bluuebunny/crossref_metadata_2025 huggingface dataset:
Kidney function decline in heart failure patients: an audit of out-patient heart failure services
Authors: Lehane M , Connolly S , Crowley M , Hart C , O"flynn AM
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

A bidirectional relationship exists between the kidney and the heart; the lower the eGFR the more challenging it is to manage the heart failure (HF) patient. Worsening renal function is common in HF patients and associated with a two-fold increase in mortality and a lower likelihood of being prescribed efficacious HF therapy. The role of cardio-renal interactions in HF is essential to identify risk and subsequent treatment strategies.

Purpose

The purpose of this audit is to provide insights into the assessment of renal function in a real world heart failure population by identifying the degree of renal dysfunction and changes in renal function over a five year time frame.

Methods

A retrospective audit included patients with HFrEF attending a heart failure service. These patients were classified using KIDGO criteria CKD 1-5. A current eGFR sample was compared with a sample taken five years earlier, identified using the electronic laboratory record. Ethical approval was granted from the Research Ethics Committee.

Resultss

100 patients with HFrEF attending a heart failure service fulfilled the selection criteria of which sixty three patients with an eGFR >60ml/min/1.73 m2 were audited. Of this group 43 were CKD class 2 and 20 were CKD class 1. Thirty seven patients had an eGFR <60ml/min/1.73 m2 of which 9 were class 3b, 9 were CKD class 4 and 1 was CKD Class 5.

Of the 100 patients enrolled, 6 were excluded from the analysis of kidney function decline as an eGFR from five years earlier was unavailable. Within a five year time span, 44 patients did not change their CKD class, 31 patients declined by one class, 9 patients declined by two classes, 3 patients declined by three classes and 7 patients improved their kidney function.

GFR < 60mL/min/1.73m2,

n = 37

GFR > 60mL/min/1.73m2, n = 63

Age – mean (range)

77.8 (49-94)

66.5 (45-89)

Gender – female (%)

12 (32%)

16 (25%)

Average renal function measurements (mean, range)

6.4

6.7

Total albumin

creatinine ratio measurements

8

6

Actively attending renal service

6

0

Conclusion

Nurses should be aware of the increasing risk conferred by the dual diagnosis of heart failure and chronic kidney disease. Patients with heart failure who have decreasing eGFR levels (especially less than 30 mL/min), should have collaborative management with nephrology services to optimise outcomes. Recognition of CKD in our institution and referral to nephrology services was suboptimal and further work is necessary to optimise the management of these patients.
Somatic changes experienced by patients with heart failure during acute exacerbation: A qualitative text mining analysis
Authors: Okada AKIKO , Tsuchihashi-Makaya MIYUKI , Ochiai RYOTA
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Ministry of education

Background

In patients with heart failure (HF), symptom perception’ is a self-care requirement for effective disease management. However, previous studies have reported that these patients have inadequate symptom perception. When patients experience somatic changes, they generally interpret these as symptoms, which can cause them to adopt coping behaviours. To improve symptom perception, it is important that health care providers understand the somatic changes experienced during an acute HF exacerbation based on patients’ representation of symptoms, rather than clinical symptom names.

Purpose

This study aimed to clarify the comprehensive picture of somatic changes experienced by patients with HF during acute exacerbations by analysing the expressions they use to describe these changes.

Methods

In semi-structured interviews, 21 patients with HF hospitalised due to acute exacerbation were asked to use their own words to describe any somatic change they perceived before hospitalisation. A three-step text mining process was used to analyse the expressions patients used to describe these changes. First, the frequency of use was calculated for the terms used to describe somatic changes. Next, the extracted words were classified into clusters based on concatenation between words. Finally, cluster names were assigned using patient expressions.

Results

The sample was 76.2% male, and the mean patient age was 71.3 ± 13.7 years. Of the 21 patients, 52.4% had a history of hospitalisation. The interviews generated 59 pages of data. Analysis indicated that 472 terms were related to somatic changes. The most frequently used terms were ‘breath’ (46 times), ‘painful’ (40 times), ‘foot’ (29 times), ‘ha-ha’ (the sound of gasping; 28 times) and ‘walking’ (25 times).

The somatic changes experienced by patients were classified into 10 clusters based on concatenation between words. The cluster names were ‘shortness of breath when moving’, ‘not being able to walk the distances one normally walks without a rest’, ‘not being able to sleep at night because of difficulty breathing’, ‘increased frequency of urination at night’, ‘swollen and tense legs’, ‘socks leave marks in legs’, ‘projecting abdomen and tighter pants’, ‘fatigue while moving’, ‘increased phlegm and a feeling of discomfort in the throat’, and ‘a vague feeling of being unwell’.

Conclusions

Instead of employing symptom names used by medical professionals, patients described their perceived somatic changes in diverse ways using various expressions, such as mimetic words and metaphorical expressions. Moreover, some patients described vague physical changes that could not be classified with corresponding symptom names. These findings indicate that the symptoms patients experience during an acute exacerbation cannot always be categorised using clinical symptom names.
Incidence and impact of acute cardiorenal syndrome
Authors: Mantis C , Vasiliadis I , Anadiotis A , Papadakis E , Patsilinakos S
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Acute (or type 1) cardio-renal syndrome (ACRS) is defined as the acute kidney injury  in patients hospitalized for acute heart failure (HF), which often is associated to a complex and complicated clinical course. In addition, renal failure is a strong predictor of long-term adverse events in patients with acute heart failure (HF).

