S196 Journal of Cardiac Failure Vol. 11 No. 6 Suppl. 2005

398Spousal Caregiving in Heart Failure Co-ManagementSusan Barnason1, Bunny Pozehl1, Louise LaFramboise1; 1College of Nursing,University of Nebraska Medical Center, Omaha, NE

Introduction: Heart failure (HF) affects nearly 5 million Americans with more than550,000 new cases diagnosed annually. To decrease the considerable costs that sur-round the treatment of HF, hospitals have shortened lengths of stay. Patients withHF are often discharged while relatively ill and functionally dependent, requiringextended assistance from an informal caregiver, often a spouse. Spousal caregiversmay themselves be elderly, have their own chronic illnesses to manage, and experienceincreased burden or stress with caregiving. Research has indicated that increasedburden or stress contributes to increased risk for health problems, overall decline inphysical health, and increased risk for death.Purpose: To explore the experience of spousal caregivers in co-management of HFpatients. Methods: A purposive sample of 20 spousal caregivers, obtained from alarge HF clinic, completed structured phone interviews. Qualitative content analysisof the taped and transcribed interviews was completed. Results: Themes identifiedwere: 1) HF knowledge: pathophysiology, manifestations, and management; 2) care-giver stress and burden: social support, social isolation, and lifestyle changes; and 3)caregiver co-morbidities. With regard to HF knowledge, there was limited knowledgeof pathophysiology, manifestations, and management among the spousal caregivers.Participants referred to “pamphlets” or information given to them at the office orclinic, and described themselves as knowledgeable, but could not explain HF; identifiedswelling, SOB, and fatigue as the symptoms of problems; and rarely could describethe purpose of the HF medications. With regard to stress and burden, participantsidentified that needs for social support exceeded provision of social support, that theyexperienced social isolation because their HF spouse wasn’t up to social activities oroutings, and that they had significant lifestyle or role changes as a result of their spouse’sHF. Finally, all of the caregivers identified chronic health conditions of their ownthat required time and energy to manage. Conclusions: Spousal caregivers are notconsistently considered in educational and supportive interventions provided to pa-tients with HF. Time, space, and availability of caregivers for education and supportare often limited in offices or clinics.Spouses of patients with HF are important membersof the health care team. It’s imperative that spousal caregivers of HF patients be wellinformed and given adequate support for the often overwhelming role they assumein co-management of HF.

399Impact of a Hospitalization for Acute Decompensated Heart Failure on theTreatment: The Argentinean HOSPICAL RegistryJuan P. Cimbaro Canella1, Eduardo R. Perna1, Carlos Poy1, Lilia L. LoboMarquez1, Roberto Colque1, Soledad Alvarez1, Sergio V. Perrone1, Fabian Diez1; 1HeartFailure Committee, Federacion Argentina de Cardiologia, Corrientes, Argentina

Acute decompensated heart failure (ADHF) is a worldwide major public health prob-lem. Despite the large number of patients hospitalized there has been little effort toimprove the quality of care for patients hospitalized with ADHF in Argentina. Objec-tives: Evaluate the pharmacologic management before, during and after hospitalizationas well as pre discharge strategies used for ADHF. Material and Methods: Be-tween Sep/04 and Feb/05, 301 patients admitted for ADHF were prospectivelyrecruited in 23 Argentinean centers, corresponding to HOSPICAL Registry (meanage, 6713 years, 60% males, 64% with an ejection fraction � 40%). Results: Theintravenous treatment included: diuretics 93% (administered as continuous infusionin 17%); inotropics in 19% (low-dose dopamine 12%, dobutamine 9% and levosi-mendan 1%); and vasodilators in 139 (46%) patients (nitropruside 7% and nitroglycerin39%). The in-hospital management of ACE-I, betablockers and spironolactone isshowed in the table 1. The prescription of drugs before hospitalization vs predischargewas as following: ACE-I/ARB in 71 vs 78% (p � 0.013), betablockers in 48 vs65% (p � 0.001), spironolactone in 29 vs 51% (p � 0.001) and diuretics in 60 vs78% (p � 0.001). The most frequent recommendations before discharge were: low-sodium diet (80%), first visit scheduled in the next 10 days (79%), scheduled chemistrycontrol (56%), daily weight (54%), water restriction (47%), elastic diuretics regimen(28%) and physical activity (24%). Conclusion: The medical treatment of ADHFincluded more vasodilators than inotropics. The strategy in the use of recommendeddrugs was favourable (low reduction and high start). However, since the interventionpre discharge was insufficient there are substantial opportunities to improve the qualityof care for ADHF patients in the Argentinean hospitals.

