Heart failure affects people of all ages and is the leading cause of death for both men and women in most racial and ethnic groups in the United States. Infections are one of the most common causes of hospitalization in heart failure, with respiratory infections as the most frequent diagnosis. Vaccinations provide the best protection against preventable respiratory infections. Despite being an easily accessible intervention, vaccines are underused in patients with heart failure. The purpose of this study was to determine rates of influenza, pneumococcal, and COVID-19 vaccination among a population of patients with heart failure (heart failure persevered ejection fraction [HFpEF], heart failure mid-range ejection fraction [HFmrEF], heart failure reduced ejection fraction [HFrEF], and heart failure unspecified ejection fraction [HFuEF]), identify patient factors associated with vaccination, and examine the association between provider type (primary care and cardiology) and vaccination status.

An observational study was conducted using data from an academic health system Heart Failure Registry from 2019 to 2022. The conceptual framework used to inform the study was the Chronic Care Model. The Heart Failure Registry contained adult patients (N=7341) with heart failure and data about their demographics, clinical and social characteristics, treatment background, and provider type. Descriptive statistics and frequencies were used to characterize the sample on all analytic variables. Chi square tests were used to compare sample differences by patient and provider factors and vaccination status. Multiple logistic regression models were estimated to examine the odds of vaccination among patients while adjusting for covariates.

Vaccination rates varied between influenza, pneumococcal, and COVID-19 vaccines. Of the three respiratory vaccines, 54.5% of patients had received an influenza vaccine, 74.7% had received a pneumococcal vaccine, and 81.3% had received a COVID-19 vaccine. Patients with preserved and mid-range heart failure had the highest vaccination levels in all three vaccine groups, while patients with reduced and unspecified heart failure had the lowest odds. Patients with a primary care provider, 65 years and older, Hispanic compared to White, accountable care organization member, or had managed care compared to commercial insurance, had higher odds of receiving all three vaccines. There is a need for individual providers and health systems to develop strategies to overcome heart failure vaccine disparities.

Background: Early mobility and ambulation of the extracorporeal membrane oxygenation (ECMO) patients has shown to decrease mechanical ventilation time, delirium, Intensive Care Unit (ICU) length of stay, and improve physical functioning. However, few ECMO centers use a protocol to guide mobilization and ambulation practices. Objectives: To improve the current practice in ambulating ECMO patients by examining the feasibility of an evidence-based ambulation protocol (AAP4ECMO; Adult Ambulation Protocol for ECMO) compared to historic controls on patient safety, number of ambulation sessions, time standing, ambulation time, and distance. Methods: Implementation of the protocol in a 24 bed ICU to determine the feasibility and safety in ECMO patients ≥ 18 years of age and compared to an age and gender-matched historical control group who ambulated without the protocol. Demographic and clinical outcome data were collected prospectively in the protocol group and retrospective chart review for the control group (safety events, ambulation outcome measures). Results: From January to March 2021, 13 (28%) ECMO patients utilized the developed AAP4ECMO protocol compared to 35 (10% 2019; 15% 2020) historic controls who ambulated without the protocol. There were no statistical differences in all ambulation measures with minimal adverse events. Conclusion: The AAP4ECMO protocol is feasible and safe to use in V-A and V-V ECMO patients deemed ready for ambulation. Despite an increased number of ambulation sessions in the protocol group, further prospective evaluation of the protocol is needed in a larger sample to verify findings and patient outcomes.

Background: Although many atherosclerotic cardiovascular disease (ASCVD) risk factors are well established, less is known about a woman’s cardiovascular response to pregnancy, which appears to be an early marker of future maternal CVD risk. Adverse pregnancy outcomes (APO) including spontaneous preterm delivery (sPTD) has been associated with up to a three-fold increased risk of maternal ASCVD later in life. However, little is known about the association between changes in vascular function associated with APOs and future maternal CVD risk.

Methods: We completed a case controlled, matched study, “Is Spontaneous Preterm Delivery Associated with Clustering of Future Maternal Cardiovascular Risk MarkErs?” (SPACE) enrolled 20 women with sPTD (gestation ≤34 weeks) and 20 control women (gestation ≥39 weeks) matched for age (�5 years), parity, race/ethnicity and route of delivery collected between 24-72 hours postpartum. Vascular function was measured by augmentation index corrected for heart rate 75 bpm (AIx75), central pulse pressure (CPP), and pulse wave velocity (PWV). Linear regression models were used to analyze the data.

