Heart & LungPub Date : 2025-05-30DOI: 10.1016/j.hrtlng.2025.04.018
Juvel-lou P. Velasco (she/her/hers) AGACNP-BC, CCRN, CHFN
{"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":"<div><h3>Background</h3><div>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.</div></div><div><h3>Aim</h3><div>This scoping review aims to summarize and synthesize the association of dysphagia with heart failure.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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}
Heart & LungPub Date : 2025-05-30DOI: 10.1016/j.hrtlng.2025.04.013
Jennifer Coleman CHFN, RN, Nancy Kanat RN, BSN, CHFN
{"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, 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}
Heart & LungPub Date : 2025-05-30DOI: 10.1016/j.hrtlng.2025.04.007
Mackenzy T. Scott (he/him/his) MBA, RN
{"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":"<div><h3>Background</h3><div>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).</div></div><div><h3>Purpose</h3><div>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.</div></div><div><h3>Setting/Population</h3><div>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.</div></div><div><h3>Method/Process</h3><div>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).</div><div>April 2023: Initial draft of the CHF Discharge Order Set was developed and presented to the Inpatient Mount Sinai Hospital Epic Committee.</div><div>May 2023: Revisions were made based on feedback, and a second draft was submitted.</div><div>April 2023: Initial draft of the CHF Discharge Order Set was developed and presented to the Inpatient Mount Sinai Hospital Epic Committee.</div><div>May 2023: Revisions were made based on feedback, and a second draft was submitted.</div><div>June 2023: Final approval was obtained from the Mount Sinai Hospital Epic Committee.</div><div>July 2023: The order set was uploaded into the Epic Playground for testing and training.</div><div>August 2023: The order set went live system wide. Training sessions and tip sheets were disseminated to ensure staff familiarity.</div></div><div><h3>Outcome Measures</h3><div>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.</div><div>ARNI prescribing rates: Improved from 72.8% in 2022 to 81.1% in 2024.</div><div>Beta-blocker prescribing rates: Improved from 94.6% in 2022 to 95.5% in 2024.</div><div>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, Melissa Wenzel BSN, RN, CCRN, Kathryn Arkin RN, BSN, Corrine Benacka MSN, CCRN, Jane Wilcox MD","doi":"10.1016/j.hrtlng.2025.04.009","DOIUrl":"10.1016/j.hrtlng.2025.04.009","url":null,"abstract":"<div><h3>Background</h3><div>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).</div><div>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.</div></div><div><h3>Purpose</h3><div>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.</div></div><div><h3>Setting/Population</h3><div>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.</div></div><div><h3>Method/Process</h3><div>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.</div></div><div><h3>Outcome Measures</h3><div>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%.</div><div>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%.</div></div><div><h3>Practical Implications</h3><div>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.</div><div>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}
Heart & LungPub Date : 2025-05-30DOI: 10.1016/j.hrtlng.2025.04.012
Cynthia Bither ACNP, ANP, AACC, CHFN, Marianna Fontana MD, PhD, Mathew S. Maurer MD, Scott D. Solomon MD, Julian Gillmore MD, PhD, Shaun Bender PhD, Emre Aldinc MD, Satish Eraly MD, PhD, Patrick Jay MD, PhD
{"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, Marianna Fontana MD, PhD, Mathew S. Maurer MD, Scott D. Solomon MD, Julian Gillmore MD, PhD, Shaun Bender PhD, Emre Aldinc MD, Satish Eraly MD, PhD, 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}
Heart & LungPub Date : 2025-05-30DOI: 10.1016/j.hrtlng.2025.04.008
Gladys F. Baksh NP-C
{"title":"The Impact Of Increased Early Utilization Of Angiotensin Receptor Neprilysin Inhibitor (ARNi) And Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) In New Onset And Chronic HFrEF","authors":"Gladys F. Baksh NP-C","doi":"10.1016/j.hrtlng.2025.04.008","DOIUrl":"10.1016/j.hrtlng.2025.04.008","url":null,"abstract":"<div><h3>Background</h3><div>Despite strong evidence of randomized clinical trials on GDMT for HFrEF in improving mortality and outcomes and reducing HF-related hospitalization, we continue to experience suboptimal use of GDMT. The beneficial medical effects of the 4 pillars of HFrEF cannot be ignored. Considerable efforts, such as guidelines and quality improvement (QI) initiatives, are implemented to mitigate the gaps, and results remain unsatisfactory. Aggressive initiation of GDMT should be a high priority.