bluuebunny/crossref_metadata_2025_split huggingface dataset:
Xerostomia in patients with heart failure - prevalence, intensity and reported strategies of symptom reduction
Authors: Wefer F , Koeberich S 
Published: July 2024

Abstract

Background
Xerostomia is a common symptom in patients with chronic heart failure (CHF), with a reported prevalence rate of up to 62%. It is defined as the perception of oral dryness, along with swallowing difficulties, oral burning, and altered taste. Despite being a widespread symptom, xerostomia is insufficiently studied CHF patients from german-speaking countries.

Purpose
The purpose of this study was to assess the prevalence, perceived intensity, and severity of xerostomia in German CHF patients. Additionally, patients´ reported strategies of symptom reduction were investigated.

Methods
Multi-center, cross-sectional study. Patients with a confirmed diagnosis of heart failure were recruited during visits to heart failure outpatient clinics or while hospitalized for any reason. If they consented to participate, they received a self-administered questionnaire containing questions about xerostomia, perceived distress and severity of xerostomia, and patients' measures to reduce xerostomia. Disease-related data were extracted from the patients' medical records. Perceived intensity of mouth dryness was measured using a visual analog scale (VAS) with 0 for "little dry" and 100 for "maximum imaginable dryness." To assess the severity of xerostomia, the short version of the xerostomia inventory (XI) was used with 5 items inquiring about the frequency of specific xerostomia symptoms. Sumscores of the XI ranged from 5 to 15, with higher scores indicating a higher severity of xerostomia. Measures to reduce dry mouth could be stated in patients' own words.

Results
Overall, 371 patients with a mean age of 62.4 (± 14.9) took part in this study. Most patients (230; 62%) had CHF with reduced ejection fraction. The main aetiology for heart failure was ischemic heart disease (118; 31.8%), followed by dilated cardiomyopathy (116; 31.3%).
Out of 371 patients, 361 answered the question of whether they had suffered from dry mouth in the last three days. The prevalence rate of xerostomia was 65% (n=234) (95% CI: 60%; 70%). Perceived intensity of mouth dryness, using VAS, was 55.5 (± 22.3). The median severity score of the XI was 9 (Interquartile-Range: 8;11). Patients mostly experienced dry mouth in the morning and at night. The most frequently mentioned measures against dry mouth were drinking something (water, juice, coffee, tea, buttermilk), rinsing or moistening the mouth, sucking candies (sugar-free candies, peppermint, lemon, menthol), eating fruits, and using chewing gums.

Conclusion
Xerostomia is a widespread symptom in German heart failure patients, affecting more than half of the patients included in the study. The intensity and degree of severity appear to be in a medium range. CHF patients used various interventions to relieve the burden of xerostomia. These measures should be further investigated for their effectiveness.
Functional capacity evaluation in acute isquemic patients
Authors: Delgado B M , Lopes I V O , Neto C E L I A , Pereira A N A , Rodrigues F A T I M A , Novo A N D R E 
Published: July 2024

Abstract

Background
An acute ischemic event may cause a functional deterioration even in previously autonomous patients. The determination of functional capacity is relevant to determine health indicators for rehabilitation nursing care, allowing at the same time to determine the patient's functional status throughout their health-disease cycle and to prescribe exercise-based rehabilitation for home-based programs. The six-minute walking test is widely used in studies involving cardiac patients, however, reference values for ischemic population after immediate clinical stabilization are not known. Also the 6MWT has a prognostic value for cardiac patients, being of utmost importance to evaluate it, after clinical stabilization in order to properly determine goals for patient´s rehabilitation process.

Aim
Determine the functional capacity level of ischemic patients, by gender and type of event, after clinical stabilization using the 6-minute walking test.

