Heart & Lung最新文献

{"title":"Evolving Trends in Antihypertensive Therapy for Heritable Thoracic Aortic Disease:A 28-Year Retrospective Analysis","authors":"Brittany D. Rhoades (she/her/hers) PhD, APRN, CCNS, CCTN, FCNS, Gilda E. Martinez (she/her/hers) MSN, APRN, FNP-C, Veronica Glover (she/her/hers) PhD, Susan Green (she/her/hers) MPH, Lynna Nguyen (she/her/hers) MSC, Marc R. Moon (he/him/his) MD, Joseph Coselli (he/him/his) MD","doi":"10.1016/j.hrtlng.2025.04.015","DOIUrl":"10.1016/j.hrtlng.2025.04.015","url":null,"abstract":"<div><h3>Background</h3><div>Aortic aneurysms, dissections, and ruptures rank as the 19th leading cause of death in the United States, contributing to nearly 50,000 fatalities annually. These conditions often remain silent until catastrophic events occur, underscoring the importance of early detection, including clinical and phenotypic recognition, and proactive management. In contrast to age-related abdominal aortic disease, 20% of thoracic aortic aneurysms are attributed to heritable thoracic aortic disease (HTAD). Typically, HTAD is identified in young patients by surviving an acute aortic event, detecting an incidental imaging finding or phenotypic concern, or investigating familial relationships.</div><div>Optimizing medical management of hypertension is essential for mitigating the progression of aortic disease and reducing the risk of dissection and rupture. Beta-blockers (BBs) and angiotensin II receptor blockers (ARBs), specifically Losartan, can decrease hemodynamic stress on the aortic wall, potentially slowing aneurysmal expansion and minimizing life-threatening events.</div></div><div><h3>Aim</h3><div>This study aims to evaluate a 28-year trend in antihypertensive therapy among HTAD patients undergoing elective aortic repair at a robust aortic center in the Southwest.</div></div><div><h3>Methods</h3><div>We included 990 HTAD patients ≥18 years (median age, 43 years; quartile 1-quartile 3, 36-49) who underwent elective aortic surgery within a high-volume practice in the Southwest United States (1996-2024). Patients were categorized into one of four groups based on antihypertensive medication regimen at the time of surgery: no medication (NoMeds, n=98), beta-blockers only (BBs only, n=675), angiotensin II receptor blockers only (ARBs only, n=70), or both BBs and ARBs (BBs+ARBs, n=147). Descriptive statistics and group comparisons were performed to retrospectively evaluate trends and outcomes.</div></div><div><h3>Results</h3><div>Overall, most patients were male (68%, n=668), had hypertension (75%, n=744), and were ≤50 years of age (84%, n=827). Notably, nearly 10% of patients (n=98) were not receiving any antihypertensive medication. Over time, there has been a significant decline in the proportion of patients managed without antihypertensive therapy or with beta blockers (BBs) alone. Specifically, the use of BBs as monotherapy decreased by nearly 24% (p< 0.01) as clinical practice evolved toward greater adoption of angiotensin receptor blockers (ARBs), either alone or in combination with BBs (Figure 1). This shift highlights advancements in evidence-based strategies for optimizing perioperative hypertensive medical management of HTAD patients (Figure 2).</div></div><div><h3>Conclusions</h3><div>Managing hypertension is essential for reducing the risk of aortic disease progression, dissection, and rupture; beta-blockers (BBs) and angiotensin II receptor blockers (ARBs) are effective treatments. This analysis underscores significant ","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 98-99"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Volume in Ambulatory Heart Failure Patients: Beyond Oral Diuretics","authors":"Donna Moser BSN RN CHFN","doi":"10.1016/j.hrtlng.2025.04.016","DOIUrl":"10.1016/j.hrtlng.2025.04.016","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) is a chronic, progressive disease that effects over 6 million Americans. Despite growing options in the Guideline Directed Medical Therapy and innovative technology, 25% may return to the hospital within 30 days for IV diuresis. This results in CMS financial penalties for the hospital and personal cost to the patient in reduced quality of life and mortality.</div></div><div><h3>Aim</h3><div>The purpose of this study is to examine effectiveness of appropriate options for patients that may be resistant to standard oral diuretic volume management utilizing a nurse-run outpatient diuresis center and/or home diuresis with subcutaneous furosemide (Furoscix(R)).