A congestão sistêmica é o principal fator relacionado à descompensação de pacientes com insuficiência cardíaca (IC), conferindo manifestações clínicas como dispneia, ortopneia, cansaço, distensão da veia jugular e edema. Estes sinais e sintomas, assim denominados características definidoras (CD) na classificação de Diagnósticos de Enfermagem (DE) da NANDA-International, fazem parte do diagnóstico de Volume de líquidos excessivo (VLE) frequentemente estabelecido em pacientes congestos. Estes sinais e sintomas também são frequentemente associados a diagnósticos do sistema respiratório e, por conseguinte, podem comprometer a acurácia diagnóstica. É nessa perspectiva, que se apresenta um marcador bastante estudado nas duas últimas décadas, Peptídeo Natriurético tipo B (BNP), que consegue diferenciar a dispneia de origem cardíaca da dispneia de causa pulmonar. Visando agregar este biomarcador ao conjunto de CD do diagnóstico VLE que este estudo foi desenvolvido. O objetivo do estudo é analisar o comportamento do Peptídeo Natriurético tipo B com a presença das CD do diagnóstico VLE em pacientes com IC descompensada durante a internação. Trata-se de um estudo de coorte conduzido em hospital público universitário, Porto Alegre, RS. Foram incluídos pacientes com diagnóstico de IC, função sistólica reduzida ou preservada, que internaram por descompensação aguda. A coleta foi sistematizada por meio de uma avaliação clínica na admissão e após compensação da IC (até sete dias após a admissão, denominado avaliação final), contendo as CD já validadas clinicamente para este diagnóstico em pacientes com IC como principais e secundárias. Também foram coletadas amostras de sangue para dosagem do BNP nestes dois períodos. Foram incluídos 64 pacientes, com média de idade de 69±13 anos, fração de ejeção do ventrículo esquerdo 50±16%. Da avaliação inicial à final, houve redução significativa das seguintes CD principais: dispneia (97% x 62%), ortopneia (91% x 67%), edema (89% x 62%), refluxo hepatojugular positivo (60% x 32%), dispneia paroxística noturna (95% x 26%), congestão pulmonar (66% x 49%), pressão venosa central elevada (53% x 27%); e secundárias, como ganho de peso (59%x9%), hepatomegalia (14%x11%), crepitação (86%x 50%) e oligúria (3%x1,5%). Em uma análise quantitativa das CD, observa-se uma redução da admissão à avaliação final no estudo, 11,3 ±3 versus 7,5±3, p<0,001; os valores de BNP da admissão no estudo à avaliação final reduziram significativamente 381(202-707) pg/ml versus 309(180- 640) pg/ml, p=0,012. Houve correlação positiva de moderada magnitude e significativa entre o delta do BNP com o número das CD presentes na avaliação clínica inicial do estudo r=0,304 e p=0,018. A área da curva ROC verificada resultou em 0,552, mostrando o nível de sensibilidade de 66,7%, quando o ponto de corte do valor do BNP for 447pg/ml e no teste de especificidade 54%. Os achados deste estudo indicam que o BNP apresentou um comportamento semelhante às CD, diminuindo seus valores de acordo com as manifestações do estado congestivo em pacientes internados por IC descompensada. A inclusão desse marcador como CD pode melhorar a acurácia diagnóstica. / Systemic congestion is the main factor related to decompensation of patients with heart failure (HF). The main clinical manifestations resulting from congestion are dyspnea, orthopnea, tiredness, distension of jugular vein, and edema. These signs and symptoms called Defining Characteristics (DC) in the classification of NANDA-International Nursing Diagnoses (ND) are part of the diagnosis of Excess Fluid Volume (EFV) often established in congested patients. These signs and symptoms are also often associated with respiratory system diagnoses and therefore may compromise diagnostic accuracy. In that sense, a wellstudied marker has been presented in the last two decades, B-type Natriuretic Peptide (BNP), which can distinguish cardiac dyspnea from pulmonary dyspnea. Aiming to add this biomarker to the DC set of the EFV diagnosis, this study was developed. This study aimed to analyze the behavior of BNP with the presence of defining characteristics of nursing diagnosis excessive fluid volume in hospitalized patients with decompensated HF during hospitalization. This is a Cohort study conducted in the emergence of a public university hospital, of a Southern Brazilian University Hospital. We included patients with HF diagnosis, reduced or preserved systolic function who were hospitalized by acute decompensation. The collection was systematized through a clinical evaluation at admission and discharge, containing the signs and symptoms already clinically validated as major and secondary for this diagnosis in patients with HF. Blood samples were also collected for BNP measurements. In the study, 64 patients were included, with mean age of 69±13 years, and fraction ejection of the left ventricular of 50±16%. From the initial to the