Medicine and Health Sciences Commons^™

Contrast-Enhanced Ultrasound Of Muscle Perfusion May Indicate Patient Response To Left Ventricular Assist Device Therapy., Lauren J. Delaney, Kathleen Fitzgerald, Maria Stanczak, Priscilla Machado, John W..C. Entwistle, Flemming Forsberg, Gordon R. Reeves

Department of Radiology Faculty Papers

PURPOSE: Left ventricular assist device (LVAD) support is associated with peripheral vascular abnormalities beyond those associated with heart failure (HF). These abnormalities are associated with persistent functional impairments that adversely impact quality of life (QoL). Methods for measuring peripheral vascular function in this population are needed.

METHODS: This pilot study investigated the use of contrast-enhanced ultrasound (CEUS) using standardized protocols to estimate changes in peripheral (quadriceps) muscle perfusion among patients with HF (INTERMACS profile 3) undergoing LVAD implantation (n = 7). Patients were then stratified by those who did ("responders", n = 4) and did not ("nonresponders", n = 3) …

Cheyne-Stokes Respiration In A 17-Year-Old Boy Awaiting Heart Transplantation, Nooralam A Rai, Aliva De, Carin Lamm

The Texas Heart Institute Journal

Cheyne-Stokes respiration is a pattern of alternating central apnea and hyperpnea. It is well described in adults with congestive heart failure, but not in children.

We report the case of a 17-year-old boy whose systolic heart failure was complicated by Cheyne-Stokes respiration. He was given supportive therapy until heart transplant, after which his Cheyne-Stokes respiration clinically resolved. Clinicians should be aware of this uncommon condition in pediatric and adolescent patients who have advanced heart failure and irregular breathing.

Heart Failure, Meredith Louden

Nursing Student Class Projects (Formerly MSN)

Abstract

Background: Heart failure (HF) is the heart’s inability to maintain the blood flow needed by the body’s organs for perfusion. HF affects millions of adults worldwide annually and holds detrimental characteristics with its high hospitalization and mortality rates. As a result, healthcare systems spend exponentially more resources and money to take care of HF patients. An interactive poster is presented on HF to educate patients with HF, healthcare providers, and other related parties.

Methods: Research articles that focused on HF, including the following topics: pathophysiology, clinical signs and symptoms, treatment, complications, impact on healthcare, and etiology, were evaluated and …

Patient Portal Use, Health Information Technology Self-Efficacy, Electronic Health Literacy, And Self-Management Among Patients With Heart Failure: A Cross Sectional Study, Pamel Kallmerten

Electronic Theses and Dissertations

Background: By the year 2030, the prevalence of heart failure (HF) is anticipated to rise by 46%, impacting over 8 billion persons. Self-management of HF is key to maintaining a healthy lifestyle and quality of life. Yet many have sub-optimal self-management skills necessitating innovative strategies to enhance self-management. An innovative strategy to support the person with HF is the use of health information technology (HIT) such as a patient portal (PP). Additionally, self-efficacy and health literacy are important to self-management of HF. Further understanding is needed of the relationship between PP use, HIT self-efficacy (HIT SE), electronic health literacy …

A Simple Effective Method For Frailty In Heart Failure With Impact On Clinical Outcomes In North Indian Population, Gurbhej Singh, Rohit Tandon, Neelesh C. Pandey, Namita Bansal, Abhishek Goyal, Bhupinder Singh, Shibba Takkar Chhabra, Naved Aslam, Gurpreet Singh Wander, Bishav Mohan

Journal of the Saudi Heart Association

Introduction and Objectives: Frailty has been studied extensively in elderly population as a predictor and prognostic marker for morbidity and mortality. Frailty is being increasingly recognised as a distinct pathophysiological condition which plays a major role in outcomes of various disease states including heart failure. Our aim was to study the prevalence of frailty in heart failure and see its prognostic significance in such patients. Methods: This was a prospective study conducted in an out-patient HF clinic. All consecutive patients with HF, > 25 years age, with LVEF < 40 % were included. All patients were asked a simple frailty questionnaire. Hand-dynamometer was used to assess handgrip strength in kilograms and were classified as frail, pre-frail or non-frail. The primary end point was cardiovascular mortality and hospitalization, and secondary end-point was composite of all cause mortality, hospitalization,device implantation and documented arrythmia. Results: 210 patients were studied for clinical outcomes.Mean age was 60.59+ 11.55 years with 15 % patients aged less than 50 years. Mean LVEF was 30.24+ 6.8%. Handgrip strength was poor in the frail vs non/pre-frail patients (p=0.001) with a strength >16.95 kg having sensitivity of 72% and specificity of 63% for the prediction …

