Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience.

PURPOSE: The coronavirus-2019 (COVID-19) infection is associated with a high risk of complications and death among heart transplant recipients. However, most cohorts are from high-income countries, while data from Latin America are sparse. METHODS: This is a retrospective cohort of heart transplant recipients followed at a hospital in Rio Grande do Sul, Brazil, between March 1st 2020 and October 1st 2021. RESULTS: Of the 62 heart transplant recipients on follow-up, 21 (34%) were infected by COVID-19, 58 (36-63) years of age, 67% male, body mass index of 26 (23-29) kg/m2, 48% with hypertension, 43% with chronic kidney disease, 5% with diabetes, within 2 (1-4) years of post-transplant follow-up. At presentation, the main symptoms were fever (62%), myalgia (33%), cough (33%), headache (33%), and dyspnea (19%). Hospitalization was required for 13 (62%) patients, with a time from first symptoms to the admission of 5 (1-12) days. In 38%, supplementary oxygen was needed, 19% required intensive care, and 10% mechanical ventilation. Three (14%) were infected after at least a first dose of COVID-19 vaccine. The main complications were bacterial pneumonia (38%), renal replacement therapy (19%), sepsis (10%) and venous thromboembolism (10%). Immunosuppression therapy was modified in 48%, with a reduction in the majority (89%). Two (10%) patients died in the hospital due to refractory hypoxemia and multiple organ dysfunction. The incidence of COVID-19 among transplant patients was comparable to the general population in the State of Rio Grande do Sul with a peak in December 2020. CONCLUSION: Heart transplant recipients shown a high rate of COVID-19 infection in Southern Brazil, with typical symptom presentation in most cases. There was an elevated rate of hospitalization, supplementary oxygen support, and complications. In-hospital lethality among infected heart transplanted recipients was similar to previously reported data worldwide despite the high rates of infection in Latin America.

Comparison of quality of life between patients on the waiting list and heart transplant recipients. / Comparação da qualidade de vida entre pacientes em lista de espera e pacientes submetidos a transplante cardíaco.

OBJECTIVES: To compare the quality of life (QOL) between wait-listed patients and heart transplant recipients. METHODS: Cross-sectional study of 56 adult patients at two institutions in Southern Brazil, 9(16%) wait-listed patients and 47(84%) transplant recipients. Data were collected from August to December 2012. QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), with scores ranging from zero to 100. RESULTS: There was statistically significant difference between the two groups in the overall QOL score (p=0.010) and in four dimensions. The mean rank was 16.9 in wait-listed patients and 30.7 in transplant recipients. Wait-listed patients presented the lowest for general health (9.1) and the highest scores for role-emotional (24.8). Transplant recipients obtained the highest scores for general health (32.2) and the lowest scores for bodily pain (29.1). CONCLUSIONS: Undergoing a transplant has a positive impact on the QOL of recipients compared to that of patients awaiting transplantation.

Applicability of nursing outcomes in patients with heart failure and fluid volume excessive. / Aplicabilidade dos resultados de enfermagem em pacientes com insuficiência cardíaca e volume de líquidos excessivo.

OBJECTIVE: The purpose of this study was to test the clinical applicability of the Nursing Outcomes Classification in patients with decompensated heart failure and the nursing diagnosis of fluid volume excess. METHODS: This is a longitudinal study conducted in two stages at a university hospital, in 2013. During the first stage the consensus of experts was used to select the nursing outcomes and the indicators related to diagnosing fluid volume excess. The longitudinal study was conducted in the second stage to clinically evaluate the patients using the instrument containing the results and indicators produced in the consensus. RESULTS: A total of 17 patients were assessed. The nursing outcomes were measured during the clinical evaluation by analysing their indicators. The scores increased in six of the results, in comparison with the average results of the first and last assessment. The Nursing Outcomes Classification during medical practice revealed a clinical improvement among the patient who were admitted following decompensated heart failure. CONCLUSION: The Nursing Outcomes Classification managed to detect changes in the clinical status of patients.

