bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiences of informal caregivers taking care of heart surgery patients after discharge from hospital: a qualitative study
Authors: Lie I , Moons P , Tonnessen T , Halvorsen S , Blakoe M , Moller C H , Kaljusto M L , Parry M L , Bjornnes A K , Hojskov I E 
Published: November 2023

Abstract

Background/Introduction
Open heart surgery is still the main treatment option for severe coronary and heart valve disease. After discharge from hospital, caregivers of heart surgery patients are given the main responsibility for care of their next of kin at home. There is a lack of studies on caregivers’ experiences with information from health care professionals regarding the discharge to home.

Purpose
To explore the informal caregivers' information and communication experiences with health care professionals following discharge to home after heart surgery

Methods
In-depth interviews using a semi-structured interview guide 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 was analyzed in the NVivo software tool following Braun and Clarke`s 6-step thematic analysis process.

Results
Twelve informal caregivers (10 women, 2 men, mean age 65 years) were interviewed two to four weeks after the heart surgery patient had been discharged to home.
Four main themes were identified: i) Lack of information ii) Insecurity, iii) Responsibility without knowledge and iv) Readmission to hospital is a challenge. Shortly after discharge the caregivers realized the consequences of lack of information and knowledge to facilitate for their next of kin` comfort, and how to manage if their symptoms worsened. Several caregivers were afraid, and especially if readmission to hospital due to serious complications were needed (Figure 1).

Conclusion(s)
Informal caregivers of heart surgery patients lack information from health care professionals, and communication with health care professionals at hospital discharge to gain knowledge, feel secured, and to be prepared for the responsibility for follow-up of their next of kin at home.Figure 1.Caregivers heart surgery pts.
Exploring the association between self-care behaviour, knowledge and cognition in patients with heart failure: a secondary analysis from the HF-Wii study
Authors: Stromberg A , Van Der Wal 'M , Jaarsma T 
Published: November 2023

Abstract

Background
Self-care is vital for patients with heart failure and is influenced by different factors, Knowledge and the ability to reflect on behaviors is important to make decisions on self-care. Cognition may also be an important factor in relation to both knowledge and self-care. It has been found that cognitive impairment in patients with heart failure is common, with a reported prevalence of 20–80%.

Aim
To explore association between self-care behaviour, knowledge and cognition in patients with heart failure.

Methods
This is a secondary analysis of the baseline measures from the HF-Wii study with data from 605 patients, mean age 70 ± 12, 29% female, 30 % in New York Heart Association Class III-IV. Data on self-care was collected with European Self-care Behaviour Scale (EHFScBS) (possible range 0-100). Knowledge was collected with the Dutch HF Knowledge Scale (possible range 0-15 points). Cognition was assessed Montreal Cognitive Assessment (MoCA). Knowledge was dichotomised into low vs. high knowledge (cut off 13) and cognition into mild, moderate or severe cognitive problems vs. no or light cognitive problems.

Results
The total score on the EHFScBS was 64.6 ± 21.0 with 41% (N=245) of the patients performing good self-care (score &gt; 70). The mean score on the Dutch HF Knowledge Scale was 12.3 ± 1.9 and 308 patients had high knowledge (score &gt; 13). The majority of the patients (61%; N=371) had mild cognitive problems and 195 (32%) had no or light cognitive problems with a mean MOCA score of 24.4 ± 3.8.
Self-care was significantly correlated to total knowledge (r = .23; p &lt; .001), but it was not correlated to cognition. Furthermore, there was a positive correlation between total knowledge and cognition (r = .43; p &lt;.001).
Out of the 308 patients with high level of knowledge (&gt;13), 130 had mild, moderate or severe cognitive problems. The other 178 patients with high knowledge had no or only light cognitive problems. Patients with high knowledge had a significantly higher score on the self-care behavior scale, independently of their cognitive function.
In a multivariable logistic regression analysis, higher age [odds ratio (OR) 1.03; 95% confidence interval (CI) 1.02-1.06), better quality of life (OR .95; 95% CI .90 - .99) and higher levels of knowledge (OR 1.25; OR 1.13 – 1.38) were independently related to self-care.