Sustained Use Of The Impella 50 Heart Pump Enables Bridge To Clinical Decisions In 34 Patients, Daniel W Nelson, Sakthi Sundararajan, Evan Klein, Lyle D Joyce, Lucian A Durham, David L Joyce, Asim A Mohammed

The Texas Heart Institute Journal

We studied whether sustained hemodynamic support (>7 d) with the Impella 5.0 heart pump can be used as a bridge to clinical decisions in patients who present with cardiogenic shock, and whether such support can improve their outcomes. We retrospectively reviewed cases of patients who had Impella 5.0 support at our hospital from August 2017 through May 2019. Thirty-four patients (23 with cardiogenic shock and 11 with severely decompensated heart failure) underwent sustained support for a mean duration of 11.7 ± 9.3 days (range, ≤48 d). Of 29 patients (85.3%) who survived to next therapy, 15 were weaned from …

Continuous-Flow Left Ventricular Assist Device Explantation After More Than 5 Years Of Circulatory Support And Ventricular Reconditioning, George V Letsou, Andrew C W Baldwin, Andrew B Civitello, William E Cohn, O H Frazier

The Texas Heart Institute Journal

Continuous-flow left ventricular assist devices have proved to be effective, durable, life-saving tools in patients with end-stage heart failure. However, because of the risks associated with mechanical circulatory support (including stroke, infection, gastrointestinal bleeding, and device malfunction), the optimal goal of device therapy is myocardial recovery and device removal. Ventricular reconditioning and pump explantation after continuous-flow support have been reported; however, little is known about variables that govern the pace and degree of myocardial response in patients who experience such recovery. We describe our long-term pump-weaning strategy for a 25-year-old man who had a continuous-flow device implanted and then needed …

Effects Of Palliative Care On Nurses’ Knowledge And Attitudes, Daniel Kerr

MSN Capstone Projects

Heart failure (HF) is a chronic, progressive disease that affects 6 million Americans (Ng & Wong, 2017). During the course of the disease, patients have worsening symptoms and need increasing levels of care from both medical staff and home caregivers. Often, these caregivers are family members or friends who spend a significant amount of their free time assisting the patient, leading to significant stress and burden on the caregivers. Recent changes in recommendations from the American Heart Association (AHA) include Palliative Care (PC) consultation for patients diagnosed with advanced stage heart failure, but many physicians have not included a PC …

Utilizing Heart Failure Education Materials To Reduce Hospital Readmissions, Miranda P. Peterson

MSN Capstone Projects

With the initiation of the Centers for Medicare and Medicaid Services Hospital Readmission Reduction Program, hospitals are heavily penalized for heart failure patients who re-present to the hospital within 30-days for any cause. Patients also prefer to stay out of the hospital so they do not miss important life events and can live happily and comfortably in their own environments. Therefore, there has been a push to implement change projects to reduce hospital readmissions.

This project serves to implement the usage of the Heart Care Tool Kit, which is an educational aid to assist nurses in delivering proper heart failure …

The Effectiveness Of A Nurse Practitioner (Np) Led Clinic For Heart Failure (Hf) Patients Following Hospital Discharge In A Rural Community Setting, Tami Collins, Michelle Renaud

College of Health Sciences Posters

Purpose: To explore if patient participation in the NP led HF clinic may reduce 30-day HF readmissions while providing HF specific education, recognition of symptoms/ management, teaching self-care, while ensuring that continued follow up occurs.

