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Background: Restricting dietary sodium is a common recommendation to address symptoms in heart failure (HF) patients. However, using the information provided on nutrition labels can be complex, leading to lapses in adherence. This problem is compounded by insufficient information on ethnic preferences in dietary habits. Based on our previous findings we developed a prototype dialogue agent (HF-DA) to assist African American (AA) and Hispanic Latino (H/L) patients with their HF self-care needs, including understanding nutrition labels and providing practical information per FDA recommendations. Objective: Compare HF-DA against existing technology in the public domain in assisting AA and H/L HF patients to make healthy food choices. Methods: We conducted a review of existing technology in two ways. 1: Google search engine: We measured the number of actions (typing, scrolling, clicking) required to find a source for a food’s sodium content matching the U.S. Department of Agriculture’s recommendations and used a calculator to understand the total sodium in a desired serving size. We identified relevant search terms by analyzing the commonly used words in the transcripts from our HF patient education sessions with their health educators (18 AA and 2 H/L) and 1:1 interviews with HF patients (3 AA and 1 H/L). 2: Google Play Store: We downloaded the top 15 apps using the search term “heart failure” and explored their functionality. Results: Google’s search engine required users to perform 1 action to identify the sodium content and percent daily value but then needed 6-8 actions (dependent on query length) to calculate sodium content of total serving size. Our HF-DA provides this information in 4 actions. Of the 15 apps available in the Play Store, none had any features for understanding nutrition labels. Conclusion: Our preliminary analysis revealed there are very few culturally sensitive technological resources available to assist HF patients in understanding nutrition labels. These resources require a patient to understand nutrition labels, perform arithmetic, and recall dietary restrictions. HF-DA is capable of promoting healthy eating habits by aiding HF patients' decision-making process by providing reliable information in fewer steps.

Introduction Heart failure (HF) is a public health problem, and self-care remains poor, especially among minorities. Access to personalized educational material via an interactive dialogue agent (DA), a system intended to converse with humans in natural language, has the potential to improve self-care. This abstract outlines the initial steps of developing an artificial intelligence-based DA to assist African American (AA) and Hispanic/Latino (H/L) HF patients with their self-care needs. Hypothesis Analysis of HF education sessions between health educators (HE) and patients can provide insight into the topics that AA and H/L patients value. Method In this IRB approved pilot study, we have recorded, transcribed, and verified 20 (18 AA and 2 H/L) HF education sessions between HE and HF patients. Latent Dirichlet Allocation (LDA), a topic modeling algorithm and Empath, a text analysis tool were used to identify common discussion topics in the transcripts. An initiative analysis was performed to identify conversation drivers where each turn (unit of speech by a single speaker, without interruption from the other speaker) was classified as either a question (ending with ‘?’), a prompt (having only filler words like umm, okay) or an assertion/command (others). Lastly, we compared the transcripts against a HF ontology published by the National Center for Biomedical Ontology and the Consumer Health Vocabulary (CHV) available in the Unified Medical Language System (UMLS) to identify the term overlap. Results On average, HE took 117 turns comprising 205 sentences and 2281 words per conversation, whereas patients took 108 turns comprising 131 sentences and 850 words. Per conversation, HE asked 26 questions and had 17 prompts as opposed to 3 questions and 39 prompts by the patients. LDA identified HF and heart function, effects of HF, low salt diet, and follow-up appointment and medication as the top 4 most common topics discussed by the HE. When looking at the entire transcripts, Empath identified eating, health, and cooking as the most common topics for both the HE and the patients. Patients frequently discussed children and family, whereas HE focused on providing HF information as indicated by LDA. Lastly, only 2.1% of HE terms overlapped with the HF ontology. Our analysis revealed that 25% and 22% of the terms (without stop words such as at, the) used by the patients and HE respectively match with the ‘preferred label’ in the CHV. For both, the high frequency terms included heart, heart failure, salt, water, and fluid. This also correlated with our topic analysis findings from Empath and LDA. Conclusion Our analysis helps triangulate the kind of information HE and HF patients value. Though mostly HE dominated the conversation, it is essential to incorporate the topics that patients brought up into the DA and use culturally sensitive vocabulary while communicating them. Next, we will collect more recordings, conduct focus groups, and evaluate the usability of our prototype DA.

