bluuebunny/crossref_metadata_2025 huggingface dataset:
High-Volume Colonic Lavage Is a Safe and Preferred Colonoscopy Preparation for Patients With Inflammatory Bowel Disease
Authors: Gajera Amit , South Christopher , Cronley Kevin M , Ziebert John J , Wrigh Cynthia H , Levitan Orly , Burleson Dawn B , Johnson David A
Published: July 2022

Background

Colonoscopies provide a crucial diagnostic and surveillance tool for inflammatory bowel disease (IBD). Accordingly, IBD patients undergo repeated and frequent colonoscopies. The oral purgative bowel prep (BP) is often burdensome on patients, resulting in delayed or missed colonoscopies due to patient noncompliance. Additionally, oral BP has been noted to possibly induce colon mucosal inflammatory changes in some patients, which may be misleading when assessing actual disease activity.

Methods

In this retrospective clinical study, we evaluated the use of an FDA cleared, defecation-inducing high-volume colon irrigation (>40 L) BP to prepare IBD patients for colonoscopy. Data were collected at 4 US Hygieacare centers from September 2016 to March 2021. The IBD patient population consisted of 314 patients that underwent 343 BPs. The BPs were prescribed by 65 physicians and performed by 16 nurses and technicians.

Results

Patient ages were 20–85 years old, 76% females, 24% males, and 97% of the patients were adequately prepared for their colonoscopy (n = 309). Patient satisfaction with the BP was very high, as reflected in postprocedure surveys and open-ended responses text analyses, and there were no serious adverse events.

Conclusions

We present data supporting that the defecation-inducing high-volume colon irrigation BP for colonoscopy is safe, effective, and preferred for IBD patients. Using this BP for IBD patients can allow earlier interventions, significantly impacting disease management and future outcomes.
Timing of Live Attenuated Vaccination in Infants Exposed to Infliximab or Adalimumabin Utero: A Prospective Cohort Study in 107 Children
Authors: Liu Zheng , Julsgaard Mette , Zhu Xiao , Martin Jennifer , Barclay Murray L , Cranswick Noel , Gibson Peter R , Gearry Richard B , van der Giessen Janine , Connor Susan J , Rosella Ourania , Grosen Anne , Toong Catherine , Flanagan Emma , Wieringa Jantien W , Janneke van der Woude C , Bell Sally J ,   The CARINA Study Group, Kanis Shannon , Fallingborg Jan , Hvas Christian L , Christensen Lisbet A , Connell William R , Brown Steven J , Kjeldsen Jens , Wildt Signe , Svenningsen Lise , Sparrow Miles P , Walsh Alissa , Radford-Smith Graham , Lawrance Ian C , Andrews Jane M , Ellard Kathrine
Published: July 2022

Background and Aims

For infants exposed in utero to anti-tumour necrosis factor-α [TNF] medications, it is advised that live-attenuated vaccinations be postponed until the drug is cleared, but little is known about time to clearance. To minimize delays before live-attenuated vaccination can be given, we aimed to develop a pharmacokinetic model to predict time-to-clearance in infants exposed during pregnancy.

Methods

We prospectively followed in utero infliximab/adalimumab-exposed infants of mothers with inflammatory bowel disease across four countries between 2011 and 2018. Infants with a detectable anti-TNF umbilical-cord level and at least one other blood sample during the first year of life were included.

Results

Overall, 107 infants were enrolled, including 166 blood samples from 71 infliximab-exposed infants and 77 samples from 36 adalimumab-exposed infants. Anti-TNF was detectable in 23% [n = 25] of infants at 6 months. At 12 months, adalimumab was not detected but 4% [n = 3] had detectable infliximab. A Bayesian forecasting method was developed using a one-compartment pharmacokinetic model. Model validation showed that the predicted clearing time was in accordance with the measured observations. A clinician-friendly online calculator was developed for calculating full anti-TNF clearing time: https://xiaozhu.shinyapps.io/antiTNFcalculator2/.

Conclusions

Almost one-quarter of infants born to mothers receiving anti-TNF during pregnancy have detectable anti-TNF at 6 months. To limit the time to live-attenuated vaccination in infants of mothers receiving anti-TNF during pregnancy, the results of a cord drug level at birth and a second sample ≥ 1 month thereafter can be used to estimate the time for full anti-TNF clearance in these children.
Illuminating the need for a specific clinical care pathway for patients living with heart failure and identified as clinically frail.
Authors: Lehane M , Caples N , Wassell G
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Against a background of increasing global population aging, frailty affects 8-10% of those over 65 years and 25-50% in those over 85 years. Frailty has a 4-6 times greater prevalence in heart failure patients and is increasingly recognised as a predictor of increasing hospitalisation and mortality in cardiovascular disease. The Rockwood Clinical Frailty Scale estimates an individual’s degree of frailty on a scale of 1(very fit) to 9 (terminally ill) with a score of 5 or greater indicating frailty.

Purpose

To estimate the 30-day prevalence of frailty in patients attending an ANP-led Heart Failure Clinic as a precursor to developing a clinical care pathway that systematically identifies frailty and triggers a comprehensive geriatric assessment.

