bluuebunny/crossref_metadata_2025 huggingface dataset:
Increasing patient advocacy: The development of patient guidelines for cardio-oncology
Authors: Lee G , Lopez Fernandez T
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

As people live longer, many are living with two conditions- cardiovascular disease and cancer. With advancements in treatment in cancer including surgery and immunotherapy and, a relatively new specialty- cardio-oncology- has evolved. As patients can either have a pre-existing cardiovascular condition or present with a cardiac complication such as Acute Coronary Syndrome or Atrial Fibrillation during cancer treatment, there is a need for cardiovascular assessment prior to, during and after cancer treatment.

The first cardio-oncology guidelines were released in 2022 for use in clinical practice that is aimed at clinicians. Despite increased involvement of patients in the research process, the evidenced-based results are not always written in ‘patient’ friendly language. Often lay summaries and thus the practical aspects of the condition or treatment are not available to patients and their families.

Purpose

Given the need to be more inclusive and make research findings and guidelines more patient friendly, the aim was to develop patient guidelines for

Methods

The ESC clinical practice guidelines on cardio-oncology for patients were written by a multidisciplinary team of healthcare professionals, including doctors, nurses, scientists and patients, and are intended mainly for use in clinics and hospitals with the aim of ensuring the language was inclusive and non-technical.

Results

Guidelines are useful in making diagnoses and deciding on treatment using the most up-to-date medical and scientific evidence to ensure that patients receive the most appropriate care. The guidelines outline recommendations on (i) Being treated by a multidisciplinary cardio-oncology team, (ii) Looking after your heart health, during and after cancer treatment, (iii) Paying particular attention to your heart health if you have previously had a heart attack, a stroke, an arrhythmia (irregular heartbeat) or you have high blood pressure, diabetes or high cholesterol and (iv) Making appropriate healthy lifestyle choices. A final version was published in late 2022 and the plan is to translate thee guidelines into several languages so they can be widely used and disseminated.

Conclusion

These guidelines demonstrate how clinicians and patients can work collaboratively to develop patient-friendly guidelines that can be used in practice and potentially optimise the shared-decision making process between patients and their healthcare team.
Incidence of premature ventricular contractions in patients with cardiovascular diseases risk factors
Authors: Bielinskyi M , Vytryhovskiy A I , Seredyuk N M , Kulayets N M , Kiritsa N , Bielinska K V
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Aim of the study

To establish the incidence of premature ventricular contractions among individuals with high and very high risk of cardiovascular diseases.

Materials and methods

During the period between 2007-2013 a total of 4,214 individuals were examined, age ranged from 35 to 85 years. Each individual underwent 24-hour Holter monitoring. All participants of the study were divided into groups: 1-st - patients with coronary artery disease (mainly stable angina), but without accompanying risk factors for cardiovascular diseases, such as smoking and obesity (n=234); 2nd group - people who smoked 5 or more cigarettes per day for more than 2 years (n=144); 3rd group - obese people without concomitant coronary artery disease and arterial hypertension (n=197); 4th group - people with obesity and hypertension (n=187). The control group included 149 practically healthy people. The groups were statistically homogenic in age and gender. The incidence of premature ventricular contractions in was following according to V. Lown and M. Wolf classification: the 1st group – I - 16 (6,83%), II - 23 (9,82%), III - 2 (0,85%), IV - 13 (5,55%), V - 18 (7,69%); the 2nd group - 14 (9,72%), II – 10 (6,95%), III - 5 (3,47%), IV - 28 (19,44%), V - 13 (9,02%); the 3rd - I - 1 (7,61%), II - 6 (3,04%), III - 3 (1,52%), IV - 21 (10,65%), V - 13 (6,6%), the 4th - I - 22 (11,76%), II - 13 (6,95%), III - 2 (1,07%), IV - 24 (12,83%), V - 8 (4,27%). The lowest incidence of this arrhythmia was observed among patients with stable angina - 30,34%. This can be explained by patients being more thoroughly supervised by doctors and higher compliance for treatment. Another reason was that groups 2-4 included people with only risk factors, and group 1 - people with the coronary artery disease. Among obese people with and without hypertension, the incidence of this arrhythmia was almost the same – 35,1% and 36,7%, respectively, and was not significantly different from control group (33,6%). Therefore, analyzing the data presented above, we established that people who smoke tobacco have higher incidence of ventricular premature contractions than in healthy individuals and people with obesity and hypertension. There was observed no statistically significant difference in the incidence of ventricular premature contractions in individuals with isolated obesity or obesity concomitant with arterial hypertension.
Relationship of the occurrence of self-reported anxiety and depression symptoms and achievement of cardiovascular risk factors control
Authors: Pietrzykowski L , Michalski P , Kosobucka-Ozdoba A , Ratajczak J , Siodmiak J , Kasprzak M , Kubica A
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Nicolaus Copernicus University in Torun.

