AAHFN Posters

The purpose of this DNP project is to determine 30-day hospital readmission rates, frequencies, and heart failure classification for patients with heart failure. A retrospective chart review was conducted at an urban hospital in Memphis, TN. The study was deemed exempt by the Review Board. Electronic medical records were queried from July 1, 2019 through December 31, 2019 for heart failure ICD-10 codes beginning with the prefix 150 and a report was generated. The total number of heart failure admissions was computed and compared to national average. Using age ranges 40-80, the number of patients readmitted withing 30 days was computed and descriptive and inferential statistics were computed using Microsoft Excel and R. A total of 3524 patients were admitted for heart failure within the six-month time frame. Of those, 297 were re-admitted within 30 days for heart failure exacerbation (8.39%). An annual estimate was computed (16.86%), well below the national average (21%). Of those re-admitted within 30 days, 50 were readmitted sequentially, on multiple occasions, ranging from two to eight readmissions. The median age was 60 and 60% were male. Due to the skewed distribution (most readmitted twice), nonparametric statistics were used for correlation. While graphic display of charts suggested a trend for most multiple readmissions due to diastolic dysfunction and least number due to systolic heart failure, there was no statistically significant correlation between age and number or multiple re-admissions (Spearman rank, p = 0.6208) or number of multiple re-admissions and heart failure classification (Kruskal Wallis, p =0.2553).

The study reports patient satisfaction with virtual heart failure visits during the initial 30 day surge of the COVID 19 pandemic, and compares their satisfaction with in-office visits over the preceding 3 months.

INTRODUCTION •Hereditary transthyretin amyloidosis (hATTR/ATTRv) is a progressive and fatal disease caused by mutations in the transthyretin (TTR) gene •These mutations destabilize protein folding, resulting in amyloid deposits and causing multisystem dysfunction such as cardiomyopathy (CM), whose etiology may be attributed to traditional causes of cardiovascular diseases •Genetic testing is required for determining a diagnosis of hATTR/ATTRvwith CM OBJECTIVE •To describe the prevalence and characteristics of patients with TTRmutations versus patients with mutations associated with other inherited cardiovascular conditions

BACKGROUND •Hereditary transthyretin amyloidosis (hATTR or ATTRv[variant]) is a progressive and fatal disease caused by mutations in the transthyretin (TTR) gene. These mutations lead TTR to misfold and deposit as insoluble amyloid fibrils in major organs and systems, resulting in multisystem dysfunction •Cardiomyopathy, resulting in heart failure and arrhythmias, is a frequent manifestation of hATTR •The peripheral nervous system is often affected, leading to polyneuropathy. The polyneuropathy manifestations include autonomic manifestations, such as orthostatic hypotension •Early diagnosis, which can be facilitated with genetic testing, and treatment are key to achieving optimal patient outcomes OBJECTIVE •To describe the characteristics of patients with TTRmutations compared with patients with mutations associated with other inherited cardiovascular diseases that can mimic the symptoms of hATTR

BACKGROUND/INTRODUCTION • Hereditary transthyretin amyloidosis (hATTR or ATTRv [variant]) is a progressive and fatal disease often associated with infiltrative cardiac involvement • Cardiac involvement in ATTRv is associated with poor survival • Patients often have long-standing cardiac symptoms prior to their amyloidosis diagnosis, and it has been shown that diagnostic delay can result in increased disease burden and progressive myocardial injury and failure • Real-world evidence focusing on cardiac manifestations throughout the ATTRv patient journey is limited • Nurses who work closely with patients with heart failure are positioned to recognize the symptoms and early signs that should raise clinical suspicion and uncover an underlying diagnosis of ATTRv OBJECTIVE • To determine whether patients with ATTRv demonstrate significant cardiovascular symptom manifestations and health care utilization before diagnosis

Background: Transthyretin-mediated amyloid cardiomyopathy (ATTR-CM) is a fatal condition caused by misfolding and aggregation of transthyretin (TTR). Despite the treatment with a TTR stabilizer, tafamidis, disease progression still occurs. Eplontersen is an antisense oligonucleotide that inhibits TTR production by the liver. It has the same sequence as inotersen but is conjugated to a triantennary N-acetyl galactosamine (GalNAc) moiety, which allows the use of a lower dose to achieve identical pharmacodynamic results. Study Design and Methods: CARDIO-TTRansform (ClinicalTrials.gov NCT04136171) is a Phase 3 global, double-blind, randomized, placebo-controlled study assessing the efficacy and safety of Eplontersen in hereditary and wild-type ATTR-CM patients. Approximately 750 patients will be randomized 1:1 to receive either Eplontersen 45 mg or placebo administered by monthly SC injection. Key inclusion criteria include ATTR-CM diagnosis by biopsy or positive PYP/DPD/HMDP scan, interventricular septum thickness >12mm, NT-proBNP >600 pg/mL, NYHA class I-III and 6-minute walk distance (6MWD) ≥150m. Concomitant treatment with tafamidis is allowed. Primary efficacy endpoint is the composite of cardiovascular (CV) mortality and recurrent CV clinical events at Week 120 study visit using the Andersen-Gill method. Conclusions: The CARDIO-TTRansform trial is a Phase 3 trial designed to evaluate the clinical efficacy and safety of Eplontersen for the treatment of ATTR-CM.