Methods

A multi-centre audit was conducted in three hospitals in Ireland. We retrospectively audited consecutive patients attending three ANP-led HF clinics in November 2021 to assess the prevalence of frailty. Demographic data, NYHA classification, number of hospital admissions in the previous year, clinical Frailty Score (CFS) and the number of patients under the care of a geriatrician was obtained from the medical notes of 170 heart failure patients consecutively reviewed. CFS was calculated in those patients over 65 years.

Results

Of 376 HF reviews in November 2021, 170 individual patients were identified, 65% were male, 86% were aged 65ys or older of which 34% were over 80 years and a mean age of 73.4 years. 52% of the cohort were admitted at least once in the previous year of which 12% were admitted twice and 5% were admitted 3-4 times. 37% were classified as NYHA III and 0.6% were NYHA IV. The majority (68%) were newly diagnosed with HF within the previous year. 14% of patients were aged under 65yrs and did not have a CFS, 19% were deemed vulnerable (CFS 4), 41% were CFS 5 or greater and only 5% were under the care of a geriatrician.

Conclusion(s)

The prevalence of frailty (41%) was high in comparison with the national average of 24% and global average of 17%. Despite a strong association between age, frailty and heart failure, few patients were managed by a geriatrician. This audit emphasises the importance of developing a regional clinical care pathway that promptly recognises frailty in a high-risk population and triggers a comprehensive geriatric assessment. Furthermore, this audit highlights the limitations of the CFS in demonstrating cognitive and social vulnerability provoking further discourse in how patients are assessed and managed in the future.
Gender-dependent compliance with therapeutic recommendations in patients with heart failure
Authors: Mlynarska A , Mlynarski R , Golba K S
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Non-pharmacological therapies are one of the key elements in the treatment of heart failure. Those therapies are effective if the instructions are followed. Aim of this study was the assessment of whether gender influence the degree of compliance with therapeutic recommendations in elderly patients with heart failure.

Methods

180 patients (aged 72,77 ± 7,98) with heart failure recognized based on ESC criteria were included in the study. In all, capability for self-care of patients with HF were analyzed by using Polish version the nine-item European Heart Failure Self-care Behavior Scale (EHFScBS-9). The complete results are obtained by adding up the number of points – the more the points, the worse is the capability for self-care. Patients were divided into 2 groups according to the gender: 70,6% men and 29,4% women.

Results

A satisfactory or good level of the capability for self-care of patients with HF was found in 27,8% of the patients. More than 65% of the patients followed the recommendations for taking medication and 41,7% used a low-sodium diet, while only 5,5% of the patients followed the recommendations for physical exercise. The average value of the level of the capability for self-care of patients was 27,7 ± 5,25 points. Women significantly worse comply with the overall level of self-care (p=00441) and recommendations regarding among the following variables: "I weigh myself every day" (p=0,0342) and "I limit the amount of fluids" (p=0,0139). Exact results of EHFScBS-9 scale are presented in the table below.

Conclusion

Gender may be a factor in compliance with therapeutic recommendations. Women are less likely to follow therapeutic recommendations for heart failure.
How do Heart Failure Caregivers gain information and support for their role? The contribution of specialist nurses.
Authors: Schutz S E , Walthall H
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Current evidence shows caregivers of people with Heart Failure are susceptible to a deterioration of their own health as a consequence of carrying a high degree of burden as a result of this role (McIlfatrick et al 2018, McHorney et al 2021). This level of burden appears to be a consequence of a limited understanding of heart failure symptoms and complex medication management, further perpetuated by being unsure of where to ask for help (Boyd et al 2004, Exley et al 2005).

The empirical evidence further suggests caregivers of people with Heart Failure experience a reduced quality of life, lack understanding of the Heart Failure trajectory (Etemadifar et al 2015, Fitzsimmons et al 2019), do not have adequate support networks (Shahrbabaki et al 2016) and require help and guidance with the care needs of the person with Heart Failure (Tavakoli et al 2018, Hayashi et al 2021).

Purpose

The aim of this study was to explore the support and information needs of caregivers of people with Heart Failure, in particular to explore the support provided by specialist Heart Failure Nurses.

Methods

A qualitative interview study was designed following the approach detailed by Brinkmann and Kvale (2015). A thematic analysis of the transcripts was conducted using the Braun and Clark’s Thematic Analysis approach (Braun and Clarke 2012). Coding of the interview transcripts was undertaken by two researchers (HW and SS), agreement reached and subsequent discussion and refinement by the Public/Patient Involvement (PPI) group of two heart failure nurse specialists and an ex-caregiver.

Results

Thematic analysis identified 4 themes: Taking on the role of caregiver; Getting to grips with being a caregiver; Impact on own health and wellbeing; Need for information and Support. This presentation will focus on the data that was a thread through each of the themes relating to the role of the Heart Failure Specialist Nurse in providing information and support. Whilst the specialist nurse was universally seen as informative and someone who actually valued caregiver input, consultants and general practitioners lacked consistency and failed to include the caregiver.

