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Eichner NZM, Zhu QM, Granados A, Berry NC, Saha SK. Factors that predict compliance in a virtual cardiac rehabilitation program. Int J Cardiol 2023; 393:131364. [PMID: 37722456 DOI: 10.1016/j.ijcard.2023.131364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Despite the well-established benefits of cardiac rehabilitation (CR) for patients with cardiovascular disease (CVD), participation in CR remain low. Virtual CR programs present a unique opportunity to promote utilization. To date, few virtual CR cohorts have been analyzed for compliance. This study aims to determine factors that predict compliance within a large virtual CR program in the United States. METHODS We analyzed 1409 patients enrolled in the Kaiser Permanente Mid-Atlantic States Virtual CR program that consists of 12 CR sessions via telephone. Demographic characteristics, as well as body weight, blood pressure, HbA1c level, and smoking status were collected at admission. Patients were further classified by CVD diagnosis codes. Compliance was defined as at least 75% (9/12 sessions) attendance. Data was analyzed using simple and multiple regression models with significance defined as P < 0.05. RESULTS Age was the single strongest predictor for virtual CR compliance (adjusted R2 = 0.58; P < 0.001), and non-compliant patients were younger. HbA1C level, CVD diagnosis codes, and smoking status each moderately predicted compliance (adjusted R2 = 0.48, 0.42, and 0.31, respectively; P < 0.001). Smoking and HbA1C level combined in a multiple regression model significantly improved prediction of compliance (adjusted R2 = 0.79, P < 0.01). Sex, baseline weight or hypertension were not significant predictors of CR compliance. CONCLUSIONS Age, diabetes, CVD diagnoses, smoking status at admission are independent predictors of compliance in a large virtual CR program. Targeted intervention could be designed accordingly to improve CR compliance.
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Affiliation(s)
| | - Qiuyu Martin Zhu
- Kaiser Permanente Mid-Atlantic States Internal Medicine Residency Program, Gaithersburg, MD 20879, USA
| | - Adelita Granados
- Kaiser Permanente of the Mid-Atlantic States, Rockville, MD 20852, USA
| | - Natalia C Berry
- Mid-Atlantic Permanente Medical Group, McLean, VA 22102, USA.
| | - Sudip K Saha
- Mid-Atlantic Permanente Medical Group, McLean, VA 22102, USA
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Xie X, Chen Q, Liu H. Barriers to hospital-based phase 2 cardiac rehabilitation among patients with coronary heart disease in China: a mixed-methods study. BMC Nurs 2022; 21:333. [PMID: 36447215 PMCID: PMC9706833 DOI: 10.1186/s12912-022-01115-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) has become a leading cause of morbidity and premature death worldwide. Cardiac rehabilitation (CR) was proved to have substantial benefits for patients with CHD. The CR was divided into three phases. Phase 2 is the important part of CR which involves hospital-based structured and closely monitored exercises and activities. However, CR utilization is low worldwide. The barriers to hospital-based phase 2 CR in China have not been well identified. AIMS To investigate barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in China and to explore the reasons. METHODS This study employed an explanatory sequential mixed-methods design. The study was conducted in a university hospital in China from July 2021 to December 2021. Quantitative data was collected through the Cardiac Rehabilitation Barrier Scale. Qualitative data was collected through unstructured face-to-face interviews. Data analysis included descriptive statistics and inductive qualitative content analysis. RESULTS One hundred and sixty patients completed the Cardiac Rehabilitation Barrier Scale and 17 patients participated in unstructured face-to-face interviews. The main barriers identified were distance (3.29 ± 1.565), transportation (2.99 ± 1.503), cost (2.76 ± 1.425), doing exercise at home (2.69 ± 1.509) and time constraints (2.48 ± 1.496). Six themes were identified; logistical factors, social support, misunderstanding of cardiac rehabilitation, program and health system-level factors, impression of CR team and psychological distress. The first four themes confirmed the quantitative results and provide a deeper explanation for the quantitative results. The last two themes were new information that emerged in the qualitative phase. CONCLUSION This study provides a better understanding of the barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in the Chinese context during the Covid-19 pandemic. Innovative programs such as home-based CR, mobile health, and hybrid programs might be considered to overcome some of these barriers. In addition, psychosocial intervention should be included in these programs to mitigate some of the barriers associated with the impression of CR team and psychological distress.