final evaluation, there was a significant reduction of the following major dyspnea (97% x 62%), orthopnea (91% x 67%), edema (89% x 62%), hepatojugular reflux positive (60% x 32%), paroxysmal nocturnal dyspnea (95%x26%), pulmonary congestion (66% x49%), elevated central venous pressure (53% x27%) and secondary DC such as: weight gain (59% x9%), hepatomegaly (14% x11%), crepitations (86% x 50%) and oliguria (3% x 1,5%). The frequency of those signs and symptoms of the EFV DC on admission (11,3 ±3) and discharge (7,5±3) were statistically significant p<0,001. The median of the BNP values were reduced significantly: 381(202-707) pg/ml in admission and 309(180-640) pg/ml in discharge, p=0,012. There was a moderate and significant positive correlation between the BNP delta and the number of DC present in the initial clinical evaluation of the study r = 0.304 and p = 0.018. There was also a moderate and significant positive correlation between BNP´s delta and number of DC presented in the clinical initial evaluation of this study r=0,304 e p=0,018. The area of the ROC curve was found to be 0.552, showing the sensitivity level of 66.7% when the BNP value cutoff point was 447pg / ml and the specificity test was 54%. The findings of this study indicate that BNP presented a similar behavior to DC, reducing its values according to the reduction of clinical of congestive status in patients admitted for decompensated HF. Inclusion of this marker as a DC can improve diagnostic accuracy.

This dissertation aims to examine factors associated with telehealth initiation among heart failure patients in home care settings using a mixed methods study design. Chapter One identifies the current gap in the literature on telehealth adoption and the significance of this study in filling this gap. Chapter Two provides an integrative review of the literature on factors affecting heart failure patients’ decision making to accept telehealth services in a home setting. Chapter Three presents a quantitative analysis of data from the Outcome and Assessment Information Set (OASIS) on 2,832 heart failure patients referred to telehealth services using a modified Unified Theory of Acceptance Use of Technology (UTAUT) framework, to identify patient-related factors or characteristics associated with telehealth initiation. Chapter Four describes the findings of a qualitative study using individual telephone interviews with heart failure patients at home to explore reasons for telehealth initiation. Finally, in Chapter Five, the findings of all three studies are summarized and overarching conclusions are reported with a discussion of their relationship to previous research. This chapter concludes with a consideration of the strengths and limitations of the study, and implications for practice, policy, and research.

Heart failure is a prevalent health concern within the western world. It has huge economic, financial and personal implications. Despite the development of several clinically available treatments, heart failure associated mortality remains high. Heart failure patients display with dysfunction of the autonomic nervous system, including a high degree of vagal withdrawal. Consequently, the up-regulation of cardiac vagal tone, using vagal nerve stimulation (VNS) has recently gained attention as a potential new therapeutic approach to the treatment of heart failure. Clinical trials of VNS have produced mixed outcomes and very little is known about the mechanisms mediating the cardioprotective effects of VNS. This study has therefore implemented VNS in an ovine tachypaced model of heart failure, with the primary aim of quantifying its therapeutic effect in this model. Secondly, two potential underlying mechanisms of VNS have been investigated: 1) the effects of VNS on cellular calcium handling and 2) the effects of VNS on myocardial S-nitrosylation (S•NO).VNS treatment in this model of heart failure had a modest therapeutic effect. However, no differences in echocardiographic parameters, including those used as outcome measures in ongoing clinical trials, were observed between treated and untreated animals. Similarly, no differences in calcium handling parameters were observed between ventricular myocytes isolated from treated and untreated animals. Finally, VNS caused an increase in S•NO of several identified myocardial proteins when compared to untreated heart failure controls. However, this was a relatively small change compared to that observed between control and heart failure tissues. This data, as with studies before, highlights the need for a greater understanding of autonomic regulation and VNS in the heart failure setting, so that treatment strategies can be more effectively optimised. Given the limited therapeutic effect observed in this study, these potential mechanisms cannot be excluded as contributing to the cardioprotective effects of VNS observed in other studies.

