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Moons P, Norekvål TM, Arbelo E, Borregaard B, Casadei B, Cosyns B, Cowie MR, Fitzsimons D, Fraser AG, Jaarsma T, Kirchhof P, Mauri J, Mindham R, Sanders J, Schiele F, Torbica A, Zwisler AD. Placing patient-reported outcomes at the centre of cardiovascular clinical practice: implications for quality of care and management. Eur Heart J 2023; 44:3405-3422. [PMID: 37606064 DOI: 10.1093/eurheartj/ehad514] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/01/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023] Open
Abstract
Patient-reported outcomes (PROs) provide important insights into patients' own perspectives about their health and medical condition, and there is evidence that their use can lead to improvements in the quality of care and to better-informed clinical decisions. Their application in cardiovascular populations has grown over the past decades. This statement describes what PROs are, and it provides an inventory of disease-specific and domain-specific PROs that have been developed for cardiovascular populations. International standards and quality indices have been published, which can guide the selection of PROs for clinical practice and in clinical trials and research; patients as well as experts in psychometrics should be involved in choosing which are most appropriate. Collaborations are needed to define criteria for using PROs to guide regulatory decisions, and the utility of PROs for comparing and monitoring the quality of care and for allocating resources should be evaluated. New sources for recording PROs include wearable digital health devices, medical registries, and electronic health record. Advice is given for the optimal use of PROs in shared clinical decision-making in cardiovascular medicine, and concerning future directions for their wider application.
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Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35 PB7001, 3000 Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Klipfontein Rd, Rondebosch, 7700 Cape Town, South Africa
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5009 Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Jonas Lies veg, 875021 Bergen, Norway
| | - Elena Arbelo
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS). Rosselló 149-153, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense, Denmark
| | - Barbara Casadei
- Division of Cardiovascular Medicine, RDM, University of Oxford; Headley Way, Headington Oxford OX3 9DU, UK
- NIHR Biomedical Research Centre, Headley Way, Headington Oxford OX3 9DU, UK
| | - Bernard Cosyns
- Department of Cardiology, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Martin R Cowie
- Royal Brompton Hospital & School of Cardiovascular Medicine, Faculty of Medicine & Lifesciences, King's College London, Sydney St, London SW3 6NP, UK
| | - Donna Fitzsimons
- School of Nursing & Midwifery, Queens University Belfast, 97 Lisburn Road, Belfast | BT9 7BL, Northern Ireland
| | - Alan G Fraser
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XW, UK
| | - Tiny Jaarsma
- Department of Medicine, Health and Caring Sciences, Linköping University, Campus Norrköping, 601 74 Norrköping, Sweden
- Nursing Science, Julius Center, University Medical Centre Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, D-20246 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Martinistrasse 52, D-20246 Hamburg, Germany
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston Birmingham B15 2TT, UK
| | - Josepa Mauri
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Richard Mindham
- European Society of Cardiology (ESC) Patient Forum, 2035 route des colles, CS 80179 Biot, 06903 Sophia Antipolis Cedex, France
| | - Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London EC1M 6BQ, UK
| | - Francois Schiele
- Department of Cardiology, University Hospital Besancon, 3 Bd Alexandre Fleming, 25030 Besançon, France
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Via Sarfatti, 10 20136 Milan, Italy
| | - Ann Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
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Murphy BM, Rogerson MC, Hesselson S, Iismaa SE, Hoover V, Le Grande M, Graham RM, Jackson AC. Prevalence of Anxiety, Depression, and Distress in SCAD and Non-SCAD AMI Patients: A Comparative Study. J Cardiopulm Rehabil Prev 2023; 43:338-345. [PMID: 36892564 PMCID: PMC10467813 DOI: 10.1097/hcr.0000000000000782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute myocardial infarction (AMI), particularly in younger women without classic cardiac risk factors. Spontaneous coronary artery dissection is considered to be particularly stressful; however, few studies have quantified SCAD survivor stress levels. This study compared anxiety, depression, and distress levels in SCAD and non-SCAD AMI patients. METHOD A sample of 162 AMI (35 [22%] SCAD) patients was recruited from hospitals and via social media, in Australia and the United States. All had had their AMI in the past 6 mo. Participants completed an online questionnaire comprising the Generalized Anxiety Disorder-2 (GAD2), Patient Health Questionnaire-2 (PHQ2), Kessler-6 (K6), and Cardiac Distress Inventory (CDI). T-tests, χ 2 tests, Mann-Whitney tests, and analysis of covariance were used to compare SCAD and non-SCAD samples. Logistic regression was used to identify the unique predictors of anxiety, depression, and distress, controlling for relevant confounders. RESULTS Patients with SCAD were more commonly female and significantly younger than non-SCAD patients. Patients with SCAD scored significantly higher on the GAD2, PHQ2, K6, and CDI and a significantly larger proportion was classified as anxious, depressed, or distressed using these instruments. In logistic regression, together with mental health history, having had a SCAD-AMI predicted anxiety, depression, and distress, after controlling for female sex, younger age, and other confounding variables. CONCLUSION This study supports the view that anxiety, depression, and distress are more common after SCAD-AMI than after traditional AMI. These findings highlight the psychosocial impacts of SCAD and suggest that psychological support should be an important component of cardiac rehabilitation for these patients.
