bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of perceived caregiver strain in carers of patients living with heart failure: data from a collectivist society
Authors: Massouh A , Deek H , Avedissian T
Published: July 2024

Background

Informal caregivers are individuals voluntarily caring for someone facing a disease, disability, or any condition requiring particular attention.1 They provide around 90% of in-home care and play a key role in supporting the wellbeing and care of people living with chronic illnesses.2 Such diagnoses alter roles within the family unit and cause feelings of uncertainty, anxiety, depression, resentment, among others. This is true in caregivers of patients living with Heart Failure [HF]. High care dependency and lack of formal support for caregiving have increased the prevalence of caregiver strain.

Purpose

To describe caregiver strain and identify its determinants among caregivers of patients living with HF.

Methods

This was a cross-sectional correlational study. Caregivers were assessed for caregiver strain (Modified Caregiver Strain Index [MCSI]), social support (Carers of Older People in Europe Index [COPE]), and quality of life (QOL; Short Form 12). MCSI scores were compared across dyadic variables and then used as the outcome variables to create the regression model.

Results

108 patients (age 63.54 ± 10.52 years, 70.4% males, 81.55% married) and caregivers (age 49.37 ± 13.69 years, 14.8% males, 82.2% married) were included. More than 80% of the dyads lived in the same household. Caregivers have been assuming this role for an average of 8.53 years and a mean of 37.73 hours per week. Almost 50% of the caregivers reported providing minimal care for their patient while 35% reported providing full care. An alarming 67.6% of the dyads were considered discordant and did not agree on how and by who the care is performed. Caregiver strain was average in this sample with a mean of 11.32 ± 6.94.

Caregivers who provided full care had significantly higher caregiver strain (13.75 ± 6.16 versus 9.82 ± 7.16; F (2,76) = 3.329, p = 0.041). Poor caregiver perceived quality of the dyad was significantly associated with higher caregiver strain (16.07 ± 6 versus 10.71 ± 6.9; p < 0.001). Caregivers of symptomatic patients had lower caregiver strain than caregivers of asymptomatic patients (9.90 ± 7.43 versus 12.69 ± 6.21; p = 0.019). Being stressed in caregiving was significantly associated with higher caregiver strain (r = 0.774; p < 0.001). Having lower physical and/or mental QOL were associated with higher strain (r = -0.291 and -0.536 respectively; p < 0.001). Finally, a higher negative impact from caregiving, a lower mental and physical QOL, and a lower relationship quality explained about 63% of the variance in Caregiver Strain (F = 44.001; p < 0.001).

Conclusion

Knowledge from this study will help place caregivers’ health at the core of caregiving processes. HF nurses and physicians should start giving special attention to caregivers of HF patients who show signs if high caregiver strain. Interventions to reduce strain should be designed to address caregivers’ appraisal of dyad relationship quality, instrumental social support, and QOL.
Exergaming in patients with heart failure. A pilot study of the HEART-EXERGAME (Heart-eXg) intervention
Authors: Andreassen M , Klompstra L , Lans C , Antoniadou M , Stromberg A , Jaarsma T
Published: July 2024

Background

Physical activity in patients with heart failure (HF) can improve physical function, quality of life, reduce rehospitalization and mortality. A new approach increase physical activity for patients with heart failure (HF) is the use of exergames (games that requires physical activity to play). An international multi-centre RCT study, called the Heart-eXg study (clinicaltrials.gov ID: NCTxxx), is developed to determine the effectiveness of 3-months exergaming for patients with HF to decrease their sedentary time. The mobile exergame is co-designed for this study, entails a farming theme, and personalized on patients exercise capacity. The aim of this pilot study was to test the protocol of the intervention, in terms of recruitment, procedures of the intervention, assessment of outcomes and adherence to exergaming.

Material and methods

In the pilot study, the inclusion of patients was assessed. The randomization was tested but all patients were assigned to the exergame group. To further test the procedures the time was recorded of the installation/instructions to the exergame, the telephone follow-ups (to increase motivation) and outcome assessment.

Outcomes were the 6-minute walk test (exercise capacity), Fried frailty test (frailty), VAS-Score EQ5D, 0-100 (quality of life), Canadian Occupational Performance Measure (occupational performance). Adherence (walking 10 minutes every day with the exergame) was assessed during the 3 months exergaming, as the time exergaming was recorded.

Results Pilot study

In total 13 patients were eligible and 5 included. Mean age was 71 (±10), 2 females, 1 patient in NYHA-class II and 4 patients in NYHA-class III. One patient dropped out directly after baseline (severe disease) and 1 never exergamed (time constraints). Result of exercise capacity, quality of life and occupational performance are presented in the Table. The procedures of the intervention were feasible, the visits to the hospital took between 1 hour and 1.5 hour and the telephone follow up approximately 5-10 minutes. Test of occupational performance took longer time than calculated (30 min instead of 15 min).

Of the 3 patients who exergames, 1 patient played irregularly and stopped after 4 weeks. Two patients were adherent, see Figure.