Class of 2006 Abstract / Doxorubicin is a member of the anthracycline antibiotic class of chemotherapeutic agents and is among the most effective chemotherapies in the treatment of breast cancer1. However, the efficacy of the drug is limited by its ability to cause a heart failure. In younger women with high – risk breast cancers, doxorubicin improves their chances of survival from the breast cancer, but the risk of heart failure, should they survive, will shorten their lives substantially and reduce their quality of life. Periodic monitoring of left ventricular ejection fraction (LVEF) during treatment with doxorubicin has been shown to reduce morbidity and mortality from doxorubicin – induced heart failure19 and for the past 20 years, the Schwartz guidelines have provided an algorithm for the frequency of LVEF monitoring19. According to this guideline, women in their 30’s who are otherwise healthy do not receive LVEF monitoring until they have received a threshold dose of 250-300mg/m2. We have conducted a decision – analysis cost – effectiveness study of heart failure prevention by LVEF monitoring with equilibrium radionuclide angiography (ERNA) either in adherence to the Schwartz guidelines or before each dose of doxorubicin (serial monitoring). Our findings show that, both in terms of quality of life and cost outcomes, ERNA monitoring of LVEF according to the Schwartz guidelines is the dominant strategy. Monte Carlo analysis of 5000 patients showed that the Schwartz guidelines have an average cost- effectiveness of $110/QALY, versus $390/QALY for serial monitoring. Sensitivity analysis of uncertain variables invariably showed that Schwartz guidelines are dominant.

O objetivo deste trabalho foi avaliar o status de ferro (Fe) em pacientes hospitalizados por insuficiência cardíaca avançada. Participaram do estudo 50 pacientes, sendo que 24 foram diagnosticados com anemia e desses 8 apresentam anemia por deficiência de ferro. Foram incluídos no estudo indivíduos do sexo masculino, com idade entre 30 e 60 anos e fração de ejeção do ventrículo esquerdo (FEVE) <0,45. Para análise dos níveis séricos de hepcidina, interleucina 6 (IL-6), fator de necrose tumoral-alfa (TNF-&#945;) e eritropoietina os pacientes foram submetidos a coleta de sangue após jejum de 8 horas. Os parâmetros hematológicos e bioquímicos foram avaliados por meio dos resultados de exames laboratoriais rotineiramente realizados e foram verificados em prontuário médico. O consumo alimentar foi avaliado pelo método direto de pesagem dos alimentos. Os resultados entre os grupos foram comparados pelo teste de Mann Whitney e foram feitas correlações de acordo com o teste de Spearman e teste de Pearson. Não foram encontradas diferenças nos níveis séricos de hepcidina entre os anêmicos com e sem deficiência de ferro. Houve correlação negativa entre a concentração de hepcidina e a de ferritina entre os anêmicos com deficiência de ferro e não foi observada correlações da hepcidina com os outros parâmetros inflamatórios. A desnutrição e a baixa ingestão calórica foram frequentes e não foi verificada baixa ingestão alimentar de ferro. Não foi caracterizada anemia de doença crônica com base na concentração sérica de hepcidina. / The aim of this study was to evaluate the iron status in hospitalized with advanced heart failure. 50 patients participated of this study, 24 of them have been diagnosed with anemia and among these 8 were identified with iron deficiency anemia. Males, aged between 30 and 60 years old, with left ventricular ejection fraction (LVEF) <0,45 were include in the study. For analysis of serum levels of hepcidin, interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-&#945;) and erythropoietin patients underwent blood collection after 8 hours fasting. Haematological and biochemical parameters were obtained laboratory tests routinely performed and were checked in medical records. Food consumption was evaluated by direct weighing method. The results the groups anemic and nonanemic with or without iron deficiency groups were compared by Mann Whitney test and correlations was made according to the Spearman`s and Pearson`s tests. No differences were found in serum hepcidin levels between anemic patients with or without Fe deficiency. There was a negative correlation between hepcidin and ferritin iron-deficiency patients, and correlations of hepcidin with other inflammatory factors were not significant. Malnutrition and low caloric intake were frequent and dietary intake of iron intake was adequate. Chronic disease anemia was not characterized based on serum hepcidin.

