Medicine and Health Sciences Commons^™

Sglt2 Inhibitors Among Patients With Heart Failure With Preserved Ejection Fraction: A Meta-Analysis Of Randomised Controlled Trials, Akash Jaiswal, Vikash Jaiswal, Song Peng Ang, Muhammad Hanif, Ananya Vadhera, Vibhor Agrawal, Tushar Kumar, Anagha M. Nair, Vamsikalayan Borra, Vamsi Garimella

School of Medicine Publications and Presentations

Background: Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been recommended in the practice guidelines for the treatment of patients with heart failure with reduced ejection fraction; however, their effects among patients with preserved ejection fraction have been debatable.

Objective: We aim to evaluate the SGLT2 inhibitor effect among patients with heart failure with reduced ejection fraction, including DELIVER and EMPEROR-Preserved trials.

Methods: We performed a systematic literature search using the PubMed, Embase, Scopus, and Cochrane libraries for relevant articles from inception until August 30th, 2022. Statistical analysis was performed by calculating hazard ratio (HR) using the random effect model with a …

Tailoring The Gut Microbiome Through Diet To Target Short Chain Fatty Acids And Trimethylamine N-Oxide For Heart Failure Prevention, Julia M. Gabel

PANDION: The Osprey Journal of Research and Ideas

The number of people diagnosed with heart failure is on the rise—it’s becoming an epidemic. There are treatment options available for heart failure, but unfortunately there is not a cure. However, most cases of heart failure can be prevented. One mechanism that provides promise for preventing heart failure is the implementation of a heart healthy diet. However, not in the context that most are familiar with. In this case, a heart healthy diet is in reference to the ability of diet to tailor the gut microbiome in order to target specific metabolites that are associated with heart failure. Diet plays …

The Therapeutic Potential Of Targeting Cardiac Rgs4., Giselle Del Calvo, Teresa Baggio Lopez, Anastasios Lymperopoulos

HPD Articles

G protein-coupled receptors (GPCRs) play pivotal roles in regulation of cardiac function and homeostasis. To function properly, every cell needs these receptors to be stimulated only when a specific extracellular stimulus is present, and to be silenced the moment that stimulus is removed. The regulator of G protein signaling (RGS) proteins are crucial for the latter to occur at the cell membrane, where the GPCR normally resides. Perturbations in both activation and termination of G protein signaling underlie numerous heart pathologies. Although more than 30 mammalian RGS proteins have been identified, each RGS protein seems to interact only with a …

Improving Health Outcomes Among Patients With Chf Through Implementation Of Telehealth Depression Screening And Chf Symptom Management, Akudo Udodiri Unanwa

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Comorbid congestive heart failure (CHF) and depressive disorder is a leading cause of mortality globally. Despite effective detection and therapeutic options, 30-day hospital readmission rates for CHF patients remain high, with patients experiencing adverse clinical outcomes and poorer quality of life. Depression is identified as a common comorbidity among CHF patients that may negatively impact patient self-care and adherence to a CHF treatment plan.

Problem: Telehealth applications are an increasingly utilized approach to healthcare delivery that enhances timely access to healthcare services by reducing physical proximity and transportation barriers to care. Currently, telehealth screening for CHF in the …

"Reducing Heart Failure Readmission Rates Through Implementation Of Heart Failure Diuretic", Caley Tatrn, Yvonne Weideman, Venkatraman Srinivasan

Doctor of Nursing Practice (DNP) Manuscripts

Background and significance: heart disease was the number one cause of death in the United States in 2021, with 696, 962 deaths (Leading Causes of Death, 2022). There are about 6.2 million individuals in the U.S. total with heart failure (Kilgore et al., 2017). About one-quarter of patients with heart failure are readmitted within thirty days of discharge, while one-quarter of hospital readmissions are preventable. Between 2010-2017, over seven million patients were admitted for heart failure in the United States. Eighteen percent had a readmission within thirty days and thirty-one percent had a readmission within ninety days (Khan et …

Kdm5b As A Potential Epigenetic Regulator Of Cardiomyocyte Regeneration And Cell Cycle Activation., Dana Hammouri

