Medicine and Health Sciences Commons^™

Heart Failure Readmission And The Physical Activity Vital Sign (Pavs): Is There A Relationship?, Jacob Aaron Barlow

Theses and Dissertations

Background - Heart failure costs Americans billions of dollars a year and takes a toll on the patients afflicted by the disease. Recent changes in how healthcare systems and providers are reimbursed have motivated them to find new ways to prevent heart failure readmission. There is no cure for heart failure so healthcare providers try to help patients manage their symptoms. Physical activity is one of the interventions healthcare providers recommend for their patients in the management of heart failure. The Physical Activity Vital Sign is a tool that can be quickly administer and has significant validity. Objective - The …

Diet-Induced Leukocyte Telomere Shortening In A Baboon Model For Early Stage Atherosclerosis, Genesio M. Karere, Michael C. Mahaney, Deborah E. Newman, Angelica M. Riojas, Clint Christensen, Shifra Birnbaum, John L. Vandeberg, Laura Cox

School of Medicine Publications and Presentations

Reported associations between leukocyte telomere length (LTL) attrition, diet and cardiovascular disease (CVD) are inconsistent. This study explores effects of prolonged exposure to a high cholesterol high fat (HCHF) diet on LTL in a baboon model of atherosclerosis. We measured LTL by qPCR in pedigreed baboons fed a chow (n = 105) or HCHF (n = 106) diet for 2 years, tested for effects of diet on LTL, and association between CVD risk factors and atherosclerotic lesions with LTL. Though not different at baseline, after 2 years median LTL is shorter in HCHF fed baboons (P < 0.0001). Diet predicts sex- and age-adjusted LTL and LTL attrition (P = 0.0009 and 0.0156, respectively). Serum concentrations of CVD biomarkers are associated with LTL at the 2-year endpoint and LTL accounts approximately 6% of the variance in aortic lesions (P = 0.04). Although heritable at baseline (h2 = 0.27, P = 0.027) and after 2 years (h2 = 0.46, P = 0.0038), baseline LTL does not predict lesion extent after 2 years. Atherogenic diet influences LTL, and LTL is a potential biomarker for early atherosclerosis. Prolonged exposure to an atherogenic diet decreases LTL and increases LTL attrition, and shortened LTL is associated with early-stage atherosclerosis in pedigreed baboons.

Using Education To Increase Compliance With Heart Failure Medications, Kara Stout Do, Isaac Navarro Dmd

Internal Medicine

• Approximately 5.7 million adults in the United States have heart failure.
• 25% of individuals die within one year of diagnosis and more than 80% die within 8 years.
• Full adherence to medications may be as low as 30% in heart failure patients.
• Non-compliant patients are two times more likely to be readmitted to the hospital and have a three times higher mortality rate.

Evaluation Of Epas1 Variants For Association With Bovine Congestive Heart Failure [Version 1; Peer Review: 2 Approved], Michael P. Heaton, Adam S. Bassett, Katherine J. Whitman, Greta M. Krafsur, Sang M. Lee, Jaden M. Carlson, Halden J. Clark, Helen R. Smith, Madeline C. Pelster, Veronica Basnayake, Dale M. Grotelueschen, B. Vander Ley

School of Veterinary and Biomedical Sciences: Faculty Publications

Background: Bovine congestive heart failure (BCHF) has become increasingly prevalent in feedlot cattle in the Western Great Plains of North America. BCHF is an untreatable complex condition involving pulmonary hypertension that culminates in right ventricular failure and death. A protein variant of hypoxia-inducible factor 2 alpha (HIF2α, encoded by the endothelial PAS domain-containing protein 1 gene, EPAS1) was previously reported to be associated with pulmonary hypertension at altitudes exceeding 2,000 m. Our aim was to evaluate EPAS1 haplotypes for association with BCHF in feedlot cattle raised at moderate altitudes (1,200 m).