Conclusions

Caregivers in this study felt they were lacking information and knowledge about Heart Failure and consequently felt ill-equipped to deliver and manage care. Needs identified within our study reflect earlier work demonstrating the key role played by specialist nurses in supporting and informing caregivers of people with Heart Failure.
Malnutrition: a mascaraed and underused prognostic marker in coronary patients
Authors: Martinho A , Almeida J , Goncalves F , Monteiro S , Franco F , Goncalves L
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Malnutrition had been associated with worse prognosis in heart failure (HF) patients, especially in elder. However, this association wasn’t demonstrated in coronary patients, after a ST-segment elevation myocardial infarction (STEMI). We want to evaluate the prognosis value of malnutrition, in elder patients, after a STEMI.

Methods

We conducted a retrospective, observational study of 200 elderly patients (365 years) consecutively admitted with STEMI between 2016 and 2017. At discharge, we applied a validated formula who evaluate nutritional status: "Prognostic Nutritional Index" (PNI), [10 x serum albumin at discharge (g/dL) + 0.005 x total lymphocytes at discharge], whose lowest values were associated with malnutrition. At 1 year follow-up, we evaluated the relation between PNI and major adverse cardiac events (MACE): myocardial infarction (MI), HF hospitalization, cardiovascular (CV) and all-cause death.

Results

Mean age was 74±8 years, 71% (n=149) were male and with multiples risks factors (75% hypertense, 63% with dyslipidemia, 33% diabetes and 11% smokers). At discharge, patients had a mean Left Ventricular Ejection Fraction (LVEF) of 47±8% and a mean PNI of 37±5. Low PNI values (malnutrition) were significant associated with MACE at 1-year [OR 0.87 (95% CI 0.78 to 0.97, p=0.01)], after adjusting for age, sex and LVEF. When evaluated individually, low PNI was associated with more incidence of 1-year HF hospitalization [OR 0.88 (95% CI 0.78 to 0.99, p=0.03)] and all-cause death [OR 0.84 (95% CI 0.75 to 0.95, p=0.004)], after adjusting for age, sex and LVEF, but not with MI and CV death.

Conclusion

Malnutrion associated with other comorbidities inherent to elderly people were associated with MACE, 1-year after STEMI, in this type of population. Thus, we want to draw attention to the importance of evaluating the nutritional status during hospitalization for STEMI, allowing to initiate measures that contribute to its improvement.
A behavioural intervention to increase lay-people's intentions to initiate CPR in the event of Out-of-Hospital Cardiac Arrest: results from BICeP pilot trial
Authors: Farquharson B , Dixon D , Williams B , Clegg G , Macinnes L , Ramsay P
Published: July 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Medical Research Council

Background

Cardiopulmonary resuscitation (CPR) is the single most important factor determining survival from out of hospital cardiac arrest (OHCA). Even when trained, most lay-people don’t attempt CPR when they encounter OHCA. Working closely with intended users and CPR experts we developed a theory-based text-messaging intervention designed to increase rates of CPR. This pilot study was conducted to evaluate the acceptability of the messages, explore participant responses to them and to trial measures for a full evaluation.

Design

A before-and-after study plus qualitative interviews

Methods

Twenty lay-people from across Scotland agreed to take part and to receive the intervention (35 text-messages over approx. 6 weeks) At baseline and after participants had received intervention (approx. 6 weeks later) we measured how likely people were to perform CPR (intention) in relation to 4 scenarios and self-assessed competence and confidence about performing CPR (self-efficacy) in general. We conducted qualitative interviews with 10 participants to elicit their views of the intervention

Results

Twenty lay-people (6F, 14M; aged 20-84) participated, all providing full baseline data. 19/20 participants received at least 20 messages. 15/20 provided follow-up data and ten were interviewed. Baseline intentions to initiate CPR in CPR scenarios were high (18.1) but still greater after the intervention (19.5). Increases in theory-based predictors of intention, self-efficacy (pre:74.5 post:81.0) and self-assessed competence (pre:19.5 post:20.5) were also observed following the intervention. Qualitative data suggested the intervention was positively received and viewed as helpful in improving confidence by reinforcing and building on messages from training. Interviewees suggested additional options for delivery format and pace would be helpful.

Conclusions

A behaviour-change text-message intervention delivered after CPR training is acceptable, easily scalable and may help improve rates of lay CPR initiation. Full scale evaluation of effectiveness is planned.
Association of age on the time of primary pci activation for stemi patients at emergency department
Authors: Berga Congost G , Martinez Momblan M A M M , Valverde Bernal J V B , Marquez Lopez A M L , Ruiz Gabalda J R G , Garcia Picart J G P , Puig Campmany M P C , Brugaletta S B
Published: July 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Strategic Health Research and Innovation Plan (PERIS) 2016-2020

Background

Time between arrival at the Emergency Department (ED) and STEMI activation is a good indicator of the ED quality. Times of attention are of particular importance in some STEMI subgroups, such as elderly. Elderly patients are underdiagnosed and inadequately treated, resulting in a worse prognosis and survival rate.

Aim

To determine association of age with the activation time in STEMI patients admitted to ED.

