Does an Intervention Designed to Improve Self-management, Social Support and Awareness of Palliative-care Address Needs of Persons with Heart Failure, Family Caregivers and Clinicians?

Aims and Objectives To conduct a formative evaluation of the iPad‐Enhanced Shared Care Intervention for Partners (iSCIP) among persons with heart failure (HF), family caregivers and clinicians. Together, persons with HF and family caregivers are referred to as partners. Background There is growing awareness of the caregiver\u27s contributions to HF self‐management, social support and reciprocal benefits of interventions that involve both partners. The iSCIP engages both partners in a six‐session psychosocial intervention to address three preventable causes of poor outcomes in a HF population: poor self‐management skills, inadequate social support and underutilisation of palliative care. An iPad app is used to organise the intervention. The goals of the iSCIP are to engage partners in HF self‐management, communication about the HF patient\u27s care values and preferences, and future planning. Design A qualitative focus group design was used. Methods Seven clinicians and eight partners participated in focus groups to explore their experiences, needs and reaction to the iSCIP content and technologies employed. Open‐ended questions and closed‐ended surveys were used to collect data. Deductive content analysis was used to analyse the qualitative data. NVivo software was used for qualitative data analysis. Bayesian statistical models were used to analyse numeric data. Results The iSCIP met partners’ and clinicians’ needs to improve self‐management, communicate about care values and preferences and plan for the future. Quantitative analysis of numeric data supported our qualitative findings, in that both groups rated the intervention components useful to very useful. Implications for practice These findings add to the growing evidence of the feasibility and acceptability of programs that address care values and preferences, and care planning. The iSCIP can be used as a guide for developing interventions and software applications, which involve both partners in care and palliative‐care discussions

Favorable Outcomes of LVAD as Bridge to Simultaneous Heart-Kidney Transplantation

Background Chronic kidney disease (CKD) is an established risk factor for incident cardiovascular disease and progression of heart failure disease state, and is associated with decreased survival after left ventricular assist device (LVAD) therapy or heart transplantation (HT). Combined heart-kidney transplantation (HKT) compared with isolated HT recently has been shown to have survival advantage among patients whose estimated glomerular filtration rate is less than 37 ml/min/m2. Data on LVAD to HKT are limited. Methods At our center, a total of 803 patients have received HT, 594 patients LVAD therapy, and 23 patients HKT from single donors; of those 23, 15 were without the use of LVAD and 8 were after support with LVAD. Results Kaplan-Meier survival analysis found LVAD-supported patients with CKD stages 4 or 5 had statistically worse 24-month survival after HT as compared with those with CKD stage 1, 2, and 3 (58% vs 88%, p=0.01). Patients who received combined HKT after LVAD had comparable 24-month survival with those who received HKT without LVAD (87% and 85%, p=NS); both groups had numerically better survival compared with those who had CKD (stage 4-5) with isolated HT (58%). Conclusions Patients supported with LVAD who demonstrate advanced CKD (stage 4-5) have worse 24-month post-HT survival compared with those with less advanced CKD (stage 1-3). Combined HKT after LVAD support is feasible and confers comparable 24-month survival compared with HKT without prior LVAD therapy. Our study supports combined HKT for select LVAD patients with advanced CKD (stage 4-5)

Involvement of private investors on the financial market of the Russian Federation: analysis of problems and actions of regulating authorit

In this article, the problems of attracting private investment in the financial markets of the Russian Federation are examined. The analysis of measures carried out by the regulator of the financial market on achievement of positive dynamics in attraction of savings of the population in the financial markets is carried out. Conclusions have been made about the need for additional instruments of impact on the population and on the pfessional market participants who would help stimulate the population in choosing the Russian stock market

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Management of End Stage Heart Failure (Advanced Heart Failure)

Video/audio presentation of Aurora St. Luke\u27s Transplant Grand Rounds on June 27, 2012, presented by Nasir Sulemanjee, MD, Advanced Heart Failure & Transplant Cardiologist. 59 minutes