Methods: Paired samples of clinical cases and unaffected controls …

Yearly Trend Of Acute Venous Thromboembolism In Patients Admitted With Heart Failure In The United States., Sijan Basnet, Rashmi Dhital, Biswaraj Tharu, Dilli Ram Poudel, Anthony Donato

Reading Hospital Internal Medicine Residency

Introduction: Heart failure (HF) patients are at risk for venous thromboembolism (VTE) during the hospital stay. We aim to study the recent trend of deep vein thrombosis (DVT), pulmonary embolism (PE), and VTE in heart failure patients from years 2000-2013. Methods: We utilized the National (Nationwide) Inpatient Sample database and selected non-pregnant patients over the age of 18 years for this purpose. We selected HF, DVT, PE, and VTE based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). We used STATA for analysis. Results: We noted an increase in prevalence of DVT, PE and composite …

The Place Of Arbs In Heart Failure Therapy: Is Aldosterone Suppression The Key?, Uma Markan, Samhitha Pasupuleti, Celina M. Pollard, Arianna Perez Bhs Student, Beatrix Aukszi, Anastasios Lymperopoulos

Chemistry and Physics Faculty Articles

Since the launch of the first orally available angiotensin II (AngII) type 1 receptor (AT₁R) blocker (ARB) losartan (Cozaar) in the late 1990s, the class of ARBs (or ‘sartans’, short for Angiotensin-RecepTor-ANtagonistS) quickly expanded to include candesartan, eprosartan, irbesartan, valsartan, telmisartan, and olmesartan. All ARBs have high affinity for the AT₁ receptor, expressed in various tissues, including smooth muscle cells, heart, kidney, and brain. Since activation of AT₁R, the target of these drugs, leads, among other effects, to vascular smooth muscle cell growth, proliferation and contraction, activation of fibroblasts, cardiac hypertrophy, aldosterone secretion from the …

Symmetrical Peripheral Gangrene Associated With Low Output Cardiac Failure., Sijan Basnet, Priya Rajagopalan, Rashmi Dhital, Ataul Qureshi

Department of Medicine Faculty Papers

Symmetrical peripheral gangrene (SPG) is a rare entity characterized by ischemic changes of the distal extremities with maintained vascular integrity. We present the case of a 64-year-old man with bilateral necrotic toes and deranged liver function tests. This was thought to be related to severely depressed ejection fraction from non-ischemic etiology, presumably chronic alcohol ingestion. We hope that awareness of SPG and association with a low output state will aid in early detection and prevention.

The Use Of Cardiomems In Dialysis Patients With Heart Failure, Karolina Viquez, Peggy Hardesty, Karim Fahmy, Amr Elhusseini, Mohamed Elyamny, Maya Guglin

The VAD Journal

In patients with chronic kidney disease (CKD) and heart failure (HF), volume overload is a major problem. Removal of fluid during the dialysis treatment, is the cornerstone management in these conditions but, assessing the amount of volume that should be removed is a challenge since physical exam findings are not accurate. Ambulatory pulmonary artery (PA) pressure measurement is a promising intervention in HF that potentially could be used as well in CKD population, predicting volume status changes and allowing a promptly intervention. We presented two cases of patient with CKD, HF and cardioMEMS

Heart Failure Knowledge Among Cnas In A Skilled Nursing Facility: A Pilot Project, Amanda Mcdannald

Doctor of Nursing Practice Projects

Heart failure (HF) is one of the leading causes of hospitalization among patients over the age of 65 years. Many are transitioned to skilled nursing facilities (SNF) following hospital discharge. HF-specific SNF staff education was designed for early detection of changes and improved management of this patient population. Computer-based education modules and hands on skill demonstration stations were created to provide basic HF knowledge and specific guideline recommended care measures for the SNF environment. A pretest, post-test, and skill demonstration were implemented and included weight assessment, application of compression stockings, volume status monitoring, and low sodium diet recommendations. Pretest scores …

Implementing A Heart Failure Education Program For Bedside Nurses In The Acute Care Setting, David L. Morrow

UNLV Theses, Dissertations, Professional Papers, and Capstones

Heart failure is a chronic disease in which a weakened heart is no longer able to deliver adequate blood flow to supply the body with needed oxygen and nutrients. Heart failure is the most common reason for hospitalization in the United States for patients age 65 and over, accounting for over 1,000,000 hospital admissions annually. Due to the chronic nature of this debilitating condition and associated symptoms, patients discharged from the hospital with a diagnosis of heart failure are at high risk for readmission. Effective self-care behaviors have been shown to reduce readmissions and improve quality of life for these …