Aplicabilidade dos resultados de enfermagem em pacientes com insuficiência cardíaca e volume de líquidos excessivo / Aplicabilidad de los resultados de enfermería en pacientes con insuficiencia cardíaca y exceso de volumen de líquidos / Applicability of nursing outcomes in patients with heart failure and fluid volume excessive

RESUMO Objetivo Testar a aplicabilidade clínica da Nursing Outcomes Classification em pacientes com insuficiência cardíaca descompensada e Diagnóstico de Enfermagem Volume de Líquidos Excessivo. Métodos Estudo longitudinal conduzido em duas etapas em um hospital universitário no ano de 2013. Na primeira etapa, utilizou-se a validação por consenso de especialistas para selecionar os resultados de enfermagem e os indicadores relacionados ao diagnóstico de enfermagem; na segunda, foi realizado um estudo longitudinal para avaliação clínica dos pacientes, utilizando-se o instrumento contendo os resultados e indicadores produzidos no consenso. Resultados Foram realizadas avaliações em 17 pacientes. Na avaliação clínica, mensuraram-se os resultados de enfermagem através da avaliação de seus indicadores. Seis resultados apresentaram aumento nos escores, quando comparados às médias da primeira e da última avaliação. A utilização da Nursing Outcomes Classification na prática clínica demonstrou melhora dos pacientes internados por insuficiência cardíaca descompensada. Conclusão A Nursing Outcomes Classification foi sensível às alterações no quadro clínico dos pacientes.

RESUMEN Objetivo Testar la aplicabilidad clínica de la Nursing Outcomes Classification en pacientes con insuficiencia cardíaca descompensada y Diagnóstico de Enfermería Volumen de Líquidos Excesivo. Método Estudio longitudinal, realizado en dos etapas, en un hospital universitario, en 2013. En la primera etapa se utilizó la validación por consenso de especialistas para seleccionar los resultados de enfermería y los indicadores relaciones al diagnóstico de enfermería; en la segunda fue realizado un estudio longitudinal para evaluación clínica de los pacientes, utilizándose el instrumento que contiene los resultados y los indicadores producto del consenso. Resultados Fueron realizadas evaluaciones en 17 pacientes. Durante la evaluación clínica se midieron los resultados de enfermería a través de la evaluación de sus indicadores. Seis resultados mostraron un aumento en las puntuaciones, cuando se comparó las medias de los resultados de la primera y última evaluación. La utilización de la Nursing Outcomes Classification en la práctica clínica fue capaz de demostrar mejoría clínica de los pacientes internados por insuficiencia cardíaca descompensada. Conclusión La Clasificación de Resultados de Enfermería fue sensible a las alteraciones en el cuadro clínicos de los pacientes.

ABSTRACT Objective The purpose of this study was to test the clinical applicability of the Nursing Outcomes Classification in patients with decompensated heart failure and the nursing diagnosis of fluid volume excess. Methods This is a longitudinal study conducted in two stages at a university hospital, in 2013. During the first stage the consensus of experts was used to select the nursing outcomes and the indicators related to diagnosing fluid volume excess. The longitudinal study was conducted in the second stage to clinically evaluate the patients using the instrument containing the results and indicators produced in the consensus. Results A total of 17 patients were assessed. The nursing outcomes were measured during the clinical evaluation by analysing their indicators. The scores increased in six of the results, in comparison with the average results of the first and last assessment. The Nursing Outcomes Classification during medical practice revealed a clinical improvement among the patient who were admitted following decompensated heart failure. Conclusion The Nursing Outcomes Classification managed to detect changes in the clinical status of patients.

Comparação da qualidade de vida entre pacientes em lista de espera e pacientes submetidos a transplante cardíaco / Comparación de la calidad de vida entre pacientes en lista de espera y pacientes sometidos a trasplante cardíaco / Comparison of quality of life between patients on the waiting list and heart transplant recipients

RESUMO Objetivos Comparar a qualidade de vida (QV) entre pacientes em lista de espera e pacientes submetidos a transplante cardíaco. Métodos Estudo transversal conduzido com 56 pacientes adultos em duas instituições de referência no sul do Brasil, 9(16%) em lista de espera e 47(84%) transplantados. A coleta de dados ocorreu entre agosto e dezembro de 2012. Utilizou-se o Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), com escores variando de zero a 100. Resultados Houve diferença estatística no escore geral da QV entre os grupos (p=0,010) e em quatro domínios. A média das ordenações (mean rank) foi igual a 16,9 nos pacientes em lista de espera e 30,7 nos pacientes transplantados. Pacientes em lista de espera tiveram o menor escore no estado geral de saúde (9,1) e maior escore nos aspectos emocionais (24,8); pacientes transplantados apresentaram maior pontuação no estado geral de saúde e pior pontuação na dor (29,1). Conclusões A realização de transplante impacta positivamente na QV dos pacientes, quando comparada à CV daqueles em lista de espera.

