bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac rehabilitation referral for PCI patients in Victoria, Australia - gender gap is closing but high-risk patients still miss out
Authors: Cartledge S , Driscoll A , Dinh D , O'neil A , Thomas E , Brennan A , Liew D , Lefkovits J , Stub D 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Following percutaneous coronary intervention (PCI), outpatient cardiac rehabilitation (CR) is essential for secondary prevention.(1) However, uptake of CR is suboptimal(2), despite strong evidence demonstrating benefits. The aim of this study was to identify contemporary trends and predictors of CR referral of PCI patients in Victoria.

Methods
A prospective, observational study using anonymised data from the Victorian Cardiac Outcomes Registry was undertaken. A total of 41,739 patients were discharged following PCI over the study period (2017-2020) and included for analyses.

Results
CR referral was 85%, with an increasing trend over time observed (p &lt;0.001). Multivariable modelling identifying the independent predictors of CR referral included hospitals with high volumes of ST-elevation myocardial infarction patients (STEMI) (OR 4.89, 95% CI 4.41 – 5.20), STEMI diagnosis (OR 1.90, 95% CI 1.69 – 2.14), or treatment in a private hospital (OR 1.45, 95% CI 1.33 – 1.57). Predictors of non-referral included cardiogenic shock (OR 0.54, 95% CI 0.41 - 0.71), aged over 75 years (OR 0.62, 95% CI 0.57 – 0.68) and previous PCI (OR 0.66, 95% CI 0.62 – 0.70) (See Fig 1). PCI patients with an acute coronary syndrome who were referred to CR were also more likely to be prescribed four or more major preventive pharmacotherapies, compared to those who were not referred (90% vs 82%, p &lt;0.001).

Conclusion
Referral to CR in Australia for PCI patients has improved over time compared to previously published reports. Pleasingly, we did not observe a gender difference in rate of CR referral. However, older, more acute or co-morbid patients require consideration for CR referral as these patients may have the most to gain. We also included novel key hospital characteristics in our analysis, such as high-volume STEMI hospitals, which increase the odds of CR referral. Referral does not imply attendance, nor completion of CR and we need better linked data in Australia to examine these outcomes.
The meaning of CPR in the life-world of hospital: perspectives of patients who witnessed CPR and healthcare professionals.
Authors: Fiori M , Coombs M , Endacott R , Cutello C A , Latour J M 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Resuscitation Council (UK)

Background
Cardiopulmonary resuscitation (CPR) in hospital is a stressful experience for patients who witness it and for the healthcare professionals involved. Limited evidence and guidance exist regarding the experience of witnessing a fellow patient’s CPR. Informed by a systematic review [1] and a multi-stakeholder consultation [2], the WATCH (Witnessing an Attempt of CPR in Hospital) study has explored the lived experiences of hospital patients and healthcare professionals on patient-witnessed CPR with the primary aim of understanding the impact of such an experience [3].

Purpose
The purpose of this study was to understand the meaning of CPR in the context of the hospital life-world of patients who witness CPR and of healthcare professionals.

Methods
The WATCH study used a qualitative descriptive phenomenological design. The lived experiences of 16 witnessing patients admitted to nine clinical wards and of 20 healthcare professionals involved in CPR were explored through in-depth interviews and focus groups conducted in one hospital in the UK.

Results
Three themes were developed from analysis indicating that, despite a shared understanding of CPR as part of hospital life and as a potential result of emergencies, patients and healthcare professionals had different perspectives of hospital CPR. 1) Unfamiliarity vs Exposure: although patients were aware of CPR, witnessing CPR was often unexpected and traumatic, as many had not experienced it before. Instead, healthcare professionals with previous knowledge and expertise, held an emotional distance and focused on the clinical tasks of CPR. 2) Fiction vs Reality: healthcare professionals considered patients to have unrealistic expectations of CPR, often uninformed and influenced by distorted portrayal of CPR to the lay public through television. Patients acknowledged that witnessing hospital CPR helped their understanding of the reality of it, which differed from their initial idea. 3) Life vs Death: Patients felt disturbed by the presence of a dead body in their room after CPR, whilst daily activities of hospital life were carried out, highlighting a contrast between life and death in the same environment. Finally, healthcare professionals reflected on the meaning of performing CPR as a process to help the ones witnessing it to face and accept the reality of death.