Methods

An observational retrospective study was conducted including all patients admitted to the ED activated as a STEMI between 2013 and 2016. The main variable was the activation time, defined as the time between ED arrival and primary PCI activation.

Results

A total of 330 patients were included. They were classified by age: 51.1% (167) <65 years old and 48.9% (160) ≥65 yo. Elderly patients exhibited more atypical symptoms and ECG changes as compared to younger. Being elderly (p=0.003) and having had medical contact prior to going to the ED (p=0.015) were associated with a longer activation time. Women older than 65 years old showed the longest activation time.

Conclusion

STEMI delays are longer in elderly with atypical presentation. Age ≥65 and first medical contact outside the ED were associated with an increase in the activation time. This highlights the need to develop strategies to improve STEMI activation time for elderly.
Relationship between multimorbidity and prevalence of frailty syndrome in patients qualified for elective cardiac surgery.
Authors: Wleklik M , Kaluzna-Oleksy M , Czapla M , Uchmanowicz I
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Intorduction

Frailty syndrome (FS) and multimorbidity are closely related but separate constructs that are associated with higher risk of death, higher rehospitalization rates, disability, and reduced quality of life. Identification of multimorbidity and FS in the cardiac surgery patient population appears to be important in terms of the qualification process, incidence of perioperative risk, and optimization of patient status before the cardiac surgery procedure.

Purpose

Analysis of the relationship between multimorbidity and FS in patients qualified for elective cardiac surgery.

Methods

The study included 100 patients ≥ 65 years of age (40 women and 60 men, mean age M±SD =71.69±4). The study included elderly patients qualified for elective cardiac surgery (coronary artery bypass grafting, valvular surgery or combined surgery). In the study group frailty was identified with the use of standardized research tools including those for one-dimensional and multidimensional assessment (FRAIL scale, Frailty Phenotype, 5-meter gaid speed, Tilburg Frailty Indicator, Tilburg Frailty Indicator - TFI). The presence of more than 3 chronic diseases was considered as multimorbidity. A significance level of 0.05 was assumed in the analysis, so all p<0.05 values were interpreted as indicating significant relationships.

Results

Multimorbidity was reported in 88% of patients qualified for cardiac surgery. The prevalence of FS varied according to the screening tool used.Based on FRAIL was reported in 27% of patients, based on Frailty Phenotype in 17% of patients, based on 5-meter gaid speed in 43% of patients, and based on TFI in 63% of patients. In patients with multimorbidity FS was significantly more frequent than in patients without frailty syndrome, which was confirmed by FRAIL (96.3% vs. 60.0%; p-=0.003) and TFI questionnaire (95.2% vs. 75.7%; p=0.008) scores.

Conclusions

1. Most elderly patients qualified for elective cardiac surgery procedures are characterized by multimorbidity. 2 Multimorbidity is associated with a higher prevalence of FS in both unidimensional and multidimensional assessment. 3 This phenomenon requires further study, especially with regard to the occurrence of outcomes in this patient population.
Seasonal differences in nutritional status of patients hospitalized with heart failure with reduced ejection fraction.
Authors: Szubarga A , Sawczak F , Soloch A , Cierzniak M , Kukfisz A , Szczechla M , Migaj J , Dudek M , Straburzynska-Migaj E , Krysztofiak H , Przytarska K , Kaluzna-Oleksy M
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Heart failure (HF) is increasing steadily while the prognosis still stays poor despite improvements in care and availability of new therapies. The nutritional status. is important in management of HF, as an part of multidisciplinary approach. It is known that the diet depends on the availability of nutritional products and therefore also on the season. The seasonal differences of the nutritional status in HF to our knowledge has not been studied before.

Purpose

The assessment of variability in nutritional status among patients with heart failure with reduced ejection fraction (HFrEF) in different seasons of the year.

Methods

We enrolled 240 consecutive patients hospitalized at the department of cardiology, due to HFrEF with left ventricular ejection fraction (LVEF) <=40%. Patients were interviewed with MNA form to assess their nutritional status. Detailed medical history was collected. Patients were divided according to the astronomical season of the year (spring summer fall winter), depending on the time of the admission to the hospital. We compared MNA scores between mentioned groups of patients using U Mann Whitney test. Due to the possible influence of HF exacerbations on nutritional status, the second analysis was done after exclusion of patients with HF decompensation.

Results

Mean age was 56.4±11.3 years, 15.8 % patients were women, mean BMI – 28.8±5.5 kg/m2, mean LVEF – 23.9±7.7%, mean MNA score – 23.0±2.9 points. MNA score was higher (the sign of better nutritional status) in patients interviewed during spring compared to those assessed in summer (p=0.0094) or fall (p=0.014). The same situation was observed after the exclusion of patients with decompensation of HF: MNA score measured in patients admitted in spring was better than those hospitalized in summer (p=0.042) or fall (p=0.0064). The difference between spring and winter lacked statistical significance (p=0.058). Mean MNA scores and more important data for every season are presented in Figure 1 and 2.

