1
|
Li X, Li R, Li M, Yao L, Van Spall H, Zhao K, Chen Y, Xiao F, Fu Q, Xie F. A Systematic Review and Quality Assessment of Cardiovascular Disease-Specific Health-Related Quality-of-Life Instruments Part I: Instrument Development and Content Validity. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02331-3. [PMID: 38608875 DOI: 10.1016/j.jval.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 02/12/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Health-related quality-of-life (HRQoL) instruments for cardiovascular diseases (CVD) have been commonly used to measure important patient-reported outcomes (PROs) in clinical trials and practices. This study aimed at systematically identifying and assessing the content validity of CVD-specific HRQoL instruments in clinical studies. METHODS The research team searched Cumulative Index to Nursing and Allied Health Literature, Embase, and PubMed from inception to January 20, 2022. The research team included studies that reported the development and content validity for CVD-specific instruments. Two reviewers independently assessed the methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments methods on evaluating content validity of PROs. Content analysis was used to categorize the items included in the instruments. RESULTS The research team found 69 studies reporting the content validity of 40 instruments specifically developed for CVD. Fourteen (35.0%) were rated "sufficient" with very low to moderate quality of evidence. For PRO development, all instruments were rated "doubtful" or "inadequate." Twenty-eight (70.0%) instruments cover the core concepts of HRQoL. CONCLUSIONS The quality of development and content validity vary among existing CVD-specific instruments. The evidence on the content validity should be considered when choosing a HRQoL instrument in CVD clinical studies and health economic evaluations.
Collapse
Affiliation(s)
- Xue Li
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Health Technology Assessment, China National Health Development Research Center, Beijing, China
| | - Rui Li
- Department of Health Technology Assessment, China National Health Development Research Center, Beijing, China; Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Meixuan Li
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Harriette Van Spall
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Research Institute of St Joseph's and Population Health Research Institute, Hamilton, ON, Canada
| | - Kun Zhao
- Department of Health Technology Assessment, China National Health Development Research Center, Beijing, China; Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yunxiang Chen
- Department of Library, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Feiyi Xiao
- Department of Health Technology Assessment, China National Health Development Research Center, Beijing, China
| | - Qiang Fu
- Department of Health Technology Assessment, China National Health Development Research Center, Beijing, China
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Center for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
2
|
Nordblom AK, Kjellsdotter A, Norberg Boysen G, Berglund M. Foreign movement in one's own body: Patients' experiences of being awake while treated with catheter ablation-a phenomenological study. Int J Qual Stud Health Well-being 2023; 18:2238972. [PMID: 37499138 PMCID: PMC10375920 DOI: 10.1080/17482631.2023.2238972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE To address the consequences of living with supraventricular tachycardia and to improve the quality of treatment, there is a need to highlight patient experiences of treatment with catheter ablation. Therefore, the aim was to describe the phenomenon of catheter ablation, as it is experienced by patients being treated awake. METHODS A descriptive design was applied based on a reflective lifeworld research founded on phenomenological epistemology. Interviews were conducted between December 2021 and Mars 2022 with seven women and five men, three to twelve months after they underwent catheter ablation. RESULTS Patients undergoing catheter ablation while awake during treatment, which includes experiences of relying on others expertise, being actively passive, and striving to be cured. It entails experiences of having a foreign object moving in one's body and heart and can be endured through strategies of mainly shifted one's mental focus. CONCLUSIONS The effort of undergoing a catheter ablation procedure is worthwhile as the confirmation of a physical curable condition that opens a future with possibilities instead of the obstacle in daily life that tachycardia entails. For the patients, an informative and caring conversation was needed that would have provided the support they lacked before and during the ablation.
Collapse
Affiliation(s)
- Ann-Katrin Nordblom
- Department of Cardiology, Skaraborgs Hospital Skövde, Skövde, Sweden
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Anna Kjellsdotter
- School of Health Sciences, Skövde University, Skövde, Sweden
- Research and Development Centre, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Gabriella Norberg Boysen
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Prehospen, Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Mia Berglund
- School of Health Sciences, Skövde University, Skövde, Sweden
| |
Collapse
|
3
|
Wood KA, Han F, Ko YA, Wharton WW. Is the association between cognitive disease progression and atrial fibrillation modified by sex? Alzheimers Dement 2023; 19:4163-4173. [PMID: 37350284 PMCID: PMC10524524 DOI: 10.1002/alz.13060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION It is unclear if sex differences exist in cognitive disease progression in mild cognitive impairment (MCI) and dementia associated with atrial fibrillation (AF). METHODS Using a variety of statistical methods, we examined sex differences between AF and neuropsychological tests and cognitive disease progression, using the National Alzheimer's Coordinating Center data (N = 43,630). RESULTS AF is associated with higher odds of dementia (odds ratio [OR] 3.00, 95% confidence interval [CI] [1.22, 7.37] in women and MCI in women (OR 3.43, 95% CI [1.55, 7.55]) versus men. Women with AF and normal baseline cognition had a higher risk of disease progression (hazard ratio [HR] 1.26, 95% CI [1.06, 1.50]) from normal to MCI and from MCI to vascular dementia (HR3.27, 95% CI [1.89, 5.65]) than men with AF or men and women without AF. DISCUSSION AF was associated with more rapid progression to MCI and dementia in women, but more research is needed to confirm these findings.
Collapse
Affiliation(s)
- Kathryn A Wood
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Feier Han
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Whitney W Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Li X, Zhao K, Li K, Wang W, Feng S, Wu J, He X, Xie S, Hu H, Fan J, Fu Q, Xie F. China Health Related Outcomes Measures (CHROME): development of a descriptive system to support cardiovascular disease specific preference-based measure for the Chinese population. Qual Life Res 2023:10.1007/s11136-023-03416-y. [PMID: 37119354 DOI: 10.1007/s11136-023-03416-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE Preference-based measures have been increasingly recommended to measure health outcomes for economic evaluation. However, none of existing cardiovascular disease (CVD)-specific health-related quality of life (HRQoL) instruments are preference-based. This study aimed to develop the descriptive system of preference-based HRQoL instrument for Chinese patients with CVDs under the Initiative of China Health Related Outcomes Measures (CHROME). METHODS Qualitative face-to-face interviews were conducted with Chinese patients with CVDs. Content analysis was employed to generate candidate items for the instrument. Then expert consultation and cognitive debriefing interviews were conducted to guide further selection and revision of the items. RESULTS We interviewed 127 CVD patients with 67.7% being male and 63.8% living in the urban area. A hierarchical code book comprised of four themes, 20 categories, 62 sub-categories, and 207 codes, was developed. Candidate items were selected based on the criteria set by the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology and ISPOR PRO guidance. An online survey and meeting with an expert advisory panel (n = 15) followed by cognitive debriefing interviews with 20 patients and 13 physicians were conducted to further select and revise the candidate items. The descriptive system of CHROME-CVD consists of 14 items, namely frequency and severity of chest pain, chest tightness, palpitation, shortness of breath, dizziness, fatigue, appetite, sleeping, mobility, daily activities, depression, worry, and social relationship. Four or five level responses were selected based on cognitive debriefing results to each item. CONCLUSION The current study developed the descriptive system (items and response options) of CHROME-CVD, the future CVD-specific preference-based HRQoL instrument for Chinese CVD patients.
Collapse
Affiliation(s)
- Xue Li
- Department of Health Technology Assessment, China National Health Development Research Center, Beijing, China
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Kun Zhao
- Department of Health Technology Assessment, China National Health Development Research Center, Beijing, China
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kexin Li
- China Alliance for Rare Disease, Beijing, China
| | - Wenjun Wang
- Department of Health Technology Assessment, China National Health Development Research Center, Beijing, China
| | - Siting Feng
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Shitong Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Hao Hu
- Liaoning Institute of Basic Medicine, Liaoning, China
| | - Jing Fan
- National Center for Cardiovascular Diseases, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Fu
- China National Health Development Research Center, 9 Chegongzhuang Street, Xicheng District, Beijing, 100444, China.