Electronic Theses and Dissertations

The limited regenerative capacity of adult cardiomyocytes (CMs) is manifested in prevalent morbidity and mortality associated with ischemic heart disease. We previously demonstrated that a combination of four cell cycle factors (4F) promotes efficient cell division in differentiated CMs. The temporal transcriptional reprogramming in the 4F-transduced CMs indicates that epigenetic modifications mediate the cell cycle progression. Through small molecule screening, we evaluated the epigenetic impact on CM’s response in the 4F-transduced CMs. We identified the histone demethylase 5B (KDM5B), which through in vitro and ex vivo genetic knockdown and overexpression studies, exhibited a modulative effect on CM’s cell cycle plasticity …

Natriuretic Peptide Biomarkers In The Imminent Development Of Preeclampsia., Stefanie Marek-Iannucci, Estefania Oliveros, Yevgeniy Brailovsky, Preethi Pirlamarla, Amanda Roman, Indranee Rajapreyar

Division of Cardiology Faculty Papers

Preeclampsia is the most common cause of morbidity and mortality in pregnancy, the incidence being significantly higher in low-income countries with reduced access to health care. Women with preeclampsia are at a higher risk of developing cardiovascular disease with a poorer long-term outcome. Early recognition and treatment are key to improving short- and long-term outcomes. Approximately 3%-5% of pregnant women will develop preeclampsia, with potentially fatal outcomes. Despite ongoing research, the exact pathophysiologic mechanism behind its development remains unclear. In this brief report, we describe the potential role of natriuretic peptides as biomarkers in the imminent development of preeclampsia. In …

A Clinical Nurse Leader Nurse Navigator Program For Heart Failure Patients, Shanna Lantel Negron

Doctoral Dissertations and Projects

The purpose of this integrative review is to examine the literature regarding nurse-led educational interventions, transitional care (TC) strategies for heart failure (HF) patients, nurse navigation, HF self-care, and the clinical nurse leader (CNL) role to support integrating a CNL into the care delivery model serving as a nurse navigator (NN) for adult HF patients being discharged home from the hospital. The basis for this review is to identify an innovative way to improve patient reported and clinical outcomes for the HF population which increases each year. The economic and symptom burden associated with this disease is high further enhanced …

Etiologies And Predictors Of 30-Day Readmission In Heart Failure: An Updated Analysis, Akhil Jain, Shilpkumar Arora, Viral Patel, Maharshi Raval, Karnav Modi, Nirav Arora, Rupak Desai, Behnam Bozorgnia, Raphael Bonita

Einstein Health Papers

BACKGROUND AND OBJECTIVES: Readmissions in heart failure (HF), historically reported as 20%, contribute to significant patient morbidity and high financial cost to the healthcare system. The changing population landscape and risk factor dynamics mandate periodic epidemiologic reassessment of HF readmissions.

METHODS: National Readmission Database (NRD, 2019) was used to identify HF-related hospitalizations and evaluated for demographic, admission characteristics, and comorbidity differences between patients readmitted vs. those not readmitted at 30-days. Causes of readmission and predictors of all-cause, HF-specific, and non-HF-related readmissions were analyzed.

RESULTS: Of 48,971 HF patients, the readmitted cohort was younger (mean 67.4 vs. 68.9 years, p≤0.001), had …

Arrhythmogenic Left Ventricular Cardiomyopathy Associated With A Phospholamban Gene Mutation In A Young Female: A Case Report And Literature Review, Wahab J Khan, Muhammad Asif, Hammad S Chaudhry, Sadia Aslam, Ifrah Nadeem, Mohammed A. Chowdhury

Journal of Community Hospital Internal Medicine Perspectives

Arrhythmogenic cardiomyopathy (ACM) is a myocardium disease characterized by phenotypic features of myocardial scarring due to fibrofatty myocardial replacement often associated with global or regional ventricular dysfunction. For years after arrhythmogenic right ventricular cardiomyopathy (ARVC) was first described, the left ventricle (LV) was generally considered normal or minimally involved. In recent years, however, LV involvement has been recognized. It usually presents with early-on arrhythmias more than heart failure symptoms compared to dilated cardiomyopathy. It can be right ventricular, biventricular, or left ventricular. The underlying pathophysiology involves either desmosomal or non-desmosomal mutations. Phospholamban (PLN) mutation is one of those and is …

