bluuebunny/crossref_metadata_2025_split huggingface dataset:
What happened? Perceptions of patients with hypertension on conflicting results between self-reported adherence of medication and chemical adherence testing
Authors: Westland H , Soldan S , Flint C , Jaarsma T 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Hypertension is one of the most prevalent causes of death worldwide. Despite the widespread availability and efficacy of pharmacological therapy for hypertension, few patients reach their blood pressure target values. Nonadherence to antihypertensive medication is common and can lead to adverse clinical effects, such as stroke, reduced quality of life and higher health care costs. Adherence to antihypertensive medication can objectively be measured with chemical adherence testing. In clinical practice, some patients state that they are taking the medication while the chemical adherence testing does not confirm this. Understanding of this discrepancy is needed to better support these patients in their treatment decisions.

Purpose
To explore the perceptions of outpatients with hypertension on conflicting results between self-reported adherence and chemical adherence testing.

Methods
An explorative generic qualitative study design is used with face-to face semi-structured interviews. The study population consists of adult patients who are diagnosed with hypertension and are treated with antihypertensive medication. Patients have had negative blood levels for one or more antihypertensive drugs after chemical adherence testing, but report to adhere to the prescribed medication advice. To achieve data saturation, 12-15 adult patients are interviewed using a topic list with open ended questions. Interviews are audio-recorded and thematically analysed according to Braun & Clarke.

Results
At the time of this abstract submission, data collection is ongoing till the beginning of April 2023. At the time of the conference, we can present the results of our study addressing this very delicate and clinically relevant topic.

Conclusion
Data on the reasons for conflicting results between subjective and objective measures on medication adherence can help clinicians to optimize for patients with hypertension.
Assessing physical activity in heart failure with the CHAMPS physical activity questionnaire
Authors: Denfeld Q , Hiatt S O , Lee C S , Roberts Davis M , Camacho S A , Winters-Stone K 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Office of Research on Women’s Health and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health

Background
It is difficult to quantify physical activity among adults with heart failure (HF) in the context of many disease-driven limitations. The Community Healthy Activities Model Program for Seniors (CHAMPS) Physical Activity Questionnaire, designed to measure physical activity among older adults, may be helpful in quantifying physical activity in HF.

Purpose
To quantify physical activity levels among adults with HF using the CHAMPS Physical Activity Questionnaire and to compare physical activity expenditure and frequency between adults ≥ 65 years vs. &lt; 65 years, women and men, and those physically frail vs. non-physically frail.

Methods
This was an analysis of data collected from a cohort study of adults with New York Heart Association Functional Class I-IV HF. Using the CHAMPS Questionnaire, we calculated caloric expenditure (kcal) and frequency per week in all activities and moderate intensity activities. Physical frailty was measured with the Frailty Phenotype Criteria. Comparative statistics were used to compare physical activity between groups.

Results
The average age of the sample (n = 117) was 63.6±15.6 years, 48.7% were female, and most (76.9%) had non-ischemic HF etiology. Median caloric expenditure from all physical activities was 1827 kcal/week [Interquartile Range 735-3943] and moderate intensity activities was 397 kcal/week [Interquartile Range 0-1886]. For caloric expenditure from all physical activities, there was no significant difference between adults ≥ 65 years vs. &lt; 65 years (p = 0.894), but women and those physically frail had significantly lower caloric expenditure (both p &lt; 0.001). For caloric expenditure from moderate intensity physical activities, there was no significant difference between adults ≥ 65 years vs. &lt; 65 years (p = 0.346), but women had significantly lower caloric expenditure (p &lt; 0.001) as well as those physically frail (p &lt; 0.001). Median frequency of all physical activities was 13 times per week [Interquartile Range 8-21] and of all moderate intensity activities was 3 times per week [Interquartile Range 0-8].

Conclusions
Many adults with HF, regardless of age, report low physical activity using the CHAMPS Physical Activity Questionnaire; however, women and those physically frail report considerably lower physical activity than men and those non-physically frail, respectively. Capturing physical activity levels across multiple activities is necessary for the design and implementation of physical activity interventions in HF, and the CHAMPS measure may be one tool to do this.
Perceptions of physical activity levels after a diagnosis of acute coronary syndrome and in the context of cardiac rehabilitation
Authors: Mchale S , Neubeck L , Dawkes S , Astin F , Hanson C L 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Physical activity [PA] is a core component of cardiac rehabilitation [CR] but those who consider themselves active are less likely to participate. It is unclear how CR services can better engage with this group and what support they should offer to encourage a return to PA at appropriate levels.