Introduction

Anxiety and depression influence lifestyle and therefore interfere with preventive measures aimed at eliminating or reducing the severity of modifiable risk factors for cardiovascular diseases (CVD).

Aim

The study aimed to evaluate the influence of self-reported anxiety and depression symptoms on achieving the control of cardiovascular (CV) risk factors in patients without a history of atherosclerotic coronary heart disease (CHD).

Methods

A total of 200 patients from the Polish arm of the EUROASPIRE V were included. The median age was 52.0 years (IQR 43.0-60.5). Patients were assessed regarding the control of major CV risk factors: blood pressure, BMI, waist circumference, physical activity, smoking, and the concentration of LDL cholesterol, triglycerides, and blood glucose. Risk factors were considered adequately controlled when the therapeutic target was achieved. The number of controlled CV risk factors was assessed for each individual, as well as the rate of patients who achieved the therapeutic target for particular risk factor was analyzed. Total CVD risk was analyzed with the SCORE scale. The level of anxiety and depression was evaluated based on the results of the Hospital Anxiety and Depression Scale (HADS), which consists of two subscales (HADS Anxiety and HADS Depression). For each subscale obtained score indicated normal, borderline, or abnormal level.

Results

The median score of anxiety (HADS Anxiety) and depression (HADS Depression) levels were 3.0 (IQR 2.0-6.0) and 3.0 (IQR 1.0-5.0), respectively. In the studied group the median of adequately controlled CV risk factors was 4.0 (IQR 3.0-5.0) and the median SCORE result was 2.0% (IQR 1.0-3.0%). No relationship between the level of anxiety or depression and the CVD risk measured by the SCORE sale was observed (Table 1.). Patients with self-reported anxiety or depression symptoms (borderline and abnormal level) had a significantly lower median number of adequately controlled CV risk factors (HADS Anxiety p = 0.0014; HADS Depression p = 0.0304) (Table 1.). A significantly lower rate of patients with adequate waist circumference (HADS Anxiety p = 0.0464; HADS Depression p = 0.0200) and with regular physical activity (HADS Anxiety p = 0.0431; HADS Depression p = 0.0055) was observed in groups with anxiety or depression symptoms (Table 2.). In patients with anxiety symptoms, a significantly lower rate of normal BMI (p = 0.0218) and adequate triglycerides concentration (p = 0.0278) was found (Table 2.).

Conclusion

The occurrence of anxiety and depression might influence the achievement of therapeutic targets regarding the control of CV risk factors in patients without a history of CHD.
Retrospective evaluation of the effect of nutritional status of patients with left ventricular assist device on clinical results in the postoperative period
Authors: Milaniak I , Wasilewski G , Gorkiewicz-Kot I , Wisniowska-Smialek S , Kaleta M , Krupa-Hubner A , Wierzbicki K
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Objective

Malnutrition in patients undergoing left ventricular assist device (LVAD) implantation has negative consequences, such as infection and limited functional capacity. The effects of nutritional status of patients with LVAD on their clinical outcomes were investigated.

Methods

116 records of patients with LVAD implantation were retrospectively analysed. For nutritional evaluation, nutrition risk score NRI score was calculated to divide the patients into two groups with and without malnutrition risk. Demographic and clinical data before LVAD, early postoperative adverse events after LVAD, prognostic data, and laboratory findings were analysed.

Results

116 patients (6 females, 110 man) had a mean age of 60.5±9,46 years; Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) scores were determined as 1 (n=11), 2 (n=36), 3 (n=65), and 4 (n=4). Forty four patients (44%) (19 mild, 6 moderate, 19 severe) had MR. The MR was higher in patients with preoperative INTERMACS score 1, low level of haemoglobin and albumin The incidence of adverse events was found to be significantly higher in patients with higher preoperative grade NRI (death during the pooperative period, bleeding).

Conclusion

In the early postoperative period, a MR of 44% was detected in patients who underwent LVAD. Total 72.2 % patients had any adverse events. We found that the presence of MR was effective in predicting postoperative adverse events according to NRI score before LVAD treatment.
Informal caregivers must open the door to information during heart surgery patients hospitalization. A qualitative study
Authors: Hojskov I E , Bjornnes A K , Tonnessen T , Halvorsen S , Blakoe M , Moller C H , Kaljusto M L , Parry M , Moons P , Lie I
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Despite the possibility of invasive procedures, open heart surgery is still recommended in cases of severe ischemic heart disease and valvular heart disease. National health authorities recommend that health care professionals in hospital should offer informal caregivers necessary learning and support for burdensome caring duties. Follow-up of heart surgery patients after discharge from hospital can be an informal caregiver challenge. There is a lack of studies on the informal caregivers’ experiences with information from health care professionals from before and during hospitalization.

Purpose

This study explores the informal caregivers of heart surgery patients experiences of information and communication from health care professionals before and during hospitalization.