Purpose

To investigate the impact of ACRS, what factors are related to its occurrence, and how it affects the outcome of patients hospitalized with acute HF.

Methods

We studied consecutive patients hospitalized with acute HF from January 2019 to December 2020. Renal function as well as other biomarkers were recorded and monitored during hospitalization, and correlated with various clinical characteristics, risk factors and patient outcome.

Results

The sample consists of 612 patients, mean age 77 ± 12 years, 63% men with average duration of hospitalization 6 ± 4 days. A total of 37 deaths (6%) were observed. ACRS was found in 141 patients (23%) and independent prognostic factors for its occurrence were ischemic cardiomyopathy, age, prolonged hospitalization, use of aldosterone antagonists and high CRP upon admission. The incidence of ACRS during hospitalization was an independent prognostic factor of death (r = 0.15, p = 0.02) and anemia (r = 0.24, p = 0.04), while the outcome of death was more common in patients with ACRS - but without statistical significance - compared to patients without ACRS.

Conclusion

Deterioration of renal function in acute HF is associated with anemia and death. Factors such as ischemic cardiomyopathy, age, length of hospital stay seem to play a role in the onset of ACRS and should be taken into account in these patients, to prevent negative outcomes.
Is the disability of elderly patients related to increased blood transfusions after cardiac surgery?
Authors: Wleklik M , Wisnicka A , Chudiak A , Lomper K , Lisiak M , Uchmanowicz I
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Intorduction. Perioperative bleeding occurs in 2 to 15% of patients. Cardiac surgeries are associated with perioperative blood loss due to the invasive nature of the procedures, the need for high doses of anticoagulation and the need for extracorporeal circulation. Both transfusions and reoperations due to excessive postoperative bleeding are associated with adverse clinical outcomes and increased costs of care. In 2017, the common position of the European Association of Cardiac Cancer Surgeons (EACTS) and the European Association of Cardiac Cancer Surgical Anesthesiologists (EACTA) regarding the management of patient blood in order to maintain adequate perioperative homeostasis and minimizing bleeding, and thus reducing the amount of blood transfusions. Advanced age is one of the factors associated with an increased risk of perioperative bleeding, including the need for transfusion and reoperation.

Purpose. Assessment of the relationship between preoperative disability and the amount of blood transfused in elderly patients after cardiac surgeries.

Methods. The study included 100 patients ≥ 65 years of age (40 women and 60 men, mean age M ± SD =71.69 ± 4). A sociodemographic questionnaire and the Nagi scale for disability assessment were used to collect the research material. The Nagi scale assesses the limitations of the patient in seven activities. A significant disability is considered to be ≥ 3 points. The number of blood transfusions was assessed based on the analysis of medical records. The number of blood units transfused during hospitalization was taken into account. Statistically significant was assumed to be p < 0.05.

Results. In the study group the mean score on the Nagi scale was M ± SD = 3.41 ± 1.83 points. Blood transfusions were required by 66% of the study participants. The number of transfused blood units ranged from 1 to 11. The mean number of transfused blood units was 1.41 ± 1.83 points: M ± SD = 1.56 ± 1.93. 28 patients required 1 blood unit, 11 blood units required 1 patient. There was a significant positive correlation between the values of the Nagi scale and the number of blood units transfused (r = 0.233, p = 0.019) . Moreover, the number of blood units transfused to patients with values of the Nagi scale ≥3 points turned out to be significantly higher than in patients with values of this scale <3 points (p = 0.015).

Conclusions. 1) Patients with disability are qualified for cardiac surgeries. 2) Patients with disabilities require more blood units to be transfused.
Family-based eHealth interventions to reduce cardiovascular disease risk: a systematic review
Authors: Kemp B , Thompson DR , Mc Guigan K , Watson CJ , Woodside JV , Ski CF
Published: July 2021

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Department for the Economy, Northern Ireland

Background

Family-based eHealth interventions have potential to reduce cardiovascular disease (CVD) risk and improve health of parents and children.

Purpose

To evaluate the effectiveness of family-based eHealth interventions to reduce parent and child CVD risk.

Methods

Systematic review. Five electronic databases were searched (CENTRAL; MEDLINE; CINAHL; EMBASE; PsycINFO) up to April 2020. Data extraction included: study design, setting, methodology, eHealth technology, experiment/control group constituents, risk factors, outcomes, incentivisation and limitations. Data were synthesised narratively. Cochrane methodology was used to assess risk of bias and reporting quality.

