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OBJECTIVE: To examine the effect of a change in body position (right or left lateral) and timing of backrub (immediate or delayed) on mixed venous oxygen saturation in surgical ICU patients. METHODS: A repeated-measures design was used to study 57 critically ill men. Mixed venous oxygen saturation was recorded at 1-minute intervals for 5 minutes in each of three periods: baseline, after turning, and after backrub. Subjects were randomly assigned to body position and timing of backrub. Subjects in the immediate-backrub group were turned and given a 1-minute backrub. Mixed venous oxygen saturation was measured at 1-minute intervals for 5 minutes at two points: after the backrub and then with the patient lying on his side. For subjects in the delayed-backrub group, saturation was measured at 1-minute intervals for 5 minutes at two different points: after the subject was turned to his side and after the backrub. RESULTS: Both position and timing of backrub had significant effects on mixed venous oxygen saturation across conditions over time. Subjects positioned on their left side had a significantly greater decrease in saturation when the backrub was started. At the end of the backrub, saturation was significantly lower in subjects lying on their left side than in subjects lying on their right side. The pattern of change differed according to the timing of the backrub, and return to baseline levels of saturation after intervention differed according to body position. CONCLUSIONS: Two consecutive interventions (change in body position and backrub) cause a greater decrease in mixed venous oxygen saturation than the two interventions separated by a 5-minute equilibration period. Turning to the left side decreases oxygen saturation more than turning to the ride side does. Oxygen saturation returns to clinically acceptable ranges within 5 minutes of an intervention. In patients with stable hemodynamic conditions, the standard practice of turning the patient and immediately giving a backrub is recommended. However, it is prudent to closely monitor individual patterns of mixed venous oxygen saturation, particularly in patients with unstable hemodynamic conditions.

Chemotherapy-induced cardiotoxicity resulting in heart failure (HF) is one of the most dreaded complications of cancer therapy that can significantly impact morbidity and mortality. With a high prevalence of cardiovascular disease in cancer patients, the risk of developing HF is significantly increased. A new discipline of Onco-Cardiology has evolved to address the cardiovascular needs of patients with cancer, however, there is limited evidence-based data to guide clinical decision-making in the management of the cardiovascular complications of cancer therapy. The department of cardiology at MD Anderson Cancer Center initiated the MD Anderson Practice (MAP) project and developed algorithms to guide the management of the cardiovascular complications of cancer therapy. For chemotherapy-induced HF, we initiated the Heart Success Program (HSP), a patient-centered program that promotes interdisciplinary collaboration for the management of concurrent HF resulting from chemotherapy-induced cardiotoxicity. After one year of HSP implementation, compliance with the Center for Medicare and Medicaid Services HF core measures has significantly improved. The measurement of LVEF and initiation of recommended pharmacologic therapy for HF (angiotensin converting enzyme inhibitor [ACE-I] or angiotensin receptor blocker for ACE-I intolerant patients) has improved to 100%; provision of discharge instruction has improved from 50 to 94%; and the 30-day hospital readmission rate decreased from 40 to 27%. This article will describe the MD Anderson Practice in the management of chemotherapy-induced cardiomyopathy and HF in cancer patients through the HSP. The novelty of the HSP has raised clinician’s awareness of the magnitude of the clinical problem of HF in cancer and the

