bluuebunny/crossref_metadata_2025 huggingface dataset:
The psychological effects of interventions targeting caregivers of patients with heart disease, a systematic review
Authors: Risom S , Moeller E , Wind G , Prip A , Hillersdal L , Pii K H , Grew J
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): University College Copenhagen, Denmark.

Background

The healthcare system is facing major challenges due to an increasing number of patients with chronic diseases, including patients with cardiovascular diseases. As a consequence more caregivers will experience having a greater role in the treatment and care of their loved ones. This can have significant psychological consequences for the caregivers. For that reason, there is a need for evidence-based interventions that support caregivers of patients with cardiovascular disease.

The aim: Is to contribute with evidence-based knowledge about the effects of interventions supporting caregivers in the care and treatment of patients with heart disease focusing on psychological effects.

Method

A systematic review has been conducted based on the methodology described by Cochrane Handbook (2022). The following databases have been searched: Pubmed, Embase, Cochrane Library, CINAHL & PsychInfo. The literature search was carried out on the basis of the developed search strategy and studies were collected based on pre-specified inclusion and exclusion criteria. Subsequently, a critical quality assessment using RoB-2 quality assessment tool, a data extraction and a data synthesis were carried out after.

Results

The systematic search revealed 3,659 manuscripts, from where eight randomized controlled studies were included. The results of the data synthesis showed that the interventions were heterogeneous in regard to timing, intensity, and length of interventions. Most of the interventions included educational face-to-face sessions, in combination with telephone support or written resources. Likewise, the synthesis showed inconsistent results across studies, but positive effects were seen on caregivers (including caregiver burden, quality of life and depression) in some studies and no harm were observed in any study. The results indicated that the intensity of the interventions was related to better outcomes.

Conclusion

The included studies contribute knowledge about the psychological effects of interventions targeting caregivers of patients with cardiovascular diseases. Overall, inconsistencies were found across studies, which can be expected to be attributed to the heterogeneity across the complex interventions. There is a need for further research in the area to map which elements or combinations of elements that are ideal to test in future interventions. The development of effective interventions supporting caregivers and their well-being is of great importance, as it has the potential to benefit patients, caregivers, as well as society in general.
Listening to the patient voice on home-based cardiac rehabilitation: a qualitative audit mapping patient-reported outcomes to current european guidelines
Authors: Talty A , Morris R , Deighan C , Cameron S , Taylor L
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): NHS Lothian.

Background and Purpose

Increasing evidence supports the efficacy of facilitated home-based cardiac rehabilitation as an alternative to hospital-based rehabilitation for individuals recovering from myocardial infarction and revascularisation. The objective of this audit was to explore qualitative patient-reported outcomes of a home-based cardiac rehabilitation programme in relation to current european guidelines.

Methods

Following their participation in the six-week cardiac rehabilitation programme, patients completed an evaluation questionnaire consisting of 1) a 25-item survey rating their satisfaction with elements of the programme and 2) five open-ended questions regarding their experiences and resulting outcomes. The anonymous patient responses were transcribed and stored securely using an electronic database. For the purpose of this audit, the qualitative data from 203 patients between April 2021 and January 2023 were analysed. The data was coded into the key risk, psychosocial and behavioural factors presented in current european guidelines, while also capturing additional themes. Once identified, inductive thematic analysis was employed to extract further meaning from featured codes.

Results

Deductive coding identified the following constructs from the guidelines within the data: risk factors (blood pressure, cigarette smoking, diabetes mellitus, adiposity), sex and gender and their impact on health, communication of cardiovascular disease risk, psychosocial factors, optimising lifestyle (physical activity and exercise, and nutrition and alcohol) and medication adherence. Within this, inductive themes that emerged included: successful risk modification (of factors such as diabetes and adiposity), successful behaviour modification, increased awareness, understanding and confidence, decreases in stress and anxiety, increased pacing and relaxation, preference for more content, resentment of generalised information, the impact of Covid-19 and the benefit of the programme to family members.

Conclusions

The results of this qualitative audit suggest that patient satisfaction was high, post-participation in the cardiac rehabilitation programme. The findings of reported successful risk and behaviour modification in relation to nutrition, exercise, smoking, alcohol intake, diabetes, adiposity and psychological factors indicate the programme’s efficacy in facilitating lifestyle changes amongst cardiac rehabilitation patients with multiple conditions. The preference for more content with regard to blood pressure and factors specific to women provides valuable insight for ongoing resource development and research.
Developing a care pathway for heart failure with preserved ejection fraction: patient perceptions of existing care and their needs
Authors: Mckeddie M , Cowie A , Mckay J , Cooke M
Published: July 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Scottish Government

Background

The Heart Disease Action Plan’s vision is that everyone in Scotland receives care that supports them in living well with their heart condition [1]. In 2021 NHS Ayrshire and Arran (NHS A&A) was successful in attaining Scottish Government funding to develop and pilot a care pathway for those with heart failure with preserved ejection fraction (HFpEF). HFpEF is not widely understood by the wider healthcare community, and access to care for this population is limited. To help inform development of this pathway, a scoping exercise was undertaken to fully understand the needs of those with HFpEF, and to provide baseline data for evaluation of the new pathway.