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
5
|
Nordblom AK, Boysen GN, Berglund M, Kjellsdotter A. Health care centre and emergency department utilization by patients with episodes of tachycardia. BMC Cardiovasc Disord 2022; 22:124. [PMID: 35321644 PMCID: PMC8944063 DOI: 10.1186/s12872-022-02568-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Outpatients seek to visit health care facilities for episodes of tachycardia-related signs and symptoms. The challenge for physicians is to balance a proper initial assessment and avoid overlooking a possible arrhythmia. This common clinical situation affects individuals and health care utilization, and effective management may substantially affect health care resources. This study aimed to explore health care utilization for outpatients with episodes of tachycardia visiting health care centres (HCCs) and/or emergency departments (EDs). Method This retrospective study used data of adult outpatients (≥ 18 years) who were assessed by a physician as having a specific or nonspecific diagnosis of arrhythmia between 2017 and 2018, and data were retrieved from medical records and a regional registry database. Data was analysed with appropriate statistical analyses to identify disparities between sex, age and terms of search pattern for each health care facility. Analysis of variance was used to test disparities between the sexes, and one-factor ANOVA was used for the incidence of missed arrhythmias. Results A total of 2719 visits with 2373 outpatients were included in the study. The result showed a significant difference in the total number of visits (n = 2719) between female and male patients (68% vs. 32%, p < .001). In the 60–69- and 70–79-year age groups, females had significantly higher frequencies of visits than males (p = .018). A significant difference was also observed between sexes in terms of which health care facility they tended to visit (p < .001). Ninety-five percent of the outpatients visiting EDs were hospitalized. When estimating the incidence of missed arrhythmias (diagnoses) in relation to assessments, the results showed a 5% missed diagnosis involving potential atrioventricular nodal re-entry tachycardia and atrioventricular re-entry tachycardia. Moreover, the referral rate was low, especially from HCCs to cardiologists. Conclusions This study shows a significant difference in total visits in HCCs and/or EDs by patients of different sexes and indicates the need for improved care for outpatients with episodes of tachycardia. Sex- and age-related differences must be addressed with an aim of providing equal care. Finally, the low rate of referral from HCCs to cardiologists compared to the high proportion of hospitalizations from EDs, deserves further investigation.
Collapse
Affiliation(s)
- Ann-Katrin Nordblom
- Department of Cardiology, Skaraborg Hospital Skövde, 54185, Skövde, Sweden. .,Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden.
| | - Gabriella Norberg Boysen
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden.,PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Mia Berglund
- School of Health Sciences, Skövde University, Skövde, Sweden
| | - Anna Kjellsdotter
- School of Health Sciences, Skövde University, Skövde, Sweden.,Research and Development Centre, Skaraborg Hospital Skövde, Skövde, Sweden
| |
Collapse
|
6
|
Cannavan PMS, Cannavan FPDS, Oliveira HC, Walfridsson U, Lopes MHBDM. A Brazilian Portuguese translation, cultural adaptation and validation of the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) health-related quality of life (HRQOL) scale. PLoS One 2021; 16:e0256851. [PMID: 34449831 PMCID: PMC8396783 DOI: 10.1371/journal.pone.0256851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The health-related quality of life (HRQOL) of patients with tachyarrhythmia can be negatively influenced by the clinical manifestations. The evaluation of HRQOL with validated instruments can provide valuable information that will contribute to clinical decision-making and treatment. In Brazil, however, there is no available scale that evaluates HRQOL in different types of arrhythmia. The purpose of this study was to adapt the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia-HRQOL scale (ASTA-HRQOL scale) to the Brazilian culture, and to assess the psychometric properties of the adapted questionnaire. METHODS The study used a methodological process of cultural adaptation based on international literature guidelines. The analyses were performed with 172 participants, 32 for cultural adaptation and 140 for psychometric validation. Calculation included analysis of reliability by Cronbach's α coefficient, construct validity with convergent validity using the WHOQOL-BREF questionnaire and by the Spearman correlation coefficient, Average Variance Extracted, and assessment of confirmatory factor analysis. RESULTS The translation and adaptation processes showed a satisfactory degree of comprehension and applicability (93% reported them to be easy to understand). Confirmatory factor analysis indicated exclusion of one item from the mental scale, but after qualitative analysis the item was retained. The items presented adequate internal consistency (Cronbach's alpha coefficient = 0.88), and an inverse correlation of moderate magnitude with the physical domain (rho = -0.63) and with the mental domain (rho = -0.58) of the WHOQOL-BREF. CONCLUSIONS The Brazilian Portuguese version of the ASTA-HRQOL scale, the ASTA-Br-HRQOL scale, can be a valuable tool for use in clinical practice and research.
Collapse
Affiliation(s)
| | - Fernando Piza de Souza Cannavan
- Department of Clinical Medicine, Discipline of Cardiology, School of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil
| | | | - Ulla Walfridsson
- Department of Cardiology, University Hospital, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | |
Collapse
|
7
|
Markendorf S, Saguner AM, Brunckhorst CB. [CME ECG 68: Gender Specificities in Heart Rhythm Disorders]. PRAXIS 2021; 110:131-139. [PMID: 33653104 DOI: 10.1024/1661-8157/a003656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CME ECG 68: Gender Specificities in Heart Rhythm Disorders Abstract. Sex differences in heart rhythm disorders have been described, especially due to differences of hormone status in women and men. In general, women do have a higher baseline heart rate than men and shorter refractory periods of most structures in the conduction system, except the ventricles. This is particularly apparent in paroxysmal supraventricular tachycardias. The incidence of a dual AV nodal physiology is the same in both sexes. However, an AV-nodal reentry tachycardia is much more frequent in women than in men. The embryonal disposition for an accessory pathway, as well as the resultant AV reentry tachycardia is more common in men than in women. Focal atrial tachycardias do not reveal a clear dominance between the sexes. Knowledge about sex-related differences in heart rhythm disorders are relevant for its diagnostics. Therefore, important aspects will be discussed in this article.
Collapse
Affiliation(s)
- Susanne Markendorf
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | - Ardan M Saguner
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | | |
Collapse
|
8
|
Sacks NC, Everson K, Emden MR, Cyr PL, Wood DR, Raza S, Wood KA, Pokorney SD. Disparities in the Management of Newly Diagnosed Paroxysmal Supraventricular Tachycardia for Women Versus Men in the United States. J Am Heart Assoc 2020; 9:e015910. [PMID: 32954896 PMCID: PMC7792362 DOI: 10.1161/jaha.120.015910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Information on differences in paroxysmal supraventricular tachycardia (PSVT) diagnosis, healthcare resource use, expenditures, and treatment among women versus men is limited. Methods and Results Study participants identified in the IBM MarketScan Commercial Research Databases were aged 18 to 40 years with newly diagnosed PSVT (International Classification of Diseases, Ninth Revision [ICD-9]: 427.0; International Classification of Diseases, Tenth Revision [ICD-10]: I47.1) from October 1, 2012, through September 30, 2016, observable 1 year preindex and postindex diagnosis. Study outcomes were mean annual per-patient healthcare resource use and expenditures before and after diagnosis. Among 5466 patients newly diagnosed with PSVT, most (66.9%) were women. Compared with men, women with PSVT tended to have higher rates of anxiety (13.9% versus 10.9%; P<0.01) and chronic pulmonary disease (10.9% versus 8.3%; P<0.01). Following diagnosis, mean annual per-patient expenditures increased for all patients, but were significantly lower for women ($26 922 versus $33 112; P<0.05), reflecting lower spending for services billed as a result of a PSVT diagnosis ($8471 versus $11 405; P<0.05). After diagnosis, nearly half of all patients had at least 1 emergency department visit (women versus men, 49.6% versus 44.5%; P<0.01) and more had hospital admissions (women versus men, 24.7% versus 20.0%; P<0.01). Fewer women were treated with cardiac ablation (12.6% versus 15.3%; P<0.01), and more were treated with medical therapy, including β blockers or calcium channel blockers (odds ratio, 1.15; 95% CI, 1.02-1.31). Conclusions Among patients aged 18 to 40 years, ≈2 of 3 patients diagnosed with PSVT were women. After diagnosis, spending was significantly lower for women, reflecting lower ablation rates and less spending on services with a PSVT diagnosis.