</div></div><div><h3>Methods</h3><div>HF specialists and HF physician assistants (PAs) identify inpatient or outpatient HF clinic patients as volume overloaded and at high risk for readmission. Referral to the nurse-supervised Outpatient Diuresis Clinic by an order set is placed in the Electronic Medical Record for serial weekly infusions (Bumetanide 2 mg or Furosemide 80 mg IVP) with standard lab work (BMP, Magnesium level). After insurance authorization is determined, the appointment is scheduled. A hospital van service provides transportation within a 6-mile radius. When the patient arrives, they are provided a comfortable recliner in a private curtained area. Weight and vital signs are recorded, an IV access placed, and the IV diuretic given. HF provider or CHFN is notified by the infusion nurse if a patient is hypotensive, hypertensive or has a serious lab results requiring Emergency Department evaluation. Labs are reviewed after 2 hours. Oral potassium and magnesium are provided if needed per order set and IV access removed. If distance to the Outpatient Diuresis Center is prohibitive or the patient has difficulty ambulating, Furoscix(R) 80 mg subcutaneous is an effective option. Coverage by insurance is investigated, and the medication ordered through Furoscixdirect.com. Our patients and carepartners are instructed in application in clinic or a trained homecare nurse is ordered for application, clinical assessment and HF education in the home. The collaboration of the CHFN, the HF PAs and MDs with the Diuresis Center and homecare nurses is key to the success of this model.</div></div><div><h3>Results</h3><div>Between Jan 2022 and November 2024, 74 men and 55 women with HF (N=129), age 30-91, with insurance (Medicare N=100, Medicaid N=24, Commercial N=5) were identified and agreed to Outpatient Diuresis. Thirty-six-point four percent (36.4% N=47) did not go to any Outpatient Diuresis sessions. Of these 47 patients, 36% (N=16) were readmitted in less than 30 days (Average 10.4 days). Adherent patients (63.6%. N=82) attended at least 1 to 4 weekly sessions. Only 6% (N=5) of these patients were readmitted within 30 days (Average 17.2 days). Average hospitalization-free time of the 82 adherent patients utilizing outpatient diuresis and/or Furoscix","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Page 99"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of the GEtting iNTo Light Exercise for Heart Failure (GENTLE-HF) Randomized Controlled Trial on Physical-Psychological Outcomes and Exercise Adherence","authors":"Jane Kim (she/her/hers) BSN, RN","doi":"10.1016/j.hrtlng.2025.04.017","DOIUrl":"10.1016/j.hrtlng.2025.04.017","url":null,"abstract":"<div><h3>Background</h3><div>Exercise is recommended to improve the lives of patients with heart failure (HF), but numerous barriers prevent exercise engagement and long-term exercise adherence. Yoga has been studied as a complementary therapy for patients with HF. Small pilot studies show short-term benefits of yoga-like gentle exercise for individuals with HF. Few investigators have examined the effect of online yoga exercise interventions on long-term benefits and exercise adherence.</div></div><div><h3>Aim</h3><div>The study aims were to: 1) Evaluate the efficacy of a 6-month online yoga and educational intervention on physical and psychological function, 2) Evaluate whether age or sex moderated the efficacy of the intervention on physical function, and 3) Determine the relationship between quality of life scores and exercise adherence in patients with HF.</div></div><div><h3>Methods</h3><div>Data from the Getting iNTo Light Exercise for HF (GENTLE-HF) randomized control trial (n = 61) was analyzed. Measures included physical function (tests of flexibility, upper/lower body strength, agility, balance, endurance, waist circumference), psychological function (depression and anxiety), quality of life, and exercise adherence. A general linear ANCOVA-approach model was used to examine physical and psychological function, adjusting for age, years of education, baseline study scores, and grouping (control or intervention). Pearson correlation analysis was used to examine the relationship between baseline quality of life scores and yoga intervention adherence.</div></div><div><h3>Results</h3><div>Compared to control, the intervention group had improved upper body strength (p = .004), lower body strength (p = .002), and endurance (p = .003). Age moderated the effect of the intervention on upper body strength (p = .012) and endurance (p = .028). Psychological (depression and anxiety) function did not significantly differ between the groups. Adherence was high at 62.5%. Greater quality of life scores were associated with higher exercise adherence (p = .039).</div></div><div><h3>Conclusions</h3><div>The online yoga intervention led to significant improvements in upper/lower body strength and endurance among participants, had a stronger, additional effect for participants over 65 years, and had high adherence rates. The study also demonstrated that greater quality of life was associated with higher exercise adherence. Online exercise programs incorporating yoga can increase exercise accessibility and improve exercise adherence rates. The findings from this study can impact HF exercise guidelines with potential recommendations for gentle types of exercise, inform future large-scale yoga studies, and improve outcomes among patients with HF.