bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-effectiveness of Internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms
Authors: Mourad G , Lundgren J , Andersson G , Husberg M , Johansson P 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): The Swedish Research Council and the Medical Research of Southeast Sweden

Introduction
Cost-effectiveness evaluations of psychological interventions, such as Internet-delivered cognitive behavioural therapy (iCBT) programs, in patients with cardiovascular disease (CVD) are rare. In a recent study we reported that a 9-week iCBT program (n=72) compared to an online discussion forum (ODF) (n=72) had moderate to large effect on depression in CVD outpatients.

Purpose
To evaluate the cost-effectiveness of this intervention.

Methods
Cost-effectiveness analysis of a RCT, using an incremental cost-effectiveness ratio (ICER). The costs and effects included in the ICER are from baseline to one year post intervention, but also costs for guidance and support to patients in iCBT and ODF groups. Data on healthcare costs were retrieved from healthcare registries, and the EQ-5D-3L was used to calculate the quality-adjusted life years (QALYs). The ICER can be seen as the additional costs needed to gain an additional QALY by the iCBT compared to ODF.

Results
At 12-month follow-up, the QALY was significantly higher in iCBT compared to the ODF group (0.713 vs.0.598, p=.007). The mean difference of 0.115 corresponds with 42 extra days in best imaginable health status in favour of the iCBT group over the course of one year. The ICER for iCBT versus ODF was €18,865 per QALY saved. The cost-effectiveness plane indicated that iCBT is a cheaper and more effective intervention in 24.5% of the cases, and in 75% a costlier and more effective intervention than ODF. Only in about 0.5% of the cases, there was an indication of a costlier, but less effective intervention compared to ODF.

Conclusions
The ICER of €18,865 was lower than the cost-effectiveness threshold range of €23,400-€35,100 as proposed by the NICE guidelines, suggesting that the iCBT treatment of depressive symptoms in patients with CVD is cost-effective.
Supervision by direct observation with video recording in the operating room: educational tool for learning and formative evaluation
Authors: Mleyhi S , Miri R , Daoued Z , Derbel B , Denguir R 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Directly observed supervision with video recording (DOSVR) is used as a learning method in several countries. This technique has proven itself, but remains little used in Tunisia. On the other hand, the use of DOSVR in surgery is rarely described. The objectives of our work were to describe the development and experimental implementation of DOSVR in surgery and to evaluate the feedback from residents and teachers.

Methods
This is a prospective, observational and descriptive study concerning the experimentation of DOSVR in five surgical procedures performed by residents of cardiovascular surgery department. These video recordings were followed by a backscatter with self and heteroevaluation.
We based ourselves on the methodology of teaching by simulation for the design of the protocol: the Briefing, the scenario and then the debriefing.

Results
A total of ten took part in this experiment. The average age was 28.5 years [26 -33 years] with a sex ratio F/M of 4. All residents declared that the protocol provided was easy to understand and apply. After obtaining the consent of the patients, five interventions were filmed in whom three were in emergency. Seven residents said that using a smartphone to vdeo recording was not easy and 8 easily got rid of the presence of the camera. All the learners denied having to change their operating techniques because they were being filmed. All the residents agreed that a minimum number of six DOSVR sessions in each residency year is appropriate and praised the technique as a powerful tool for the development of their practical training.

Conclusions
Our study showed that the application of Directly observed supervision with video recording in vascular surgery is feasible. It is a promising educational tool for the practical learning of residents as well as a tool for the continuous formative evaluation of their progress.
Patients experiences of using a publicly avaliable mobile health application for self-care of heart failure in a real-world setting
Authors: Madujibeya I , Chung M L , Moser D K , Miller J L , Humbert J , Chih M , Pelzel J M , Lennie T A 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): University of Kentucky disseration award

Background
Publicly available patient-focused mobile health applications (mHealth apps) are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patients’ experiences using mHealth apps for self-care in real-world settings. The purpose of this study was to explore patients’ experiences using a publicly available mHealth app, OnTrack to Health, for HF self-care in a real-world setting.

