Based on the definition by percent weight loss, we did not find a significant association between cachexia and mortality during VAD support. Interestingly though ...
S58 Journal of Cardiac Failure Vol. 22 No. 8S August 2016 hospital readmission/mortality (adjusted HR 1.41, 95% CI 0.96–2.05, P = .078) and the percent weight loss as a continuous variable was an imprecise predictor of this composite endpoint (adjusted HR 13.88 95% CI 1.79–107.61, P = .012). Conclusion: Cachexia is common in stage D HF and was present in a third of pre-VAD patients. Based on the definition by percent weight loss, we did not find a significant association between cachexia and mortality during VAD support. Interestingly though, percent weight loss pre-VAD may be associated with the composite of hospital readmission/ mortality post-implantation. The absence of a mortality association may reflect underpowering due to a small cohort size, or the effect of changes in volume status that may limit the ability of weight changes to represent the catabolic state of cachexia.
154 Prolonged QT Interval and Ventricular Tachycardia in a Cohort of HIV Infected African American Population Puvanalingam Ayyadurai, Adhurthy Shankar, Heath Burchfield; Bronx Lebanon Hospital Center, New York, New York Background: Long QT interval has been described in HIV patients. This may be related to the drugs used in HIV infection, metabolic causes or due to the acquired form of long QT interval seen in HIV infection. The aim of this study is to find out the prevalence of prolonged QT interval among HIV infected African American population and to find out the relation between CD4 count and prolonged QT interval.The study also aims to analyze the prevalence of ventricular tachycardia among HIV infected African American patients with prolonged QT interval. Methods: A retrospective analysis of 5892 (males—3320; females—2572) patients with HIV infection who were seen in the Bronx Lebanon hospital and it’s affiliated clinics from 2009 to 2014 was done to evaluate for the presence of prolonged QT interval . Mean age of all the patients who were analysed was around 50. Both inpatients and outpatients were analysed involving patients of all age and both sexes. Out of the 5892 patients, 2356 had meet the criteria for AIDS . Prolonged QT interval was diagnosed by looking into the EKG. A corrected QT interval of more than 440 was taken as prolonged QT interval. Mean CD4 count of the entire sample was 362. Results: Out of the 5892 HIV infected African American patients analysed, 17% (1009) patients had prolonged QT interval. This included males—598, females—411. Prevalence among females was 16 % and among males was 18%. There was no sex predilection in the occurrence of prolonged QT interval among HIV patients (P value > .05). Mean age of the HIV patient with prolonged QT interval was 53. The mean CD 4 count of HIV patients with prolonged QT interval was found to be 124. Lower CD4 count was associated with prolonged QT interval. (P value < .05). Prevalence of long QT among African American population with AIDS was 25%.(589 out of 2356). 2% of the HIV infected patients with prolonged QT interval had developed ventricular tachycardia . In contrast 2.7% of AIDS patients with prolonged QT interval had VT. The occurrence of ventricular tachycardia was more common in patients with AIDS with prolonged QT interval than in HIV patients with no AIDS. (P value < .05). Conclusion: We observed higher prevalence of prolonged QT interval among African American patients with AIDS and higher incidence of ventricular tachycardia in the same population. This implies that HIV infected African American patients with AIDS needs close monitoring of QT interval and avoidance of drugs that can prolong QT interval. Also lower CD4 count predicted higher chance of prolonged QT interval. Key words: VT-Ventricular tachycardia; HIV—Human immunodeficiency virus; AIDS— Acquired immunodeficiency syndrome.
