New research was presented at HFSA 2018, the Heart Failure Society of America Annual Scientific Meeting, from September 15-18 in Nashville. The features below highlight some of the studies that emerged from the conference.
Excess Polypharmacy in Heart Failure
Data assessing patients with heart failure concurrently taking at least 10 medications (hyperpolypharmacy, HPP) are lacking. Researchers who analyzed data from adult heart failure patients in the community from the National Health and Nutrition Examination Survey found that about 25% were HPP patients, who took an average of 12.0 different medications, compared with an average of 5.5 among non-HPP patients. Non-cardiovascular medications accounted for 55% of the drugs taken by HPP patients, compared with 42% in non-HPP patients. While older age, functional and cognitive impairment, third-party coverage, and lack or coverage did not correlate with number of medications taken by participants, number of comorbidities and lower levels of education and household income emerged as significant predictors of HPP. Based on their findings, the study authors speculate that a lack of continuity in care may play a role in HPP among patients with HFF.
Heart Failure Care Modifications & Outcomes
To assess the impact on outcomes among patients with heart failure (HF), investigators compared the time prior to implementation of a standardized care protocol for this patient population at their center to a period following implementation. The protocol included modifying initial doses of diuretics, monitoring urine output of furosemide and alerting the HF team of inadequate output, early implementation of HF guideline-directed medical therapy, early HF-specific consultation, daily multidisciplinary rounds, and close attention from nursing staff and HF nurse coordinators. With the protocol, average length of stay (LOS) decreased from 7.60 days to 6.56 days. Beyond LOS improvements, higher-dosage diuretic use increased from 36% to 93%, HF order set use increased from 32% to 81%, cardiology consultations for acute decompensated HF rose from 75% to 99%, and early cardiology consultation rose to 98%.
Self-Care in Low-Income Heart Failure Patients
Previous research suggest that patients with low socioeconomic status (SES) have worse heart failure (HF) outcomes than those with high SES, including higher readmissions. Reasons why interventions to improve outcomes in patients with low SES have been unsuccessful remain unclear. To determine social factors impacting psychological stress and self-care in a low SES patient population with HF and multiple readmissions, study investigators conducted semi-structured interviews about personal and community factors during inpatient readmissions for acute decompensated heart failure. Participants also completed a standardized instrument measuring psychological stress and the Self-Care Heart Failure Index (SCHFI). Only 8.5% of patients scored “adequate” on the management subscale of the SCHFI, with 17.0% scoring adequate on the maintenance subscale and 23.0% scoring adequate on the confidence subscale. More than one-third scored high on measures of perceived stress. The most common stresses affecting self-care were financial difficulties (63%), past impactful deaths (54%), recent stressful events (37%), children/grandchildren (34%), and personal health (29%).
Outcomes With Lung Impedance-Guided Treatment
Few studies have assessed factors associated with whether patients with heart failure (HF) are ready for hospital discharge. For a study, patients with HF were randomized to a control group or to lung impedance (LI)-oriented care. Those in the latter group had their LI evaluated at monthly outpatient hospital visits as well as at admission and discharge for every HF-associated hospitalization. Patients receiving LI-guided care had 52% fewer HF-associated hospitalizations, 33% fewer deaths from any cause, and 47% fewer HF-related deaths. Following HF-related readmissions, 90-day mortality rates were 46% in the LI-guided group and 61% in the control group.
Newer Left Ventricular Assist Device Improves Long-Term Stroke Outcomes
Whether the change from a cardiac axial-flow pump to a centrifugal-flow pump helps improve outcomes in patients implanted with a newer version of a continuous-flow left ventricular assist device (LVAD) has not been determined. A comparison of the newer version with its predecessor among patients with advanced heart failure found stroke rates of 10.1% in those implanted with the newer version and 19.2% in those implanted with the predecessor. While stroke event rates were similar during the first 180 days with both devices, thereafter, the new device was associated with significantly fewer strokes (0.04 vs 0.13 per patient-year). The sole predictor of having fewer strokes in the long run was treatment with the newer device (odds ratio, 0.44). The finding that neither blood pressure nor antithrombotic regimens appeared to impact the risk of stroke in the study population likely reflects the superior hemocompatability of the newer devices, say the study authors. Participants who experienced any type of stroke had lower 2-year survival rates than those who did not.