Conclusion
HF knowledge and cognition are related in patients with heart failure, but only knowledge, not cognition, was independently related to self-care.
Evaluation of PHARM-HF, a pharmacist-led heart failure medication titration clinic
Authors: Turgeon R , Ladhar S , Hawkins N , Virani S 
Published: November 2023

Abstract

Background
Optimal medical therapy (OMT) is the bedrock of heart failure with reduced ejection fraction (HFrEF) management. The pharmacist-led PHARM-HF clinic provides rapid, pharmacist-led, telehealth-based initiation, titration, and optimization of medications for HFrEF. We evaluated OMT changes in patients from PHARM-HF referral to discharge.

Methods
This retrospective pre-post study evaluated patients attending PHARM-HF from January 2021 to February 2023. The primary outcome was a modified version of the OMT score, which integrates utilization and dosing of ACEi/ARBs/ARNI, beta-blockers, MRAs and SGLT2is. Secondary outcomes included OMT score categorized as suboptimal (score 0-4), acceptable (score 5-7) or optimal (score 8; all four drugs at max-tolerated dose); use of individual agents at 1 year follow-up; and change in left ventricular ejection fraction (LVEF) from baseline to 1-year follow-up. Change in modified OMT score from baseline to discharge was compared using the Wilcoxon signed rank test.

Results
We included 81 patients. Median age was 68 (interquartile range [IQR] 57-74), 21% were female, 44% in NYHA class 2, and median LVEF was 31% (IQR 25%-37%, range 0-8). Patients had a median 5 (IQR 4-7) encounters with the PHARM-HF clinic pharmacist. The median OMT score at baseline was 6 (IQR 4-7, range 0-8), which an improvement to a median score of 8 (IQR 8-8, range 2-8) at discharge (p&lt;0.0001). At baseline, 7% of patients were categorized as optimal, which improved to 78% at discharge, with 16% of patients on target doses of all four medications. Medication use at 1 year follow-up was 83.4% for sacubitril-valsartan, 14.3% for ACEi/ARB, 97.6% for beta-blockers, 85.7% for MRA, 78.6% for SGLT2i. For 31 patients with baseline and 1-year LVEF, median LVEF improved from 30% (IQR 25%-37%) to 38% (IQR 34%-46%).

Conclusions
A pharmacist-led clinic increased prescription OMT uptake. Future multicentre studies should explore the role of pharmacists as collaborators and prescribers to optimize HFrEF care.
Palliative care for cardiovascular patients: description of motives for referral and actual care provided
Authors: Ecarnot F , Giffard M , Van Bulck L , Sall F S , Becoulet N , Seronde M F 
Published: November 2023

Abstract

Background
Palliative care (PC) for cardiovascular patients remains suboptimal, whereby only a small proportion of patients are referred to specialist palliative care, and often too late in the disease course. We investigated the reasons that prompted cardiologists to request an intervention from the PC team, and we describe the actions implemented by the PC in response to referrals from the cardiology department.

Methods
This retrospective study included all patients with cardiovascular disease who were referred to the mobile palliative care team of a large University Hospital in France between 2010 and 2020. All data were extracted from the medical hospital files. For all patients referred to PC during the study period, we recorded the original motive for requesting assistance, as cited in request sent from cardiology to PC. We also recorded the types of services provided by PC, the date of the first and last consultation of the patient with PC, and the number of PC consultations per patient.

Results
From a total of 142 cardiology patients for whom PC assistance was requested, 136 (95.8%) died, while 6 (4.2%) are still alive. In 42 patients (29.6%), there was a generic request for intervention without indicating any particular domain where specific assistance was needed. In other cases, a motive for referral to the PC mobile team was provided by cardiologists, with ethical dilemmas (35 patients; 24.6%), symptom management (23 patients; 16.2%), and discussion about where the patient could live (11 patients; 7.7%), as the most common motives (see Figure 1). In response to these referrals, the PC team provided assistance with ethical dilemmas in 69 patients (48.6%), symptom management in 28 patients (19.7%), discussion about where the patient could live in 15 patients (10.6%), 2 or more of these issues in 16 patients (11.3%), and other issues in 14 patients (9.8%) (e.g. reorientation to oncology or family support). The majority of patients had 1 (n=90, 63.4%) or 2 PC consultations (n=27, 19%), while 10 patients (7%) had 3, 9 patients (6.4%) had 4, and 6 (4.2%) had 5 or more PC consultations. Among those who died, the median number of days between the first and the last PC consultation was 0 (quartile 1=0, quartile 3=3).