RESUMEN Objetivo Comparar la calidad de vida (CV) entre pacientes en lista de espera y pacientes sometidos a trasplante cardíaco. Método Estudio transversal, realizado con 56 pacientes adultos en las dos instituciones más importantes en el sur de Brasil, 9(16%) en lista de espera y 47(84%) sometidos a trasplante de corazón. Los datos fueron recogidos entre agosto y diciembre de 2012. Se utilizó el Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), con puntuaciones que van de cero a 100. Resultados Hubo diferencia estadísticamente significativa en la puntuación global de QV entre los grupos (p=0.010) y en cuatro dominios. El promedio de las ordenaciones (mean rank) fue igual a 16,9 en pacientes en lista de espera y 30,7 en pacientes con trasplante. Los pacientes en lista de espera tuvieron la puntuación más baja en la salud general (9.1) y la puntuación más alta en los aspectos emocionales (24.8); pacientes con trasplante mostraron puntuaciones más altas en el estado general de salud y la peor puntuación en el dolor (29.1). Conclusión El trasplante cardíaco provoca impacto importante en el aumento de la QV en comparación con pacientes en lista de espera.

ABSTRACT Objectives To compare the quality of life (QOL) between wait-listed patients and heart transplant recipients. Methods Cross-sectional study of 56 adult patients at two institutions in Southern Brazil, 9(16%) wait-listed patients and 47(84%) transplant recipients. Data were collected from August to December 2012. QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), with scores ranging from zero to 100. Results There was statistically significant difference between the two groups in the overall QOL score (p=0.010) and in four dimensions. The mean rank was 16.9 in wait-listed patients and 30.7 in transplant recipients. Wait-listed patients presented the lowest for general health (9.1) and the highest scores for role-emotional (24.8). Transplant recipients obtained the highest scores for general health (32.2) and the lowest scores for bodily pain (29.1). Conclusions Undergoing a transplant has a positive impact on the QOL of recipients compared to that of patients awaiting transplantation.

Effect of a diuretic adjustment algorithm and nonpharmacologic management in patients with heart failure: study protocol for a randomized controlled trial.

BACKGROUND: One of the challenges in treating patients with heart failure (HF) is achieving clinical stability and reducing the hospital readmission rate. A diuretic dose adjustment algorithm developed in the United States (Diuretic Treatment Algorithm, DTA) and later validated for use in Brazil (as the Algoritmo de Ajuste de Diurético, AAD) has proved feasible and readily applicable, but its effect on clinical outcomes has yet to be assessed. This report aims to describe a randomized clinical trial protocol designed to assess the effectiveness of the AAD and of nonpharmacologic management in improving clinical stability and reducing the readmission rate at 90 days in patients with HF. METHODS/DESIGN: A PROBE (prospective randomized open blinded endpoint) parallel-group design will be used. Adult patients with a diagnosis of reduced ejection fraction HF, who are being treated at a specialized HF clinic are being recruited. Those with indications for loop diuretic dose adjustment during routine clinic visits will be randomized to take part in the trial. Participants in the intervention group (IG) shall have their diuretic doses adjusted in accordance with the AAD and receive four telephone calls (one per week) over 30 days to reinforce guidance on nonpharmacological management (fluid and sodium restriction). Participants in the control group (CG) shall have their diuretic doses adjusted by a physician during the first trial visit and shall not receive any telephone calls. Patients in both groups shall return at 1 month for face-to-face reassessment. The study endpoints shall comprise readmission and/or emergency department visits due to HF decompensation within 90 days and clinical instability. All participants shall be required to have a scale at home (or easy access to one), a telephone number, agree to telephone-based follow-up, and be available to return for a 1-month trial visit. Overall, 135 patients are expected to be enrolled in each group. DISCUSSION: This trial shall assess the effectiveness of the AAD algorithm and non-pharmacologic management by early identification of clinical deterioration and establishment of a combined intervention to reduce emergency department visits, readmission rate, or a composite endpoint thereof. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier, NCT02068937 (23 February 2014).