Methods
Using the 6-minute walking test, the functional capacity of ischemic inpatients was evaluated at discharge, after clinical stabilization. Patients with acute coronary syndrome with and without ST-segment elevation were included. All patients were accompanied by the rehabilitation nursing team during the in-hospital stay period and performed phase 1 cardiac rehabilitation. The 6MWT was performed based on the 2016 ATS guidelines and the expected value of the distance covered was determined based on the Enright equation. The sample was divided by gender, taking into account their widely known differences in functional capacity and also by event, namely ST elevation and Non ST-segment elevation myocardial infraction. The profile of modifiable cardiovascular risk factors (CRF) was also evaluated, being considered the following: Hypertension, Dyslipidemia, obesity, tobacco, sedentary lifestyle and stress.

Results
A total of 303 patients were studied (229 male), with a mean age of 62 years (men) and 62 (women). About 36% of men and 7% of women were admitted with ST elevation Myocardial Infraction, with a mean number of cardiovascular risk factors (CVRF) of 3.2 in men and 3.9 in women. The most prevalent CVRF in females is dyslipidemia and sedentary lifestyle, while in males it is dyslipidemia.
The sample was divided in two groups by type of event, namely ST-elevation (group A) and NonST-elevation (group B) and in each group, data was evaluated by gender.
A statistically significant difference (p&lt;0.01 for males and p&lt;0.02 for female) was found between the value of the 6MWT performed (441.2 meters – males; 369.5 meters - females) compared to the value estimated by the equation (559.9 males; 482.8 female gender). There is a very significant difference between the expected value and the value actually covered in the walking test. It may be pertinent to define reference values for this typology of patients, so that their functional capacity can be properly measured.
Evaluating the integration of CTCA as part of an accelerated diagnostic pathway for patients presenting to the Emergency Department with acute chest pain: a two-year review
Authors: Farrand N , Mcguone D , Stuart L , Carmody D , Roe A , Curtin E , Blennerhassett L , Emeka-Okafor U , Daly C , Sheehy N , Mcmahon G 
Published: July 2024

Abstract

Introduction
Chest pain accounts for 8.8% of all presentations to an Hospital Emergency Department. In line with ESC guidelines (2019), an adapted HEART pathway, utilising CT Coronary Angiogram (CTCA) is delivered by our Emergency Cardiology Advanced Nurse Practitioners (ANP) and Clinical Nurse Specialists (CNS) as part of an ambulatory chest pain pathway. It is our first line diagnostic test for patients with a non-ischaemic 12-lead ECG and normal cardiac biomarkers, with a low-to-intermediate HEART score. Responsibility for the referral of patients onto the pathway is shared with the Cardiology Registrars. This is a collaborative interdisciplinary pathway between Emergency Medicine, Cardiology, and Radiology.

Purpose
To evaluate the effectiveness and safety of CTCA as part of an Accelerated Diagnostic Pathway (ADP), for evaluation of chest pain of possible cardiac origin in low-to-intermediate risk chest pain patients.

Methods
We examined the CTCA and safety outcomes of patients presenting between Jan 1st 2022 – Dec 31st 2023 who were risk stratified as low-to-intermediate risk for coronary artery disease, based on Heart score, 12-lead ECG and biomarker testing, using the electronic patient records. Institutional ethics was in place.

Results
Between January 1st and December 31st 2022, 290 patients were referred for CTCA, with a total of 268 CTCAs completed. The number of patients referred on the ADP increased by 53.4% in 2023 with 445 being referred for CTCA, 416 of which have been completed, with 12 pending completion.
38% of patients were found to have evidence of coronary artery disease (CAD). Coronary artery disease causing at least 50% stenosis was identified in 11% of patients. 4.5% of these patients required revascularisation, 17 of whom underwent Percutaneous Coronary Intervention (PCI) with a further 13 being referred for Coronary Artery Bypass Grafting. A positive family history was the most dominant risk factor associated with significant CAD. An equivalent number of males to females were referred for CTCA, however, men were more than 7 times more likely to have severe disease. (12% vs 88%). All patients referred for CTCA via the chest pain pathway were followed up by the Emergency Cardiology ANP/CNS in a virtual clinic, delivering risk factor modification advice and preventative therapies, when indicated. There was no evidence of any major adverse cardiovascular events within a 30-day period for this patient cohort.