Background Patient populations with low socioeconomic status (SES) experience psychological stress because of social determinants of health. Social determinants of health contribute to self-care-especially among patients with heart failure (HF). Objective We sought to describe the influence of stress and social determinants of health on self-care in patients with HF who have low SES. Methods In this mixed-methods, concurrent embedded study, participants (N = 35) were recruited from 2 urban hospitals in Chicago if they had low SES and were readmitted within 120 days of an exacerbation of HF. We conducted semistructured interviews to collect qualitative data about stressors associated with patients' living circumstances, strategies patients used to foster self-care, family dynamics, and coping strategies patients used to decrease stress. We measured psychological stress (Perceived Stress Scale [PSS-10]), and self-care (Self-care of Heart Failure Index). Content analysis was used to analyze the qualitative data, and descriptive statistics were used to describe the sample. In the final analytic phase, the qualitative and quantitative data were integrated. Results Self-care was poor: 91.5% of participants had Self-care of Heart Failure Index subscale scores lower than 70. Perceived stress was high: 34% of participants had PSS-10 scores of 20 or higher. Several social determinants of health emerged as affecting self-care: financial stress, family personal health, past impactful deaths, and a recent stressful event (eg, child's death). Participants lived in areas with high crime and violence, and participants described many stressful events. However, among participants whose PSS-10 scores were lower than 20 (indicating lower stress), there was discordance among the description of factors impacting self-care and their PSS-10 score. Conclusions Social determinants of health negatively impact the ability of low-SES patients to manage their HF symptoms and adhere to a medication and dietary regimen. It is important that healthcare providers assess patients' stressors so appropriate referral to services can occur.

Background: More than 80% of patients presenting to the emergency department (ED) with acute decompensated heart failure (ADHF) are admitted and categorized as either observation (OBS) or inpatient (IP) post discharge using Interqual criteria (severity of illness and intensity of service). Identifying patient characteristics upon admission to determine OBS or IP status may optimize hospital resource utilization. Purpose: To determine patient characteristics upon admission that are associated with the categorization (OBS vs IP) for patients with ADHF presenting to the ED of an urban academic medical center. Methods: Retrospective medical record review of 172 randomly selected adult patients from 2013 who presented to the ED with ADHF. Patients had been categorized as OBS vs IP after discharge based on Interqual Criteria. Based on the literature, we identified variables traditionally associated with an admitting diagnosis for heart failure (HF) including: symptoms (shortness of breath, paroxysmal nocturnal dyspnea, orthopnea, and lower extremity edema), physiologic measures (B-type natriuretic peptide and blood pressure), and patient characteristics (number of co-morbidities, type of HF- HF with reduced ejection fraction vs HF with preserved ejection fraction, 30 day readmission rate, gender, ethnicity, and history of substance abuse within the past 12 months). Chi square tests and student t-tests were used to compare variables between groups. Results: Of the 172 ADHF patients, 76% (n=131) were categorized as IP and 24% (n=41) were OBS. The majority of patients were African American (n = 130, 75.6%), female (n = 101, 58.7%) and had HF with a reduced ejection fraction (n = 99, 57.6%). There were no significant differences between the OBS and IP groups in terms of symptoms, B-type natriuretic peptide levels, blood pressure, number of co-morbidities, type of HF, 30 day readmission rate, gender, ethnicity, or socio-demographic characteristics. A history of substance abuse was more common among the OBS group versus the IP group ( p = 0.013). Conclusions: In this single center retrospective medical record review comparing the categorization of patients presenting to the ED with ADHF as OBS vs IP, we found no difference in the traditional clinical variables between groups. However, a history of substance abuse was associated with the patient being categorized as OBS. Substance abuse may be an important non-traditional variable to consider in resource utilization.

