1
|
Fekete M, Liotta EM, Molnar T, Fülöp GA, Lehoczki A. The role of atrial fibrillation in vascular cognitive impairment and dementia: epidemiology, pathophysiology, and preventive strategies. GeroScience 2024:10.1007/s11357-024-01290-1. [PMID: 39138793 DOI: 10.1007/s11357-024-01290-1] [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] [Received: 06/12/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
The aging population in Europe faces a substantial burden from dementia, with vascular cognitive impairment and dementia (VCID) being a preventable cause. Atrial fibrillation (AF), a common cardiac arrhythmia, increases the risk of VCID through mechanisms such as thromboembolism, cerebral hypoperfusion, and inflammation. This review explores the epidemiology, pathophysiology, and preventive strategies for AF-related VCID. Epidemiological data indicate that AF prevalence rises with age, affecting up to 12% of individuals over 80. Neuroimaging studies reveal chronic brain changes in AF patients, including strokes, lacunar strokes, white matter hyperintensities (WMHs), and cerebral microbleeds (CMHs), while cognitive assessments show impairments in memory, executive function, and attention. The COVID-19 pandemic has exacerbated the underdiagnosis of AF, leading to an increase in undiagnosed strokes and cognitive impairment. Many elderly individuals did not seek medical care due to fear of exposure, resulting in delayed diagnoses. Additionally, reduced family supervision during the pandemic contributed to missed opportunities for early detection of AF and related complications. Emerging evidence suggests that long COVID may also elevate the risk of AF, further complicating the management of this condition. This review underscores the importance of early detection and comprehensive management of AF to mitigate cognitive decline. Preventive measures, including public awareness campaigns, patient education, and the use of smart devices for early detection, are crucial. Anticoagulation therapy, rate and rhythm control, and addressing comorbid conditions are essential therapeutic strategies. Recognizing and addressing the cardiovascular and cognitive impacts of AF, especially in the context of the COVID-19 pandemic, is essential for advancing public health.
Collapse
Affiliation(s)
- Mónika Fekete
- Institute of Preventive Medicine and Public Health, Semmelweis University, Budapest, Hungary
- Doctoral College, Health Sciences Program, Semmelweis University, Budapest, Hungary
| | - Eric M Liotta
- Doctoral College, Health Sciences Program, Semmelweis University, Budapest, Hungary
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Tihamer Molnar
- Department of Anaesthesiology and Intensive Care, Medical School, University of Pecs, Pecs, Hungary
| | - Gábor A Fülöp
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Lehoczki
- Institute of Preventive Medicine and Public Health, Semmelweis University, Budapest, Hungary.
- Doctoral College, Health Sciences Program, Semmelweis University, Budapest, Hungary.
| |
Collapse
|
2
|
Hu S, Lei Z, Wang Y, Ren L. Awareness of risk factors for cerebrovascular diseases among acute ischemic stroke patients in Shenzhen, China. Neurol Res 2024:1-8. [PMID: 39056400 DOI: 10.1080/01616412.2024.2381161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 07/11/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND AND PURPOSE Unawareness of the risk factors is one of the most important issues that need to be settled for stroke prevention. We aimed to evaluate the awareness of risk factors for cerebrovascular diseases (CVDs) among acute ischemic stroke patients and to investigate the characteristics of patients who were unaware of their risk factors in Shenzhen, China. METHODS Registered data on awareness of CVD risk factors of patients with confirmed acute ischemic stroke (AIS) from June 2020 to December 2022 were analyzed in May 2023. The data were extracted from the database of Shenzhen Quality Control Center for Management of Cerebrovascular Diseases. RESULTS Totally, there were 5147 AIS patients with complete data eligible for this study. AIS patients' awareness regarding existing hypertension, diabetes, dyslipidemia, and atrial fibrillation (AF) was 76.1%, 76.2%, 24.2%, and 53.4%, respectively. Patients who were lack of awareness of the CVD risk factors were more likely to be males, individuals with younger ages, and those without medical insurance or a CVD history. CONCLUSIONS The overall awareness of the CVD risk factors was suboptimal among AIS patients in Shenzhen, especially for the existing dyslipidemia. The health education of AIS should be further improved in males as well as individuals without medical insurance or any CVD histories. Age was an independent factor associated with the lack of awareness of the CVD risk factors. The stroke screening program should be extended to younger people.