Results

In total, 2193 articles were screened and seven trials included for review. The most consistently improved CVD risk factor across parents and children was reduced alcohol use, whilst reduction in BMI the least consistently improved. Behaviour-change theoretical underpinning, extended follow-up duration, interactivity and incentivisation were identified as effective components of these interventions. Four studies were assessed as overall ‘low risk’ of bias and three studies had concerns with randomisation and intention-to-treat analysis. Conclusions: This is the first systematic review to evaluate family-based eHealth interventions to reduce CVD risk. Despite a paucity in high-quality trials, there is evidence of their potential effectiveness. Recommended, more high quality, behaviour-change-theory-based, clearly reported interventions with explicit outcomes.
Womens health-related quality of life substantially improves with tailored cardiac rehabilitation: a systematic review and meta-analysis
Authors: Chung S , Candelaria D , Gallagher R
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Women have poorer outcomes from coronary heart disease (CHD) compared to men and participation in exercise-based cardiac rehabilitation (EBCR) offers an opportunity for improvement. However, synthesised evidence for women-specific patient-reported outcomes are often lacking. We aimed to synthesise HRQL outcomes from EBCR in women with CHD.

Methods

Four electronic databases (PUBMED, CINAHL, SCOPUS and Cochrane) were searched for studies reporting HRQL using validated measures in women attending EBCR. Two reviewers independently screened papers and extracted data. Random effects model (RevMan v5.4) was used for analysis.

Results

Eleven studies (1292 women participants) were included: six observational, three randomised controlled trials, and two quasi-experimental design. Seven studies were included in the meta-analyses. EBCR participation was associated with HRQL benefits in several domains of the Short-Form (SF-12 or 36). Improvements were greatest in Role Physical (MD 19.09 95% CI 2.37, 35.81), Physical Functioning (MD 10.43, 95% CI 2.60, 18.27) and Vitality (MD 9.59, 95% CI 0.31, 18.86). When tailored components were added to traditional EBCR, gains in HRQL were also observed, specifically in Bodily Pain (MD 9.82, 95% CI 4.43, 15.21), Role Physical (MD 8.48, 95% CI 1.31, 9.97), Vitality (MD 8.17, 95% CI 3.79, 12.55), General Health (MD 5.64, 95% CI 1.31, 9.97), and Physical Function (MD 5.61, 95% CI 0.83, 10.40) domains.

Conclusion

Women attending EBCR achieve clinically meaningful improvements in multiple areas of HRQL, and additional benefits were seen when strategies tailored to their needs and preferences were included. Future research should focus on promoting EBCR uptake in women.
7500 steps per day is associated with lower cardiovascular risk in rural residents with a high prevalence of sedentary lifestyle
Authors: Madujibeya I , Misook L , Lennie T , Mudd-Martin G , Biddle M , Moser D
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Sedentary lifestyle is one of the modifiable risk factors that account for the high prevalence of cardiovascular diseases (CVD) in the rural areas.1,2 Daily step counting, using wearable devices, is increasingly used to monitor physical activity levels in interventions targeting CVD risk reduction in the rural areas.3,4 However, there is a lack of evidence to support a daily step count threshold that may reduce CVD risk among rural residents. The purpose of this study was to examine the relationship between daily step count cut-points and CVD risk.

Methods

This secondary analysis included 312 adults living in the rural areas in the southern United States. Daily step counts from pedometers were collected for 14 consecutive days. Established cut-points were used to categorize participants into groups based on mean daily step count as sedentary (≤ 5000 steps/day), less active (5000 -7499 steps/per), and physically active (≥7500 steps/day).5-7 CVD risk was measured with the Framingham risk score. Generalized additive models were used to examine differences among the 3 activity groups in Framingham risk score, controlling for educational level, perceived physical health status, depressive, marital status, and years of residence in a rural county.

Results

Among the participants (75% female, mean age 50.1 (±13.6) years), 40.7% were sedentary, 35.2% were less active, and 24.0% were physically active. The average Framingham risk score was 11.2% (±9.4%). Framingham risk scores were 1.7% lower in the less active compared to the sedentary group, but the effect was not significant (p <  .11), and 2.6% lower in the physically active compared to the sedentary group (p < .04). The model accounted for 22% of the variation in Framingham risk scores.

Conclusion

These findings indicate that rural residents who averaged 7500 steps or more per day had lower CVD risk, and the difference is clinically significant.
Physical function and frailty in elderly patients with acute coronary syndrome
Authors: Ruescas-Nicolau MA , Sastre-Arbona C , Alabadi-Pardines B , Gonzalez-Timoneda A , Sanchis J , Ruiz-Ros V
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants from CIBER CV, Madrid, Spain [grant number 16/11/00420] and Instituto de Salud Carlos III-FEDER, Madrid, Spain.

Background

Frailty is described a complex clinical syndrome of increased vulnerability to stressors that places the individual at increased risk of adverse health outcomes. It results from multiple impairments (among others, in physical functioning) and its severity ranges from mild to severe. In older cardiac patients, frailty is reported to be a significant and an independent predictor of functional decline.

Purpose

To analyze the relationship between physical functioning and frailty of elderly patients with an Acute Coronary Syndrome (ACS).