Conclusion

The protocol of the intervention was feasible to use. In total, 38% of patients accepted to be included in the intervention and 20% of the patients dropped out (1 out of 5) and 50% were completely adherent to the intervention. Time for installation/introduction and telephone follow-ups were appropriate. As the occupational performance assessment took more time than then expected, we decided to test this in 100 out of the 600 patients planned to be included in the RCT study.TableFigure
Impact of reduced ejection fraction on affect, cognition and self-care behaviors in adults with heart failure
Authors: Jedrzejczyk M , Lee C S , Denfeld Q E , Szczepanowski R , Nowak B , Czapla M , Vellone E , Uchmanowicz I
Published: July 2024

Introduction

In response to the escalating complexity of clinical care for individuals with heart failure, there is a growing need for in-depth investigations. This study investigated the influence of ejection fraction (EF) on affective symptoms (i.e. anxiety and depression), cognitive function, and self-care behaviors in adults with heart failure.

Aim

The primary aim of this study was to compare affective symptoms, cognitive function and self-care behaviors between adults who had heart failure with reduced EF (HFrEF: EF≤40%) and adults who had heart failure with preserved EF (HFpEF: EF>40%). The secondary aim was to explore differences in the relationship between cognitive function and self-care behaviors.

Material and Methods

Participants in this cross-sectional study were recruited from heart failure clinics in Wroclaw, Poland between 2022 and 2023. Comprehensive clinical characteristics, including EF, were extracted from the medical record. Participants completed a survey that included reliable and valid measures of affective symptoms (Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9)), cognitive function (i.e. the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE)), and self-care behaviors (self-care of heart failure index).

Results

The study included a total of 250 participants with heart failure: 145 (58%) had HFrEF and 105 (42%) had HFpEF. Patients with HFrEF were younger (71.1±6.2 years) than those with HFpEF (73.0±7.0 years; p=0.011). There were fewer women with HFrEF (n=16 (15.2%)) than HFpEF (n=61 (42.1%); p<0.001). There were no statistically significant differences in affective symptoms, cognitive function or self-care behaviors comparing adults with HFrEF vs. HFpEF (all p>0.05). Overall, worse cognitive function was associated with worse self-care based on the MMSE (r=-0.20, p=0.001) but not the MoCA (r=-0.12, p=0.056).

Conclusion

Although there were no affective, cognitive, or self-care behavioral differences between adults with HFrEF and HFpEF, age and gender differences between these groups must be considered in clinical care. Additionally, cognitive dysfunction, especially as measured by the MMSE, must serve as a red flag for poor self-care in heart failure irrespective of EF.
A study to determine if the fluid heart tracker app supports patient decision-making at the onset of worsening heart failure
Authors: Caples N , O'brien F , Mooney M
Published: July 2024

Background

Delay in seeking early intervention for worsening heart failure (HF) can result in poorer patient outcomes, hospital admission and increased risk of mortality (Andersen 2017, Matsue et al. 2017, Mikami et al. 2021). Despite the availability of health-related mobile apps for HF self-care, no study has focused on whether apps designed for HF weight monitoring make a meaningful contribution to the decision-making process of HF self-care.

The Fluid Heart Tracker App was developed as a simple app to support the patient in the identification of significant weight gain as a result of worsening HF. An Advanced Nurse Practitioner in HF proposed the concept of the app, and it was developed by an Open-Source Volunteer team. It has one feature which is weight monitoring. It does not require interpretation of symptoms. The app has CE approval. It does not have a backend. The Irish Heart Foundation (IHF) has championed the app and the National Heart Programme listed it as a patient resource in the National Model of Care for Heart Failure in Ireland. The app is free to download from play store and the app-store in Ireland and the UK.

Pilot study

An evaluative, cross-sectional pilot study was initially carried out in potential users from three acute general hospitals. to determine the acceptability and usefulness of the Fluid Heart Tracker-App for patients with HF. This to garner feedback to use to develop, alter or refine the app.

Methods

Participants downloaded the app and used it to monitor their daily weight for two weeks. A short bespoke questionnaire was developed for the survey. It comprised five valid questions with dichotomous answers and an option at the end for participants to add any additional six comments.

Results

31 participations- 13 female. The average age was 72. All participants (N=31, 100%) used the app, found it useful and found it easy to use and all participants would recommend the app to other patients with heart failure. 30 participants used the app daily, while one used it on alternate days. Participants stated that it was easy or very easy to use. Based on these positive results a before and after, quasi-experimental study is currently being undertaken.

Aim of current study

The aim of this current study is to determine the impact, use and the effect of the Fluid Heart Tracker App on patient decision making in HF.

Primary Outcomes

1) Compare if using the app improved previous engagement patterns for weight monitoring.

2) Determine which factors influence engagement with the app.

3) Determine the impact of an app alert to the patient on seeking medical attention for worsening heart failure.

