bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shared decision-making for the treatment of aortic stenosis (SEEK-AS): rationale and study design of the implementation of a patient decision aid to facilitate a high-quality treatment decision
Authors: Lauck S , Lewis K B , Turgeon R , Wells J , Wijeysundera H , De Sousa I , Adhami N , Stacey D , Webb J G 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Heart & Stroke Foundation (Canada)

Background
Shared decision-making (SDM) is endorsed by multiple guidelines to help clinicians and patients achieve a high-quality treatment decision that integrates patients’ priorities, preferences and values. Patient decision aids (PDAs) are evidence-based tools designed to support the process of SDM. There is a gap in knowledge translation to facilitate the adoption of guideline recommendations for the treatment of aortic stenosis (AS).
Rationale: There is strong evidence of improved outcomes associated with SDM; in contrast, implementation research is needed to address the pressing question of "how to do SDM". Therefore, the SEEK-AS study aims to plan and evaluate the implementation of a PDA for AS to facilitate the integration of SDM in the treatment of valvular heart disease.
Study Design: We will present the design of a prospective multi-method implementation study of a novel set of paper-based and individualised web-based PDAs for AS. We aim to explore diverse perspectives and uncover barriers and enablers to investigate the "real-world" implementation of the PDAs. The study prioritises patient and family engagement, and is informed by the Ottawa Model for Research Use (OMRU) conceptual model to guide the sequential objectives: (1) select and tailor implementation strategies in four distinct healthcare organisations, across diverse patient and clinician populations to develop distinct implementation blueprints, and (2) evaluate the implementation of the PDAs across health care organisations and users. Data collection will include a series of in-depth focus group and individual interviews with patients treated with different modalities and multidisciplinary clinicians using content analysis organised under the OMRU levels (innovation, potential adopters, and practice environment; objectives 1 and 2), and patient and clinician surveys using outcomes mapped to OMRU levels and patient/clinician levels (objective 2).
Anticipated Research Output: We will present the stakeholder engagement plan and patient engagement strategies. The findings of the study will include the identification of barriers and facilitators of regional implementation, and provide evidence to guide the successful adoption of PDAs to help shift the culture of care from clinician-driven to patient-centred and improve the care of patients with valvular heart disease.
Risk factors for readmission after isolated coronary bypass graft surgery: context matters
Authors: Wynne R , Mctier L , Matthews S , Nolte J , Ferguson C 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Risk prediction scores are primarily based on preoperative factors and most applicable to their country of origin. Factors that contribute to these scores are commonly used to predict risk of readmission that is also highly variable. A recent systematic review of risk factors for unplanned readmission after first time isolated coronary artery bypass grafting (CABG)1 included cohort studies from the USA alone.

Purpose
To contrast risk factors for unplanned readmission in an Australian cohort with those identified in the systematic review.

Methods
A single centre, retrospective cohort analysis of adult patients from a major metropolitan tertiary teaching hospital having first time isolated CABG (N = 6155) between August 2002 and 2022. Unplanned inpatient readmission within 30-days of surgery was the primary outcome measure. Direct entry logistic regression modelling was used to identify risk factors for readmission in this cohort.

Results
The rate of readmission was 10.6% (n = 655). Female sex (OR 1.0, 95%CI 1-1.01), preoperative dialysis (OR 3.3, 95%CI 2.19-5.12), preoperative atrial fibrillation (OR 1.4, 95%CI 1.06-1.87), diabetes (OR 1.22, 95%CI 1.03-1.45), and peripheral vascular disease (OR 1.3, 95%CI 1.05-1.67) were the only significant predictors retained in the full model (c2(27, N = 6155) = 111.28, p &lt;0.001) that correctly classified 89.3% of cases but only explained 3.6% (Nagelkerke R squared) of variation in readmission rate. The Hosmer-Lemeshow goodness of fit test indicated good support for the model despite this (p 0.841).
Conclusion(s): Risk factors predicting readmission in this patient cohort were not consistent with those identified in the review of studies from the USA. Risk prediction is context specific. Research investigating factors associated with risk needs to capture variables that impact on context.
Perceptions of patients with heart failure before and after CRT implantation regarding their self-care
Authors: Westland H , Van Rijn M R , Meine M , Jaarsma T 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): ESC Nursing Training Grant

Background
Cardiac Resynchronization Therapy (CRT) is increasingly used to improve ventricular contraction and physical performance in patients with heart failure (HF). Although implantation of a CRT is associated with improved health status, not all patients benefit from a CRT implantation. Physical activity is an important self- care behaviour but some patients struggle with physical activity and experience lack of improvement of their physical condition and symptoms of HF. To optimise support to improve self-care of patients after a CRT implantation, information is needed on their expectations of the CRT and their needs and preferences towards self-care support.