Representing The Patient Experience Of Heart Failure Through Empathy, Journey And Stakeholder Mapping, Leanna Woods, Jed Duff, Erin Roehrer, Kim Walker, Elizabeth Cummings

Patient Experience Journal

Heart failure is a long-term condition requiring those affected to manage numerous self-care related activities. People with heart failure report multiple challenges accommodating self-care activities in their every-day life. The aim of this study is to (1) understand the experience of people with heart failure and their caregivers in the local patient population, and (2) visually represent these experiences to inform the design of a mobile health intervention supporting self-care. Seven patients and four family caregivers were interviewed using an empathic approach. Data was collected using rapid design methods including an empathy map to uncover patient and caregiver perspectives and …

End-Of-Life Decision Making In Patients With A Cardiac Device, Jessica Harman

Jessica Harman

Improving Heart Failure Care Plan Coordination Across The Health Care Continuum, Amy Veltkamp

Doctoral Projects

Heart failure costs the United States 31 billion dollars each year, with much of those costs attributed to hospital admissions. Coordinating care across the health care continuum is a critical factor in improving heart failure care and reducing readmissions. An organizational assessment was conducted using the Burke and Litwin Causal Model of Organizational Performance and Change. The quality improvement project implemented a longitudinal plan of care (LPOC) across 10 hospitals and numerous ambulatory care sites at a large Midwestern health organization. Nurse care managers (NCMs) were the focus of this project due to their high-level of involvement in care coordination. …

Successful Extracorporeal Membrane Oxygenation In The Management Of Acute Respiratory Distress Syndrome And Cardiopulmonary Collapse Secondary To Amniotic Fluid Embolism, Sumon Roy, Nishit A. Biniwale, Venkata S. Pendela, Patricia Oates, Katrina Wojciechowski, Scott C. Feitell

The VAD Journal

Amniotic fluid embolism (AFE) is one of the most devastating complications of pregnancy that typically manifests as acute cardiopulmonary collapse during delivery or in the postpartum period. The potential role of extracorporeal membrane oxygenation (ECMO) as a management technique in severe cases of AFE remains largely unknown given the limited literature available. In this report, we present the first case, to our knowledge, of successful implementation of ECMO as a life-saving measure in a case of hemorrhagic shock due to postpartum bleeding complicated by severe AFE leading to acute respiratory distress syndrome (ARDS) ultimately requiring tracheostomy. Hemodynamic decompensation is often …

What Did We Learn About Vads In 2018?, Maya Guglin

The VAD Journal

No abstract provided.

Why Did Coapt Win While Mitra-Fr Failed? Defining The Appropriate Patient Population For Mitraclip., Kimberly Atianzar, Ming Zhang, Zachary Newhart, Sameer Gafoor

Articles, Abstracts, and Reports

In 2018, the world of functional mitral regurgitation changed with the presentation of two trials - Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation (MITRA-FR) and Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT). The trials, which seemed to point in two different directions, raised significant questions for the field. This article looks at the differences in effective regurgitant area, guideline-directed medical therapy, patient selection, technical clues and other reasons why the trials had similar aims but very different findings.

Rapid 5 Lb Weight Gain Is Not Associated With Readmission In Patients With Heart Failure, Jill Howie-Esquivel, Kathleen Dracup, Mary A. Whooley, Charles Mcculloch, Chengshi Jin, Debra K. Moser, Robyn A. Clark, Michele M. Pelter, Martha J. Biddle, Linda G. Park

Nursing Faculty Publications

Aims Heart failure (HF) patients are taught to identify a rapid 5 lb body‐weight gain for early detection of cardiac decompensation. Few data support this common advice. The study aim was to determine whether a 5 lb weight gain in 1 week and signs and symptoms of HF increased risk for unplanned physician or emergency department (ED) visits or hospital admission in rural HF patients.

Methods and results This was a secondary analysis of a randomized trial. Patients tracked body weight and HF symptoms using diaries. We included patients adherent to daily diaries > 50% over 24 months (N = …

Hemodynamic, Therapeutic, And Clinical Outcomes Of Ambulatory Pressure-Guided Heart Failure Management, Jacob Abraham, Lian Wang, Rebecca Lewis, Katherine Callis, Joshua Remick, Kateri J. Spinelli

The VAD Journal

Background: Heart failure (HF) management guided by CardioMEMS™ pulmonary artery pressure (PAP) monitoring reduces PAP and HF hospitalizations. The objective of this project was to characterize the relationship between medication adjustments, PAP change, and outcomes for all patients at an advanced HF center.

