bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge about atrial fibrillation and direct oral anticoagulation agents in Greek patients
Authors: Ioannidis A , Fragkiskou A , Paraskelidou M , Pechlevanis A 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) poses significant burden to patients, physicians, and healthcare systems globally. Patient knowledge about AF and its management is often limited though it is a perquisite for patient involvement and shared decision making. Direct oral anticoagulants (DOACs) are recommended for stroke prevention.

Purpose
The aim of this study was to assess the knowledge about AF and anticoagulation of AF patients.

Methods
Patients with AF on DOACs visiting the outpatient clinics of a city hospital in northern Greece were invited to participate. The Jessa AF Knowledge Questionnaire (JAKQ) was used (as part of the validation study of the Greek translation).

Results
In total, 285 patients participated (female 57.9%) with mean age 65 ± 13 years. The mean JAKQ score was 57.2 ± 17.4% corresponding to medium level of knowledge. Higher scores were positively associated with more schooling years and longer AF duration. The percentage of correct answer varied among the questions. One third of the participants answered wrongly (59 patients, 20.7%) or didn’t know (38 patients, 13.3%) what atrial fibrillation means. More than half of the patients didn’t know that AF is not always accompanied by symptoms and that medication cannot prevent AF permanently (154, 54.0% and 169, 59.3% respectively). The majority of patients knew that strokes are a consequence of AF and that blood thinners are prescribed in order to prevent clot formation (222, 77.9% and 226, 79.3% correspondingly). Moreover, most patients didn’t know correctly which painkiller they should prefer (177, 62.1%) and what to do when missing a dose (172, 60.4%). As expected patients who has experienced a bleeding event (minor or major that lead to medical care) scored higher (62.3% vs. 56.2%, p &lt; 0.05). All patients replied that they would like to be offered more information (leaflets, online site, mobile applications, etc.).

Conclusions
A brief and validated questionnaire could be used to assess patients" knowledge of their condition and treatment, which would reveal important gaps. Further research is needed to evaluate if such an instrument could be used as a tool for individually tailored patient education.
Assessing the impact of education in atrial fibrillation: A systematic review
Authors: Cano Valls A , Hendriks JM , Sanders P , Mont LL , Gallagher C 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial Fibrillation (AF) is the most common heart rhythm disorder. Patient education is recommended as part of comprehensive AF management. Despite this the impact of education alone on outcomes in AF populations is unknown.

Purpose
The aim of this study was to describe the impact of education on clinically relevant outcomes in patient with AF including mortality, hospital admissions, emergency department presentations, stroke and quality of life.

Methods
The authors searched Pubmed, Embase, CINAHL, Cochrane database and Psycinfo from inception until September 2019. Studies were included if they were prospective and of randomized controlled or observational design with a minimum follow-up 3 months and published in English.

Results
A total of 1667 studies were screened with 37 undergoing full text review and 6 meeting eligibility criteria. There was a total of 588 participants with a mean age of 65.63 ± 11.05 and 60.71% were male. A meta-analysis was unable to be performed due to heterogeneity in reporting of outcomes. Two studies examined the impact of education on mortality with no impact evident from either intervention. The impact of education on hospitalisations (all cause – 3 studies, cardiovascular – 1 study and AF - 2 studies) was explored in five studies with no impact on this outcome from any intervention. Similarly, there was no impact of education on emergency department presentations, except for one study in which a video was used in addition to standardised education. There was no impact on stroke from two studies exploring this outcome. There was no evidence of impact of education on general or AF specific quality of life.

