A. Kao

Wearable defibrillator use in heart failure (WIF): results of a prospective registry

BackgroundHeart failure (HF) patients have a high risk of death, and implantable cardioverter defibrillators (ICDs) are effective in preventing sudden cardiac death (SCD). However, a certain percentage of patients may not be immediate candidates for ICDs, particularly those having a short duration of risk or an uncertain amount of risk. This includes the newly diagnosed patients, as well as those on the cardiac transplant list or NYHA class IV heart failure patients who do not already have an ICD. In these patients, a wearable cardioverter defibrillator (WCD) may be used until long term risk of SCD is defined. The purpose of this study was to determine the incidence of SCD in this population, and the efficacy of early defibrillation by a WCD.MethodsTen enrolling centers identified 89 eligible HF patients who were either listed for cardiac transplantation, diagnosed with dilated cardiomyopathy, or receiving inotropic medications. Data collected included medical history, device records, and outcomes (including 90 day mortality).ResultsOut of 89 patients, final data on 82 patients has been collected. Patients wore the device for 75±58 days. Mean age was 56.8±13.2, and 72% were male. Most patients (98.8%) were diagnosed with dilated cardiomyopathy with a low ejection fraction (<40%) and twelve were listed for cardiac transplantation. Four patients were on inotropes. There were no sudden cardiac arrests or deaths during the study. Interestingly, 41.5% of patients were much improved after WCD use, while 34.1% went on to receive an ICD.ConclusionsIn conclusion, the WCD monitored HF patients until further assessment of risk. The leading reasons for end of WCD use were improvement in left ventricular ejection fraction (LVEF) or ICD implantation if there was no significant improvement in LVEF.

Health literacy in heart transplantation: Prevalence, correlates and associations with health behaviors—Findings from the international BRIGHT study

BACKGROUND Health literacy (HL) is a major determinant of health outcomes; however, there are few studies exploring the role of HL among heart transplant recipients. The objectives of this study were to: (1) explore and compare the prevalence of inadequate HL among heart transplant recipients internationally; (2) determine the correlates of HL; and (3) assess the relationship between HL and health-related behaviors. METHODS A secondary analysis was conducted using data of the 1,365 adult patients from the BRIGHT study, an international multicenter, cross-sectional study that surveyed heart transplant recipients across 11 countries and 4 continents. Using the Subjective Health Literacy Screener, inadequate HL was operationalized as being confident in filling out medical forms none/a little/some of the time (HL score of 0 to 2). Correlates of HL were determined using backward stepwise logistic regression. The relationship between HL and the health-related behaviors were examined using hierarchical logistic regression. RESULTS Overall, 33.1% of the heart transplant recipients had inadequate HL. Lower education level (adjusted odds ratio [AOR] 0.24, p < 0.001), unemployment (AOR 0.69, p = 0.012) and country (residing in Brazil, AOR 0.25, p < 0.001) were shown to be associated with inadequate HL. Heart transplant recipients with adequate HL had higher odds of engaging in sufficient physical activity (AOR 1.6, p = 0.016). HL was not significantly associated with the other health behaviors. CONCLUSIONS Clinicians should recognize that almost one third of heart transplant participants have inadequate health literacy. Furthermore, they should adopt communication strategies that could mitigate the potential negative impact of inadequate HL.

Heart transplant centers with multidisciplinary team show a higher level of chronic illness management – Findings from the International BRIGHT Study

Objectives The objectives of this study were to: (1) explore the proportion of HTx centers that have a multidisciplinary team and (2) assess the relationship between multidisciplinarity and the level of chronic illness management (CIM). Background The International Society for Heart and Lung Transplantation (ISHLT) recommends a multidisciplinary approach in heart transplant (HTx) follow‐up care but little is known regarding the proportion of HTx centers that meet this recommendation and the impact on patient care. HTx centers with a multidisciplinary team may offer higher levels of CIM, a care model that has the potential to improve outcomes after HTx. Methods We conducted a secondary analysis of the BRIGHT study, a cross‐sectional study in 11 countries. Multidisciplinarity in the 36 HTx centers was assessed through HTx director reports and was defined as having a team that was composed of physician(s), nurse(s), and another healthcare professional (either a social worker, psychiatrist, psychologist, pharmacist, dietician, physical therapist, or occupational therapist). CIM was assessed with the Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression assessed the relationship between multidisciplinarity and the level of CIM. Results Twenty‐nine (80.6%) of the HTx centers had a multidisciplinary team. Furthermore, multidisciplinarity was significantly associated with higher levels of CIM (&bgr; = 5.2, P = 0.042). Conclusion Majority of the HTx centers follows the ISHLT recommendation for a multidisciplinary approach. Multidisciplinarity was associated with CIM and point toward a structural factor that needs to be in place for moving toward CIM.

251: Importance of Tricuspid Annuloplasty at the Time of Heart Transplantation

had 2 episodes of CMV infection despite prophylactic Gancyclovir and 3 had recurrent respiratory tract infections), 5 experienced biopsy proven rejection and 3 pts were started on a CNI free protocol due to CNI side effects. The contribution of the Immuknow assay measurement was assessed. Results: Mean Immuknow levels were low in the infected pts (235) and high in the pts with rejection (575). During the change to CNI free protocol, mean Immuknow levels were appropriate (426). In the fungal infected pts, the immunosuppressive treatment was diminished to low doses of steroids, lower trough CNI levels, omitting mycophenolate moefetil. The lower Immuknow levels encouraged us to continue the low potency immunosuppression. In the CMV and the respiratory tract infected pts, the Immuknow levels were low despite CNI therapeutic drug levels. Their immunosuppressive regimen was changed to a less potent one. In the pts with rejection, steroids were added and MMF was changed to everolimus. The appropriate Immuknow levels during the change to the CNI free protocol reflect the uneventful protocol change. Conclusions: Monitoring the Immuknow levels is a valuable and simple tool for immunosuppressive therapy monitoring. It helps decision making in complex situations allowing therapeutic changes that can favorably affect the outcome of HTx recipients.