Methods

A cross-sectional study was carried out. A total of 110 patients, aged ³ 70 years and hospitalized for ACS were included. Frailty status was determined by using the Fried scale. The Short Physical Performance Battery (SPPB), which includes three timed tasks (balance, walking and leg strength), was used to assess physical functioning. The SPPB total score and the partial scores of its different dimensions were compared between frail and pre-frail patients.

Results

Sample characteristics and results are shown in table 1. There were differences between groups for all the studied variables (p<.01). Pre-frail patients achieved higher total and partial scores in the SPPB.

Conclusion

Our results showed that, in elderly patients with ACS, those in a pre-frail status showed better physical function (SPPB total score and partial scores of its dimensions) than those who were frail. Due to unbalanced groups size, these results must be interpreted with caution requiring future research with larger samples.
Handheld ultrasound; point-of-care examinations by intensive care nurses in a cardiac intensive care unit. An interrater agreement study
Authors: Jorgensen M , Oterhals K , Ponitz V , Morken I
Published: July 2021

Background

Adding point-of-care ultrasound to the physical examination of patients to assess early signs of decompensation and fluid overload has been proven to add information and improve quality of care, also when performed by nurses. Few studies have examined intensive care nurses’ point-of-care ultrasound examinations in acute cardiac settings.

Purpose

 To evaluate if the findings of intensive care nurses ultrasound examinations, after brief training, were in agreement with conventional ultrasound examination performed by physicians.

Methods

 This comparative cross sectional interrater agreement study included 50 patients admitted with signs and symptoms of dyspnoea and suspected cardiac disease to a cardiac intensive care unit. After brief training, the study nurses performed standardized examinations of the patients’ inferior vena cava (IVC) and the pleural- and pericardial cavities using a handheld ultrasound device. A physician repeated the same examinations using conventional ultrasound, blinded of the nurses’ findings.

Results

Analysis using Gwets agreement coefficient (AC2) with quadratic weights showed moderate agreement for the IVC respiration variation 0.60 (95% CI 0.38-0.82), and substantial agreement for the IVC diameter 0.70 (95% CI 0.50- 0.90) and right-sided pleural effusion 0.70 (95% CI 0.52-0.88). For left-sided pleural effusion 0.85 (95% CI 0.75-0.95) and for pericardial effusion 0.95 (95% CI 0.90-1.01) the agreement was almost perfect. 

Conclusion

This study indicates that intensive care nurses, after brief training in point-of- care ultrasound, can perform reliable examinations of the IVC and pleural- and pericardial cavities compared to a physicians conventional ultrasound examination.
Health literacy of Icelandic patients with coronary heart disease
Authors: Ingadottir B , Ketilsdottir A , Svavarsdottir MH
Published: July 2021

Funding Acknowledgements

Icelandic Nurses" Assoc., Landspitali Univ Hosp., Icelandic Reg Dev Instit, Univ of Akureyri, Akureyri Hosp,

OnBehalf

KRANS

Background

 Sufficient health literacy (HL) is vital for patients to effectively manage their chronic disease. There are indications that around 50% of the public have limited HL, which can lead to difficulties in self-care, such as medication adherence and lifestyle management. In order to develop effective patient education for patients with coronary heart disease (CHD) and support their self-care, more knowledge is needed on their HL. This is one of the first studies on HL in Iceland and the first on HL in the cardiac patient population.

Purpose

 To describe HL and related factors in patients, 6 months after hospital admission for their CHD.

Methods

 Data was collected from patients with questionnaires (in 2018-2019), six months following an acute or elective treatment for their CHD. Patients answered the European Health Literacy Survey Questionnaire- short version (HLS-EU-Q16), a 16 items instruments with scores ranges from zero (low/no HL) to 16 (high HL). A score of 0 to 8 is considered an indicator of "insufficient" HL, a score from 9 to 12 as "limited" health literacy, and a score of 13 or more as "sufficient" HL. Data on educational needs (on 19 CHD related topics), disease-related knowledge (CADE-Q SV), general (mental and physical) health (SF-12V2) and self-care (SC-CHDI) were collected from patients as background data.

Results

 Preliminary data analysis shows that patients (N = 376, mean age 65 (SD 8.9), 80% male, 30% with basic education only) had a mean HL score of 13.7 (SD 2.5). Sufficient HL was observed in 71.7% of patients, limited HL in 24.5% and 3.8% had insufficient HL.  Health literacy was inversely associated with educational needs (odds ratio (OR) 0.58 (0.35;0.98). An increase in HL level was associated with an increase in knowledge (OR 1.13 (0.01; 1.26), self-care maintenance (OR 1.03 (1.01; 1.06), self-care confidence (OR 1.03 (1.01; 1.04) and mental health (OR 1.02 (1.01;1.04).

