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Nursing research at Heart Failure congress 2018 in Vienna, Austria

Leonie Klompstra, MSc, PhD

The 26th-29th of May I went to the Heart Failure Congress 2018, Including the World Congress on Acute Heart Failure in Vienna, Austria. The congress had over 5,750 participants from over 80 countries. To see all the tweets during this congress, search for the #HeartFailure2018.

This year there were a lot of interesting talks and I would like to highlight a few in this blog.

Dr. Tiny Jaarsma gave a talk about sex and heart disease. Pointing out that heart disease can lead to sexual problems. Furthermore, patients think that sexual counseling should be part of cardiac rehabilitation, which is often not a subject that is discussed. Patients prefer to receive written material and/or individual discussions.

Dr. Cecilia Line from @karolinskaint pointed out that one third of patients with an ICD are not aware that they can deactivate their ICD. Furthermore, patients with ICDs would like to be informed especially when the life expectancy is short. And we should remember, according to Dr. Anna Strömberg, that patients with an LVAD are going through a transition in life and that there are psychosocial challenges in patients with an LVAD. See her take-home messages in the pictures below.

managing patients psychosocial distress slide

Some talks highlighted the importance of frailty in cardiac patients. Dr. Inger Ekman from @SahlgrenskaAcad discussed the importance of screening for frailty in cardiac patients and suggested existing instruments to do so (see picture below). Dr. Kentaro Kamiya’s research showed that frailty is associated with clinical outcomes in elderly patients hospitalized for heart failure, which indicates that frailty is useful for prognosis in in hospital settings.

frailty instruments slide

In the late breaking trials, the results of the HF-Wii study were discussed. This study proves that exergaming (being physical active through video gaming) has positive influence with the exercise capacity and wellbeing of patients with heart failure. See an interview about this study during the interview. In a poster presenting a sub-study of the HF-Wii showed that exergaming could also be feasible for patients with an LVAD, and patients especially liked to exergame with their grandchildren.

conclusion slide

There was also a great session on alternative ways to be physically active in patients with heart failure. One of the alternative ways was presented by Dr. Anna Strömberg: medi-yoga. Read more about medi-yoga. A second alternative way to exercise was presented by Dr. Taylor-Piliae: Tai-Chi. And a third way presented by Dr. Tiny Jaarsma was exergaming. In this session Dr. Von Haehling pointed out that testosterone therapy could increase exercise capacity. Dr. Massimo Piepoli concluded that half of the patients with heart failure are denied a highly recommended therapy and that scientific societies should strongly promote a well-recognized therapeutic tool to improve exercise capacity, quality of life and outcomes in patients with heart failure.

exergaming has physical and quality of life benefits for heart patients flier

And last but not least, I would like to congratulate Lilas Ali, who won the nursing investigator award session with her research that showed that person-centered telephone-support is effective in patients with chronic obstructive pulmonary disease and/or chronic heart failure (see picture below).

photo of women receiving award

Please save the date for next years’ Heart Failure congress 2019, 25-28th of May 2019 in Athens, Greece.

save the date for heart failure and world congress on active heart failure

Leonie Klompstra Headshot

Leonie Klompstra is a Nurse Scientist at the Linköping University in Sweden. Her primary focus is on heart failure and rehabilitations.
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Nursing And Allied Professional Sessions At The American Heart Association

Leonie Klompstra, MSc, PhD

During the American Heart Association Scientific Sessions, there were great sessions. It was really a struggle to make an overview of all the nurses and allied professional sessions in a short blog; they were just all very interesting and informative. But I summarized the topics that were for me the most interesting during the Sessions.
 
Adherence to medication use
Dr. Todd Ruppar (@ToddRuppar) presented the importance of the use of behavior prompt for cardiac patients to remember medication intake. Dr. Ellis presented one of the new examples of these behavioral prompt: the printable pillboxes with the possibility to connect to a mobile app (InterACT Pillbox).

Slide showing example of printable pill box with app capabilities

Dr. Rhonda Copper-deHoff suggested that pharmacogenetic testing could be a piece of the adherence puzzle in cardiac patients and Dr. Anton Vehovec (@antonvehovec) points out that medication adherence mediate the relationship between memory and emergency room visits and hospitalization. He stated that we should test interventions that aim to improve memory and look at the effect this has on medication adherence.

 

2. Technology use
Dr. Maria Liljeroos’ (@MartorMaria) research showed that telemonitoring is feasible to implement, but that we have to remember that it is still a challenge to include older cardiac patients.

Dr. Megan Reading gave a talk on technology use in patients with atrial fibrillation. In her research, they found that being asymptomatic was the main reason for not using technology. Also traveling and simply forgetting to use the technology were important reasons for not using it.

Dr. Mary Dolansky found in her research that the current evaluation of technology used to measure self-care behaviors, such as activity monitors, is insufficient. Future research should be focused on evaluating technologies for measuring and use in self-care in cardiac patients.

examples of self care measures slide

3. Palliative care/end of life in cardiac patients
A quote of Isaac Asimov, which Dr. Lisa Kitko used in her presentation, presents the importance of palliative care in cardiac patients:

Life is pleasant death is peaceful it's the transition that troublesome - Isaac Asimov

She further stated that we should remember that 67% of all patients with an LVAD have 5 or more comorbidities.