Conclusions
There is little evidence to suggest that educational interventions to date have significantly impacted on death, hospitalisations, emergency department presentations or quality of life in AF populations. There is an urgent need to identify optimal modes and components of educational interventions to improve patient outcomes and reduce health care burden in AF.
Use of multiplate electrode aggregometry for personalisonalisation of antiplatelet therapy in left ventricular assisst device patients
Authors: Wypych-Zych A , Edwards G , Synowiec E , Stevens K , Mcdonagh S , Kiff K , Stoch U 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The use of Left Ventricular Assist Devices (LVAD) has noticeably improved the survival for patients with advanced heart failure. However, this treatment is associated with significant adverse effects. Personalisation of antiplatelet therapy is a key in control and reduction of bleeding/thromboembolic complications of this treatment. However, ISHLT and the manufacturer still recommend unified treatment of 150 mg of acetylsalicylic acid for all LVAD patients. In our centre, we base the treatment decision on clinical picture and patient’s responsiveness to antiplatelet therapy.
The treatment of choice is acetylsalicylic acid in doses 37.5 mg (1 patient), 75 mg (25 patients) and 150 mg (33 patients). For patients unresponsive or intolerant to acetylsalicylic acid we use 75 mg of clopidogrel, currently 9 patients. 1 patient receives both, 75 mg clopidogrel and 75 mg acetylsalicylic acid.

Purpose
To gain a better understanding of the platelets function and patients" responses to antiplatelet therapy. In aim to reduce the prevalence of bleeding/thromboembolic related adverse events in LVAD patients, and therefore improve patients outcome.

Methods
In 2020, we decided to introduce a structured/test-based approach to antiplatelet therapy in this patients group. With the use of Multiplate Electrode Aggregometry (MEA) we have attempted to diagnose platelet disorders and monitor effectiveness of antiplatelet therapy. Based on MEA platlets inhibition test we were able to tailor the therapy.
The retrospective audit was conducted with inclusion criteria;
1. Thromboembolic events include pump thrombosis and any other ischemic complications. Bleeding events contains gastrointestinal (GI) and central nervous system (CNS) events.
2. Any thromboembolic and bleeding events after starting antiplatelet therapy, in the first year after LVAD implantation

Results
The tables below presents reduction in both thromboembolic and bleeding complications.

Conclusion
Presented data can be interpreted that, the test-based approach to antiplatelet therapy may be beneficial in limiting the adverse effects of LVAD therapy. However, it needs to be acknowledged that the observation was carried out on a small group of the patients, over a short period of time. Therefore, an extended period of observation is recommended to obtain further data.
Predictors of delay in door-to-balloon time in STEMI patients, treated in centers capable in primary PCI
Authors: Berga Congost G , Martinez Momblan MA , Valverde Bernal J , Marquez Lopez A , Ruiz Gabalda J , Garcia Picart J , Puig Campmany M , Brugaletta S 
Published: July 2021

Abstract

Funding Acknowledgements
The Government of Catalonia (Spain) provided funding for this research grant: PERIS 2019-2021

Introduction
European Society of Cardiology (ESC) clinical guidelines recommend a diagnosis-to-balloon time &lt; 60 minutes in acute myocardial infarction with ST elevation (STEMI) when the patient directly arrives to emergency room (ER) of a center with primary angioplasty (PCI) capacity. Hospitals that implement a greater number of improvement strategies tend to have a shorter door-to-balloon time (D2B).

AIM
to describe the attendance times and to evaluate the causes of delay in attendance in STEMI patients.

Methods
This is an observational retrospective study, including all consecutive ≥18 years STEMI patients attended in the ER of a terciary Hospital capable in primary PCI from January 2013 to December 2016. Patients who were not activated as STEMI code from the hospital ER and without coronariography were excluded. Sociodemographic and clinical variables were collected for all the patients. ER management is based on the Plan-Do-Study-Act methodology, for this reason other organizational variables have been considered such as brief educational interventions aimed at emergency nurses. All the patients were stratified into two groups, according to their door-to-balloon time (&lt; 70 minutes or equal/more).