Progress to date

179 participants were recruited from 12 HF sites in Ireland. Data collection was completed November 2nd, 2023. Currently the data set is being cleaned prior to statistical analysis. This investigation has been undertaken as part of a PhD study.
Sex differences in acute myocardial infarction - Preliminary results from an umbrella review
Authors: Torres C , Ann Kristin Bjornnes A K B , Milada Hagen M H , Sigrun Halvorsen S H , Tomas Jernberg T J , Irene Lie I L
Published: July 2024

Background

Cardiovascular disease (CVD) is the leading cause of premature death among women, and the negative impact on public health is profound. Women have higher rates of comorbidities, complications such as stroke, in addition to higher mortality compared to men (1-6) and targeting sex-related differences regarding the treatment of CVD in women is of great importance to prevent the number of CVD events. The purpose of this study was to get an overview of the systematic reviews and meta-analyses investigating sex differences in patients with acute myocardial infarction (AMI) the past 10 years.

Methods

A systematic search was carried out in Epistemonikos, the largest database of systematic reviews that screens PubMed, Cochrane, Embase, CINAHL, PsycInfo and others (i.e., currently nine databases) (7, 8). The search was conducted 12 January 2024, with the general search strings: (1) sex differences OR gender differences AND myocardial infarction, (2) sex differences OR gender differences OR women OR female AND myocardial infarction. The search was restricted to systematic reviews conducted the last 10 years.

Results

Forty-nine (search 1: 19, search 2: 30) systematic reviews and meta-analyses were identified, and five studies investigating sex differences in relation to AMI were included. Two systematic reviews, Babioakis (2021) and Meer (2015), reported of longer door-to-balloon (D2B) time and/or symptom-to-balloon (S2B) time in female patients presenting with STEMI and referred for PCI, compared to male patients (9). Chaudhary (2022) investigated adverse event of MINOCA (more commonly in women/ younger age (51-59 years) and reported higher risk of MACE among women than men (10.1% vs. 9.1%, OR 1.15, 1.04-1.23), in addition to higher incidence of stroke (3.5% vs. 2.2%, OR 1.3, 1.01-1.68), however no significantly differences were observed for all-cause mortality, non-fatal AMI, and cardiovascular readmissions between the groups (10).

Three systematic reviews reported of higher risk of mortality after STEMI among women, compared to men (11-13). Xi (2022) reported of higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96)) (adjusted RR, 1.24; 95% CI 1.11 to 1.38) (13), Pancholy (2014) reported of higher risk of in-hospital mortality (RR, 1.93; 95% CI, 1.75-2.14) (adjusted RR, 1.48; 95% CI, 1.07-2.05) (11), and van der Meer (2015) reported of higher crude short- and long-term mortality in women, in addition to less use of GP IIb/IIIa inhibitors in women, compared to men (women 51%, men 57%) (12).

Conclusions

Our umbrella review revealed that women had longer timeline for treatment in AMI, had less use of medication and higher risk of mortality and MACE compared to men. Clinical practice needs further improvements in management in female patients.
Out-of-hospital cardiac arrest - does location affect ROSC?
Authors: Mickiewicz A , Czapla M , Lewandowski L , Kubielas G , Kedzierski K , Wroblewski P , Smereka J
Published: July 2024

Introduction

Out-of-hospital cardiac arrest (OHCA) is a significant public health problem, with hundreds of thousands of cases occurring annually in the UE and the USA. While overall survival rates remain low, studies indicate that the location of OHCA plays a critical role in survival outcomes. The discrepancy in survival rates between public and non-public locations can be stark, with public OHCA showing a notably higher chance of the return of spontaneous circulation (ROSC). This exploratory study aims to investigate the effect of OHCA location (public vs non-public) on ROSC in Poland.

Methods

The study was a retrospective analysis of patient records, focusing on cases handled by the Polish EMS from January 2021 to June 2022. This research utilized data from the National Emergency Medical Services. From a total of 4,925,214 EMS calls, 54,190 patients diagnosed with cardiac arrest (CA, ICD 10-I46), where paramedics initiated CPR on-site, were initially selected from the database. The study excluded patients whose CAs were due to suicide attempts, criminal acts, trauma and cases that lacked initial rhythm data of CA. Ultimately, data from 33,636 patients were analyzed. Data preprocessing was performed with Python 3.10.6 and STATISTICA 13.3. The α value used for statistical inference was 0.05.

Results

A higher frequency of CAs was in public places among younger individuals (p < 0.001). In public locations, we have also observed a lower prevalence of diabetes and higher incidences of myocardial infarction and return of spontaneous circulation (ROSC) in cases of CA (31.53 vs 35.79%). The odds of ROSC were modulated by age depending on the CA location – each subsequent increase in age by one year decreased the odds by 1.62% in at-home cases (p < 0.001) or by 0.40% upon public incidence (p ≈ 0.009). (Table 1). In multi-factor-adjusted logistic regression models, it is evident that the initial rhythm of VF/pVT significantly increases the likelihood of ROSC by more than 3.7 times compared to the Asystole/PEA rhythm, regardless of location. Obesity notably decreases ROSC chances in home incidents, unlike public cases. In public location CAs, conditions like stroke or myocardial infarction significantly increased ROSC odds. Additionally, the impact of age on ROSC probability varies with the location of the cardiac arrest, showing different rates of decrease with each additional year of age in home versus public incidents.

