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Aldajani A, Bérubé M, Mardigyan V. How and Why to Set Up a Pericardial Disease Clinic. Can J Cardiol 2023; 39:1149-1151. [PMID: 37172644 DOI: 10.1016/j.cjca.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/10/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Ahmed Aldajani
- Department of Cardiovascular Medicine and Cardiovascular Imaging, McGill University Health Centre, Montréal, Québec, Canada; Department of Internal Medicine, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Marlène Bérubé
- Department of Medicine, Jewish General Hospital, Montréal, Québec, Canada
| | - Vartan Mardigyan
- Department of Medicine, Jewish General Hospital, Montréal, Québec, Canada.
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Wong AKC, Bayuo J, Wong FKY, Kwok VWY, Yuen BMK, Fong CS, Chan ST, Pung HL, Kwek OL. The feasibility and effectiveness of telecare consultations in nurse-led post-acute stroke clinics: A study protocol. Digit Health 2023; 9:20552076231180759. [PMID: 37334318 PMCID: PMC10272633 DOI: 10.1177/20552076231180759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Background Globally, nurse-led post-acute stroke clinics have been developed to provide secondary care services to stroke survivors. Although synthesized evidence supports the idea that the secondary prevention services delivered by nurses in these clinics can improve the functional ability of stroke survivors and reduce their readmission rates, long travel and waiting times, high costs, and the pandemic have limited the utilization of such clinics. Telecare consultations are a new modality for expanding public access to healthcare services, although how it can be applied in nurse-led clinics has not been reported. Objective The aim of this study is to determine the feasibility and effects of telecare consultations in nurse-led post-acute stroke clinics. Methods The study adopts a quasi-experimental design. The participants will receive three secondary stroke care consultations in 3 months provided via telecare by experienced advanced practice nurses. The outcome measures include feasibility (reasons for refusing to participate and for dropping-out, the attitudes and satisfaction of both the advanced practice nurses and their patients towards the programme), and preliminary effectiveness (degree of disability after stroke, activities of daily living, instrumental activities of daily living, health-related quality of life, depression) outcomes. Data will be collected at pre-(T1) and post-(T2) intervention. Conclusions The findings of this study may help facilitate the implementation of telecare consultations in a nurse-led post-acute stroke clinic, which may benefit the stroke survivors who are having mobility restrictions from accessing customary healthcare services and may protect them from being exposed to the infectious risk.
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Affiliation(s)
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | | | | | | | - Ching Sing Fong
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Shun Tim Chan
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Hoi Lam Pung
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Oi Lam Kwek
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Burr A, Lampert R. Nurse-led syncope and loop-recorder implantation clinics-A win-win approach for patients, clinicians, and hospitals. Heart Rhythm 2021; 19:448-449. [PMID: 34838719 DOI: 10.1016/j.hrthm.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Alicia Burr
- Yale New Haven Hospital, New Haven, Connecticut
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Eftekhari H, He H, Lee JD, Paul G, Zhupaj A, Lachlan T, Kuehl M, Dhanjal T, Panikker S, Yusuf S, Hayat S, Osman F. Safety and outcome of nurse-led syncope clinics and implantable loop recorder implants. Heart Rhythm 2021; 19:443-447. [PMID: 34767989 DOI: 10.1016/j.hrthm.2021.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implantable loop recorders (ILRs) are effective in achieving symptom-rhythm correlation. Data on the diagnostic yield of ILRs, on nurse-led syncope clinics, and on nurse-led ILR implants are limited. OBJECTIVE We evaluated the safety and efficacy of our nurse-led syncope clinic and nurse-led ILR implants. METHODS A retrospective study of all consecutive patients undergoing nurse-led ILR implantations was performed between April 2016 and April 2018. Patients were referred from both nurse-led and physician-led clinics. Data were collected on baseline demographic characteristics, referral source, symptom-rhythm correlation, ILR findings, and subsequent changes to management. All ILRs were enrolled into remote monitoring with automatic arrhythmia detection, and all immediate (≤24 hours) ILR implant complications were recorded. Comparisons were made between nurse-led and physician-led clinics and subsequent outcomes. RESULTS A total of 432 patients with an ILR were identified: 164 (38%) from nurse-led and 268 (62%) from physician-led clinics; 200 (46%) were women (mean age 66.5 ± 18.2 years; mean follow-up duration 28.9 ± 9.5 months). Primary ILR indications were syncope (n = 251 [58%]), presyncope (n = 33 [7%]), palpitation (n = 39 [9%]), cryptogenic stroke (n = 78 [18%]), and other reasons (n = 31 [7%]). No immediate ILR implant complications occurred. Overall, 156 patients (36%) had a change in management as a direct result of ILR findings, with no overall differences between nurse-led and physician-led clinics (35% vs 36%; P = .7). More patients had newly diagnosed atrial fibrillation in physician-led clinics (15% vs 7%; P = .01), and more patients had pacemaker implants for bradycardia in nurse-led clinics (23% vs 13%; P < .01). CONCLUSION Nurse-led ILR implantation was safe and effective. Nurse-led syncope clinics achieved good symptom-rhythm correlation with resultant significant changes to management in comparison to physician-led clinics. Larger prospective studies are needed to evaluate their longer-term impact.