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Affiliation(s)
- Barbara M. Murphy
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Michelle C. Rogerson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Stephanie Hesselson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Siiri E. Iismaa
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Valerie Hoover
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Michael Le Grande
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Robert M. Graham
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Alun C. Jackson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
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Le Grande MR, Murphy BM, Rogerson MC, Ski CF, Amerena J, Smith JA, Hoover V, Alvarenga ME, Higgins RO, Thompson DR, Jackson AC. Development of a short form of the Cardiac Distress Inventory. BMC Cardiovasc Disord 2023; 23:408. [PMID: 37596516 PMCID: PMC10439557 DOI: 10.1186/s12872-023-03439-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Cardiac distress may be viewed as a persistent negative emotional state that spans multiple psychosocial domains and challenges a patient's capacity to cope with living with their heart condition. The Cardiac Distress Inventory (CDI) is a disease-specific clinical assessment tool that captures the complexity of this distress. In busy settings such as primary care, cardiac rehabilitation, and counselling services, however, there is a need to administer briefer tools to aid in identification and screening. The aim of the present study was to develop a short, valid screening version of the CDI. METHODS A total of 405 participants reporting an acute coronary event in the previous 12 months was recruited from three hospitals, through social media and by direct enrolment on the study website. Participants completed an online survey which included the full version of the CDI and general distress measures including the Kessler K6, Patient Health Questionnaire-4, and Emotion Thermometers. Relationship of the CDI with these instruments, Rasch analysis model fit and clinical expertise were all used to select items for the short form (CDI-SF). Construct validity and receiver operating characteristics in relation to the Kessler K6 were examined. RESULTS The final 12 item CDI-SF exhibited excellent internal consistency indicative of unidimensionality and good convergent and discriminant validity in comparison to clinical status measures, all indicative of good construct validity. Using the K6 validated cutoff of ≥ 18 as the reference variable, the CDI-SF had a very high Area Under the Curve (AUC) (AUC = 0.913 (95% CI: 0.88 to 0.94). A CDI-SF score of ≥ 13 was found to indicate general cardiac distress which may warrant further investigation using the original CDI. CONCLUSION The psychometric findings detailed here indicate that the CDI-SF provides a brief psychometrically sound screening measure indicative of general cardiac distress, that can be used in both clinical and research settings.
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Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health, Melbourne, VIC, Australia
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Barbara M Murphy
- Australian Centre for Heart Health, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | | | - Chantal F Ski
- Australian Centre for Heart Health, Melbourne, VIC, Australia
- Integrated Care Academy, University of Suffolk, Ipswich, UK
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - John Amerena
- Barwon Health, Geelong, VIC, Australia
- Deakin School of Medicine, University Hospital Geelong, Geelong, VIC, Australia
| | - Julian A Smith
- Department of Cardiothoracic Surgery, Monash Health, Clayton, VIC, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Victorian Heart Institute, Clayton, VIC, Australia
| | - Valerie Hoover
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Marlies E Alvarenga
- Australian Centre for Heart Health, Melbourne, VIC, Australia
- Victorian Heart Institute, Clayton, VIC, Australia
- Institute of Health and Wellbeing, Federation University, Berwick, VIC, Australia
- Monash Health & Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Rosemary O Higgins
- Australian Centre for Heart Health, Melbourne, VIC, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia
| | - David R Thompson
- Australian Centre for Heart Health, Melbourne, VIC, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Alun C Jackson
- Australian Centre for Heart Health, Melbourne, VIC, Australia.
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.
- Centre on Behavioral Health, University of Hong Kong, Hong Kong, China.