Purpose

As part of the scoping exercise, patient interviews were conducted. The purpose of these was to establish patient perceptions of existing care for HFpEF and to ascertain how closely this aligned with their needs.

Methods

Five telephone interviews were conducted with individuals recently diagnosed and admitted to hospital with HFpEF within NHSA&A.

Interviews focused upon the following questions, with prompts on ‘what went well?’ and ‘what could have gone better?’:

- What brought you to hospital?

- How was your in-patient care?

- What was the support like after discharge?

- How is your current management of your medications?

All interviews were conducted by the HFpEF Project Lead Nurse and took approximately 20-30 minutes.

Results

Care experience varied widely and three main themes were identified: support, communication, and continuity. Patients highlighted the importance of feeling listened to, and of having clear communication around the HFpEF diagnosis and care plan, with an appropriate channel available for them to ask questions and access relevant support. Continuity of care was dependent upon good multidisciplinary communication and integrated working, and upon staffing levels. There was a desire for ongoing clinical support for self- and medical management of their HFpEF at home.

"No one is supporting....I manage myself"

[someone] "…should contact you on discharge….[because]…you get an explanation in hospital but then there are questions that arise after discharge…."

"I think they could have explained things better to me….just to have an opportunity to have questions answered and my heart condition discussed"

"…I would say that there was a breakdown in the service [after discharge]."

Conclusions

The interviews demonstrate a clear need for a pathway for HFpEF that provides support, communication and continuity of care. It is hoped that evaluation of the pathway will demonstrate a positive impact upon these data.
Experiences of participation in patient's with infective endocarditis: a qualitative study
Authors: Sarmanlu D , Ryom K , Risom S , Grum M , Bech B , Hoejlund H , Rasmussen T
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Infective Endocarditis (IE) is a life-threatening disease with increasing incidence worldwide. An important aspect in a patient’s course of illness is having a close and understanding caregiver. Receiving support from a partner or spouse has been found to be associated with increased survival and lower recurrence of heart diseases. Likewise, the caregiver may be able to experience positive emotions and personal growth by being an important part of the patient’s course of illness. Previous studies have explored patients’ and caregivers’ experiences with participation during the patient’s course of illness. To our knowledge, these perspectives have not yet been studied in patients with IE and their caregivers.

Purpose

The purpose of this study was to explore and elucidate patients with IE and their caregivers’ experiences with each other’s participation during the patient’s course of illness including hospitalization and recovery at home.

Methodology

The design was a holistic single-case study, where patients with IE and their caregivers were the target of interest. The empirical data was collected using qualitative, semi-structured dyadic interviews where the participants were interviewed in pairs. Theory-driven and data-driven coding was used as the analytical tools in the analysis of the data.

Results

The empirical data suggest that social support plays a significant role in the participants’ lives and course of illness, in which emotional support, physiological and practical assistance, as well as attitude transmission accounted for the greatest sources of impact. Important factors to the psychological well-being of participants were spending time with family members and maintaining a positive outlook on life. In light of theories of coping in social psychology, some participants reported using emotion-focused coping, problem-focused coping and protective buffering coping, whilst others did not use these. The majority of the caregivers reported that the course of illness did not have an impact on their working life and social relations, while some stated that it had a negative impact on their work, finances, mental and physical energy and social relations. An additional insight was given as the participants shared their thoughts on a need for psychological counseling and their experiences with compassionate healthcare professionals.

Conclusion: The study concludes that the participation of patients with IE and their caregivers in the course of illness played an important and positive role in their lives. As such, it could be advised that healthcare professionals should focus more on how patients and their caregivers cope both individually and together in the course of illness. Understanding their perspectives could have implications on how healthcare professionals plan health measures to improve outcomes for both the patient and the caregiver.
Occupational burnout in nurses employed in cardiology and noncardiology departments
Authors: Wolfshaut-Wolak R , Nowacka A , Micek A , Kolacz J , Piskorz A , Wadas T , Gniadek A
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Uniwersytet Jagiellonian Collegium Medicum, Krakow

Prevalence of occupational burnout in nurses employed in cardiology and non-cardiology departments in hospitals in the Małopolska region

Introduction

An increase in the incidence of burnout symptoms was observed in nurses employed in hospitals.