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Affiliation(s)
- Helen Eftekhari
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Hejie He
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - James Doug Lee
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Geeta Paul
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Albiona Zhupaj
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Thomas Lachlan
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Michael Kuehl
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Tarv Dhanjal
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sandeep Panikker
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Shamil Yusuf
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Sajad Hayat
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Faizel Osman
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom.
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Adlan AM, Eftekhari H, Paul G, Hayat S, Osman F. The Impact of a Nurse-Led Syncope Clinic: Experience from a single UK tertiary center. J Arrhythm 2020; 36:854-862. [PMID: 33024463 PMCID: PMC7532277 DOI: 10.1002/joa3.12420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/30/2020] [Accepted: 08/06/2020] [Indexed: 12/02/2022] Open
Abstract
Background Syncope is a leading cause of hospital admission and is associated with significant morbidity and mortality. Our Syncope Clinic commenced in 2014 and we sought to evaluate its impact on outcomes (1‐yr mortality and syncope re‐hospitalization) in patients discharged following syncope admission. Methods A single‐center study of all consecutive patients discharged with syncope (ICD‐10 R55) between April 2012 and 2017. Patient demographics, comorbidities, hospital stay, syncope re‐hospitalization, and mortality at one‐year were collected. Those subsequently referred and seen in Syncope Clinic were compared with those who were not and predictors of poor outcome were evaluated. Results In total 2950 patients were discharged from hospital with syncope (median age: 73years, 51% male) with 1220 (41%) discharged same‐day; after commencement of Syncope Clinic 231were subsequently reviewed here. Overall mortality was 11%, which was lower in the Syncope Clinic group (3% vs 12%, P < .001). Temporal analysis revealed reduced re‐hospitalization following commencement of Syncope Clinic (2% vs 6%, P = .027). Independent predictors of mortality were increasing age (HR 1.03, 95% CI 1.03‐1.04), AF (HR 1.6, 95% CI 1.2‐2.1), HF (HR 2.2, 95% CI 1.6‐3.0), COPD (HR 1.9, 95% CI 1.4‐2.7), and CHADS2 score ≥ 1 (HR 1.45, 95% CI 1,12‐1.87). Syncope Clinic attendance was associated with reduced mortality (HR 0.3, 95% CI 0.1‐0.6). Conclusions Syncope patients discharged from hospital had reduced 1yr mortality if seen in subsequent Syncope Clinic. Independent predictors of mortality were COPD, HF, AF, and CHADS2 ≥1. Prospective randomized trials of Syncope Clinics are warranted.
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Affiliation(s)
- Ahmed M Adlan
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK
| | - Helen Eftekhari
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK
| | - Geeta Paul
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK
| | - Sajad Hayat
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK.,Department of Adult Cardiology Heart Hospital Hamad Medical Corporation Doha Qatar
| | - Faizel Osman
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK.,University of Warwick (Medical School) Coventry UK
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