Collapse
Affiliation(s)
- Naomi C. Sacks
- Tufts University School of MedicineBostonMA
- Precision Health Economics and Outcomes ResearchBostonMA
| | - Katie Everson
- Precision Health Economics and Outcomes ResearchBostonMA
| | - Maia R. Emden
- Precision Health Economics and Outcomes ResearchBostonMA
| | - Phillip L. Cyr
- Precision Health Economics and Outcomes ResearchBostonMA
- College of Health and Human ServicesUniversity of North CarolinaCharlotteNC
| | | | - Sajjad Raza
- Precision Health Economics and Outcomes ResearchBostonMA
| | - Kathryn A. Wood
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGA
| | - Sean D. Pokorney
- Duke University Medical CenterDurhamNC
- Duke Clinical Research InstituteDurhamNC
| |
Collapse
|
9
|
Clinical presentation of paroxysmal supraventricular tachycardia: evaluation of usual and unusual symptoms. Cardiovasc Endocrinol Metab 2020; 9:153-158. [PMID: 33225230 DOI: 10.1097/xce.0000000000000208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
Objective Clinical presentation of paroxysmal supraventricular tachycardia may vary from asymptomatic occurrence or mild perception of palpitation to severe chest pain or syncope. This variation is the most challenging issue in the diagnostic evaluation of rhythm disturbances and paroxysmal supraventricular tachycardia as well. This study sought to evaluate the symptoms during the tachycardia attack or index event in patients who underwent electrophysiological study and ablation procedure. Methods This retrospective study included 100 consecutive patients who underwent electrophysiological study and ablation procedures due to supraventricular tachycardia. Structural heart disease, moderate/severe valvular pathology, systemic pathologies, such as connective tissue disease and chronic obstructive lung disease, history of pacemaker implantation was defined as exclusion criteria. In addition, medically managed patients and patients with unsuccessful ablation were not included in the study. Results Palpitation was the most frequently observed symptom in 84% of patients, followed by chest pain in 47%, dyspnea in 38%, syncope 26%, lightheadedness in 19%, and sweating in 18% of the patients. The most common symptoms after tachycardia event were fatigue and lightheadedness with frequencies of 56% and 55%, respectively. Forty-five percent of the patients reported more than one, unusually frequent urination within the following 1-3 hours after the index event. Conclusions Paroxysmal supraventricular tachycardia might manifest itself as gastrointestinal, neurological, psychosomatic symptoms, and unusual complaints in association with or without main symptoms, including palpitation, chest pain, syncope, and dyspnea. Symptoms after tachycardia or index event should be questioned systematically.
Collapse
|
10
|
Translation and Validation of the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA) to the Brazilian Context: An Instrument Focusing on Arrhythmia Symptoms. Cardiol Res Pract 2020; 2020:1402916. [PMID: 32351731 PMCID: PMC7171627 DOI: 10.1155/2020/1402916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/26/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction The wide variety of symptoms in patients with cardiac arrhythmias can affect daily living activities. The evaluation of symptoms with patient-reported outcome measures (PROMs), with validated instruments, can provide information that contributes to clinical decisions and treatment. In Brazil, however, there is no available scale that evaluates symptoms in different types of arrhythmias. Purpose This study aimed to translate the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia symptom scale (ASTA-symptom scale) and then validate the questionnaire in terms of Brazilian culture. Method The methodological process of cultural adaptation used was based on international literature guidelines consisting of forward translation, synthesis, back translation, review by an expert committee, and pretest. Psychometric analyses were conducted with 140 patients. These included measuring internal consistency (Cronbach's alpha), construct validity with item-total correlations, and convergent construct validity with correlations with the quality of life questionnaire for patients with atrial fibrillation-version 2 (QVFA-v2). Usability and understandability were evaluated through the usability evaluation of instruments. Results The translation and adaptation processes were performed by obtaining the Brazilian Portuguese version of the original Swedish instrument. This version presented the internal consistency of items, evaluated through Cronbach's α (0.79). Construct validity was demonstrated by item-total correlations for the nine items, all except one reached the level of >0.30 (0.24). Convergent validity showed a high correlation with QVFA-v2 (0.89). As for the evaluation of usability and understanding, after two small suggested changes, no additional alterations were necessary. Conclusion The psychometric properties of the Brazilian version of ASTA-symptom scale evaluated in this study were satisfactory, and the scale was proved to be a valid and reliable tool to assess the symptom burden in patients with different forms of tachyarrhythmia. The ASTA-Br-symptom scale questionnaire can be an important addition to PROMs for patients with arrhythmias and could help healthcare professionals in decision-making.
Collapse
|
11
|
Stridsman M, Strömberg A, Hendriks J, Walfridsson U. Patients' Experiences of Living with Atrial Fibrillation: A Mixed Methods Study. Cardiol Res Pract 2019; 2019:6590358. [PMID: 31885904 PMCID: PMC6915031 DOI: 10.1155/2019/6590358] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/24/2019] [Accepted: 10/26/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Awareness of epidemiological and clinical consequences of atrial fibrillation (AF) has increased, as have disease-related costs. Less attention has been paid to patient-related issues, such as understanding how symptoms, different therapies, and lifestyle adjustments affect daily life. We aimed to describe patients' experiences of living with AF. METHODS The study design used a parallel convergent mixed methods approach. Patients with AF were included in the SMURF study and referred for catheter ablation. Patients completed questionnaires on symptoms, health-related quality of life, depression, anxiety, and perceived control and were interviewed. The datasets were analysed separately using inductive content analysis and descriptive statistics. Data were merged to obtain a final interpretation. RESULTS Nineteen patients were interviewed and 18 completed questionnaires. Twelve of the patients were male, mean age 60 years (45-75 years). Inductive qualitative analysis revealed three categories: (i) symptoms and concerns limiting life, (ii) dimensions of worries, and (iii) strategies for management. The most common symptoms were tiredness, weakness/fatigue, and breathlessness during activities, and the most pronounced negative impacts on health-related quality of life (HRQOL) were physically related, shown in the ASTA questionnaire. The most negative SF-36 scores were found in role limitations due to physical health problems and vitality. HADS revealed five patients with some degree of anxiety and four with some degree of depression. Patients had lower scores on perceived control than perceived helplessness in CAS. Patients' perceived control was higher than their families', and families experienced more helplessness. CONCLUSIONS The mixed methods design deepens our understanding of challenges faced by patients. Patients experienced a limited ability to perform activities of daily living due to AF which created different kinds of worries that encouraged the use of various strategies to manage their lives. Healthcare providers need to be aware that relationships between patients and their relatives can change, and therefore they need to be supported and integrated into the care system.
