Background: Exercise is a class 1A recommendation to improve the lives of patients with heart failure, yet less than one-third adhere to physical activity guidelines, and less than 3% attend cardiac rehabilitation. Objective: The aim of this study was to determine the effect of gentle nonaerobic exercise on initial and long-term adherence in patients with heart failure. Methods: We used a qualitative descriptive approach with qualitative content analysis to analyze previously recorded interview data collected as part of the 6-month GEtting iNTo Light Exercise-Heart Failure study and looked for trends in responses among our sample. Thematic statements, representing salient aspects of the participants' experiences, were created and supported by illustrative excerpts from the data. Results: Twenty-two interviews were analyzed. Eight participants had >= 80% adherence, and the remaining 14 participants were super-adherers (>100% adherence). Super-adherers tended to be male and 65 years or older, and have no exercise for 3 months before the study, a body mass index >= 30, and poor to good Kansas City Cardiomyopathy Questionnaire scores. Participants initially enrolled because they saw the program as an opportunity to improve a health issue and to exercise. Long-term adherence was facilitated by convenience, individualization, experiencing psychological and physical improvements, and peer fellowship. Conclusions: The GEtting iNTo Light Exercise-Heart Failure study that used home-based gentle nonaerobic exercise had 64% of participants come more than was asked. It is imperative that clinicians incorporate what participants with heart failure have directly stated is important for their initiation and long-term adherence to exercise so that we can work toward bridging sedentary patients to the full exercise guidelines to reduce morbidity and mortality.

Consultation-liaison (CL) psychology is a subspecialty of clinical health psychology primarily focused on providing both consultation and liaison services in the medical inpatient setting to benefit patients, families, and/or healthcare providers. The goals of this paper are threefold. The first is to educate clinicians about the scope and functions of traditional CL psychology services. The second is to identify contemporary areas of growth and development in CL psychology services. The third is to discuss practical recommendations and lessons we have learned throughout the process of establishing and sustaining CL psychology services at our organization. Additionally, we discuss the future of CL psychology particularly with regard to the dearth of CL psychology research.

BACKGROUND:Patients with heart failure (HF) who engage in effective HF self-care have better quality of life, and lower risks of all-cause and HF-related hospital readmission and mortality. It is unclear whether social isolation and loneliness, which are prevalent among patients with HF and known to affect other self-care behaviors, can predict HF self-care. OBJECTIVE:The aim was to explore the relationship between social isolation, loneliness, and HF self-care. METHODS:This was a cross-sectional secondary analysis (n = 49) of the GEtting iNTo Light Exercise for HF randomized controlled trial, a 6-month home-based live group gentle exercise intervention for patients with HF. Measures included the following: 6-item Lubben Social Network Scale for social isolation, Patient-Reported Outcomes Measurement Information System Social Isolation survey for loneliness, Self-Care of Heart Failure Index, and Patient-Reported Outcomes Measurement Information System Depression survey. Multiple linear regression modeling was used to examine the relationships of 4 HF self-care processes to social isolation and loneliness, adjusting for depression and grouping (control group or intervention group). RESULTS:Scores indicating less social isolation predicted higher self-care maintenance ( B = 0.937, P = .015), monitoring ( B = 0.799, P = .041), and management ( B = 1.812, P < .001). Loneliness did not predict HF self-care. CONCLUSIONS:To our knowledge, this is the first study to predict HF self-care using distinct measures for social isolation and loneliness. Patients who were less socially isolated engaged in better HF self-care; loneliness had no relationship with HF self-care. Prospective studies are needed to investigate causal relationships between social isolation and HF-self-care engagement to determine the effect on outcomes such as hospital readmission and mortality.