Objective

An assessment of the frequency of burnout symptoms among nurses working in hospital cardiology and non-cardiology departments.

Metody: A cross-sectional, descriptive study was conducted between 2020 and 2022. It was carried out in a group of 155 nurses working in cardiology departments and 202 nurses working in non-cardiology departments. The nurses were randomly selected from the register of hospital employed nurses of Malopolska Regional Chamber of Nurses and Midwives. The incidence and intensity of burnout syndrom were determined based on Maslach Burnout Inventory (MBI). The study described the burnout syndrome the level of occupational burnout using the dimensions of emotional exhaustion, depersonalization, and personal accomplishment.

Results

Among the surveyed nurses, a high level of emotional exhaustion was the most common, 52.9% in cardiology nurses and 45% in other nurses. The average level of depersonalization was most common (37.4% vs 33.2%). Personal accomplishment was dominated by a low degree in both groups (48.4% and 48.0%). No significant differences were found between the types of departments. There were a significant relationship between the occurrence of depersonalization symptoms and age (p<0.007) and work experience of nurses (p<0.009). Nurses with a high degree of depersonalization were significantly younger or had shorter work experience.

Conclusions

The study found that nurses worked in hospital departments in Małopolska region were very high level of burnout. The incidents of exposure was no depend on the departments where they work.
Characterization of therapeutic programs headed at post-myocardial infarction patients or at risk of: a scoping review
Authors: Santos D S , Taveira A T , Macedo A M
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Worldwide stays confirmed that more than 7 million people experience acute myocardial infarction, in which one-year mortality rates range from 10%. The consequences are more dramatic among patients who survived because they are 20% likely to suffer a second cardiovascular event in the first year and mostly occur in those with a previous hospital discharge. Evidence has shown that prevention after a myocardial infarction has been positively associated with an improvement in its prognosis. The European Society of Cardiology was determined to embrace this challenge, endorsing the crucial role of secondary programs. However, recent studies allow us to state some gaps between the correlation of some important variables, related to secondary programs and patients that should be considered to reinforce good intervention practices.

Purpose

To analyze data capable of characterizing therapeutic programs considering the correlation between variables such as quality indicators, settings of implementation, use of digital technology, health professionals/organization enrolled, and the program's overall length.

Methods

We performed the analyses in different electronic databases, including published studies from 2007 to September 2022 that reported health therapeutic programs headed post at post-myocardial infarction patients or at risk. After identifying 609 titles, and screening 131 articles, accepting 20 full-text for systematic analysis.

Results

16 studies included outpatient presence requirements in the relationship with the health care provider; 4 studies used mobile phone/ digital applications in patient health communication; 3 programs included multi-professional collaboration, the other 7 studies were single-professional with relevance to psychologists and physiotherapists; only 3 studies were conducted in the community setting; Overall, the maximum of programs length ranged from 3 to 42 months; Only 4 studies evaluated the efficiency of the interventions, considering the cost to the organization of the programs and the hospitalized patients; 18 studies related their efficiency based on changes in patient's health behavior and biological parameters. Overall, in terms of the methodology outlined 60% of the studies used a quantitative design, 10% used a mixed plan, and 15% did not refer to it.

Conclusions

we confirmed the absence of prior guidelines for secondary programs' uniformization, which corroborate the need affirmed for the European Society of Cardiology of endorsing the crucial role and the impact of secondary programs on patient`s health path, tailored to patients needs. We highlight the importance of using mixed methodologies, and prospective design capable of capturing the whole phenomenon. We did not identify any study considering the interoperability of health organizations as a strategy capable of adding value.
Barriers and facilitators of cardiac rehabilitation uptake and completion in south Asian minorities: a meta-synthesis
Authors: Inayat S , Hayden A , Shier K K , Campbell T
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac rehabilitation is a proven modality to prevent future cardiac events and complications in cardiac patients. However, the uptake and completion rate are suboptimal in cardiac patients and even worse in ethnic minorities and women. South Asian minorities experience several barriers and facilitators to cardiac rehabilitation uptake and completion.

Aim

To develop a comprehensive understanding of barriers and facilitators to cardiac rehabilitation uptake and completion by South Asian minorities.

Methods

A meta-synthesis was conducted, and findings were reported using PRISMA guidelines. The following databases: Medline, Embase, APA PsycInfo, Cochrane Database of Systematic Review, CINHAL, Scopus, and Web of Science were searched from inception to July 2022. The inclusion criteria comprised the studies that focused on South Asian adult minorities’ barriers and/or facilitators of a structured cardiac rehabilitation program. Studies were critically appraised using the Mixed Methods Appraisal Tool. Thematic synthesis was used in the analysis.