Collapse
Affiliation(s)
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Jeroen Hendriks
- Department of Medical and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden
- Centre for Heart Rhythm Disorders, University of Adelaide, South Australian Health & Medical Research Institute and Royal Adelaide Hospital, Adelaide, Australia
| | - Ulla Walfridsson
- Department of Medical and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| |
Collapse
|
12
|
Çakmak Karaaslan Ö, Özilhan MO, Çöteli C, Ünal S, Akdi A, Selçuk T, Selçuk H, Maden O. Gender and age differences in patients with atrial fibrillation referred for catheter ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 43:158. [PMID: 31782185 DOI: 10.1111/pace.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Cem Çöteli
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Sefa Ünal
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Akdi
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Timur Selçuk
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Hatice Selçuk
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Orhan Maden
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
13
|
Walfridsson U, Steen Hansen P, Charitakis E, Almroth H, Jönsson A, Karlsson LO, Liuba I, Samo Ayou R, Poci D, Holmqvist F, Kongstad O, Walfridsson H. Gender and age differences in symptoms and health-related quality of life in patients with atrial fibrillation referred for catheter ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1431-1439. [PMID: 31495941 DOI: 10.1111/pace.13795] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/12/2019] [Accepted: 08/30/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Primary indication for catheter ablation of atrial fibrillation (AF) is to reduce symptoms and improve health-related quality of life (HRQoL). There are data showing differences between the genders and between younger and older patients. To evaluate this, we studied a large Scandinavian cohort of patients referred for catheter ablation of AF. METHODS Consecutive patients filled out the ASTA questionnaire, assessing symptoms, HRQoL, and perception of arrhythmia, prior to ablation. Patients were recruited from four Swedish and one Danish tertiary center. RESULTS A total of 2493 patients (72% men) filled out the ASTA questionnaire. Women experienced eight of the nine ASTA scale symptoms more often than men. Patients <65 years reported four symptoms more often, only tiredness was more frequent in those ≥65 years (P = .007). Women and patients <65 years experienced more often palpitations and regarding close to fainting and this was more common among women, no age differences were seen. Women and men scored differently in 10 of the 13 HRQoL items. Only negative impact on sexual life was more common in men (P < .001). Older patients reported more negative influence in four of the HRQoL items and the younger in one; ability to concentrate. CONCLUSIONS Women experienced a more pronounced symptom burden and were more negatively affected in all HRQoL concerns, except for the negative impact on sexual life, where men reported more influence of AF. Differences between age groups were less pronounced. Disease-specific patient-reported outcomes measures (PROMs) add important information where gender differences should be considered in the care.
Collapse
Affiliation(s)
- Ulla Walfridsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Emmanouil Charitakis
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Henrik Almroth
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anders Jönsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars O Karlsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ioan Liuba
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Romeo Samo Ayou
- Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden
| | - Dritan Poci
- Department of Cardiology, University Hospital Örebro, Örebro, Sweden
| | | | - Ole Kongstad
- Dept of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Håkan Walfridsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
14
|
Insulander P, Carnlöf C, Iwarzon M, Jensen-Urstad M, Gadler F. Women with PSVT are more often misdiagnosed compared to men. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1282-1283. [PMID: 31390067 DOI: 10.1111/pace.13771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Per Insulander
- Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Carina Carnlöf
- Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Marie Iwarzon
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Gadler
- Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
15
|
Linde C, Bongiorni MG, Birgersdotter-Green U, Curtis AB, Deisenhofer I, Furokawa T, Gillis AM, Haugaa KH, Lip GYH, Van Gelder I, Malik M, Poole J, Potpara T, Savelieva I, Sarkozy A. Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society. Europace 2018; 20:1565-1565ao. [PMID: 29961863 DOI: 10.1093/europace/euy067] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | | | | | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | | | - Anne M Gillis
- Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Alberta, Canada
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Thrombosis Research Unit, Aalborg University, Denmark
| | - Isabelle Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London
| | - Jeannie Poole
- University of Washington Medical center, Seattle, Washington, USA
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Irina Savelieva
- St. George's, University of London, Cranmer Terrace, London, UK
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | | |
Collapse
|
16
|
Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
| | | | | | | |
Collapse
|
17
|
Diagnostic challenges in supraventricular tachycardia: anticipating value of natriuretic peptides. Cardiovasc Endocrinol Metab 2018; 7:34-36. [PMID: 31646277 DOI: 10.1097/xce.0000000000000148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/21/2017] [Indexed: 12/30/2022]
Abstract
It is important not to overlook supraventricular tachycardia (SVT) in patients complaining of palpitation or tachycardia-related symptoms but with normal ECG and heart rate in emergency department or outpatient clinics. The severity and presentation of symptoms is highly variable and depends on features including heart rate, duration of tachycardia, underlying heart disease, and individual patient perception. Early measurement of natriuretic peptides in patients presenting with palpitation and/or tachycardia-related symptoms would guide the clinician to rule out tachycardia and/or SVT. High levels of natriuretic peptides within 30 min of postattack period would certainly increase the likelihood of SVT.
Collapse
|
18
|
Wood KA, Barnes AH, Paul S, Hines KA, Jackson KP. Symptom challenges after atrial fibrillation ablation. Heart Lung 2017; 46:425-431. [PMID: 28923248 PMCID: PMC5811184 DOI: 10.1016/j.hrtlng.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is unclear what symptom challenges occur during the recovery phase after atrial fibrillation (AF) ablation. OBJECTIVES This longitudinal pilot study explored the patient perspective of the first six months following an AF ablation. METHODS Telephone interviews and questionnaires were used with 20 patients at baseline, at 1, 3, and 6 months after AF ablation. Telephone interview data were analyzed using content analysis. Longitudinal outcomes were analyzed using repeated measures analysis of variance (ANOVA). RESULTS Mean age was 65 ± 7 years and the sample was 55% female. The severity and duration of fatigue was the most concerning symptom. Patient expectations differed from providers' expectations. Recovery was a much slower process than patients expected. CONCLUSIONS Patients struggled to manage symptoms after AF ablation. A more accurate understanding of the symptom challenges following AF ablation could lead to development of more realistic education to improve patient self-management.
Collapse
Affiliation(s)
| | | | | | | | - Kevin P Jackson
- Division of Clinical Cardiac Electrophysiology, Duke University Medical Center, USA.
| |
Collapse
|
19
|
Carnlöf C, Iwarzon M, Jensen-Urstad M, Gadler F, Insulander P. Women with PSVT are often misdiagnosed, referred later than men, and have more symptoms after ablation. SCAND CARDIOVASC J 2017; 51:299-307. [DOI: 10.1080/14017431.2017.1385837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Carina Carnlöf
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Iwarzon
- Karolinska Institute of Medicine, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
| | - Mats Jensen-Urstad
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Gadler
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
20
|
Taylor EC, O'Neill M, Hughes LD, Carroll S, Moss-Morris R. 'It's like a frog leaping about in your chest': Illness and treatment perceptions in persistent atrial fibrillation. Br J Health Psychol 2017; 23:3-21. [PMID: 28875586 DOI: 10.1111/bjhp.12267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 09/09/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Persistent atrial fibrillation (AF) is an abnormal heart rhythm associated with low quality of life (QoL) and significant health-related costs. The purpose of the study was to examine patients' illness and treatment beliefs and ways of coping with AF symptoms, to provide insight into promoting better QoL and treatment-specific management. DESIGN Beliefs were explored across three procedural treatment groups using a qualitative cross-sectional design. METHODS Thirty semi-structured interviews were carried out with patients undertaking cardioversion (n = 10), catheter ablation (n = 11) and atrioventricular node ablation (n = 9). Interviews were transcribed and analysed using inductive thematic analysis with elements of grounded theory. RESULTS An overarching theme of a vicious cycle was evident, which related to perceived lack of knowledge and understanding of AF, attempts to control symptoms and negative emotional reactions to failed control attempts. This vicious cycle related to three subordinate themes: (1) unpredictability and uncertainty of AF and symptoms; (2) coping with symptoms through (a) avoidance (b) all-or-nothing- (c) slowing down behaviours; and (3) concerns and expectations about treatment. CONCLUSIONS Patients outlined a need to gain control of unpredictable symptoms by monitoring and varying activity levels. These behaviours were often appraised as ineffective at controlling symptoms, leading to heightened uncertainty and increased activity avoidance. Treatment concerns escalated with increasing number and invasiveness of procedures. Improving AF patients' perceived understanding of their illness and treatment and promoting more effective symptom-management strategies may alleviate psychological distress and improve QoL. Themes elaborated on the common-sense model whereby patients' beliefs about illness and treatment interact with coping behaviours. Statement of contribution What is already known about this subject? Quality of life (QoL) is disproportionately low in people with persistent atrial fibrillation (psAF). The common-sense model suggests illness perceptions and coping predict QoL in chronic illnesses. No previous studies have examined the idiosyncratic beliefs and coping behaviours of psAF patients. What does this study add? A vicious cycle of perceived lack of understanding of AF, attempts to control AF and distress at failed attempts at control, was a key theme. PsAF patients reported continued avoidance/all-or-nothing behaviours despite symptomatic relief post-procedure, and disengagement from enjoyable activities. PsAF patients reported procedure-specific concerns/expectations, which could be targeted in future interventions aimed at reducing distress.