Conclusions

 The health literacy of patients in this study is satisfactory. Their HL is associated with their disease-related knowledge, educational needs, confidence, mental health and self-care maintenance.  HL should be assessed when planning patient education for patients with CHD and the education tailored to individual needs.
The barts heart attack centre early discharge pathway:- a novel protocol for next day discharge after primary pci for ST-elevation myocardiai infarction
Authors: Comer K , Casey-Gillman O , Moore E , Adey S , Mower S
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

To respond to the challenges of COVID-19 and based on evidence confirming low rates of Major Adverse Cardiac Events (MACE) occurring between 24- and 48-hours post AMI (Acute Myocardial Infarction), we sought to design and implement a novel Early Hospital Discharge (EHD) pathway

Aim

The goal of the EHD protocol is to accurately and efficiently identify low-risk AMI patients who can be safely discharged between 24 and 48 hours after successful primary PCI, aiming to provide a  safe discharge for low risk patients, reduce length of stay  enhance the follow up of patients post AMI

Methodology :

Project was designed a QI project and patients were discharged with a structured follow up at 48 hours , 2 weeks and 8 weeks and with a interventional cardiologist at 3 months 

Virtual follow up was conducted using a bespoke application enable a 2 way messaging and video consultation

Patients with AMI are taken for primary PCI in an unselected manner which includes post cardiac arrest, intubated and ventilated patients

Results :The median follow-up was 201 days (OQR: 98-268 days). In the early discharge group, there were 2 deaths (0.5%), both due to COVID-19 (both >30 days after d/c) with 0% cardiovascular mortality (comparator group 5% mortality, 2.5% cardiovascular

 Overall, this resulted in a significant reduction in the overall length of stay for all patients presenting with STEMI undergoing primary PCI over the time period. The median length of stay was 3 days (IQR 2-5 days) from October 2019 to March 2020 before the pathway was introduced. Following the pathway introduction, from April 2020 to February 2021 the median length of stay was 2 days (1-4 days) (p < 0.0001), significantly reduced from pre pathway introduction

Conclusion :Driven by the necessity to adapt to the pandemic, we report the safe and successful implementation of an early post MI discharge pathway with an integrated and structural multidisciplinary virtual follow up schedule.  This has shortened hospital admission times, decreasing the risk of nosocomial infections and optimised resource utilization, while at the same time enhancing the quality of post discharge care with high levels of patient satisfaction.
Same day CT angiography in a nurse-led Rapid Access Chest Pain Clinic
Authors: Pottle A , Deane S , Dent N , Mackay N , Marshall G , Mittal T
Published: July 2021

Funding Acknowledgements

None

Background

Rapid Access Chest Pain clinics (RACPCs) were established in the UK in 2000 following the publication of the National Service Framework for Coronary Heart Disease. Patients underwent an exercise test (ETT) in the clinic as part of a ‘one-stop’ protocol with follow-up only if further investigation was required. In 2010, the National Institute for Health and Care Excellence (NICE) produced guidelines for the assessment and diagnosis of chest pain of recent onset (CG95),  replacing the recommendation for ETT with non-invasive functional testing for patients with an intermediate pre-test probability of coronary artery disease (CAD), necessitating multiple appointments to evaluate the patient’s symptoms. The guidelines were updated in 2016, with a new recommendation that patients with atypical or typical chest pain should undergo CT coronary angiography (CTCA) as the first diagnostic test.

Purpose

The aim of this study was to investigate the feasibility and potential benefit of performing same -day CTCA in the RACPC.

Method

From November 2016 all patients with atypical or typical chest pain attending the RACPC at this tertiary cardiac centre were referred for CTCA unless alternative investigation was clinically indicated.  From February 2018, same day CTCA was offered to some patients. Up to two scans could be performed in each clinic, which was increased to up to three in June 2018.

Results

A total of 985 patients were seen in the nurse-led clinic between 12/02/2018 and 30/11/2019. 473 patients were referred for CTCA (48.0%) and 314 scans were carried out in the clinic (66.4%). Of those scans carried out in clinic, 128 patients had a CTCA which showed no evidence of CAD (40.8%) and 34.4% of scans showed non-obstructive CAD. In 18.2% of patients, the CTCA showed significant CAD and in 21 patients (6.7%) the scan was inconclusive. Patient with inconclusive scans underwent further testing which was negative in all cases. The outcome for patients with significant CAD (57 patients) is shown in the table.

Conclusion

CTCA on the same day as the RACPC appointment is feasible and facilitates rapid further investigation and treatment of patients with potentially significant CAD. It also enables patients with non-significant or no CAD to be reassured that their symptoms are unlikely to be cardiac which will reduce anxiety and allow timely investigation of other causes of the chest pain. Nurses need training in the risks of radiation in order to be able to request the scans and enable the clinic to be nurse-led.
Usefulness of the japanese version of rapid dementia screening test for mild cognitive impairment in older patients with cardiovascular disease
Authors: Adachi T , Tsunekawa Y , Kameyama T , Kobayashi K , Matsuoka A , Tanimura D
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI

Background

Cognitive decline is common among older patients with cardiovascular disease and can decrease their self-management abilities. Therefore, early detection of cognitive decline is clinically important, as it can help guide effective home-based care measures, including education of family members and deployment of healthcare resources. However, the standard instruments for identifying mild cognitive impairment (MCI) are not always feasible in clinical practice.

Purpose

This study evaluated whether MCI could be detected using the Japanese version of the Rapid Dementia Screening Test (RDST-J), which is a simple screening tool for identifying cognitive decline.