Purpose
We aimed to identify individuals from four UK CR services who considered themselves active prior to acute coronary syndrome [ACS] diagnosis and understand their PA support requirements.

Methods
A sequential mixed methods study, with data collected between October 2019 and April 2020. A quantitative survey examined self-reported PA levels, illness perceptions, and physical self-concept of ACS patients using validated questionniaires after their event but before the start of CR. Data were analysed via descriptive, correlational, and multiple regression analysis. Qualitative individual semi-structured telephone interviews were conducted with participants who self-reported to be at least moderately active. Data were thematically analysed. Data were integrated during study design and discussion stage.

Results
Sixty-seven participants (male n=53, 79.1%) with a median age of 63 (IQR = 56-71) completed the survey. Of these, 50 (74.6%) self-reported being at least moderately active before starting CR. During regression analysis, only physical self-concept for being physically active (F (9,56)=3.59, p&lt;.005, adjusted R2 0.26) was significantly associated with PA level. Twenty-six participants completed qualitative interviews. Participants who perceived that they were active prior to their event based this on recollections of past PA, and step count monitoring. They made decisions about whether to engage with CR based on pre-CR information and comparison with peers. Despite considering themselves to be active, this group still required support to return to PA at appropriate intensity levels to gain secondary prevention benefits. This included information about how to self-monitor intensity effectively.

Conclusions
CR services should recognise that ACS survivors who consider themselves to be active prior to their event require support to return to PA at appropriate levels. Support should include exploring what patients mean when they say they are active so that CR professionals are better informed to provide indivualised advice.
Spontaneous coronary artery dissection in cardiac rehab: an exploration of lived experiences of patients and the knowledge, understanding, and perceptions of healthcare professionals
Authors: Plaza Godoy M , Midgley A , Levy A , Butler T 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic type of cardiovascular disease (CVD) that affects young and middle-aged women more than men. Many aspects of SCAD, however, remain unclear, including the outcomes of cardiac rehabilitation (CR) and the lived experiences of people with this condition in the programme. Furthermore, the awareness and knowledge of healthcare professionals (HCPs) regarding SCAD may be an important factor in determining patient engagement with rehabilitation services. A longitudinal study examining changes in physical and mental health outcomes of patients with SCAD is yet to be performed. Similarly, an in-depth exploration of HCPs' perspectives on SCAD is also needed.

Objectives
The objectives of this project are to understand the lived experiences of patients with SCAD, examine the knowledge of HCPs about the management of SCAD, and analyse the outcomes of CR on physical activity, diet, body mass index, waist circumference, stress, anxiety, depression and health-related quality of life upon completion of phase III and phase IV CR, and a year post-event.

Methods
A mixed-methods longitudinal observational study will be performed with four time points (pre-phase III CR, post-phase III CR, post-phase IV CR, and a year follow-up after SCAD event). Lived experiences of both male and female patients with SCAD, their pathways of care and barriers to engagement to CR will be explored through semi-structured interviews. Physical activity (short-form IPAQ questionnaire), dietary intake, anthropometric measures (waist circumference and body mass index), stress (PSS-10 questionnaire), anxiety (GAD-7 questionnaire), depression (PHQ-9 questionnaire) and health-related quality of life (EQ-5D-5L questionnaire) will be assessed at each timepoint. Patients with SCAD who are not engaged with CR will be used as a control group. Outcome measures will be compared between two groups using a mixed model ANOVA (time x intervention). A qualitative cross-sectional study using semi-structured interviews with HCPs will explore their understanding and management of SCAD.
Discussion: The findings of this project will indicate weather current CR needs are met in this patient group and what changes need to be made to existing CR services to improve uptake in patients with SCAD. This could lead to a larger clinical trial that examines the effectiveness of tailored CR for this group of patients. Additionally, the information received from HCPs will indicate if there is an unmet educational need regarding SCAD, which may ultimately lead to better recognition, medical and lifestyle management for this patient group.
Can AI-led remote ECG monitoring result in service improvement for cardiac investigations
Authors: Baker M , Rosengarten J , Hart E , Ojo M 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): iRhytm

Background
Ambulatory ECG monitoring is needed to investigate intermittent heart rhythm symptoms. Traditional monitoring approaches are resource intensive, requiring multiple patient hospital visits and time-consuming analysis, using fixed capacity monitoring equipment.

Purpose
We carried out a 4000-patient pilot with an AI-led remote ECG monitoring service (Zio XT) to determine its impact on patients and the service. Single-use monitoring patches were sent directly to the patient to fit at home or fitted in outpatients. Patients wore the patch for 14 days of continuous monitoring and then returned it by Freepost for outsourced analysis and reporting.