Conclusion
This study shows that cardiologists do not necessarily have a specific motive in mind when referring patients to PC. Because many more patients received assistance with ethical dilemmas than was requested, this indicates that cardiologists may not be aware of the ethical issues at stake in the care of cardiology patients, or that they only refer patients to PC when they have no other solution or do not know what else to do for the patient. There is clearly a need to raise awareness among cardiologists about ethical issues and about the services that the PC team can provide.
Device specific quality of life in subcutaneous versus transvenous implantable cardioverter defibrillator implantations: results from the ATLAS multi-centre randomized controlled trial
Authors: Carroll S , Mondesert B , Krahn A D , Bashir J , Fisher K , Nair K , Healey J S 
Published: November 2023

Abstract

Background
Newer innovative subcutaneous implantable cardioverter defibrillators (S-ICDs) offer an alternative to transverse ICDs (TV-ICDs), placing leads outside of the heart thereby potentially reducing lead-related complications. The ATLAS trial, a multi-centre randomized controlled trial, showed a significant reduction in perioperative complications in TV-ICD versus S-ICD patients. The following results report device-related quality-of-life (QoL) measured in the trial. QoL measures are recognized as key patient-reported outcome measures (PROMs).

Purpose
To compare TV-ICD and S-ICD post implantation device-related QoL in the ATLAS trial.

Methods
Sample included all randomized ATLAS trial patients. The Florida Patient Acceptance Survey (FPAS) was completed at 1- and 6-months post implantation. The FPAS includes a total score and 4 subscale scores; 1) return to function, 2) device-related distress, 3) positive appraisal, and 4) body image concerns. Scores are scaled from 0-100, with total scores below 63 suggesting poor device acceptance. The primary analysis was based on complete cases and used analysis of covariance (ANCOVA) with 6-month scores as the dependent variable, group as the independent variable, and 1-month FPAS scores as the covariate. Change in FPAS total score over time within each group was explored using paired t-tests.

Results
There were 252 TV-ICD and 251 S-ICD patients enrolled in the main ATLAS trial, and of these, in the present analysis, 404 patients (197 TV-ICD; 207 S-ICD) had complete FPAS data. Sample mean age (SD) was 49.31 (11.54) years, males (74.3%) and Caucasian (83.7%). There were no substantive differences in patient characteristics between groups. The primary analyses found no differences between TV-ICD and S-ICD groups for FPAS total score (Mean Difference=-0.75; 95% CI, -3.15, 1.66; p=0.510) or FPAS subscale scores. Mean FPAS total scores increased from 74.43 (15.35) to 78.25 (15.88) and 73.73 (16.09) to 77.05 (16.13) between 1-month and 6-months in the TV-ICD and S-ICD groups respectively. The increase from 1-month to 6-months was statistically significant in both groups (p&lt; 0.001). These findings suggest that regardless of ICD type, there is device acceptance in both groups from implantation and over time.

Conclusion
Analysis of the FPAS measure, a device-specific QoL measure, found both TV-ICD and S-ICD patients reported good acceptance of their devices, with no significant differences between groups for up to 6 months post implantation. These findings provide an important piece to the TV-ICD versus S-ICD line of inquiry in ICD patient populations particularly for this newer S-ICD innovation and can be included in decision making between health professionals and patients.
The perceptions of disease and its symptoms compared by gender among patients with AF and their quality of life
Authors: Tsai Y H , Lou M F , Kuo C T , Weng L C 
Published: November 2023

Abstract

Background
Patients' atrial fibrillation (AF) symptoms can vary by gender, and their quality of life (QOL) is affected by their disease perceptions should be considered.

Purpose
This study assessed patients with AF about their perceptions of the disease and its symptoms. Participants' symptom conditions, AF and symptom perception, and QOL were compared based on their genders. In addition, we accessed the prediction factors of QOL.

Methods
We included cases of having been diagnosed with AF from the cardiology department of a medical centre. Research tools mainly included AF symptoms and conditions, perceptions of AF and its symptoms (modified from AF Illness Perception Questionnaire-Revised, AF IPQ-R), and QOL (Atrial Fibrillation Effect on QualiTy-of-life, AFEQT). A two-tailed test was adopted, with 0.05 being statistically significant. A multiple regression analysis was conducted to analyze predictive factors for QOL.