Methods

This cross-sectional study included patients who were ≥ 65 years old and hospitalised because of cardiovascular disease. Patients with a pre-hospitalisation diagnosis of dementia were excluded. Each patient’s cognitive function had been measured at discharge using the RDST-J and the Japanese version of the Montreal Cognitive Assessment (MoCA-J), which is a standard tool for MCI screening. The RDST-J includes a number transcoding task and a supermarket task, and can be completed in 3 min (range: 0–12 points). The MoCA-J assesses nine domains of cognition and requires 10–15 min to complete (range: 0–30 points). The correlation between the two scores was evaluated using Spearman’s rank correlation coefficient. Receiver operating characteristic (ROC) analysis was also conducted to evaluate whether the RDST-J could identify MCI, which was defined as a MoCA-J score of ≤ 25 points.

Results

The study included 78 patients (the mean age: 77.2 ± 8.9 years, men: 56.4%). Based on a MoCA-J score of ≤ 25 points, MCI was identified in 73.1% (n = 57) of the patients. The RDST-J and MoCA-J scores were strongly correlated (r = 0.835, p <0.001). The ROC analysis revealed that an RDST-J score of ≤ 9 points provided 75.4% sensitivity and 95.2% specificity for identifying MCI, with an area under the curve of 0.899 (95% confidence interval: 0.835–0.964, Figure 1). The same cut-off value was identified when excluding patients with a high probability of dementia (RDST-J score of ≤ 4 points).

Conclusions

The RDST-J is a simple instrument and its score was highly correlated with the standard test for identifying MCI in older patients with cardiovascular disease. Our results suggest that the RDST-J may be useful for routine cognitive assessments in clinical practice. Longitudinal studies are needed to evaluate whether the RDST-J scores respond to changes in cognitive status, as well as whether this tool can be used to predict adverse health outcomes after discharge.
Using co-design to develop an online intervention for families after a sudden cardiac death in the young
Authors: Yeates L , Gardner K , Do J , Van Den Heuvel L , Fleming G , Semsarian C , Mcewen A , Adlard L , Ingles J
Published: July 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): National Heart Foundation of Australia / NHMRC Co-funded Post Graduate Scholarship

Introduction

Sudden cardiac death (SCD) is a devastating complication of many genetic heart diseases. The psychological impact on surviving family members is significant and lifelong. Previous needs analysis found medical and psychological needs are of high importance but remain unmet in some cases. Co-design is an increasingly popular research method for the development of interventions and services that include users as contributing members of the research team. Previous research has shown co-design leads to innovative ideas that better address user needs.

Purpose

To use co-design to develop an online support intervention for families after SCD.

Methods

Semi-structured moderated online focus groups were held with key stakeholders, including family members who had experienced young SCD, healthcare professionals and researchers. Guided discussions were used to co-design an online support intervention. Thematic analysis of discussions and iterative feedback on draft materials guided content development.

Results

Four focus groups were held (average 11 participants per group). Stakeholder involvement facilitated development of high-level ideas and priority issues. Key benefits included creative content and materials developed based on user preference for stories, narratives and information reflecting everyday experience of families navigating the legal and medical processes surrounding SCD, normalising and supporting grief responses in the context of family relationships, and fostering hope.

Conclusion

Co-design supported creative presentation, tailoring of information and development of psychosocial interventions to meet the needs of SCD families. Further work is needed to pilot and trial the intervention, prior to it becoming a key resource in the care of these families.
Effect of an exercise-based intervention on physical function of frail elderly patients with acute coronary syndrome
Authors: Ruescas-Nicolau MA , Sastre-Arbona C , Alabadi-Pardines B , Gonzalez-Timoneda A , Sanchis J , Ruiz-Ros V
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants from CIBER CV, Madrid, Spain [grant number 16/11/00420] and Instituto de Salud Carlos III-FEDER, Madrid, Spain

Background

Frail elderly patients with cardiovascular diseases are vulnerable and more likely to experience physical function decline. Of the interventions that have shown some efficacy in the management of frailty, exercise is the only treatment found to consistently improve physical function. Since the number of older persons with cardiac diseases is gradually increasing, understanding how therapeutic exercise might be successfully prescribed to prevent, or at least to reduce, the gradual decline in physical function in frail elderly patients, is a relevant issue.

Purpose

To evaluate the effect of an exercise-based intervention on performance-based measures of physical function in frail elderly patients after acute coronary syndrome (ACS).

Methods

A pretest-posttest design study was carried out. A cohort of  elderly patients (age ≥70 years) hospitalized for ACS was included. Frailty was determined with the Fried scale. Participants received a three-month structured physiotherapy intervention that included, along with aerobic training, particular exercises for strength, flexibility, balance and coordination. Before and after the intervention, physical function was assessed with the Short Physical Performance Battery (SPPB).