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Pardo Y, Garin O, Oriol C, Zamora V, Ribera A, Ferrer M. Patient-centered care in Coronary Heart Disease: what do you want to measure? A systematic review of reviews on patient-reported outcome measures. Qual Life Res 2022; 32:1405-1425. [PMID: 36350473 PMCID: PMC10123044 DOI: 10.1007/s11136-022-03260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Background
The number of published articles on Patient-Reported Outcomes Measures (PROMs) in Coronary Heart Disease (CHD), a leading cause of disability-adjusted life years lost worldwide, has been growing in the last decades. The aim of this study was to identify all the disease-specific PROMs developed for or used in CHD and summarize their characteristics (regardless of the construct), to facilitate the selection of the most adequate one for each purpose.
Methods
A systematic review of reviews was conducted in MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews. PROQOLID and BiblioPRO libraries were also checked. PROMs were classified by construct and information was extracted from different sources regarding their main characteristics such as aim, number of items, specific dimensions, original language, and metric properties that have been assessed.
Results
After title and abstract screening of 1224 articles, 114 publications were included for full text review. Finally, we identified 56 PROMs: 12 symptoms scales, 3 measuring functional status, 21 measuring Health-Related Quality of Life (HRQL), and 20 focused on other constructs. Three of the symptoms scales were specifically designed for a study (no metric properties evaluated), and only five have been included in a published study in the last decade. Regarding functional status, reliability and validity have been assessed for Duke Activity Index and Seattle Angina Questionnaire, which present multiple language versions. For HRQL, most of the PROMs included physical, emotional, and social domains. Responsiveness has only been evaluated for 10 out the 21 HRQL PROMs identified. Other constructs included psychological aspects, self-efficacy, attitudes, perceptions, threats and expectations about the treatment, knowledge, adjustment, or limitation for work, social support, or self-care.
Conclusions
There is a wide variety of instruments to assess the patients’ perspective in CHD, covering several constructs. This is the first systematic review of specific PROMs for CHD including all constructs. It has practical significance, as it summarizes relevant information that may help clinicians, researchers, and other healthcare stakeholders to choose the most adequate instrument for promoting shared decision making in a trend towards value-based healthcare.
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Affiliation(s)
- Yolanda Pardo
- CIBER Epidemiología y Salud Pública (CIBERESP), Dr. Aiguader 88, 08003, Barcelona, Spain
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Olatz Garin
- CIBER Epidemiología y Salud Pública (CIBERESP), Dr. Aiguader 88, 08003, Barcelona, Spain.
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - Cristina Oriol
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Víctor Zamora
- CIBER Epidemiología y Salud Pública (CIBERESP), Dr. Aiguader 88, 08003, Barcelona, Spain
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Aida Ribera
- CIBER Epidemiología y Salud Pública (CIBERESP), Dr. Aiguader 88, 08003, Barcelona, Spain
- Cardiovascular Epidemiology and Research Unit, University Hospital and Research Institute Vall d'Hebron (VHIR), Barcelona, Spain
| | - Montserrat Ferrer
- CIBER Epidemiología y Salud Pública (CIBERESP), Dr. Aiguader 88, 08003, Barcelona, Spain
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Jackson AC, Grande MRL, Rogerson MC, Ski CF, Amerena J, Smith JA, Hoover V, Alvarenga ME, Higgins RO, Thompson DR, Murphy BM. The cardiac distress inventory: A new measure of psychosocial distress associated with an acute cardiac event. BMC Cardiovasc Disord 2022; 22:460. [PMID: 36329396 PMCID: PMC9633013 DOI: 10.1186/s12872-022-02897-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: 07/22/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background Many challenges are posed by the experience of a heart attack or heart surgery which can be characterised as ‘cardiac distress’. It spans multiple psychosocial domains incorporating patients’ responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design. Method An item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and individual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors. Results Psychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI. Conclusion The CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. Individual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02897-y.
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Affiliation(s)
- Alun C Jackson
- Australian Centre for Heart Health, Melbourne, VIC, Australia. .,Centre on Behavioral Health, University of Hong Kong, Hong Kong SAR, China.