Conclusion(s)

The differences in nutrition state in stable patients with HFrEF suggest that the seasonality of the diet might result from veritable modification in nutrition associated with availability and price of fruit and vegetables or the respondents mood, unrelated to the real nutritional status, impacts the score in the MNA questionnaire. This requires further analyses.
Cardiac profile and risk factors of patients with coronary artery disease undergoing cardiac rehabilitation
Authors: Munoz Gomez E , Mont J , Sentandreu-Mano T , Sempere-Rubio N , Orihuela L , Moreno-Segura N , Berga-Congost G , Marques-Sule E
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiovascular risk factors (CVRF) may contribute to the development and adverse outcome of coronary artery disease (CAD), thus the screening for CVRF in CAD patients undergoing cardiac rehabilitation is relevant.

Purpose

This study aimed assessing the cardiovascular risk factors in patients with CAD undergoing cardiac rehabilitation.

Methods

A cross-sectional study was performed. 201 patients with CAD undergoing cardiac rehabilitation were recruited. Anthropometric measurements and analytical tests were performed for each patient. Several variables related to cardiovascular risk factors were identified: weight, body mass index, abdominal circumference, blood pressure, smoking status, sedentary lifestyle, family history, basal level of glycosylated hemoglobin, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides.

Results

82,5% of patients were men, mean age 58,24 ± 9,40 years. 46,2% had effort angina pectoris, 32,4% had infarction and 21,4% had unstable angina pectoris. Most of the sample had a moderate risk (51,5%), whereas 33,8% had low risk and 14,7% had high risk. 63,9% underwent percutaneous coronary intervention with stent, and 27% underwent coronary artery bypass grafting. The most prevalent risk factors were overweight (77,05%), dyslipidemia (64,3%), hypertension (58,10%), sedentary lifestyle (50%), family history (44,90%), smoking (22%) and diabetes mellitus (20,40%).

Conclusions

The prevalence of cardiovascular risk factors among patients with coronary artery disease undergoing cardiac rehabilitation is high. 51,5% had a moderate risk, whereas overweight and dyslipidemia are leading risk factors.
Antidepressant medication and risk of cardiovascular disease in posttraumatic stress disorder patients: application of marginal structural models in Korean National Health Insurance Database
Authors: Kim K , Kang S , Jung S J
Published: July 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): - National Research Foundation of Korea (NRF) grant funded by the Ministry of Science and ICT

Introduction

Previous evidence on antidepressant medication and cardiovascular disease (CVD) in posttraumatic stress disorder (PTSD) patients is mixed. We evaluated associations between antidepressant medication and CVD by applying marginal structural model.

Methods

We gathered medical utilization records of 27,170 patients diagnosed with PTSD in years 2004 - 2018 without prior CVD diagnosis from Korean National Health Insurance Database (NHID). PTSD and CVD were characterized in correspondence of ICD-10 diagnostic codes. We acquired information on antidepressant use from medical utilization records and categorized by medication category: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs). Discrete-time survival analysis with marginal structural inverse probability weighting was used to test association between antidepressants and CVDs and were compared to results from traditional time-fixed model and simple time-varying model. We calculated cumulative daily defined doses (DDDs) of each antidepressant categories and conducted polynomial splining to test dose response.

Results

SSRI use was associated with acute coronary syndrome (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.26 - 1.86) and ischemic stroke (HR 1.33, 95% CI 1.08 - 1.63). SNRI use was associated with acute coronary syndrome (HR 1.52, 95% CI 1.09 - 2.12). TCA use was associated with acute coronary syndrome (HR 1.54, 1.21 - 1.96) and ischemic stroke (HR 1.34, 1.06 - 1.70). Polynomial spline showed positive dose-response in association between antidepressant use and CVD.

Conclusion

Antidepressant use is causally associated with CVD in patients with PTSD. Higher cumulative DDD of antidepressant increases the risk of CVD.
Spontaneous coronary artery dissection; a systematic review of physical and psychosocial recovery following discharge from hospital
Authors: Neubeck L , Mchale S , Ross M , Galbraith M , Hanson C
Published: July 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Edinburgh Napier University

Introduction

Spontaneous coronary artery dissection (SCAD) is increasingly recognised as an important cause of myocardial infarction, particularly among women. SCAD survivors may not know what physical activity is safe and effective and there may be a psychosocial burden of living with a SCAD diagnosis. This review aimed to determine the evidence regarding physical activity, cardiovascular risk factors, or associated factors, and the psychosocial impact of SCAD for SCAD survivors after hospital discharge.

Methods

A systematic review completed in accordance with PRISMA guidelines

Results

The review included 28 studies. These used a range of methods. None were randomised controlled trials. There were 4167 SCAD participants although some were sourced from the same SCAD registries, so may not be unique. They were mainly female (n=3897 93.5%, range=57.7%-100%), with mean age 48.0±9.8 years at index event. Participants mostly came from the USA, Canada, or the Netherlands. We found very limited evidence for cardiorespiratory fitness improvements following cardiac rehabilitation (CR). Existing CR was not tailored to SCAD specific needs and SCAD survivors lacked guidance about appropriate physical activity. Some participants had high levels of psychosocial distress. SCAD survivors highlighted the need for tailored support that included family members. Many SCAD survivors have traditional risk factors including hypertension, hyperlipidaemia and overweight/obesity. Chest pain following SCAD is common.