Results

Twenty three subjects (mean age 79 ± 3 years, 56.5 % men) participated. Of them, 13 were in a pre-frail status (Fried score = 1-2 points) while the other 10 were frail (Fried score >3 points). At baseline, the average Fried score was 2.35 ± 1.11. After the intervention, a significant difference was found for the SPPB total score (9.26 ± 2.73 vs 10.35 ±  1.87, p<.001). According to literature, this average 1.09-point increase in the SPPB score could be considered a clinically meaningful change. Also, there was a statistical significant increase after treatment in the partial scores of balance (3.3 ± 1.02 vs 3.83 ± 0.49 points,  p=.005), gait speed (3.39 ± 1.11 vs 3.61 ± 0.78 m/s, p<.001) and leg strength (2.35 ± 1.19 vs 2.91 ± 1.1 points, p=.006).

Conclusion

The proposed exercise-based physiotherapy intervention showed positive results in improving physical function in frail elderly patients with ACS. From a clinical viewpoint, measuring physical function and determining change over time are crucial since the deterioration of physical abilities are a strong predictor of future poor health outcomes, frailty, disability, and mortality in cardiovascular diseases.
Should cardiac rehabilitation programmes be specifically targeting sedentary time?
Authors: Henderson A , Curley J , Mcdaid D , Clendenning G , Mcglinchey D , Bayle S , Jones J , Connolly SB
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background / Introduction

Structured exercise classes and advice regarding regular moderate intensity physical activity are well-established components of cardiac rehabilitation (CR). Sedentary behaviour, refers to activities typically sitting or lying that do not substantially increase energy expenditure above resting, and increasing evidence suggests adults should limit their sedentary time to less than 9 hours/day as such behaviour with increased cardiovascular and all-cause mortality with additional benefits likely gained sitting less than 6-8 hours/day. Nonetheless sedentary behaviours are often overlooked or are only partially assessed via self-report in CR programmes. Due to covid restrictions (lockdown, social distancing, suspension of face-to-face CR programmes) there is concern that sedentary time may further increase in this population. Thus, it may be important to effectively monitor and target sedentary time, alongside traditional advice, to minimise its negative health impacts.

Purpose

Can a CR programme, adapted to remote delivery due to covid, objectively measure sedentary behaviour in a way that is feasible in every day practice and acceptable to patients?

Methods

Consecutive cardiovascular patients attending an initial assessment (via telephone or video) on the Our Hearts Our Minds Programme for Cardiovascular Health between December 2020 and February 2021 were asked to wear activPAL (PAL technologies Ltd., Glasgow, UK), a triaxial accelerometer, on their thigh for 7 days to measure the postural aspect of sedentary behaviour. On return of the monitor, the data was analysed using proprietary algorithms (intelligent activity classification) generating a report summarising time spent sitting, prolonged sitting, step count average, number of sit to stand transitions, moderate intensity activity minutes, most sedentary time(s) of the day and percentages spent in these activities. This personalised report was shared with the patient and their goals in terms of sedentary behaviour and physical activity were discussed and agreed.

Results

59 referrals were received between mid December 2020 and February 2021, of which 52 had an initial virtual assessment. Of these, 50 patients accepted an activPAL (96% response rate). Mean age 62.6 years. The output from the activPal is shown in table 1. The average sitting time overall was 9 hours 36 minutes. The breakdown in proportions sitting for extended periods of time are detailed in table below

Conclusion

2/3 of cardiovascular patients attending CR had levels of sitting time greater than what is recommended following their IA. Measuring sedentary time beyond self-report in CR programmes using activPal was feasible in a CR programme with 96% of consecutive patients wearing and returning activPAL.  Repeat analysis at end of programme will show if use of this data results in reduction of same .
How to use remote patient monitoring successfully in cardiac and pulmonary patients: a realist review
Authors: Thomas E , Taylor M , Smith A , Caffery L
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Queensland Health

Background

Remote patient monitoring (RPM) is an underutilised telehealth intervention that can enhance self-management of cardiovascular and pulmonary disease and reduce acute care use. However, studies of effectiveness of RPM interventions vary widely. This study aimed to explain the variation in outcomes related to RPM interventions within cardiac and pulmonary populations. Specifically, we aimed to answer why some RPM interventions are more successful than others in reducing demand on acute care services.

Methods

In brief, search terms for remote monitoring and acute care utilisation were used across three electronic databases: PubMed, EMBASE and CINAHL. The search, conducted in October 2020, included articles published in the last five years (2015-2020). Articles were included if they used RPM to monitor an individual’s biometrics (e.g. heart rate, blood pressure) from a distance while they are not in hospital. Realist review methodology was used to enable exploration of how, why and for whom interventions do and do not work.  Outcomes were evaluated to determine contextual factors and potential mechanisms that led to variation in cardiac and pulmonary intervention outcomes.

Results

After screening, 91 articles met the eligibility criteria and were included. We found that across a broad range of RPM interventions 31 factors emerged that are likely to impact the effectiveness of cardiac and pulmonary RPM innovations. These were synthesised into six theories of intervention success: 1) targeting populations at high risk; 2) accurately detecting a decline in health; 3) providing responsive and timely care; 4) personalising care; 5) enhancing self-management and, 6) ensuring collaborative and coordinated care.