Methods

Qualitative in-depth interviews were conducted in informal caregivers to patients, who had undergone open heart surgery. A semi-structured interview guide was used during videotelephony (Facetime), phone or face-to-face onsite interview. The settings were university hospitals in Norway and Denmark respectively and were carried out between November 2022 – January 2023. Data analysis in NVivo software tool, following Braun and Clarke`s 6-step thematic analysis process.

Results

A total of 12 informal caregivers, married or partnered, two men, mean age 65 years, were interviewed two to four weeks after the patient had been discharged to home following open heart surgery. Two main themes were identified: i) lack of preoperative information and ii) responsibility to chase for in-hospital communication. Informal caregivers must invite themselves to gain access to information before admission. Informal caregivers experienced being a team with the patient before admission and then be separated in the health care system. The information and communication were targeted to the patient. Therefore, it was necessary for informal caregivers to be communicatively strong and thereby force doors open to get needed information for themselves. For some informal caregivers it was manageable while others felt lost and withdrew.

Conclusion(s)

Informal caregivers to patients undergoing open heart surgery want to be part of the information process before and during hospital admission. They want to be in a team with the patient, but it requires an active invitation from health care professionals.
The role of the icc coordinator within the NHS-SUD pilot project
Authors: Neculau G , Frampton K
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Inherited Cardiac Conditions services across the country provide excellent care to families affected by sudden unexpected death, with many Coroners and Pathologists facilitating appropriate referrals and retention of post mortem tissue samples for future genetic testing. However, service provision varies greatly resulting in missed opportunities for tissue retention, signposting to ICC services and disparities in clinical screening. To ensure this gap is closed, the seven NHS Genomic Medicine Service Alliance (GMSA) regions have partnered with the British Heart Foundation to recruit seven ICC coordinators, tasked with coordinating the delivery of a nationally standardised NHS - Coronial Sudden Unexpected Death (SUD) pilot pathway.

Methods

The ICC coordinator’s main role is to improve the processes and collaboration between the Coronial and their nearest ICC service, increase the number of affected families who are assessed in an NHS ICC service and facilitate genomic counselling and testing at the beginning of the pathway. ICC nurses and genetic counsellors have been recruited into these posts. Their unique skillsets and existing links with pathologists, coroners, coroner officers, families, nurses, geneticists, support groups and cardiologists maximises the deliverables for the duration of the pilot.

Results

30 cases of sudden unexplained deaths eligible for entry into the pilot have been signposted and 65 at risk family members have been identified by the seven sites. Some of the most notable results have been facilitation of family referrals, cardiac-genomic counselling, and timely results dissemination. Furthermore, ICC Coordinators have established relationships and delivered training to pathologists, coroner officers and local MDTs, ensuring consistent pathway delivery. Genomic samples are tracked and transferred to the regional genomic laboratory hubs in a standardised manner. Collaboration with external evaluators is ongoing and methods of data capture have been established.

Conclusion

To ensure national delivery and equitable access to genomic testing, the ICC coordinator role is vital to each ICC service and coronial network. We have highlighted some of the unique skills and relationships needed for a national rollout. Following the outcome of the project evaluation, this role can be expanded to other cardiac nurses and genetic counsellors in other regions.
Differences between non-obese and obese patients after cardiac arrest
Authors: Czapla M , Fehler P , Lewandowski Ł , Juarez-Vela R , Karniej P , Uchmanowicz B , Zielinski S , Zielinska M
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Sudden cardiac arrest (SCA) is still one of the leading causes of death. Obesity can increase the risk of post-SCA mortality. The aim of this study was to retrospectively analyze the differences between non-obese and obese patients admitted to the intensive care unit (ICU) after out and in-hospital cardiac arrest.

Material and Method

A retrospective study and analysis of 161 medical records of patients admitted for SCA to the ICU (in an university clinical hospital in Poland) was conducted. Patient comorbidity, and laboratory results were collected. The study was approved by the independent Bioethics Committee of Wrocław Medical University No. KB-776/2022. Statistical analysis was performed with Python 3.9.13.

Result

The median age of obese patients was 71 years old and of non-obese 65 years old (p = 0.039).The sample population was divided into groups: according to WHO criteria. Differences between non-obese and obese patients in survivors group are shown Table 1. Significant differences in frequency were observed for cerebral stroke (CS) and diabetes mellitus (DM).

Differences between non-obese and obese patients in non-survivors group are shown Table 2. Significant differences in frequency were observed for chronic kidney disease (CKD), DM, and hypertension (HT)

Conclusion

Among obese patients after cardiac arrest, the odds of comorbidities are higher. The research and medical community, should take up this challenge head-on and work harder on addressing the preventive and curative components of Non-Communicable Diseases.Survivors: obese vs obeseNon-survivors: obese vs obese
An internet-based cardiac rehabilitation intervention for patients with coronary artery disease: a pilot feasibility analysis
Authors: Li P W C
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): The University of Hong Kong

Background

Cardiac rehabilitation is confined to those high-risk patients, such as those with acute myocardial infarction and heart failure. Most patients with coronary artery disease (CAD) are not eligible for this evidence-based therapy.

