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Background Virtual Reality (VR) is used as an effective tool for distraction and as an adjunct for pain management. This study was conducted to compare VR to standard iPad use after surgery and examine its effect on pain score and opioid consumption.Methods This was a randomized controlled study, with stratification by surgery type, age group (7-12yo, 13-18yo) and gender. Pain and anxiety were assessed with validated scales (STAI, FACES, VAS, FLACC) and outcomes were compared between each group.Results 50 of the 106 enrolled patients used the VR device. After adjusting for age, gender, and STAI, patients had a decreased FLACC score while using the VR device compared to the iPad group (odds ratio 2.95, P= .021). The younger patients were found to have lower FLACC scores while using the VR device (odds ratio 1.15, p=0.044); this finding was most significant when patients used the VR device for 20-30 minutes (odds ratio 1.67, P= .0003). Additionally, after adjusting for treatment group, gender, and STAI, the younger patients had higher odds of withdrawal or exclusion from the study (odds ratio 1.18, P= .021). No significant difference in opioid consumption between the groups was found.Discussion Virtual reality was well tolerated and more effective in decreasing pain during the immediate postoperative period than iPad use. Despite a slightly higher withdrawal rate, younger patients benefited more from the intervention.

Examine the associations of sleep measures with kidney function changes over time among individuals from a community-based study.

Background:Racial disparities in blood pressure (BP) control persist, but whether differences by race in antihypertensive medication intensification (AMI) contribute is unknown. Objective:To compare AMI by race for patients with elevated home BP readings. Methods:This prospective cohort study followed adult patients from 6 rural primary care practices who used home BP monitoring (HBPM) and recorded/reported values. For providers, AMI was encouraged when mean HBPM systolic blood pressure (SBP) values were ⩾135 mm Hg; patients received phone-based coaching on HBPM technique and sharing HBPM findings. AMI was assessed between baseline and 12 months using defined daily dose (DDD) and summed to create a total antihypertensive DDD value. Results:A total of 217 patients (mean age = 61.4 ± 10.2 years; 66% female; 57% black) provided usable HBPM data. Among 90 (41%) intensification-eligible hypertensive patients (ie, mean HBPM SBP values for 6-months ⩾135 mm Hg), mean total antihypertensive DDD was increased in 61% at 12 months. Blacks had significantly higher mean DDD at baseline and 12 months, but intensification (+0.72 vs +0.65; P= 0.83) was similar by race. However, intensification was greater in males than females (+1.1 vs +0.39; P= 0.031). Reduction in mean SBP following intensification was greater in white versus black patients (−8.2 vs −3.9 mm Hg; P= 0.14). Conclusion/Relevance:Treatment intensification in HBPM users was similar by race, differed significantly by gender, and may produce a greater response in white patients. Differential AMI in HBPM users does not appear to contribute to persistent racial disparities in BP control.

Introduction:Left ventricular assist device (LVAD) support improves quality of life and survival in patients with end-stage heart failure (HF), but predicting which patients benefit most remains a challenge. The Penn Columbia Risk Score (PCR) and pretransplant risk stratification score (RSS) have predicted 1-year mortality in LVAD and transplant patients, respectively. We sought to compare the PCR and RSS in our single center’s LVAD population and evaluate additional predictors of survival at 1 year.Methods:Perioperative data were collected from 202 patients who received an LVAD (HVAD, Heartmate II, or Heartmate III) from 2014-2020. The logistic regression model assessed goodness-of-fit of the PCR and RSS in our population. The PCR model is based on age, creatinine, total bilirubin (tbili), body mass index, right ventricular dysfunction, aortic insufficiency while the RSS score is based on age, prior sternotomy, HF etiology, eGFR, tbili, and mechanical support. Logistic regression models were used to identify additional predictors of 1-year mortality.Results:In our 202 patients, the RSS was more predictive of 1-year mortality (R2=0.14) than PCR (R2=0.02). In addition to age, tbili, inotrope score, pulmonary artery pulsatility index (PAPi), right ventricular dysfunction, mechanical support (defined as intra-aortic balloon pump, ECMO, or temporary LVAD), and albumin were each associated with 1-year mortality (p <0.05). A multivariate model including age, tbili, PAPi, right ventricular dysfunction, and albumin, had higher correlation with 1-year mortality than the RSS (R2=0.21). The addition of inotrope score and mechanical support to this model did not significantly change the association (R2=0.20).Discussion:In our patient population, the PCR and RSS were poorly predictive of 1-year survival showing almost no association. Our novel model showed higher association, while still being suboptimal. Further research is needed to refine which clinical characteristics will best predict success and survival in LVAD patients.

