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Welcome to the final on-site issue of the 2007 Annual Meeting Gazette! Day 3 of the 2007 AAHFN Annual Meeting was another huge success beginning with a keynote address by Dr. Clyde Yancy and ending with the announcement of the 2008 meeting location by President-Elect, Sue Wingate, DSN, RN!
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| Keynote Address- Saturday, June 30th |
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"Racial Disparities in HF:
Real or Imagined?"
ClydeYancy, MD
The goal of Dr. Yancy's provocative lecture was to challenge our perceptions of the disparities in treatment of patients of different racial and ethnic groups. "Racial and ethnic disparities in healthcare exist and may be associated with worse outcomes" stated Dr. Yancy, "bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial/ethnic disparities in healthcare which needs to be addressed in future research". Some potential sources of disparities in care cited are the health system itself (financing, structure of care, cultural, and linguistic barriers), patient-level factors (refusal of treatment, poor adherence), and disparities arising from the clinical encounter.
Dr. Yancy posed the question, "How could well-meaning and highly educated health professionals working in their usual circumstances with diverse populations of patients, create a pattern of care that is discriminatory?" The disparities in the clinical encounter might be due to bias (prejudice), uncertainty, and stereotyping. There may be evidence that unconscious bias may exist. The uncertainty may be contributed by the providers treating patients that are dissimilar in cultural or linguistic background. Stereotyping may occur when we as health care providers use 'cognitive shortcuts' when treating patients of similar ethnic/cultural backgrounds. The risks of stereotyping can exert powerful effects on thinking and actions at an implicit, unconscious level, even among well-educated persons who are no overly biased. Stereotyping can influence how information is processed and recalled
Shifting to the area of heart failure (HF), the question of whether this disease is different in the African American (AA) population was well discussed. The unsettling data presented regarding prevalence in AA vs. non AA:
- AAs have a 2.5 times higher premature death rate in the middle ages
- HTN as the etiology is 3-7 times more prevalent in AA
- Higher incidences of LVH
- Higher risk of stroke
- Higher incidence of ESRD due to HTN (20x higher)
Dr. Yancy briefly reviewed the results from some clinical trials to help answer the question on whether HF is different in African Americans. In A-HeFT, over 1000 AA patients with NYHF Class III-IV were studied and followed for 18 months. Seventy percent of the patients were on ACE-I and 17 percent on ARBs. Patients were treated with a combination of isorbide dinitrate and hydralazine in addition to optimal heart failure medications. Results of the trial demonstrated a 40 percent decrease in death, 40 percent decrease in the perception of disease and 40 percent decrease in time to first hospitalization. The Genetic Risk Assessment Study demonstrated some genetic components to answer the question on whether one can use genetic markers to predict a response to therapy. There appears to be some interesting findings that can help answer that question but needs to be further studied. From the OPTIMIZE-HF data, in-hospital mortality for AA was 2.2 percent compared to 4.4 percent in whites, demonstrating that point that when treatment is the same, disparities/difference are not apparent.
Dr. Yancy eloquently concluded that the natural history of cardiovascular diseases differs as a function of the population in question and differences in outcomes between groups can be overcome with education, research, awareness and cultural competence. He quoted Johann Von Goethe in the final slide, "Knowing is not enough; we must apply. Willing is not enough; we must do."
Submitted by Lynne J Bouffard, RN MSN FNP DNP(c)
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| Advanced Aspects of HF |
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"Left Ventricular Assist Devices:
More Than a Bridge to Transplant"
Renee Lassinger, RN, MSN, CCRN, ANP-BC, APRN and Debra Borgeson, RN, MSN
 Left Ventricular Assist Devices are used in a growing number of patients with stage D heart failure. Renee Lassinger presented an interesting and informative overview of permanent and temporary devices. Renee focused on the who, what, and when of referrals which is all very appropriate information for heart failure nurses. Debra Borgeson followed this with a description of how a remote heart failure clinic can work with a transplant center to refer patients for destination or bridge to transplant LVAD insertion. Some of Debra's patients live 140 miles from her clinic and the clinic is 200 miles from the transplant center. Good nursing care can be delivered to the high technology-dependent population with good communication and collaboration.
Submitted by Linda Baas, PhD, RN, ACNP
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| Global Aspects of HF |
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"Controversies in Heart Failure Management"
Nesiritide Friend or Foe
By ClydeYancy, MD
Ultrafiltration: Who? When? How?
By William Abraham, MD, FACP, FACC, FAHA
This session addressed two of the major issues in the field of ADHF - vasodilator therapy and mechanical means of volume removal.
The session began with a broad overview and a generation of the context of therapy for ADHF. Both speakers emphasized the unmet need that exists in ADHF - specifically the absence of therapies proven to reduce morbidity and mortality for ADHF.
The first presentation reviewed the potential benefits of nesiritide and revisited the data which established and indication for use of nesiritide. That was followed by a review of the questions that have since affected the use of nesiritide. The focus was both on renal insufficiency and an apparent increased mortality question.
Since those data were released, more data regarding the use of nesiritide have come forward. The NAPA, ADHERE, and FUSION-II data were discussed and no evidence of harm due to nesiritide have emerged and more studies are underway - ASCEND-HF, NAPA-II and TMAC. As for now, nesiritide remains with an FDA approved indication and should be used per label indications and as directed by current guidelines.
The second presentation specifically addressed the potential role of ultrafiltration. The background mechanisms were reviewed and the UNLOAD trial was discussed. The limitation of that study were acknowledged but the provocative signals which emerged and represents a target for future study. The OhioState experience with ultrafiltration was reviewed. Unlike the UNLOAD trial, the patients at OSU are those who are both volume overloaded and impacted by diuretic resistance. This is a different patient population and this effort represents an exploratory approach done in a highly specialized medical center.
The presentation ended by emphasizing the potential of ultrafiltration but also the need for more data.
A healthy Q & A followed where once again, both speakers emphasized the need to respect FDA label indications for both drugs and devices and to adhere to published guidelines for now in hope that more data will soon be available to address the unmet needs in ADHF.
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| 2008 Annual Meeting Location Announced! |
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Think you know where the 2008 AAHFN Annual Meeting will be? Attendees of this year's annual meeting were provided clues as to where the 2008 Annual Meeting will take place, and were encouraged to submit their guesses. Clues included:
- In 1919 a flood of molasses killed 21 people in this city
- One letter can take you through the entire city
- Take a ride on a feathered friend through this city
- This city is located in one of the original 13 colonies
- The first YMCA was established in this city
- The tradition of sending Christmas cards began in this city
- This city has been called "the hub of the universe"
- A sports fan is in sports heaven in this city
Attendees waited anxiously for Sue Wingate, DSN, RN and AAHFN President-Elect to announce the location of the 2008 Annual Meeting at the closing session.
 Drum roll please.....the 2008 Annual Meeting will take place in Boston, Massachusetts!!!!!!!
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Thank you for reading the Annual Meeting Gazette. We hoped you enjoyed your glimpse into the 2007 Annual Meeting! Thank you to those who attended and helped to make the meeting a success. If you were unable to make it this year, we hope to see you in Boston in 2008!
Sincerely,
AAHFN Annual Meeting Committee
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