Results

A total of 7110 records were retrieved and eight studies from Canada and United Kingdom met the inclusion criteria. There were more identified barriers than facilitators. Communication constraints resulted in inadequate health education, while conservative socio-religious beliefs, negative attitudes about healthcare professionals, and systemic constraints (e.g., transportation problems, and work schedule concerns) were the key barriers themes. Peer and family support and patient-preferred specific mechanisms for cardiac rehabilitation implementation were substantial facilitators.

Conclusion

South Asian minorities experience multilevel barriers and facilitators to cardiac rehabilitation uptake and completion. Further research with a robust and culturally contextual intervention and methodology can help improve the uptake and cardiac rehabilitation completion in this population. Healthcare professionals and policymakers can utilize these findings to develop tailored cardiac rehabilitation programs for South Asian minorities.
Testosterone and depression in men with heart failure
Authors: Dumitrascu A R , Diaconu R , Donoiu I
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Low testosterone levels are frequently seen in men with chronic heart failure. Testosterone interacts with neurotransmitters like dopamine, serotonin, and noradrenaline and its levels affect neurobehavioral characteristics such as irritability, emotional tone, and cognitive function. Depression and anxiety are very frequent in patients with heart failure

Purpose

To evaluate the relationship between testosterone levels and depression severity in a cohort of males with dilated cardiomyopathy and heart failure.

Methods

In this cross-sectional single-center study we included 78 Caucasian male patients with dilated cardiomyopathy and chronic heart failure (mean age 58.5 years, range 29 – 80 years old; mean left ventricular ejection fraction 24.54%). All patients were subjected to clinical, biological, and echocardiographic examinations. Depressive symptoms were assessed using the PHQ-9 Depression Test Questionnaire which is a simple 97% sensitivity test used for guiding the diagnosis of depression in high-risk populations including patients with heart failure. Serum total T levels and sex hormone-binding globulin were measured by chemiluminescence assays and free testosterone (FT) levels were calculated. Based on the results from these assays, patients were divided into five groups according to the 5 stages of the PHQ-9 scale (minimal, mild, moderate, moderately severe, and severe).

Results

Patients with high levels of FT (82.83±55.73 pg/mL) didn’t show any features consistent with depression, however patients with lower levels of FT had a proportional increase in the number of signs and symptoms suggestive of depression (67.97±37.12 pg/mL– mild depression, 45.24±28.52 pg/mL - moderate depression, 29.79±20.32 pg/mL – moderately severe depression, 18.56±14.28 pg/mL- severe depression). Patients with depression also had higher levels of higher C-reactive protein, urea, and creatinine (p<0.001).

Conclusion

Lower levels of free testosterone are associated with a proportional increase in depressive symptoms in patients with dilated cardiomyopathy and heart failure.
Role of nursing in the implantation of the injectable holter
Authors: Mesa-Rico R , Sanchez-Jimenez M , Carrasco-Campos M , Repullo-Cortes G , Gomez Garcia-Olias S , Campos-Marin A , Ruiz-Serrano A , Molina-Fernanez E , Llamas-Rios A , Berga-Congost G , Moreno-Segura N , Fuentes-Aparicio L , Marques-Sule E
Published: July 2023

Funding Acknowledgements

Type of funding sources: None. Main funding source(s): No

Introduction

The injectable Holter monitor is a useful tool in the evaluation of patients with recurrent syncope of unknown etiology and in patients with suspected embolic paroxysmal AF. This device monitors heart rhythm for 2-3 years. In our center, the implantation and follow-up of this type of patient is carried out exclusively by nursing, with three centers in Andalusia performing this type of procedure. The objective is to describe the injectable holter implant procedure prepared by nursing.

Material and Method

Through the bibliographic search in the CUIDEN and PubMed databases, a procedure for the implantation of an injectable Holter monitor by nursing has been developed. The types of Holter that are implanted in the Hemodynamics Unit, the implantation procedure, as well as the necessary material are described. When an injectable Holter monitor is implanted in a patient, a series of steps are followed, such as checking them the next day, conducting health education, as well as delivering the remote monitoring device.

Results

Since 2010, 266 devices have been implanted, with the nursing staff being fully responsible for both implanting and monitoring them. In the insertion procedure, the previous preparation of the patient, information, the necessary material for the implant, procedure and activation of the device by means of a programmer are highlighted. After the implant, monitoring and remote control are performed by the nursing staff for functional tests.

Conclusions

The complete approach to the implantation and follow-up of the injectable Holter monitor by nursing has allowed us to grow, helping closely in the diagnosis and treatment of heart rhythm disorders. The utility in the early detection of cardiac events in the injectable Holter monitor is a leap in the quality of life of patients, in the optimization of resources and in response time.
Filling the gap between research evidence and clinical practice to promote cardiovascular nursing-related knowledge
Authors: Mostafa S M , Elkhateb M , Abdelhay M
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The journal club is intended to improve nurses' understanding of the research process and their capacity to analyse and synthesise research studies, serve as a forum for discussing research evidence in relation to clinical practice, disseminate research results into practice, and reinforce the need for evidence-based practice. The journal club encourages nurses to engage in evidence-based activities and to perform nurse-driven research investigations.