Method
Patient satisfaction, measured with a 5-point Likert scale and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients’ responses was conducted with qualitative software, Atlas. ti version 8.

Results
Patients (median age = 64.0 [57.0, 70.5] years, 73.9% (n = 17) male) used OnTrack to Health for a median duration of 164.0 [ 51.2, 639.9] days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Four themes emerged from the responses to the open-ended questions: (1) perceived benefits (simplified self-care tasks, improved adherence to medications, enhanced communication and connection with healthcare providers, facilitated HF symptoms monitoring, improved HF knowledge, decreased hospitalization, and provided assurance of safety); (2) barriers (challenges of abandoning previous self-care strategies); (3) facilitators (perceived ease of use, availability of technical support); (4) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features).

Conclusion
Patients were satisfied with using mHealth apps for self-care. They perceived apps as a valuable tool for improving self-care ability and decreasing hospitalization rates. Personalization of app features and integration of mHealth apps with electronic health records are essential to sustain high-quality patient experiences related to app use for self-care.
Validation of the virtual measurement of the Essential Frailty Toolset
Authors: Sahota P , Yu M , Polderman J , Achtem L , Stephenson A , Morgan K , Lauck S 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The Essential Frailty Toolset (EFT) is a valid measurement of frailty in people with heart valve disease. COVID-19 has prompted the transition to virtual health consultations and necessitates the validation of the virtual assessment of frailty.

Methods
We conducted a prospective observational cohort study to compare the measurement of EFT in person and virtual format within a maximum 2-week window of repeated measurement. The weighted Kappa tests was used to measure the agreement of EFT scores between assessments; we explored the effect of the sequence of measurement using the Cochran-Mantel-Haenszel statistic to test the general association between the timing of measurement and differences of EFT score.

Results
We recruited a sample of 49 patients, with a mean age of 81 ± 7 years, including 29 men (59.2%); the primary valvular heart diseases were aortic stenosis (n=40, 81.6%), mitral regurgitation (n=2, 4.1%) and tricuspid regurgitation (n=7, 14.3%). The virtual measurement of frailty was conducted using a standardised protocol. The platform for virtual connection selected by patients was FaceTime (n=20, 40.8%) and Zoom (n=29, 59.2%); the median (IQR) number of days between the in-person and the virtual assessment was 5 (3,10). The weighted Kappa estimate was 0.69 (95% CI 0.55, 0.82), illustrating a strong agreement between the separate scores obtained. The test for the general association was non-significant (p=0.82), indicating a lack of evidence for detecting an association between EFT scores and chronological order of assessment.

Conclusion
The EFT can be reliably measured virtual in older patients with valvular heart disease to inform clinical care.
Perceptions of an eHealth family-based cardiovascular disease risk reduction intervention: a mixed methods study
Authors: Kemp B J , Thompson D R , Mcguigan K , Watson C J , Ski C F 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Department for the Economy, Northern Ireland

Introduction
Controllable cardiovascular disease (CVD) risk factors are often initiated in the family home, yet risk reduction is seldom targeted toward families. Participatory design of eHealth interventions with end-users has potential to increase acceptability and adherence of such interventions. Despite their shared risk of developing CVD, few eHealth interventions target both parents and children at CVD risk. Therein lies an evidence gap; the need for coproduction of a family-based eHealth intervention aimed at early CVD prevention.

Purpose
The aim of this study was to identify the perceptions of families towards the design, functionality and acceptability of an eHealth, family-based, CVD prevention intervention.

Methods
Thee online focus groups comprising six families were conducted between April and May 2021. Families consisted of at least one parent who met CVD risk factor criteria, and at least one child aged five to 17 years. Content analysis and narrative synthesis were used to identify categories and subcategories regarding development of and engagement with the proposed intervention. Additionally, quantitative, and demographic measures were used to determine psychosocial and health profiles.