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 100-101"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Board of Directors","authors":"","doi":"10.1016/S0147-9563(25)00098-6","DOIUrl":"10.1016/S0147-9563(25)00098-6","url":null,"abstract":"","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Page iii"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Exercise on Depression in Patients Diagnosed with Heart Failure with Preserved Ejection Fraction","authors":"Harrison L. Krebs (he/him/his) MSN, RN, CCRN,&nbsp;Marilyn A. Prasun PhD, CCNS, CNL, CHFN, FAHA,&nbsp;John Blakeman PhD, RN, PCCN,&nbsp;Annette Hubbell PhD, RN,&nbsp;Matthew Hesson-McInnis PhD","doi":"10.1016/j.hrtlng.2025.04.014","DOIUrl":"10.1016/j.hrtlng.2025.04.014","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Millions of Americans are living with heart failure in the United States, and about 50% of those individuals have a preserved ejection fraction (HFpEF). Many patients living with heart failure may deal with managing depression. Depression, combined with HFpEF, puts individuals at risk for increased mortality rates and hospital admissions—making the management of these diseases of the utmost importance. Exercise is recommended for individuals with HFpEF. However, exercise to manage depressive symptoms in individuals with HFpEF has yet to be fully explored.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;This systematic literature review aimed to examine the effects of exercise therapy on depression reported by individuals diagnosed with HFpEF.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology in five electronic databases: SPORTDiscus, PubMed, Cumulative Index to Nursing and Allied Health Literature, Academic Search Complete, and the Joanna Briggs Institute Evidence-Based Practice Database, using specific terms for research studies published between 2010 and 2024. The Joanna Briggs Institute critical appraisal tool was used to assess the quality of the included studies. Inclusion criteria consisted of original human subjects’ peer-reviewed research, studies that enrolled adults diagnosed with HFpEF, studies using exercise as a form of treatment, studies published in the English language, and studies that used depression as an outcome measure. Exclusion criteria consisted of nonhuman subjects research, studies with participants younger than 18 years of age, studies that did not include patients with HFpHF, studies that did not use exercise as a treatment, studies that used no valid measure of depression, or incomplete studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Sixty-seven studies were identified, but only five (totaling 306 participants) met the inclusion criteria. Exercise therapy consisted of strength, endurance training, and Tai Chi. Depression was measured using various validated instruments: the Patient Health Questionnaire (PHQ-9), Geriatric Depression Scale-15, Profile of Mood States, and the Hare-Davis Cardiac Depression Scale. All five studies showed improved depression scores following exercise therapy, with four studies reporting statistically significant improvements. Depression scores improved significantly in four of the five included studies. Specifically, depression was reduced by 0.8 points (measured with the Geriatric Depression Scale-15), 2 points (measured with the PHQ-9 tool), 1.7 points (measured with the subscale of Depression in Profile of Mood State), and 3.95 points (measured with the PHQ-9) in these 4 studies. The fifth study demonstrated a 7-point improvement in depression (measured with the Hare-Davis Cardiac Depression Scale), though this change was not statistically sign","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 97-98"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Failure and Dysphagia: A Scoping Review","authors":"Juvel-lou P. Velasco (she/her/hers) AGACNP-BC, CCRN, CHFN","doi":"10.1016/j.hrtlng.2025.04.018","DOIUrl":"10.1016/j.hrtlng.2025.04.018","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Swallowing is a complex physiological process involving the coordinated movement of food from the mouth to the stomach. Dysphagia, or difficulty swallowing, can arise from abnormalities in the anatomy or physiology of the structures involved in this process. In heart failure (HF) patients, dysphagia may occur due to the anatomical proximity of the esophagus to the heart. Despite its potential impact, this symptom is not routinely assessed in patients with HF.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;This scoping review aims to summarize and synthesize the association of dysphagia with heart failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This scoping review was conducted using a comprehensive search strategy across databases including PubMed, CINAHL, Embase, and Google Scholar. The review adhered to the Joanna Briggs Scoping Review Methodology and complied with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The inclusion criteria focused on studies involving heart failure patients aged 18 years or older, with no restrictions on publication date or study duration, acknowledging the chronic nature of heart failure. To capture the global prevalence of the condition, no geographical limitations were applied. However, due to constraints in translation resources, only articles published in English or those with available English translations were included.