Conclusion
The WATCH study highlighted that patients and healthcare professionals hold different perspectives of CPR in hospital. Awareness of different perspectives of hospital CPR will help healthcare professionals initiate CPR conversations with hospital patients. Education and accurate information should be offered to hospital patients around CPR to have realistic expectations. Further work is required to guide and support clinical practice around patient-witnessed CPR in hospital.
Consequences of chronic heart failure on the persons social dimension
Authors: Wolf A , Martin-Martin J , Wallstrom S W , Olano-Lizarraga M 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Chronic heart failure (CHF) is a progressive and disabling illness that affects daily life. Decreased opportunities to participate in social life are among the most common aspects experienced by these patients, leading to reduced social interaction, loneliness, social isolation, and lack of social support to continue their activities of daily living. These experiences, in turn, have significant consequences for the health of patients with CHF, increasing the risk of comorbidities and complications.

Purpose
This study aimed to identify the consequences of the altered social dimension on the health of those with CHF.

Methods
A scoping review was carried out according to the method proposed by Arksey and O'Malley. The search was conducted in PubMed, CINAHL, PsychINFO, Scopus, and Web of Science databases from January 2010 to November 2021. The following main steps were carried out: (1) the research question was formulated; (2) the most relevant studies were identified; (3) the studies were selected; (4) the data were analysed; and (5) the results were integrated and synthesised. The selection criteria can be found in Table 1.

Results
Ten articles met the selection criteria. Alterations in the social dimension of patients with CHF were identified as influencing several of their health outcomes. In particular, higher rates of depression, higher risk of readmission and death, more visits to the emergency department and outpatient specialist appointments were identified. Along with this, influences on self-care behaviors and treatment adherence were reported.

Conclusions
This study has shown the relevance of deepening the knowledge of each patient with CHF, giving greater importance to assessing their social dimension. This will help detect patients at greater risk of complications due to a lower perception of social support, a more significant perception of social isolation, or a poorer social network.
The cost-effectiveness of nurse-led self-care interventions in patients with heart failure
Authors: Iovino P , Daniela D'angelo D D , Ercole Vellone E V , Matteo Ruggeri M R 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Nurse-led self-care interventions (NLSCI) in heart failure (HF), defined as the nurse education delivered to improve the daily patient self-management, are not widely adopted by the health-care systems, even though they are effective to improve outcomes (e.g., mortality, readmission). Moreover, few studies have evaluated whether NLSCI are also cost-effective.

Purpose
To determine the cost-effectiveness of NLSCI in the context of HF care compared with standard care (care delivered by general practitioner and/or cardiologist).

Methods
We performed a cost-effectiveness analysis, with a 20-year time horizon, from the perspective of the Italian National Health Service. We developed a Markov model to simulate the progression of a cohort of 1,000 HF patients aged 70 years, who were assumed to alternatively receive a NLSCI after hospital discharge, or usual care. Effectiveness on mortality and on hospitalizations of NLSCI and usual care were extrapolated from a review of randomized control trials. Health-care costs were derived from literature and national formularies. The differences in costs and the differences in Quality Adjusted Life Years (QALY) between the NLSCI and usual care were estimated to present an incremental cost-effectiveness ratio (ICER). A willingness to pay (WTP) threshold of €40,000 per QALY was considered. Probabilistic sensitivity analyses were conducted to test the robustness of results and to estimate a cost-effectiveness acceptability curve.

Results
Over the 20-year time horizon, NLSCI implied an extra cost of € 1.3 million and a gain of 247 QALYs compared to usual care. This resulted in an ICER of € 5,490/QALY, which is far below the €40,000/QALY WTP threshold. Sensitivity analysis showed that the ICER remains below the WTP threshold in 100% of simulations. Moreover, the cost-effectiveness acceptability curve showed a probability of 80% of being under € 7,500/QALY.

Conclusions
This study demonstrated that NLSCI represent an affordable solution to support patients with HF as the related extra costs of € 1.3 million is justified by the reduction in mortality and improvement in quality of life. This finding supports the promotion of NLSCI as part of routine care, in order to pursue an optimal allocation of public health expenditures.
Dyadic strain mediates the association of shared care with caregiver burden in caregivers of patients with heart failure
Authors: Cha G , Moser D K , Chung M L 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health

Background
Many patients with heart failure (HF) need family caregivers’ support to manage HF efficiently, but caregivers commonly experience a burden due to their caregiving responsibility. The term, shared care, reflects a system of interpersonal interactions characterized by exchange of support between members of a patient-caregiver dyad in illness management. Higher levels of shared care are associated with better patient self-care and health outcomes, but it is not known whether shared care influences caregivers' burden. Dyadic relationship quality between dyad members also influences caregivers' burden. We hypothesize that dyadic relationship quality may mediate the association of shared care with caregiver burden.