Conclusion

 While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and with the key variables identified within this review  incorporated, it is more likely that they will be effective at reducing acute hospital events.
Electric myocardial inhomogeneity and stroke: connection and specifics
Authors: Sharafutdinova R , Ruzov VI , Gimaev RH , Skvortsov DY , Belogubov PV
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background.

The inconsistency of the literature data on the influence of different hemispheric localization of Cerebrovascular accident (CVA) on the development of cardiac arrhythmias suggests the expediency of further study of the so-called "zones" of the cerebral cortex associated with electrical instability of the myocardium.  It is known that dispersion of QT interval and fragmented myocardial activity belong to the markers of electrical instability of the heart and are associated with arrhythmogenesis. 

The aim of the study. 

To study the severity of abnormalities of the parameters of electrical instability of myocardium in right and left hemispheric stroke localization in patients with hypertension.

Material and methods.

111 patients with left hemispheric localization of ischemic stroke and 75 patients with right hemispheric stroke were examined. Hemorrhagic stroke was observed in 17 patients in the left hemisphere and in 13 patients in the right hemisphere. The average age was 58,2 ± 7,48 years. For all strokes, men prevailed (64% vs. 36%). For the first day of the stroke, all patients were evaluated for QT dispersion and fragmented myocardial activity on the device "Polyspectro-8EX" (Russia). 

Research results. 

Evaluation of the parameters of electrical instability of myocardium in patients with stroke revealed more pronounced disorders in hemorrhagic stroke of left hemispheric localization (Table 1). In ischemic stroke, the severity of electrophysiological parameters, reflecting the instability of the myocardium depending on the hemispheric localization, indicates the absence of differences. 

Conclusions. 

1.The most pronounced disturbances in the parameters of electrical stability of the myocardium is observed in hemorrhagic stroke. 

2.The severity of myocardial electrical instability in ischemic stroke is not associated with the localization of the focus.
Occurrence of professional burnout and severity of depressive symptoms among cardiac nurses: A prospective and observational study
Authors: Larysz A , Prokopowicz A , Zakliczynski M , Uchmanowicz I
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Depression impacts 14% of the adult population in the European Union, and it is known to impact work performance. Nurses with depression are not only likely to suffer themselves, but their illness may have an impact on their coworkers and potentially the quality of care they provide.

Objective

The purpose of this study was to determine the prevalence of depression in a sample of hospital-employed cardiac nurses to determine if burnout is associated with depression.

Methods

A cross-sectional survey design of 400 registered nurses was used. Measures included individual characteristics, workplace characteristics, burnout and depression using the standardized instruments: the Maslach Burnout Inventory (MBI), the Beck Depression Inventory (BDI), and the Patient Health Questionaire-9 (PHQ-9).

Results

The level of professional burnout (MBI) showed high levels of emotional exhaustion (EE) in 53.25% of nurses, high depersonalization (DEP) in 52.50%, and low personal accomplishment (PA) in 72.75%. PHQ-9 and BDI were shown to correlate significantly and positively with all three MBI subscales (p < 0.05). Data analysis demonstrated a high depressive symptom rate and a high occupational burnout which had significant relationships with depression (p < 0.05).

Conclusions

Nurses play an important role in health care system; therefore, it is very important to recognize the symptoms of occupational burnout and depression. The prevalence of nurses with depression and professional burnout is high and may negatively affect the quality of patient care.
Associations between density and quality of health promotion programmes and built environment features across Jerusalem
Authors: Besor Omri , Paltiel Ora , Manor Orly , Donchin Milka , Rauch Orly , Kaufman-Shriqui Vered
Published: July 2021

Background

Health promotion programmes (HPPs) have the potential to influence individual health, depending on their quality and characteristics. Little is known about how they interact with built environment features and neighbourhood demographics in cities with substantial health disparities.

Methods

Using the European Quality Instrument for Health Promotion (EQUIHP), we assessed the quality of HPPs, operating between 2016 and 2017, among adults aged 18–75 in Jerusalem. Areas were characterized by ethnicity and area socioeconomic level. Health information (body mass index, physical activity level) was obtained from the city profile survey. Geospatial information on the location and length of walking paths and bicycle lanes was obtained. Spearman correlations were used to assess associations among variables.

Results

Ninety-three HPPs operating in 349 locations in Jerusalem were identified. Programmes were unevenly distributed across urban planning areas (UPAs), with the highest density observed in the southwest, areas populated mainly by non-orthodox Jewish residents. However, the best performing HPPs based on EQUIHP score were in the north and east UPAs, inhabited primarily by Arab residents. At a neighbourhood level, characteristics of the built environment positively correlated with higher total EQUIHP scores: the ratio between walking lane length to the neighbourhood’s population size (r = 0.413, P < 0.001) and length of bicycle lane per population (r = 0.309, P = 0.5). Median EQUIHP score negatively correlated with the number of programmes per neighbourhood size (m2) (r = −0.327, P = 0.006) and neighbourhood average socioeconomic status (SES; r = −0.266, P = 0.027).

Conclusions

Our findings suggest that higher quality HPPs were preferentially located in areas of lower SES and served minority populations in Jerusalem.