Purpose
To explore perceptions of patients before and after CRT implantation regarding their expectations and explore factors that influence their physical activity, HF symptom monitoring and management and their needs and preferences towards self-care support.

Methods
An explorative generic qualitative study with semi-structured interviews is currently performed. A total of 18 adult patients were interviewed: 8 patients &lt;3 months prior to the CRT implantation and 10 patients 5 to 24 months after CRT implantation. Patients varied in age and gender. Interviews were audio-recorded and thematically analysed according to Braun & Clarke.

Results
Prior to the CRT implantation, patients expected to feel more energetic and experience less dyspnea to resume activities they could not perform due to their poor cardiac condition. Remote monitoring of the CRT made them feel safe. Patients trusted the professional opinion of the healthcare providers. Few patients experienced support in their self-care from a HF nurse. Patients felt the need to easily contact their healthcare provider when experiencing symptoms or having HF–related questions. Informal caregivers play a key role in supporting patients in being physically active and monitoring and managing HF symptoms.

Conclusion
Before implantation patients have high expectations of the effects of CRT implantation. It is important to consider patients’ need for support to improve physical activity, symptom monitoring and thoughtfully responding to symptoms and engaging assistance of informal caregivers in their health.
Usage and the effect on knowledge about atrial fibrillation of an educational application, AF-EduApp
Authors: Knaepen L , Delesie M D , Theunis R T , Gorissen P G , Vijgen J V , Dendale P D , Desteghe L D , Heidbuchel H H 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): The AF-EduApp study is supported by an BMS/Pfizer European Thrombosis Investigator Initiated Research Program (ERISTA) grant.

Introduction
As the management of atrial fibrillation patients (AF) is complex, an integrated care approach is suggested, including tackling modifying risk factors together with rate and rhythm control and anticoagulation therapy. Patients often underestimate the effect of these pillars on their health and often have poor knowledge about these aspects. As smart devices have become more important in the past decades, they create opportunities to educate patients and improve the follow-up of these patients.

Purpose
We aimed to evaluate the usage of an in-house developed application, AF-EduApp, and its effect on patients’ AF knowledge levels.

Methods
A total of 152 patients with AF were included in this multicenter study with a follow-up of 12 to 15 months. One of the modules of the AF-EduApp contains information on AF, its treatment and related self-care. Knowledge about AF and its treatment was assessed through the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) with direct feedback on incorrectly answered questions. The JAKQ (and immediate feedback) were given to the patients via the application at baseline and after 1, 3, 6 and 12 months. Patients are free to decide how frequently they want to use the app (except when questionnaires are available).

Results
The 152 patients had a total follow-up of 386.8±108.1 days and used the application on 130.1±144.7 days (33.6%). The education module was visited by 135 patients with a median time of 3.1 (IQR: 1.3-21.8) min (mean: 18.6±32.9 min) spent on education. The most visited education chapters were AF treatment (3.1 (0.4-9.5) min) and selfcare (3.1 (0.9-7.1) min)(Fig1). A significant increase in the knowledge level was seen in the 130 patients who completed all 5 moments (p&lt;0.001, Fig 2A). This increase was driven by a significant increase during the first month of follow-up (baseline: 70.4±14.4 vs FU1: 82.4±14.4; p&lt;0.001). The number that one of the 8 questions on AF in general was correctly answered at these 5 time points ranged from 2.7±1.6 to 4.8±0.7 (p&lt;0.001, Fig 2B). The questions ‘Why are most patients with AF prescribed with oral anticoagulation?’ and ‘What is AF?’ were answered best, whereas the questions ‘Is AF always accompanied by symptoms?’ and ‘Can medication prevent AF?’ were most difficult to get right.

Conclusion
The AF application was reasonably used, about 1 out of every 3 days. Targeted education focused on JAKQ answers that were answered incorrectly significantly improved knowledge level over time. Stronger incentives need to be developed to have patients effectively look at the educational sections that pertain to incomplete knowledge.
Improving secondary prevention knowledge in immigrants after a heart attack: adapting and evaluating a virtual patient education resource to promote behaviour change
Authors: Shi W , Zhang L , Ghisi G L M , Panaretto L , Gallagher R 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Coronary heart disease (CHD) is prevalent and recurrent (40%), whereas an estimated 75% of events could be avoided by secondary prevention of modifiable risk factors and healthy lifestyle. Structured in-person secondary prevention and patient education programs are both efficient and effective strategies; however, these programs may not meet immigrants’ care or home-based learning needs, and thus alternative educational models are needed.