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Affiliation(s)
- Xiaoqi Xie
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Qiongshan Chen
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Hui Liu
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
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Abstract
PURPOSE Cardiac rehabilitation (CR) has been shown to improve functional status, quality of life, and recurrent cardiovascular disease (CVD) events. Despite its demonstrated compelling benefits and guideline recommendation, CR is underutilized, and there are significant disparities in CR utilization particularly by race, ethnicity, sex, and socioeconomic status. The purpose of this review is to summarize the evidence and drivers of these disparities and recommend potential solutions. METHODS In this review, key studies documenting disparities in CR referrals, enrollment, and completion are discussed. Additionally, potential mechanisms for these disparities are summarized and strategies are reviewed for addressing them. SUMMARY There is a wealth of literature demonstrating disparities among racial and ethnic minorities, women, those with lower income and education attainment, and those living in rural and dense urban areas. However, there was minimal focus on how the social determinants of health contribute to the observed disparities in CR utilization in many of the studies reviewed. Interventions such as automatic referrals, inpatient liaisons, mitigation of economic barriers, novel delivery mechanisms, community partnerships, and health equity metrics to incentivize health care organizations to reduce care disparities are potential solutions.
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Affiliation(s)
- Lena Mathews
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine
- Welch Center for Prevention, Epidemiology and Clinical Research; Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic College of Medicine, Rochester, Minnesota
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota
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Review of Recent Cardiac Rehabilitation Research Related to Enrollment/Adherence, Mental Health, and Other Populations. J Cardiopulm Rehabil Prev 2021; 41:302-307. [PMID: 34461620 DOI: 10.1097/hcr.0000000000000649] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This review overviews three topic areas observed to be highly active in the cardiac rehabilitation (CR) research literature published in 2019 and 2020. Topics summarized were enrollment or adherence in CR programs; mental health, particularly depression, stress, and anxiety of patients participating in CR programs; and patients participating in CR programs with diagnoses other than coronary artery bypass graft, myocardial infarction, or percutaneous coronary interventions.
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Pack QR, Visintainer P, Farah M, LaValley G, Szalai H, Lindenauer PK, Lagu T. Development of a Simple Clinical Tool for Predicting Early Dropout in Cardiac Rehabilitation: A SINGLE-CENTER RISK MODEL. J Cardiopulm Rehabil Prev 2021; 41:159-165. [PMID: 32947327 PMCID: PMC8147728 DOI: 10.1097/hcr.0000000000000541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonadherence to cardiac rehabilitation (CR) is common despite the benefits of completing a full program. Adherence might be improved if patients at risk of early dropout were identified and received an intervention. METHODS Using records from patients who completed ≥1 CR session in 2016 (derivation cohort), we employed multivariable logistic regression to identify independent patient-level characteristics associated with attending <12 sessions of CR in a predictive model. We then evaluated model discrimination and validity among patients who enrolled in 2017 (validation cohort). RESULTS Of the 657 patients in our derivation cohort, 318 (48%) completed <12 sessions. Independent risk factors for not attending ≥12 sessions were age <55 yr (OR = 0.23, P < .001), age 55 to 64 yr (OR = 0.35, P < .001), age ≥75 yr (OR = 0.64, P = .06), smoker within 30 d of CR enrollment (OR = 0.40, P = .001), low risk for exercise adverse events (OR = 0.54, P = .03), and nonsurgical referral diagnosis (OR = 0.66, P = .02). Our model predicted nonadherence risk from 23-90%, had acceptable discrimination and calibration (C-statistics = 0.70, Harrell's E50 and E90 2.0 and 3.6, respectively) but had fair validity among 542 patients in the validation cohort (C-statistic = 0.62, Harrell's E50 and E90 2.1 and 11.3, respectively). CONCLUSION We developed and evaluated a single-center simple risk model to predict nonadherence to CR. Although the model has limitations, this tool may help clinicians identify patients at risk of early dropout and guide intervention efforts to improve adherence so that the full benefits of CR can be realized for all patients.
