Search

Background At the epicenter of the COVID-19 pandemic, there was an urgent need to limit the exposure of patients (pts) to SARS-CoV-2, including areas within outpatient medical offices. Nevertheless, high risk heart failure (HF) pts continued to require close management. To overcome this predicament, at our institution pts were asked to stay at home and engage in virtual HF visits (VHFVs) via telephone or video, in lieu of in-office visits (IOVs). Objective The purpose of this abstract is to report patient satisfaction with VHFVs during the initial 30 day surge of COVID 19, compared to their satisfaction with IOVs over the preceding 3 months. Methods The Montefiore- Einstein Heart Failure service cares for over 4,000 pts who predominantly reside within the Bronx borough, and represent a vulnerable, urban, low socioeconomic population. Our team includes 12 providers consisting of both NPs and MDs. On 3/17/20 all non-urgent IOVs were stopped, and as a work around a virtual platform was created within our electronic medical record system (EPIC) to facilitate VHFVs. As of April 1st, all IOVs were converted to VHFVs, with few exceptions. We retrospectively identified all HF pts (N=502) who engaged in VHFVs (N=609) during the month of April, 2020. Those pts who also had IOVs within the preceding 90 days made up the survey cohort (N=283). A patient satisfaction survey was created in English and Spanish, using a 5 point Likert Scale. The survey was administered by phone, in the subjects' native language. Results The survey was completed by 117 of the 283 eligible subjects (41%), with clinical characteristics as described (Table 1). In 5 of 8 categories of patient satisfaction, pts indicated that they preferred IOVs to VHFVs (Figure 1). IOVs and VHFV were equally ranked in regard to the scheduled appointment time, and also how well pts were listened to and understood by the clinician. Only the convenience of VHFVs was favored more. Nevertheless, 90% of pts were willing to have another VHFV if necessary. Conclusion Even in the setting of a pandemic and despite the convenience (of time, cost and travel), pts overall tended to prefer IOVs to VHFVs, yet remained open to engaging in future VHFV if necessary. Given the unique situation of the COVID-19 surge during the conduct of this survey, the results may not reflect patient satisfaction during ordinary times.

Aims Patients with left ventricular assist device (LVAD) suffer from persistent exercise limitation despite improvement of their heart failure syndrome. Exercise training (ET) programmes to improve aerobic capacity have shown modest efficacy. High‐intensity interval training (HIIT), as an alternative to moderate continuous training, has not been systematically tested in this population. We examine the feasibility of a short, personalized HIIT programme in patients with LVAD and describe its effects on aerobic capacity and left ventricular remodelling. Methods and results Patients on durable LVAD support were prospectively enrolled in a 15‐session, 5 week HIIT programme. Turndown echocardiogram, Kansas City Cardiomyopathy Questionnaire, and cardiopulmonary exercise test were performed before and after HIIT. Training workloads for each subject were based on pretraining peak cardiopulmonary exercise test work rate (W). Percentage of prescribed training workload completed and adverse events were recorded for each subject. Fifteen subjects were enrolled [10 men, age = 51 (29–71) years, HeartMate II = 12, HeartMate 3 = 3, and time on LVAD = 18 (3–64) months]. Twelve completed post‐training testing. HIIT was well tolerated, and 90% (inter‐quartile range: 78, 99%) of the prescribed workload (W) was completed with no major adverse events. Improvements were seen in aV̇O2 at ventilatory threshold [7.1 (6.5, 9.1) to 8.5 (7.7, 9.3) mL/kg/min, P = 0.04], work rate at ventilatory threshold [44 (14, 54) to 55 (21, 66) W, P = 0.05], and left ventricular end‐diastolic volume [168 (144, 216) to 159 (124, 212) mL, n = 7, P = 0.02]. HIIT had no effect on maximal oxygen consumption (V̇O2peak) or Kansas City Cardiomyopathy Questionnaire score. Conclusions Cardiopulmonary exercise test‐guided HIIT is feasible and can improve submaximal aerobic capacity in stable patients with chronic LVAD support. Further studies are needed on its effects on the myocardium and its potential role in cardiac rehabilitation programmes.

Purpose High-Intensity interval training (HIIT) has been shown to induce reverse left ventricular (LV) remodeling in patients with heart failure. We tested whether this effect could be reproduced in patients supported with long-term LVAD. Methods Chronic LVAD pts prospectively completed 15 cycle ergometer based, supervised HIIT sessions. Cardiopulmonary exercise test (CPX) with full LVAD support and resting turn-down echocardiogram (HM II speed reduced to 6000 rpm) were performed before and after training. Training intensity was based on peak power output (PPO) attained during baseline CPX. Each session lasted 30 min: 3 min warm-up (50% PPO), six 30 sec challenges (100% PPO) and six interspersed 4 min recovery periods (40% of PPO). One reader, unaware of the study intervention, interpreted the turn-down echocardiograms. Two blinded independent readers identified oxygen uptake (VO2) at ventilatory threshold (VT) and peak exercise (pVO2) in all CPXs. Results Nine subjects were enrolled (6 male, 7 NICM, 7 BTT) mean ± SD age 47±16yrs. Time from heart failure diagnosis to LVAD 60±34 mos., time on LVAD 28±16 mos. Adherence to HIIT was high; one pt withdrew due to drive line malfunction and one voluntarily withdrew. No serious adverse events occurred during exercise. All patients had ICD in place. Four were on ACE-I/ARB, 9 on Beta-blocker and 5 on loop diuretics. Two had DM2, 4 had AF, 2 had prior CVA and 3 had prior pump exchange. Seven pts completed the protocol. HIIT significantly reduced LV end-diastolic (193±90 to 183 ±89 ml; p=0.0041) and end-systolic (133±63 to 128±63; p=0.04) volumes. LV size decreased in all pts. Submaximal aerobic capacity, VO2 at VT (7.0±1.5 to 9.0±1.6 ml.kg.min-1; p=0.02) and pVO2 (11.3±2.3 to 12.2±2.4 ml.kg.min-1 p=0.02) also improved after HIIT. Conclusion A short HIIT program guided by CPX induced reverse LV remodeling and improved aerobic capacity in pts with long-term LVAD support. Addition of HIIT to established recovery protocols warrants further investigation.

The reproducibility of cardiopulmonary exercise testing (CPX) has previously been reported in patients with NYHA Class II-III heart failure but not in patients with LVAD support. These two patient populations are known to have differing hemodynamic and metabolic responses to exercise. Here, we