Purpose
To adapt and evaluate the simplified Chinese version of Cardiac College, a co-designed evidence-based virtual patient education resource for heart attack, in Chinese immigrants on secondary prevention knowledge and behaviour change outcomes.

Methods
A prospective longitudinal pre-post study was undertaken in heart attack survivors recruited from cardiac rehabilitation programs at four metropolitan tertiary hospitals from May 2021 to November 2022. Chinese Cardiac College intervention was adapted and provided education via nine booklets and 10 pre-recorded video sessions structured and delivered to patients for four weeks following hospital discharge. Validated surveys measured health literacy, disease-related knowledge, physical activity, heart-healthy diet, and self-management behaviours at baseline and one to two weeks post-intervention. Acceptability, engagement, and satisfaction were also assessed post-intervention.

Results
From 81 patients assessed for eligibility, 67 were recruited, and 64 (95.5%) completed the study. The sample was aged mean 67.23 ± 8.12 years, and 81.25% were males. Participants had significant improvement in disease-related knowledge in total and in each domain, with the most improvement identified in medical, followed by exercise and psychological domains (p&lt;0.001) (Table 1). Healthy dietary behaviour and other self-management behaviours also significantly improved (all p&lt;0.05). All participants (100%) self-reported being engaged with the materials, rating content as highly acceptable (n=20, 31.3%) and highly satisfactory (n=30, 46.9%). In addition, most participants reported that the delivered information amount was adequate (n=44, 68.8%), and 26.6% (n=17) found it overwhelming.

Conclusion
A virtual patient-education intervention adapted for Chinese immigrants (Chinese Cardiac College) significantly improves secondary prevention knowledge and self-care behaviour in heart attack survivors and offers a suitable model for intervention, especially where there are limited bilingual staff or resources. Further testing of randomised controlled trials and multiple populations is required.
Comparison of 30-day readmission rates and 1-year mortality of cardiovascular disease between Australian- and overseas-born residents: a large cohort study of older Australian adults
Authors: Zhang L , Buskirk J V , Gallagher R , Ding D 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular disease (CVD) is prevalent, causing high hospital readmission rates and mortality. Social determinants of health such as ethnicity and cultural background are known to influence CVD outcomes. However, comparisons of CVD outcomes between Australian- and overseas-born residents for 30-day readmissions and mortality patterns in ischemic heart disease (IHD), heart failure (HF) and stroke, are not well understood.

Purposes
This study aimed to compare 30-day readmission after hospitalisation due to IHD, HF or stroke and 1-year CVD mortality across three country of birth groups (Australian-born, born in English-speaking countries and born in non-English-speaking countries).

Methods
The study group was drawn from the 45 and Up cohort, Australia’s largest ongoing study of health and ageing, consisted of participants free of IHD, HF and stroke at baseline who were admitted to hospital for a CVD-related diagnosis after baseline, linked with hospital admissions (mean follow-up time 11.2 years) and mortality data (mean follow-up time 9.9 years). Risk ratios for 30-day readmission and 1-year CVD mortality across three country of birth groups (Australia, English-speaking countries other than Australia, and non-English-speaking countries) were calculated using binary logistic regression, adjusting for age, sex, socioeconomic status, marital status, age at migration and education.

Results
A total of 39,458 participants were analysed with a mean age of 66.5, of which 54% were male, 13% and 10% were born in English-speaking countries other than Australia and non-English-speaking countries, respectively.
The crude rates for 30-day readmission and 1-year CVD mortality of the overall sample were 32 per 100 and 2.6 per 100. Compared to Australian-born participants, those born in English-speaking countries had a 7 % lower risk of 30-day readmission (RR: 0.93, 95% CI: 0.87-0.99), and those born in non-English-speaking countries had a 16% lower risk (RR: 0.84, 95 CI: 0.78-0.91). No evidence of an association between country of birth and 1-year CVD mortality was found.