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Affiliation(s)
- Quinn R Pack
- Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts (Drs Pack and LaValley and Ms Szalai); Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield (Drs Pack, Visintainer, Lindenauer, and Lagu); Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield (Drs Pack, Farah, Lindenauer, and Lagu); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (Dr Lindenauer)
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Vonk T, Nuijten MAH, Maessen MFH, Meindersma EP, Koornstra-Wortel HJJ, Waskowsky MM, Snoek JA, Eijsvogels TMH, Hopman MTE. Identifying Reasons for Nonattendance and Noncompletion of Cardiac Rehabilitation: INSIGHTS FROM GERMANY AND THE NETHERLANDS. J Cardiopulm Rehabil Prev 2021; 41:153-158. [PMID: 33797455 PMCID: PMC8081445 DOI: 10.1097/hcr.0000000000000580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite strong recommendations and beneficial health effects of cardiac rehabilitation (CR), participation rates remain low. Little data are available on reasons beyond quantitative factors in the underutilization of CR. The aim of this study was to identify personal reasons for nonattenders and noncompletions of CR among Dutch and German patients with cardiovascular diseases (CVD) eligible for CR. METHODS Between December 2017 and January 2019, a total of 4265 questionnaires were distributed among eligible patients for CR in the bordering area of the eastern Netherlands and western Germany. Patients were eligible if they had an indication for CR according to national guidelines. Questionnaires were used to assess reasons of nonattendance and noncompletion of CR, when applicable. RESULTS A total of 1829 patients with CVD completed the questionnaire. Of these, 1278 indicated that they received referral to CR. Despite referral, 192 patients decided not to participate in CR and 88 patients with CVD withdrew from the CR program. The three most reported reasons for nonattendance were as follows: (1) did not need the supervision (56%, n = 108), (2) did not need the CR trajectory (55%, n = 105), and (3) already exercised regularly (39%, n = 74). The most reported reasons for noncompletion were as follows: (1) could no longer participate because of other physical problems (30%, n = 26), (2) did not need the CR trajectory (26%, n = 23), and (3) the CR program was not personal enough (23%, n = 20). CONCLUSIONS Most patients had motivational or perceptive reasons for nonattendance or noncompletion to CR. These possible misconceptions as well as perceived shortcomings of traditional CR underline the need for adequate motivation, information, and more personalized solutions (eg, eHealth, home-based CR) to increase the uptake and completion of CR.
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Affiliation(s)
- Thijs Vonk
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Malou A. H. Nuijten
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Martijn F. H. Maessen
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Esther P. Meindersma
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Hetty J. J. Koornstra-Wortel
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Marc M. Waskowsky
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Johan A. Snoek
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Thijs M. H. Eijsvogels
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Maria. T. E. Hopman
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
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7
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Silva PF, Ricci-Vitor AL, Cruz MM, Borges GL, Garner DM, Marques Vanderlei LC. Comparison of acute response of cardiac autonomic modulation between virtual reality-based therapy and cardiovascular rehabilitation: a cluster-randomized crossover trial. Physiother Theory Pract 2020; 38:969-984. [PMID: 32880504 DOI: 10.1080/09593985.2020.1815261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess the acute response of cardiac autonomic modulation (ACAM) during and after a session of virtual reality-based therapy (VRBT) compared to a session of conventional cardiovascular rehabilitation (CR) and to evaluate the effects of 12 weeks of training on this response. METHODS We assessed 28 volunteers (63.4 ± 12.5 years). The ACAM was judged by linear indexes of heart rate variability (HRV) in VRBT and CR sessions. Later, patients completed 12 weeks of VRBT+CR and the assessment was repeated at the 12th week. RESULTS Throughout the 1st VRBT session vagal withdrawal occurred (RMSSD/HFnu); sympathetic nervous system stimulation (LFnu) and progressive decrease of global HRV (SDNN). During the recovery, the SDNN, HFnu, and LFnu improved from the 5thminute on both therapies. After 12 weeks, the LFnu, HFnu, and the LF/HF-ratio revealed no significant changes in Ex3-Ex4 equated to Rep during VRBT. In recovery, the HFnu and LFnu improved before the 5thminute on both therapies. CONCLUSIONS ACAM during and after the VRBT was comparable to CR, yet, the extents were greater in the VRBT. After 12 weeks of VRBT training, the subjects adapted to the exercises from the 15thminute and exhibited faster recovery of HFnu and LFnu indexes compared to the 1st week.