| | - Michael R Le Grande
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | | | - Chantal F Ski
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Integrated Care Academy, University of Suffolk, Ipswich, UK.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - John Amerena
- Barwon Health, Geelong, VIC, Australia.,Deakin School of Medicine, University Hospital Geelong, Geelong, VIC, Australia
| | - Julian A Smith
- Department of Cardiothoracic Surgery, Monash Health, Clayton, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health), Monash University, Clayton, VIC, Australia
| | - Valerie Hoover
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Marlies E Alvarenga
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Institute of Health and Wellbeing, Federation University, Berwick, VIC, Australia.,Victorian Heart Institute, Clayton, VIC, Australia.,Monash Health & Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Rosemary O Higgins
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia
| | - David R Thompson
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Barbara M Murphy
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
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Ilonzo N, Taubenfeld E, Yousif MD, Henoud C, Howitt J, Wohlauer M, D'Oria M, MacCarrick G. The Mental Health Impact of Aortic Dissection. Semin Vasc Surg 2022; 35:88-99. [DOI: 10.1053/j.semvascsurg.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/11/2022]
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Jackson AC, Rogerson MC, Amerena J, Smith J, Hoover V, Alvarenga ME, Higgins RO, Grande MRL, Ski CF, Thompson DR, Murphy BM. Unraveling the Complexity of Cardiac Distress: A Study of Prevalence and Severity. Front Psychiatry 2022; 13:808904. [PMID: 35432039 PMCID: PMC9009040 DOI: 10.3389/fpsyt.2022.808904] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/23/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION While much research attention has been paid to anxiety and depression in people who have had a recent cardiac event, relatively little has focused on the broader concept of cardiac distress. Cardiac distress is a multidimensional construct that incorporates but extends beyond common mood disorders such as anxiety and depression. In the present study we assessed the prevalence, severity and predictors of a broad range of physical, affective, cognitive, behavioral and social symptoms of cardiac distress. This is the first study to investigate cardiac distress in this comprehensive way. METHOD A sample of 194 patients was recruited from two hospitals in Australia. Eligible participants were those who had recently been hospitalized for an acute cardiac event. Data were collected at patients' outpatient clinic appointment ~8 weeks after their hospital discharge. Using a questionnaire developed through a protocol-driven 3-step process, participants reported on whether they had experienced each of 74 issues and concerns in the past 4 weeks, and the associated level of distress. They also provided sociodemographic and medical information. Regression analyses were used to identify risk factors for elevated distress. RESULTS Across the 74 issues and concerns, prevalence ratings ranged from a high of 66% to a low of 6%. The most commonly endorsed items were within the domains of dealing with symptoms, fear of the future, negative affect, and social isolation. Common experiences were "being physically restricted" (66%), "lacking energy" (60%), "being short of breath" (60%), "thinking I will never be the same again" (57%), and "not sleeping well" (51%). While less prevalent, "not having access to the health care I need," "being concerned about my capacity for sexual activity," and "being unsupported by family and friends" were reported as highly distressing (74, 64, and 62%) for those experiencing these issues. Having a mental health history and current financial strain were key risk factors for elevated distress. CONCLUSION AND IMPLICATIONS Specific experiences of distress appear to be highly prevalent in people who have had a recent cardiac event. Understanding these specific fears, worries and stressors has important implications for the identification and management of post-event mental health and, in turn, for supporting patients in their post-event cardiac recovery.
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Affiliation(s)
- Alun C Jackson
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Center on Behavioral Health, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Behavioral Health, University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | | | - John Amerena
- Barwon Health, Geelong, VIC, Australia.,Deakin School of Medicine, University Hospital Geelong, Geelong, VIC, Australia
| | - Julian Smith
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences, Monash Health, Melbourne, VIC, Australia
| | - Valerie Hoover
- Psychiatry and Behavioral Sciences, Stanford Women's Heart Health Clinic, Stanford, CA, United States
| | - Marlies E Alvarenga
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,School of Health and Life Sciences, Federation University Australia, Berwick, VIC, Australia.,Victorian Heart Institute, Melbourne, VIC, Australia.,Monash Health & Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Rosemary O Higgins
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Department of Psychology, Deakin University, Geelong, VIC, Australia.,Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia
| | - Michael R Le Grande
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Chantal F Ski
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Integrated Care Academy, University of Suffolk, Ipswich, United Kingdom.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - David R Thompson
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
| | - Barbara M Murphy
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Center on Behavioral Health, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Department of Psychology, University of Melbourne, Melbourne, VIC, Australia
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8
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Tran VD, Cao NTT, Le MH, Pham DT, Nguyen KT, Dorofeeva VV, Loskutova EE. Medical staff perspective on factors influencing their prescribing decisions: a cross-sectional study in Mekong Delta, Vietnam. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
Understanding medical staff’s prescription behaviors helps improve the quality of prescriptions and the rationality of medication use. Although factors affecting the prescribing decisions were discussed in various studies worldwide, limited knowledge of these issues has been reported in Vietnam. This paper aims to examine factors that influence prescribing behavior concerning medical staff’s demographics and characteristic differences.