Conclusion

Patients with OHCA were statistically more likely to achieve ROSC if the CA occurred in a public location. In addition, if the initial rhythm was VF/pVT, the odds of ROSC were almost four times higher for both public and non-public locations. The odds of ROSC decreased with each additional year of age, regardless of the location of the CA. In addition, the presence of myocardial infarction increased the odds of ROSC in public locations. In non-public locations, obesity was associated with decreased odds of ROSC.
The course of COVID-19 infection in patients with cardiovascular diseases
Authors: Smoktunowicz M , Zbroch E
Published: July 2024

Background

Certainly, the COVID-19 pandemic has changed the paths of modern medicine. Elevated morbidity and mortality that was observed especially during first and second year focused health care providers on highlighting the high risk group of patients. Many results have showed the influence of comorbidities on the course of COVID-19.

Purpose

The aim of the study was to demonstrate whether cardiovascular diseases correlate to severity of coronavirus disease 2019 infection.

Methods

The study group contained 70 patients admitted to the hospital from the 1st of January 2021 to the 10th of November 2022 due to symptoms indicating respiratory infection. The survey's inclusion criteria was U07.1 COVID-19, virus identified (code from Chapter XXII: Codes for special purposes of The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) – WHO, Version 2019: COVID expanded). The used research method was the analysis of patients' medical records. Subsequently the data were subjected to quantitative and statistical analysis.

Results

There were 16 different cardiovascular diseases diagnosed in the study group. The most common were: I10 Essential (primary) hypertension (46/70 patients; 65,71%), I50.9 Heart failure, unspecified (16/70 patients; 22,86%), I48 Atrial fibrillation and flutter (16/70 patients; 22,86%). The data of concerning hospitalizations of groups of patients with the most commonly observed cardiovascular diseases, along with a comparison to the entire study group, are presented in Table 1. Furthermore, there was statistically significant correlation between at least one cardiovascular comorbidity and the need to transfer the patient to continue the treatment of COVID-19 in the intensive care unit (p<0,001).

Conclusions

The results of this study showed that patients with most common cardiovascular diseases stayed hospitalized for longer time, were older and more often needed antibiotic and anticoagulant therapy compared to the entire study group. That provide a basis to conclude that patients with cardiovascular diseases are at higher risk of severe COVID-19 and the special management to this group should be applied into common medical practice.
The relationship between gender, body mass index, and length of hospital stay in patients with hypertension
Authors: Lokiec K , Kwasny A , Uchmanowicz B , Kubielas G , Smereka J , Juarez-Vela R , Czapla M
Published: July 2024

Introduction

Globally, hypertension impacts approximately 40-45% of the adult demographic. This condition serves as a changeable risk factor for cardiovascular diseases (CVD), and its escalation demonstrates a direct correlation with heightened mortality rates and the onset of additional medical issues, including myocardial infarction, heart failure, and cerebrovascular accidents. The financial burden of CVD management is substantial, marking it as a significant issue in public health worldwide. Influencing factors that contribute to the duration of a patient's hospital stay (LOS) encompass both suboptimal nutritional status and the coexistence of other health conditions.

Purpose

The aim of this study was to assess whether there are sex differences in the prognostic impact of BMI, as calculated on admission to the cardiology department, on the length of hospital stay in patients with hypertension (HT).

Methods

We performed a retrospective analysis of 486 medical records of patients who had been admitted to an University Hospital between January 2017 and June 2021. Linear regression was used to analyse the impact of selected variables on continuous outcomes. Regression parameters with 95% confidence intervals were shown. The significance level for all statistical tests was set to 0.05. R 4.3.0. was used for computations.

Results

Women accounted for 53% of the study group and were significantly older than men (64.7±12.8 vs. 60.5±11.8, p=0.466). The mean BMI in women was 28.49±5.39 and in men 29.14±4.88. In an unadjusted linear regression mode, underweight, overweight and obesity by BMI were not independent predictors of longer hospitalization in either sex. The same result was noted after adjusting the model for patient age. After adjusting the model for comorbidities for women, a significant independent predictor of prolonged hospitalization was a prior MI, which prolonged hospitalization by an average of 1,727 days (B=1,727, p=0.034). For men, none of the analyzed features was a statistically significant predictor of length of hospitalization.

Conclusions

The result of body mass index score assessed at the time of a patient's admission to the cardiology department is not a predictor of length of hospitalization in both men and women with hypertension.
A study of the effect of congenital heart disease on somatic growth by comparing identical twins anthropometric profiles
Authors: Lee J , Dacck Hirsch S , Kwon S , Yun T J
Published: July 2024

Purpose

This study seeks to evaluate the impact of congenital heart disease (CHD) on somatic growth while controlling for the influence of other growth-related factors.