Introduction Patients with low socioeconomic status (SES) have worse heart failure (HF) outcomes than patients with high SES, including higher readmissions. Interventions to improve outcomes in low SES patient populations have not been successful however the reasons remain unclear. Objective To describe the social factors impacting psychological stress and self-care in a low SES patient population with HF and multiple readmissions. Methods In this mixed methods study, 35 subjects with low SES participated in semi-structured interviews about personal and community factors impacting their stress and self-care. Subjects were interviewed during an inpatient readmission for acute decompensated heart failure from two urban hospitals in Chicago. Subjects completed standardized instruments measuring psychological stress (PSS-10), and self-care (SCHFI). Subjects were categorized into high stress (PSS-10 >20) and moderate/low stress (PSS-10 Results Ninety one percent of subjects were African American and 91% were from neighborhoods with high rates of poverty and violence according to US Census data. Subjects experienced a range of admissions (2–12) within the previous 180 days of the current HF admission. Across all three SCHFI sub-scales, the majority of scores were 20 (PSS-10 (14.9 [8.2]). The overarching qualitative theme was that social factors and psychological stress influence self-care. Subjects described the following events as stressful and impacting their self-care: financial difficulties, concern for children/grandchildren's safety, personal health, past impactful deaths, and a recent stressful event. Among subjects whose PSS-10 scores were Conclusion Social factors and psychological stress has impacted the ability of this low SES patient population to perform adequate HF self-care. Research to develop and test sensitive interventions that address social determinants influencing self-care are needed since low SES patient populations continue to experience poorer outcomes.

Background: Anemia is a frequently encountered comorbidity that affects both death and hospitalization in patients with heart failure (HF). The effect of anemia on 30-day hospital readmission in African Americans (AA) with HF has not been studied. Methods: We retrospectively enrolled all 243 (61% female) self-reported AA adults admitted to the University of Illinois at Chicago hospital with the diagnosis of HF from January 2011 to December 2012. Extensive medical chart reviews were performed. Results: The prevalence of anemia with hemoglobin (Hb) Conclusion: Lower Hb levels are associated with higher 30-day readmission rates in hospitalized AA patients with HF. Interventions towards appropriate treatment and prevention of anemia in AA with HF might reduce their readmission rates and improve their outcome.

Introduction End stage liver disease (ESLD) is a highly morbid condition. While awaiting liver transplantation, many patients experience adverse events including cardiovascular events. Performing invasive cardiac procedures is a precarious undertaking given abnormal bleeding profiles that are common in this patient population. Revascularization options are challenging due to a need a potentially life changing operation, inability to tolerate dual antiplatelet therapy, and other comorbidities. Objective To examine the characteristics and outcomes of patients who are awaiting a liver transplant with ESLD who undergo cardiac catheterization at a University Medical Center. Methods We reviewed the medical records of all patients awaiting liver transplantation that were referred for cardiac catheterization between March 2006 and December 2010. We recorded demographic data, cardiac risk factors, relevant laboratories, results of their catheterization procedure and adverse events for the following year. Death from any cause within one year of the procedure, myocardial infarction, stroke, repeat revascularization, cardiac re-hospitalization and periprocedural bleeding were recorded as adverse events. Only patients with complete follow-up records were included. The MELD score, a common measurement of liver disease severity, was calculated at the time of initial referral Results Of the 440 charts reviewed, 18% (78) patients had a left heart catheterization. The demographics of the patients who had a left heart catheterization were women 35% (n=28), 50% (39) Caucasian, 21% (16) Black, 23% (18) Hispanic and 6% other. The average MELD score at the time of the procedure was 17, with the average platelet count 101. Cardiac risk factors were diabetes 59% (46), hyperlipidemia 13% (10) and hypertension. 30% (23) had radial access, while 70% (55) had femoral. 14% (n=11) underwent revascularization (7 PCI and 4 CABG). Complications for all patients undergoing cardiac catheterization included bleeding 26% (20) and death within one year 28% (22). Conclusion Patient with ESLD undergoing a cardiac catheterization have a higher rate of bleeding complications and death than patients who don’t have ESLD (26% versus

