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Abstract Aims A cardiopulmonary exercise (CPX) test is considered the gold standard in evaluating maximal oxygen uptake. This study aimed to evaluate the predictive validity of equations provided by Burr et al., Ross et al., Adedoyin et al., and Cahalin et al. in predicting peak VO2 from 6 min walk test (6MWT) distance in patients with heart failure (HF). Methods and Results New York Heart Association Class I–III HF patients performed a maximal effort CPX test and two 6MWTs. Correlations between CPX VO2 peak and the predicted VO2 peak, coefficient of determination (R2), and mean absolute percentage error (MAPE) scores were calculated. P‐values were set at 0.05. A total of 106 participants aged 62.5 ± 11.5 years completed the tests. The mean VO2 peak from CPX testing was 16.4 ± 3.9 mL/kg/min, and the mean 6MWT distance was 419.2 ± 93.0 m. The predicted mean VO2 peak (mL/kg/min) by Burr et al., Ross et al., Adedoyin et al., and Cahalin et al. was 22.8 ± 8.8, 14.6 ± 2.1, 8.30 ± 1.4, and 16.6 ± 2.8. A significant correlation was observed between the CPX test VO2 peak and predicted values. The mean difference (0.1 mL/kg/min), R2 (0.97), and MAPE (0.14) values suggest that the Cahalin et al. equation provided the best predictive validity. Conclusions The equation provided by Cahalin et al. is simple and has a strong predictive validity, and researchers may use the equation to predict mean VO2 peak in patients with HF. Based on our observation, equations to predict individual maximal oxygen uptake should be used cautiously.

Background: Guideline-directed medical therapy (GDMT) reduces mortality and hospitalizations in adults with heart failure with reduced ejection fraction (HFrEF); however, few are receiving GDMT. National registries show as few as 1% of patients are receiving appropriate GDMT. Development of heart failure clinics achieving optimal GDMT are crucial to improve outcomes for HFrEF patients., Objective: We developed a multidisciplinary HF-Optimize clinic aimed at improving GDMT use along with providing education, resources, and comorbidity screening for adults with HFrEF., Methods: We targeted patients with newly diagnosed HFrEF and/or recent or multiple admissions for 6 visits over 12 weeks. We measured medication use, ejection fraction, 6-minute walk test distance, and health-related quality of life (EuroQol Visual Analog Scale) at visits 1 and 6., Results: One-hundred ten patients completed all visits. Patients were a mean age of 58 (±14) years, 37% were female, and 42% were of non-White race. From visit 1 to visit 6, utilization of GDMT increased from 35.5% to 85.5% (p < 0.001) and significant improvements in ejection fraction (25.9% to 35.5%, p < 0.001), 6-minute walk distance (1032 feet to 1121.7 feet, p = 0.001), and quality of life (63.8/100 vs 70.8/100, p = 0.002). Only 2 patients (1.8%) that completed HF-Optimize had a 30-day heart failure readmission., Conclusion: Our multidisciplinary HF-Optimize clinic improved medication usage and clinical outcomes. Further studies are needed to validate outcomes of multidisciplinary GDMT clinics., Competing Interests: Declaration of Competing Interest No authors have conflicts of interest to disclose for our article, The Role of a Multidisciplinary Heart Failure Clinic in Optimization of Guideline-Directed Medical Therapy: HF-Optimize, (Copyright © 2022 Elsevier Inc. All rights reserved.)

Competing Interests: The authors have no funding or conflicts of interest to disclose.

Multiple chronic conditions (MCC) are becoming increasingly common and self-management (SM) interventions to address MCC are emerging. Prior reviews have broadly examined SM interventions in MCC; however, interventional components were not thoroughly described. Components of SM interventions that have been delivered to individuals with MCC were identified. A review of CINAHL, Cochrane, PubMed, PsycINFO, Scopus, and Embase was completed. This search yielded 13,994 potential studies; 31 studies among those 13,994 studies met inclusion for analysis. The literature is multidisciplinary and describes a wide variety of interventional strategies implementing various combinations of components. A descriptive analysis of the studies' components, application of the components, delivery methods, and primary outcomes demonstrated clear variations between programs. The most common components noted in the 31 studies were education, action planning/goal setting, self-monitoring, and social/peer support. The variation in SM programs limits conclusive evidence for which components are recommended to improve self-management in individuals with MCC.