Method

A retrospective cohort study was conducted on identical twins, with one twin having CHD (CHD group) and the other without CHD (non-CHD group). Anthropometric measures, including weight-for-age (WAZ), height-for-age (HAZ), weight-for-height (WHZ), and head-circumference (HCZ) z-scores based on WHO growth standards, were employed, and growth failure was defined by z-scores below -2. Predictive factors of growth failure included gestational age, cyanosis, pulmonary arterial hypertension (PAH), heart failure, and ventricular physiology.

Results

Anthropometric indices from 41 pairs of twins were analyzed. The CHD group exhibited a significant decline in all growth parameters from the age of 1 year (p < .001). Although the growth disparity between twins lessened over time, the CHD group continued to lag behind the non-CHD group at follow-up (p < .05). Moreover, a higher proportion of the CHD group experienced malnutrition (46.3%) compared to the non-CHD group (7.5%, RR 1.724, 95% CI 1.280 to 2.232, p < .001, at the age of 1). Among disease characteristics, children with cyanosis, PAH, and heart failure displayed a significant decrease in growth z-scores compared to their unaffected twin siblings. However, statistical significance was observed only between weight-for-height z-scores and cyanosis (cyanosis 1.8±1.7 vs acyanosis -0.8±1.4, p = .032).

Conclusion

Children with CHD exhibited compromised growth compared to their non-affected twin siblings, with no complete catch-up growth observed during the observation period. The heightened prevalence of growth failure in the CHD group emphasizes the increased risk of malnutrition in children with CHD.
Prevalence of hypertension in women under 50 in the PICTURE cohort study
Authors: Poltyn-Zaradna K , Basiak-Rasala A , Matera-Witkiewicz A , Gawel-Dabrowska D , Kilis-Pstrusinska K , Zatonska K , Zatonski T
Published: July 2024

Background

Epidemiological data indicate an upward trend in hypertension (HT) prevalence in the recent decades. The risk of elevated blood pressure (BP) significantly increases with age, but it has been observed also in the younger population. Currently it is estimated that nearly 10 million adults in Poland have HT. Despite some improvement in treatment and BP control, they are still below expectations in the Polish population. Common misconception assumes that HT rarely occurs in women in comparison to men, which can lead to lower awareness, lower participation in routine screening and delayed diagnosis, especially in younger women.

Purpose

To assess the prevalence of hypertension (HT) among women under 50 years of age in the PICTURE cohort study.

Methods

The analysis is based on 769 women (average age 41.6±4.2 years) participating in "Population Cohort Study of Wroclaw Citizens (PICTURE)" established between 2019 and 2021. HT was diagnosed based on (1) patient-reported HT previously diagnosed by a physician, and/or (2) patient-reported intake of hypotensive medication, and/or (3) the average of two blood pressure measurements of systolic ≥140 mmHg and/or diastolic ≥90 mmHg. Additional analysis included other parameters such as BMI, WHR, attitudes toward tobacco smoking and alcohol consumption.

Results

HT was diagnosed in 12.5% of women under 50 years of age. More than half (55.2%) of HT cases in this group were previously undiagnosed. Women with hypertension had significantly higher chance of excessive body mass and abdominal obesity in comparison to women with normal BP. Excessive body weight characterized 68.7% of women with HT vs 34.5% without HT (p<0.0001), whereas abdominal obesity characterized 71.9% of women with HT vs 44.8% without HT (p<0.0001). Tobacco smoking was more prevalent among women with HT. A total of 21.3% of women with HT were current tobacco smokers vs 11.8% without HT (p=0.01).

Conclusions

More than half of HT cases were previously undiagnosed. Majority of HT cases in women were associated with traditional modifiable risk factors including excessive body mass, abdominal obesity and tobacco smoking. Intensive screening programs to increase HT diagnosis should be introduced in younger age groups, also in younger women.
Expectations and experiences of tele-yoga in persons with heart failure a longitudinal qualitative design
Authors: Hedbom T , Liljeroos M , Thylen I , Martensson J , Stridsman M , Orwelius L , Jaarsma T , Stromberg A
Published: July 2024

Background

Persons with heart failure need rehabilitation, but often face challenges due to their illness to participate. Yoga is an alternative form of rehabilitation. In this study we introduced tele-yoga that enables participants to practice group yoga at home with a live-streamed instructor via video communication and individual yoga using an application. Expectations of the participants play a crucial role in the perception of health and healthcare experiences. The aim was to explore the relationship between expectations and experiences of tele-yoga in persons with heart failure over time.

Methods

The study had a longitudinal qualitative design with data collected at 3 time points. Data were collected through interviews and analyzed using summative content analysis. Study participants were recruited from the intervention group of a randomized controlled trial evaluating effects of 12 weeks of group tele-yoga. The interview guide explored participants' expectations of tele-yoga at baseline before the intervention started and their experiences after 3 and 6 months.