Purpose

This study aimed to examine the feasibility and preliminary effects of a mobile intervention, titled "internet-based CArdiac Rehabilitation Enhancement (i-CARE)", on self-care behaviors, functional status, health-related quality of life (HRQoL), blood pressure, waist-to-height ratio and cholesterol level in patients with CAD.

Methods

This mixed-methods study comprised a pilot randomized controlled trial (RCT) and a qualitative phase. Patients in the intervention group received a 12-week i-CARE intervention, consisting of a single face-to-face orientation session and a mobile app consisting of three key user interfaces, including a self-monitoring dashboard with personalized interface according to their own risk profile, an interactive e-library covering various CAD-related self-care dimensions and a chat room for the nurse to provide continuous coaching and facilitate behavioral changes. The control group received standard care.

Results

Fifty patients with CAD were randomly allocated to the intervention (n = 25) or control group (n = 25). The i-CARE intervention was feasible and acceptable to CAD patients. Participants gave excellent ratings in the satisfaction survey. The i-Care group showed greater improvements in self-care behaviors (β = 6.213, 95%CI: 1.924 – 12.236, p = 0.016), HRQoL (β = 6.132, 95%CI: 1.276 – 15.237, p = 0.032) and functional status (β = 2.584, 95%CI: 1.050 – 7.226, p = 0.039) than the standard care group at the immediate post-intervention. No significant between-group changes in blood pressure, cholesterol and waist-to-height ratio were detected. The average number of logins to the app by the intervention group was 92.84 (21.45) and 84% of them accessed all modules available in the app. A total of 4,987 hits to the exercise videos were recorded during the intervention period. Most of the participants (88%) actively initiated a discussion or responded in the chat room. The qualitative data converged with the quantitative data, indicating that the intervention was highly feasible and acceptable to CAD patients.

Conclusion

The i-Care intervention is feasible and acceptable to CAD patients. It improves patients’ self-care behaviors, HRQoL and functional status. A full-scale RCT is warranted to investigate the longer-term effects of this intervention.
A nurse-led multicomponent behavioral activation intervention for patients with atrial fibrillation: a randomized controlled trial
Authors: Li P W C , Yu D S F
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Grants Committee of Hong Kong through the General Research Fund

Introduction

Patients with atrial fibrillation (AF) often play a passive role in the treatment decision-making process, rendering jeopardized health-related quality of life, suboptimal medication optimization and self-care.

Purpose

This study aimed to examine the effects of a Nurse-led Multicomponent Behavioral Activation (N-MBA) intervention on HRQoL, knowledge about AF, medication adherence and psychological distress among patients with AF.

Methods

This parallel two-arm randomized controlled trial recruited community-dwelling patients aged ≥65 years with a confirmed diagnosis of atrial fibrillation, moderate to high risk of stroke but not receiving oral anticoagulation. Participants were randomized in a 1:1 ratio to receive the N-MBA intervention or standard care. The 13-week intervention adopted a novel behavioral activation approach to equip AF patients as an active agent to manage the disease. It consisted of care components to prepare patients for shared decision-making by using a decision aid, an empowerment-based educational module covering relevant AF self-care topics and continuous support through telephone calls. A set of validated instruments was administered at baseline, immediate and 6 months post-intervention.

Results

A total of 252 participants were randomized to the intervention (n = 127) or control (n = 125) group. Compared with the control group, the intervention group showed greater improvements in HRQoL [β = 10.617, 95% confidence interval (CI) = 1.285 – 20.501, p = 0.023] and AF knowledge (β = 2.129, 95% CI =1.026 – 5.712, p <0.001) at immediate post-intervention. The effects on both outcomes sustained at 6-month follow-up time point. No significant between-group changes in medication adherence, anxiety and depression were detected. Participants in the intervention group were activated to raise their concerns about AF and its treatment with the attending doctors, and they perceived higher compatibility between patient and physician decisions of OAC use upon completion of the intervention.

Conclusion

The empowerment-based nurse-led intervention is effective at sustaining improvements in HRQoL, AF knowledge and treatment decision making in AF patients with moderate to high stroke risk. It does not increase their psychological distress.
The experience of living with congenital heart disease from the perspective of the affected child or adolescent and its family: a systematic qualitative review
Authors: Martinez-Sarria A , Martin-Martin J , Van Bulck L , Olano-Lizarraga M
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Congenital heart disease is one of the most prevalent congenital disabilities and significantly affects the lives of children and adolescents with congenital heart disease and their families. They tend to experience psychological, behavioural and relational comorbidities, leading to many complications and maladaptive behaviours. However, no literature review has been identified that addresses the whole family perspective.

Objective

To describe the experience of living with congenital heart disease from the perspective of the affected child or adolescent and their family.