Table 1

Increased Kept Decreased Stopped Started

ACE-I 18.3% 36.4% 4.7% 6.3% 16%Beta Blockers 6% 23% 9% 7% 26%Spironolactone 3.7% 21% 1% 3.3% 32%

400Heart Success Program: Management of Cancer Patients with Heart Failurethrough Collaborative PracticeAnecita Fadol, Janet Taubert, Margaret Holm, Stephanie Fulton, Myrshia Woods,Jean-Bernard Durand, Daniel Lenihan; Cardiology, MD Anderson Cancer Center,Houston, TX

Introduction: Management of cancer patients with heart failure requires complextherapeutic interventions and presents challenging issues to health care providers,patients and families. The “Heart Success Program”, a collaborative, interdisciplinarystrategy was developed to provide cost effective quality care without compromisingcancer therapy. Methods: Ninety-one patients with cancer and heart failure admittedto MD Anderson Cancer Center in 2004 were included in the initial implementationof the Heart Success Program. 73% of patients have solid tumor and 27% havehematological cancer. Co morbid conditions include atrial fibrillation (40%), coronaryartery disease (42%), diabetes (27%), hyperlipidemia (27%), hypertension (59%),myocardial infarction (19%), pulmonary disease (30%), renal insufficiency (26%),anemia (58%), and smoking history (29%). The Heart Success Program includescomprehensive education of patients, family, and health care providers regarding heartfailure management, and utilization of a heart failure order set, patient educationbooklet, educational videotapes, and a patient diary. Weekly interdisciplinary clinicalrounds provide a forum for discussion of identified patient’s problems and formulatesolutions. Endpoint outcomes include decreased length of stay, cost effective care, im-proved functional status, and improved provider compliance with evidence-basedpharmacological therapy as recommended by national guidelines for heart failuremanagement. Results: Length of stay has decreased by 57% from 10.1 to 5.8 days,and inpatient average charge per admission decreased by 60% ($63, 571 to $38,000).Despite multiple co morbid conditions, patients were discharged with improved func-tional status and on standard heart failure medications of angiotensin convertingenzyme inhibitors (49%), angiotensin receptor blocker (23%), ACE or ARB (56%),beta -blockers (65%), and diuretics (60%). Conclusions: Data from this qualityimprovement activity demonstrate that a multidisciplinary approach to cancer patientswith heart failure through adherence to well-established heart failure guidelines havean impact on both functional capacity and clinical outcomes. It is this team approachthat medically manages, educates and inspires these patients to increase their levelof activity over time can improve their functional ability. Studies should be conductedto establish evidence based guidelines specific for cancer patients with heart failure.

401The Relation between Admission Systolic Blood Pressure and Outcomes inHospitalized Patients with Heart Failure: An OPTIMIZE-HF AnalysisMihai Gheorghiade1, Liviu Klein1, William T. Abraham2, Nancy M. Albert3, BarryH. Greenberg4, Christopher M. O’Connor5, Lilian She5, Wendy G. Stough5, Clyde W.Yancy6, James B. Young3, Gregg C. Fonarow7; 1Cardiology, Northwestern University;2Ohio State University; 3Cleveland Clinic Foundation; 4University of California SanDiego; 5Duke Clinical Research Institute; 6University of Texas Southwestern;7University of California Los Angeles

The relation between systolic blood pressure (SBP) and outcomes in hospitalizedheart failure (HF) patients (pts) has not been well studied. Methods: OPTIMIZE-HFis a registry/performance improvement program for hospitalized HF pts and includesa subgroup with 60–90 day follow-up. The relations between admission SBP andoutcomes were analyzed using chi-square and ANOVA across quartiles of SBP.Results: There were 48612 pts enrolled at 259 hospitals. Pts with higher SBP weremore likely to be women, African American, and have preserved EF (Table). SBP wasinversely related to in-hospital and post discharge mortality, but not rehospitalization.Conclusions: Systolic hypertension is common in pts admitted for HF. These ptshave lower in-hospital and post discharge mortality, but similarly high rehospitalizationrates. These findings should be considered in designing clinical trials.

Admission SBP mmHg

�119 120-139 140-161 �161Variable % (SD) (n � 12252) (n � 12096) (n � 12099) (n � 12120) P

Mean Age, y 72.9 (14.0) 74 (13.5) 73.8 (13.6) 72.1 (14.6) � .0001Women 43.4 49.1 45.2 48.7 � .0001African American 12.4 14.0 18.8 25.7 � .0001Mean EF 33.3 (17.4) 37.8 (17.6) 40.9 (17.1) 44.4 (16.5) � .0001ICD 9.3 5.2 3.6 2.3 � .0001Ischemic Etiology 50.7 48.8 44.1 39.2 � .0001HTN Etiology 13.4 18.1 25.4 34.8 � .0001SCr�2 20.7 18.0 18.1 21.5 � .0001Mean Wt change �2.45 (5.00) �2.68 (4.82) �2.60 (4.64) �2.42 (4.62) .0003

(kg)Mean SBP 104.8 (10.9) 129.3 (5.8) 149.6 (6.5) 187.3 (21.7) � .0001

AdmissionMean SBP DC 111.6 (18.7) 120.6 (19.1) 128.3 (20.2) 138.2 (22.5) � .0001Edema Admission 63.9 65.1 65.6 63.9 .0096Edema DC 30.1 27.1 27.0 23.8 � .0001All cause mortality 7.2 3.6 2.5 1.7 � .0001

in-hospitalAll cause mortality 14.0 8.4 6.0 5.4 � .0001

60-90 dayspost discharge

Readmission 30.6 29.9 30.3 27.6 NSMean LOS, days 6.5 (6.6) 5.7 (5.3) 5.4 (5.0) 5.1 (4.8) � .0001