Methods
We undertook a retrospective analysis of 200 consecutive patients attending for standard Holter monitoring, and compared this cohort with 200 consecutive patients who underwent monitoring with Zio. The Holter sample was taken from a time period prior to the introduction of the new remote service. Patients had been referred to cardiology for investigation of heart rhythm symptoms.

Results
The age ranges in the two groups were broadly comparable. In the Holter group, 100% of patients required a separate outpatient appointment to fit the monitor compared with 0% in the Zio group. Median time from monitor fitting to result was 18 days in the Zio group compared with 106 days in the Holter group (p&lt;0.001). Test results were unavailable at follow-up in 16% of the Holter group compared with 2% of the Zio group (p&lt;0.001). Arrhythmias were detected in more patients in the Zio group vs the Holter group (p&lt;0.05), (SVT ≥ 30s 7.4% vs 0.5%; VT ≥ 8bts 10.5% vs 2.0%; Pause ≥ 3s 6.3% vs 2.5%; PAF 7.4% vs 2.5%). In the Holter group, 24 patients (12%) had no follow-up in cardiology outpatients. Of these, 9 were lost to follow-up and 3 deceased before completing the pathway. By comparison, 3 patients (1.6%) in the Zio group had no follow-up. In patients who had a follow-up appointment, 75% of patients in the Zio group had a non-face-to-face follow-up vs 48% in the Holter group (p&lt;0.05). Repeat test was required in 11.5% of the Holter group compared with 4.7% of the Zio group (p&lt;0.05). In the Holter group, 6 (3%) of the repeat tests were ILRs, compared with 2 (1.1%) in the Zio group.

Conclusions
Patients in the Zio group received their test results more quickly. Use of Zio XT resulted in fewer visits to hospital and a reduced need for repeat testing. Earlier detection of significant clinical arrhythmia, especially AF, facilitates rapid clinical decision making, and is expected to result in more patients receiving appropriate therapy.
Using co-design to develop INTERCEPT, a mobile health (mHealth) App, for the secondary prevention of cardiovascular disease
Authors: Gibson I , Neubeck L , Corcoran M , Morland C , Jones J , Costello C , Hynes L , Harris A , Atrey A , Savickas V , Ski C , Murphy A W , Byrne M , Wood D , Jennings C 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Health Research Board, Ireland
SOLVE CHD SYNERGY Grant, University of Sydney, Australia

Background
Co-design adopts a participatory, person-centred approach to the development of health interventions, which aims to maximise their acceptance and effectiveness. However, despite this many mobile applications are designed with little input from target end users, resulting in poor uptake and usage.

Purpose
The aim of our study was to optimize the evolution of the INTERCEPT (I-App) mHealth app by integrating target users’ (patients and healthcare professionals) perspectives into its design and development.

Methods
A core project team of health care professionals (nurse specialists, physicians, physiotherapists, dietitians, psychologists and a pharmacist), software developers and patients was established. A four phase iterative anrticipatory approach to the design process for I-App was adopted using online workshops conducted over a 12-month period. Phase one involved identification of the guiding principles, content and design features. In phase two, a working prototype of the I-App was developed and in phase three a beta version of this prototype was pilot tested among the project team and reviewed for clarity of language, ease of navigation and functionality. Phase four involved user acceptance testing of the I-App with patients who had a recent cardiac event (&lt;2 years). Improvements in the usability of the app were assessed using the System Usability Scale (SUS), which was administered pre and post user acceptance testing.

Results
From target user insights and scientific literature five key design principles were identified: simplicity and ease of use; behavioural change through goal setting; self-monitoring and use of rewards; provision of credible information and data privacy. Medication adherence, psychosocial support and tracking physiologic parameters like blood pressure were considered important components. Usability testing of I-App resulted in 64 recommendations for the app and of these 51 were implemented. Significant improvements in SUS scores were observed from 61 to 82 (p&lt;0.001) demonstrating the effectiveness of adopting a co-design apporach.

Conclusion
Using co-design methodology resulted in the INTERCEPT mHealth app responding to the end users’ needs and preferences including desired content and features. The next step in the development process is to trial the feasibility and usage of the I-App in the real-world clinical setting.
Cardiac rehabilitation patient data management and quality improvement in Australia: A national survey
Authors: Gallagher R , Cartledge S , Zwack C , Hollings M , Zhang L , Gauci S , Gordon N , Zecchin R , O'neil A , Tiramacco R , Phillips S , Candelaria D , Astley C , Briffa T , Redfern J 
Published: July 2023

Abstract

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

Background
Receipt of guideline-indicated comprehensive cardiac rehabilitation improves patient outcomes. Optimum service delivery and meeting quality standards necessitates accurate standardised data collection and reporting. The methods, processes and systems used for data capture and reporting in cardiac rehabilitation are under-documented, limiting identification of areas needing change and creation of a platform for quality improvement (QI) at national levels.