Conclusions

There is an urgent need to develop physical and psychological recovery programmes for SCAD survivors, and test effectiveness via randomised controlled trials. Psychosocial support is particularly required, given the high burden of psychosocial issues.
Mortality, morbidity, and cardiovascular risk factor outcomes from cardiac rehabilitation, in ethnic minorities: a systematic review and meta-analysis
Authors: Duggan S , Candelaria D , Zhang L , Ghisi G , Gallagher R
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Abstract

Background

Cardiac rehabilitation (CR) is a secondary prevention intervention for coronary heart disease that has well-established efficacy in reducing mortality, morbidity, and cardiovascular risk factors. However, outcomes from CR are known to differ between population groups, with ethnic minorities reported to have health outcome disparities. However, there is no synthesis of these CR outcomes for ethnic minority populations.

Purpose

The main purpose of this study was to evaluate the impact of CR on rates of mortality, morbidity, and important cardiovascular risk factor outcomes including exercise performance, exercise capacity, low-density lipoproteins, cholesterol levels, body mass index, weight, waist circumference and systolic blood pressure, within ethnic minority groups.

Methods

Four electronic databases (Medline, EMBASE, CINAHL, Scopus) were searched from February to September 2021, for studies that reported CR outcomes of ethnic minorities. Potential papers were independently screened by two reviewers, and discrepancies were resolved by a third reviewer. Data was extracted from the studies using an electronic data extraction form. Meta-analyses for eligible studies were performed using Revman 5.4. Risk of bias were assessed using the Cochrane Tool.

Results

Across 13 studies (n = 132,109 participants), the 10,494 participants of ethnic minority groups achieved significant improvements in mortality, morbidity, and most cardiovascular risk factor outcomes including exercise performance, exercise capacity, body mass index, waist circumference, and systolic blood pressure. However, while ethnic minority groups achieved equivalent outcomes from CR for exercise performance and low-density lipoproteins, some outcomes were worse (exercise capacity, body mass index, waist circumference, systolic blood pressure). In addition, minority participants had greater reductions in cholesterol levels.

Conclusion

Ethnic minority groups achieve important improvements in mortality, morbidity, and cardiovascular risk factor outcomes from CR, although to a lesser extent than majority groups. Therefore, this information can be used to support efforts to improve participation in CR and prompt changes to the delivery of CR services for ethnic minority participants.
Interests and preferences towards technology-based cardiac rehabilitation in men and women with coronary artery disease
Authors: Munoz Gomez E , Orihuela L , Deka P , Klompstra L , Pathak D , Sempere-Rubio N , Sentandreu-Mano T , Mont J , Moreno-Segura N , Cruz M , Westas M , Marques-Sule E
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Several studies have demonstrated the effectiveness of telemedicine programmes in patients with coronary artery disease (CAD). However, the development of these programmes is driven from a technical point of view and does not usually take into account the needs and expectations of patients. Thus, we found a need to study the interests and preferences towards technology-based cardiac rehabilitation (CR) in patients with CAD.

Purpose

The aim of this study was to compare the interests and preferences towards technology-based CR in men and women with CAD.

Method

A cross-sectional study was conducted. A total of 70 subjects with CAD (84.28% male) were included. Participants' interests and preferences were measured using the Technology Usage Questionnaire, which includes items on digital health and technology usage.

Results

On the one hand, men showed a greater interest in receiving CR counselling via mobile phone (p=0.022), would sign up for a free technology-based CR programme (p=0.034) and would like to receive less than 1-2 messages a week (p=0.010). On the other hand, women showed greater interest in receiving information about the different components included in the CR programme (receiving healthy meal/recipe ideas (p=0.002), reminders to take medication (p=0.039) and showed greater interest in meeting other people with heart disease (p=0.034). No differences were found by gender in type of communication that participants would like to receive through their mobile phone (p=0.154) or through the Internet (p=0.648), interest in receiving treatment through the Internet (p=0.454), interest in receiving an exercise-based CR program using virtual reality (p=0.810), nor usefulness of a virtual CR session (p=0.801).

Conclusions

In subjects with CAD, gender appears to be a determinant of interest. Men showed a greater interest in receiving CR counselling via mobile phone, would sign up for a technology-based CR programme and would like to receive fewer notifications. Women were more interested in receiving information about different components of the CR programme.
Cardiac rehabilitation referral for PCI patients in Victoria, Australia - gender gap is closing but high-risk patients still miss out
Authors: Cartledge S , Driscoll A , Dinh D , O'neil A , Thomas E , Brennan A , Liew D , Lefkovits J , Stub D
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Following percutaneous coronary intervention (PCI), outpatient cardiac rehabilitation (CR) is essential for secondary prevention.(1) However, uptake of CR is suboptimal(2), despite strong evidence demonstrating benefits. The aim of this study was to identify contemporary trends and predictors of CR referral of PCI patients in Victoria.