Partial Support In Chronic Heart Failure, Bart Meyns, Walter Droogne, Steven Jacobs

The VAD Journal

Partial left ventricular assist device (LVAD) support offers several advantages in treating chronic heart failure. It also raises concerns about insufficient support, worsening symptoms, and impediment of myocardial recovery. The clinical trial results for the CircuLite device (Medtronic) have shown that close monitoring can ensure improved outcomes for partial support. Another study on the ovine model demonstrated that partial and full support have similar effects regarding reverse remodeling. Thus, patients receiving partial LVAD support need regular follow-up care. Clinical assessment of symptoms and organ function must be used alongside objective judgment of patients’ needs to ensure support levels are appropriately …

Highlights Of The 2022 Brano Heart Failure Forum: Part Two, Ugolino Livi, Rajko Radovancevic, Bojan Vrtovec, Igor D. Gregoric

The VAD Journal

Since 2007, the Branislav “Brano” Radovancevic Heart Failure Forum (BHFF) has been held annually to provide a venue for experts to present and discuss “Innovations and New Treatment Strategies in Heart Failure.” Clinicians and researchers gather yearly in a different Eastern European city to discuss the latest in heart failure diagnostics and therapeutics. The 2022 BHFF forum was held on the 6^th thru 8^th of September 2022 in Trieste, Italy. It was attended by over 94 faculty from 14 countries. In addition, participation through online streaming was available. Throughout the forum, 17 sessions focused on challenges and solutions …

Reduced Heart Failure-Related Healthcare Costs With Furoscix Versus In-Hospital Intravenous Diuresis In Heart Failure Patients: The Freedom-Hf Study, Daniel Bensimhon, William S. Weintraub, William Frank Peacock, Tamas Alexy, Dalton Mclean, Donald C. Haas, Kathleen L. Deering, Stefanie J. Millar, Matthew M. Goodwin, John F. Mohr

Abington Jefferson Health Papers

Aim: Compare heart failure (HF) costs of Furoscix use at home compared with inpatient intravenous (IV) diuresis.

Patients & methods: Prospective, case control study of chronic HF patients presenting to emergency department (ED) with worsening congestion discharged to receive Furoscix 80 mg/10 ml 5-h subcutaneous infusion for ≤7 days. 30-day HF-related costs in Furoscix group derived from commercial claims database compared with matched historical patients hospitalized for <72 h.

Results: Of 24 Furoscix patients, 1 (4.2%) was hospitalized in 30-day period. 66 control patients identified and were well-matched for age, sex, ejection fraction (EF), renal function and other comorbidities. Furoscix patients had …

The Daily Activity Of Patients With Heart Failure During Covid-19 Pandemic., Christine Sykalo, Ugochukwu Egolum, Hua Ling

PCOM Scholarly Papers

BACKGROUND: Sedentary behavior is thought to contribute to worsening heart failure syndromes. Here, we examined whether the shelter-in-place order during the coronavirus disease 2019 (COVID-19) pandemic changed daily activity duration, which was monitored by an implantable cardiac device-based multisensor index and alert algorithm called HeartLogic.

METHODS: We performed a retrospective review of the HeartLogic data from patients with heart failure managed at our clinic and compared the individual daily activity duration 90 days prior to vs. after implementation of the shelter-in-place order. The activity data were prepared by Boston Scientific. Demographic data were extracted from our electronic medical record.