Resumo: A insuficiência cardíaca (IC) é uma síndrome grave associada a alta mortalidade em 5 anos, após o início dos sintomas. Portanto, é de interesse o estudo de tratamentos farmacológicos e não-farmacológicos que visem impedir a progressão da lesão miocárdica, reduzir os sintomas e melhorar a qualidade de vida. Uma das formas de tratamento não farmacológico é o uso de Pressão Positiva Contínua em Vias Aéreas (CPAP). Estudos mostraram que a CPAP está associada com melhora da função sistólica ventricular esquerda. Entretanto, há poucos dados na literatura referentes aos seus efeitos na função diastólica. Objetivos: o objetivo primário desse estudo foi avaliar os efeitos de sessão única de CPAP na função diastólica ventricular e na capacidade funcional de pacientes com IC compensada. Adicionalmente, foram analisadas, nesses pacientes, as associações entre capacidade funcional e função ventricular; capacidade funcional e qualidade de vida; e função ventricular e qualidade de vida. Estudo prospectivo, randomizado e duplo-cego, utilizando programa informatizado de números aleatórios, na proporção 1:1. Vinte e um pacientes foram alocados no grupo sham (ou CPAP simulado) e 23 no grupo CPAP, que recebeu a intervenção. Os pacientes, inicialmente, permaneciam 10 minutos em repouso e passavam por avaliação clínica. Em seguida, eram submetidos a ecocardiograma basal. Então, realizavam Teste de caminhada de 6 minutos (TC6) para aprendizagem, sendo que os dados obtidos nesse teste foram descartados. Enquanto descansavam por, no mínimo, 15 minutos, os pacientes respondiam ao Questionário de Qualidade de Vida de Minnesota (QQVM). Após, realizavam um segundo TC6, no qual os dados foram utilizados para análise. Ao seu término, os pacientes do Grupo CPAP recebiam a intervenção por 30 minutos a uma pressão de 10 cmH20. O pacientes do Grupo Sham permaneciam... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Heart failure (HF) is a syndrome associated with high mortality within 5 years after the onset of symptoms. Therefore) the study on pharmacological and non-pharmacological therapies for preventing myocardial damage progression) reducing symptoms and improving quality of life is desirable. One of the forms of non-drug treatment is the use of Continuous Positive Airway Pressure (CPAP). Studies have shown that CPAP is associated with left ventricular systolic function improvement. However) few data are available referring to its effects on diastolic function. The primary aim of this study was to evaluate the effects of a single CPAP session on ventricular diastolic function and on the functional capacity of patients with compensated HF. Additionally) the associations between functional capacity and ventricular function) functional capacity and quality of life and ventricular function and quality of Iife were analyzed in these patients. This was a prospective) randomized) double-blind study using a random-figure computerized program in the proportion of 1:1. Twenty-one patients were included in the Sham group (or simulated CPAP) and 23 in the CPAP group) which received the intervention. Initially) the patients rested for 10 minutes and then underwent c1inical evaluation. Next) they were submitted to a basal echocardiogram. Then) the six-minute walk test (6MWT) was performed for learning) and the data obtained in that test were discarded. While they rested for at least 15 minutes) the patients answered the Minnesota Living with Heart Failure Questionnaire (MLHFQ). They then performed the second 6MWT) in which the data were used for analysis. Upon completion) the patients in the CPAP group received the intervention for 30 minutes at apressure of 10 cmH20. The patients in the Sham group kept the CPAP mask on for that period of time) but without producing positive pressure. Next)... (Complete abstract click electronic access below) / Orientador: Beatriz Bojikian Matsubara / Coorientador: Silméia Garcia Zanati / Banca: Victor Zunica Dourado / Banca: Audrey Borghi e Silva / Mestre

No description available.