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Affiliation(s)
- Paula F Silva
- Department of Physiotherapy, São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Brazil
| | - Ana Laura Ricci-Vitor
- Department of Physiotherapy, São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Brazil
| | - Mayara M Cruz
- Department of Physiotherapy, São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Brazil
| | - Giovanna L Borges
- Department of Physiotherapy, São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Brazil
| | - David M Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Luiz C Marques Vanderlei
- Department of Physiotherapy, São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Brazil
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Hendriks J, Andreae C, Ågren S, Eriksson H, Hjelm C, Walfridsson U, Ski CF, Thylén I, Jaarsma T. Cardiac disease and stroke: Practical implications for personalised care in cardiac-stroke patients. A state of the art review supported by the Association of Cardiovascular Nursing and Allied Professions. Eur J Cardiovasc Nurs 2020; 19:495-504. [PMID: 31996016 DOI: 10.1177/1474515119895734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiac and stroke conditions often coexist because of common risk factors. The occurrence of stroke may have significant consequences for patients with cardiac conditions and their caregivers and poses a major burden on their lives. Although both cardiac and stroke conditions are highly prevalent, primary stroke prevention in cardiac patients is crucial to avert disabling limitations or even mortality. In addition, specific interventions may be needed in the rehabilitation and follow-up of these patients. However, healthcare systems are often fragmented and are not integrated enough to provide specifically structured and individualised management for the cardiac-stroke patient. Cardiac rehabilitation or secondary prevention services are crucial from this perspective, although referral and attendance rates are often suboptimal. This state of the art review outlines the significance of primary stroke prevention in cardiac patients, highlights specific challenges that cardiac-stroke patients and their caregivers may experience, examines the availability of and need for structured, personalised care, and describes potential implications for consideration in daily practice.
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Affiliation(s)
- Jeroen Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Australia.,Institute of Health, Medicine and Caring Sciences, Linköping University, Linköping. Sweden
| | - Christina Andreae
- Institute of Health, Medicine and Caring Sciences, Linköping University, Linköping. Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Susanna Ågren
- Institute of Health, Medicine and Caring Sciences, Linköping University, Linköping. Sweden.,Julius Centrum, University Medical Centre Utrecht, The Netherlands
| | - Helène Eriksson
- Institute of Health, Medicine and Caring Sciences, Linköping University, Linköping. Sweden
| | - Carina Hjelm
- Institute of Health, Medicine and Caring Sciences, Linköping University, Linköping. Sweden.,Department of Cardiothoracic Surgery, Linköping University, Sweden
| | - Ulla Walfridsson
- Institute of Health, Medicine and Caring Sciences, Linköping University, Linköping. Sweden.,Department of Cardiology, Linköping University, Sweden
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Ingela Thylén
- Department of Cardiology, Linköping University, Sweden
| | - Tiny Jaarsma
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.,Julius Centrum, University Medical Centre Utrecht, The Netherlands
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