Methods

A prospective, observational study using anonymised data from the Victorian Cardiac Outcomes Registry was undertaken. A total of 41,739 patients were discharged following PCI over the study period (2017-2020) and included for analyses.

Results

CR referral was 85%, with an increasing trend over time observed (p <0.001). Multivariable modelling identifying the independent predictors of CR referral included hospitals with high volumes of ST-elevation myocardial infarction patients (STEMI) (OR 4.89, 95% CI 4.41 – 5.20), STEMI diagnosis (OR 1.90, 95% CI 1.69 – 2.14), or treatment in a private hospital (OR 1.45, 95% CI 1.33 – 1.57). Predictors of non-referral included cardiogenic shock (OR 0.54, 95% CI 0.41 - 0.71), aged over 75 years (OR 0.62, 95% CI 0.57 – 0.68) and previous PCI (OR 0.66, 95% CI 0.62 – 0.70) (See Fig 1). PCI patients with an acute coronary syndrome who were referred to CR were also more likely to be prescribed four or more major preventive pharmacotherapies, compared to those who were not referred (90% vs 82%, p <0.001).

Conclusion

Referral to CR in Australia for PCI patients has improved over time compared to previously published reports. Pleasingly, we did not observe a gender difference in rate of CR referral. However, older, more acute or co-morbid patients require consideration for CR referral as these patients may have the most to gain. We also included novel key hospital characteristics in our analysis, such as high-volume STEMI hospitals, which increase the odds of CR referral. Referral does not imply attendance, nor completion of CR and we need better linked data in Australia to examine these outcomes.
The meaning of CPR in the life-world of hospital: perspectives of patients who witnessed CPR and healthcare professionals.
Authors: Fiori M , Coombs M , Endacott R , Cutello C A , Latour J M
Published: July 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Resuscitation Council (UK)

Background

Cardiopulmonary resuscitation (CPR) in hospital is a stressful experience for patients who witness it and for the healthcare professionals involved. Limited evidence and guidance exist regarding the experience of witnessing a fellow patient’s CPR. Informed by a systematic review [1] and a multi-stakeholder consultation [2], the WATCH (Witnessing an Attempt of CPR in Hospital) study has explored the lived experiences of hospital patients and healthcare professionals on patient-witnessed CPR with the primary aim of understanding the impact of such an experience [3].

Purpose

The purpose of this study was to understand the meaning of CPR in the context of the hospital life-world of patients who witness CPR and of healthcare professionals.

Methods

The WATCH study used a qualitative descriptive phenomenological design. The lived experiences of 16 witnessing patients admitted to nine clinical wards and of 20 healthcare professionals involved in CPR were explored through in-depth interviews and focus groups conducted in one hospital in the UK.

Results

Three themes were developed from analysis indicating that, despite a shared understanding of CPR as part of hospital life and as a potential result of emergencies, patients and healthcare professionals had different perspectives of hospital CPR. 1) Unfamiliarity vs Exposure: although patients were aware of CPR, witnessing CPR was often unexpected and traumatic, as many had not experienced it before. Instead, healthcare professionals with previous knowledge and expertise, held an emotional distance and focused on the clinical tasks of CPR. 2) Fiction vs Reality: healthcare professionals considered patients to have unrealistic expectations of CPR, often uninformed and influenced by distorted portrayal of CPR to the lay public through television. Patients acknowledged that witnessing hospital CPR helped their understanding of the reality of it, which differed from their initial idea. 3) Life vs Death: Patients felt disturbed by the presence of a dead body in their room after CPR, whilst daily activities of hospital life were carried out, highlighting a contrast between life and death in the same environment. Finally, healthcare professionals reflected on the meaning of performing CPR as a process to help the ones witnessing it to face and accept the reality of death.

Conclusion

The WATCH study highlighted that patients and healthcare professionals hold different perspectives of CPR in hospital. Awareness of different perspectives of hospital CPR will help healthcare professionals initiate CPR conversations with hospital patients. Education and accurate information should be offered to hospital patients around CPR to have realistic expectations. Further work is required to guide and support clinical practice around patient-witnessed CPR in hospital.
Consequences of chronic heart failure on the persons social dimension
Authors: Wolf A , Martin-Martin J , Wallstrom S W , Olano-Lizarraga M
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Chronic heart failure (CHF) is a progressive and disabling illness that affects daily life. Decreased opportunities to participate in social life are among the most common aspects experienced by these patients, leading to reduced social interaction, loneliness, social isolation, and lack of social support to continue their activities of daily living. These experiences, in turn, have significant consequences for the health of patients with CHF, increasing the risk of comorbidities and complications.

Purpose

This study aimed to identify the consequences of the altered social dimension on the health of those with CHF.

Methods

A scoping review was carried out according to the method proposed by Arksey and O'Malley. The search was conducted in PubMed, CINAHL, PsychINFO, Scopus, and Web of Science databases from January 2010 to November 2021. The following main steps were carried out: (1) the research question was formulated; (2) the most relevant studies were identified; (3) the studies were selected; (4) the data were analysed; and (5) the results were integrated and synthesised. The selection criteria can be found in Table 1.