</div></div><div><h3>Purpose</h3><div>We analyzed the impact of early GDMT initiation with intensified use of ARNi and SGLT2 in new-onset and chronic HFrEF patients with ischemic and nonischemic cardiomyopathy.</div></div><div><h3>Setting/Population</h3><div>From 2020 to 2023, 284 patients with HFrEF were enrolled in the GDMT optimization program as a QI initiative led by HF NP and pharmacist.</div></div><div><h3>Method/Process</h3><div>Patients were followed until they achieved the target or maximum tolerated dose of triple or quadruple therapy. Data collected included echocardiography, laboratory values, NYHA, and HF-related hospital readmissions. Follow-up echocardiography was completed between 3 and 6 months, and HF-related readmission was assessed up to 6 months after completion of the program.</div></div><div><h3>Outcome Measures</h3><div>Among the participants, 94.9% were enrolled within 3 months after being evaluated in the HF clinic. The average age was 64; 70% were male. There were more patients with new onset HF (55%), and the majority were nonischemic (62.3%). Upon completion, there was a similar increase in both groups of those who were on triple and quadruple therapy. The use of ARNi (79.2% vs 84.9%) and SGLT2i (64.8% vs 65.6%) was higher in the two groups at the end of evaluation. A higher percentage of the new onset group had improvement of LVEF, and their absolute degree of improvement was also greater. NYHA Class improved in both groups over the course of therapy. A reduction of BNP was observed, and HF-related readmissions were significantly lower in the new-onset (7.5%) vs the chronic group (19.2%).</div></div><div><h3>Practical Implications</h3><div>The outcome of intensified use of ARNi and SGLT2i underscores the urgency of initiating treatment immediately after diagnosis of HFrEF. Despite etiology, early initiation of GDMT in newly diagnosed HFrEF demonstrates a greater improvement of LVEF, reduction in BNP, and HF-related readmission compared to chronic HFrEF.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Page 103"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170658","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":"Unite to Thrive: Building an Interdisciplinary Team for Heart Failure Care","authors":"Jacqueline Fitzgerald MSN, APRN, AGCNS-BC, CHFN, Katie Konopacz MSN, APRN, CNP, CHFN","doi":"10.1016/j.hrtlng.2025.04.010","DOIUrl":"10.1016/j.hrtlng.2025.04.010","url":null,"abstract":"<div><h3>Background</h3><div>In 2018 Northwestern Lake Forest Hospital initiated the hospital's first Heart Failure program. At that time, it was a suburban hospital with 114 licensed beds. The program was developed in response to enrollment with the Medicare Bundled Payment initiative and high readmission rates within the heart failure patient population. At that time the readmission rate was over 18% for 30-day all-cause readmissions and the hospital saw 292 patients with a primary diagnosis of heart failure.</div></div><div><h3>Purpose</h3><div>We recognized the need to develop a structured interdisciplinary Heart Failure team that would be able to improve access to clinical care and provide interventions to reduce readmission rates for multiple different angles. In turn the goal was to improve patient outcomes and satisfaction.</div></div><div><h3>Setting/Population</h3><div>The team cared for patients in the acute hospital setting as well as in the ambulatory clinic post discharge. We focused interventions on patients admitted with a heart failure exacerbation.</div></div><div><h3>Method/Process</h3><div>Developed an interdisciplinary team that consists of RNs (ambulatory clinic, navigators, Clinical Documentation Specialist), APRNs, MDs, PharmD, Pharmacy Technician. The inpatient Heart Failure team consists of a Heart Failure MD, APP, PharmD, and navigator; this team evaluates all patients with a primary heart failure diagnosis provided both medical care and self-management education. The interdisciplinary team meets weekly to review heart failure readmissions, currently admitted patients, patients within the 30-day window of discharge, and all CardioMEMs patients. A heart failure Epic InBasket Pool was created to allow for streamlined communication between with entire team.</div><div>Outpatient interventions implemented to assist in reducing readmissions were discharge callbacks within 72 hours, APP run heart failure clinic with hospital follow up appointments as well as urgent appointment slots for new or worsening symptoms, ability to administer IV push diuretics in the outpatient setting, PharmD run Medication Adjustment and Titration (MAT) clinic, Pharmacy Technician assistance with medication access and affordability, free transportation to assist patient is coming to the scheduled appointments, and development of CardioMEMs program.