Conclusion
The integration of CTCA into an adapted HEART pathway has resulted a safe and timely discharge for patients presenting to ED with acute chest pain, of possible cardiac origin. CTCA offers excellent early detection of coronary artery disease in this patient cohort with normal ECGs and cardiac biomarkers, but with a history of chest pain suggestive of CAD.
Differences between non-obese and obese patients with hypertension according to gender
Authors: Uchmanowicz B , Lokiec K , Kwasny A , Kubielas G , Smereka J , Juarez-Vela R , Czapla M 
Published: July 2024

Abstract

Introduction
In recent years, obesity has escalated markedly, emerging as a one of major worldwide health issue. The frequency of obesity in both adults and children is rising at an alarming rate, leading to severe consequences for public health. The World Health Organization (WHO) reports that as much as 13% of the global population is grappling with obesity. Numerous research studies have established that obesity not only heightens the risk of cardiovascular diseases (CVD) including hypertension, coronary heart disease, and heart failure, but also exacerbates complications in individuals already suffering from these conditions.

Purpose
The aim of this study was to retrospectively analyze the differences between non-obese and obese patients admitted to the cardiology department due to hypertension according to gender.

Methods
We performed a retrospective analysis of 486 medical records of patients who had been admitted to the Institute of Heart Diseases of the University Clinical Hospital in Wroclaw (Poland) between January 2017 and June 2021. The study group was divided in two ways. The division of patients was into one of two groups based on the following cut-off BMI values: non-obese (BMI &lt; 30) and obese (BMI ≥ 30). The study was conducted following the principles of the Declaration of Helsinki and approved by the independent Bioethics Committee of Wroclaw Medical University, protocol no. KB-837/2022. The significance level for all statistical tests was set to 0.05. R 4.3.0. was used for computations.

Results
Women accounted for 53% of the study group and were significantly older than men (64.7±12.8 vs. 60.5±11.8, p=0.466). Women with obesity had significantly higher triglycerides (TG), high-sensitivity C-reactive protein and thyroid-stimulating hormone concentrations and significantly lower high-density lipoprotein (HDL) concentrations than women who were not affected by obesity. Men with obesity had significantly higher TG levels, lower HDL levels, more more frequent to have diabetes (DM) and less frequent stroke in the past compared to men without obesity. (Table 1 and 2)

Conclusions
This study highlights important differences between patients with hypertension without and with obesity, with notable gender differences. Women with obesity showed differences only in laboratory test results, while men with obesity showed differences in laboratory test results and comorbidities. These findings emphasize the need for gender-specific management strategies and research in hypertension and obesity, underscoring the distinct cardiovascular risks associated with obesity in both genders.
Adiponectin and visfatin as potential biomarkers of cardiovascular disease in postmenopausal women
Authors: Cybulska A , Schneider-Matyka D , Cwiek D , Grochans E , Rachubinska K 
Published: July 2024

Abstract

Background
Adiponectin and visfatin are involved in many changes associated with obesity and metabolic disorders so may be related to metabolic syndrome and cardiovascular disease. During the perimenopausal period, the risk of obesity and cardiometabolic diseases increases. Therefore, the aim of this study was to assess the relationship between cardiometabolic parameters and circulating levels of visfatin and adiponectin in perimenopausal women with regard to their obesity status.

Material and methods
This survey-based study was conducted among 168 perimenopausal women. It involved the use of questionnaires, anthropometric measurements, blood pressure measurements, and venous blood collection.

Results
Our study found that visceral adiposity index (VAI) and lipid accumulation product (LAP) were negatively correlated with adiponectin levels. Preliminary multivariate linear regression analysis revealed a positive correlation between circulating visfatin and IL-6 levels. Adiponectin was negatively correlated with HbA1C, fasting blood glucose, insulin, and triglycerides. Furthermore, circulating adiponectin was positively correlated with HDL, and negatively with HOMA-IR.