Methods

A systematic qualitative review was conducted in PubMed, CINAHL, PsycINFO and Scopus databases between May and July 2022. The review protocol has been registered prospectively in PROSPERO. The key terms used were "experiences", "congenital heart disease'', "family", and "infants" with their respective synonyms, identified from MeSH terms, the thesaurus and the literature. The methodological quality of the studies was assessed. The Critical Appraisal Skills Programme questionnaire was used to assess qualitative studies. The Joanna Briggs Institute tool was utilised to evaluate literature reviews. Subsequently, two researchers jointly performed a qualitative content analysis of the selected articles.

Results

Ten studies were identified, and their methodological quality was generally good. None of the studies included in the same investigation the experience of more than one of the populations described (children or adolescents, siblings or parents). The sample sizes of the studies varied between 2 and 30 participants, and some did not report the sample size. The analysis permitted the child or adolescent and their family's experience to be grouped into four main themes: 1) Experiencing the impact of the initial diagnosis, 2) Living a "roller coaster" of emotions, 3) Coping with the day-to-day burden of the disease, 4) Finding sources of strength and opportunities.

Conclusions

The potential impact of a diagnosis of congenital heart disease on the life experience of children, adolescents, and their families has been evidenced. However, no studies have explored the family experience as a whole. It would be necessary to have more information about the family unit experience. Although healthcare disciplines conceptually recognize whole-family care as the focus of their practice, this idea remains a clinical ideal in most cases. Therefore, a paradigm shift in health care is necessary, from a model of attention exclusively focused on the patient to one in which the family is incorporated into the care process.
A pilot RCT of an mHealth self-help intervention on readmission rate reduction after adult cardiac surgery: preliminary findings
Authors: Nolte J , Wynne R , Matthews S , Angel J , Moore A , Campbell T , Ferguson C
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): The Royal Melbourne Hospital

Background

Readmission is multifaceted, potentially avoidable and costly. Patients’ ability to enact self-care behaviors after cardiac surgery are under-investigated.

Purpose

To evaluate the feasibility of a RCT investigating an mHealth intervention for self-help, and readmission rate reduction.

Methods

Elective adult (>18 years) elective cardiac surgery (via median sternotomy) patients were eligible for inclusion. Patients had to be discharged home, able to understand spoken English, and own and use a smartphone, tablet or computer. The intervention comprised a narrative online library (Healthily GoShare platform) with videos describing patient and carer experiences focused on preoperative preparation, acute postoperative care (sent within 1 week of discharge) and ongoing recovery Sent 30 days after surgery). Patients were randomised preoperatively 1:1 to the intervention, accessible via a text or email link, or the control group receiving usual care that comprised postoperative education and a brochure. Follow-up phone interviews took place 30, 60 and 90 days after surgery.

Results

From August 2021 to December 2022, 341 (65%) patients were scheduled for elective surgery, 229 (67.2%) were transferred elsewhere secondary to COVID-19 bed closures, 22 (6.5%) were undergoing reoperation, 13 (3.8%) did not adequately understand spoken English and 7 (2.1%) did not own a smartphone or tablet. Of the 70 (20.5%) eligible patients, 61 (87.1%) agreed to participate and 2 (2.8%) did not proceed. Follow-up (FUP) is complete for 43 (72.9%) patients. Accessed preoperative 14 (63.6%), postoperative 16 (72.7%) and recovery bundles 12 (54.5%) were reported as helpful or very helpful by 95% (n = 21) of participants. A single patient from the intervention group was lost to FUP at 30 days and 5 control group patients at 60 days. 30-day readmission was more frequent in the control (3/21, 14.3%) than intervention group (0/22; p = 0.06).

Conclusion(s): Findings to date indicate COVID-19 bed closures have impacted on elective surgical scheduling thus recruitment. The intervention was feasible and acceptable. To be 95% confident the readmission rate is within 10%, assuming a 15% readmission rate, a minimum of 50 patients are required. Follow-up is ongoing.
Feasibility and acceptability of using a patient reported outcome measure (OxFAB) to help patients with heart failure to recognise and communicate worsening symptoms to specialist nurses
Authors: Walthall H , Diaz L , Harris E , Astin F
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): General Nursing Council for England and Wales Trust

Background

The incidence of Heart Failure (HF) is increasing. Breathlessness and fatigue are symptoms that signal clinical deterioration. However, patients often do not recognise worsening symptoms. This can lead to avoidable hospital admission. We developed with patients a validated tool to evaluate fatigue and breathlessness (OxFAB) in patients with HF but had not established its acceptability and feasibility in clinical practice.

Purpose

To evaluate the feasibility and acceptability of OxFAB as a tool to optimise patient-specialist nurse communication of symptoms of fatigue and breathlessness.