A secondary analysis of psychosocial health outcomes reported by patients with cardiovascular disease during the COVID-19 social distancing guidelines. Findings include significant difference in social isolation, anxiety, depression and cognitive function. Additionally, telemedicine was utilized by 64% of the sample. Implications for practice and research are discussed.

The purpose of this investigation was to examine the association between diuretic nonadherence and BNP in those with a 30-day heart failure readmission and further explore the usefulness of BNP as an objective marker for diuretic adherence. Results suggest that variables relating to patient characteristics are not as important as those relating to BNP for predicting diuretic nonadherence. BNP could be useful in identifying patients at risk for diuretic nonadherence and a hospital readmission.

Recent studies have demonstrated the harmful effects of COVID-19 on the cardiovascular system, causing myocardial injury, inflammation, microthrombi, and ventricular dysfunction, and myocardial infarction. Up to one-half of patients hospitalized with COVID-19 suffer from cardiac complications, yet little information has been published that aids clinicians in stratifying patients at greatest risk for cardiac complications. The primary objective of this observational retrospective cohort study was to analyze risk factors associated with cardiovascular events (CEs). Secondary objective was to determine whether risk factors and outcomes were influenced by race. This study involved 700 inpatients hospitalized in nine different hospitals from March 9, 2020 to June 20, 2020. All inpatients hospitalized with COVID-19 were included and those COVID-19 patients who were not hospitalized or under the age of 18 years were excluded. Predictor variables included age, sex, race, comorbidities, and current clinical and laboratory data. Outcome variables were experiencing CEs, death, and length of stay (LOS). Multiple logistics regression was used to examine which variables predicted CEs. Kaplan-Meier was used for survival analysis. Of 700 COVID-19 positive inpatients,126 experienced CEs and 574 did not (18% incidence rate). Factors found to be highly associated with the odds of new onset of CEs: advanced age, males, AA, presence of comorbidities, and decreased saturation levels and inpatients that had CEs had a much higher mortality rate than those without CEs (45.2% vs. 8.7%). Highest prevalence of complications among patients with COVID-19 were cardiac arrhythmias, new onset of HF diagnoses, and acute myocardial infarctions.

When the COVID Pandemic hit New Jersey, it was no longer safe for Mechanical Circulatory Support patients to receive routine follow up care in the hospital-based clinic. The MCS team at Newark Beth Israel Medical Center implemented telemedicine practices to provide safe, uninterrupted, care for this medically complex patient population; a novel change in practice.

Background Heart failure (HF) symptom management is the cornerstone to improving HF related outcomes.1 Rehospitalization rates due to HF sequelae are high and symptom management remains an ongoing issue at PACE. Standardization of physician visits, patient education, and focused Nurse Practitioner (NP) visits to enhance engagement and self-care management of HF will improve outcomes for participants in the PACE program. Purpose The purpose of this quality improvement project was to evaluate the efficacy of focused NP visits on improving HF related outcomes among participants of the PACE program. Conclusions The results for the AHFKT were statistically significant (p = .037) indicating the evidence-based education provided was effective. The self-efficacy and knowledge portion of the KCCQ was the only statistically significant result (p = .047) indicating the education and focused NP visits increased participant knowledge and ability to effectively manage their HF. In evaluation of the symptom severity questions it was determined that participants were more self-aware of their HF symptoms after the HF education, thus providing responses to the KCCQ that showed an inverse relationship. Clinical Implications The result of the AHFKT surmises the education provided was effective which is supported by the results from the KCCQ on knowledge and self-efficacy. The clinical implication for this conclusion supports the evidence-based education booklet as an effective tool in the management of HF when combined with focused NP visits. In terms of sustainability, the education booklet has been adopted by PACE for all HF patients.

74 yo M with HFrEF, HTN, HLD, CAD, Obesity, and OSA was referred to cardiology April, 2020 for exacerbation of HF. Given the Covid-19 crisis, patient declined hospitalization. Thus, Tele Health management was implemented. Through Tele Health, motivational interviewing, diagnostics, and GDMT, hospitalization was prevented, patient was safely managed at home, and QoL was improved.

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