Dr. Lorraine Evangelista brings up in her presentation the importance of optimal palliative care in the beginning of the heart failure trajectory. She also presented a poster of Lisa Hjelmfors on the importance of communication about the heart failure prognosis in the US and Europe. And although most nurses think they have knowledge on prognosis and the communication with the patients, around 70% would like further education about this topic.

Dr. Dougherty gave a talk about technology advances create complex decision making for patients, family and providers. Health care professionals need to have conversations and discussions about device management at end of life.

Dr. Loreena Hill (@HillLoreena) and Dr. Donna Fitzsimons (@FitzsimonsDonna) stated that there is a paradigm shift regarding when deactivation should be discussed and who is responsible in long overdue if end of life care for patients with an ICD is to improve.

Study Characteristics

4. The importance of involving caregivers
Dr. Anna Strömberg (@Anna_Submitting) talked about the importance of involving caregivers and the support and education these caregivers want. Caregivers would like easy access to health care and support groups with caregivers alone. This could help them to handle their life situation.

J.N. Dionne-Odem (@jn_dionneodom) pointed out that caregivers are vital in care for patients with heart failure, but that we have to realize that only 1 in 3 are comfortable giving heart failure care.

A poster presented by Dr. Hiroko Ishida shows the importance of health literacy in caregivers. They found that health literacy of patients with heart failure and their caregivers was independently associated with caregivers burden.

5. Diet, fluid restriction and appetite
Dr Anna Strömberg (@Anna_Submitting) stated the importance of the need for more research in nutrition and fluid restriction and Dr. Lennie presented that we are all on a diet, but that just finding the best food for you, as a person is a challenge. Dr. Martha Biddle advised that cardiac patient should have a healthy, varied diet. She even presented a recipe for a cardiovascular health:

recipe for cardiovascular health slide

Dr. Lora Burke suggests that mobile apps could be a tool for nutrition research to increase adherence. Mobile apps could give feedback to the patients, which could improve dietary choice/eating behavior by make patients more aware of their choices. Dr. Misook Chung presented a poster concluding that diet quality was similar in patients with heart failure regardless their adherence to sodium restriction diet. Christina Andrea’s (@C_Andreae) poster demonstrated that patients who are more physically active have better appetites compared to those who are less physically active. This research underscore that in future studies, a need is for attention on physical activity and appetite.

physical activity and appetite in patients poster

6. Physical activities
Dr. Tiny Jaarsma (@DrJaarsma) presented a new way for patients in cardiac care to be active at home: Exergaming. Exergaming is being physical active with a gaming computer. In her research, (@HFWii) they found that installing such a computer at home with patients with heart failure increased their exercise capacity.

Another promising and alternative way to exercise in community-dwelling older adults, presented by Dr. Marjorie Funk, was Qigong. Qigong is a form of exercise composed of movements that are repeated a number of times, often stretching the body, increasing fluid movement (blood, synovial, and lymph) and building awareness of how the body moves through space. This research showed that Qigong was feasible for older adults and that they accepted this form of exercise. This research group next step is to test this on cardiac patients.

A intervention presented was the Heart Up!, (a text message intervention) showed promising in improving in physical activity and decreasing hopelessness in patients with ischemic heart disease.

Leonie Klompstra Headshot

Leonie Klompstra is a Nurse Scientist at the Linköping University in Sweden. Her primary focus is on heart failure and rehabilitations.
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Hemodynamics Live: Lights, Cameras, Action!

Megan Kamath, MD

If a picture is worth a thousand words, then what does that make a live simulation worth? A million? I’d argue that the experience of seeing hemodynamics come to life was pretty much magical!

We’ve all had those times when we are struggling to understand the patient’s physiology.
The University of Arizona TAH/VAD simulator shared at Sessions by Drs. Jen Cook and Sophia Airhart, is a true #gamechanger when it comes to using simulation for medical education.

With the help of the dynamic duo VAD engineer team of Rich Smith and Eddie Betterton,
we were able to recreate scenarios to illustrate first-hand the effects of certain interventions on the patient.

During the LVAD session, we were able to use a scenario of the patient who had significantly elevated left sided pressures and right sided pressures as a technique for discussion on different ways to optimize LVAD patients: through unloading of the left ventricle by increasing the LVAD speed, while keeping in mind that pulmonary hypertension also needs to be treated. With a little movie magic (simple adjustments of the vials of water mounted on the buret stand) we could watch the PVR drop in response to vasodilator therapy.

Another unique aspect of the simulation was the group of panelists which had been carefully selected for each session. Each of these members were truly experts in the field and provoked thoughtful discussion among all attendees.

For the pulmonary hypertension simulation, we were treated to some great pearls to keep in mind when thinking about this unique population.

hemodynamics graphics 

I think the beauty of the simulator lies in its ability to create virtually any hemodynamic situation AND display the waveforms in real time. Personally, I believe that this is a vital tool and should be a standard component of every cardiology fellow’s educational armamentarium.  Studies have shown that employing multiple teaching methods enhances student learning.

Megan Kamath Headshot

Megan Kamath is a Fellow in Advanced Heart Failure and Transplant Cardiology at the University of California, Los Angeles. Her research interests include outcomes in advanced heart failure, decision making and relational medicine, and utilizing technology in healthcare. She is now tweeting @MeganKamath, so follow her on there!