Background: Regular exercise is associated with numerous benefits; yet up to 91% of patients with heart failure (HF) do not exercise regularly. This study explored factors supporting long-term exercise adherence in patients with HF., Design: This study was a qualitative multiple-case study., Methods: Data were collected via semi-structured interviews from patients with HF at completion of an 18-month exercise intervention in a health care exercise facility and analyzed using a directed content analysis approach., Results: Participants (n=22) identified perceived health status, scheduling/making exercise part of a routine, social support from coaches and family, knowledge about exercise, and motivation/perseverance as supports for long-term exercise adherence., Conclusions: Perceived health status may be key when promoting exercise adherence in this population. Knowledge, social support from coaches and family members, and motivation should be considered for long-term exercise adherence., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The number of individuals with advanced heart failure (HF) receiving left ventricular assist devices (LVADs) is growing. Postimplantation LVAD recipients return home to both rural and urban locations. The impact of rural or urban living on postimplantation outcomes has not been adequately explored., Objective: This cohort study examined adverse event-free survival, hospitalization-free survival, and all-cause mortality between rural and urban LVAD recipients in the first 2 years after implantation., Methods: Data from LVAD recipients (N = 141) implanted at a single center in the northeastern United States were analyzed. Recipients of LVAD were designated as rural or urban by county of residence. Adverse events, hospitalizations, and survival time were examined using multivariate Cox proportional hazards models., Results: Thirty-seven percent of LVAD recipients in the cohort were rural. Two-thirds of all LVAD recipients experienced at least 1 adverse event (96/141, 68.1%). Although more urban recipients experienced adverse events, including death, rural versus urban models of both adverse events and survival were nonsignificant (adverse events: log-rank = 1.18, P = .28; hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.57-1.63; P = .89; survival: log-rank =2.81, P = .09; HR, 0.45; 95% CI, 0.17-1.23; P = .12). Rural LVAD recipients experienced significantly more hospitalizations and shorter hospitalization-free survival (log-rank = 6.67, P = .009). However, the HR for survival was nonsignificant (HR, 1.5; 95% CI, 0.94-2.39; P = .08)., Conclusions: Frequent adverse events and hospitalizations are of ongoing concern for LVAD recipients. More data are necessary to understand why urban LVAD recipients may experience shorter survival time compared with rural counterparts. Hospitalization may serve as a protective factor for rural LVAD recipients.

Background: Family caregivers (FCGs) often participate in the decision for their loved one to receive a left ventricular assist device (LVAD). Little is known about the contribution of FCGs to this complex decision., Objectives: To investigate family caregiver-reported outcomes related to decision-making for LVAD implantation and their experiences post-implantation., Methods: Descriptive thematic analysis was used to analyze longitudinal data. Thematic saturation was achieved., Results: Three key themes emerged from the data. The main theme in the pre-implantation period was: Not a decision. The two themes in the post-implantation period were: More satisfaction than regret and Unanticipated situational change., Conclusions: Family caregiver-reported outcomes inform clinical practice and future research. FCGs of LVAD recipients did not see viable alternatives to LVAD implantation, were generally satisfied with post-implantation outcomes, and experienced unexpected life changes in the post-implantation period despite feeling prepared preoperatively. Education of both LVAD recipients and their FCGs must be optimized., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: This study examined life descriptions of persons with stage D heart failure (HF) comparing those newly diagnosed to those with chronic HF., Methods: A secondary analysis of interviews from 75 participants followed in a longitudinal study of persons with stage D HF was thematically analyzed. There were 24 participants who were recently diagnosed with stage D HF (less than 2 years) and 51 participants with HF longer than 2 years., Results: Both groups shared life descriptions along a continuum, where recently diagnosed participants described naive expectations with hope for improvement, while the chronic group appeared resigned to their fate and the reality of the limitations of living with HF. Four themes illustrated differences between the groups: outlook on life, activity adjustments, understanding of HF, and mood., Conclusions: Although persons with stage D HF share the same life descriptions, they have differing perspectives of life with HF. Findings from this study can help health-care providers tailor interventions based on the length of time from diagnosis., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To assess perceptions of illness severity and terminality in caregivers of advanced heart failure (HF) patients and how these perceptions influence utilization of palliative care and end-of life services., Background: HF is a terminal disease; yet patients and caregivers do not understand the severity of HF or acknowledge disease terminality., Methods: This study was conducted using a qualitative design with in-depth interviews and content analysis., Results: Most caregivers did not understand the severity of HF (68%) or disease terminality (67%). Patients were more likely to receive services when their caregivers expressed an understanding of illness severity and/or terminality., Conclusions: Inclusion of caregivers in discussions of goals of care, advance care planning, and palliative care and end-of-life services with patients and providers is imperative., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: To examine patients' pre-implantation decision-making and pre and post-implantation expectations of left ventricular assist devices (LVADs)., Background: LVADs have been shown to improve both quantity and quality of life of patients living with Stage D heart failure (HF). However, they also pose significant risks., Methods: 15 LVAD participants followed in a longitudinal study of Stage D HF patients were included in this thematic analysis., Results: Three themes were identified: no choice; I thought I would be doing better; I feel good, but now what. Evidence from pre-implantation to post-implantation suggested that patients' perceived expectations of quality of life improvement were not met., Conclusions: In light of their declining health, most patients felt their only alternative to implantation was death. In the post-implantation period, patients expected greater improvements in their quality of life. Evidence based guidelines for discussions of goals of care, post-implant expectations, and palliative care are necessary., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The number of patients with heart failure is growing; the associated morbidity and mortality remains dismal. Advance care planning, end-of-life conversations, and palliative care referrals are appropriate, but do not occur regularly. Palliative care focuses on patients and families from diagnosis, to hospice, death, and bereavement. It is delivered as basic palliative care by all providers and by specialty-certified palliative care specialists. Nurses are well-positioned to provide basic. Nurses are also instrumental in initiating referrals to the specialized palliative care team as the patient's needs become too complex or the disease progresses and the patient approaches the end of life., (Copyright © 2015 Elsevier Inc. All rights reserved.)