Results

Ten articles met the selection criteria. Alterations in the social dimension of patients with CHF were identified as influencing several of their health outcomes. In particular, higher rates of depression, higher risk of readmission and death, more visits to the emergency department and outpatient specialist appointments were identified. Along with this, influences on self-care behaviors and treatment adherence were reported.

Conclusions

This study has shown the relevance of deepening the knowledge of each patient with CHF, giving greater importance to assessing their social dimension. This will help detect patients at greater risk of complications due to a lower perception of social support, a more significant perception of social isolation, or a poorer social network.
The cost-effectiveness of nurse-led self-care interventions in patients with heart failure
Authors: Iovino P , Daniela D'angelo D D , Ercole Vellone E V , Matteo Ruggeri M R
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Nurse-led self-care interventions (NLSCI) in heart failure (HF), defined as the nurse education delivered to improve the daily patient self-management, are not widely adopted by the health-care systems, even though they are effective to improve outcomes (e.g., mortality, readmission). Moreover, few studies have evaluated whether NLSCI are also cost-effective.

Purpose

To determine the cost-effectiveness of NLSCI in the context of HF care compared with standard care (care delivered by general practitioner and/or cardiologist).

Methods

We performed a cost-effectiveness analysis, with a 20-year time horizon, from the perspective of the Italian National Health Service. We developed a Markov model to simulate the progression of a cohort of 1,000 HF patients aged 70 years, who were assumed to alternatively receive a NLSCI after hospital discharge, or usual care. Effectiveness on mortality and on hospitalizations of NLSCI and usual care were extrapolated from a review of randomized control trials. Health-care costs were derived from literature and national formularies. The differences in costs and the differences in Quality Adjusted Life Years (QALY) between the NLSCI and usual care were estimated to present an incremental cost-effectiveness ratio (ICER). A willingness to pay (WTP) threshold of €40,000 per QALY was considered. Probabilistic sensitivity analyses were conducted to test the robustness of results and to estimate a cost-effectiveness acceptability curve.

Results

Over the 20-year time horizon, NLSCI implied an extra cost of € 1.3 million and a gain of 247 QALYs compared to usual care. This resulted in an ICER of € 5,490/QALY, which is far below the €40,000/QALY WTP threshold. Sensitivity analysis showed that the ICER remains below the WTP threshold in 100% of simulations. Moreover, the cost-effectiveness acceptability curve showed a probability of 80% of being under € 7,500/QALY.

Conclusions

This study demonstrated that NLSCI represent an affordable solution to support patients with HF as the related extra costs of € 1.3 million is justified by the reduction in mortality and improvement in quality of life. This finding supports the promotion of NLSCI as part of routine care, in order to pursue an optimal allocation of public health expenditures.
Dyadic strain mediates the association of shared care with caregiver burden in caregivers of patients with heart failure
Authors: Cha G , Moser D K , Chung M L
Published: July 2022

Funding Acknowledgements

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

Background

Many patients with heart failure (HF) need family caregivers’ support to manage HF efficiently, but caregivers commonly experience a burden due to their caregiving responsibility. The term, shared care, reflects a system of interpersonal interactions characterized by exchange of support between members of a patient-caregiver dyad in illness management. Higher levels of shared care are associated with better patient self-care and health outcomes, but it is not known whether shared care influences caregivers' burden. Dyadic relationship quality between dyad members also influences caregivers' burden. We hypothesize that dyadic relationship quality may mediate the association of shared care with caregiver burden.

Purpose

The purpose of this study was to examine the association of shared care with caregiver burden and determine whether dyadic relationship quality mediates the association of shared care with caregiver burden in caregivers of patients with HF.

Methods

In this cross-sectional study, primary caregivers of patients with HF completed questionnaire surveys about shared care using the Shared Care Instrument (SCI), caregiver burden using the Zarit Burden Interview, and dyadic relationship quality using the Dyadic Relationship Scale (DRS). The SCI has communication, decision making, and reciprocity subscales. The DRS has positive interaction and dyadic strain subscales. A series of multiple parallel models were used to test the mediation effect of dyadic relationship quality with 5000 bootstrap samples while controlling age, sex, education, and type of dyadic relationship.

Result

Of the 143 caregivers (mean age= 56 years), most were female (76%) and in a spousal relationship with patients (73%). Among SCI subscales, only shared care communication was directly associated with caregiver burden (B = -.5247, P = .0006, 95% CI: -.8199 to -.2296) when age, sex, education, and DRS scores were controlled. There was a significant indirect effect of shared care communication on caregiver burden (B = -.2090, 95% CI: -.4225 to -.0022; Figure 1), indirect effect of shared decision-making on caregiver burden (B = -.3559, 95% CI: -.5984 to -.1588; Figure 2), and indirect effect of shared care reciprocity on caregiver burden (B = -.2342, 95% CI: -.5508 to -.0499; Figure 2) through dyadic strain. Positive interactions within dyad members did not mediate the association of shared care with caregiver burden.

Conclusion

Better shared care in HF management was associated with low dyadic strain, which reduced caregivers’ burden. These findings underpin the need to improve shared care and reduce dyadic strain for caregivers of patients with HF.