Purpose
The purpose of this study was to examine the association of shared care with caregiver burden and determine whether dyadic relationship quality mediates the association of shared care with caregiver burden in caregivers of patients with HF.

Methods
In this cross-sectional study, primary caregivers of patients with HF completed questionnaire surveys about shared care using the Shared Care Instrument (SCI), caregiver burden using the Zarit Burden Interview, and dyadic relationship quality using the Dyadic Relationship Scale (DRS). The SCI has communication, decision making, and reciprocity subscales. The DRS has positive interaction and dyadic strain subscales. A series of multiple parallel models were used to test the mediation effect of dyadic relationship quality with 5000 bootstrap samples while controlling age, sex, education, and type of dyadic relationship.

Result
Of the 143 caregivers (mean age= 56 years), most were female (76%) and in a spousal relationship with patients (73%). Among SCI subscales, only shared care communication was directly associated with caregiver burden (B = -.5247, P = .0006, 95% CI: -.8199 to -.2296) when age, sex, education, and DRS scores were controlled. There was a significant indirect effect of shared care communication on caregiver burden (B = -.2090, 95% CI: -.4225 to -.0022; Figure 1), indirect effect of shared decision-making on caregiver burden (B = -.3559, 95% CI: -.5984 to -.1588; Figure 2), and indirect effect of shared care reciprocity on caregiver burden (B = -.2342, 95% CI: -.5508 to -.0499; Figure 2) through dyadic strain. Positive interactions within dyad members did not mediate the association of shared care with caregiver burden.

Conclusion
Better shared care in HF management was associated with low dyadic strain, which reduced caregivers’ burden. These findings underpin the need to improve shared care and reduce dyadic strain for caregivers of patients with HF.
A gradual taste adaption intervention reduced dietary sodium intake among adults with hypertension
Authors: Chung M L , Lennie T A , Moser D K 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): University Kentucky College of Nursing Internal Grant

Introduction
Despite the recommendations and substantial benefits of reducing dietary sodium intake in adults with hypertension, adherence to a sodium-restricted diet (SRD) remains poor. One of the biobehavioral barriers in following SRD is a poor taste of SRD that leads preference for salty food. We developed a systematic and comprehensive approach of gradual taste adaptation to the SRD (Sodium Watchers Program [SWaP]) to reduce dietary sodium intake by overcoming these sensory barriers. The purpose of this pilot study was to examine the effects of the SWaP-HTN on dietary sodium intake, blood pressure (BP), preference for salty food, and enjoyment of SRD in adults with hypertension.

Methods
A total of 29 adults with hypertension were randomly assigned to the intervention (n=19) and usual care group (n=10) in a 2:1 ratio. The intervention group received a 16-weeks SWAP-HTN intervention via video-conferencing on a tablet. All participants completed collecting 24-h urine specimens and blood pressure baseline and 4-month follow-up. Blood pressure was taken three times at each assessment, and mean BP was calculated. Preference for salty food and enjoyments of SRD were assessed on a 10-point rating scale. Repeated measures ANOVA was used to compare outcomes changes between two groups from pre- to post-intervention.

Results
Of the 27 participants (mean age = 62.8 years, 55% male), only 3 (11%) were withdrawn. The mean 24-hour urine sodium excretion (24h UNa) was 3,911 mg/day (range 1,563 mg- 8,138 mg) and mean systolic and diastolic blood pressures was 135.7/85.6 mmHg at baseline. The intervention group significantly reduced sodium intake by 1,158 mg/day of sodium, a 30% reduction (TimeX Group P = 0.011: Figure 1), and reported an increase in the enjoyment of SRD at 4-month follow-up (TimeXGroup P = 0.01; Figure 1). Although there was a trend of decreasing mean systolic BP(143.4 mmHg vs. 133.9 mmHg, baseline and 4-month respectively) in the intervention group, it did not reach statistical significance (TimeXGroup, P = 0.061). There was also no significant difference in changes in the preference of salty food and diastolic BP between the two groups.

