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S110 Journal of Cardiac Failure Vol. 20 No. 8S August 2014

Figure.

Conclusion: The results demonstrate that a multidisciplinary team-based risk assess-ment and mitigation model is able to produce a meaningful and sustained reduction inHF readmissions. Moreover, the results challenge the notion that urban hospitalsserving large numbers of low socioeconomic patients are incapable of readmissionrates comparable to other facility types.

278Culturally-Appropriate Education Can Improve Self-Care in Hispanic Patientswith Heart Failure: A Pilot StudyJill H. Esquivel1, Zenelia Roman1, Robyn A. Clark2, Bronwyn Fredericks3, KathleenDracup1; 1UCSF, San Francisco, CA; 2Flinders University, Adelaide, Australia;3Central Queensland University, Rockhampton, Australia

Introduction: Hispanics constitute the largest US ethnic group and have been shownto have more frequent heart failure (HF) hospitalizations than non-Hispanic whites.Disease management programs that teach HF self-care are known to successfullyreduce hospitalization rates and mortality. However, most programs are limited topatients who speak English. Hypothesis: Project Fluido, a culturally appropriateself-care education intervention, will improve self-care behaviors and knowledgein Hispanic patients with HF, compared with usual care. Methods: Project Fluido(N542) was a randomized controlled pilot trial over 3 months that included: 1 ses-sion of individualized education in Spanish using the “teach-back” method of educa-tion, nurse phone call every 2 weeks, script for calling provider, scale, and diary inthe intervention group (n522). The usual care group (n520) received a scale andwritten information. Health literacy was measured using the Short Assessment ofHealth Literacy for Spanish Adults. Four knowledge topics were included when usingteach-back: high salt foods, when to call the MD, when to report weight gain, and theuse of diuretics. Self-care was measured using the Self Care Heart Failure Index andknowledge using Teach-back scores. The intervention was vetted by cultural and HFexperts. Results: Participants’ mean age was 57+14 years, 57% (24) were male,64%(27) had hypertension, 86% (36) were New York Heart Association Class I-III, and 65% (26) had HF with reduced ejection fraction. Participant health literacyscores showed poor health literacy in 30%(13) with 67% (28) who spoke Spanishonly. Participant income was reported as !20K in 93% (39) with 38% (16) livingwith 4 or more in the home. Self-care and knowledge scores significantly improved(p ! .001, p!.001 respectively) in the intervention group compared to usual care.Conclusions: The intervention utilized in Project Fluido was a remarkably effectivemethod to improve HF knowledge and self-care in a group of Spanish-speaking HFpatients. This improvement is in spite of low physical function, health literacy, accul-turation and economic challenges that the participants faced. In addition, teach-backwas an effective teaching strategy to improve HF knowledge. Future work is neededto investigate the relationship between increased self-care knowledge and readmis-sions and mortality in Spanish-speaking patients with HF.

279The Natural History of Subjects with Isolated Metabolic Syndrome- APopulation Based StudyPratik A. Patel1, Christopher Scott2, Richard Rodeheffer3, Horng Chen3; 1MayoClinic, Rochester, MN; 2Mayo Clinic, Rochester, MN; 3Mayo Clinic, Rochester, MN

Background: Metabolic syndrome (MS) as defined by the presence $3 ATP-NCEP-III criteria is associated with increased risk of cardiovascular disease and mortality.Isolated MS is defined as metabolic syndrome subjects that do not meet the diagnosisof hypertension and diabetes and are not on therapy for either, despite havingelevated blood pressure and hyperglycemia. The natural history of isolated MS re-mains undefined. Objectives: To determine the natural history of isolated MS.Methods: Data was collected prospectively on a population-based random sampleof 2042 Olmsted County, Minnesota, residents aged 45 years or older who underwentclinical evaluation, medical record abstraction, and echocardiography (Visit 1 [1997-