Background Exercise is a class 1A recommendation to improve the lives of patients with heart failure, yet less than one-third adhere to physical activity guidelines, and less than 3% attend cardiac rehabilitation. Objective The aim of this study was to determine the effect of gentle nonaerobic exercise on initial and long-term adherence in patients with heart failure. Methods We used a qualitative descriptive approach with qualitative content analysis to analyze previously recorded interview data collected as part of the 6-month GEtting iNTo Light Exercise–Heart Failure study and looked for trends in responses among our sample. Thematic statements, representing salient aspects of the participants' experiences, were created and supported by illustrative excerpts from the data. Results Twenty-two interviews were analyzed. Eight participants had ≥80% adherence, and the remaining 14 participants were super-adherers (>100% adherence). Super-adherers tended to be male and 65 years or older, and have no exercise for 3 months before the study, a body mass index ≥ 30, and poor to good Kansas City Cardiomyopathy Questionnaire scores. Participants initially enrolled because they saw the program as an opportunity to improve a health issue and to exercise. Long-term adherence was facilitated by convenience, individualization, experiencing psychological and physical improvements, and peer fellowship. Conclusions The GEtting iNTo Light Exercise–Heart Failure study that used home-based gentle nonaerobic exercise had 64% of participants come more than was asked. It is imperative that clinicians incorporate what participants with heart failure have directly stated is important for their initiation and long-term adherence to exercise so that we can work toward bridging sedentary patients to the full exercise guidelines to reduce morbidity and mortality.

Introduction: With the unprecedented expansion of women's roles in the U.S. military during recent (post-9/11) conflicts in Iraq and Afghanistan, the number of women seeking healthcare through the Veterans Health Administration (VHA) has increased substantially. Women Veterans often present as medically complex due to multiple medical, mental health, and psychosocial comorbidities, and consequently may be underserved. Thus, we conducted the nationwide Women Veterans Cohort Study (WVCS) to examine post-9/11 Veterans' unique healthcare needs and to identify potential disparities in health outcomes and care. Methods: We present baseline data from a comprehensive questionnaire battery that was administered from 2016 to 2019 to a national sample of post-9/11 men and women Veterans who enrolled in Veterans Affairs care (WVCS2). Data were analyzed for descriptives and to compare characteristics by gender, including demographics; health risk factors and symptoms of cardiovascular disease, chronic pain, and mental health; healthcare utilization, access, and insurance. Results: WVCS2 included 1,141 Veterans (51% women). Women were younger, more diverse, and with higher educational attainment than men. Women also endorsed lower traditional cardiovascular risk factors and comorbidities (e.g., weight, hypertension) and greater nontraditional cardiovascular risk factors (e.g., trauma, psychological symptoms). More women reported single-site pain (e.g., neck, stomach, pelvic) and multisite pain, but did not differ from men in posttraumatic stress disorder (PTSD) symptoms or treatment for PTSD. Women seek care at VHA medical centers more frequently, often combined with outside health services, but do not significantly differ from men in their insurance coverage. Conclusion: Overall, this investigation indicates substantial variation in risk factors, health outcomes, and healthcare utilization among post-9/11 men and women Veterans. Further research is needed to determine best practices for managing women Veterans in the VHA healthcare system.

Background: Heart failure (HF) is common among people aging with HIV (PWH) and without HIV (PWoH). Despite the poor prognosis for HF, advance directives (AD) completion is low but has not been compared among PWH and PWoH. Objectives: Determine the prevalence and predictors of AD screening among PWH and PWoH with incident HF. Methods: We included Veterans with an incident HF diagnosis code from 2013-2018 in the Veterans Aging Cohort Study (VACS) without prior AD screening. Health records were reviewed for AD screening note titles within-30 days to 1-year post-HF diagnosis. Analyses were stratified by HIV status. Trends in annual AD screening were evaluated with the Cochran-Mantel-Haenszel test. The associations of AD screening with demographics, disease severity (Charlson Comorbidity Index, VACS 2.0 Index), and healthcare encounters (cardiology, palliative care, hospitalization) were evaluated with Cox proportional hazards regression. Results: HF was diagnosed in 4516 Veterans (28.2% PWH, 71.8% PWoH). Annual AD screening rates increased in both groups (Ptrend<0.0001) and aggregate rates were higher among PWH than PWoH (53.5% vs. 48.2%, p = .001). In both groups, the likelihood of AD screening increased with greater disease severity, palliative care contact, and hospitalization (HR range = 1.04-3.32, all p <= .02) but not with cardiology contact (p >= .53). Conclusions: AD screening rates after incident HF remain suboptimal but increased over time and were higher in PWH. Future quality improvement and implementation efforts should aim for universal AD screening with incident HF diagnosis, initiated by providers skilled in discussing AD, including in the cardiology subspecialty setting. Published by Elsevier Inc.