Results
Overall 327 patients were included. Mortality was 11,6% and 88 minutes between arrival at the ER to balloon time. The delayed treatment group was older (p = 0.005), with more female (p = 0.060), usually admitted in not working hours (p = 0.001), with more atypical ECG STEMI signs or symptoms (p = 0.058) and (p = 0.087). They had also a longer hospital stay (p = 0.041). Predictors of shorter D2B time were: typical STEMI ECG signs and brief education sessions to nurses for identification of a STEMI.

Conclusion
There are delays in the treatment of STEMI, especially in specific groups of patients with atypical clinical presentations. Brief educational session aimed at emergency nurses correlate with less delay. This shows that continuing education to emergency nurses along with other organizational improvement strategies can contribute to increasing the quality of care in the STEMI.
Quality of life after transcatheter aortic valve implantation: Perspectives from a Canadian data base
Authors: Lauck S , Yu M , Ding L , Webb J 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
We examined changes in quality of life (QOL) of patients after transcatheter aortic valve implantation (TAVI).

Methods
We conducted an observational cohort study of consecutive patients who had TAVI between 2016-2019 in British Columbia, Canada. QOL was measured at baseline, 30-day and 1-year using the Kansas City Cardiomyopathy Questionnaire (KCCQ-OS). We used linear regression modelling to examine factors associated with 30-day changes in QOL, logistic regression modelling to identify predictors of having a poor outcome, and Cox regression modelling to ascertain risk estimates of the effect of QOL on 1-year mortality.

Results
The cohort included 1,706 patients [742 women (43.5%)]; median [interquartile range, IQR] age 83 (77,86). Median (IQR) baseline KCCQ-OS was 45 (28.2,67), indicating severe impairment. Patients alive at 1-year (91.3%) reported a mean improvement of 24.1 (95% CI, 22.7-25.6) points in the KCCQ-OS at 30-day, which was sustained at 1-year (25.3; 95% CI, 23.8,26.8). Older age, lower baseline health status, lower aortic valve gradient, lower hemoglobin, atrial fibrillation and non-transfemoral access were associated with worse 30-day QOL. At 1-year, 65% of patients had a favourable outcome; additional risk factors for 1-year mortality (8.7%) were male sex, NYHA Class IV, severe pulmonary and renal disease, diabetes, and in-patient status.

Conclusions
TAVI is associated with significant early improvement in QOL which is sustained at 1 year in a "real world" registry. The inclusion of QOL can support treatment decision and the patient-centred evaluation of TAVI
Short-term health-related quality of life in patients with ischaemic stroke after PFO closure
Authors: Christopoulou G , Sigala E , Aragiannis D , Stamatopoulou E , Manthou P , Gkiata P , Vlachopoulos C , Trantalis G , Drakopoulou M , Toutouzas K , Tsioufis K 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction/Purpose: Patent foramen ovale (PFO) is common in asymptomatic adults and is associated with cryptogenic stroke (CS). We sought to evaluate the impact of PFO closure in health-related quality of life (HRQoL) in PFO patients with CS.

Method
In this pilot study, 19 patients (mean age 47 ± 7.7; 13 male) who underwent PFO closure at our center were invited to a short-term clinical follow up (mean follow-up period 6-10 months). All patients had suffered an ischaemic stroke and their disability level was assessed using the Modified Rankin Scale (MRS, no significant disability 63%). HRQoL was assessed using the 36-Item Short Form Survey (SF-36) and the European Quality of Life-5 Dimensions Questionnaire (EQ-5D) preoperatively and at follow-up.

Results
Both SF36 and EQ-5D scores improved after the operation as shown by the self-rating scores (20,67% and 40,52% higher scores, respectively). Patients with major mobility problems were more likely to be current smokers (r = 0.481) and those who had lower scores on the MRS scale (r=-0.571) rated higher their scale diagram. The categories of energy/fatigue (r = 0.459; p = 0.048), social functioning (r = 0.547; p = 0.015) and pain (r = 0.550; p = 0.015) were positively correlated with physical function. Finally, there was a positive correlation between role limitations due to emotional problems and energy/fatigue (r = 0,519; p = 0.023), and between energy/fatigue and emotional well-being (r = 0.519; p = 0,023).