Methods
Quantitative descriptive cross-sectional study, using adapted questionnaire consisting of 27 factors divided into 9 factor categories, was conducted with medical staff in Mekong Delta during June–July, 2019. Rasch analysis was performed to assess the questionnaire psychometric properties. Descriptive analysis, parametric tests and non-parametric tests were utilized to address the study objectives.
Key findings
A total of 201 participants completed the questionnaire. A majority of participants (>90%) agreed that their own decision to prescribe a drug was influenced by several factors such as drug safety and efficacy (92.5%), patient history (92.0%), patient income (92.0%) and patient disease status (91.0%). There were significant age differences in influences on prescribing decision. Medical staff aged under 30 appreciated the role of pharmacists higher than whose aged 31–40 (P-value = 0.010) and over 40 (P-value = 0.013). Additionally, they were more concerned with ‘patient characteristics’ including patient request, expectations, and disease status when making prescribing decisions compared with whose aged over 40 (P-value = 0.005).
Conclusions
The study revealed various factors influencing medical staff prescription decision-making processes. These findings could be useful for pharmaceutical companies in Vietnam in developing marketing strategies, and for policy-makers in timely improvement of prescription quality.
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Affiliation(s)
- Van De Tran
- Department of Traditional Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Department of Drug Administration, Faculty of Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Department of Pharmaceutical Management and Economics, Faculty of Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Nguyen Thi Tai Cao
- Department of Biology and Genetics, Faculty of Basic Sciences, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Minh Hoang Le
- Department of Traditional Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Duy Toan Pham
- Department of Chemistry, College of Natural Sciences, Can Tho University, Can Tho, Vietnam
| | - Kien Trung Nguyen
- Department of Physiology, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Valeria Valeryevna Dorofeeva
- Department of Pharmaceutical Management and Economics, Faculty of Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Ekaterina Efimovna Loskutova
- Department of Pharmaceutical Management and Economics, Faculty of Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
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9
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Matsuoka K, Watanabe A, Kawaguchi T, Misawa K, Murakami K, Fukuda M. Development of a New Daily Activities Scale for the Affected Hand after Stroke. Prog Rehabil Med 2020; 5:20200031. [PMID: 33367132 PMCID: PMC7747013 DOI: 10.2490/prm.20200031] [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: 10/05/2020] [Accepted: 12/02/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives: There are few scales that reflect the function of the stroke-affected arm as it relates
to the performance of daily activities while also indicating the difficulty of scale
items. In this study, we developed the Activities Specific Upper-extremity Hemiparesis
Scale (ASUHS) to evaluate daily activities performable by the affected arm after stroke.
We also clarified the validity, reliability, and item difficulty of the scale. Methods: The participants were 145 patients with stroke who were consecutively admitted to a
convalescent rehabilitation ward. The unidimensionality of ASUHS was assessed by
principal component analysis. Analyses of item discrimination and content validity were
conducted to assess the overall validity. Reliability was evaluated by assessing
internal consistency and inter-rater reliability. Item difficulties were determined by
Rasch analysis. Results: Unidimensionality, high discrimination, and good content validity were shown for all
items. ASUHS consists of a dominant hand scale and non-dominant hand scale. Both scales
showed good internal consistency (Cronbach’s α coefficient = 0.99) and substantial
inter-rater reliability (Cohen’s Kappa coefficient = 0.74 and 0.75, respectively). Item
difficulty was determined as being in the range –8.71 to +5.18 logit. Conclusions: This study suggested good validity and reliability of ASUHS. Furthermore, because the
item difficulties of daily activities performed by the affected arm were clarified,
therapists can use ASUHS to identify the process that should be the next focus for
training. Consequently, therapists may be able to train patients in daily activities
that match the affected arm’s ability step by step rather than determining training
activities empirically.
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Affiliation(s)
- Koshi Matsuoka
- Department of Rehabilitation Medicine, Tamakyuryo Hospital, Machida, Japan.,Graduate School of Medical Science, Kitasato University, Sagamihara, Japan
| | - Aki Watanabe
- Graduate School of Medical Science, Kitasato University, Sagamihara, Japan.,Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Takayuki Kawaguchi
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Koji Misawa
- Department of Rehabilitation Medicine, Tamakyuryo Hospital, Machida, Japan
| | - Keiichi Murakami
- Department of Rehabilitation Medicine, Tamakyuryo Hospital, Machida, Japan
| | - Michinari Fukuda
- Graduate School of Medical Science, Kitasato University, Sagamihara, Japan.,Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
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