Introduction: Advance care planning (ACP) and prognosis education are key components of high-quality, patient-centered care in heart failure (HF) and associated with better patient-reported outcome...

Background Associations between depression, incident heart failure (HF), and mortality are well documented in predominately White samples. Yet, there are sparse data from racial minorities, including those who are women, and depression is underrecognized and undertreated in the Black population. Thus, we examined associations between baseline depressive symptoms, incident HF, and all‐cause mortality across 10 years. Methods and Results We included Jackson Heart Study (JHS) participants with no history of HF at baseline (n=2651; 63.9% women; median age, 53 years). Cox proportional hazards models tested if the risk of incident HF or mortality differed by clinically significant depressive symptoms at baseline (Center for Epidemiological Studies–Depression scores ≥16 versus <16). Models were conducted in the full sample and by sex, with hierarchical adjustment for demographics, HF risk factors, and lifestyle factors. Overall, 538 adults (20.3%) reported high depressive symptoms (71.0% were women), and there were 181 cases of HF (cumulative incidence, 0.06%). In the unadjusted model, individuals with high depressive symptoms had a 43% greater risk of HF (P=0.035). The association remained with demographic and HF risk factors but was attenuated by lifestyle factors. All‐cause mortality was similar regardless of depressive symptoms. By sex, the unadjusted association between depressive symptoms and HF remained for women only (P=0.039). The fully adjusted model showed a 53% greater risk of HF for women with high depressive symptoms (P=0.043). Conclusions Among Black adults, there were sex‐specific associations between depressive symptoms and incident HF, with greater risk among women. Sex‐specific management of depression may be needed to improve cardiovascular outcomes.

Manganese is a bioelement essential for the proper functioning of the body. Mn2+ is a cofactor for many enzymes, including manganese superoxide dismutase. Together with the enzymes, it participates in cell defense against reactive oxygen species, immune response, and energy production in mitochondria. The aim of this study was to evaluate the effect of manganese added to Biolasol solution on the storage efficiency of isolated pig kidneys.Twenty kidneys from Polish Great White pigs were used in the study. Biolasol solution was modified with the addition of Mn2+ at a concentration of 1 µg/L. Grafts were assigned to 2 groups: A/Biolasol (n = 10) and B/Biolasol + Mn2+ (n = 10). The kidneys were washed with the developed solutions, then stored using the static method for 48h under hypothermia (4°C) and washed again. Markers of normal renal function were analyzed in the collected perfusates—aspartate aminotransferase (AST), alanine aminotransferase (ALT), protein, creatinine, urea, and electrolytes.After 48 hours and 30 minutes of renal preservation, activities/concentrations of biochemical parameters in the Biolasol + Mn2+ group increased (ALT: by 33%; AST: by 86%; urea: by 18%; creatinine: 3.25-fold [P < .05]) vs Biolasol. K+ ion concentration was 33% lower in the Biolasol group after 48 hours and 30 minutes (P < .05) vs group B. The presence of manganese in the composition of Biolasol solution influenced the maintenance of optimal Na+ ion concentration.Manganese added to the Biolasol solution formulation at a dose of 1 µg/L showed low efficacy in protecting nephrons. We do not recommend adding manganese to the preservative solution formulation.