Results

Interviews were conducted with 93 study participants, of which 30 were women, with a mean age of 64.8 years (range 31-84 years). The most frequently expected effect of the yoga was reduced stress, anxiety, and worries (57%). A majority of the participants (84%) reported this effect after 3 and 6 months, described as ways to cope with stress, manage their illness, and reduce anxiety. Fifteen percent of the participants expected improved breathing, and 57% of the participants indeed experienced improved breathing after yoga training. Thirty-five percent of participants expected to have increased flexibility, and 47% indeed experienced that after 3 and 6 months. There was little congruence between expectations and experiences of relief from aches and pain. Most of those expecting relief did not experience it, and several who did not expect relief reported to experience decreased pain. At the 6 month interviews, 3 months after the ending of the tele-yoga intervention, no participant practiced yoga to the same extent as during the intervention. However, the majority stated that they had incorporated yoga techniques, particularly breathing and relaxation, into their daily lives.

Conclusions

The most prominent experiences of the tele-yoga intervention were improved stress relief, anxiety and worries, and an improved breathing and increased flexibility. Experienced effects were much higher than expected effects.
Patients with and without history of atrial fibrillation after percutaneous coronary intervention increased focus on modifiable risk factors
Authors: Kjoelseth A , Norekvaal T M , Broers G , Hendriks J M , Risom S S , Rotevatn S , Wentzel-Larsen T , Pettersen T R
Published: July 2024

Background

Atrial fibrillation (AF) and coronary artery disease (CAD) have several common risk factors, and 10-15% of patients with AF undergo percutaneous coronary intervention (PCI). Little is known about the changes over time in modifiable risk factors for AF and CAD and self-reported health when comparing patients with and without history of AF after PCI.

Purpose

To determine and compare changes in modifiable risk factors and self-reported health in patients with and without history of AF after PCI, from the index admission to 2-, 6- and 12 months after hospital discharge.

Methods

CONCARDPCI, a prospective multicentre cohort study including 3417 consecutive patients after PCI, was conducted at seven high-volume PCI centres in Norway and Denmark. Of these, 408 patients had a history of AF. Socio-demographic characteristics were self-reported at baseline. Medical history (medical and cardiovascular comorbidities), and clinical status (body weight and height) were collected from patients’ medical records and national registries at baseline. Information about the patients’ comorbidities was used to identify modifiable risk factors for AF and CAD in this study population. Smoking status and physical activity were self-reported at baseline and the 2-, 6- and 12-month follow-up. Self-reported health was assessed with RAND-12 Item Short Form Health Survey and the Myocardial Infarction Dimensional Assessment Scale (MIDAS).

Results

Eighty one percent of the patients with history of AF were men, and the mean age was 72 (SD 9, range 43-93). In patients without AF, 78% were men and the mean age was 65 (SD 11, range 20-96). In patients with history of AF, the proportion of smokers increased from 2- to 12 months (p=0.041). In patients without AF, there was a reduction in proportion of smokers from baseline to six months (p<0.001). No significant differences between the patients with history of AF and without AF regarding changes in physical activity over time were found (p=0.452). Most patients in both groups did not adhere to the guideline recommended 150 minutes of physical activity per week. Patients with a history of AF reported a poorer general physical health at baseline. However, the general physical (p=0.012) and mental (p<0.001) health improved from baseline to the six-month follow-up in both groups. For MIDAS, the patients with AF reported a poorer health regarding emotional reactions (p=0.029) and insecurity (p=0.015) from two- to twelve-month follow-up.

Conclusion

Lifestyle interventions might be beneficial to further improve self-reported health, as well as modifiable risk factors, among patients with and without history of AF after PCI. Considering the complex treatment of patients with AF after PCI, more attention is needed to improve the follow-up care regarding modifiable risk factors for this patient population.
Autonomic dysfunction is prevalent in PASC of Covid-19 [PASC]
Authors: Seeley M C , Gallagher C , Wilson G , Page A , Lau D H
Published: July 2024

Background

Post-acute sequelae of COVID-19 [PASC] is thought to occur in 10% of all COVID infections and has previously been associated with autonomic dysfunction including postural orthostatic tachycardia syndrome [POTS].[1,2]

Purpose

To assess prevalence of autonomic disorders in those with PASC.

Methods

Consecutive patients reporting unexplained symptoms persisting for ≥3 months after SARS-CoV-2 infection were recruited through social media platforms. Beat to beat plethysmography was used to determine autonomic haemodynamic response to 10-minute active stand test, Valsalva maneuverer and deep breathing. International criteria were used to diagnose POTS, initial orthostatic hypotension (IOH), and classical orthostatic hypotension (COH). Validated patient reported outcome measures were used to determine symptom severity and health related quality of life (HrQoL) including, composite autonomic symptom score [COMPASS-31], Euroquol 5-Dimension [EQ-5D] and fatigue severity score (FSS).