Research Questions: 1) Is there a significant difference between readmission rates in patients followed in the HF clinic compared to general HF follow up? 2) Is there a significant difference in patient knowledge including HF symptoms, self-management for patients followed in the NP led HF clinic for a minimum of 30 days? 3) How satisfied are patients that followed in the NP led HF clinic …

A Phase Ii Study Of Autologous Mesenchymal Stromal Cells And C-Kit Positive Cardiac Cells, Alone Or In Combination, In Patients With Ischaemic Heart Failure: The Cctrn Concert-Hf Trial, Roberto Bolli, Raul D Mitrani, Joshua M Hare, Carl J Pepine, Emerson C Perin, James T Willerson, Jay H Traverse, Timothy D Henry, Phillip C Yang, Michael P Murphy, Keith L March, Ivonne H Schulman, Sohail Ikram, David P Lee, Connor O'Brien, Joao A Lima, Mohammad R Ostovaneh, Bharath Ambale-Venkatesh, Gregory Lewis, Aisha Khan, Ketty Bacallao, Krystalenia Valasaki, Bangon Longsomboon, Adrian P Gee, Sara Richman, Doris A Taylor, Dejian Lai, Shelly L Sayre, Judy Bettencourt, Rachel W Vojvodic, Michelle L Cohen, Lara Simpson, David Aguilar, Catalin Loghin, Lem Moyé, Ray F Ebert, Barry R Davis, Robert D Simari

Journal Articles

AIMS: CONCERT-HF is an NHLBI-sponsored, double-blind, placebo-controlled, Phase II trial designed to determine whether treatment with autologous bone marrow-derived mesenchymal stromal cells (MSCs) and c-kit positive cardiac cells (CPCs), given alone or in combination, is feasible, safe, and beneficial in patients with heart failure (HF) caused by ischaemic cardiomyopathy.

METHODS AND RESULTS: Patients were randomized (1:1:1:1) to transendocardial injection of MSCs combined with CPCs, MSCs alone, CPCs alone, or placebo, and followed for 12 months. Seven centres enrolled 125 participants with left ventricular ejection fraction of 28.6 ± 6.1% and scar size 19.4 ± 5.8%, in New York Heart Association …

Successful Pregnancy With Centrifugal Flow Left Ventricular Assist Device: A Case Report And Review Of The Literature, Seyed Hamed Hosseini Dehkordi, Matthew R. Lippmann, Travis Abicht, Andrew J. Sauer, Nicholas A. Haglund, Marc R. Parrish, Jared Staab, Bhanu Gupta

The VAD Journal

Successful deliveries from patients supported by axial flow left ventricular devices have been previously reported. We present the first case of a successful pregnancy and birth in a patient with a centrifugal-flow left ventricular assist device. A 24-year-old female with methamphetamine-induced cardiomyopathy and end-stage congestive heart failure supported by a HeartWare™ ventricular assist device (Medtronic) presented two years after device implantation with an unplanned pregnancy at 11-weeks of gestation. Following a multidisciplinary evaluation by experts in advanced heart failure, maternal fetal medicine, cardiothoracic surgery, anesthesia, ethics, psychiatry, and palliative care, an advanced plan of care was established. An elective induction …

Evaluation Of A Telehealth Program For Heart Failure Patients, Virginia Elizabeth Lucas

Walden Dissertations and Doctoral Studies

AbstractHeart failure (HF) is a progressive and life -threatening disease that places a large burden on the health care systems worldwide with increased rates of re-hospitalization, readmissions, and outpatient visits. With the use of telehealth monitoring and support from nursing case managers, HF patients are able to manage this disease at home. The focus of this project was to evaluate a home health agency (HHA) telehealth program, exploring if there was an improvement in 30-day readmission rates, and patient satisfaction scores for the HHA telehealth program one year after revising the program incorporating nursing virtual case managers. This project used …

The Outcomes Of Cope, A Cognitive Behavioral Therapy Program, In Patients Awaiting Lvad Implantation, Aaron G. Harris