Methods

A multi-method feasibility study conducted in HF nurse specialist clinics at two sites in England, between January 2022 and September 2022. Participants completed the tool in the clinics at 2 time points 4 to 7 weeks apart. The tool asked for symptom assessment over the previous 2 weeks. Acceptability was determined through qualitative interviews and adherence to OxFAB at the 2 time points. Feasibility was determined through questionnaire completion rates and qualitative interviews.

Results

Thirty-five patients and three HF nurse specialists completed the study. Nurse-led HF clinics were conducted either by telephone consultation remotely or face to face within the hospital setting. Over half the patient sample were male (58%), and 66% of the patients had HF with reduced ejection fraction, 86% NYHA Class II-III, age (µ68.5 years-SD 12.55) years. Eighty-one percent completed OxFAB in µ7.49 minutes (time-point 1) and µ6.59-mins (time-point 2). Interview data suggested that OxFAB was easy to complete, relevant and optimised symptom communication.

Conclusion

This feasibility study demonstrated OxFAB was acceptable and feasible in clinical practice to optimise patients-health professional communication of HF symptoms.
Predictors for arterial hypertension in middle aged adults
Authors: Abidova D , Mukhamedova M G , Uzokov J K , Abdullaeva G J
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Subclinical atherosclerosis is a marker for development of future atherosclerotic cardiovascular disease. However, it is still unclear whether subclinical atherosclerosis predicts hypertension in patients who have not diagnosed it yet. Aim of the study was to evaluate possible significance of subclinical atherosclerosis for the development of hypertension in patients who have not diagnosed hypertension yet.

Methods

418 middle aged adults who had subclinical atherosclerosis and without hypertension enrolled in this study (aged 31-49 years, mean age 39.12±12.0 years, male=53%). All participants were examined general clinical, anthropometric, laboratory and instrumental measures. Subclinical atherosclerosis were diagnosed using ultrasound methods via ankle-brachial index (ABI) using established cutoffs. All patients followed up to 6 years. Mean follow up was 4.5±2.1 years. All statistical analysis were performed using STATA software.

Results

During the mean follow up period 17% (71) patients were diagnosed hypertension (SPB<140 mmHg and/or DBP<90 mmHg). Among them 12% (50) were males whilst 5 % (21) were females and men tended to have more levels of blood pressure than women did (P<0.05). During the follow up period, subclinical atherosclerosis level has increased more than 20% to those who was diagnosed hypertension. Patients who developed hypertension tended to have more smokers (OR 1.58, 1.14-2.28, CI 95%, P<0.05), BMI<30 kg/m2 (OR 1.57, 1.12-1.98, CI 95%, P<0.05), family history of hypertension (OR 1.45, 1.09-1.87, CI 95%, P<0.05), frequent stress at work (OR 1.35, 1.06-1.82, CI 95%, P<0.05) and financial problems at home (OR 1.23, 1.05-1.72, CI 95%, P<0.05).

Conclusion

Subclinical atherosclerosis is a predictor for new onset hypertension in men especially for those who were smoker, obese and had family history of hypertension as well as frequent stressed at work.
Optimization of antiplatelet therapy in patients with coronary artery disease and type 2 diabetes mellitus after percutaneous coronary interventions
Authors: Mukhamedova M , Orziev D Z , Uzokov J K , Abdullaev A X
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Dual antiplatelet therapy (DAP) with clopidogrel and aspirin after percutaneous coronary interventions (PCI) in patients with chronic coronary syndrome (CCS) are mainly used to prevent stent thrombosis and restenosis. Despite the use of approved doses of the antiplatelet, major adverse cardiac events (MACE) frequently occur in short and mid-term period in patients with type 2 diabetes mellitus (T2DM) and CCS. Aim of the study was to evaluate the efficacy of ticagrelol in patients with CCS and T2DM after elective PCI.

Material and Methods

The prospective, open label randomized study with 112 patients with CCS and T2DM who admitted for the elective PCI were enrolled in the study from 2018 to 2022 (aged 49-72 years, mean age 59.2±12.2 years, male 52%). Patients were divided into two groups by 56 via open randomization. Group I patients were assigned ticagrelol 90 mg BID after the loading dose of 180 mg ticagrelol along with standard dose of aspirin for 1 year whereas Group II were assigned clopidogrel along with aspirin for 1 year. 20 µmoll ADP induced platelet aggregation was assessed at baseline and after the 12 hours of administering loading dose of antiplatelet. Efficacy and safely were assessed during the follow up in both group of patients. All statistical analysis were performed using STATA software.

Results

Inhibition of platelet aggregation (IPA) with 20 µmoll ADP at 12 hours was significantly higher in ticagrelol group than clopidogrel group (71.65±14.25% vs. 42.74±18.25%, P<0.001). During the maintenance dose, IPA with 20 µmoll ADP at 48 hours was significantly higher in ticagrelol group than clopidogrel group (68.12±13.27% vs. 45.82±17.54%, P<0.001). PCI bleeding complications were similar in each group and there was not observed any statistically significant changes (P>0.05). During the mean follow-up period ticagrelol group tended to have higher bleeding than clopidogrel group, however they were not observed any statistically significant changes (log-rank test; 0.752). Pertaining to MACE, ticagrelol group tended to have lesser MACE than clopidogrel group, (Mantel–Cox test; P=0.045). 56 ticagrelol treated patients showed that MACE tended to be negatively associated with post PCI bleeding complications (P=0.048).