Results

Institutional ethics was granted from our university. A total of 150 PASC participants (79% female, 93% Caucasian) with a mean age of 40.7 ± 11.5 years and BMI 25.8 ± 6.7 were prospectively consented and enrolled. In total 86% were vaccinated with at least 2 vaccines at the time of acute SARS-CoV-2 infection. The mean time to onset of PASC symptoms after acute infection was 18.3 ± 35.3 days and duration of symptoms at time of testing was 306.9 ± 188.1 days. In total 75% of participants met the criteria for an autonomic disorder with the most common diagnoses being POTS (55%), initial orthostatic hypotension (38%), and classic orthostatic hypotension (5%) respectively. Valsalva ratio was within normal limits for the majority (90%) of participants however it was statistically higher in those with POTS compared to those without (1.9±.6 versus 1.7±.8: p=.014). Total composite autonomic symptoms were more severe in women than men (42.6±13.1 vs. 35.4±19.9; p = .018) and those with a COMPASS-31 score >40 (49%) had worse fatigue severity (57.9±6.9 vs. 50.3±14.3: p<.001) and poorer EQ-5D utility health scores (0.611±0.247 vs 0.701±0.237: p =.008) on a scale from 0-1 where ‘1’ = ‘full health’. The mean FSS score was 53.9±11.8 out of a maximum score of 63 and fatigue was universally problematic with 92% experiencing FSS score >36. Participants reported only being a mean of 40.5%±21.2% of their previous health status and the mean self-reported ‘health today’ [100 = ‘full health’] was 40.5 ± 14.2. A significant 91.3% reported missing work due to symptoms in the last month and 50.3% had been unable to return to work due to PASC symptoms.

Conclusion

Autonomic disorders are prevalent in PASC and greatly impact on working capacity and health related quality of life. We call for routine autonomic testing in PASC and further research to explore efficacy of autonomic treatment modalities in this cohort.
Sleep disorders in patients with heart diseases - present knowledge
Authors: Malewicz K , Grzebieluch J , Felinczak A
Published: July 2024

Introduction

The problem of sleep disorders plays a significant role in the functioning of people in the contemporary world, particularly affecting cardiac patients. It entails a series of consequences that impact health. The study analyzed the occurrence of sleep disorders among cardiac patients.

Purpose

The project aimed to assess the available literature regarding described sleep disorders in patients with cardiovascular diseases and to analyze the impact of sleep disorders on the functioning of cardiac patients.

Methods

Materials available in PubMed and Google Scholar were analyzed using keywords such as "sleep disorders," "insomnia," "cardiovascular disease," "heart attack," "heart failure," "hypertension," "coronary artery disease" in various configurations. A comprehensive analysis of publications was conducted to identify studies on sleep disorders in cardiac patients, focusing on risk factors and management strategies for sleep problems in this patient group.

Results

Sleep disorders occur in cardiac patients and significantly affect their health. Sleep disorders also increase cardiovascular risk in healthy individuals. Sleep disorder management methods include problem recognition, lifestyle modifications, pharmacotherapy, and behavioral interventions. A crucial aspect of care appears to be the need for diagnosing sleep problems in cardiac patients and implementing integrated multidisciplinary care.

Conclusions

Sleep disorders pose a significant risk for cardiac patients, requiring an interdisciplinary therapeutic approach. Future research should assess the scale of sleep disorders in cardiac patients in Poland, as well as identify factors influencing sleep disorders in this patient group. Subsequently, treatment strategies and integrated care should be developed.
The role of illness acceptance and social support in assessing readiness for hospital discharge following myocardial infarction
Authors: Lisiak M H , Krol E , Wleklik M , Vellone E , Hydzik P , Uchmanowicz I
Published: July 2024

Introduction

The hospital discharge process refers to the patient's readiness to return to proper daily functioning. It is important to note that the discharge process is not solely based on physical readiness. It also includes psychological capacity, social support, and the provision of information and knowledge.

Purpose

The purpose of this study was to examine the correlation between readiness for hospital discharge and acceptance of illness and social support following myocardial infarction.

Materials and Methods

The study included 100 patients (56 women, mean age M±SD 64.95 y/o) who had experienced a myocardial infarction. The study employed a socio-demographic and clinical survey, as well as standardized measures including the Readiness for Hospital Discharge After Myocardial Infarction Scale (RHD-MIS), Acceptance of Illness Scale (AIS), and The Multidimensional Scale of Perceived Social Support (MSPSS). The statistical analysis includes a significance level of 0.05. Therefore, all values of p<0.05 were interpreted as indicating significant relationships.

Results

The majority of respondents were in a relationship (73%), lived in an urban area (70%) and had a secondary education (56%). The overall RHDS-MIS score showed that 46% of patients had a low level of readiness for discharge. There is a significant negative correlation (r=-0.228, p=0.022) between patient age and subjective knowledge score (p<0.05). The respondents reported a moderate level of acceptance towards their illness, with a mean score of 26.38 points. The AIS was shown to correlate significantly (p<0.05) and positively (r>0) with the RHDS-MI (r=0.525, p<0.001) and with all subscales: (1) subjective (r=0.405, p<0. 001) and (2) objective (r=0.538, p<0.001) assessment of patient knowledge about the disease, and (3) patient expectations (r=0.386, p<0.001). The analysis of the impact of social support on patients' readiness for discharge after MI revealed a significant positive correlation (r > 0, p < 0.05) between family support and readiness for discharge (r = 0.281, p = 0.005), subjective (r = 0.251, p = 0.012), and objective (r = 0.421, p < 0.001) assessment of knowledge.

