ICD placement. These preliminary findings reinforce the importance of maximizing medical therapy prior to referral for ICD placement in accordance with ACC/AHA guidelines and merit validation in a larger cohort.