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Social determinants of health (SDOH) affect quality of life. We investigated SDOH impacts on self-perceived resilience among people with adult congenital heart disease (ACHD). Secondary analysis of data from two complementary studies: a survey study conducted May 2021-June 2022 and a qualitative study conducted June 2020-August 2021. Resilience was assessed through CD-RISC10 score (range 0-40, higher scores reflect greater self-perceived resilience) and interview responses. Sociodemographic and SDOH (education, employment, living situation, monetary stability, financial dependency, area deprivation index) data were collected by healthcare record review and self-report. We used linear regression with robust standard errors to analyze survey data and performed a thematic analysis of interview data. Survey participants (N = 127) mean age was 42 ± 14 years; 51% were female, 87% white. ACHD was moderate (75%) or complex (25%); 41% functional class C or D. Resilience (mean 30 ± 7) varied by monetary stability: compared to people with difficulty paying bills, resilience was 15.0 points higher (95% CI: 6.9-23.1, p < 0.001) for people reporting having enough money and 14.2 points higher (95% CI: 5.9-22.4, p = 0.001) for those reporting just enough money. Interview participants' (N = 25) mean age was 32 years (range 22-44); 52% were female, 72% white. ACHD was moderate (56%) or complex (44%); 76% functional class C or D. Participants discussed factors affecting resilience aligned with each of the major SDOH, prominently, economic stability and healthcare access and quality. Financial stability may be important for supporting self-perceived resilience in ACHD. This knowledge can inform the development of resilience interventions for this population. [ABSTRACT FROM AUTHOR]

Physicians who specialize in pulmonary arterial hypertension (PAH) care for patients facing a serious, life-limiting illness. Palliative care is underutilized in patients with PAH, and little is known about how best to provide palliative care to this patient population. Using a qualitative approach, assess physicians' perspectives on barriers and facilitators to the use of palliative care in PAH. Participants were board-certified pulmonologists and cardiologists recruited from the Pulmonary Hypertension Association's list of physician specialists and academic center websites. We performed one-on-one semi-structured interviews that were recorded, transcribed, and analyzed using thematic analysis. Twelve physicians participated in the study, with a median age of 48.5 years and 20.5 years of clinical experience caring for patients with PAH. We identified the following themes and associated barriers and facilitators to effective implementation of palliative care for patients with PAH: a tailored approach to the individual patient; a PAH-specialist-led culture of care; effective collaboration with palliative care clinicians; and limitations imposed by health systems. PAH physicians are open to palliative care for their patients and are willing to partner with palliative care clinicians to implement this effectively and in the right setting. Areas for targeted improvement in enhancing palliative care for patients with PAH exist, especially enhancing collaboration between PAH physicians and palliative care specialists and navigating barriers in health systems. [ABSTRACT FROM AUTHOR]

In contrast to its prevalence in cancer care, palliative care is much less integrated into cardiovascular medicine.[14] It is unknown how palliative care may improve ACHD care, neither is it known at what point in the disease trajectory specialist palliative care is best utilized. Only 4% of the patients who died of a cardiovascular cause saw a palliative care specialist in the last month of life, which should raise concern, as it strains credulity that patients with such high resource utilization did not have unmet palliative care needs. [Extracted from the article]

Purpose: Multimorbidity is associated with increased intensity of end-of-life healthcare. This association has been examined by number but not type of conditions. Our purpose was to understand how intensity of care is influenced by multimorbidity within specific chronic conditions to provide guidance for interventions to improve end-of-life care for these patients. Methods: We identified adults cared for in a multihospital healthcare system who died between 2010–2017. We categorized patients by 4 primary chronic conditions: heart failure, pulmonary disease, renal disease, or dementia. Within each condition, we examined the effect of multimorbidity (presence of 4 or more chronic conditions) on hospital and ICU admission in the last 30 days of life, in-hospital death, and advance care planning (ACP) documentation >30 days before death. We performed logistic regression to estimate associations between multimorbidity and end-of-life care utilization, stratified by the presence or absence of ACP documentation. Results: ACP documentation >30 days before death was associated with lower odds of in-hospital death for all 4 conditions both in patients with and without multimorbidity. With the exception of patients with renal disease without multimorbidity, we observed lower odds of hospitalization and ICU admission for all patients with ACP >30 days before death. Conclusions: Patients with dementia and multimorbidity had the highest odds of high-intensity end-of-life care. For patients with dementia, heart failure, or pulmonary disease, ACP documentation >30 days before death was associated with lower likelihood of in-hospital death, hospitalization, and ICU use at end-of-life, regardless of multimorbidity. [ABSTRACT FROM AUTHOR]

Background: Maximizing quality of life and honoring care preferences are at the forefront of high-quality care for patients with adult congenital heart disease (ACHD). Palliative care (PC) and advance care planning (ACP) have accordingly gained recognition. Yet best methods for implementation are not well-defined. Prior studies indicate patients want information about prognosis, believe discussions about future care are important, and are willing to participate in such discussions. However, these discussions rarely occur prior to severe illness, and practices vary. This study explored, through qualitative methods, patients' perspectives on how PC and ACP apply in ACHD. Methods: Patients with ACHD participated in semi-structured interviews (30-60 minutes), in person or by phone. Participants were chosen via purposive sampling to achieve diversity in heart lesion severity, sex, race, and education. We asked about prior experience with PC and ACP, reasons for or against, and ideal timing. Interviews were transcribed and analyzed using a grounded theory approach. Results: We interviewed 20 patients with ACHD (ages 21 to 63, mean 38 years), of whom 55% were female, 60% identified as White/Caucasian, and all had at least a high school education. Heart lesion severity was simple in 25%, moderate in 35%, complex in 40%. Less than half reported compromised heart-related quality of life, but 70% had structured their lives around limitations and planning ahead to accommodate them. Four major themes were identified: 1) participants had minimal knowledge of PC and equated it to hospice, dying, or giving up; 2) ACP was a conceptually important part of routine care, but best timing is individualized; 3) ACP "did not apply" because patients were young and not sick enough; 4) those who saw ACP as a priority had experienced death of a friend or family member. Conclusions: Patients with ACHD expressed a general appreciation for early, routine ACP, but many did not think it applied to them yet. They equated PC to hospice and were unaware of its other features. This reveals an opportunity for education about scope and utility of these services in order to improve whole-person care for these patients. [ABSTRACT FROM AUTHOR]

1. Identify approaches for efficient team and grant management. 2. Compare and contrast team management and communication techniques. 3. Outline team member accountability and conflict management strategies The mid-career breakout session will focus on grant management and leading research teams. Three mid/senior investigators will share their multi-disciplinary perspectives about research team and grant management strategies and lessons learned. During this moderated session, the presenters will relay successes and challenges in stepping into a leadership role, maintaining an environment of inclusion and effective communication, and delegating tasks to team members. After a brief introduction by each investigator, the remainder of the session will be interactive with a discussion format. [ABSTRACT FROM AUTHOR]