The application of new knowledge gained via participation can improve the quality of care provided to patients and their families.

Aim

Filling the gap between research evidence, clinical practice, and promoting nursing-related knowledge.

Process

Nursing Journal Club commenced in AHC on July 28, 2022; by the end of 2022, the total number of sessions held was 12.

All topics presented and discussed are nursing-focused, evidence-based practise research that enhances or changes the practice.

Since the launch of the club, all AHC nursing units have participated in presenting various topics.

The club met twice a month, where two nursing units presented recent research evidence based on current related practice, issues, areas for improvement, and/or areas of interest.

Data Analysis

The questionnaire was filled out by 55 nurses. Five nurses from each nursing department were chosen at random to fill it out. The survey's goal is to determine the effectiveness of using journal club in cardiac healthcare facilities. (Chart 1)

The survey reported that 96.4% of participants sensed that the club promoted interest in research and promoted the ability to apprise nurses of nursing research, 90.9% confirmed that the club strengthened the nurse's ability to analyse current evidence-based research; 94.5% agreed that the club allowed open discussions, 96.4% were disclosed that the club enhanced the chance to change practise to reflect the highest and most updated evidence; and 89.1% of participants reveled that the club answered dilemmas related to daily practice. The journal club was a main place to discuss the current research and evidence in nursing; as 98.2% of participants reported. Eventually, 94.5% of participants exposed that the club was a suitable educational method.

The participants were asked one open-ended interview question; the majority responded that the club allowed nurses to have a vision for nursing research, expand knowledge, and was a useful approach for education in bridging the gap between research and daily practise.

Conclusion

Nurses' critical-thinking skills were sustained by the introduction of the journal club into cardiac healthcare facilities, which increased their familiarity with the latest research and strengthened their ability to evaluate the quality of published studies. Moreover, it encourages the use of newly acquired knowledge in clinical practice, which should enhance patient outcomes.The survey results
Peri-procedure experiences during minimalist transcatheter aortic valve implantation: insights from patients' perspectives
Authors: Lauck S , Percy C , Howard A F , Lee B
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

There is growing evidence to support the implementation of a streamlined clinical pathway to optimise outcomes, improve program capacity, and facilitate safe early discharge home after transcatheter aortic valve implantation (TAVI). In the peri-procedure phase, the adoption of a minimalist approach has accelerated the rapid transition from the use of general anaesthesia to default strategies ranging from conscious sedation to local anaesthesia only. Little is known of patients’ perspectives with undergoing minimalist TAVI. We aimed to explore what could be learned from this episode of care to inform multidisciplinary practice.

Methods

We conducted a prospective single centre qualitative study of TAVI patients within the first week of their discharge home, using purposeful sample to recruit a diverse population. We conducted individual interviews, using a semi-structured interview guide informed by pilot work and current evidence; open-ended questions were designed to explore patients’ perspectives of their peri-procedural experiences, inclusive of their recall of the procedure, interactions with team members, and the overall care received. Data were analyzed using interpretive description, a methodological approach appropriate to inform the knowledge needs of applied disciplines and conducive to generating new ideas and augment existing knowledge in the context of clinical practice.

Results

We recruited 15 participants, including 5 women, median age 82 (IQR 77,86); all patients had severe symptomatic aortic stenosis and multiple co-morbidities. TAVI was conducted using a transfemoral approach, with local anaesthesia only (n=4) or minimal sedation (n=11). Median length of stay was 1 day; one participant required a new permanent pacemaker; all participants were discharged home. The overarching theme of "I want to be a member of my Heart Team during my procedure" emerged; this aspiration, request and/or need was illustrated by three main themes: (1) "Who am I to them?", (2) "How can I be a good patient?", and (3) "How do I manage this complex wave of emotions?".

Conclusions

The rapid emergence of minimally invasive options for the treatment of valvular heart disease has established a new standard of care. Peri-procedure care initially informed by surgical practices have now shifted to most patients being conscious during TAVI and cared for by a smaller clinical team. The awareness of patients’ perspectives, and their inclusion in the Heart Team’s dynamics and processes offer important insights to optimise patients’ experiences of procedural care and clinical outcomes.
Knowledge, attitudes and behaviours of cardiac health professionals towards cognitive screening in acute coronary syndrome patients
Authors: Zhao E , Lowres N L , Bloomfield J B , Weddell J W , Tofler J T , Gallagher R G
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cognitive impairment (CI) is common in acute coronary syndrome (ACS) patients but is often undetected and may impact recovery and secondary prevention uptake. Health professionals play a vital role in the early detection of CI through screening and managing CI in ACS patients.