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 36 articles were reviewed, comprising case reports (n=20), literature reviews (n=2), longitudinal studies (n=3), prospective cohort studies (n=5), retrospective cohort studies (n=5), and a cross-sectional study (n=1). Major risk factors for dysphagia include advanced age and poor oral health, with a higher prevalence observed following cardiac surgery and in patients with comorbidities such as dementia, chronic obstructive pulmonary disease, cancer, and anemia. Pathophysiological contributors include esophageal dysmotility and stricture, esophageal dilation causing cardiac compression, and cardiomegaly causing esophageal compression. Clinically, dysphagia in HF is associated with dehydration, malnutrition, aspiration, and suffocation. Furthermore, it is linked to higher readmission rate, prolonged hospital stays, non-home discharges, and increased mortality. More importantly, volume overload is both a contributing factor and an adverse outcome of dysphagia in HF patients. Management strategies range from dietary modifications and pharmacological treatments to invasive and non-invasive therapeutic measures. Continuous surveillance is essential to ensure early detection and prevention of complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Dysphagia is a prevalent and significant concern in heart failure (HF) patients, compounded by various risk factors and associated with notable clinical challenges and adverse outcomes. This review highli","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Page 101"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precise Volume Management with CardioMEMS: Effects on Chronic Kidney Disease Progression and Kidney Function Preservation in Heart Failure Patients","authors":"Jennifer Coleman CHFN, RN,&nbsp;Nancy Kanat RN, BSN, CHFN","doi":"10.1016/j.hrtlng.2025.04.013","DOIUrl":"10.1016/j.hrtlng.2025.04.013","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) often coexists with chronic kidney disease (CKD), creating a bidirectional cycle of organ dysfunction that accelerates disease progression. Traditional volume management methods relying on clinical judgment and fixed diuretics can result in suboptimal outcomes. Innovative strategies, such as hemodynamic monitoring with the CardioMEMS Heart Failure Monitoring System, offer potential benefits in slowing CKD progression and preserving kidney function.</div></div><div><h3>Aim</h3><div>The aim of this retrospective cohort study was to evaluate the impact of strict volume management using CardioMEMS on CKD progression and estimated glomerular filtration rate (eGFR) preservation compared to standard care.</div></div><div><h3>Methods</h3><div>A total of 100 patients with HF and CKD (Stages 3–4) were included, with 50 receiving CardioMEMS implants and 50 managed through standard care. Data collection occurred at implant or initial hospitalization, 6 months post-implant, and 2 years post-implant. Primary outcomes included changes in eGFR over time and differences between CKD Stage 3 and Stage 4 patients. Statistical analysis was conducted using independent sample tests.</div></div><div><h3>Results</h3><div>CardioMEMS patients demonstrated significantly better kidney function preservation over 2 years compared to standard care (t98 = 2.798, p = .006). The average eGFR in the CardioMEMS group was 7.56 units higher than the standard care group after 2 years. Patients implanted at CKD Stage 3 showed greater eGFR preservation than those implanted at Stage 4, highlighting the benefits of early intervention.</div></div><div><h3>Conclusions</h3><div>Strict volume management using CardioMEMS is associated with slower CKD progression and better long-term kidney function preservation in HF patients. Early use of CardioMEMS may shift the standard of care, promoting personalized volume management to improve patient outcomes and delay dialysis. Larger studies are warranted to confirm these findings and refine clinical guidelines.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Page 97"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming Heart Failure Care: Leveraging Guideline-Directed Medical Therapy (GDMT) Discharge Order Sets to Drive Better Outcomes","authors":"Mackenzy T. Scott (he/him/his) MBA, RN","doi":"10.1016/j.hrtlng.2025.04.007","DOIUrl":"10.1016/j.hrtlng.2025.04.