DNP Projects

PURPOSE: The purpose of the Doctor of Nursing Practice (DNP) project was to pilot Creating Opportunities for Personal Empowerment (COPE), an evidence based cognitive behavioral therapy (CBT) intervention, with patients diagnosed with advanced heart failure who are awaiting Left Ventricular Assist Device (LVAD) implantation or those who have had one recently implanted before they are discharged home. METHODS: A cross-sectional study design was used for this Pilot project. Patients were identified for potential participation by LVAD coordinators and represent a convenience sample. The patients were screened for anxiety and depression using the GAD-7 and PHQ-9 screening tools. If patients scored …

Rad Modulation Of The L-Type Calcium Channel Confers Systolic Advantage In The Heart, Brooke Mildred Ahern

Theses and Dissertations--Physiology

Heart failure is a major public health problem and a leading cause of mortality. This clinical condition affects populations of all ages, and is the result of various cardiomyopathies. Almost half of these patients suffer specifically from heart failure with reduced ejection fraction; these hearts have decreased performance due to a failure of the heart to contract with sufficient force to meet demand. While there are therapies available to increase contractility, none of these enhance contraction without also further promoting pathological signaling and remodeling.

Under normal physiological conditions, the body elevates cardiac output through the fight-or-flight response. This response activates …

Comparison Of Traditional Management Of Heart Failure With Cardiomems, Quinn Jacobs

Physician Assistant Scholarly Project Posters

The purpose of this research and literature review is to compare the efficacy of the implantable pulmonary artery pressure monitoring device, CardioMEMS, to traditional heart failure management in terms of reducing hospital readmissions. The data bases of Cochrane Library, PubMed, Clinical Key, and DynaMed Plus were utilized. Because the CardioMEMS device is relatively novel in the treatment of heart failure, the time frame of search results was expanded to 10 years to include research from the original clinical trials. A total of 17 peer reviewed works were chosen for this review which included meta-analyses, systematic reviews, randomized controlled trials, and …

The Effects Of Interleukin-1Β On Cardiac Reserve And Exercise Capacity In The Mouse, Habeebah Z. Vohra

Theses and Dissertations

Heart failure (HF) is characterized by dyspnea, fatigue, and exercise intolerance. Clinical evidence points to increased interleukin-1β (IL-1β) activity in patients with HF, with an IL-1 blockade improving the exercise capacity in HF patients. In healthy mice, recombinant-mouse IL-1β (rmIL-1β) induces acute systolic dysfunction, peaking 4 hours after administration. However, the direct effects of rmIL-1β on exercise capacity are unknown. We hypothesized that rmIL-1β diminishes the exercise capacity in the mouse. Adult mice were trained to run on a treadmill and exercise capacity was assessed before, 4 hours, and 96 hours after intraperitoneal administration of rmIL-1β (3 μg/kg) or vehicle …

Utilizing Video Education To Improve Self-Care In Heart Failure Population At Home, Adrienne Wharry

West Chester University Doctoral Projects

Abstract

This quality improvement project was implemented to improve self-care in home health patients using video education provided on the tablet-based monitoring system. Heart failure is a chronic, progressive disease with high hospital readmission rates. However, consistent use of self-care behaviors improves patient quality of life and reduces hospital readmission rates in heart failure patients. Literature has shown that continued self-care education is essential for the success of the heart failure patient. The use of Bluetooth tablet systems for home health care and monitoring has expanded in recent years. The Self-Care of Heart Failure Index (SCHFI) was administered to heart …

A Comparison Of Sglt2 Inhibitors To Current Guideline Directed Medical Therapy For The Treatment Of Heart Failure In Non-Diabetic Patients, Rebecca R. Beyer

Physician Assistant Scholarly Project Posters

Heart failure remains a complex disease that affects an increasing number of patients annually. For heart failure, most of the research has focused on the hemodynamic changes of the heart chambers and the medications that slow the disease progression. Recent studies have investigated treatment options that may disrupt the neuro-hormonal and pathophysiologic cell changes that lead to further progression of heart failure. Although the mechanisms by which the sodium-glucose cotransporter 2 (SGLT2) inhibitors are not entirely understood, they are believed to directly affect the cardiac electrolyte imbalances that trigger the cellular changes which contribute to the altered contractility, adrenergic receptor …