Conclusion
Even with a small sample size, we demonstrated that a gradual adaptation strategy to a sodium-restricted diet effectively reduced dietary sodium intake by increasing the hedonic state of SRD. This innovative approach may also have the potential for controlling blood pressure, but this needs to be tested in a large clinical trial.
Telehealth Education And Counselling program to optimise secondary prevention of Heart disease for patients with cardiovascular Disease living in Rural Australia: TEACH-RA study
Authors: Negesa L , Clark R , Trimacco T , Hendriks J 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): SOLVE CHD Collaboration grant

Introduction
The burden of cardiovascular disease (CVD) is rapidly increasing, however, access to secondary prevention in rural areas is limited. Moreover, rural and remote CVD patients have limited access to primary care and other health services to receive ongoing support and post-discharge follow-up, and this may predispose them to insufficient secondary prevention in terms of a high risk of uncontrolled blood pressure and consequent life-threatening complications including coronary heart disease. Therefore, reform of secondary prevention in rural and remote areas is required to improve reach and access for patients living in such areas, and consequently improve clinical and other health outcomes.

Objective
To evaluate the feasibility of an innovative, tailored telehealth education and counselling program to optimise secondary prevention of CVD in patients living in rural areas in South Australia.

Methods
A quasi experimental study will be conducted by recruiting patients from existing database; country access to cardiac health (CATCH) program. Patients with CVD, aged ≥ 18, enrolled into CATCH program and living in rural and remote South Australia. Sample size is calculated using an online tool and is based on the primary endpoint to detect reduced readmission rate in patients with CVD and cardiac events. Patients with acute coronary syndrome/myocardial infarction, revascularisation procedure, stable and unstable angina, post coronary artery bypass grafting, post cardiac valve replacement surgery, and heart failure will be included. The sample size is calculated using online tool with appropriate statistical assumptions, which gives 113. The intervention of this study consists of two components: 1) delivery of a tailored telehealth counselling and education through telephone by a nurse and 2) use of an iPad application for patient education. Primary outcome is readmission for CVD and cardiac events. Secondary outcomes are knowledge of cardiovascular risk factors, lifestyle modification (e.g. smoking, alcohol, diet and physical exercise), medication adherence, health related quality of life and clinical outcomes such as lipid profile and blood pressure.

Conclusion
TEACH-RA study will test the feasibility of a tailored telehealth education and counselling program in patients with cardiac conditions living in rural and remote areas.
Health education of patients with cardiovascular disease for effective self-care
Authors: Todorova M T 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiovascular Disease leads to physical and psychosocial problems and worsens the quality of life of patients. Cardiovascular Disease Management is focused not only on reducing morbidity and mortality, but also on opportunities to improve daily life and overcome risk factors. Nurses play a key role in patient health education and their contributions have expanded in recent decades in Bulgaria.

Purpose
The aim of this study was to explore the possibilities for nurses' active participation in the health education of patients with Cardiovascular Disease.

Methods
The study included 146 patients with Cardiovascular Disease and a control group. The mean age of the respondents is 61.15 ± 2.35. The practical part of the study included 52 patients. The toolkit contains questionnaires for assessing stress and coping with everyday life, behavioral risk factors, a health education program and self-care. All participants have signed an informed consent, in accordance with the ethical principles of the Declaration of Helsinki.

Results
The results of physical activity, routine activities, self-care and anxiety show some disorders in the patient group. Patients with anxiety were 49.3%, individuals in the control group were 21.9%, (χ2 = 23.89, p &lt;0.001). There was a statistically significant difference in anxiety level between patients and the control group (t = 4.07, p &lt;0.001). There was a statistically significant difference in the relative shares of the two groups in terms of anxiety and physical activity (Z = 7.09, p = 0.000). Patients with self-care difficulties and anxiety are 24.0%. A relationship between anxiety and self-care options was found in patients (Z = 6.29; p = 0.000). A structured interview was conducted to identify lifestyle risk factors. The results show that 55.8% of patients are overweight. The relationship between waist circumference and BMI is straight moderate (r = 0.397, p = 0.004). The predominant number of men who smoke is 60.7%. A relationship was established between smoking and the gender of the respondents (χ2 = 18.21, df = 2, p = 0.000). The nurse conducted an individual interview with each patient to improve diet, daily routine, control blood pressure, blood sugar and more. A pedagogical model for health education was applied, based on goal setting, motivation, and self-care to achieve long-term results in terms of risk factor management. Positive changes were reported after 3 months in terms of hygiene and diet, physical activity, regular monitoring of blood pressure and medication.

Conclusion
Patient education is one of the most important aspects of nurses' work. Primary care nurses are a key factor in improving the quality of life of patients by implementing self-care education programs, reducing risk factors and monitoring the condition.