Conclusions

Patients who have suffered from MI are at risk of experiencing adverse cardiovascular events, such as complications or hospital readmission. The level of hospital discharge readiness in patients after MI is correlated with the degree of acceptance of illness and social support. Assessing a patient's readiness for hospital discharge after an MI can help identify their educational and therapeutic needs. Involving the patient's family in the discharge readiness process is crucial as they can actively participate in the therapeutic process by providing support to the patient.
Anxiety and depression in patients with an implantable cardioverter defibrillator does personality and icd expectations play a role?
Authors: Schmidt Pedersen S , Johansen J B H , Nielsen J C N , Larroude C E L , Riahi S R , Melchior T M M , Vinther M V , Skovbakke S J S , Skov O S
Published: July 2024

Background

The implantable cardioverter defibrillator (ICD) is the treatment of choice for the prevention of sudden cardiac death. Given that 22.6% of patients with an ICD develop anxiety and 15.4% depression (1), it is paramount to identify factors contributing to their distress. Anxiety may lead to depression if untreated and both have been associated with risk of morbidity and mortality.

Purpose

To examine if Type D personality and expectations to ICD therapy are associated with anxiety and depression in ICD patients at 12 months follow-up.

Methods

Patients with a first-time ICD or cardiac resynchronization therapy device (CRT-D) participating in the national Danish ACQUIRE-ICD trial completed the Type D Scale (2), the EXPECT-ICD Scale containing both negative and positive expectations at baseline, the Generalized Anxiety Disorder scale (GAD-7), and the Patient Health Questionnaire (PHQ-9) to determine anxiety and depression, respectively, both at baseline and 12 months follow-up.

Results

Of the 478 patients participating in the study, the mean age was 60.2 ± 11.2, 397 (83.1%) were male and 81 (16.9%) women. Of all patients, 255 (53.3%) had a primary prevention indication for the ICD and 223 (46.7%) a secondary prevention indication, while 441 (92.3%) were in NYHA Class I-II and 37 (7.7%) in NYHA class III-IV at the time of implant. With respect to personality, 73 patients (15.3%) had a Type D personality. Mean scores on Positive expectations towards ICD implantation were 12.8 ± 3.18, and mean scores on negative expectations were 5.37 ± 3.30. In the multivariate, adjusted analysis for depression, Type D personality was independently associated with 12 months depression scores, over and above the impact of baseline depressive symptoms (B = 2.43, 95% CI [1.42, 3.43], p < .001). ICD expectations were not significantly associated with 12 months depression scores.

In the multivariate, adjusted analysis for anxiety, Type D personality was independently associated with 12 months anxiety scores, over and above the impact of baseline anxiety symptoms (B = 1.90, 95% CI [1.07, 2.73], p <.001). ICD expectations were not significantly associated with 12 months depression scores.

Conclusion

In a large Danish national cohort of ICD patients, depressive symptoms at baseline and Type D personality were associated with increased depressive symptoms at 12 months follow-up. Neither positive nor negative ICD expectations were associated with depressive symptoms at 12 months follow-up, adjusting for other variables. Similar results were found for anxiety symptoms. Anxiety symptoms at baseline and Type D personality were associated with increased anxiety at 12 months follow-up, adjusting for all other variables, including ICD expectations. It may be worthwhile to screen cardiac patients for this personality type in clinical practice.
Different levels of continuous training improve echocardiographic parameters, quality of life, and functional capacity in heart failure with reduced ejection fraction patients
Authors: Atef H , Helmy Z M , Elnaggar M , Marques-Sule E , Abdeen H
Published: July 2024

Background

Various comorbidities and physiological alterations contribute to the complexity of heart failure conditions, influencing the optimal approach to exercise-based rehabilitation.

Purpose

This study sought to investigate and compare the effects of continuous training at three distinct intensities, specifically examining left ventricular (LV) remodeling, functional capacity, and quality of life in patients with heart failure with reduced ejection fraction (HFrEF).

Methods

In a randomized control trial, 60 male patients (mean age: 54.33 ± 2.35 years) diagnosed with HFrEF were randomly assigned to three groups: 1) High-Intensity Continuous Training group (HICT), 2) Moderate-Intensity Continuous Training group (MICT), and 3) Low-Intensity Continuous Training group (LICT). All participants underwent training on a bicycle ergometer three times per week for 12 weeks. Echocardiographic parameters (left ventricular ejection fraction, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, N-terminal pro–B-type natriuretic peptide (NT-proBNP)), quality of life (assessed through the Minnesota Living with Heart Failure Questionnaire), and functional capacity (measured by the 6-minute walking test) were evaluated before and after the study.

Results

The HICT group exhibited the most significant improvements in all assessed variables compared to the other two groups (P < 0.05). These findings were consistently observed across all measured outcomes.

Conclusion

It was deduced that High-Intensity Continuous Training (HICT) emerged as the most advantageous approach in enhancing echocardiographic measures, NT-proBNP levels, quality of life, and functional capacity among patients with heart failure and reduced ejection fraction (HFrEF).