Conclusions
In the women studied, some adipokines may have played a significant role in the development of obesity, metabolic syndrome, and cardiometabolic diseases.
Increased heart attack mortality in a medium sized city in Germany: key informant interviews with local medical health care workers
Authors: Jost U , Joggerst B , Baernighausen T , Souares A 
Published: July 2024

Abstract

Background
Cardiovascular diseases are the leading cause of death worldwide. However, there are significant regional differences regarding mortality rates. A city located in Southwest Germany with approximately 125.000 inhabitants, has revealed a significantly increased heart attack mortality for the last two decades. In most of these years it recorded the highest rate in the federal state.

Purpose
The aim of this study was to assess influencing factors on the increased heart attack mortality in this city.

Methods
The study recruited health care workers in regular contact with heart attack patients in this city. Using a heterogenous sampling approach, the selection included different medical specializations (e.g. family doctor, intensive care nurse). We conducted qualitative interviews following a semi-structured guideline. Audio records of interviews were transcribed and processed using content analysis.

Results
We performed 17 interviews (female=6, immigration background=4). The central theme was an unhealthy cardiovascular lifestyle predominantly focusing on modifiable risk factors. Interviewees described the intensity of risk factors as much higher in the city than in the surrounding districts. Mostly they connected this to a high population share of people with low socioeconomic status or immigration background. Most interviewees did not see severe differences in health care provision and institutions in the city compared to other districts.

Conclusion
Socioeconomic factors were seen as the most powerful influence on the heart attack mortality. A healthier cardiovascular lifestyle of the population can only be achieved addressing social disparities within the city.
Communicate, support and integrate: strategies to improve engagement with cardiac rehabilitation
Authors: Caughers G , Bradley J , Wilson A , Donnelly P , Fitzsimons D 
Published: July 2024

Abstract

Background
Factors beyond Cardiac Rehabilitation (CR) service continue to negatively impact CR attendance and programme completion. Intrapersonal, socioeconomic, health perception/co-morbidity and logistical factors can have a significant impact on CR uptake. During the COVID-19 pandemic many services reconsidered their approach and utilised novel but more flexible delivery solutions (1). As clinical services remodel post-COVID we sought to incorporate the patient perspective.

Purpose
To identify and co-design strategies to improve engagement with CR.

Methods
Experience Based Co-Design (EBCD) is a Codesign methodology that incorporates the experiences of patients, caregivers and service providers (2). The project involved staff, patients and caregivers linked to CR across the region. In an iterative process, a literature review followed by focus groups and co-design workshops were conducted by the research team during 2019-2021.

Results
The co-design workshops identified numerous multifaceted issues in relation to engagement with CR. These can be described in three distinct themes.

Communicate
Misunderstandings about CR content and efficacy persist amongst patients and the public. Health Care Professionals must streamline, and focus information provided to patients in order to highlight the multifaceted benefits of CR, a patient-led information video for patients and public was produced and shared through CR networks.

Support
Patients require additional emotional and social support following a cardiac event. Significant concerns described by patients relate to family, work, socialising and future health. A supportive, facilitated discussion was warranted and a brief cardiac intervention (CABIN) was developed and will be tested in a feasibility trial.

Integrate
Following COVID-19 patients are more receptive to hybrid approaches to delivering CR. Diverse options for delivery of CR should be integrated into standard practice. Patient suggestions included online learning modules, social exercise, video libraries, online support meetings, text chat facilities, and regionally specific webpages.
The study resulted in three key outputs; a short regional information video, a regional webpage and the brief supportive intervention, CABIN.

Conclusion
Co-designing with staff and patients provides relevant and important information about highlighting the importance of and accessing and delivering a service which can be incorporated into future service changes.
Co-designing an information map guiding patients on their journey to cardiac rehabilitation in Austria
Authors: Hoeppchen I , Kulnik S T , Meschtscherjakov A , Niebauer J , Pfannerstill F , Smeddinck J D , Strumegger E M , Young F , Wurhofer D 
Published: July 2024

Abstract

Background
Cardiac rehabilitation (CR) is underutilised worldwide. Cardiac patients lack sufficient information about CR, for example, regarding the health benefits of CR and how to obtain a referral. This gap presents a significant barrier to CR uptake.