Collapse
Affiliation(s)
- Elaina C Taylor
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Mark O'Neill
- Divisions of Imaging Sciences & Biomedical Engineering & Cardiovascular Medicine, King's College London, UK
| | - Lyndsay D Hughes
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Carroll
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
21
|
Farkowski MM, Pytkowski M, Maciag A, Golicki D, Kowalik I, Czech M, Rucinski P, Szwed H. Patient's age rather than severity of the arrhythmia influences the cost of medical treatment of atrioventricular nodal or atrioventricular reciprocating tachycardia. J Interv Card Electrophysiol 2016; 47:197-202. [PMID: 27488509 PMCID: PMC5080303 DOI: 10.1007/s10840-016-0167-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/28/2016] [Indexed: 11/30/2022]
Abstract
Purpose Radiofrequency ablation (RFA) is considered the treatment of choice in cases of atrioventricular nodal reciprocating tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). Published studies suggest a considerable time gap between the onset of the arrhythmia, correct diagnosis, and RFA which may reach 10–15 years. The cost of medical treatment during that period may be substantial. The aim of the study was to calculate the annual direct medical cost of medical treatment of patients with AVNRT and AVRT and identify potential factors influencing this cost. Methods Based on the consumption of particular resources and the unit costs of services in 2013, we calculated the annual direct medical cost of care for patients with AVNRT and AVRT in Poland. We adopted the public payer’s and societal perspectives. Data on health resources was collected with a structured questionnaire and medical records of patients scheduled for RFA. Additional analyses were performed to identify factors influencing this cost. Results We enrolled 82 patients: mean age 43.9 ± 14.1 years old and mean symptom duration before the RFA 13.0 ± 11.3 years. The median annual cost of medical treatment was 546 USD [312–957], 411 € [278–786], and 616 USD [369–1044], 464 € [235–721], for the public payer and the common perspective, respectively, with hospitalizations being the main cost component. In multivariate analysis, only the age of the patient significantly influenced this cost. Conclusions The annual cost of medical treatment of AVNRT or AVRT is substantial and dependent on the age of the patient rather than the severity of the arrhythmia (NCT01594814).
Collapse
Affiliation(s)
- Michal M Farkowski
- The 2nd Department of Coronary Artery Disease, Institute of Cardiology, Spartanska 1 St., 02-637, Warsaw, Poland.
| | - Mariusz Pytkowski
- The 2nd Department of Coronary Artery Disease, Institute of Cardiology, Spartanska 1 St., 02-637, Warsaw, Poland
| | - Aleksander Maciag
- The 2nd Department of Coronary Artery Disease, Institute of Cardiology, Spartanska 1 St., 02-637, Warsaw, Poland
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Ilona Kowalik
- The 2nd Department of Coronary Artery Disease, Institute of Cardiology, Spartanska 1 St., 02-637, Warsaw, Poland
| | - Marcin Czech
- Business School, Warsaw University of Technology, Warsaw, Poland
| | | | - Hanna Szwed
- The 2nd Department of Coronary Artery Disease, Institute of Cardiology, Spartanska 1 St., 02-637, Warsaw, Poland
| |
Collapse
|
22
|
Nordblom AK, Broström A, Fridlund B. Impact on a Person’s Daily Life During Episodes of Supraventricular Tachycardia. J Holist Nurs 2016; 35:33-43. [DOI: 10.1177/0898010116639722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To describe the impact of episodes of supraventricular tachycardia (SVT) on a person’s daily life from a holistic perspective. Method: A deductive descriptive design was used. Twenty semistructured interviews (12 women and 8 men) were conducted before planned ablation of SVT and were analyzed using qualitative content analysis. Results: Living with SVT had a complex impact on daily life. Initially, the patients described an inhibited existence due to demands to give up things that they had previously been doing, in case the unpredictable episodes of SVT would occur. The episodes caused fatigue and worry, which together created a barrier for living life to the full by making the person give up undertakings. The patients constantly needed to find short-term and long-term strategies to prevent new episodes from happening. Conclusion: Episodes of SVT entail a complex life situation as the person’s entire existence is affected in daily life. To understand the impact of SVT on daily life, nurses and other health care professionals need increased knowledge and understanding to be able to provide support through relevant information and take optimal care measures.
Collapse
Affiliation(s)
| | - Anders Broström
- Jönköping University, Jönköping, Sweden
- University Hospital, Linköping, Sweden
| | | |
Collapse
|
23
|
Symptoms in supraventricular tachycardia: Is it simply a manifestation of increased heart rate? Med Hypotheses 2016; 91:42-43. [PMID: 27142141 DOI: 10.1016/j.mehy.2016.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/08/2016] [Indexed: 11/21/2022]
Abstract
A significant proportion of patients in clinical practice may not have ECG recordings of the index tachycardia (non-documented SVT), or only have recordings of limited diagnostic value. Despite the highly specified symptomatic and ECG diagnostic criteria, diagnosis and referral for ablation treatment is not always straightforward. Although ECG based diagnostic or treatment algorithms have been well defined in literature, we need a symptom based diagnostic algorithm or scoring system in patients with suspected supraventricular arrhythmia. Individual approaches with a high suspicion index and concerning the paroxysmal nature and post attack symptoms would help us to identify patients suffering from SVT in complex cases.
Collapse
|
24
|
Development and validation of an arrhythmia-specific scale in tachycardia and arrhythmia with focus on health-related quality of life. J Cardiovasc Nurs 2015; 30:98-108. [PMID: 24763354 DOI: 10.1097/jcn.0000000000000149] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Arrhythmias can cause a profoundly negative impact on a person's daily life, leading to impaired health-related quality of life (HRQOL). Assessment of HRQOL can provide valuable information before, during, and after healthcare interventions for arrhythmias. OBJECTIVE The aim was to develop and validate a disease-specific scale evaluating HRQOL in patients with different forms of arrhythmia. METHODS The Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA HRQOL) was developed from a literature review, patient interviews, and expert panel evaluations. This version was then psychometrically evaluated in patients treated with radiofrequency catheter ablation because of different forms of arrhythmias and patients who sought emergency care because of atrial fibrillation. Construct validity was evaluated with item-total correlations, confirmatory factor analyses, and convergent and discriminant validity. Internal consistency was evaluated using Cronbach's α. RESULTS All items reached the expected level of item-total correlations of greater than 0.3 for the total scale. The content validity index was sufficient for all items, as was the total scale (0.86-1.0). The 2-factor confirmatory factor analysis model that included the physical and mental factors showed a better fit between model and data than the 1-factor model did (P < .001). Convergent and discriminant validities were evaluated in the correlation analyses between the ASTA HRQOL subscales and SF-36 physical and mental dimensions. A strong correlation was found between the hypothesized physical and mental scales. Internal consistency was satisfactory with a lower bound confidence interval (95%) for Cronbach's α .70 or greater for all the ASTA HRQOL scales. CONCLUSIONS The ASTA HRQOL questionnaire can be a valuable contribution to HRQOL assessments in patients with different forms of arrhythmia. Until there is more evidence regarding validity and reliability, using both the total and subscale scores is recommended.
