Christopher S. Hayward

Facilitating needs-based support and palliative care for people with chronic heart failure: preliminary evidence for the acceptability, inter-rater reliability, and validity of a needs assessment tool.

CONTEXT Understanding the types and extent of need is critical to informing needs-based care for people with chronic heart failure (CHF). OBJECTIVES To explore the psychometric quality of a newly developed rapid screening measure to assess the supportive and palliative care needs of people with CHF. METHODS A convenience sample of multidisciplinary health professionals working in heart failure care was invited to comment, via an online survey and consultation, on suitability and required modifications to a validated cancer care needs assessment measure to inform the support and palliative care needs of patients with CHF and their caregivers. Psychometric testing was then undertaken with 52 patients with CHF recruited from a multidisciplinary heart failure service to explore inter-rater reliability and concurrent validity of the newly adapted Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF). RESULTS Health professionals (n=21) rated the tool as easy to administer, comprehensive, and relevant for the CHF population. Prevalence- and bias-adjusted kappa values indicated good agreement between pairs of raters for each item in the NAT: PD-HF (range 0.54-0.90). Participants indicating a higher severity of concern in the NAT: PD-HF physical, daily living, and spiritual items reported significantly higher Heart Failure Needs Assessment Questionnaire physical and existential scores. CONCLUSION This study provides preliminary evidence for the NAT: PD-HF as a potential strategy for identifying and informing the management of physical and psychosocial issues experienced by people with CHF. Further work is needed to examine additional psychometrics, benefits relating to unnecessary symptom burden, futile treatments, and admissions to hospital.

A 25 year Review of Combined Cardiac and Renal Transplant Outcomes in Patients with End Stage Cardiac Failure on Renal Replacement Therapy. A Single Center Experience.

Background: Combined heart and kidney transplantation has been shown to be a viable option for patients who have concurrent end stage cardiac and renal failure. However there is limited long term survival data that compares the outcomes of patients undergoing combined heart-kidney transplantation to patients undergoing solitary cardiac transplantation. There is also limited data on patients with end stage cardiac failure who are on concurrent renal replacement therapy prior to organ transplantation and their outcomes. This study reviews the short and long term outcomes of combined heart kidney transplantation over a 25 year period in comparison to solitary cardiac transplantation in a majority of patients undergoing renal replacement therapy at time of transplant listing. Methods and Results: In total there were 16 patients who underwent combined heart and kidney transplantation in the period between October 1990 and June 2014 (including heart and kidney re-transplantation) with 14 patients (87.5%) on renal replacement therapy at time of combined procedure. They were listed for combined heart and kidney transplantation as they fulfilled our institution’s criteria for irreversible end-stage heart and kidney failure. Retrospective review of patient data from the transplant database, patient case notes and post-mortem reports were carried out. Statistical analysis was then performed on key patient demographics alongside actuarial survival analysis, which were then graphically annotated. IRB approval was obtained and informed consent from patients was also obtained. The mean (SD) recipient age was 42 (13) years and there were 3 females. Dilated cardiomyopathy was the most common primary cardiac pathology (50%) whilst ischemic nephrosclerosis (25%) and glomerulonephritis (25%) were the most common primary renal pathologies. Most patients experienced NYHA class IV symptoms (62.5%). The average wait time to transplantation at our institution was 12 months. There was no operative mortality. The cumulative 1 year survival in the combined transplant group was 0.75 with 4 out of 16 mortalities within the first year (25%). In comparison the cumulative 1 year survival of the heart only transplant group was 0.86 with 116 mortalities within the first year over a 25 year period. Cumulative survival at 5, 10, 15 and 25 years for the combined transplant group was 0.69, 0.55, 0.437 and 0.437 respectively. In comparison cumulative survival of the heart only transplant group at the 5, 10, 15 and 25 year mark was 0.76, 0.59, 0.45 and 0.23 respectively. The incidence of cardiac rejection episodes in the study time was 9 out of 16 (56%) versus 3/16 (19%) who had renal rejection. In the study period there was 1 death out of 7 deaths due to dual graft failure. Conclusions: Combined sequential cardiac and renal transplantation has good shortand long-term outcomes for patients with coexisting end stage cardiac and renal failure. At the ten year mark actuarial survival for combined heart and kidney transplantation is equivalent to cardiac transplantation alone. Received Date: February 08, 2016; Accepted Date: July 12, 2016; Published Date: July 15, 2016 Citation: Anthony, C., et al. A 25 Year Review of Combined Cardiac and Renal Transplant Outcomes in Patients with End Stage Cardiac Failure on Renal Replacement Therapy. A Single Center Experience. (2016) J Heart Cardiol 2(2): 59-67.

Tenckhoff Catheter Implantation In Refractory Ascites Due To Right Heart Failure

Tenckhoff catheter implantation and modified peritoneal dialysis as a novel therapeutic approach in diuretic resistant congestive heart failure: a single-centre case-series. Background: Progressive renal insufficiency and diuretic resistance represent significant challenges in the management of advanced heart failure, particularly in the context of intractable ascites due to Right Heart Failure (RHF). There is growing interest in the potential use of intermittent paracentesis and peritoneal dialytic ultra-filtration in this setting but clinical experience is limited. Methods: We undertook retrospective analysis of changes in the following clinical parameters in six patients (66% males, average age 53 years) who underwent Tenckhoff catheter implantation (TCI) for the management of RHF-related intractable ascites i) body weight; ii) number of heart failure related admissions and time spent in hospital; and iii) diuretic requirements. Student t-test was performed to analyse statistical significance. Results: Follow-up ranged from 4 to 16 weeks post TCI. Compared to immediately prior to TCI: i) 83% (5/6) of patients experienced an improvement in renal function; ii) average weight fell from 72.2 + 4.7 to 67.7 + 3.9 kg (mean + SEM, p = 0.054); iii) none of the patients have required heart failure related admission compared to an average number of 40 days in hospital over 6.7 admissions in the twelve months preceding TCI and iv) frusemide dose decreased from 263 + 49 to 140 + 50 mg/day, p = 0.051). All patients report a subjective improvement in overall wellbeing and quality of life. One patient developed peritonitis which was controlled with antibiotic treatment without needing catheter removal. Conclusion: Our experience supports the use of TCI as a therapeutic modality in patients with RHF and intractable ascites resistant to medical management. Received Date: February 08, 2016 Accepted Date: March 22, 2016 Published Date: March 29, 2016 Citation: Anthony, C., et al. Tenckhoff Catheter Implantation in Refractory Ascites Due to Right Heart Failure. (2016) J Heart Cardiol 2(2): 1-5. DOI: 10.15436/2378-6914.16.020