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Heart failure (HF) is a leading cause of hospital readmissions, with approximately 20% of patients being readmitted within 30 days (Virani et al., 2021). Adherence to guideline-directed medical therapy (GDMT) has been shown to significantly improve patient outcomes and reduce readmissions, with studies demonstrating reductions in mortality and readmission rates when GDMT is optimized (Greene et al., 2018). Structured workflows, such as discharge order sets, enhance GDMT adherence and improve the continuum of HF management (Yancy et al., 2017).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;This initiative's purpose was to enhance compliance with GDMT in patients with heart failure through the integration of a CHF discharge order set within the Epic electronic health record (EHR) system. This intervention aimed to standardize the discharge process, improve GDMT adherence, and reduce 30-day HF readmission rates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting/Population&lt;/h3&gt;&lt;div&gt;This initiative was conducted at Mount Sinai Hospital, which included cardiology and non-cardiology units. The population included adult patients admitted with a primary diagnosis of heart failure, with a focus on those eligible for GDMT at discharge.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method/Process&lt;/h3&gt;&lt;div&gt;A multidisciplinary team comprising cardiologists, nurses, and Epic analysts reviewed existing discharge workflows and identified gaps in GDMT compliance. The team developed a CHF discharge order set designed to standardize prescribing practices for GDMT. The order set included prompts for evidence-based therapies such as beta-blockers, ACE inhibitors/ARBs, angiotensin receptor-neprilysin inhibitors (ARNIs), and mineralocorticoid receptor antagonists (MRAs).&lt;/div&gt;&lt;div&gt;April 2023: Initial draft of the CHF Discharge Order Set was developed and presented to the Inpatient Mount Sinai Hospital Epic Committee.&lt;/div&gt;&lt;div&gt;May 2023: Revisions were made based on feedback, and a second draft was submitted.&lt;/div&gt;&lt;div&gt;April 2023: Initial draft of the CHF Discharge Order Set was developed and presented to the Inpatient Mount Sinai Hospital Epic Committee.&lt;/div&gt;&lt;div&gt;May 2023: Revisions were made based on feedback, and a second draft was submitted.&lt;/div&gt;&lt;div&gt;June 2023: Final approval was obtained from the Mount Sinai Hospital Epic Committee.&lt;/div&gt;&lt;div&gt;July 2023: The order set was uploaded into the Epic Playground for testing and training.&lt;/div&gt;&lt;div&gt;August 2023: The order set went live system wide. Training sessions and tip sheets were disseminated to ensure staff familiarity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;div&gt;Implementation of the CHF discharge order set led to measurable improvements in GDMT adherence 7 Day Follow Up Appointments, which led to reduced Heart Failure Readmission rates.&lt;/div&gt;&lt;div&gt;ARNI prescribing rates: Improved from 72.8% in 2022 to 81.1% in 2024.&lt;/div&gt;&lt;div&gt;Beta-blocker prescribing rates: Improved from 94.6% in 2022 to 95.5% in 2024.&lt;/div&gt;&lt;div&gt;MRA prescribing rates: Improv","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 102-103"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Spoonful of Heart Failure Resources Helps the Medicine Units Readmission Rates Go Down","authors":"Joseph Armitage (he/him/his) MSN, RN, CHFN,&nbsp;Melissa Wenzel BSN, RN, CCRN,&nbsp;Kathryn Arkin RN, BSN,&nbsp;Corrine Benacka MSN, CCRN,&nbsp;Jane Wilcox MD","doi":"10.1016/j.hrtlng.2025.04.009","DOIUrl":"10.1016/j.hrtlng.2025.04.009","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Heart failure is the leading cause of hospitalization in the United States and is associated with increased mortality, imposed stress on patients, and financial/capacity burdens on health care systems (AHA, 2022).&lt;/div&gt;&lt;div&gt;Medicine units were experiencing 30-day heart failure readmission rates above the hospital benchmark of 15.8%. Medicine units had higher rates of readmissions than the cardiac units for the heart failure population. A gap analysis found these units were lacking evidence-based strategies for patients admitted with heart failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;The performance improvement project aimed to evaluate effectiveness of specific interventions designed to reduce heart failure 30-day readmission rates on non-cardiac medicine units. The goal was to reduce readmissions in these areas through implementing the Heart Failure Bundle; a series of targeted strategies that includes patient education, scheduling follow up appointments within 7-10 days prior to discharge, providing scales and post discharge callbacks.