Collapse
|
25
|
Abo-Haded HM. Radiofrequency ablation changes the quality of life of children with supraventricular tachycardias. Arch Dis Child 2015; 100:754-7. [PMID: 25838334 DOI: 10.1136/archdischild-2014-306466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/10/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Radiofrequency ablation (RFA) has rapidly become the first-line therapy for children with supraventricular tachycardia (SVT). Recently, more attention has been given to the measurement of health-related quality of life (QoL) in children. The primary aim of this study was to determine if there is a change in the QoL in children with SVT pre and post RFA procedure using the Pediatric Quality of Life Inventory (PedsQL) cardiac inventory. In addition, the study discusses the impact of age, gender and variety of SVT mechanisms on the QoL. DESIGN, SETTING AND PATIENTS All consecutive children with SVT referred for RFA at Mansoura University Children's Hospital were enrolled in this study. The PedsQL cardiac module questionnaire was given to the children/parents to be filled out before and 1 month following RFA procedure. Evaluated areas were physical, emotional, social, school and psychosocial function. The paired t test was used to test the difference between pre-time and post-time points for the study groups. Demographic and clinical data were collected. RESULTS The study sample consisted of 38 patients who underwent a successful ablation. The mean age of the patients at the time of RFA procedure was 12.4±5.3 years. There was a statistically significant improvement in all measured areas 1 month post successful RFA as compared with pre ablation. Post ablation, the greatest score improvement was in physical functioning. Older children (>12 years) showed the greatest benefit, but gender and type of SVT did not influence outcome. CONCLUSIONS RFA therapy is useful in improving QoL and perceptions in children with recurrent SVT.
Collapse
|
26
|
Withers KL, Wood KA, Carolan-Rees G, Patrick H, Lencioni M, Griffith M. Living on a knife edge-the daily struggle of coping with symptomatic cardiac arrhythmias. Health Qual Life Outcomes 2015; 13:86. [PMID: 26104746 PMCID: PMC4477616 DOI: 10.1186/s12955-015-0282-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/10/2015] [Indexed: 11/17/2022] Open
Abstract
Background In 2010 a retrospective audit was undertaken to assess the viability of using PROMs in patients with symptomatic cardiac arrhythmias having undergone percutaneous arrhythmia ablation. A response rate of 74 % was achieved, with finding suggesting that arrhythmia patients reported a significant impact on their work, social and family life. Aims To conduct a qualitative cross sectional survey to understand patients’ perspectives of how cardiac arrhythmias affect their daily lives, as part of a program to develop a Patient Reported Outcome Measure (PROM). Method Twenty five patients aged 18 or over, diagnosed with a variety of symptomatic cardiac arrhythmias referred for a cardiac ablation procedure took part in cognitive interviews. These aimed to inform the development of a patient reported outcome measure and to determine factors important to this patient group. Common themes were identified using content analysis. Results Participants reported that symptoms of their arrhythmia caused them considerable problems and impacted adversely on their quality of life in many ways. This extended through daily routine, work and social activities and also to friends and family, with fear and anxiety being significant factors for most responders. Patients felt their illness was poorly understood, even by health professionals, and often reported that they felt isolated, lacking support and information. Conclusion Symptomatic cardiac arrhythmias are a source of debilitating and life limiting symptoms, having a negative impact on quality of life. Symptoms and related complications are relevant across different arrhythmia substrates and patient groups. Trial registration The study is registered on the Clinical Trials website, Identifier NCT01672528
Collapse
Affiliation(s)
- Kathleen L Withers
- Cedar, Cardiff & Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK.
| | - Kathryn A Wood
- Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC, 27710, USA.
| | - Grace Carolan-Rees
- Cedar, Cardiff & Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK.
| | - Hannah Patrick
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU, UK.
| | - Mauro Lencioni
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Edgebaston, Birmingham, B15 2GW, UK.
| | - Michael Griffith
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Edgebaston, Birmingham, B15 2GW, UK.
| |
Collapse
|
27
|
Lane DA, Aguinaga L, Blomström-Lundqvist C, Boriani G, Dan GA, Hills MT, Hylek EM, LaHaye SA, Lip GYH, Lobban T, Mandrola J, McCabe PJ, Pedersen SS, Pisters R, Stewart S, Wood K, Potpara TS, Gorenek B, Conti JB, Keegan R, Power S, Hendriks J, Ritter P, Calkins H, Violi F, Hurwitz J. Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2015; 17:1747-69. [PMID: 26108807 DOI: 10.1093/europace/euv233] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
28
|
Adaptive leadership framework for chronic illness: framing a research agenda for transforming care delivery. ANS Adv Nurs Sci 2015; 38:83-95. [PMID: 25647829 PMCID: PMC4417005 DOI: 10.1097/ans.0000000000000063] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We propose the Adaptive Leadership Framework for Chronic Illness as a novel framework for conceptualizing, studying, and providing care. This framework is an application of the Adaptive Leadership Framework developed by Heifetz and colleagues for business. Our framework views health care as a complex adaptive system and addresses the intersection at which people with chronic illness interface with the care system. We shift focus from symptoms to symptoms and the challenges they pose for patients/families. We describe how providers and patients/families might collaborate to create shared meaning of symptoms and challenges to coproduce appropriate approaches to care.
Collapse
|
29
|
Withers KL, Wood KA, Carolan-Rees G, Patrick H, Lencioni M, Griffith M. Establishing content validity in a novel patient reported outcome measure for cardiac arrhythmia ablation patients. Health Qual Life Outcomes 2015; 13:38. [PMID: 25884567 PMCID: PMC4520263 DOI: 10.1186/s12955-015-0233-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/10/2015] [Indexed: 11/29/2022] Open
Abstract
AIM Preliminary content validity testing of a UK Patient Reported Outcome Measure (PROM) for use in cardiac arrhythmia patients undergoing ablation treatment. METHODS Twenty five patients diagnosed with symptomatic cardiac arrhythmias participated in qualitative interviews to obtain their perspective of a draft PROM. As part of the process to establish preliminary content validity, patients were asked to complete the questionnaires and to identify missing and redundant items within the PROM, while also reviewing the instructions and formatting. The questionnaires were updated iteratively to reflect patient feedback. RESULTS Recurring themes were identified during qualitative interviews leading to improvements to the tool. Following modification of the PROM, based on patient feedback, subjects reported that the tool was fully inclusive and easy to comprehend. Patients found the instructions and layout of the tool acceptable and easy to use. CONCLUSION Qualitative patient interviews are an important part of PROM tool development. In the case of this cardiac ablation PROM, it enabled end users to assess the tool for inclusivity and accessibility, and to ensure that it addressed concerns important to the patient. Cognitive interviews were able to obtain patients' perspectives to establish face validity and content validity of the PROM. This is part of a process which will ensure that this disease-specific PROM measures cardiac arrhythmia patient symptoms and impact on patients' lives accurately and sensitively. The next study will use the PROM prospectively in over 450 arrhythmia patients to prospectively validate the tool. CONDENSED ABSTRACT Patients diagnosed with symptomatic cardiac arrhythmias provided feedback through cognitive interviews to facilitate improvements in a new disease specific PROM establishing preliminary face and content validity.