To the Editor: In 2009, the Centers for Medicare and Medicaid Services began reporting publicly 30-day readmission rates for acute decompensated heart failure in an effort to highlight preventable readmissions, improve care, and control costs. This decision was based, in part, on recent observations of elderly Medicare fee-for-service beneficiaries that found a median readmission rate of 24.4% (range, 15.9% to 34.4%).1 A follow-up study by Ross et al2 published in Circulation: Heart Failure evaluated trends in readmission after acute decompensated heart failure hospitalization and found similar readmission rates (23.7% to 23.9%) over the 3-year period from 2004 to 2006. Both of these …

Background The goal of this study was to determine if left ventricular (LV) global longitudinal strain (GLS) predicts heart failure (HF) readmission in patients with acute decompensated heart failure. Methods and results Two hundred ninety one patients were enrolled at the time of admission for acute decompensated heart failure between January 2011 and September 2013. Left ventricle global longitudinal strain (LV GLS) by velocity vector imaging averaged from 2, 3 and 4-chamber views could be assessed in 204 out of 291 (70%) patients. Mean age was 63.8 ± 15.2 years, 42% of the patients were males and 78% were African American or Hispanic. Patients were followed until the first HF hospital readmission up to 44 months. Patients were grouped into quartiles on the basis of LV GLS. Kaplan-Meier curves showed significantly higher readmission rates in patients with worse LV GLS (log-rank p

Background Despite increasing clinical use, there is limited data regarding regadenoson in stress perfusion cardiovascular magnetic resonance (CMR). In particular, given its long half-life the optimal stress protocol remains unclear. Although Myocardial Perfusion Reserve (MPR) may provide additive prognostic information, current techniques for its measurement are cumbersome and challenging for routine clinical practice. The aims of this study were: 1) To determine the feasibility of MPR quantification during regadenoson stress CMR by measurement of Coronary Sinus (CS) flow; and 2) to investigate the role of aminophylline reversal during regadenoson stress-CMR. Methods 117 consecutive patients with possible myocardial ischemia were prospectively enrolled. Perfusion imaging was performed at 1 minute and 15 minutes after administration of 0.4 mg regadenoson. A subgroup of 41 patients was given aminophylline (100 mg) after stress images were acquired. CS flow was measured using phase-contrast imaging at baseline (pre CS flow), and immediately after the stress (peak CS flow) and rest (post CS flow) perfusion images. Results CS flow measurements were obtained in 92% of patients with no adverse events. MPR was significantly underestimated when calculated as peak CS flow/post CS flow as compared to peak CS flow/pre CS flow (2.43 ± 0.20 vs. 3.28 ± 0.32, p = 0.03). This difference was abolished when aminophylline was administered (3.35 ± 0.44 vs. 3.30 ± 0.52, p = 0.95). Impaired MPR (peak CS flow/pre CS flow

Background Measurement of myocardial perfusion reserve (MPR) can potentially extend the scope of conventional myocardial perfusion imaging from detection of flow limiting epicardial stenosis to assessment of coronary microvascular function. Recent studies have suggested that MPR may improve risk stratification of patients with known or suspected CAD. MPR has traditionally been measured using PET or CMR time-intensity curves. However, these techniques are cumbersome, require radiation (for PET) and are not practical for routine clinical practice. Measurement of coronary sinus (CS) flow with phase-contrast MRI is an alternative, simple method for assessing MPR. The aim of this study was to identify the clinical determinants of MPR using this method in patients with symptoms of possible myocardial ischemia presenting for CMR stress testing.