Conclusions

Dual antiplatelet therapy with ticagrelol and aspirin is superior than clopidogrel plus aspirin to prevent MACE in patients with chronic coronary syndrome and type 2 diabetes mellitus after elective percutaneous coronary interventions. However, ticagrelol should be used cautiously in patients with gastrointestinal ulcers due to its PCI related bleeding risks.
Caregiver contributions to general and specific self-care of patients affected by heart failure and other chronic conditions
Authors: Saurini M , Erba I , Ferro F , 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 with HF and other chronic conditions often need the support of informal caregivers in performing self-care. Caregiver contribution (CC) to patient’s self-care includes a series of recommendations (or acts to replace) made to the patient to keep their own health conditions stable and manage signs and symptoms of their chronic conditions. CC to general and specific patient self-care represents help that improves patient clinical outcomes and maintains the stability of chronic conditions. To date, no studies have investigated general and specific caregiver contributions to the self-care of patients with Heart Failure (HF) and other chronic conditions.

Purpose

Investigate caregiver contribution to general and specific self-care in patients affected by HF and other chronic conditions.

Methods

Cross-sectional study. Data collection was conducted in community and outpatient settings, from April 2017 to October 2021. Caregivers of patients affected by HF and other chronic condition were enrolled if they were >18 years old and identified by the patient as the primary informal caregiver. Caregiver Contribution to Self-Care of Chronic Illness Inventory (CC-SC-CII) and Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI), were used for measuring generic and specific CC to self-care, respectively. Values ≥70 indicate adequate CC to general and specific self-care behaviors. Paired t-test was carried out to test differences in CC-SC-CII and CC-SCHFI scores.

Results

This study enrolled 369 caregivers caring for HF patients and other chronic conditions. The sample was composed mainly of females (61.27%) with a mean age of 45.0 (±1.41) years, and that lived with their loved ones (55.28%). The two chronic conditions most frequently associated in patients with HF cared for by informal caregivers were hypertension (75%) and diabetes mellitus (70%). General CC to self-care maintenance, monitoring, and management were adequate with mean scores of 70.57 (±21.6), 81.47 (±21.85), and 72.98 (±20.61), respectively. Specific CC to self-care maintenance, monitoring, and management were inadequate with mean scores of 64.49 (±16.76), 54.08 (±26.71), and 65.24 (±17.25), respectively. CC-SC-CII scores were significantly (p<.0001) higher than CC-SCHFI scores.

Conclusion

Caregivers showed more difficulties in the contribution to specific HF self-care compared to general self-care behaviors. Knowing how caregivers contribute to self-care is important for clinicians to develop psychosocial interventions for improving CC to self-care in patients with HF and other chronic conditions.
Effectiveness of telehealth cardiac rehabilitation programs on health outcomes of patients with coronary heart diseases: an umbrella review
Authors: Shi W , Green H , Sikhosana N , Fernandez R
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac rehabilitation using Telehealth has increased rapidly over the past two decades and has become the predominant mode of delivery during the Covid 19 pandemic. Numerous systematic reviews have been conducted summarizing the evidence on the advantages and disadvantages of cardiac rehabilitation using Telehealth on various cardiovascular risk factors and health-related behaviours.

Purpose

To conduct an umbrella review summarizing the evidence from existing systematic reviews of telehealth cardiac rehabilitation on health outcomes of patients with coronary heart disease (CHD).

Methods

An umbrella review of systematic reviews was undertaken in accordance with the PRISMA and JBI guidelines. A systematic search was conducted in Medline, APA PsycInfo, Embase, CINAHL, Web of Science, Cochrane database of systematic reviews, JBI evidence synthesis, Epistemonikos, and PROSPERO, searching for systematic reviews published from 1990 to current and was limited to the language source of English and Chinese. Outcomes of interest were modifiable CHD risk factors, psychosocial outcomes, and other secondary outcomes. Study quality was appraised using the JBI checklist for systematic reviews. A narrative analysis was conducted, and meta-analysis results were synthesized.

Results

From 1,301 identified reviews, 13 systematic reviews (10 meta-analyses) comprised 132 primary studies conducted in 28 countries. All the included reviews have high quality, with scores ranging from 73% to 100%. Findings to the modifiable risk factors remained inconclusive, except solid evidence was found in the significant improvement in physical activity level and behaviours from telehealth interventions, exercise capacity from m-health only and web-based only interventions, and medication adherence from m-health interventions.