Purpose
The purpose of this study was (1) to define patients’ needs during their transition from the acute hospital setting to CR and (2) to design a need-based information map.

Methods
We conducted three sequential co-design workshops with 17 participants: ten cardiac patients, most of whom had completed a CR programme, six healthcare professionals who worked within the CR pathway, and one who was a healthcare professional with a cardiac condition who had completed a CR programme. Patients’ needs and design suggestions were elicited through generative co-design methods [1], such as paper prototyping, persona scenarios, group discussions and presentations, and card sorting. Data were analysed with thematic analysis.

Results
Workshop participants identified three "steps" at which orientation is required to guide patients along their journey: (1) during the hospital stay, (2) while at home, and (3) throughout the CR programme. Patients’ needs changed accordingly, prompting us to tailor information and tips to these steps (s. Figure).
In the hospital, patients needed orientation about follow-up care. The patients sought facts about CR, enabling them to make an informed decision for or against participation. Particularly, info about programme duration, content and health benefits were appreciated. Information about common symptoms related to the treatment and explanations of the hospital environment were also perceived as helpful. After discharge, the time at home was characterised by a need for calm after the stressful time in the hospital. Patients reflected on their cardiac events. Information on adopting a heart-healthy lifestyle and guidance on preparing for CR were perceived as helpful. Contact details for medical support were appreciated. During the CR programme, patients sought motivational support for programme adherence. They appreciated tips such as making use of the time for bonding and seeking out friendships with other patients. Testimonials sharing experiences and tips presented by fellow patients were considered helpful at any point along the patient journey.

Conclusion
When transitioning from the acute hospital to CR, cardiac patients’ needs change in distinctive steps, which the settings hospital, home and CR represent. Information and tips should be tailored accordingly. Our information map may support patients’ CR uptake and facilitate cardiac patient pathways in Austria, for example, by developing patient-facing technology.Patients' needs and required information
Cardiovascular malformation associated with esophageal atresia
Authors: Rozensztrauch A 
Published: July 2024

Abstract

Background
Congenital heart disease (CHD) is the commonest abnormality associated with esophageal atresia (EA). EA is a rare congenital malformation occurring in 3-4 in 10,000 births, in 87% occurs along with a distal tracheoesophageal fistula (TEF). The coexistence of a cardiac malformation and in addition, prematurity can be challenging and affects the further treatment and quality of life (QOL) of the child and family. Knowledge of the anatomical type and physiological consequences of CHD allows a well-coordinated treatment plan.

Purpose
The aim of this paper is to investigate whether the presence of underlying associated malformations, disease-specific problems and prematurity would have a considerable influence on the family of a child after surgical repair of EA.

Methods
We used a crossed-sectional questionnaire study. The impact of EA was assessed using an Authors-Designed Questionnaire (ADQ) to collect medical and sociodemographic background data (gestational week (HBD), comorbidities, type of EA, according to the Gross classification) as well as standardized questionnaire: the PedsQL™ Family Impact Module (PedsQL-FIM).

Results
Of the 76 children born with EA/TEF included in this study, 26% had a vascular malformation. Mean age was 5.3 years (SD = 3.7 years). Cardiovascular malformation associated with EA significantly (p=0.037) affects the functioning of the family in the emotional domain (FIM – ED). The QOL (p &lt; 0,034) of children born before 37th HBD is lower that children born in term The presence of concomitant anomalies does affect the overall generic QoL. No statistical correlation was found between the type of anomaly (with/without TEF) and patients' QoL.

Conclusions
Cardiovascular malformation and prematurity significantly affect child’s QOL and the functioning of the family with EA. Patients who have undergone EA treatment require specialist outpatient care, not only in the first years of life, but also in adolescence and adulthood.