RESULTS: …

Highlights Of The 2022 Brano Heart Failure Forum: Part One, Ugo Livi, Rajko Radovancevic, Bojan Vrtovec, Igor D. Gregoric

The VAD Journal

Since 2007, the Branislav “Brano” Radovancevic Heart Failure Forum (BHFF) has been held annually to provide a venue for experts to present and discuss “Innovations and New Treatment Strategies in Heart Failure.” Clinicians and researchers gather yearly in a different Eastern European city to discuss the latest in heart failure diagnostics and therapeutics. The 2022 BHHF forum was held on the 6^th thru 8^th of September 2022 in Trieste, Italy. It was attended by over 94 faculty from 14 countries. In addition, participation through online streaming was available. Throughout the forum, 17 sessions focused on challenges and solutions …

Implementation Of The American Diabetes Association Pharmacological Approach For Adults With Type 2 Diabetes Mellitus With Cardiovascular Disease, Jose Cedillo

Doctor of Nursing Practice Final Manuscripts

Introduction: The purpose of this evidence-based practice project is to improve the utilization of the 2022 ADA pharmacological approach for individuals with Type 2 Diabetic Mellitus (T2DM). The project implementation site was an outpatient clinic in Southern California with a large T2DM Hispanic population. The new ADA guidelines recommend selecting a glucagon-like peptide 1(GLP-1RA) and/or sodium-glucose cotransporter two inhibitors (SGLT-2) when clinically appropriate to reduce the risk of major cardiovascular events in T2DM patients.

Background: According to the American Diabetes Association, ASCVD is the leading cause of morbidity and mortality for adult individuals with T2DM. The use of …

Reducing 30-Day Heart Failure Hospital Readmissions Through The Implementation Of A Telehealth Education And Screening Program, Madison Geib, Jo Loomis, Maria (Dupi) Gomez Cogan

Doctor of Nursing Practice (DNP) Projects

Heart Failure (HF) is a difficult disease to manage. It requires knowledge on weight monitoring, diet, exercise, medications, and symptom management. With this difficulty, there is a high incidence of HF patient readmissions into the hospital, especially in the first 30-days after discharge, showing that patients are not well equipped to manage their HF on their own at home. A review of the available literature found that some of the most common reasons for readmission include poor discharge planning, a lack of continuation of care, as well as a lack of education and adherence to their medications (Mathew & Thukha, …

Assuring A Continuum Of Care For Heart Failure Patients Through Post-Acute Care Collaboration, Purnima Krishna

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Heart failure (HF) patients have a high risk of rehospitalization after discharge from acute care. Post-discharge management of HF patients requires coordinating services outside the hospital, such as skilled nursing and home health care to address patients’ complex needs.

Local Problem. High HF readmission rates negatively impact a hospital’s efficiency and pose a risk of financial penalties. In the project setting, the HF patients discharged to skilled nursing facilities and home health agencies had a higher rate of 30-day readmission than patients discharged to home.

Methods: Fourteen post-acute care (PAC) facilities were selected for the interventions. The …

Expansion Of Heart Failure Education From Hospital To Clinic, Abigail M. Fischer

Doctor of Nursing Practice Projects

Heart failure education is vital to the long-term management of this condition. Education recommendations for heart failure are given by the American Heart Association (AHA) and the American College of Cardiology (ACC). Recommendations include verbal instruction and written materials regarding the patient’s medication plan, recognition of symptoms, what to do when symptoms occur, and the importance of daily weights.

This project aimed to provide outpatient clinic providers and staff with resources and education necessary to educate heart failure patients. The project expanded use of an inpatient heart failure education packet for outpatient use. This was accomplished by conducting educational sessions …

Standardizing Initial Inpatient Palliative Care Consultations For Patients Receiving Left Ventricular Assist Devices At A Large Urban Hospital, Deborah A. Szeto

Doctoral Projects

For patients with advanced heart failure (HF) ineligible for or awaiting heart transplantation, left ventricular assist device (LVAD) implantation can be considered. LVADs have helped to improve recipients’ survival rates and quality of life. However, LVAD patients are at risk for complications such as stroke, bleeding, infection, and right ventricular failure. Moreover, events such as end-stage malignancy or progression of a neurodegenerative disorder may occur. Such complications and repeated hospitalizations can pose questions about the acceptability of LVAD therapy. As such, both the Centers for Medicare and Medicaid Services and The Joint Commission require that palliative care (PC) be part …