Results
Three categories were identified from the focus groups:
1) previous experiences of using health-related apps or devices
2) expectations of a newly developed eHealth family-based CVD prevention intervention
3) motivators for engagement with the intervention
Goal setting, rewards, accountability, adaptability, recording achievements and competition were considered crucial motivators for engagement for both parents and children. Participants welcomed the intervention, and advised they would prefer a free, personalised, easy-to-use, non-time-consuming intervention, with multiple content formats, and additional information available should they seek to access it. Parents conveyed satisfactory general self-efficacy and quality of life, low anxiety and depression and high perceived social support.

Conclusions
Overall, families were constructive and forthcoming towards the idea of an eHealth, family-based CVD prevention intervention. These findings informed a prototype of a family-based eHealth intervention aimed at early CVD prevention. The prototype is currently being developed with plans for piloting via a randomised controlled trial in the home environment, by families as an early intervention for the prevention of CVD.
Psychometric evaluation of the danish version of the electronic health literacy scale (eHEALS) in patients treated with percutaneous coronary intervention (PCI): A cross-sectional validation study
Authors: Palm P , Brors G , Borregaard B , Rasmussen T B , Helmark C , Norekval T 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
As many use the internet as a major source of health information, eHealth literacy has emerged as a potential concept for digital health care consumption. Therefore, healthcare professionals need to consider the eHealth literacy of patients when delivering health information to cardiac patients.

Purpose
The aim of this study was to translate and evaluate the psychometric properties of the Danish version of the Electronic Health Literacy Scale (eHEALS) in a population of Danish PCI treated patients.

Methods
The eHEALS was translated into Danish from the original English version, including forward translation, synthesis, backward translation and expert group consensus. The questionnaire was applied to a group of Danish PCI treated patients to be answered during hospital stay. Psychometric properties were assessed including internal consistency by Cronbach α, and confirmatory factor analysis (CFA) with a priori specified 1-, 2- and 3-factor models were performed to explore construct validity. Socio-demographic and patient-reported outcomes including health literacy, health-related internet use, and health status were collected to examine correlations with eHEALS scores.

Results
A total of 1473 PCI treated patients were included in the analysis. The mean age was 66 years (SD 10.70) and more patients were males (n=1130, 78%). The mean value for the eHEALS score was 28.87 (SD 6.34), and the Cronbach α 0.94. The CFA indicated a good fit for three out of four of the goodness-of -fit indices. A mean difference on the eHEALS score between patients with the highest and lowest educational level was found to be 4.64 (95%CI, 2.43-6.85), p&lt;0.0001.
Strong correlations were observed between eHEALS scores and "ability to find good information"(r=0.636), "Understanding health information well enough to know what to do" (r=0.505), ‘patients’ perceived usefulness’ (r= 0.650) and ‘importance of using the internet’ (r=0.621). Moderate correlations were observed to ‘having used the internet to find information about health’ (r=0.464), and "Appraisal of health information" (r=0.462), and weak correlations to self-rated physical health (r=0.119), self-rated mental health (r=0.110), and social support (r=0.207).

Conclusion
The psychometric evaluation indicates that the Danish version of the eHEALS questionnaire is a valid instrument to measure eHealth literacy in patients treated with PCI, suggesting a multidimensional construct.
The experience of internet-delivered cognitive behavioural therapy among patients with non-cardiac chest pain
Authors: Eriksson-Liebon M , Lundgren J , Rytterstrom P , Johansson P , Mourad G 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Kamprad Family Foundation
Region Östergötland

Background
Non-cardiac chest pain (NCCP) is a common health problem at emergency departments. Many patients are discharged with no further explanation regarding the cause of their chest pain. Recurring chest pain, functional limitations and cardiac anxiety affect lives of patients with NCCP and lead to increased healthcare use. Hence, we developed and tested a five-week, nurse-led iCBT program adapted to patients with NCCP in order to improve psychological distress and other patient-reported outcomes. This study was aimed to explore the experiences of patients with NCCP and cardiac anxiety regarding their participation in the iCBT program.