Purpose

To explore health professionals’ knowledge, attitudes, and behaviours toward CI screening in ACS patients

Methods

Cardiac health professionals were recruited via acute and outpatient cardiac wards in three metropolitan teaching hospitals and from emailing members of two cardiac professional associations in Australia. All completed a 38-item survey administered in either paper or electronic format.

Results

100 health professionals responded (95 nurses and five allied health workers). Respondents identified the prevalence of CI, dementia, or delirium at 25% post-ACS (50% of respondents), and 74% identified difficulties in recalling recent information as the most common indicator of CI. The cognitive screening was performed at least some of the time in ACS patients by 73%. After accounting for age, receiving training in CI, work experience, and profession, cognitive screening was conducted more than eight times more often by health professionals who work in acute settings (OR=8.78, 95%CI 2.13, 36.25) versus non-acute. Participants identified the main reasons for conducting cognitive screening as early detection of change/establishing a baseline (n=27) and when they suspected any cognitive issue or decline (n=26). The most common barriers to both screening for CI and taking further actions when CI was detected were patients being unable to communicate well (60% and 49%), patients being too unstable/unwell (59% and 42%), and the priority being the patient’s clinical care (53% and 44%).

Conclusions

Health professionals working in acute settings are most likely to screen for CI regardless of experience or training in CI, leaving CI likely to be undetected in ACS patients receiving care in other settings. Barriers to screening are common and challenging to address due to time shortages and the appropriateness of tools. A standardised screening guideline and more feasible screening tools are needed to overcome the barriers to cognitive screening in ACS patients. Pre-professional education should also be implemented in the future.
Cardiovascular disease patient reported experiences with a web-based, interactive, clinically integrated cardiac rehabilitation program
Authors: Nesbitt K A T I E , Gebremichael L G , Champion S , Bulamu N , Clark R A , Beleigoli A
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background/introduction

Patient reported experience measures (PREMS) encompasses a person’s interactions within the healthcare system. Understanding the patient experience is key to quality patient-centered care, and evaluating these experiences is essential to improving clinical outcomes and health care quality. Cardiac rehabilitation (CR) programs contribute to redressing cardiovascular disease (CVD) morbidity and mortality by slowing the progression of CVD and restoring quality of life. There is consensus that CR suboptimal attendance and completion is multifactorial, and that different causes are involved. Thus, evaluating patient experience to improve CR program attendance and completion and reduce the burden of CVD is essential.

Method

A retrospective descriptive survey design was used for patients ≥18 years, who were enrolled and active with the interactive, and clinically integrated web-based program for their CR between July 2021 to December 2022. The primary outcome was patient experience, and the aim was to evaluate this experience.

Results

Of the 54 enrolled patients, 16 met the inclusion criteria and received an online survey link. Of these 9 (56.3%) responded. Most respondents were aged between 60-70 years (55.6%) and male (77.8%). Seven (77.8%) did a web-based program only, and hybrid (combined web-based and centre CR) were two, (22.2%). The main reasons for choosing this mode of delivery were restrictions relating to the COVID-19 pandemic (66.7 %), and/or geographical isolation and work commitments (33.3%). Most stated that they participated in their goal setting (89%), and 77.8% achieved these goals. Program completion was reported by 77.5% of patients, with 7.89 (SD 4.12) mean weeks completed. Information delivered in the education sessions was clear and easy to understand, contributing to positive lifestyle changes as reported by 77.7% of patients. All patients reported increased confidence across the CR health domains and being treated with respect and dignity. Regarding Phase 3 CR, extended ongoing outpatient attendance and exercise programs, 77.9% reported working with their GP and practice nurse to maintain lifestyle changes. Overall patients reported a positive experience from the web-based CR program stating, "I found this program to be very beneficial and would strongly recommend it to people having heart ops. Pity about covid stopping me attending face to face sessions. The phone and internet support was top notch".

Conclusions

Patients reported a high level of satisfaction with the education received and respect and dignity shown via a web-based CR program. This is fundamental to engagement with the program, behavior change and improved clinical outcomes in particular for patients with no access to center-based CR due to pandemics, work commitments and geographical isolation.
How the dyads of heart failure patients and their informal caregivers cope with the disease process: a qualitative synthesis
Authors: Xiong C , Li P W C , Yu D S F , Wong C W Y
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Heart failure (HF) is a debilitating and progressive condition requiring consistent self-care by patients and their caregivers. Understanding the dyadic coping experience is crucial to inform the development of effective self-care interventions. Existing reviews focused on coping experience of patients or informal caregivers separately, without considering dynamic interaction between patients and caregivers.