A Nurse Led Heart Failure Education For Self-Care Symptom Monitoring And Management, Lynda Browning

Doctoral Projects

Title

Nurse-led education heart failure education for symptom monitoring and management

Abstract

Problem Statement: Over six million adults in the United States have heart failure (CDC.gov,2020). According to the Agency for Healthcare Research and Quality (AHRQ), almost 20% of heart failure patients hospitalized are readmitted under 30 days (AHRQ, 2013). The American Heart Association (AHA) (2022) recommends a visual symptom tracking tool for self-care symptom monitoring to increase patient adherence and reduce readmissions. Despite this recommendation, the AHA tool for symptom monitoring is not fully incorporated into the discharge of every heart failure patient often because of nursing management …

Patient Experience In An Interprofessional Collaborative Practice For Underserved Patients With Heart Failure, Connie White-Williams, Maria R. Shirey, Reid Eagleson, Wei Su, Terri Poe, Brittany Fitts, Vera Bittner

Patient Experience Journal

Heart failure is a complex chronic condition that results in multiple patient visits throughout the care continuum. Patient experience has associations with clinical outcomes. The purpose of this study was to examine patient experience among the underserved in a specialized interprofessional collaborative practice heart failure clinic. This prospective study utilized both qualitative and quantitative data to describe the patient experience within an interprofessional collaborative practice. Data were collected from patient experience surveys in 1128 patients seen in the Heart Failure Transitional Care Services for Adults (HRTSA) clinic between January 1, 2018, and December 31, 2021. Interprofessional collaborative practice surveys were …

Metformin Discontinuation In Acute Heart Failure, Curtis Wong, Erica Junqueira, Nayda Parisio-Poldiak Ph.D., Nancy Crossley, Shantae Jenkins

South Atlantic Division Research Day 2023

No abstract provided.

Teach-Back Education In Heart Failure Patients Benchmark Study, Bethany N. Johnson

MSN Capstone Projects

Heart failure exasperation is one of the most common causes of hospital readmission in the United States (Breathett et al., 2018). It is estimated that greater than half of all heart failure patients will be readmitted to the hospital within six months of discharge (Caluya, 2021). Additionally, one in four individuals with heart failure are readmitted within thirty days of discharge (Rahmani et al., 2020). This data shows a large area of improvement for hospitals in order to improve patient outcomes. Due to the lack of standardized discharge teaching, heart failure patients are often admitted to the hospital for the …

Outcomes Among Heart Failure Patients Hospitalized For Acute Pulmonary Embolism And Covid-19 Infection: Insight From The National Inpatient Sample, Bruce Adrian Casipit, Sahana Tito, Isaac Ogunmola, Abiodun Idowu, Shivaraj Patil, Kevin Lo, Behnam Bozorgnia

Einstein Health Papers

There is paucity of data regarding the outcomes of hospitalized acute pulmonary embolism (PE) patients with heart failure (HF) and Coronavirus Disease 2019 (COVID-19) infection. We utilized the 2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study to investigate the outcomes of hospitalized acute PE patients with HF and COVID-19, looking at its impact on in-hospital mortality, thrombolysis, and thrombectomy utilization as well as hospital length of stay (LOS). A total of 23,413 hospitalized acute PE patients with HF were identified in our study, of which 1.26% (n = 295/23,413) had COVID-19 infection. Utilizing a stepwise survey …

Cardiac Rgs Proteins In Human Heart Failure And Atrial Fibrillation: Focus On Rgs4., Jordana I. Borges, Malka S. Suster, Anastasios Lymperopoulos

HPD Articles

The regulator of G protein signaling (RGS) proteins are crucial for the termination of G protein signals elicited by G protein-coupled receptors (GPCRs). This superfamily of cell membrane receptors, by far the largest and most versatile in mammals, including humans, play pivotal roles in the regulation of cardiac function and homeostasis. Perturbations in both the activation and termination of their G protein-mediated signaling underlie numerous heart pathologies, including heart failure (HF) and atrial fibrillation (AFib). Therefore, RGS proteins play important roles in the pathophysiology of these two devasting cardiac diseases, and several of them could be targeted therapeutically. Although close …

Utilizing Telehealth To Decrease Hospital Readmissions For Heart Failure Patients, Madison Geib, Jo Loomis

DNP Qualifying Manuscripts

Abstract

Background: Without proper education, heart failure (HF) is very difficult to manage. A lack of education and proper management of HF can lead to frequent hospital readmissions, decreased quality of life, and early morbidity and mortality.

