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Background: Left ventricular assist devices (LVAD) improve functional class and survival in selected patients with advanced heart failure. Right Ventricular Failure (RVF) after LVAD implantation is associated with increased mortality, morbidity and hospitalization. Identification of LVAD candidates at risk for RVF remains challenging. The purpose of this research is to determinate association of clinical and echocardiographic parameters with early and late RVF, clinical outcomes, and mortality after LVAD implantation. Methods: We retrospectively reviewed 156 consecutive LVAD implantations at the University of Florida at Gainesville, FL, from 2006 to 2016. Clinical and transthoracic echocardiographic data were studied. Early RVF was defined as the unplanned need for a right ventricular assist device or inotrope dependence for ≥14 days. Late RVD defined as either starting IV inotropes after 6 months of LVAD implantation or need for LVAD speed reduction after 6 months of LVAD implantation. Results: Data were collected for 91 patients whose longitudinal follow up data were available. Our cohort was predominantly males (78%) with a mean age of 59.1 years. Early RVF was detected in 27 patients (29.7%) late RVF was detected in 10 patients (11%). Obesity was associated with increased late RVF (P = .035). There was a negative correlation between pre-implantation right ventricular diameter and late RVF (r = −250, P = .021), however, it did not predict RVF on linear regression analysis. Pre-implantation echocardiographic right ventricular parameters such as tricuspid regurgitation severity, right ventricular fractional area change, and tricuspid annular excursion showed no correlation with post-LVAD implantation RVF, hospitalization, or mortality. Conclusions: Right ventricular dilation was inversely related to the development of late RVF after LVAD implantation, but predictors may extend beyond routine echocardiographic parameters. In our institution, these parameters were not predictive of outcomes. Obesity was associated with late RVF suggesting that patient factors play an important role in this disease process. There is need for in-depth investigation of the pathophysiological changes to the right ventricular in LVAD patients. Our results also highlight the responsibility for centers to determine center-specific risk factors and approaches to RVF.

Background: Congestive heart failure(CHF) is a common outcome of many cardiac diseases, notorious for recurrent hospitalizations. While studies have noted the importance of weight monitoring with outpatient diuretic use, we observed that patients who get admitted with an acute CHF exacerbation do not consistently get accurate daily weights with inpatient diuresis. We aim to identify the adherence to daily weight monitoring and assess the prevalent barriers that exist at a tertiary care center. Methods: We conducted a retrospective study at our tertiary care center. A survey was sent to the nursing staff in all Medicine patient units to evaluate when daily weights were being obtained, what their opinion was on the ideal time to obtain daily weights as well as the barriers to doing so, in order of significance. We performed a chart review of patients admitted with CHF between June 1st 2014 to June 30th 2015, who were managed with intravenous diuretics. Data variables collected were length of hospital stay, number of days accurate standing weights were recorded including admission and discharge days and the nursing unit on which the patient was located during their hospitalization. Results: A total of 110 patients required intravenous diuresis for CHF in the studied period. Average length of stay was 4.2 days. On average, weights were recorded for 87.51% of hospital days. 4% of patients did not have initial weight checked at admission. 12% of patients did not have discharge weights recorded. 90% of nurses responded on the surveys that morning weights are ideal. Around 86% of nurses responded that barriers to obtaining morning weights were patient concerns of sleep interruption. Conclusion: Determining the appropriate end-point for diuresis can be challenging. Achieving euvolemia or a dry weight is a good indicator of clinical improvement. We found that patients with CHF had their weights monitored on most days of inpatient stay, while being managed with intravenous diuresis. Ideally, morning standing weights are best used to monitor treatment response. While majority of nursing staff was aware of the same, compliance rates to achieve this were low due to patient-related barriers such as concern of sleep interruption. More interventions targeting dissemination of awareness regarding daily weight monitoring, among healthcare workers and patients, is required to achieve higher compliance rates and improve patient outcomes.