Methods
A qualitative interview study using content analysis to explore the experiences of patients participating in the iCBT program. The data was collected by individual face-to-face interviews with 16 patients after their participation in the iCBT using a semi-structured interview guide.

Results
The study resulted in three categories and eight subcategories, presented in Table 1. "Driving factors for participation in the iCBT program" was the first category and described the impact of pain on patients´ lives and their struggle before participating in the program. The second, "The program facilitates change", described how the program helped them make changes regarding pain, fear and anxiety. The last category, "Learning to live with chest pain", described the program as a tool for gaining the strength and skills to live a normal life despite chest pain.

Conclusions
The life impacted by recurrent chest pain, anxiety and feeling of being disregarded by healthcare was commonly experienced by participants. The invitation to the program was perceived as an opportunity to return to a normal life, without fear or chest pain. By being trustworthy, supportive and encouraging, the program helped participants to challenge their fear, and gain the strength and new insights they needed to live a normal life.
Quality of life and frailty: an important issue for elderly patients with an implanted pacemaker.
Authors: Bujak-Rogala E , Lisiak M H , Uchmanowicz I 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Quality of life (QoL) and Frailty Syndrome (FS) are increasingly considered in the clinical evaluation after invasive cardiac procedures, such as pacemaker implantation in the elderly.

Purpose
The aim of the study was to report on the baseline to follow-up changes in QoL and FS in patients following pacemaker implantation.

Methods
The population of the study comprised 101 elderly patients (≥65 y/o) who were qualified for pacemaker implantation. The medical record analysis and self-administered questionnaire were used twice: before the implantation (Cardiology Department) and after 6 months (outpatient clinic). The following instruments were used: sociodemographic and clinical data, WHO Quality of Life and the Tilburg Frailty Indicator (TFI).

Results
The mean age of the participants (54 men) was 76.44 ± 6,92. The 6-month analysis showed that QoL scores in all domains were significantly higher than before implantation, respectively (p&lt;0.001): physical domain (SD = 15.72 vs. SD = 21.17; T = 4810.50, z = - 8.154) psychological domain (SD = 27.55 vs. SD = 23.14; T = 4553.50, z = - 8.135), social domain (SD = 12.10 vs. SD = 17.36; T = 2396.50, z = - 6.776), and environmental domain (SD = 13.00 vs. SD = 16.80; T = 4414.00, z = - 7.932). The analysis of the FS showed that all FS components decreased compared to the subjects' score at baseline measurement (p&lt;0.001), respectively: physical component level: SD = 1.42 vs. SD = 1.53; T = 3916, z = -9.381), psychological components (SD = 0.67 vs. SD = 0.94; T = 990, z = - 6.633), social components (SD = 0.83 vs. SD = 0.89; T = 300, z = - 4.899). The additional analysis revealed that age (in all domains) and FS (only in the physical domain) were predictors of better QoL. The results indicate that as age increases by one year, post-implantation QoL decreases by 0.4 points, B = -0.40; β = -0.18 (physical domain), by 0.89 points, B = -0.89; β = -0.22 (psychological domain), by 0.55 points, B = -0.55; β = -0.32 (social domain), and by 0.44 points, B = -0.44; β = -0.25 (environmental domain). In contrast, greater severity of FS symptoms before implantation is a significant predictor of lower QoL after implantation, B = -0.99; β = -0.40.