Collapse
Affiliation(s)
- Kathleen L Withers
- Cedar, Cardiff & Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK.
| | - Kathryn A Wood
- Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC, 27710, USA.
| | - Grace Carolan-Rees
- Cedar, Cardiff & Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK.
| | - Hannah Patrick
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU, UK.
| | - Mauro Lencioni
- University Hospitals Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, B15 2GW, UK.
| | - Michael Griffith
- University Hospitals Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, B15 2GW, UK.
| |
Collapse
|
30
|
Dalteg T, Benzein E, Sandgren A, Fridlund B, Malm D. Managing uncertainty in couples living with atrial fibrillation. J Cardiovasc Nurs 2014; 29:E1-10. [PMID: 24108265 DOI: 10.1097/jcn.0b013e3182a180da] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Living with a chronic disease such as atrial fibrillation (AF) not only affects the patient but also has implications for the partner. There is a lack of research on couples living with AF and, in particular, how they experience and deal with the disease. OBJECTIVE The aim of this study was to explore couples' main concerns when one of the spouses is afflicted with AF and how they continually handle it within their partner relationship. METHODS Classical grounded theory was used throughout the study for data collection and analysis. Interviews were conducted with 12 couples (patient and partner together). There were follow-up interviews with 2 patients and 2 partners separately. RESULTS Couples living with AF experience uncertainty as a common main concern. This uncertainty was fundamentally rooted in not knowing the cause of AF and apprehension about AF episodes. Couples managed this uncertainty by either explicitly sharing concerns related to AF or through implicitly sharing their concerns. Explicit sharing incorporated strategies of mutual collaboration and finding resemblance, whereas implicit sharing incorporated strategies of keeping distance and tacit understanding. Time since diagnosis and time being symptom-free were factors influencing afflicted couples' shifting between implicit and explicit sharing. CONCLUSIONS Atrial fibrillation affects the partner relationship by bringing uncertainty into couples' daily lives. Even though this study shares similarities with previous studies on couples living with chronic disease, it contributes to the existing knowledge by presenting a set of strategies used by couples in managing uncertainty when living with AF.
Collapse
Affiliation(s)
- Tomas Dalteg
- Tomas Dalteg, MSc, RN Doctoral Student, School of Health Sciences, Jönköping University, Jönköping, Sweden. Eva Benzein, PhD, RN Professor, School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden. Anna Sandgren, PhD, RN Senior Lecturer, School of Health Sciences, Jönköping University, Jönköping, Sweden. Bengt Fridlund, PhD, RN Professor, School of Health Sciences, Jönköping University, Jönköping, Sweden. Dan Malm, PhD, RN Senior Lecturer, School of Health Sciences, Jönköping University, and Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | | | | | | | | |
Collapse
|
31
|
McCabe PJ, Rhudy LM, DeVon HA. Patients' experiences from symptom onset to initial treatment for atrial fibrillation. J Clin Nurs 2014; 24:786-96. [PMID: 25421608 DOI: 10.1111/jocn.12708] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2014] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe patients' experiences from symptom onset to initial treatment for atrial fibrillation. BACKGROUND The estimated number of individuals with atrial fibrillation globally in 2010 was 33·5 million. World-wide, each year, new cases of atrial fibrillation approach 5 million, and prevalence will increase 2·5-fold by 2050. As a result, clinicians worldwide will treat a growing number of patients with atrial fibrillation. Early intervention to promote atrial fibrillation self-management is critical to reduce associated complications of stroke and heart failure. Greater understanding of patients' experiences from symptom onset to initial treatment for atrial fibrillation is needed to guide development of interventions to promote early effective self-management. DESIGN A descriptive qualitative design was used. METHODS Twenty females and 21 males at an academic medical centre were interviewed using open-ended questions to explore their experiences from symptom onset to initial treatment for atrial fibrillation. Data were analysed using qualitative content analysis. RESULTS Participants' mean age was 64·3 (SD = 10·1) years. Four themes were identified: (1) misinterpreting symptoms; (2) discovering the meaning of atrial fibrillation; (3) facing fears, uncertainty, and moving to acceptance; and (4) receiving validation and reassurance. Participants lacked knowledge of atrial fibrillation and took cues from providers' responses to appraise symptoms and diagnosis. Fear and uncertainty were reduced when providers initiated prompt treatment and took time to explain atrial fibrillation. Patients appreciated receiving clear information about atrial fibrillation, were engaged in learning, and motivated to participate in their care. CONCLUSIONS Providers played a critical role in helping patients to develop an accurate understanding of atrial fibrillation, to cope with the new diagnosis, and motivated them to engage in effective self-management. RELEVANCE TO CLINICAL PRACTICE Insight into participant experiences from symptom onset to initial treatment for atrial fibrillation may inform development of interventions to promote effective atrial fibrillation self-management.
Collapse
|
32
|
Farkowski MM, Pytkowski M, Maciag A, Golicki D, Wood KA, Kowalik I, Kuteszko R, Szwed H. Gender-related differences in outcomes and resource utilization in patients undergoing radiofrequency ablation of supraventricular tachycardia: results from Patients' Perspective on Radiofrequency Catheter Ablation of AVRT and AVNRT Study. Europace 2014; 16:1821-7. [DOI: 10.1093/europace/euu130] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
33
|
Withers KL, White J, Carolan-Rees G, Patrick H, O'Callaghan P, Murray S, Cunningham D, Wood KA, Lencioni M, Griffith M. Patient reported outcome measures for cardiac ablation procedures: a multicentre pilot to develop a new questionnaire. Europace 2014; 16:1626-33. [PMID: 24627541 PMCID: PMC4209127 DOI: 10.1093/europace/euu032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Aim To assess the feasibility of administering Patient Reported Outcomes Measures (PROMs) in patients treated with ablation for cardiac arrhythmias, and to conduct the first stage of development and testing of a new PROM tool. Methods and results A new tool was developed by a multidisciplinary team and tested alongside an adaptation of the patient perception of arrhythmia questionnaire (PPAQ) and EQ-5D-5L in a multicentre retrospective audit involving 791 consecutive cardiac arrhythmia patients treated with catheter ablation at three UK centres over 13 months. Data were recorded in the National Cardiac Rhythm Management Database, part of the National Institute for Cardiovascular Outcomes Research. The response rate was 71.9% (n = 569). Patients reported significant improvements across all outcomes and impacts, with reductions in symptoms of 51.7% (heart racing), 33.9% (fatigue) 31.8% (heart flutters), 43.5% (dizziness), 38.6% (breathlessness), 44.2% (chest pressure), 33.1% (trouble concentrating), 15.9% (headache), 28.3% (neck pressure), and 23.4% (fainting) (P < 0.001). The mean number of social days affected reduced by 7.49 days/month (P < 0.001); mean work/school days affected/month reduced by 6.26 (P < 0.001); mean GP/hospital visits reduced by 1.36 days/month (P < 0.001). The procedure met patient expectations in 72% of responders. Conclusions The high response rate suggests that the use of PROMs in this patient group is feasible, with rates equalling those of the National PROMs Programme. The results showed that patients experienced significant improvements in their quality of life following ablation, while feedback allowed the tools to be improved. Further work is required to validate these tools; however, the findings suggest that PROMs could be useful in the audit of ablation techniques.
Collapse
Affiliation(s)
- Kathleen L Withers
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK
| | - Judith White
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK
| | - Grace Carolan-Rees
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK
| | - Hannah Patrick
- National Institute of Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU, UK
| | - Peter O'Callaghan
- Cardiology Department, Cardiff and Vale University Health Board, Heath Park, Cardiff, CF14 4UJ, UK
| | - Stephen Murray
- Cardiology Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN, UK
| | - David Cunningham
- National Institute for Cardiovascular Outcomes Research, University College London Institute of Cardiovascular Outcomes, London, W1T 7HA, UK
| | | | - Mauro Lencioni
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Michael Griffith
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| |
Collapse
|
34
|
Royster C, Melander S. Radiofrequency Ablation for Common Supraventricular Tachycardias Other Than Atrial Fibrillation. J Nurse Pract 2013. [DOI: 10.1016/j.nurpra.2013.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
35
|
Abstract
Panic attacks occur in about 2 % of the population. Symptoms include a racing or pounding heart beat, chest pain, dizziness, light-headedness, nausea, difficulty in breathing, tingling or numbness in the hands, flushes or chills, dreamlike sensations or perceptual distortions. The symptoms of paroxysmal supraventricular tachycardia (PSVT) may be similar. A PSVT is often difficult to document on the ECG since it has often ceased before the patient comes to medical attention. Besides, a tachycardia may still be present and even be documented but interpreted as a phenomenon secondary to the panic attack. In addition, ECG abnormalities between episodes can often not be identified. The evidence that in some patients paroxysmal SVT is the cause, but not the consequence of a panic attack, is based on observations that catheter ablation was able to cure patients presenting with panic disorders. To better establish the prevalence of SVT as the underlying mechanism of a panic attack, there is a need for prospective studies and/or registries. Whereas gastric ulcer has in some patients changed from a psychosomatic disorder to an infectious disease, we may hypothesise that a certain proportion of panic disorders may mutate into an underlying arrhythmia rather than a primary psychiatric disorder.