Results: The mean age at enrollment for sPTD and controls was 33 � 6 years and 32 � 6 years respectively. Women with sPTD had significantly lower AIx75 compared to controls (24.10 � 16.10 % vs 39.90 � 15.2 %, p=0.001), respectively. In addition, CPP was significantly lower in sPTD compared to controls (29.1�5 mmHg vs. 34.6 �6 mmHg, respectively, p=0.004). Furthermore, women with sPTD and chorioamnionitis both clinically and/or on pathology report (n=8) had significantly lower AIx75 than matched controls (13.5 �13.7% vs 39.9 � 15.2% vs, p=0.001) respectively, while women with sPTD and no signs or symptoms of chorioamnionitis had a trend toward lower AIx75 than matched controls (26.6� 15.9 % vs. 39.9 � 15.2 %, p=0.065). There was no difference between sPTD and controls in PWV (5.12 � 1.62 m/s vs 5.58 � 1.51m/s, p=0.1219), respectively.

Objectives: Our objectives were to understand the patterns of cognitive and depressive change during and following a hospital admission for Acute Decompensated heart failure (ADHF) and to examine the relationship of clinical variables related to cognition over time and 30 day readmissions.

Methods: After hospital admission to a medical-surgical floor, within seven days following hospital, and after 30 days following hospital discharge, 40 patients admitted for ADHF (mean [SD] age = 73.8 [11.3] years; 72% male) completed the Montreal Cognitive Assessment (MoCA), Trail Making A & B, the Patient Health Questionnaire (PHQ)-9, and the Brief Symptom Inventory – Anxiety (BSI-A). The Medical Outcomes Study Social Support Survey (MOS-SSS) and the Self-Care Heart Failure Index (SCHFI) was completed in the hospital. Cognitive and depressive symptoms were evaluated using repeated-measures analysis of variance. Demographic and clinical variables associated with trends of cognitive and depressive symptoms were described with Kendall’s Tau correlations. Linear regressions were performed to determine if change in fluid volume status measurements were related to change of MoCA scores, controlling for demographical and clinical variables. Separate linear regressions were performed to determine if variables in the hospital were related to MoCA scores in the hospital, MoCA scores at 30 days post discharge, and the occurrence of 30 day readmissions.

Results: Neither global MoCA or TMT scores improved from hospital to 30 days post discharge. Improvement in the MoCA sub domain Visuospatial/ Executive function and depressive symptoms from hospital discharge to 30 days were observed. Four groups of MoCA change and three groups of depressive symptom change were found and associated with varied clinical and demographic variables. In multivariate analysis, only changes in weight (p=.001), HJR (p=.036), not clinical and demographical variables, were related to change of MoCA score. In multivariate analysis, only hospital variables CCI (p=.014) and anxiety (p=.005) were related to MoCA in the hospital; in a separate analysis only CCI (p=.05) remained related to MoCA post 30 days of discharge. In a fourth multivariate analysis, only CCI (p=.083) trended in association with 30 day readmission.

Conclusions: Executive function and depressive symptoms improve from hospitalization to 30 days after for ADHF. Higher anxiety symptoms and comorbidities are independently associated with worse cognition in the hospital. Findings suggest that when HF patients are in fluid overload, their cognition is worse. Clinicians should assess the patient’s cognitive, anxiety and depressive state in the hospital prior to teaching the patient as learning abilities are likely compromised. Further research is needed to explore these relationships and ultimately, to test interventions that may help HF patients with CI avoid unnecessary admissions.

Background: Effective utilization of resources and attention to a healthy work environment are at the forefront of nursing leadership agendas. The practice of telemetry stewardship supports a healing environment for patients and reduces alarm burden on staff. The literature is replete with studies in medical units regarding reduction of alarm burden using telemetry stewardship. However, there are no existing, prospective studies addressing the impact of telemetry utilization on alarms in surgical units. Objectives: This quality improvement (QI) project applied the best available evidence and provider preference to encourage telemetry stewardship and identified the associated impacts of appropriate telemetry monitoring on patients and staff. The unintended consequences of overuse of electrocardiographic (ECG) monitoring in the project unit included interruptions to care and alarm fatigue for patients and staff. Methods: A nurse-led interdisciplinary evidence-based QI project based on the 2017 American Heart Association (AHA) revised practice standards (Sandau et al., 2017) was implemented over ten weeks in a surgical unit in an academic medical center. Pre and post educational intervention aggregate data was obtained from the electronic health record (EHR) and standard reports. Perception of alarm fatigue and baseline adoption of standard practices were obtained using a nationally recognized survey. Results: The percentage of patients on the monitor did not change in response to the intervention (p = .12), and there was no significant reduction in alarms per patient per day

(p = .07). Results of the perception of alarm fatigue survey, while not clinically significant (p = .56), provided a baseline for the scholarly project and future QI projects. There was no increase in adverse patient events during the project. Conclusion: A nurse led interdisciplinary strategy using the AHA revised practice standards can be safely applied to a complex surgical population to create a common platform to address the burden of inappropriate telemetry monitoring on patients and staff.

