Effect of exercise training on weight control in patients with chronic heart failure

S44 Abstracts The Journal of Heart and Lung Transplantation February 2005 Conclusions: A signiﬁcant increased risk of cardiovascular mortality was seen in heart transplant recipients with patterns of AMR or mixed rejection relative to those with a cellular rejection pattern, even when excluding deaths from acute rejection. With growing acceptance of AMR in heart transplantation by the ISHLT community, there is a greater need for standardized diagnostic criteria, prevention, and appropriate therapy. EFFECT OF EXERCISE TRAINING ON WEIGHT CONTROL IN PATIENTS WITH CHRONIC HEART FAILURE L.S. Evangelista, 1 K. Dracup, 2 L.V. Doering, 1 M.A. Hamilton, 3 School of Nursing, Univeristy of California Los Angeles, Los Angeles, CA; 2 School of Nursing, University of California San Francisco, San Francisco, CA; 3 Ahmanson Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA Exercise is an important behavior for long-term weight control in obese individuals. However, little evidence exists conﬁrming such ﬁndings in chronic heart failure (HF) patients. Methods: Using a prospective, experimental design, we described the effects of 24 weeks of home-based walking program on weight control in obese (body mass index ⱖ25) HF patients randomized to exercise (n⫽48) and a control group (n⫽51). Weight changes between the 2 groups at baseline and 6 months were compared using repeated measures ANOVA. We compared patients who had lost, gained or had no weight changes over time using Chi-square statistics. Results: Demographic and clinical data were similar in the 2 groups at baseline. Patients who were in the exercise vs. control group demonstrated improvement in their weights from baseline to 6 months (Figures 1 and 2). Conclusion: Our ﬁndings demonstrate the beneﬁcial effects of a home-based walking program on weight control in HF patients, suggesting that exercise produces physiological, behavioral, and psychological effects that may facilitate weight loss in this popu- lation. HOPING FOR THE BEST WHILE PREPARING FOR THE WORST: COMMUNICATION ABOUT END-OF-LIFE PLANNING IN HEART TRANSPLANT PROGRAMS J. Yager, 1 A. Hernandez, 1 J. Tulsky, 2 S. Russell, 3 1 Cardiology, Duke University Medical Center, Durham, NC; 2 General Medicine, Duke University Medical Center and VAMC, Durham, NC; 3 Cardiology, Johns Hopkins Hospital, Baltimore, MD Background: Up to 10% of adults awaiting heart transplantation die while on the waiting list (UNOS data), and another 10 –20% do not survive the ﬁrst post-operative year. Given this context and recent guidelines recommending end of life (EOL) discussions with ad- vanced heart failure patients, we sought to describe the EOL planning and education that occur as part of the pre-transplant evaluation process. Methods: Transplant coordinators or program managers at high- volume adult U.S. transplant centers (deﬁned as 20 or more in any of the last 3 years) were contacted by phone for a brief structured survey. We asked about EOL content in patient-provider discussions and in written material given to patients during the transplant evaluation process. Results: We identiﬁed 37 high-volume centers (performing approximately 60% of all adult US heart transplants) and 100% responded to the survey. 28 (76%) centers formally dis- cuss the fact that not all patients survive to transplant – cardiolo- gists do so at 19 centers, surgeons at 4, coordinators at 13, social workers at 7 and psychologists at 3 (some report multiple discus- sions). At 3 centers cardiologists discuss these issues only when deemed appropriate. During outpatient evaluations, 27 (73%) centers conduct advance directive (AD) planning, usually by a social worker (23 of 27). 6 (16%) offer AD planning only to inpatients. 12 (32%) centers provide generic written AD mate- rial to patients and only 4 (11%) include speciﬁc written EOL content. Conclusion: Most high-volume centers formally discuss the possibility of death pre-transplant, with large variability as to how it is presented. Fewer than half provide written AD or EOL material, and without this most patients probably do not retain much of the discussion. Efforts should be made to standardize the inclusion of EOL content in the pre-transplant evaluation process, and to measure the impact of sharing this information with patients.