Oral Presentation Session I

Background/Significance:

Anemia is a common comorbidity among patients undergoing Transcatheter Aortic Valve Replacement (TAVR), affecting nearly one-third of this population. Anemia has been associated with increased mortality, procedural complications, and adverse outcomes. Anemia in TAVR patients can arise from pre-existing conditions or procedural factors, such as periprocedural bleeding, hemolysis, and the use of antiplatelet or anticoagulant therapy. Despite its prevalence, the impact of anemia on TAVR outcomes remains uncertain.

Purpose:

This study provides a nationwide perspective on anemia’s role in TAVR outcomes, addressing gaps in existing research. Findings may inform risk stratification, perioperative care strategies, and resource allocation. Improving anemia management could enhance patient outcomes and reduce healthcare burdens.

Methods:

We stratified patients who underwent TAVR in the national inpatient sample database from 2016 to 2020 by the presence or absence of anemia. Multivariable logistic regression was performed, adjusting for age, gender, race, income, insurance, comorbidity score, hospital location, and bed size. The primary outcome was mortality and postprocedural bleeding. Secondary outcomes were cardiac arrest (CA), cardiogenic shock (CS) and acute heart failure. A p-value < 0.05 was considered statistically significant. All analyses were performed in STATA.

Results:

Among 296,740 TAVR cases, 32% (n=94,920) had a history of anemia (TAVRAN), and these patients were older (79.06 ± 8.85 vs. 78.78 ± 8.39 years, p < 0.001), more likely to be female (48.9% vs. 42.5%, p < 0.001), and had higher rates of hypertension (81.9% vs. 74%, p < 0.001), peripheral vascular disease (11.1% vs. 9.7%, p < 0.001), chronic obstructive pulmonary disease (25.6% vs. 21.3%, p < 0.001), and pulmonary hypertension (11.7% vs. 8.7%, p < 0.001). TAVRAN patients experienced worse postprocedural outcomes, including higher in-hospital mortality (2.23% vs. 0.95%, AOR 1.22, 95% CI: 1.03–1.45, p = 0.024), increased risk of postprocedural bleeding (3.87% vs. 1.21%, AOR 2.94, 95% CI: 2.56–3.39, p < 0.001), greater likelihood of cardiac arrest (1.49% vs. 0.63%, AOR 1.55, 95% CI: 1.25–1.93, p < 0.001), higher rates of cardiogenic shock (3.76% vs. 1.14%, AOR 1.69, 95% CI: 1.43–1.99, p < 0.001), and increased incidence of acute heart failure (37.40% vs. 27.74%, AOR 1.22, 95% CI: 1.14–1.30, p < 0.001).

Conclusion:

Anemia in TAVR patients is associated with higher comorbidity burdens and adverse clinical outcomes, including increased mortality and procedural complications. These findings highlight the importance of identifying and managing anemia in TAVR patients, necessitating tailored perioperative strategies to optimize outcomes. Future research should focus on improving anemia management to enhance procedural success rates.

Background/Significance:

Recent research suggests that there is a disparity in the management of chronic pain in different races, particularly in Black, Indigenous, and People of Color (BIPOC) groups. Other findings suggest differences in pain prevalence and responses to acute and chronic pain among these groups.

Purpose:

This study examines the demographic and clinical characteristics of pain management among different racial groups.

Methods:

A total of 1,662 patients in the Chicagoland area were analyzed to determine variations in pain intensity, duration, type of pain, and treatment modalities. These patients were followed for a minimum of one year and had at least four different clinic appointments. Participants were subcategorized based on race. We collected variables such as age, Body Mass Index (BMI), duration of pain, pre-visit and post-visit pain rating on a numeric rating scale, location of pain, type of intervention received and use of different pain medications. We used IBM SPSS 27 to perform statistical analysis; data were analyzed using ANOVA, X2 and correlation analysis.

Results:

Of the 1,662 participants in this study, 47.8% identified as White, non-Hispanic; 32.6% identified as White- Hispanic and 19.6% identified as Black. Significant differences in mean age and BMI were observed across groups. The Black population reported a higher average age and BMI measurement (p=0.012 and p< 0.001, respectively). Low back pain was the most prevalent condition across all groups, particularly among Black patients (70.6%, p=0.005). Treatment strategies also varied significantly; steroid injections were most used, again especially among Black patients (90%, p< 0.001). Gabapentin and opioids were more frequently prescribed to White-Hispanic and Black patients compared to White, non-Hispanic patients (p< 0.001). These two populations also reported higher NSAID use than the White, non-Hispanic population (p=0.041).

Conclusion:

Pain assessment and management can be challenging due to its subjective nature. Its assessment and management require an organized and effective communication strategy between patients and their providers. Our findings highlight disparities in pain management approaches and outcomes across different racial and ethnic groups. Further studies should focus on overcoming these obstacles and a need for tailored pain management strategies.

Background/Significance:

Nurses were experiencing occupational stress with negative psychological effects before COVID-19. The pandemic intensified healthcare delivery demands and significantly impacted healthcare workers with negative psychological effects. Healthcare organizations worked to enhance existing wellness programs and develop new resources to support worker coping and resilience. Little is known about the status of nurses and the extent that wellness resources were used.

Purpose:

The study was conducted to explore nurse perceptions of their psychological status, personal stressors, and use of wellness resources three years after the start of COVID-19. This data collection recruited nurses across all roles during the third (T3) and final phase of COVID-19 Nurse Study that began in 2020.

Methods:

A descriptive cross-sectional study was conducted to examine the current status of and wellness resources used by nurses employed by the Midwest region of a large non-profit healthcare system. Metrics included three valid/reliable tools to evaluate self-reported psychological effects. Analysis focused on nurse characteristics, psychological effects, wellness resource use, and identified barriers.

Results:

Participants (N=1388) reported working as clinical nurses (n=1077, 77%), managers/supervisors (n=90, 7%), support (59, 4%) or other roles (n=153, 11%). Many nurses (60%+) reported having 1 or more personal stressors at T3. Screening revealed that nurses had high ratings for distress (n=287, 21%), depression (n=179, 13%), anxiety (n=202, 15%), with a few (n=77, 6%) rating high on all scales across all role types. Over half (n=775, 56%) reported using wellness resources, but most reported using one of the eleven available options. Informal peer support (31%), relaxation (16%), and manager support (16%) were used most often. Some users (110, 14%) reported barriers including limited time (81%), confidentiality (58%), and the resource didn’t help (39%). Only 11% (n=69) of nonusers (n=614, 44%) reported barriers including limited time (55%), confidentiality (45%) and limited access (29%). Low response rate may underestimate the impact on non-participants. Survey methodology may limit full capture of these experiences. Site findings were similar.

Conclusion:

Three years post-COVID-19, the need for emotional and psychological support for nurses remains significant. Utilization patterns and barriers identified in this analysis provide valuable input to confirm the need for tailored resources and inform future resource refinement.