Conclusions
The results of our study indicate that shortly after PFO, subjects perceive improvements in their QoL. However, it seems that poorly rated physical function was more common in active smokers, and affects patients" social life and their emotional state. Health care professionals should encourage these patients to participate in rehabilitation and psychological support programs postoperatively.
Continuity of care in heart failure patients
Authors: Olsen K , Falun NF , Keilegavlen HK 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart failure (HF) requires follow-up over time and by several different health services. The positive effects of follow-up care in secondary care services is well known. However, there is a lack of knowledge in how HF patients experience continuity of care a through various health care services in secondary and primary care.

Purpose
To explore how HF patients experience continuity of care through secondary and primary health care services.

Methods
The study used an inductive design by performing four semi-structured focus group interviews. Overall, 17 patients, mean age of 71 years (range 42-95), 11 men and 6 women, All patients were receiving regular and individual follow-up by cardiac nurses in primary care after hospital discharge The interviews were analysed through qualitative content analysis.

Results
Gaps in continuity of care were described as challenging. Information about HF at the time of discharge from hospital were not always fully comprehended. Patients experienced physical strain of being lost and abandoned after discharge from hospital. They did not know whom to contact for follow-up. Appointments with the GP was not agreed or scheduled weeks ahead. Patients appreciated home visit by a cardiac nurse in primary care who provided the patients with knowledge in self-care administration. When experiencing deterioration they could call the cardiac nurse, who could facilitate fast track to the hospital. Self-care was difficult to comprehend, especially for those experiencing comorbidities. Patients also described the importance of sharing knowledge and experience of living with HF with other patients in a secondary care setting, organized by specialised cardiac nurses.

Conclusions
There are gaps in continuity in patients’ pathways, throughout both secondary and primary healthcare. Even though patients receive information at discharge from hospital, they felt insecure when returning home. Health care services in the primary care provided the patients with both knowledge and confidence as they regularly met the patients, both at home and in organized primary care meetings.
Keeping the plates spinning: a qualitative study of the multifaceted role of caregiving in HFpEF
Authors: Pearson CR , Khair E , Forsyth F , Sowden E , Deaton C 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health Research School for Primary Care Research

OnBehalf
Optimise HFpEF

Background
Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of all heart failure cases yet remains poorly understood, diagnosed and managed, which can add complexity to the caregiver role. No study to date has explicitly investigated the experiences of informal caregivers of people with HFpEF.

Objective
The aim of this study was to explore and understand the role and experiences of informal caregivers of people with HFpEF.

Methods and design
A qualitative study using semi-structured interviews involving caregivers alone, patients alone or caregiver/patient dyads. The interviews were performed as part of a larger programme of research in HFpEF. Participants were recruited from three regions of England. Interviews were transcribed verbatim and analysed thematically.

Results
22 interviews were conducted with a total of 38 participants, 17 of which were informal caregivers. Three inter-related themes were identified: (1) ‘spinning plates’ - the multifaceted nature of informal caregiving: household manager, health manager and motivator; (2) ‘the spinning falters’- the barriers to caregiving: lack of HFpEF awareness, information and support, the burden of multimorbidity, caregiver stress and the caregiver’s health status; (3) ‘keeping the plates spinning’- the facilitators of caregiving: being informed, being appreciated, having a champion (a health care professional that is key to managing the patient’s HFpEF), and engaging a wider support network.