155 Impact of Borderline Pulmonary Hypertension on Survival HeartTtransplantation A UNOS Registry Analysis Abbas Bitar, Farah Ammous; University of Louisville, Louisville, Kentucky
Post
Background: Pulmonary hypertension, defined as mPAP ≥ 25 mmHg, has been associated with increased morbidity and mortality among both non-heart transplant and transplant patients. The impact of a borderline PH (mPAP < 25 mmHg) on survival among pre-heart transplant patients is unknown. Methods: Adults (≥18 years) who underwent first time heart transplantation in the United States between 1987 and 2014 were retrospectively identified from the United Network for Organ Sharing registry (UNOS). Patients were classified into 3 groups based on mPAP. Referent (mPAP ≤ 18 mmHg), borderline (mPAP = 19–24 mmHg) and PH (mPAP ≥ 25 mmHg). Cox proportional hazard model was used to assess the outcome between mPAP and all-cause mortality. Results: Data from 29,501 heart transplant recipient were analyzed. Mean age was 53 ± 11.5 years, 76.4% were males and 74.5% Caucasian. Mean follow up time was 4224 ± 29 days. There were 12,670 deaths (42.9%). The unadjusted hazard ratio (HR) for mortality was increased for the borderline PH (HR = 1.10; 95% confidence interval (CI), 1.039–1.173; P = .001) and for PH group (HR = 1.14; 95% CI, 1.080–1.194; P < .001) when compared to the referent group. After adjusting for significant confounders, both borderline PH (HR1.10; 95% CI, 1.011–1.209; P = .028) and PH (HR = 1.16;CI,1.077–1.254; P < .001) mortality hazard remained significant compared to the referent group. The borderline PH cohort remained at increased risk of mortality after excluding high risk subgroups (patients with PCWP > 15 mmHg and PVR > 2.5 Wood Unit). Borderline PH group had an adjusted mortality hazard ratio of 1.13 (95% CI,1.022–1.244; P = .016) for PCWP ≤15 mmHg) and a HR of 1.11 (95% CI,1.009–1.227; P = .033 for PVR < 2.5 WU) when compared to the referent group. Conclusion: Pre-transplant borderline PH is associated with increased posttransplant mortality. Further prospective investigations are needed to validate our finding in order to device more aggressive treatment strategies for this vulnerable group of patients.
156 Impact of a Pharmacist-Managed Heart Failure Post-Discharge (Bridge) Clinic for Veterans Genevieve Hale1, Sonia Hassan2, Carrie Lewis2, Scott L. Hummel2,3, David Ratz2, Michael Brenner2; 1Nova Southeastern University, Palm Beach Gardens, Florida; 2Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan; 3University of Michigan, Ann Arbor, Michigan Introduction: Hospitals that provide early follow-up after heart failure (HF) discharge tend to have lower readmissions. The efficacy of dedicated bridge clinics for recently hospitalized HF patients has not been extensively evaluated. This study assessed the impact of a pharmacist-managed bridge clinic on HF patient outcomes at the VA Ann Arbor Healthcare System. Methods: Patients who were hospitalized with a primary diagnosis of HF between November 1, 2010 and August 15, 2013 were identified using ICD-9 codes. A retrospective chart review was conducted to collect data on HF-associated outcomes and pharmacist interventions in 122 patients who were seen at the bridge clinic compared to 122 randomly selected discharged HF patients who were not seen at this clinic (usual care). The primary endpoint was 90 day all-cause readmission and death via Cox proportional hazard analysis, adjusted for risk with the previously published Heart Failure Patient Severity Index. Secondary outcomes were risk-adjusted 30 day all-cause readmission and death, and time to first post-discharge follow-up and first all-cause readmission as analyzed with negative binomial regression. Results: Baseline characteristics overall between groups were similar, although more high risk patients were found in the bridge clinic population (P < .001). Time to follow-up was significantly shorter in patients who attended the bridge clinic (11 ± 6 vs. 20 ± 23 days, P < .0001), and time to first all-cause readmission trended longer in the bridge clinic group (41 ± 19 vs. 36 ± 25 days, P = .11). There was no difference in 90 day death and all-cause readmission between groups (P = .12). However, risk-adjusted 30-day death and all-cause readmission was significantly lower in patients who attended bridge clinic after discharge (10 vs. 22 events, adjusted HR 0.40, 95% CI 0.19–0.86, P = .02; see Figure). Assessment of and counseling on medication adherence and HF self-care was performed in all patients. The most common pharmacist interventions made in the bridge clinic were adding medications (42%) and stopping medications (39%); possible adverse drug effects were identified in 28% of bridge clinic patients. Conclusions: Post-discharge bridge clinics allow for close follow-up after hospital discharge for HF. A pharmacist-managed HF bridge clinic provides an opportunity to adjust and optimize HF medication regimens as well as counsel patients on disease state management, and has the potential to improve short-term outcomes.