Methods: We retrospectively analyzed medication changes and hospitalizations for 32 consecutive patients implanted with the CardioMEMS™ sensor at a single HF center and related these outcomes to PAP data from the Merlin.net (Abbott) database. Absolute change in PAP from baseline was estimated using area under the curve normalized to days monitored.

Results: Patients had an average change …

Evaluation Of Potassium Status In Heart Failure Patients: A Case Control Study, Sreedharan Nair Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: Hyper and hypokalemia is a common ionic imbalance in patient with heart failure. Increased death and hospital stay is common in patients with HF and chronic kidney disease (CKD) who have hypokalaemia. The majority of the intracellular cation is potassium which is necessary to retain a normal charge difference between the intracellular and extracellular spaces. It often happens as a complication of certain diseases or drugs. As hyper or hypokalaemia are potentially hazardous and frequent complication in heart failure patient it is important to identify patients who are at increased risk for hypo and hyperkalaemia. Objectives: The objective of …

Predictors And Impact Of Right Heart Failure Severity Following Left Ventricular Assist Device Implantation, R. D. Baxter, K. M. Tecson, S. Still, J. D. G. Collier, J. Felius, S. M. Joseph, S. A. Hall, B. Lima

Journal Articles

No abstract provided.

Metabolic Modulation Predicts Heart Failure Tests Performance, Daniel Contaifer Jr., Leo F. Buckley, George Wohlford, Naren G. Kumar, Joshua M. Morriss, Asanga D. Ranasinghe, Salvatore Carbone, Justin M. Canada, Cory Trankle, Antonio Abbate, Benjamin W. Van Tassell, Dayanjan S. Wijesinghe

Pharmacotherapy and Outcomes Science Publications

The metabolic changes that accompany changes in Cardiopulmonary testing (CPET) and heart failure biomarkers (HFbio) are not well known. We undertook metabolomic and lipidomic phenotyping of a cohort of heart failure (HF) patients and utilized Multiple Regression Analysis (MRA) to identify associations to CPET and HFBio test performance (peak oxygen consumption (Peak VO₂), oxygen uptake efficiency slope (OUES), exercise duration, and minute ventilation-carbon dioxide production slope (VE/VCO₂ slope), as well as the established HF biomarkers of inflammation C-reactive protein (CRP), beta-galactoside-binding protein (galectin-3), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP)). A cohort of 49 patients with …

Caregivers’ Influence On Patients’ Heart Failure Self-Care, Hospital Readmission And Mortality, Linda Clements

Theses and Dissertations--Nursing

Background: Heart failure (HF) is a leading cause of hospitalization, readmissions, and death in the United States. Patients hospitalized for HF are at risk for readmission, in- hospital mortality, and early post-discharge death. In the United States, inpatient care has been estimated to cost $83,980 over the lifetime of each patient with HF. The majority of patients with HF depend on caregiver support for successful HF self-care, which is essential for optimal patient outcomes. Support from caregivers is thought to be important for better self-care, and lower readmission and mortality rates. Yet, there are few studies considering the influence of …

Heart Failure With Preserved Ejection Fraction, Abigalle Ryan

Nursing Student Class Projects (Formerly MSN)

Heart failure with preserved ejection fraction (HFpEF), formerly known as diastolic heart failure, is a chronic disease that affects millions of people around the world. HFpEF has no cure and can only be managed with therapeutic treatments that optimize cardiac function and quality of life (Gazewood & Turner, 2017). The condition is precipitated by several systemic, myocardial, infiltrative, and pericardial diseases that overwhelmingly ail the aging population. There is not a set of widely accepted diagnostic criteria, and as a result, the morbidity and mortality have not improved in recent years (Tawil & Gelzinis, 2016). Because HFpEF has become more …

End-Of-Life Decision-Making In Patients With A Cardiac Device, Jessica Harman Thompson