2000]). After 4 years, participants returned for Visit 2 (2001-2004). From visit 2, wehave a median (IQR) of 8.3 (7.3, 9.2) years of follow-up. Isolated MS was defined bynon-hypertensive or non-diabetic subjects with MS as defined by the presence $3ATP-NCEP-III criteria. Results: We identified 232 subjects with isolated MS andcompared them to 701 healthy controls. Subjects with isolated MS were older(61.19+8.84 years vs 58.69+9.08 years, p#0.001), had higher prevalence of diastolicdysfunction (normal 75% vs 85%,mild 18% vs 10%, moderate/severe 6% vs6%,p50.002), higher LV mass index and higher aldosterone and galectine 3 levelsas compared to healthy controls (p!0.05). At visit 2, a greater percentage of subjectshad developed new diagnoses of hypertension ,diabetes, and GFR! 60 ml/min in theIsolated MS group versus healthy controls (p!0.05) . Patients with isolated MS didnot have significantly higher rates of mortality (p50.12) or development of heart fail-ure (HF) (p50.64) than healthy controls over 8 years. Women with isolated MS hadhigher progression of diastolic dysfunction (increase in diastolic grade from normalto mild to moderate/severe) than men with isolated MS over 4 years (43% vs. 24%,p50.003). Conclusion: Subjects with isolated MS have significant LV remodelingand neurohumoral activation as compared to healthy controls. Isolated MS is associ-ated with increased risk for the development of hypertension, diabetes and renaldysfunction but not increased mortality or development of HF over an 8 year period.There is a gender difference in the progression of LV diastolic dysfunction in subjectswith isolated MS.

280High Sensitivity Troponin T (Hs-TnT) Predicts Outcomes in Patients Admittedwith Acute Decompensated HeartAhmed Soliman1, Mohamed El-Beheary1, Andrea M. Cordero-Reyes1, Craig M.Pratt1, Christie M. Ballantyne2, Arvind Bhimaraj1, Barry H. Trachtenberg1, GuhaAshrith1, Vijay Nambi2, Jerry D. Estep3; 1Houston Methodist Hospital, Houston,TX; 2Baylor College of Medicine, Houston, TX; 3Houston Methodist Hospital,Houston, TX

Introduction: Heart failure outcomes have become a focus of investigation for amultitude of different reasons in the healthcare system. Different markers havebeen evaluated to help predict outcomes for patients suffering from heart failure.We investigated High Sensitivity Troponin T (Hs-TnT) as a predictor of events in pa-tients that presented to the hospital with Acute Decompensated Heart Failure(ADHF). Methods: The study prospectively identified patients that were admittedto Houston Methodist Hospital (HMH) with clinical evidence of ADHF. With anapproved IRB protocol and patient consent Hs-TnTwas measured at baseline (admis-sion), 24 and 48 hours. Demographics and outcomes were obtained either by phonecalls, hospital records or via registered mail. Composite outcomes were defined asdeath, LVAD and/or transplant. AUC curves were used to determine optimal cut-off values for Hs-TnT and Kaplan Meier curves constructed to determine event-free survival. P-values ! 0.05 were considered significant. Results: 164 patientswere consented for the study and 17 patients were excluded. A total of 147 patientsincluded the final study population. Mean age was 69 6 15, 60 (41%) patients werefemale, and 86 (59%) were Caucasian. Hypertension was present in 131 (90%) pa-tients and DM in 71 (48%). 81 (55%) patients had a history of coronary artery dis-ease. There were a total of 38 events in the study population, which included 28(19%) deaths, 6 (4%) LVAD implants and 4 (3%) transplants. The AUC for HsTnTwas 0.78 (CI: 0.68-0.86) p-value!0.0001 with a sensitivity and specificity to predictcomposite outcomes of 86% and 53% respectively. We determined the cut-off valuefor HsTnT of 0.030 and Kaplan Meier curve demonstrated a decreased event-free sur-vival in this patient population. Conclusion: High Sensitivity Troponin (Hs-TnT),obtained during admission of a patient presenting with ADHF, is a valuable andstrong predictor of outcomes in these patients. With the projected increase in this pa-tient population and the burden this will place on the healthcare system, further inves-tigation in the use of Hs-TnT should be highly encouraged.