Purpose

This review aimed to synthesize the qualitative studies to understand how patients and their caregivers interact and jointly cope with HF.

Methods

A systematic literature searching was conducted in nine electronic databases from inception to 11 June 2022. Manual searching of the reference list of relevant articles was also conducted. Articles were eligible if they focused on exploring the dyadic coping experience of HF patient-caregiver dyads aged 18 years or older. The Critical Appraisal Skills Programme tool for qualitative studies was used to assess the methodological quality of included articles. Thematic synthesis was adopted to synthesize the findings.

Results

Thirty articles were included in the review. Eleven articles were rated as high quality and nineteen as moderate quality. Three analytical themes emerged from the findings: (1) challenges in their changing and shared life experience, (2) conditions shaping dyadic coping experience, and (3) evolving dyadic coping strategies from the illness experience (Figure 1). Patients’ progressive and debilitating disease conditions disrupted the shared lives of the dyads, consequently causing a series of stressors for both to cope with. Dyadic coping of HF is influenced by the interpersonal context (i.e., congruence of illness perception, dyadic relationship and interaction, dyadic coping capabilities) and social context (i.e., professional and informal input). During the coping process, HF dyads utilized constructive or destructive methods of adjusting relationship boundaries, transforming patterns of dyadic coping and regulating emotion in a dyadic context. Besides, the strategies of amplifying positive changes and seeking meaning were critical for dyads to normalize HF in their lives.

Conclusion

HF imposed multiple stressors on the shared life of the dyads. Under the influence of interpersonal and social context, patients and caregivers co-regulated dyadic coping strategies to respond to dyadic stress, either adaptively or maladaptively. A relationship-focused dyadic approach is needed to optimize the synergy in the dyadic coping process and support dyads to cope with HF.
Co-design of an atrial fibrillation mHealth intervention to increase medication adherence
Authors: Pearsons A , Hanson C L , Gallagher R , Clark R , O'carroll R , Hanley J , Strachan F , Mills N , Quinn T , Mckinstry B , Neubeck L
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Chief Scientist Office

Background

Atrial fibrillation (AF) related stroke risk can be reduced with oral anticoagulants (OACs). OACs need to be taken once or twice a day to maintain effectiveness but non-adherence remains a challenge mHealth applications are one way to support patients to take medication.

Purpose

We aimed to co-design an mHealth intervention to increase medication adherence to OACs in patients with AF.

Methods

We recruited individuals with AF via British Heart Foundation social media advertisement and using established contacts from the Scottish AF survey to take part in a series of remote and in-person workshops. These were 1) an initial patient experience session, gathering personal stories to contextualise the intervention 2) an interactive session, using existing mHealth AF applications identified via scoping review, and 3) a pilot session of the co-designed mobile app prototype. Data were collected using flipchart, post-it notes and researcher field notes, with emphasis placed on the use of direct quotations and storytelling. Development work was overseen by a steering group including clinicians, digital health experts, and four AF patient representatives.

Results

Eleven patients (7 males) aged 35-80 years took part. Six participants were diagnosed with AF within the last five years and eight had one or more co-morbidities. Number of daily medications ranged from 0-12, with 8/11 (72%) of participants taking OACs. Experience with smartphone use varied and only two reported using a smartphone to manage their own health. We developed a prototype mHealth app, MyAFNurse. The talking avatar-based app increases accessibility regardless of user health literacy level. It incorporates behaviour change techniques including a medication tracker and reminders, information about AF, advice on when and where to seek help, and a quiz to test knowledge.

Conclusions

A robust co-design process developed an avatar-based mHealth app that incorporates behaviour change techniques which will be evaluated in a feasibility trial.
Essesment of short-term clinical outcomes in coronary artery disease patients after PCI on the background of low glycemic diet
Authors: Payziev D , Alyavi B A , Uzokov J K , Orziev D Z
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Accumulated data suggest that low glycemic index diet (LGID) improved several clinical and biochemical parameters in patients with atherosclerotic coronary artery disease (ASCAD) after percutaneous coronary interventions (PCI) [1]. Aim of the present study was to evaluate the influence of LGID on short-term clinical outcomes in patients with ASCAD.

Material and Methods

The prospective, open label randomized study included 160 ASCAD patients collected within 2016-2019 years (Aged 38-76 years, mean age 58.2±12.0 years, male=48%). Patients were divided into 2 groups by 80 and assigned either LGID or routine recommended diet (RD). Patients were followed-up to three years after the PCI followed by stenting (medium 18.22±6.54 months) for the assessment of major adverse cardiac events (MACE). All data analyzed using STATA software.