Conclusion

Telehealth cardiac rehabilitation programs, work adjunct or in addition to traditional cardiac rehabilitation and standard care, are effective in improving modifiable CHD risk factors, particularly in physical activity. In addition, it does not increase the incidence in terms of mortality, adverse events, hospital readmission and revascularisation.
QGenome: a smart app-based clinical decision aid for inherited cardiac conditions
Authors: Bueser T , Wafik M , Carley H , Bastiaenen R , Wierzbicki T , Frampton K , Kenney A , Bustillo B , Tripathi V , Tomlinson C , Cross S , Kulkarni A , Robert L
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Guy’s and St Thomas’ Charity

South East Genomic Medicine Service Alliance

Background

QGenome is a smart application designed by a Regional Genetics service, in partnership with a Genomic Medicine Service Alliance (GMSA) and a technology company. The aims were to facilitate streamlined genomic testing, risk assessment, and referral guidance to relevant healthcare professionals in primary, secondary, and tertiary care settings; and to provide equity of "Genomics care" for patients across the UK, through standardized genomic testing and referral pathways.

Due to high clinical demand, and following a design workshop with stakeholders, the initial version of QGenome was implemented for Cancer Genomics pathways. The scope has been extended to include workflows for Cardiology and Renal Genomics. The current Inherited Cardiac Conditions (ICC) workflow includes initial genomic testing/risk assessment pathways developed for familial hypercholesterolaemia, long QT syndrome, and vascular Ehlers Danlos Syndrome (vEDS).

Methods

For each clinical indication/condition, QGenome provides workflow assessments to determine eligibility for genomic testing and/or specialist tertiary referral. The workflow takes the user through a series of questions about their patient’s personal, past medical, and family history in a user-friendly format, to assess inherited susceptibility to disease.

Eligibility criteria are derived from the UK National Genomic Test Directory, published literature and guidance from relevant advisory board working groups.

The app can be used to find relevant forms, save reports, and activate referrals to specialist services or genetics clinics. QGenome is freely available on iOS, android and web-based platforms.

Results

The ICC workflows are demonstrated through the vEDS case studies (Figure).

Conclusion

QGenome offers a quick, efficient clinical decision tool for healthcare professionals, including cardiovascular nurses and allied professionals, in busy clinical settings, to differentiate between patients with likely sporadic cardiac disease and those with probable genetic/hereditary susceptibility for ICC.
Association of heart failure symptoms burden with physical well-being: exploring the roles of self-care and sleep quality using a moderated-mediation analysis
Authors: Durante A , Di Nitto M , Juarez-Vela R , Chung M L
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients with heart failure (HF) commonly experience symptom burden. Symptoms such as breathlessness, fatigue, and fluid retention can have an important impact on the patient's daily activities and overall health. Given the evidence of symptoms' negative impact on the quality of life in patients with HF, self-care maintenance is critical. However, there is a paucity of knowledge regards the role played by self-care and the quality of sleep in this population.

Purpose

To explore the association between HF symptoms burden and quality of life (i.e., physical well-being) and how the association was moderated by levels of self-care maintenance and mediated by sleep quality.

Methods

This was a secondary analysis of a single-center cross-sectional study conducted in Spain, between February and December 2017. Symptom burden was measured using the Heart Failure Somatic Perception Scale (HFSPS), and quality of life was assessed using the physical well-being subscale of the 12-Item Short Form Survey (SF-12). Self-care was assessed using the self-care maintenance subscale of the Self-Care Heart Failure Index (SCHFI) (version 6.2), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). A moderated-mediation analysis was conducted to explore the role of self-care as a moderator and sleep quality as a mediator in the association using SPSS PROCESS macro with 5000 bootstrap samples, adjusted for age, sex, Body Mass Index (BMI) and NYHA covariates.

Results

A total of 178 patients completed the questionnaires. The patients were older (mean age 80, SD ±8,9) with a mean BMI of 29 (SD ± 5,5). About of patients were males (50.6%) and NYHA class 1 or 2 (58.4%). Symptom burden was negatively associated with sleep quality (B = -.104, t(1, 176) = -7.7675, p = <,001), which was positively associated with physical well-being (B = .5664, t(1, 176) = 2.9810, p = .003). The association between symptom burden and physical well-being was moderated by self-care maintenance (interaction value= -.0038, t(1, 176) = -2.0022, p = .047). In the moderated mediation analysis (Figure 1), we found that the direct effect strength of burden symptom on physical well-being was different by the level of self-care maintenance (Johnson-Neyman value= 32.3560, low = 15.1685 high = 84.8315). There was also a significant indirect effect of symptom burden on physical well-being through sleep quality adjusted (B = -.0589, 95% CI [ -.1001, -.0230]).

Conclusion

Self-care maintenance moderates the association symptom burden and physical well-being, while sleep quality acts as a mediator in the association. Improving quality of life, while empowering self-care, should also consider an evaluation and improving stretegies of sleep quality as it impacts physical quality of life.Moderated-mediation analysis