</div></div><div><h3>Outcome Measures</h3><div>Since the inception of the interdisciplinary Heart Failure team, the program saw an 82.5% growth in patient volumes while working to decrease the readmission rate by 27.7%. Furthermore, patients with CardioMEMs reduced their number of heart failure hospitalizations by 82% post implant and the patients that utilized the IV diuretic infusion clinic had a 30 day all cause readmission rate of 6.8%. While introducing a PharmD MAT Clinic allowed for fewer APP visits for GDMT titration, which in turn increased access on the APP clinic schedules for other types of pat","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 104-105"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170041","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}
Heart & LungPub Date : 2025-05-30DOI: 10.1016/j.hrtlng.2025.04.011
Kristen A. Sethares (she/her/hers) PhD, RN, CNE, FAHA, FHFSA, Cheryl Westlake (she/her/hers) PhD, RN, FAHA, FHFSA, FAAN
{"title":"Personal, Social and Clinical Factors Affecting Self-Care Maintenance and Management in People with Heart Failure","authors":"Kristen A. Sethares (she/her/hers) PhD, RN, CNE, FAHA, FHFSA, Cheryl Westlake (she/her/hers) PhD, RN, FAHA, FHFSA, FAAN","doi":"10.1016/j.hrtlng.2025.04.011","DOIUrl":"10.1016/j.hrtlng.2025.04.011","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure affects over 6 million people in the US. It is characterized by distressing symptoms typically managed with medications, diet and monitoring. Self-care maintenance includes health-promoting behaviors such as taking medications, following medical recommendations and a specialized diet. Self-care management includes monitoring symptoms and acting when symptoms occur. Personal, social and clinical factors affect self-care maintenance and management behaviors; however, research findings are mixed about these relationships.</div></div><div><h3>Aim</h3><div>The aim of this study is to determine the influence of personal (age, education level and health literacy), social (marital status and social support) and clinical (NYHA, comorbidity index, and EF) factors on self-care maintenance and management.</div></div><div><h3>Methods</h3><div>Demographics (age, gender, education, marital status, socioeconomic status (SES), HYHA, ejection fraction (EF), comorbidity (Charlson Comorbidity Index (CCI), higher poor), social support (Strogatz Scale, 4-16, lower more support), self-care (SCHFI v6.2, maintenance and management 0-100, > 70 adequate), and health literacy (S-TOFHLA, 0-16 inadequate, 17-22 marginal, 23-36 adequate) were collected in a convenience sample of 116 people with HF admitted to a community hospital. Hierarchical regression explored the influence of personal (step 1: age, education, and health literacy), clinical (step 2: NYHA, EF, CCI) and social (step 3: social support and marital status) factors on levels of self-care maintenance and management.</div></div><div><h3>Results</h3><div>Subjects had a mean (Mn) age of 74.8+12.3 years and education of 11.9+3.7 years, 41% female, 60% married, and 46% reported having enough to make ends meet. Clinically, subjects had a Mn NYHA of 3 + 0.61, EF of 42.1+14.7, CCI of 3.0 +1.7. Mean social support was 6.1 + 3.8 and health literacy (46% inadequate, 16% marginal, 38% adequate). Self-care maintenance (Mn of 55.5 + 17) and management (Mn of 35 + 20.5) were inadequate. Women had higher EF and were older than males. Comorbidity (r = .22, p = .01) and EF (r = -.27, p = .002) were related to self-care management. Comorbidity (r= .17, p=.03) and literacy level (r= -.15, p = .05) were related to self-care maintenance. Self-care maintenance: Personal variables explained 4.7% of variance in self-care maintenance at step 1. Clinical variables accounted for 5.7% of the variance at step 2 and the addition of social support and marital status in step 3 added 2.1% for a total of 12.5 % explained variance for self-care maintenance overall. EF was the only significant predictor of self-care maintenance (p=.05). Self-care management: In the second regression equation, personal variables explained 4.2% of variance in self-care management at step 1. Clinical variables accounted for 6.3% of the variance at step 2 and the addition of social support and marital status in step 3 added 0","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Page 95"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170692","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}
Heart & LungPub Date : 2025-05-29DOI: 10.1016/j.hrtlng.2025.05.005
Tao Liu MD , Xinchun Liu PhD , Jianwei Zeng MM , Xiexiong Zhao MD , Liping Peng MD , Huizhen Zhou MM , Xiaogang Li MD, PhD , Weihong Jiang MD, PhD
