How Enhancing Self-Care in Patients with Heart Failure Can Avert a Healthcare Crisis
1
the most recent evidence-based recommendations as well as the important gaps in ev- idence. The current diagnostic algorithm will be presented and diagnostic techniques will be discussed. The review will include both non-pharmacological management and pharmacological therapy. The role of devices and surgery will be reviewed. The impact of important comorbidities and selected populations will be highlighted. The review will include recent developments in the management of both patients with chronic and acute heart failure. SL8 Tailor-made Medicine Using the Multi-scale Heart Simulator “UT-Heart” SEIRYO SUGIURA 1 , TAKUMI WASHIO 1 , JUN-ICHI OKADA 1 , TOSHIAKI HISADA 1 , HIROSHI YAMASHITA 2 , TARO KARIYA 2 , RYOZO NAGAI 2 , YOSHIMASA KADOOKA 3 , MASAHIRO WATANABE 3 , MACHIKO NAKAGAWA 3 1 Graduate School of Frontier Sciences, The University of Tokyo, 2 Department of Cardiovascular Medicine, The University of Tokyo, 3 Next Generation Technical Computing Unit, Fujitsu Ltd The process of clinical decsion making includes the integration of physical and lab- oratory findings to visualize the status of each patient. To make this process more ef- ficient and accurate, we have developed a heart simulator (UT-Heart) which reproduces the contraction and relaxation of the heart and accompanying blood flow based on the molecular mechanisms of excitation-contraction coupling process (multi-scale). Our simulator is based on the finite element method (FEM) and solving the equations describing the the electrical activity, solid mechanics, and fluid dynam- ics (multi-physics) involved in the cardiac function. This simulator can be applied to both basic and clincal sciences. In the preentation, we will show patient-specfic models of CRT simulations for the prediction and optimization of its effect. SL9 Dissecting the Cardiac Sca1 + Cell by Clonal Analysis, Fate-mapping, and Single-cell Gene Expression: Mosaicism of Key Transcription Factors and Co-segregation with PDGFR MICHAEL D. SCHNEIDER British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Imperial College London, UK Fate-mapping studies show that mammalian cardiac regeneration exists and occurs in part through a lineage decision by progenitor/stem cells. Several markers have been proposed for the identification of adult heart resident progenitors. Existing work has chiefly relied on purified but heterogeneous populations. Here, we dissected the car- diac Sca-1 + population through clonal analysis, fate-mapping and single-cell qRT- PCR. Clonal growth after single-cell deposition was predicted by the side population (SP) phenotype. Clones shared a consensus signature of cardiogenic genes, and showed tri-lineage potential after cardiac grafting. Notably, each clone expressed just a partial subset of the factors Gata4, Mef2c, Tbx5 and Hand2. Fresh cardiac SP cells showed enrichment, in similarly mosaic patterns, and were derived equally from cells formerly expressing Nkx2-5, Isl1 and Gata5. Pdgfra and Tcf21 correlated with the SP phenotype, yet predicting both the expression of cardiac transcription factors and clonogenicity more exactly, even in non-SP cells. PDGFRa+ SP cells had a cloning efficiency of roughly 20% in physiological O2. PDGFRa - cells purified by flow sorting lacked these factors, expressed Kdr/Flk1, Cdh5, and CD31, and had 100-fold less clonal growth. Thus, PDGFRa is a precise prospective marker of adult cardiac clonogenic cells that are enriched for cardiogenic genes. SL10 How Enhancing Self-Care in Patients with Heart Failure Can Avert a Healthcare Crisis DEBRA K. MOSER 1 , MARTHA J. BIDDLE 2 , MISOOK L. CHUNG 2 , REBECCA DEKKER 2 , TERRY A. LENNIE 2 , GIA MUDD-MARTIN 2 1 University of Kentucky, 2 University of Kentucky, USA The world’s population is rapidly aging. With aging of the population comes a marked increase in the number of people who develop heart failure along with other chronic illnesses. Although there are therapies that have improved survival and reduced mor- bidity in heart failure, hospitalization rates continue to increase, discharges to nursing homes have escalated, and mortality rates remain high. Failed self-care underlies most rehospitalizations, an observation that provides clinicians and researchers with vital information for improving outcomes. Given that heart failure requires daily engagement in complex self-care activities, the key to improving these outcomes is enhancing patients’ self-care abilities. Unfortunately, self-care among patients with heart failure commonly is poor and patients have considerable difficulties performing self-care skills because there are a number of barriers (e.g., cognitive dysfunction, poor health literacy, anxiety, depression, lack of social support, multiple comorbid- ities) to self-care that have not been addressed by clinicians. In this presentation, a model of these barriers is described and evidence-based approaches to their man- agement presented. Collaborative interventions to enhance multiple self-care skills that have been tested by our research team will be presented along with evidence that use of such interventions can substantially decrease hospitalizations on a popula- tion wide basis. The 17 th Annual Scientific Meeting JHFS S107
Transcript of How Enhancing Self-Care in Patients with Heart Failure Can Avert a Healthcare Crisis
The 17th Annual Scientific Meeting � JHFS S107
the most recent evidence-based recommendations as well as the important gaps in ev-
idence. The current diagnostic algorithm will be presented and diagnostic techniques
will be discussed. The review will include both non-pharmacological management
and pharmacological therapy. The role of devices and surgery will be reviewed.