Results

At the follow up period mortality rate was higher in RD groups than LGID group (RR1.34, CI 95%, 1.025-1.85, P<0.05). MACE were significantly higher in Group II than Group I patients (RR 1.28, CI 95%, 1.018-1.76, P<0.05). During the follow up 7% of patients occurred ACS whereas 11% patients in RD group occurred ACS (P<0.05). Regarding the stent thrombosis, there were not observed statistically significant changes between groups (P>0.05). Target vessel revascularization were performed in 2.5% LGID group patients whilst 6.25% in RD group patients (P<0.05). Besides, target lesion revascularization was performed in 1.25% LGID patients whilst 3.75% RD group patients (P<0.05). When we analyzed clinical outcomes by gender there were not observed any statistically significant changed between men and women (P>0.05).

Conclusion

Low glycemic index diet had lesser risk of MACE than routine diet in the short-term period in patients with atherosclerotic coronary artery disease after PCI. Further studies are required with large amount of patients.
How patients affected by heart failure and other chronic conditions perform general and specific self-care behaviors
Authors: Erba I , Ferro F , Saurini M , Ausili D , Matarese M , Vellone E , De Maria M
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Centre of Excellence for Nursing Scholarship (CECRI), Rome, Italy.

Background

Older adults affected by chronic conditions (i.e., heart failure or any other chronic condition) need to perform self-care. It includes behaviors to maintain a healthy lifestyle (self-care maintenance), monitor signs and symptoms of chronic diseases (self-care monitoring), and manage them (self-care management). Performing self-care, allows patients to improve their quality of life, reduce hospital admission rates, and mortality. In patients affected by Heart Failure (HF) and other chronic conditions, also specific self-care behaviors are needed. To date, no prior studies have investigated general and specific self-care behaviors in patients with HF and other chronic conditions.

Purpose

Investigate how patients affected by HF and other chronic conditions perform general and specific self-care.

Methods

Cross-sectional study. We collected data from April 2017 to October 2021 in Italy. Patients with HF and other chronic conditions with more than 65 y/o were enrolled in community and outpatient settings. The Self-Care of Chronic Illness Inventory (SC-CII) and The Self-Care of Heart Failure Index (SCHFI) were used to measure generic and specific self-care behaviors, respectively. Values ≥70 indicate adequate self-care behaviors. Paired t-test was performed to identify differences between SC-CII and SCHFI scores.

Results

A sample of 369 patients with HF was enrolled. 53.3% was female with a mean age of 78.91(±7.41) years, and a median of 3 chronic conditions. The two chronic conditions most frequently associated with HF were Hypertension (75%) and Diabetes Mellitus (70%). Results showed inadequate general self-care maintenance (66.11±14.7) and management (57.77±20.1). Instead, general self-care monitoring was adequate (76.26±20.4). Specific HF self-care maintenance, monitoring and management were inadequate and equal to 57.54 (±17.24), 53.41 (±25.32) and 54.48 (±20.02), respectively. Specific self-care in HF is significantly lower than general self-care behaviors (p<0.001).

Conclusion

Patients showed more difficulties performing general self-care maintenance and management respect self-care monitoring. Regarding specific HF self-care, patients perform inadequate self-care behaviors in all dimensions. Knowing the lower self-care behaviors is important for clinicians to develop tailored interventions. In particular, patients with HF and other chronic conditions need to be supported in specific self-care behaviors.
Clinical use of voice measurement in patients with heart failure: study protocol
Authors: Erba I , Matarese M , Ausili D , Vellone E
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Chronic conditions are the main causes of morbidity and mortality worldwide. Heart failure (HF) has a prevalence between 0.5% and 2% in the western population and the number is destined to increase from 25% in 2012 to 46% in 2030. Older adults affected by HF have difficulties to recognize signs and symptoms of the disease, bringing to a reduction of life expectancy. The voice is a complex coordination mechanism between systems and subsystems (i.e. glottis, lung, nose,..). Changes in voice parameters, measuring by algorisms of artificial intelligence, could be useful markers of HF exacerbation. To date, no prior studies have investigated the changing of voice parameters in HF patients and the relationships between voice parameter changes and the clinical course of HF.

Aims

Explore voice parameter differences between HF patients and healthy subjects; to investigate the relationships between voice parameter changes and the clinical course of the disease.

Methods

Observational study. Patients with HF and healthy subjects between 60 to 80 y/o will be enrolled in inpatient and outpatient settings. Patients and healthy participants will record voices by microphones and smartphones. Voice data will be analyzed with algorithms of artificial intelligence.

Results

This study will identify differences in voice parameters between HF patients and healthy participants, and the associations between the voice parameters and the clinical changes of HF patients.

Conclusion

Monitoring of voice parameters allows to clinicians to early identify, via voice changes, signs and symptoms of HF exacerbations, and to monitor patients at home.