Theses and Dissertations--Nursing

Heart failure (HF) is one of the top causes of mortality in the United States and globally. In order to combat the high mortality rates of this disease, medical technology, including internal cardioverter defibrillators (ICD) and left ventricular assist devices (LVAD), have become one of the most common treatments. Over the past 10 years the utilization of these cardiac devices has increased exponentially, which has created a new phenomenon of how we discuss death with patients who have one of these devices. The purpose of this dissertation is to increase understanding of the end-of-life decision making processes and current experiences …

A Clinical Practice Guideline To Improve Education In The Heart Failure Population, Mailey L. Wilks

Walden Dissertations and Doctoral Studies

Managing heart failure patients in the outpatient setting can pose a challenge for nurses and health care staff due to the need to educate patients on self-care skills and management of disease. Several factors, including health literacy and numeracy, need to be considered when developing an education program for heart failure patients to promote self-care management. The purpose of this project was to provide nursing staff with a clinical practice guideline (CPG) that incorporated health and numeracy literacy assessment into an individualized education program. The Johns Hopkins nursing evidence-based practice (EBP) model, the situation-specific theory of heart failure (HF) self-care, …

Implementing A Discharge Navigator Reducing 30-Day Readmissions For Heart Failure And Sepsis Populations, Karen Weeks

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

A national focus for healthcare reform is preventing hospital readmissions. Thirty-day unplanned hospital readmissions impact patient outcomes and are costly to the healthcare system. This project explored the impact between the discharge navigator and 30-day unplanned readmissions for heart failure and sepsis populations in a 238-bed community hospital located in central Virginia. The primary aim of this discharge navigator project was to reduce 30-day readmissions for the heart failure and sepsis populations to meet the goals of the top quartile for like hospitals and the evaluation of cost avoidance for these readmissions. Heart failure and sepsis populations are high risks …

Heart To Heart: Educating Allied Healthcare Students And Professionals About Heart Failure, Samantha M. Barefoot

Occupational Therapy Doctorate Capstone Projects

Heart failure (HF) is a health problem which providing necessary education to healthcare professionals who serve individuals with HF allows for continuity of care and the promotion of disease management for this population. The intent of this research was to determine if providing an educational in-service to allied healthcare students and practitioners increased their knowledge of OT’s role with HF clients and about HF itself as a condition interfering with occupation. The design of this study involved collecting pre/post survey data to evaluate the knowledge of the participants about the HF population and gathering participant satisfaction data regarding the in-service. …

Hospital Admission From The Emergency Department For Patients Diagnosed With Heart Failure, Tammy Young

Walden Dissertations and Doctoral Studies

Approximately 25% of those hospitalized with congestive heart failure are readmitted within 30 days after discharge. Because researchers and policy makers consider hospital readmission within 30 days for patients with heart failure to be a quality of care issue, the Centers for Medicare and Medicaid Services has imposed financial penalties of up to 3% of a hospital's Medicare revenue for 1 year for excessive readmissions, potentially impacting the financial sustainability of some organizations. The purpose of the study was to address the research gap regarding the outcome quality measure of hospital admissions from the emergency department (ED) and 2 each …

Nursing Staff Education For Heart Failure Disease Management, Kerri Murphy

Walden Dissertations and Doctoral Studies

Heart failure (HF) has a global significance for the older population and is the most common reason for hospitalization. Patients with HF can reduce their risk for hospital readmissions and adverse outcomes through self-management of their disease. Nurses are responsible for educating patients about HF self-management; however, nurses at the project site lacked sufficient understanding and confidence to perform adequate HF patient education, creating a gap in practice. This project was guided by Pender's health promotion model and adult learning theory with the goal to increase nurses' knowledge and confidence with the self-management principles of HF. The purpose of this …

Evaluating The Feasibility Of Outpatient Iv Diuretic Therapy For Patients With Decompensated Heart Failure, Christina Thompson

DNP Projects

Heart failure is a prevalent chronic disease that contributes to many hospitalizations that may not always be necessary. Evidence supports that patients who present to the Emergency Department in fluid overload can be treated in the outpatient setting when only IV diuretic is warranted. Both decreases in costs and improved outcomes have been reported, yet there has been little movement toward providing outpatient diuresis versus hospitalization. The purpose of this DNP project was to evaluate the feasibility of an outpatient option for IV diuretic therapy for patients with acute decompensated heart failure experiencing symptoms of fluid overload. This descriptive study …