Background: Family caregivers are the cornerstone of support for our nation's wounded. While caregiver burden has been studied extensively in caregivers of patients with dementia, stroke, and cancer, little is known about the burden of caregiving in the context of service-related injuries like traumatic brain injury(TBI) and Post Traumatic Stress Disorder (PTSD). Studies have shown that depression, anxiety, and caregiver strain are associated with lifestyle risk factors for coronary heart disease (CHD).

Purpose: The purpose of this descriptive study was to examine the effects of caregiving on cardiovascular health in mothers and wives caring for veterans with invisible wounds of war.

Methods: The study utilized a sequential, exploratory, mixed method design with convergent results. Participants completed an online survey. Analysis included descriptive and correlational statistics. The qualitative interviews used a semi-structured interview guide that explored the daily experience of the caregiver and facilitators and inhibitors to heart health self-care. The interviews were transcribed and coded and content analysis was conducted.

Results: Caregivers reported spending the greatest amount of time providing emotional support for the veteran and managing behavioral problems. Neurobehavioral symptoms most frequently reported by caregiver as being severe included forgetfulness and anxiousness. Many caregivers demonstrated anxiety that would be classified as needing further evaluation and depressive symptoms consistent with major depression. Overall, poorer heart health was correlated with higher scores for depressive symptoms and perceived stress. Thematic content analysis was used to identify seven major themes: (1) Neurobehavioral Symptoms: Managing the Unpredictable; (2) Home as the Safe Place; (3) VA Healthcare System: Fighting to Navigate a Complex System (4) Self-Care: Finding Time to Care for Self; (5) Caregiver Peers: Creating a New Community (6) Post Traumatic Growth: Learning to Become a PTSD Expert; (7) Motivation: Sacrificial, Unconditional Love

Conclusions: Results of this study will be used to design a health promotion intervention for caregivers utilizing principles of community based participatory research and trauma informed care.

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Hookah (water pipe) smoking is a major new understudied epidemic of tobacco abuse particularly affecting youth. Hookah’s rapidly growing popularity is due to unregulated expansion of hookah cafes near college campuses and social media marketing to young adults as a safer avant-garde alternative to cigarettes. What distinguishes hookah from all other tobacco products is that burning charcoal is used to heat the tobacco. As a result, hookah smoke delivers a large exposure not only to carbon monoxide (CO), but also to carbon-rich nanoparticles that constitute putative vasoconstrictor stimuli. To determine if hookah smoking acutely impairs endothelial and vascular function, in 23 healthy young adult hookah smokers who do not smoke cigarettes (age 25?5 years, mean?SD; 6 women, 17 men; BMI 23.6?2.3 kg?m2), we measured conduit vessel endothelium-dependent flow-mediated dilation (FMD) by high-resolution ultrasound as well as exhaled CO and plasma nicotine before and immediately after 30 minutes of ad lib hookah smoking in a custom-built smoking chamber. Additionally, we measured micro-vessel endothelial function by way of reactive hyperemia peripheral arterial tonometry (EndoPAT) and central arterial stiffness by carotid-femoral pulse wave velocity (cfPWV). With hookah smoking, exhaled CO increased from 3.5?0.4 to 27?2.4 ppm (mean ?SE, p<0.001 pre-vs. post-hookah), which approximates the CO boost of a typical ad lib hookah smoking session in hookah bars and indicates an exposure to fine and ultrafine particles that is 10 times greater (and to total particles that is 250 times greater) than that with cigarette smoking. The increased heart rate and blood pressure (Δ heart rate +14?2, P<0.001; Δ mean arterial pressure +5?1, P<0.001) were accompanied by increased plasma nicotine (0.6?0.1 to 6.4?1.2 ng/mL, p<0.001). On ultrasound and in contrast to our hypothesis, brachial artery FMD did not decrease with hookah smoking but, surprisingly, increased from 6.9?0.5% to 9.7?0.6%, P<0.001: a 49.6?9.3% relative increase while micro-vessel endothelial function did not change: EndoPAT index 2.08?0.14 to 1.99?0.12, P=0.633). Moreover, cfPWV increased significantly (7.47?0.20 to 8.04?0.22, P<0.001) suggesting central arterial stiffness. Further studies are indicated to elucidate the major underlying mechanisms underpinning the augmented flow-mediated dilation and central arterial stiffness.

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