ABSTRACT
Methods: We completed semi-structured telephone interviews with 15 Veterans across 7 VHA facilities who had participated in TCMLH between Summer 2020 and Winter 2021. The interview recording transcripts were coded using a consensus-building process and analyzed to generate themes. Results: Veterans described positive experiences with TCMLH groups, while also suggesting areas for improvement. Interviewees generally appreciated the core elements of TCMLH curriculum;difficulties that were reported related to group pace and content. Social dynamics - interactions and relationships between TCMLH participants - took center stage in the interviews, with positive comments on the value of connecting with others, sharing and learning new ideas, and providing mutual support and accountability. Some challenging interactions with groupmates were also recounted. The virtual format of the TCMLH groups, which VHA rapidly adopted in the wake of the COVID-19 pandemic, was perceived as both facilitating and constraining engagement and relationships. Finally, Veteran interviewees described diverse ways in which they thought the group participation had enhanced their lives. These perceived impacts of TCMLH participation included positive changes in attitude, acquiring healthy habits, improvements in social life, and shifts in healthcare (i.e., trying new modalities, changing one's interactions with their clinical team). Background: As part of its emerging Whole Health (patient centered, holistic) system of care, the Veterans Health Administration (VHA) offers 'Taking Charge of My Life and Health' (TCMLH), a peer-led, group-based course in which Veterans explore how different areas of life impact their health and wellbeing and support one another in setting and pursuing personally meaningful health goals. We sought to understand Veteran perspectives on and experiences in TCMLH groups. Conclusion: Veterans perceived TCMLH groups to be meaningful, engaging, and impactful, offering valuable recommendations to further improve the group experience. Other health systems may consider developing similar group based programs to bolster guided self-reflection, goal setting, and peer support among patients.
ABSTRACT
Background: The use of intermittent infusion of Levosimendan (L) demonstrated to be able to reduce hospitalisations and to improve functional capacity and quality of life in patients with advanced heart failure (HF). Purpose: To describe our preliminary experience regarding L intermittent infusions in advanced HF older outpatients. Methods: A maximum of three consecutive L infusions were carried out 14 days apart. The duration of each session was 8 hours. The starting infusion rate was 0.05 μg/Kg/min, titrated every 30/60' up to a maximum of 0.2 μg/Kg/min based on blood pressure, heart rate and arrhythmias recorded during telemetry. We evaluated patients by clinical, laboratory and echocardiographic controls at baseline and two weeks after the end of treatment. Results: Since November 2020 we enrolled 17 patients with a mean age of 77 years;12% were women. HF etiology was ischemic in 64% of cases and the mean ejection fraction was 30%. A total of 41 infusions were performed, the mean dose of L administered was 5.4 mg/infusion. Three patients did not complete the expected treatment, one due to an intercurrent COVID-19 infection and two because of social issues. In 28 sessions the maximum infusion rate was reached, while in 12 a lower rate;in one case drug infusion was suspended (Figure 1). The main complication observed was marked non-symptomatic hypotension, followed by the onset of atrial fibrillation or frequently ventricular extrasystole. As shown in Figure 2, at the end of the infusion cycles, there was an improvement of clinical and hemodynamic parameters. Moreover, at the end of the infusion cycles, we observed a reduction in the mean dose of loop diuretic prescribed and an increase in the prescription of disease- modify treatment, according to HF guidelines (Figure 3). Conclusions: In our preliminary experience repeated infusions of L appear to be well tolerated in older patients with advanced HF. Although there was an improvement in congestion parameters and targeted therapy for HF, more data will be needed in the future to confirm its safety and efficacy, also in terms of guidelines-directed medical therapy. (Figure Presented).
ABSTRACT
Objective: Committed to implementing a personcentered, holistic (Whole Health) system of care, the Veterans Health Administration (VHA) developed a peerled, group-based, multi-session Taking Charge of My Life and Health (TCMLH) program wherein Veterans reflect on values, set health and wellbeing-related goals, and provide mutual support. Prior work has demonstrated the positive impact of these groups. After face-to-face TCMLH groups were disrupted by the COVID-19 pandemic, VHA facilities rapidly implemented virtual (video-based) TCMLH groups. We sought to understand staff perspectives on the feasibility and value of conducting TCMLH groups virtually. Methods: We completed semi-structured telephone interviews with 18 staff members involved in the rapid implementation of virtual TCMLH groups at 5 VHA facilities about their perspectives and experiences. Interview transcripts were analyzed using rapid qualitative analysis. Results: Virtual TCMLH groups posed technological and logistical challenges and were perceived as disruptive of the relationship-building and communication observed in faceto- face groups. However, participants noted that Veterans still found ways to bond and group facilitators adjusted their approach to improve flow and engagement. Participants also described perceived advantages of the virtual format: (1) participating from home was less stressful for Veterans and more conducive to them opening up;(2) being in one's home environment organically facilitated Veteran reflection on values and goals;(3) there are opportunities for wider-scale recruitment, greater accessibility, and potentially better Veteran retention. Conclusion: Faced with the disruption posed by COVID- 19, VHA successfully pivoted by rapidly implementing virtual TCMLH groups and addressing challenges of the new format. These groups may offer a crucial lifeline for Veterans who are feeling isolated and/or whose wellbeing has suffered during the pandemic. A virtual group-based program in which participants set and pursue personally meaningful goals related to health and well-being in a supportive environment of their peers is a promising innovation that can be replicated in other health systems.