Introduction:Heart failure (HF) exacerbations are often precipitated by dietary noncompliance, which is common around holidays. We examined whether HF hospitalizations would increase after major national holidays.Methods:The ARIC Study performed surveillance of HF admissions among patients age ≥55 years in 4 US communities from 2005-2014. HF admissions were identified by ICD-9 codes and validated by physician review. For each holiday (H), 4 days before the holiday (H-4 to H-1), and 4 days after the holiday (H+1 to H+4), we compared average daily HF admission rates, hospital length of stay (LOS), 28-day mortality, and 1-year mortality to the remaining days in each holiday’s month using Poisson regression using a complex sampling design.Results:ARIC identified 92,354 HF admissions (weighted). Patients admitted in holiday months were 46% male and 71% white, with average age 75 years. Compared to the holiday months, patients admitted on H were older (78 years, p<0.01). Race, community, and HF by ejection fraction were similar among time periods. Average daily admissions around each holiday are shown in Figure 1. For all holidays combined, average daily admissions compared to the remainder of the holiday months (25.1 per day) were less frequent on both H-1 (18.5, p=0.002) and H-1/H combined (19.5, p=0.005). Hospital LOS was shorter for patients admitted on H for Thanksgiving (5.3 v 6.9 days, p=0.02) and Christmas (4.8 v 7.5, p=0.01), on H-1 for Christmas (5.3 v 7.5, p=0.04) and during H-4 to H-2 for New Year’s Day (6.7 v 8.7, p=0.02). 28-day mortality was lower for patients admitted on H-1 (p<0.001) for Christmas. 1-year mortality was similar for all holidays and time periods.Conclusions:HF admission rates, hospital LOS, and mortality were similar in the 4 days following a holiday compared to the remainder of each holiday’s month. However, the day before and/or day of a holiday were associated with lower HF admission rates, shorter hospital LOS, and lower 28-day mortality.

Rapid fluid removal (ultrafiltration, UF) is associated with higher cardiovascular morbidity and mortality among individuals receiving maintenance hemodialysis (HD). Fluid removal rates that exceed vascular refill rates can result in hemodynamic instability, end-organ damage to the heart, kidneys, gut and brain, among other organs, and patient symptoms. There are no known evidence-based HD treatment strategies to reduce harm from higher UF rates. Ultrafiltration profiling, the practice of varying UF rates to maximize fluid removal during periods of greatest hydration and plasma oncotic pressure, has been proposed as an HD treatment intervention that may reduce UF rate-related complications. This study is a randomized 4-phase cross-over trial in which participants are successively alternated between study arms with intervening washout periods, and treatment order is randomized. After 4-week screening and 6-week baseline periods, participants are randomized to HD with conventional UF or HD with UF profiling for a period of 3 weeks followed by a 1-week washout period before crossing over. Participants cross into conventional UF and UF profiling phases twice (2 phases per arm). The primary outcomes of interest are intradialytic hypotension (nadir intradialytic systolic blood pressure <90 mmHg), pre-to post-HD change in troponin T (expressed as a percentage), change in left ventricular global longitudinal strain (an echocardiographic measure of left ventricular systolic function), and development of intradialytic left ventricular stunning (worsening of contractile function in ≥2 segments). This study will determine the impact of UF profiling on UF rate-related cardiovascular complications in prevalent, maintenance HD patients.