Conclusion(s)
The assessment of QoL and FS, in addition to the clinical assessment, should be performed in elderly patients qualified for pacemaker implantation. The results indicate that pacemaker implantation is an important factor in improving the QoL and reducing the severity of physical component of FS. Appropriate assessment may be helpful in optimizing the therapeutic management in terms of prognostic assessment and the risk of hospitalization.
Cardiovascular outcomes in transgender individuals in Sweden after initiation of gender-affirming hormone therapy
Authors: Karalexi Maria A , Frisell Thomas , Cnattingius Sven , Holmberg Dag , Holmberg Mats , Kollia Natasa , Skalkidou Alkistis , Papadopoulos Fotios C 
Published: July 2022

Abstract

Aims
We compared the incidence of cardiovascular disease (CVD) in transgender participants with a diagnosis of gender dysphoria (GD) with and without gender-affirming hormone therapy (GAHT) to the incidence observed in the general population.

Methods and results
The population-based cohort included all individuals &gt;10 years in Sweden linked to Swedish nationwide healthcare Registers (2006–16). Two comparator groups without GD/GAHT were matched (1:10) on age, county of residence, and on male and female birth-assigned sex, respectively. Cox proportional models provided hazard ratios (HRs) and 95% confidence intervals (CI) for CVD outcomes. Among 1779 transgender individuals [48% birth-assigned males (AMAB), 52% birth-assigned females (AFAB)], 18 developed CVD, most of which were conduction disorders. The incidence of CVD for AFAB individuals with GD was 3.7 per 1000 person-years (95% CI: 1.4–10.0). Assigned male at birth individuals with GD had an incidence of CVD event of 7.1 per 1000 person-years (95% CI: 4.2–12.0). The risk of CVD event was 2.4 times higher in AMAB individuals (HR: 2.4, 95% CI: 1.3–4.2) compared with cisgender women, and 1.7 higher compared with cisgender men (HR: 1.7, 95% CI: 1.0–2.9). Analysis limited to transgender individuals without GAHT yielded similar results to those with GAHT treatment.

Conclusion
The incidence of CVD among GD/GAHT individuals was low, although increased compared with matched individuals without GD and similar to the incidence among GD/no GAHT individuals, thus not lending support for a causal relationship between treatment and CVD outcomes. Larger studies with longer follow-up are needed to verify these findings, as well as possible effect modification by comorbidity.
TARGET-HF: developing a model for detecting incident heart failure among symptomatic patients in general practice using routine health care data
Authors: De Clercq Lukas , Schut Martijn C , Bossuyt Patrick M M , van Weert Henk C P M , Handoko M Louis , Harskamp Ralf E 
Published: July 2022

Abstract

Background
Timely diagnosis of heart failure (HF) is essential to optimize treatment opportunities that improve symptoms, quality of life, and survival. While most patients consult their general practitioner (GP) prior to HF, the early stages of HF may be difficult to identify. An integrated clinical support tool may aid in identifying patients at high risk of HF. We therefore constructed a prediction model using routine health care data.

Methods
Our study involved a dynamic cohort of patients (≥35 years) who consulted their GP with either dyspnoea and/or peripheral oedema within the Amsterdam metropolitan area from 2011 to 2020. The outcome of interest was incident HF, verified by an expert panel. We developed a regularized, cause-specific multivariable proportional hazards model (TARGET-HF). The model was evaluated with bootstrapping on an isolated validation set and compared to an existing model developed with hospital insurance data as well as patient age as a sole predictor.

Results
Data from 31,905 patients were included (40% male, median age 60 years) of whom 1,301 (4.1%) were diagnosed with HF over 124,676 person-years of follow-up. Data were allocated to a development (n = 25,524) and validation (n = 6,381) set. TARGET-HF attained a C-statistic of 0.853 (95% CI, 0.834 to 0.872) on the validation set, which proved to provide a better discrimination than C = 0.822 for age alone (95% CI, 0.801 to 0.842, P &lt; 0.001) and C = 0.824 for the hospital-based model (95% CI, 0.802 to 0.843, P &lt; 0.001).

Conclusion
The TARGET-HF model illustrates that routine consultation codes can be used to build a performant model to identify patients at risk for HF at the time of GP consultation.