Background Clinician burnout, stress and job dissatisfaction among Advance Practice Registered Nurses (APRNS) may have impacted work-related quality of life (WRQoL) during the COVID-19 pandemic. No studies describe burnout and resilience in APRNs who manage care for patients with HF. Objectives Among APRNs who manage care for patients with HF, study aims included: 1) Describe burnout and WRQoL levels; 2) Determine the relationship between burnout and WRQoL; 3) Examine whether resilience moderates the association between WRQoL and burnout. Methods: An online survey of American Association of Heart Failure Nurses and the Heart Failure Society of America APRN members were queried. Inclusion criteria: APRN's who practiced in ambulatory or inpatient cardiology settings at least 8 h weekly. Outcomes measured: Burnout, WRQoL, and resilience. Results Participants' (N = 101) mean age was 50 (+/- 10) years and 93% identified as female. APRNs worked more than 42 h weekly and reported moderate levels of resilience, high levels of personal (M = 51.7, norm-referenced mean: 35.9) and work-related burnout (M = 50.1, norm-referenced mean: 33.0). Correlations between high levels of burnout and low WRQoL (r range: -0.74 - -0.39 -, p<.001) were found. Burnout moderated the relationships among resilience and WRQoL. Conclusion APRNs had high levels of burnout during the COVID-19 pandemic. Patient-related burnout was not high. Level of burnout influenced the relationships among resilience and WRQoL suggesting that burnout is from workplace and personal sources, and that level of resilience could not overcome the effect of burnout. Interventions are needed regarding systems changes to uplift and support our workforce. (C) 2022 Elsevier Inc. All rights reserved.

Background: Pain and heart failure are highly comorbid. Objectives: The purpose of this study was to examine differences in pain intensity and pain medication prescriptions among Veterans with comorbid heart failure and pain and those with pain alone. Methods: The Musculoskeletal Disorder (MSD) cohort includes 5,237,763 Veteran diagnosed with a musculoskeletal disorder between 2000 and 2013. Veterans with comorbid heart failure and back pain (heart failure +, n = 3,950, M-age = 70.5 +/- 12) were compared to those with back pain alone (heart failure-, n = 165,290, M-age = 52.1 +/- 17.5). Results: In multivariate adjusted models, heart failure+ was associated with a higher likelihood of moderate/severe pain (OR = 1.12; 95% CI 1.04-1.21), a higher likelihood of opioids (OR = 1.63; CI = 1.52-1.75) and/or gabapentin prescriptions (OR = 1.18; CI = 1.02-1.36), but a lower likelihood of NSAID prescriptions (OR = 0.57; CI = 0.50-0.66). Conclusions: Comorbid cardiovascular and pain conditions present a challenge in clinical management that warrants further study. Published by Elsevier Inc.

Objective: OEF/OIF/OND Veterans have an elevated risk for developing cardiovascular disease (CVD), but research suggests that engagement in CVD preventive behaviors is low even among at-risk individuals. It is critical to understand barriers to prevention engagement among Veterans to inform the development of tailored interventions addressing barriers and reducing CVD incidence. Method: The Women Veterans Cohort Study survey of OEF/OIF/OND Veterans (586 women and 555 men) assessed patient, interpersonal, and systems level barriers to CVD risk prevention. Prevalence of barriers was determined, and chi-squares were conducted to examine sex differences. Multivariate logistic regressions were conducted to determine if sex differences remained when adjusting for demographic factors (age, marital status, education, employment status). Results: Despite a low response rate (11.5%), endorsement of barriers was high for both women and men, with most (56.8%) not perceiving themselves to be at CVD risk. More men preferred making no lifestyle change (40.9% vs. 29.1%). More women endorsed lack of confidence (42.4% vs. 36.1%), stress (36.9% vs. 27.8%) and depression (36.9% vs. 27.8%), and inadequate social support (26% vs. 20.9%), along with the belief that their clinician does not perceive them as at risk (57.8% vs. 32%) and has not explained CVD preventive behaviors (19% vs. 12.3%). Multivariate analyses reduced statistical significance of sex differences. Conclusions: Given the low response rate, testing of efforts-for example, implementation science methods-to assess CVD risk reduction barriers in this population are needed, a task for which the Veterans Health Administration is well suited.