Purpose
To describe data capture, management, and reporting and the awareness and use of quality indicators in contemporary Australian CR programs.

Methods
CR programs (n=396) were identified through professional and national directories, jurisdictional networks, webinars, and direct provider contact. Program coordinators completed an online survey on individual service characteristics, data capture and management systems (paper, electronic, database, integrated platform) including awareness, use and usefulness of the published National Cardiac Rehabilitation Quality toolkit components.

Results
Respondents totalled 319 (80.5%), from all eight states and territories. Coverage of Metropolitan, rural and remote towns, and regional centres was 46.3%, 45.9% and 7.8%, respectively. Indicative annual patient enrolments were &gt;200 (31.0%), 51-200 (46.4%) and ≤50 (22.6%). Most programs used ≥2 data management systems: paper and electronic 62.6% or multiple e-systems 19.1%, or one system, either paper 20.9% or electronic 16.3%. Use of multiple systems and combinations of systems did not differ by number of patients enrolled. QI systems were infrequently used: QI Platforms 17.2%, QI Databases 10.0%.
Supplementary to patient care, data gained was used for reports for management (57.0%), QI (56.1%), funding support (43.2%), required jurisdictional reporting (41.1%) and research (30.7%). Higher volume programs were more likely to be using the data capture for multiple purposes. Independent covariates of services using data for QI were enrolments of &gt;200 (OR 3.83 95% CI 1.76, 8.34) and the state/territory location, such that use of QI was less likely in the states of Victoria (OR 0.24 95% CI 0.08, 0.77), New South Wales (OR 0.25 95% CI 0.08, 0.76) and Western Australia (OR 0.16 95% CI 0.05, 0.57).

Conclusions
Management of cardiac rehabilitation patient data is highly variable across Australian programs and jurisdictions, often including multiple different systems, with limited use of the data for QI. A national user-friendly, low burden approach to CR data collection incorporated into daily work-flow that is capable of benchmarking and informs QI is essential.
Fatigue, shortness of breath and well-being in patients with heart failure: A daily trend analysis over 12 weeks
Authors: Deka P , Pathak D , Van Der Wal M H L , Stromberg A , Jaarsma T , Klompstra L 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work is supported by the Swedish National Science Council (2020-01109); The Swedish Heart and Lung Foundation (20200190); the Kamprad Foundation (20210074) and the Research Council in South East Sweden (FORSS-940933)

Introduction
Patients with heart failure (HF) experience symptoms of fatigue and shortness of breath (SoB) that may worsen over time and negatively impacts their well-being. Repeated admissions are partly related to delays in responding to HF symptoms.

Purpose
This study aimed to investigate the trend of fatigue, SoB and well-being over 12 weeks in patients with HF.

Methods
Diary data were collected as part of the HF-Wii study. From the 605 patients included in this study, 234 patients completed a 12-week diary. Patients rated their fatigue and SoB daily on a Likert scale (0 = no symptom, 10 = worst possible symptom). Patients also rated their daily well-being with the Cartrils Ladder of Life with 0 representing the worst possible life and 10 for the best possible life. The weekly differences in symptoms and well-being were assessed over 12 weeks. Also, the overall correlation over 12 weeks between symptoms and well-being was calculated.

Results
In total, 234 patients with HF were included in this analysis, mean age: 68±11 years, 31% female, 11% NYHA-class I, 65% NYHA-class II and 24% NYHA-class III. Over 12 weeks, patients had mild symptom experience. The minimum and maximum mean SoB score was 3.3(±2.1) and 3.8 (±2.5). The minimum mean fatigue score was 3.4 (±2.1) and the maximum was 3.9 (±2.4). The mean well-being minimum score was 5.8(±.9) and the maximum was 6.8 (±1.8). The trend analysis showed that when patients experience more symptom burden over time, this negatively impacted their well-being (Figure 1). A significant negative overall correlation between fatigue and well-being (r = -0.43) and between shortness of breath and well-being (r = -0.42) was noted.

Conclusions
Symptom experience has a significant influence on patient-reported daily well-being in patients with HF. Close monitoring of symptoms to improve well-being in this population is essential.