Background: Heart failure (HF) is one of the most common reasons for hospital admission in the United States. Typically, congestion is the primary reason for HF decompensation. Ambulatory pulmonary artery pressure (PAP) monitoring has been shown to reduce HF hospitalizations in clinical trials. Hypothesis: Real world application of CardioMEMS technology in a community hospital setting will result in reduction in HF hospitalizations. Methods: 26 patients (age 66.7 ± 9.84; 15 male; 85% HF Preserved EF) who underwent CardioMEMS device implantation between February, 2015 and February, 2016 were retrospectively reviewed. Patients enrolled were at least 60 days post implant. Baseline demographics, hospitalizations, and office based interventions were recorded. Implanted patients had an average of 6.7 ± 1.5 major comorbid conditions. One patient died following 197 days of monitoring from a non-cardiac cause. Patients were compared to their own 1 year historic control and evaluated in patient years for statistical analysis. Results: Patients who underwent CardioMEMS implantation had a reduction in all cause admissions from 3 to 2.5 per patient year (P = .5). Heart failure admissions were also reduced from 1.9 to 0.5 per patient year (P < .001). Total all cause hospitalized days decreased from 17.3 ± 14.3 to 8.5 ± 12.3 (P = .02) and heart failure days decreased from 12 ± 10.5 to 2.4 ± 7.7 (P < .001). This reduction was associated with an increased intensity of office interventions. Phone calls per week increased from 1.4 ± 1.7 to 2.7 ± 1.3 (P < .001), medication changes per week increased from 0.6 ± 0.6 to 1 ± 0.8 (P = .03), and office visits per month rose minimally 0.9 ± 0.5 to 1.1 ± 0.6 (P = .13). Conclusions: Ambulatory hemodynamic monitoring of PAP for a high-risk patient population, in the community hospital setting, has demonstrated a reduction of heart failure admissions. Managing an increased volume of phone calls and medication changes both significantly reduced the number of hospitalizations for HF, and time spent in the hospital for those admissions. In the current era of healthcare reform, process improvement and integration of technology into clinical practice are critical to delivering the best patient outcomes. Studies addressing efficiencies in heart failure program monitoring are needed to further propel current practice toward improved outcomes for heart failure populations.

Purpose: Cancer treatment-related heart failure (HF) is an emerging health concern, as the number of survivors is increasing rapidly, and cardiac health issues are a leading cause of mortality in this population. While there is general evidence for the efficacy of exercise rehabilitation interventions, more research is needed on exercise rehabilitation interventions for patients specifically with treatment-induced HF, and if such interventions are safe and wellaccepted. This study provides feasibility and health outcomes of a pilot exercise intervention for cancer survivors with chemotherapy-induced HF. Methods: Twenty-five participants were randomized to a clinic-based exercise intervention or a wait-list control group, or alternatively allowed to enroll in a home-based exercise intervention if they declined the randomized study. For purposes of analysis, both types of exercise programs

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Background Cardiotoxicity resulting in heart failure (HF) is among the most dreaded complications of cancer therapy and can significantly impact morbidity and mortality. Leading professional societies in cardiology and oncology recommend improved access to hospice and palliative care (PC) for patients with cancer and advanced HF. However, there is a paucity of published literature on the use of PC in cardio-oncology, particularly in patients with HF and a concurrent diagnosis of cancer. Aims To identify existing criteria for referral to and early integration of PC in the management of cases of patients with cancer and patients with HF, and to identify assessments of outcomes of PC intervention that overlap between patients with cancer and patients with HF. Design Systematic literature review on PC in patients with HF and in patients with cancer. Data sources Databases including Ovid Medline, Ovid Embase, Cochrane Library, and Web of Science from January 2009 to September 2020. Results Sixteen studies of PC in cancer and 14 studies of PC in HF were identified after screening of the 8647 retrieved citations. Cancer and HF share similarities in their patient-reported symptoms, quality of life, symptom burden, social support needs, readmission rates, and mortality. Conclusion The literature supports the integration of PC into oncology and cardiology practices, which has shown significant benefit to patients, caregivers, and the healthcare system alike. Incorporating PC in cardio-oncology, particularly in the management of HF in patients with cancer, as early as at diagnosis, will enable patients, family members, and healthcare professionals to make informed decisions about various treatments and end-of-life care and provide an opportunity for patients to participate in the decisions about how they will spend their final days.

Symptom assessment and management play important roles in cancer rehabilitation. The Chinese version MDASI-HF can assist appropriate and timely symptom assessment in cancer patients with concurrent HF and can promote communication between healthcare professionals and patients. On the basis of the assessment, the rehabilitation team could provide effective symptom management, evaluate the effectiveness of interventions, and improve patients' quality of life.