Trata-se de um estudo descritivo correlacional com abordagem quantitativa, que teve como objetivos: caracterizar pacientes com Insuficiência Cardíaca (IC) atendidos em clínica especializada (grupo A) e em pronto-socorro (grupo B), conforme perfil sócio-demográfico, perfil clínico, tempo de conhecimento da doença e internações no último ano; Identificar ações de autocuidado específicas nos grupos A e B; Verificar a diferença entre o autocuidado dos grupos A e B e Identificar os possíveis fatores precipitantes de descompensação no grupo B. A amostra foi constituída por 120 pacientes de um hospital especializado em cardiologia, localizado no município de São Paulo, sendo 60 em cada grupo. A coleta de dados foi realizada de julho a novembro de 2011, por meio da aplicação de instrumento elaborado para o estudo (1) e instrumento de adesão validado em estudo prévio (2). A análise estatística foi descritiva e inferencial, sendo utilizado o Alpha de Cronbach para avaliar a consistência interna do instrumento 2, Teste Exato de Fisher para variáveis categóricas, Teste t-student para comparação entre as médias das variáveis contínuas, teste não paramétrico de Mann-Whitney quando se rejeitou a hipótese de normalidade da variável. Predominou o sexo masculino 78(65%). Não houve diferença no tempo de conhecimento da doença entre os grupos. Observou-se que o grupo B teve mais internações no último ano. Não houve diferença estatisticamente significativa no escore de adesão do Instrumento 2, com média 46,09(±8,03) entre os grupos, para um escore máximo=60. Observou-se pior resultado nas ações de autocuidado referentes à percepção de piora clínica e comunicação com a equipe de saúde; controle de peso e vacinação contra influenza, sem diferença significativa entre os grupos. Identificou-se maior número de idosos, aposentados, sem renda e residindo sozinhos; chagásicos, com piores níveis de uréia, creatinina e hemoglobina e em uso de marcapasso no grupo B. No perfil hemodinâmico do grupo B, verificou-se que 44 (73,4%) pacientes apresentaram sinais de congestão e 37 (61,7%) sinais de baixo débito cardíaco, o que contribuiu para internação prolongada e alta letalidade. Conclui-se que os pacientes realizam parcialmente as ações de autocuidado, devido à dificuldade na percepção e comunicação da piora clínica; controle de peso e vacinação contra influenza, sem diferença significativa entre os grupos. Os possíveis fatores precipitantes de descompensação no grupo B relacionam-se à idade avançada, condições sócio-econômicas e pior perfil clínico. A continuidade deste estudo, com seguimento em seis meses, permitirá identificar os principais desfechos a curto prazo. Sugere-se o acompanhamento de pacientes em ambiente familiar para avaliar a real situação dos cuidados e o desenvolvimento de estudos voltados ao autocuidado de pessoas com IC avançada e/ou de etiologia chagásica, incluindo a criação de programas de cuidados paliativos. / This is a descriptive and correlational study with a quantitative approach, that aimed to characterize patients with heart failure (HF) treated in a Specialty Clinic (Group A) and Emergency Room (Group B), according to socio-demographic and clinical profiles, knowledge time of the disease and hospitalizations in the previous year; Identify specific actions of self-care specifically in Groups A and B; Check the difference between self-care in Groups A and B and identify the possible precipitating factors of decompensation in Group B. The sample consisted of 120 patients in a São Paulo, hospital specialized in cardiology, with 60 patients in each group. Data collection was conducted from July to November 2011, by applying an instrument developed for this study (1) and an instrument of accession validated in a previous study (2). Statistical analysis was descriptive and inferential, by using Cronbach\'s alpha to assess internal consistency of instrument 2, Fisher\'s Exact Test for categorical variables, Student\'s t-test for comparison between means of continuous variables, and non-parametric Mann-Whitney when it rejected the hypothesis of normality of the variable. Seventy-eight (78) males or 65% predominated in this study. There was no difference in the knowledge time of the disease between the groups however it was observed that Group B had more hospitalizations in the past year. There was no statistically significant difference in adherence score of Instrument 2, averaging 46.09 (± 8.03) between the groups, for a maximum score = 60. Worse results were observed in the actions of self-care with reference to the