Conclusions
Informal caregivers play an important role in supporting people with HFpEF. The experience of caregiving to people with HFpEF is similar to HFrEF, but complicated by challenges of poor HFpEF information and support, and the burden of multimorbidity. Healthcare providers should assess the needs of informal caregivers as part of patient care in HFpEF. Caregivers and patients would both benefit from improved information and management of HFpEF and associated multi-morbidities. Helping caregivers ‘keep the plates spinning’ will require innovative approaches and coordination across the care continuum.
Developing a behavioural intervention to increase lay-people"s intentions to initiate CPR in the event of Out-of-Hospital Cardiac Arrest (OHCA)
Authors: Farquharson B , Dixon D , Williams B , Clegg G , Macinnes L , Ramsay P , Torrens C 
Published: July 2021

Abstract

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

OnBehalf
BICeP Study Group

Background
Prompt, effective bystander cardiopulmonary resuscitation (CPR) is the single most important factor determining survival from out of hospital cardiac arrest (OHCA), increasing survival up to 4-fold. However only 35%-45% of people trained in CPR actually attempt it when required. This study uses psychological theory and behaviour change techniques (BCTs) to increase the proportion of bystanders who attempt CPR in a real emergency.

Design
Intervention development study

Methods
Intervention content was informed by two recent systematic reviews, which identified barriers to bystander CPR and BCTs within existing training programmes (PROSPERO CRD42018117438; CRD42019126745) and a qualitative study exploring participants’ views (n = 12) of draft text messages. A lay bystander user-involvement panel (n = 7) and an expert advisory group (comprising representatives from CPR training organisations) worked with the research team to co-produce the final intervention and agree the schedule for text message delivery. BCT content was assessed by two independent experts. A framework analysis of interviews was undertaken.

Results
Recognising and addressing fears, and helping people to better prepare for real-life situations were identified to be important to participants. Short, simple texts from a credible source and with a positive tone were strongly preferred, there was a strong aversion to anything "guilt-inducing". Pictures and personalisation were important, rewards less so. Regarding frequency: participants varied but around 1/week was considered adequate by most. A total of n = 35 text-messages with verified BCT content were co-developed with participants.

Conclusions
A text message intervention incorporating BCTs, which is acceptable to intended users and CPR trained individuals has been produced and will be subject to future evaluation.
Throwing cardiac rehabilitation into the 21st Century: a focus group study exploring the impact of COVID-19 on cardiac rehabilitation delivery in Victoria, Australia
Authors: Cartledge S , Rawstorn J , Tran M , Ryan P , Howden E , Jackson A 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac rehabilitation (CR) education and exercise are predominantly delivered in group face-to-face settings. This delivery model was challenged during the COVID-19 pandemic due to government enforced lockdowns which restricted the delivery of these models of care. The Australian state of Victoria experienced the longest and most severe local restrictions and was in lockdown for approximately 26 weeks of 2020.

Purpose
We aimed to explore the experience, barriers and enablers of delivering CR during a pandemic, and identify strategies for future COVID-safe programs among cardiac rehabilitation clinicians.

Methods
Victorian members of the Australian Cardiovascular Health and Rehabilitation Association (ACRA) were invited to attend an exploratory qualitative online focus group in November 2020. An inductive thematic analysis was undertaken before deductively applying the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework to identify barriers and enablers for technology adoption in CR.

Results
30 members participated in a 106 minute focus group. 17 members who provided demographics represented multiple disciplines (nursing n = 13, exercise physiology n = 3, physiotherapy n = 1) and geographical settings (metropolitan n = 10, regional n = 4, rural n = 3). Four main themes were identified: Consequences of sudden service delivery change; Technology use – challenges and benefits; Capacity (program and staff); and The way forward. The deductive NASSS analysis demonstrated the main challenges of continuing remotely delivered CR lie with all adopters (staff, patients, carers) and with organisations. Future CR strategies included the importance of resuming face-to-face programs but important barriers including finding capacity, particularly staffing, to run concurrent telehealth programs remain to be addressed.

Conclusion
The COVID-19 pandemic forced and expedited significant changes to CR delivery models. While clinicians agreed that delivery of CR via telehealth will continue, it is now timely to review remote models of care and plan how they will integrate alongside traditional face-to-face programs.