Collapse
|
36
|
Ekblad H, Rönning H, Fridlund B, Malm D. Patients' well-being: experience and actions in their preventing and handling of atrial fibrillation. Eur J Cardiovasc Nurs 2012; 12:132-9. [PMID: 22936792 DOI: 10.1177/1474515112457132] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) influences the lives of patients in the form of worsened well-being. Patients' own experience of and how to handle AF is rarely investigated. These are important aspects for healthcare services to understand in order to support the well-being of patients with AF. AIM To explore and describe critical incidents in which patients experience how AF affects their well-being and what actions they take to prevent and handle it. DESIGN AND METHODS An explorative, descriptive design based on the critical incident technique (CIT) was used. Interviews were conducted with 25 patients (16 men and 9 women) with AF in a healthcare area in southern Sweden. RESULTS Patients experienced discomfort and limitations in daily life. The actions they took were self-care related actions and healthcare related actions. CONCLUSION AF affects well-being when it is uncomfortable and leads to pronounced limitations in daily life with the patients trying to maintain or restore well-being through adapting and developing strategies for self-care. Patients base the handling of AF on their personal experience.
Collapse
Affiliation(s)
- Helena Ekblad
- School of Health Sciences, Jönköping University, Jönköping, Sweden.
| | | | | | | |
Collapse
|
37
|
Gehi AK, Sears S, Goli N, Walker TJ, Chung E, Schwartz J, Wood KA, Guise K, Mounsey JP. Psychopathology and symptoms of atrial fibrillation: implications for therapy. J Cardiovasc Electrophysiol 2012; 23:473-8. [PMID: 22429764 DOI: 10.1111/j.1540-8167.2011.02264.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Current guidelines recommend that the choice of AF management strategy be guided by the symptomatic status of the patient when in AF. However, little is known regarding what drives AF symptoms. Several limited studies suggest that psychological distress may be linked with AF symptom severity. METHODS A total of 300 patients with documented AF completed a questionnaire assessing general health and well-being, including a comprehensive psychological assessment as well as disease-specific measures of AF symptom severity. AF burden was determined by 1-week continuous looping monitor in a subset of patients. Analysis of covariance was used to determine the association between individual measures of depression, anxiety, and somatization disorder symptom severity with measures of general health status and AF-specific symptom severity, adjusting for important confounders. RESULTS Patients with worsened severity of depression, anxiety, or somatization disorder symptoms had an associated increase in the severity of symptoms attributed to AF regardless of AF severity scale used (P < 0.0001 for each measure of psychological distress). This association persisted after adjusting for important confounders. Increasing severity of depression and anxiety symptoms were also associated with increased visits to medical care for AF management. CONCLUSIONS Our study demonstrates the consequence of psychological distress on AF-specific symptom severity and healthcare resource utilization. Psychological well-being may strongly influence symptom severity and healthcare utilization. An assessment of psychological distress may be an important adjunct to standard AF management that warrants further study, particularly if symptom relief is the primary goal.
Collapse
Affiliation(s)
- Anil K Gehi
- Department of Medicine, University of North Carolina at Chapel Hill, NC, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
HANSEN BRITTS, RØRTVEIT KRISTINE, LEIKNES INGRID, MORKEN INGVILD, TESTAD INGELIN, JOA INGE, SEVERINSSON ELISABETH. Patient experiences of uncertainty - a synthesis to guide nursing practice and research. J Nurs Manag 2012; 20:266-77. [DOI: 10.1111/j.1365-2834.2011.01369.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
39
|
Walfridsson U, Walfridsson H, Årestedt K, Strömberg A. Impact of radiofrequency ablation on health-related quality of life in patients with paroxysmal supraventricular tachycardia compared with a norm population one year after treatment. Heart Lung 2011; 40:405-11. [DOI: 10.1016/j.hrtlng.2010.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Revised: 09/07/2010] [Accepted: 09/14/2010] [Indexed: 11/25/2022]
|
40
|
|
41
|
McCABE PAMELAJ, BARNASON SUSANA, HOUFEK JULIA. Illness Beliefs in Patients with Recurrent Symptomatic Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:810-20. [DOI: 10.1111/j.1540-8159.2011.03105.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
Wood KA, Stewart AL, Drew BJ, Scheinman MM, Froëlicher ES. Patient perception of symptoms and quality of life following ablation in patients with supraventricular tachycardia. Heart Lung 2009; 39:12-20. [PMID: 20109982 DOI: 10.1016/j.hrtlng.2009.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 02/08/2009] [Accepted: 04/07/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES It remains unclear which symptom experiences and aspects of quality of life (QOL) change after ablation in patients with supraventricular tachycardia (SVT). To determine how patient perceptions of symptoms and QOL change after ablation, we used a single group pretest-posttest design. METHODS Patients with SVT (n=52; mean age 41+/-17 years; 65% female) completed generic and disease-specific measures at baseline and 1 month after ablation. RESULTS Significant improvement after ablation was noted on virtually all measures (P <.05). Patients reported decreases from baseline regarding frequency and duration of episodes, number of symptoms, and impact of SVT on routine activities. All symptoms decreased in prevalence; however, no symptoms were completely eliminated at 1-month follow-up. Women, more so than men, reported larger changes in symptom and QOL scores after ablation. CONCLUSIONS Despite the small sample, statistically significant improvement was found after ablation in a variety of patients with different symptoms and QOL indices.
Collapse
Affiliation(s)
- Kathryn A Wood
- Duke University School of Nursing, Durham, NC 27710, USA.
| | | | | | | | | |
Collapse
|
43
|
Wood KA, Stewart AL, Drew BJ, Scheinman MM, Frolicher ES. Development and initial psychometric evaluation of the Patient Perspective of Arrhythmia Questionnaire. Res Nurs Health 2009; 32:504-16. [PMID: 19701927 DOI: 10.1002/nur.20347] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There are no disease-specific questionnaires to measure patient sensitive outcomes in arrhythmia patients. We report the development and preliminary psychometric testing of the Patient Perception of Arrhythmia Questionnaire (PPAQ). The PPAQ was developed using formative research, exploratory factor analysis, expert review, pilot study, and regression. The PPAQ measures frequency and duration of episodes, symptoms, impact on daily activities, and restricted activity days. After preliminary content validation, the sensitivity of the PPAQ was tested in 103 arrhythmia patients. The measures showed good sensitivity and reliability. Preliminary construct validation was supported by significant differences (p < .001) among groups of arrhythmia patients consistent with clinical patterns. Preliminary evidence from patients with supraventricular arrhythmias suggests that the questionnaire has acceptable psychometrics and could be useful in future studies of arrhythmia patients.
Collapse
Affiliation(s)
- Kathryn A Wood
- School of Nursing, Duke University, 307 Trent Drive, DUMC Box 3322, Durham, NC 27710, USA
| | | | | | | | | |
Collapse
|