perception of clinical worsening and communication with the health team; weight control and influenza vaccination, without a significant difference between the groups. It was identified that the greater number of elderly, retired, no income and living alone; chagasic patients having worse levels of urea, creatine and hemoglobin and pacemaker use were all in Group B. In the hemodynamic profile of Group B, it was found that 44 (73.4%) patients showed signs of congestion and 37 (61.7%) signs of low cardiac output, contributing to prolonged hospitalization and high mortality. It was concluded that patients perform self-care actions in part because of the difficulty in perception and communication of clinical worsening, weight control and influenza vaccination, without significant difference between the groups. Possible precipitating factors of decompensation in Group B are related to advanced age, socio-economic status and worse clinical profiles. The continuity of this study, with a follow-up in six months, will identify the principal outcomes in the short term. It is suggested that the monitoring of patients be done in a family environment to assess the real situation of care and the development of studies to self-care of people with advanced HF and / or Chagas disease, including the establishment of palliative care programs.

Le réseau lymphatique permet le drainage des liquides interstitiels, le transport des cellules immunitaires et intervient dans le métabolisme lipidique. La dérégulation de ce système est impliquée dans de nombreuses pathologies comme les lymphœdèmes, le rejet de greffe ou encore l'échappement tumoral. Le cœur est pourvu d'un réseau lymphatique abondant dont l'importance n'est apparue que très récemment dans les pathologies ischémiques. En effet, suite à un infarctus du myocarde, la dysfonction lymphatique observée favorise l'œdème et l'inflammation tissulaire, révélant le réseau lymphatique comme un acteur majeur du développement de cette pathologie. Les processus régulant la formation de vaisseaux lymphatiques chez l'adulte sont largement dépendants de facteurs de croissance aux effets pro- ou anti- lymphangiogéniques. Les cellules immunes et plus particulièrement les macrophages sécrètent un grand nombre de ces facteurs et leur importance dans la réponse lymphangiogénique a été montrée dans différentes conditions physio-pathologiques, telles que la lymphangiogenèse tumorale et inflammatoire. Il a longtemps été admis que les macrophages tissulaires provenaient exclusivement de la différenciation de monocytes sanguins. Cependant, l'existence de macrophages provenant de progéniteurs embryonnaires a été récemment mise en évidence. Dorénavant, les macrophages tissulaires résidents sont perçus comme des populations hétérogènes pouvant prétendre à des différences fonctionnelles. A ce jour, les modifications du réseau lymphatique et les mécanismes permettant sa régulation, au cours de pathologies non ischémiques, n'ont pas été abordées. Ainsi, nous avons entrepris d'identifier et de caractériser les différentes populations de macrophages cardiaques participant à la régulation du réseau lymphatique suite à une surcharge barométrique. Nos résultats ont montré une diminution précoce du réseau lymphatique cardiaque dans le cœur murin hypertrophié au cours d'une surcharge de pression induite par constriction de l'aorte transverse. Cette réduction du réseau est associée à la perte d'une population majoritaire de macrophages cardiaques portant le récepteur 1 à l'acide hyaluronique (Lyve-1). Cette population résidente diminue dans le cœur insuffisant, au profit de macrophages infiltrants dérivés de monocytes sanguins. Par ailleurs, en plus d'être corrélée à la baisse du réseau lymphatique cardiaque, la diminution du nombre de macrophages Lyve-1 est proportionnelle à la détérioration de la fonction cardiaque. La prévention de l'infiltration monocytaire a permis de maintenir le pool de macrophages exprimant Lyve-1, le réseau lymphatique et la fonction cardiaques lors d'une surcharge de pression. La caractérisation par RT-PCR des différentes populations de macrophages récupérés par tri cellulaire nous a permis de montrer que les macrophages Lyve-1 présentent des caractéristiques particulières, avec une forte expression de VEGFR3 et NRP2, molécules de signalisation lymphangiogène. De plus, ces macrophages Lyve-1 à la polarisation mixte et à l'activité phagocytaire importante, expriment de nombreux facteurs pro-lymphangiogéniques (VEGFc, VEGFd, IGF1). Ils ont montré une activité pro-lymphangiogène in vitro sur des