The impact of important comorbidities and selected populations will be highlighted.
The review will include recent developments in the management of both patients with
chronic and acute heart failure.
SL8Tailor-made Medicine Using the Multi-scale Heart Simulator “UT-Heart”SEIRYO SUGIURA1, TAKUMI WASHIO1, JUN-ICHI OKADA1,TOSHIAKI HISADA1, HIROSHI YAMASHITA2, TARO KARIYA2,RYOZO NAGAI2, YOSHIMASA KADOOKA3, MASAHIRO WATANABE3,MACHIKO NAKAGAWA3
1Graduate School of Frontier Sciences, The University of Tokyo, 2Department ofCardiovascular Medicine, The University of Tokyo, 3Next Generation TechnicalComputing Unit, Fujitsu Ltd
The process of clinical decsion making includes the integration of physical and lab-
oratory findings to visualize the status of each patient. To make this process more ef-
ficient and accurate, we have developed a heart simulator (UT-Heart) which
reproduces the contraction and relaxation of the heart and accompanying blood
flow based on the molecular mechanisms of excitation-contraction coupling process
(multi-scale). Our simulator is based on the finite element method (FEM) and solving
the equations describing the the electrical activity, solid mechanics, and fluid dynam-
ics (multi-physics) involved in the cardiac function. This simulator can be applied to
both basic and clincal sciences. In the preentation, we will show patient-specfic
models of CRT simulations for the prediction and optimization of its effect.
SL9Dissecting the Cardiac Sca1+ Cell by Clonal Analysis, Fate-mapping, andSingle-cell Gene Expression: Mosaicism of Key Transcription Factors andCo-segregation with PDGFRMICHAEL D. SCHNEIDERBritish Heart Foundation Centre of Research Excellence, National Heart and LungInstitute, Imperial College London, UK
Fate-mapping studies show that mammalian cardiac regeneration exists and occurs in
part through a lineage decision by progenitor/stem cells. Several markers have been
proposed for the identification of adult heart resident progenitors. Existing work has
chiefly relied on purified but heterogeneous populations. Here, we dissected the car-
diac Sca-1+ population through clonal analysis, fate-mapping and single-cell qRT-
PCR. Clonal growth after single-cell deposition was predicted by the side population
(SP) phenotype. Clones shared a consensus signature of cardiogenic genes, and
showed tri-lineage potential after cardiac grafting. Notably, each clone expressed
just a partial subset of the factors Gata4, Mef2c, Tbx5 and Hand2. Fresh cardiac
SP cells showed enrichment, in similarly mosaic patterns, and were derived equally
from cells formerly expressing Nkx2-5, Isl1 and Gata5. Pdgfra and Tcf21 correlated
with the SP phenotype, yet predicting both the expression of cardiac transcription
factors and clonogenicity more exactly, even in non-SP cells. PDGFRa+ SP cells
had a cloning efficiency of roughly 20% in physiological O2. PDGFRa- cells purified
by flow sorting lacked these factors, expressed Kdr/Flk1, Cdh5, and CD31, and had
100-fold less clonal growth. Thus, PDGFRa is a precise prospective marker of adult
cardiac clonogenic cells that are enriched for cardiogenic genes.
SL10How Enhancing Self-Care in Patients with Heart Failure Can Averta Healthcare CrisisDEBRA K. MOSER1, MARTHA J. BIDDLE2, MISOOK L. CHUNG2,REBECCA DEKKER2, TERRY A. LENNIE2, GIA MUDD-MARTIN2
1University of Kentucky, 2 University of Kentucky, USA
The world’s population is rapidly aging. With aging of the population comes a marked
increase in the number of people who develop heart failure along with other chronic
illnesses. Although there are therapies that have improved survival and reduced mor-
bidity in heart failure, hospitalization rates continue to increase, discharges to nursing
homes have escalated, and mortality rates remain high. Failed self-care underlies
most rehospitalizations, an observation that provides clinicians and researchers
with vital information for improving outcomes. Given that heart failure requires daily
engagement in complex self-care activities, the key to improving these outcomes is
enhancing patients’ self-care abilities. Unfortunately, self-care among patients with
heart failure commonly is poor and patients have considerable difficulties performing
self-care skills because there are a number of barriers (e.g., cognitive dysfunction,
poor health literacy, anxiety, depression, lack of social support, multiple comorbid-
ities) to self-care that have not been addressed by clinicians. In this presentation,
a model of these barriers is described and evidence-based approaches to their man-
agement presented. Collaborative interventions to enhance multiple self-care skills
that have been tested by our research team will be presented along with evidence
that use of such interventions can substantially decrease hospitalizations on a popula-
tion wide basis.