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting/Population&lt;/h3&gt;&lt;div&gt;The medicine units in a large, urban academic medical center in Chicago, Illinois. The population included adults with heart failure admitted inpatient or observation regardless of diagnosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method/Process&lt;/h3&gt;&lt;div&gt;The heart failure team met with the medicine nursing and physician leadership division to share readmission data and analyze root causes for heart failure re-admissions. A full-time heart failure nurse navigator was dedicated to the medicine units to assist in implementation of the bundle. The navigator met with each unit, identified unit specific needs, attended interdisciplinary rounds and quality meetings, and educated staff members. The navigator began meeting with patients to provide comprehensive heart failure education and issue home scales, escalating care to specialized Cardiology services when indicated, and coordinating transitions of care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;div&gt;The hospital's benchmark for heart failure readmissions is 15.8%. All cause, unplanned 30-day heart failure readmissions were measured pre and post intervention. On the pilot unit, heart failure readmissions were reduced from a pre-intervention 6-month average of 21.2% to a post intervention 6-month average of 10.6%.&lt;/div&gt;&lt;div&gt;The pre-intervention 6-month average of the remaining units was 21.46%. Five months post intervention, the remaining units showed a decrease in average readmission rate to 12.3%.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Practical Implications&lt;/h3&gt;&lt;div&gt;The team identified that heart failure readmissions occurring in non-cardiac areas were not meeting benchmark and having an overall impact on the hospital's readmission rate.&lt;/div&gt;&lt;div&gt;Designating a heart failure navigator to execute the evidence-based bundle that proved successful on cardiac units could also be implemented on medicine units. Allocating described ","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 103-104"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Vutrisiran on Outpatient Worsening Heart Failure in Patients with Transthyretin Amyloidosis with Cardiomyopathy in the HELIOS-B Trial","authors":"Cynthia Bither ACNP, ANP, AACC, CHFN,&nbsp;Marianna Fontana MD, PhD,&nbsp;Mathew S. Maurer MD,&nbsp;Scott D. Solomon MD,&nbsp;Julian Gillmore MD, PhD,&nbsp;Shaun Bender PhD,&nbsp;Emre Aldinc MD,&nbsp;Satish Eraly MD, PhD,&nbsp;Patrick Jay MD, PhD","doi":"10.1016/j.hrtlng.2025.04.012","DOIUrl":"10.1016/j.hrtlng.2025.04.012","url":null,"abstract":"<div><h3>Background</h3><div>Transthyretin amyloidosis with cardiomyopathy (ATTR-CM) is a fatal disease, caused by transthyretin amyloid fibril deposits in the heart. Practical and sensitive methods are needed to monitor patients with disease progression and optimize treatment decisions. Outpatient worsening heart failure (HF) (oral diuretic intensification or initiation) has been shown to be prognostic of mortality in patients with ATTR-CM. In the phase 3 HELIOS-B trial (NCT04153149), the RNAi therapeutic vutrisiran reduced the risk of all-cause mortality (ACM) and recurrent CV events (CV hospitalizations and urgent HF visits) vs placebo in patients with ATTR-CM.</div></div><div><h3>Aim</h3><div>To investigate the clinical and prognostic value of—in addition to the effect of vutrisiran on—outpatient worsening HF in patients with ATTR-CM.</div></div><div><h3>Methods</h3><div>Associations between outpatient worsening HF and the HELIOS-B primary composite of ACM and recurrent CV events, ACM alone, and other disease progression-related endpoints were evaluated. The impact of vutrisiran over 36 months on outpatient worsening HF and an expanded composite of ACM, recurrent CV events, and outpatient worsening HF was also assessed.</div></div><div><h3>Results</h3><div>In the overall population (n=655 randomized; n=654 treated), 321 (49.1%) patients had ≥1 outpatient worsening HF event, 245 (37.5%) had ≥1 CV event(s), and 120 (18.3%) died; 237 patients (36.2%) had no events. Patients with, vs those without, outpatient worsening HF had an increased risk of ACM and CV events (hazard ratio [HR] 2.58, 95% confidence interval [CI] 2.04–3.27) and ACM (HR 2.45, 95% CI 1.70–3.52) (Figure 1), as well as greater deterioration in 6-minute walk test distance and Kansas City Cardiomyopathy Questionnaire-Overall Summary score, and a greater increase in N-terminal prohormone of B-type natriuretic peptide. In recurrent event analyses over the double-blind period, vutrisiran reduced the rate of outpatient worsening HF (relative rate ratio 0.66, 95% CI 0.56–0.78) vs placebo. Vutrisiran also reduced the risk of the composite of ACM, recurrent CV events and outpatient worsening HF vs placebo (HR 0.69 [95% CI 0.57–0.83]) (Figure 2).</div></div><div><h3>Conclusions</h3><div>Outpatient worsening HF was frequent in patients with ATTR-CM and was associated with an increased risk of mortality and recurrent CV events. Vutrisiran reduced the risk of outpatient worsening HF vs placebo.</div><div>This abstract has been presented at AHA 2024, Nov 16–18, 2024, Chicago, IL.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 95-96"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}