Results
The 110 cases included 71 men (64.5%) and 39 women (35.5%). They averaged 64.0±0.8 (33-87) years old. Regarding the negative perception of AF and its symptoms, in 3 items, women scored higher than men did (p&lt;0.05): "AF is very unpredictable" (3.85±0.78，3.47±1.06; t=2.11), "When I think about my AF I get upset" (2.95±1.15，2.74±0.91，t=2.24) and "My AF makes me feel frustrated" (2.74±1.07，2.23±0.76，t=2.65). Regarding QOL, men scored poor QOL than women did in 2 items (p=0.03): "difficulty in walking briskly" (2.69±1.68, 3.47±1.91, t=2.21) and "difficulty in walking briskly uphill or carrying groceries or other items, up a flight of stairs without stopping" (3.35±1.84，4.18±2.01，t=2.18). QOL had five significant predictive factors; their total variance explained was 63% (Table 1). The item with the most vital explanatory factor was "total score of consequences due to AF", followed by "total score of emotional representations due to AF", "total number of symptoms", "taking Amiodarone", and "total score of treatment control of AF".

Conclusions
When patients were compared based on gender, women were more than men in the negative perceptions of AF as unpredictable, which frustrated them. Men were poor QOL related to more physical constraints. Regarding predictive factors for QOL, patients who strongly felt the consequences caused by AF, had negative emotional representations, had a negative sense of treatment control, perceived more symptoms, and took Amiodarone had lower QOL. The health provider should pay more attention to the gender differences and influencing factors of QOL and consider these individual and essential factors in health care.
Performance-based outcome measures for physical capacity and functional ability among patients with pulmonary embolism
Authors: Rolving N , Caspersen C K , Ingemann-Molden S , Grove E L , Andreasen J , Klok F A , Hoejen A A 
Published: November 2023

Abstract

Introduction
Pulmonary embolism (PE) is a serious health condition with up to 50 % of patients experiencing persisting symptoms with shortness of breath, pain, reduced physical performance and psychological distress, also known as post-PE syndrome. This condition has received increasing attention, including recommendations of assessing physical capacity to identify patients who may benefit from rehabilitation interventions to increase functional ability and health. However, as the PE population is heterogeneous compared to other cardiac patient groups, outcome measures for assessing physical capacity traditionally used in cardiac rehabilitation may not be reliable. This scoping review aims to map the performance-based outcome measures (PBOM) used in research literature to measure physical capacity in a PE population, to map the nature of the research and investigate the psychometric properties of the identified instruments in a PE population.

Methods
The methodology of the review process was guided by the Joanna Briggs Institute (JBI) framework for scoping reviews and reporting followed the PRISMA guidelines.

Results
The search identified a total of 4585 potentially relevant studies of which 234 studies met the inclusion criteria. A substantial part of studies (190 studies) was on a CTEPH population (chronic thromboembolic pulmonary hypertension), a condition developed by just 1-2% of patients with PE. The majority of included research articles originated from Europe (51%) and Asia (36%). Ten different PBOMs were identified for measuring physical capacity in a PE/CTEPH population, with 6MWT and CPET as the far most commonly used and the Bruce protocol/Modified Bruce protocol and Incremental Shuttle Walk test (ISWT) as third and fourth. No studies were identified reporting on psychometric properties of the 10 PBOMs in a PE / CTEPH population.

Conclusions
No studies were identified reporting on validity or reliability of any of the 10 identified PBOMs in a PE/CTEPH population. Thus, there is a need for conducting studies that establish the reliability, validity and responsiveness of PBOMs in a PE population, to enable identification of at-risk patients and to monitor effects of treatment and rehabilitation interventions.
A fast, novel technique for detection of left ventricular hypertrophy by electrocardiography
Authors: Somani S , Hughes J W , Ashley E A , Witteles R M , Perez M V 
Published: November 2023

Abstract

Background
Electrocardiography (ECG) is a widely used non-invasive tool for detecting left ventricular hypertrophy (LVH), but existing techniques suffer from complex rules and limited sensitivity.

Purpose
The goal of this study was to design and evaluate a new technique for rapid assessment of LVH by ECG.