The efficacy of psychological and pharmacotherapy interventions for the treatment of depression in cardiac populations and secondarily, the effect of these treatments on cardiovascular outcomes, has been a major focus in the clinical trials literature. Research provides modest support for psychological interventions for improving depression severity and promoting depression remission in these patients, with support also evident for the use of pharmacotherapy interventions in these populations. Yet, the effects of these interventions on cardiovascular outcomes has at best been inconsistent. The clinical trial literature is limited by trials with small, homogenous samples, short follow-up periods, and low or unknown treatment fidelity. The complexity of depression as a clinical syndrome, along with questions concerning implementation should be included in the design of future clinical trials, whether targeting depression alone, or the medical consequences of depression for patients with cardiovascular disease.

Prognosis communication in heart failure is often narrowly defined as a discussion of life expectancy, but as clinical guidelines and research suggest, these discussions should provide a broader understanding of the disease, including information about disease trajectory, the experiences of living with heart failure, potential burden on patients and families, and mortality. Furthermore, despite clinical guidelines recommending early discussions, evidence suggests that these discussions occur infrequently or late in the disease trajectory. We review the literature concerning patient, caregiver, and clinician perspectives on discussions of this type, including the frequency, timing, desire for, effects of, and barriers to their occurrence. We propose an alternate view of prognosis communication, in which the patient and family/caregiver are educated about the nature of the disease at the time of diagnosis, and a process of engagement is undertaken so that the patient's full participation in their care is marshalled, and the care team engages the patient in the informed decision making that will guide care throughout the disease trajectory. We also identify and discuss evidence gaps concerning (i) patient preferences and readiness for prognosis information along the trajectory; (ii) best practices for communicating prognosis information; and (iii) effects of prognosis communication on patient's quality of life, mental health, engagement in critical self-care, and clinical outcomes. Research is needed to determine best practices for engaging patients in prognosis communication and for evaluating the effects of this communication on patient engagement and clinical outcomes.

Reports indicate that long-term opioid therapy is associated with cardiovascular disease (CVD). Using VA electronic health record data, we measured the impact of opioid use on the incidence of modifiable CVD risk factors. We included Veterans whose encounter was between October 2001 to November 2014. We identified Veterans without CVD risk factors during our baseline period, defined as the date of first primary care visit plus 365 days. The main exposure was opioid prescriptions (yes/no, long-term (i.e. >= 90 days) vs no opioid, and long-term vs short-term (i.e.< 90 days)), which was time-updated yearly from the end of the baseline period to February 2015. The main outcome measures were incident CVD risk factors (hypertension, dyslipidemia, diabetes, obesity, and current smoking). After excluding prevalent CVD risk factors, we identified 308,015 Veterans. During the first year of observation, 12,725 (4.1%) Veterans were prescribed opioids, including 2028 (0.6%) with long-term exposure. Compared to patients without opioid use, Veterans with opioid use were more likely to have CVD risk factors. Those with long-term exposure were at higher risk of having hypertension (adjusted average hazards ratio [HR] 1.45, 99% confidence interval [CI] 1.33-1.59), dyslipidemia (HR 1.45, 99% CI 1.35-156), diabetes (HR 1.30, 99% CI 1.07-1.57), current smoking status (HR 1.34, 99% CI 1.24-1.46), and obesity (HR 1.22, 99% CI 1.12-1.32). Compared to short-term exposure, long-term had higher risk of current smoking status (HR 1.12, 99% CI 1.01-1.24). These findings suggest potential benefit to screening and surveillance of CVD risk factors for patients prescribed opioids, especially long-term opioid therapy.

Introduction: Advance care planning (ACP) and prognosis education are key components of high-quality, patient-centered care in heart failure (HF) and associated with better patient-reported outcome...