{"title":"The effect of doctor-patient communication on blood pressure control in hypertensive patients: Mediating role of medication adherence","authors":"Tao Liu MD , Xinchun Liu PhD , Jianwei Zeng MM , Xiexiong Zhao MD , Liping Peng MD , Huizhen Zhou MM , Xiaogang Li MD, PhD , Weihong Jiang MD, PhD","doi":"10.1016/j.hrtlng.2025.05.005","DOIUrl":"10.1016/j.hrtlng.2025.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Both doctor‒patient communication and medication adherence are related to blood pressure control in hypertensive patients. The connections among doctor‒patient communication, medication adherence, and blood pressure control have not been fully explained.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the effect of doctor-patient communication on blood pressure control and to test the hypothesis of medication adherence as a mediator.</div></div><div><h3>Methods</h3><div>In Changsha, China, this cross-sectional study was carried out in 10 affiliated communities of community health centers from January to October 2023. A multistage stratified sampling method gathered a diverse population. A structured questionnaire utilized the Set-Elicitation-Give-Understand-End (SEGUE) framework to evaluate doctor-patient communication and the Morisky Medication Adherence Scale-8 (MMAS-8) scale to assess medication adherence. Binary logistic regression was used to analyze the effect of doctor‒patient communication on blood pressure control. Stepwise regression was used to test the mediating effect of medication adherence on this effect.</div></div><div><h3>Results</h3><div>A total of 431 valid questionnaires were analyzed. A total of 66.8 % of the participants experienced poor doctor‒patient communication, and 142 participants (32.9 %) demonstrated good blood pressure control. Both univariate and multivariable logistic analyses revealed that patients with better doctor–patient communication had better blood pressure control (OR=6.93, <em>P</em> < 0.001; OR=6.52, <em>P</em> < 0.001). A total of 214 participants (49.7 %) exhibited good medication adherence. Medication adherence had a mediating effect of 0.13 (26.5 % of the total effect, <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Doctor-patient communication had a significant positive effect on blood pressure control in patients with hypertension and medication adherence was a partial mediator.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"73 ","pages":"Pages 197-206"},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167149","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}
Heart & LungPub Date : 2025-05-27DOI: 10.1016/j.hrtlng.2025.05.012
Shengyang He , Zhipeng Yang , Lihua Xie
{"title":"Suppressed autophagy of thymic cells promotes apoptosis and thymic atrophy in COPD","authors":"Shengyang He , Zhipeng Yang , Lihua Xie","doi":"10.1016/j.hrtlng.2025.05.012","DOIUrl":"10.1016/j.hrtlng.2025.05.012","url":null,"abstract":"<div><h3>Background</h3><div>Chronic obstructive pulmonary disease (COPD) is a prevalent and incurable condition characterized by persistent inflammation and systemic complications. Although the thymus is traditionally believed to undergo involution in adulthood, it continues to play a critical role in immune regulation and tumor surveillance. However, its specific involvement in COPD remains largely unexplored.</div></div><div><h3>Objectives</h3><div>This study aimed to investigate the presence and mechanisms of thymic atrophy in COPD.</div></div><div><h3>Methods</h3><div>Thymic atrophy was assessed in COPD patients through chest CT imaging and further validated in a cigarette smoke-induced COPD mouse model. We examined thymic cell counts, levels of apoptosis, epithelial-mesenchymal transition (EMT) markers, expression of aging-related markers (p53 and p21), and autophagy activity with related pathway signals.</div></div><div><h3>Results</h3><div>Chest CT scans from 251 subjects revealed progressive thymic atrophy in COPD patients, correlating with disease severity. In COPD model mice, histological analysis showed reduced thymocyte counts, increased apoptosis, and selective loss of CD8⁺ T cells. EMT features were observed, along with decreased autophagy markers and disrupted PI3K/mTOR signaling.</div></div><div><h3>Conclusion</h3><div>COPD is associated with severe thymic atrophy potentially driven by impaired autophagy and aging-related apoptosis, offering new insights into immune dysfunction and potential therapeutic targets.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"73 ","pages":"Pages 180-189"},"PeriodicalIF":2.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138829","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}