Conclusion
Overseas-born Australians regardless of English-language background have a lower risk of 30-day readmission compared to those who are Australian-born when sociodemographic characteristics are adjusted for. However, the 45 and Up Study questionnaire was available only in English. Residents born in non-English-speaking countries with limited English skills were thus less likely to be involved in this study. Further studies should consider other characteristics and potential explanations for this benefit.
Review of electrocardiogram ordering in the context of prescribing combinations of known QT prolonging medicines
Authors: Ireland J , Lai B , Fazio T , Griffett K 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The risk of medication-induced QT prolongation can be mitigated by reviewing electrocardiograms (ECG) in a hospital inpatient setting. Currently, within the Electronic Medical Record (EMR), decision support tools do not exist to conduct ECG monitoring when prescribing multiple QT prolonging medications. This retrospective review of prescribing data from 2021 looked to assess if we are appropriately ordering ECGs. The results could potentially guide developing decision support tools within the EMR to influence the prescribing of QT-prolonging medications and reduce the risk of QT-prolongation in hospitalised patients.

Purpose
To ascertain the prevalence of baseline and follow-up ECGs when three or more known QT prolonging medications were concurrently administered.

Methods
QT prolonging medications were defined using Crediblemeds [1], an online resource aimed to support the safe prescribing of QT prolonging medications. Known QT prolonging medications were defined as medications which prolong the QT interval and are associated with Torsades de Pointes. A retrospective review of inpatient prescribing in 2021 was conducted by extracting data from the EMR. Patients who received three or more of these medications on the same calendar day were included. Information reported included patient demographics, details of QT prolonging medication and whether ECGs were performed. Certain intra-operative medications were excluded from review due to the short patient exposure time to the medication. ECGs were reviewed independently by two pharmacists and the QTc interval was calculated using the Bazett formula.

Results
A total of 70 patients received three or more QT prolonging medications. In total, 30 (43%) patients had a baseline ECG performed within seven days of medication commencement and 6 (9%) patients received both a baseline and follow-up ECG within 24 hours of medication administration. One patient had a prolonged QTc (&gt;500msec) on their baseline ECG. Baseline ECGs were not performed in 29 (41%) of patients whereas Eleven patients (16%) had an ECG on record, but it was older than seven days prior to medication administration. Three patients without a baseline ECG had a follow-up ECG within 24 hours after medication administration. Overall, 28 different medications were identified with Ondansetron, Ciprofloxacin and Escitalopram appearing most commonly.

Conclusions
This audit indicates that clinicians are not consistently ordering ECGs at baseline or utilising follow up ECGs when prescribing concurrent QT prolonging medications which may increase the risk of preventable patient harm. Though QT prolongation was not detected on follow-up ECGs, this may be impacted by the low prevalence of follow-up ECGs. The utilisation of decision support tools within the EMR may improve ECG monitoring in patients at risk of QT prolongation.
Sacubitril/valsartan improves exercise performance in patients with heart failure: a dose-dependent effect
Authors: Mattavelli I , Mapelli M , Salvioni E , Paolillo S , De Martino F , Vignati C , Magri' D , Mantegazza V , Tamborini G , Agostoni P 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sacubitril/Valsartan therapy has become a cornerstone of heart failure with reduced ejection fraction (HFrEF) pharmacological therapy due to its positive prognostic impact. However, conflicting results have emerged on the effects of sacubitril/valsartan on exercise performance assessed by cardiopulmonary exercise test (CPET).

Purpose
The aim of this study was to prospectively evaluate the effects of sacubitril/valsartan on prognostically significant CPET parameters in a larger population of HFrEF patients at different drug doses.

Methods
We prospectively enrolled HFrEF outpatients eligible to start sacubitril/valsartan according to 2016 ESC Guidelines in 3 Heart Failure Units. Patients underwent CPET at baseline (before sacubitril/valsartan treatment), after 1, 2, 3 months (respectively after a month taking the 24/26 – 49/51 – 97/103mg doses), and 6 months after the maximum tolerated dose was reached (end-study). The subjective impression of disease-related limitation was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ).

Results
113 patients were enrolled (age 64.5±9.7, 81% males) (Table 1). Peak oxygen intake (peakVO2) improved at each step from 15.0±4.5 mL/min/kg at baseline to 16.5±4.9 mL/min/kg at end study visit, corresponding to 61.5±16.0 and 67.9±17.4 % of predicted, respectively (p&lt;0.05). Minute ventilation/carbon dioxide production relationship (VE/VCO2 slope) reduced from 39.6±5.5 to 35.9±7.1 (p = 0.005) in the 39 patients (42%) with pathological VE/VCO2≥34 at baseline. KCCQ improved significantly since the first visit with an overall summary score increase from 47.9±11.1 to 52.6±9.8 (p&lt;0.001).

Conclusions
These findings suggest that sacubitril/valsartan benefits on exercise capacity are immediately evident at the lowest dose and progressively improve as the dose increases.