Objective: Through literature review, this paper aims to identify the benefits of implementing telehealth education for HF patients in order to decrease hospital readmissions.

Methods: A range of relevant articles were analyzed and summarized in this literature review. An extensive literature search was performed and systematic reviews, meta-analyses, critically appraised research studies, qualitative, and peer-reviewed research studies were included.

Results: Ten articles met …

Impact Of End Stage Renal Disease On The Clinical Outcomes Of Diabetics Admitted For Heart Failure: Analysis Of National Inpatient Sample, Muhammad Usman Almani, Yaqi Zhang, Muhammed Hamza Arshad, Muhammad Usman, Muhammad Talha Ayub

Einstein Health Papers

Introduction: Patients with diabetes and heart failure (HF) can have varying outcomes depending on whether they also have End Stage Renal Disease (ESRD). This study aimed to compare the outcomes of patients with diabetes and HF with and without ESRD.

Methods: Data from the National Inpatient Sample (NIS) 2016-2018 was analyzed to find hospitalizations for patients with HF as the main diagnosis and diabetes as a secondary diagnosis, with and without ESRD. Multivariable logistic and linear regression analysis was used to adjust for confounding factors.

Results: In the total cohort of 12215 patients with a principal diagnosis of heart failure …

Retrospective Analyses Of The Outcomes Among Hospitalized Liver Cirrhosis Patients With Heart Failure And Covid-19 Infection: Insight From The National Inpatient Sample, Bruce Adrian Casipit, Hussein Al-Sudani, Ahmer Khan, Emmanuel Akuna, Aman Amanullah

Division of Cardiology Faculty Papers

Background: There is paucity of data regarding the impact of Coronavirus Disease 2019 (COVID-19) infection on the outcomes of hospitalized liver cirrhosis (LC) patients with heart failure (HF).

Methods: Utilizing the 2020 National Inpatient Sample (NIS) Database, we conducted a retrospective cohort study to investigate the outcomes of hospitalized LC patients with HF and COVID-19 infection, looking at its impact on in-hospital mortality, risk for acute kidney injury (AKI) and length of stay (LOS).

Results: We identified a total of 10,810 hospitalized LC patients with HF, of which 1.39 % (n = 150/10,810) had COVID-19 infection. Using a stepwise survey …

Combination Sodium Nitrite And Hydralazine Therapy Attenuates Heart Failure With Preserved Ejection Fraction Severity In A “2-Hit” Murine Model, Kyle B. Lapenna, Zhen Li, Jake E. Doiron, Thomas E. Sharp, Huijing Xia, Karl Moles, Kashyap Koul, John S. Wang, David J. Polhemus, Traci T. Goodchild, Ravi B. Patel, Sanjiv J. Shah, David J. Lefer

School of Medicine Faculty Publications

BACKGROUND: Recent studies have suggested that cardiac nitrosative stress mediated by pathological overproduction of nitric oxide (NO) via inducible NO synthase (iNOS) contributes to the pathogenesis of heart failure with preserved ejection fraction (HFpEF). Other studies have suggested that endothelial NO synthase (eNOS) dysfunction and attenuated NO bioavailability contribute to HFpEF morbidity and mortality. We sought to further investigate dysregulated NO signaling and to examine the effects of a NO-based dual therapy (sodium nitrite+hydralazine) following the onset of HFpEF using a “2-hit” murine model. METHODS AND RESULTS: Nine-week-old male C57BL/6 N mice (n=15 per group) were treated concurrently with high-fat …