explants de canal thoracique et sur des cellules endothéliales lymphatiques et in vivo avec la formation de vaisseaux lymphatiques naissants lors de l'injection de ces macrophages Lyve-1 dans le cœur. Leur localisation à proximité des vaisseaux lymphatiques et leur capacité pro-lymphangiogène leurs confèrent un rôle évident dans le maintien du réseau lymphatique lors d'un remodelage cardiaque de surcharge de pression. Ces travaux ont permis l'identification d'une population originale de macrophages cardiaques pouvant entrer dans la régulation du système lymphatique au cours d'une surcharge de pression. / The lymphatic system has recently emerged as an important regulator of the cardiac interstitial fluid compartment and function. Experimental obstruction of lymphatic vessel leads to cardiac œdema, myocardial stiffness, fibrosis and ventricle dysfunction. Following myocardial infarction, stimulation of lymphangiogenesis was found to reduce fibrosis and inflammation and to improve cardiac function. Macrophages have been largely described as important contributors of lymphangiogenesis in inflammatory situations such as cancer. Recently, genetic fate mapping demonstrated that distinct populations of macrophages coexist in the adult heart. In addition to monocyte derived-macrophages that massively colonize injured heart, a subpopulation of tissue-resident macrophages that originates from embryonic precursors persists into adulthood by means of local self- renewal. To date the distinct involvement of cardiac macrophage subpopulations in cardiac lymphatic remodeling and heart failure progression induced by pressure overload is largely unknown. In our study, we observed that expression of Lyve-1 identifies a resident macrophage subset abundant in mouse heart. This Lyve-1 positive macrophage subset decreased rapidly in cardiac remodeling induced by chronic pressure overload. In addition, the number of cells found in heart was positively correlated with the preservation of cardiac lymphatic network and function after transverse aortic constriction (TAC). Blocking recruitment of monocyte derived macrophages expanded Lyve-1 positive macrophages, attenuated cardiac lymphatic remodeling and contractile dysfunction of pressure overloaded heart. Lyve-1 positive macrophages express pro-lymphangiogenic factors and sustain lymphangiogenesis in vitro and in vivo. In conclusion, resident macrophage subset expressing the Lyve-1 receptor participates to maintain cardiac function after chronic pressure overload by mechanisms that may involve the preservation of cardiac lymphatic system. These results provide insight into the regulation of lymphatic homeostasis by tissue resident macrophage during heart failure induced by pressure overload.

Heart failure is a chronic disease and a common cause of hospitalizations and readmissions within 30-days of discharge. To decrease the cost of care for patients with heart failure, the Centers for Medicare and Medicaid Services initiated the Readmissions Reduction Program that reduces payment to hospitals with preventable readmissions. Among the causes for readmissions of patients with heart failure are concurrent behavioral health issues that can lead to decreased medication compliance and increased risk for disease progression. The prevalence of comorbid depression is as high as 77% among patients with heart failure and may be an important factor in readmissions. Although cardiac nurses in the emergency room, intensive care unit, and the progressive care units at a community hospital were perceived by managers to be in optimal settings to assess for behavioral health issues and make referrals as appropriate, assessments were not being conducted. The purpose of the project was to determine the barriers nurses faced in completing the assessments. Four audiotaped focus groups with a total of 18 cardiac nurses were held and the data were transcribed for analysis. Using Kalcaba's comfort contexts (physical, psychospiritual, social, and environmental), the barriers identified by the nurses were categorized into a fishbone diagram and a Pareto chart. The nurses identified lack of a standardized screening tool, lack of priority given to behavioral health assessments, lack of time to conduct the assessments, and lack of a clear facility policy related to the assessments as barriers. A positive social change resulting from the project is an initiative to address the barriers and ensure that patients with heart failure are cared for in a holistic manner that addresses physical and behavioral health issues.