Methods
The WS (Witteles-Somani) technique for LVH detection is based on recognizing the visual overlap between the S-wave of a precordial lead and the R-wave of any subsequent precordial lead. To evaluate its performance, ECGs from all patients at Stanford Healthcare with associated transthoracic echocardiograms (TTEs) between 2006 and 2018 were collected for analysis. ECGs with pre-existing bundle branch blocks or paced rhythms were excluded. A multiple adaptive thresholding technique was used to segment all QRS complexes from each ECG, with which algorithms to implement LVH detection criteria (i.e. WS, Sokolow-Lyon, Cornell, Peguero-Lo Presti) assessed performance over all ECGs. Associations between raw WS score (e.g. maximum S-wave and R-wave pair overlap value) and cardiovascular mortality, incident cardiovascular disease, and incident heart failure using age- and gender-adjusted Cox regression was also investigated.

Results
A total of 123,021 ECGs and 35,293 TTEs from 30,645 patients were collected. Of these ECGs, 36.1% belonged to patients with TTE-diagnosed LVH. The WS technique was more sensitive (46.1%) and had a higher F1-score (0.443) than other clinical criteria (Table 1), although with comparable calibration (AUROC 0.56 for WS vs. 0.54 for Sokolow-Lyon, 0.60 for Cornell, and 0.61 for Peguero-Lo Presti). Higher WS scores were associated with all-cause mortality (HR 1.08 [95% CI, 1.06, 1.11], P&lt;0.005), incident cardiovascular disease (HR 1.15 [95% CI, 1.14, 1.17], P&lt;0.005), and incident heart failure (HR 1.17 [95% CI, 1.16, 1.18], P&lt;0.005).

Conclusion
The proposed WS technique is a much simpler and more sensitive technique than standard metrics to detect LVH from ECG, with important clinical implications in the development of future cardiovascular disease.Cumulative Incidence of DiseaseCriteria Classification Performance
Electrocardiographic artificial intelligence model for timely detection of preeclampsia
Authors: Butler L , Gunturkun F , Karabayir I , Chinthala L , Batu B , Davis R L , Akbilgic O 
Published: November 2023

Abstract

Background/Introduction
Preeclampsia (PE) is a major concern for maternal and fetal health, affecting about 5%-8% of women worldwide. Assessing PE early remains an obstetric challenge. PE increases risk of cardiovascular diseases such as heart failure and ischemic and hypertensive heart disease. This is more important when the disorder persists or newly occurs within the postpartum period (postpartum preeclampsia; PPPE). Timely detection and intervention from low cost and accessible data modalities is the key to reduce the burden of preeclampsia.

Purpose
The aim of this research was to develop ECG-based models that can predict risk of PE and PPPE before onset by using raw 12-lead ECGs, and a comparative model that includes simple demographic features.

Methods
10s 12-lead digital supine ECG and demographic data was obtained from the electronic health records at a university health science center. Case data was extracted using ICD9/10 codes. Controls were matched by age and race. The data was split 80%-20% with the 20% retained as holdout data used in any way during training, while five-fold cross validation was performed on the remaining 80%. The ECG-AI model, a modified ResNet convolutional neural network (CNN) with 1D ECG signals as inputs, was used to predict incidence of PE/PPPE. The ECG-AI output, together with age, race and gestational age at time of delivery were inputted into a Cox Proportional Hazard Model (ECG-AI-Cox). Models were evaluated using the area under the receiver operator characteristics curve (ROCAUC). We also assessed time-dependent AUC at time intervals at 10 days before PE onset and 7 days into PPPE.

Results
A total of 316 (Controls=190, Cases=126) women and a total of 374 ECGs were included in the study. The patient cohort had an average age of 27.76±4.76 of which 71% were African American, 24% were of White race. The mean gestational age at time of delivery was 32.76±4.45 weeks. From the 126 cases, 114 were diagnosed with PE while 12 developed de novo PPPE from 24 hours to a maximum of 14 days after delivery. AUC(95%CI) for ECG-AI was 81.44(0.71-0.92) with Sensitivity/Specificity=0.86/074 and time-dependent AUC&gt;0.85 for ECG-AI-Cox (Table 1).

Conclusion
Results from this research show that PE and PPPE can be predicted at moderate accuracy at least 10 days before childbirth and PE onset while PPPE can be predicted with high accuracy up to 1 week after delivery. The ECG-AI and ECG-AI-Cox models are easy to implement within clinical workflows due to their simple data requirement. There is also potential for the models’ integration within smart devices to help early detection for women that might not have access to healthcare.