Collapse
Affiliation(s)
- Shiyu Hu
- Neurology department of Shenzhen Seocnd People's Hospital/First Affiliated Hospital of Shenzhen, University Health Science Center, Shenzhen, China
| | | | - Yang Wang
- Neurology department of Shenzhen Seocnd People's Hospital/First Affiliated Hospital of Shenzhen, University Health Science Center, Shenzhen, China
| | - Lijie Ren
- Neurology department of Shenzhen Seocnd People's Hospital/First Affiliated Hospital of Shenzhen, University Health Science Center, Shenzhen, China
| |
Collapse
|
3
|
Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
4
|
McIntyre D, Kovoor JG, Chow CK, Quintans D, Marschner S, Thomas S, Kovoor P, Thiagalingam A. Clinician-Created Video Education for Patients With AF: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2345308. [PMID: 38064218 PMCID: PMC10709770 DOI: 10.1001/jamanetworkopen.2023.45308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Patient education is a critical aspect of atrial fibrillation (AF) management. However, there is limited time to provide effective patient education during routine care, and resources available online are of variable quality. Objective To determine whether clinician-led creation of video-based AF education is feasible and improves knowledge of AF. Design, Setting, and Participants This single-center randomized clinical trial was conducted between 2020 and 2022. Outcomes were assessed prior to their clinic visit and 2 and 90 days after the visit by blinded assessors. Participants included adults with AF and congestive heart failure, hypertension, age at least 75 years (doubled), diabetes, prior stroke or transient ischemic attack or thromboembolism (doubled), vascular disease, age 65 to 74 years, and sex category scores of 1 or greater presenting for routine care at publicly funded outpatient cardiology clinics within a tertiary teaching hospital. Individuals too unwell to participate or with limited English were excluded. Data were assessed as intention to treat and analyzed from December 2022 to October 2023. Intervention Intervention participants viewed a series of 4 videos designed and narrated by clinicians that aimed to improve understanding of AF pathophysiology, clinical presentation, diagnosis, and management. After viewing the videos, participants received weekly email links to review the videos. The control group received usual care. Main Outcomes and Measures The prospectively selected primary outcome was AF knowledge at 90 days, measured by the validated Jessa Atrial Fibrillation Knowledge Questionnaire (JAFKQ). Results Among 657 individuals screened, 208 adults with AF were randomized (mean [SD] age, 65.0 [12.2] years; 133 [65.2%] male) and included in analysis. Participants were randomized 1-to-1, with 104 participants in the control group and 104 participants in the video intervention group. At 90 days after the baseline clinic visit, intervention participants were more likely to correctly answer JAFKQ questions than control participants (odds ratio [OR], 1.23 [95% CI, 1.01-1.49]). The difference was greater in participants who remotely accessed videos on 3 or more occasions during the study (OR, 1.46 [95% CI, 1.14-1.88]). Conclusions and Relevance In this randomized clinical trial of patients with AF, remotely delivered, clinician-created video education improved medium-term AF knowledge beyond usual care of standard in-clinic education. The improvement demonstrated in this study provides support for the implementation of clinician-created educational resources across the care continuum. Further work is needed to assess for impact on clinical outcomes. Trial Registration anzctr.org.au Identifier: ANZCTRN12620000729921.
Collapse
Affiliation(s)
- Daniel McIntyre
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Clara K. Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Desi Quintans
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Stuart Thomas
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Pramesh Kovoor
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| |
Collapse
|
5
|
Mann HK, Streiff M, Schultz KC, Halpern DV, Ferry D, Johnson AE, Magnani JW. Rurality and Atrial Fibrillation: Patient Perceptions of Barriers and Facilitators to Care. J Am Heart Assoc 2023; 12:e031152. [PMID: 37889198 PMCID: PMC10727401 DOI: 10.1161/jaha.123.031152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023]
Abstract
Background Patients experience atrial fibrillation (AF) as a complex disease given its adversity, chronicity, and necessity for long-term treatments. Few studies have examined the experience of rural individuals with AF. We conducted qualitative assessments of patients with AF residing in rural, western Pennsylvania to identify barriers and facilitators to care. Methods and Results We conducted 8 semistructured virtual focus groups with 42 individuals living in rural western Pennsylvania using contextually tailored questions to assess participant perspectives. We inductively analyzed focus group transcripts using paragraph-by-paragraph and focused coding to identify themes with the qualitative description approach. We used Krippendorff α scoring to determine interreviewer reliability. We harnessed investigator triangulation to augment the reliability of our findings. We reached thematic saturation after coding 8 focus groups. Participants were 52.4% women, with a median age of 70.9 years (range, 54.5-82.0 years), and most were White race (92.9%). Participants identified medication costliness, invisibility of AF to others, and lack of emergent transportation as barriers to care. Participants described interpersonal support and use of technology as important for AF self-care, and expressed ambivalence about how relationships with health care providers affected AF care. Conclusions Focus group participants described multiple social and structural barriers to care for AF. Our findings highlight the complexity of the experience of individuals with AF residing in rural western Pennsylvania. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04076020.
Collapse
Affiliation(s)
| | - Meg Streiff
- University Center for Social and Urban ResearchUniversity of PittsburghPA
| | - Kevan C. Schultz
- University Center for Social and Urban ResearchUniversity of PittsburghPA
| | - David V. Halpern
- University Center for Social and Urban ResearchUniversity of PittsburghPA
| | - Danielle Ferry
- Center for Research on Health Care, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Amber E. Johnson
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Jared W. Magnani
- Center for Research on Health Care, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| |
Collapse
|
6
|
Bobinac A. Access to Healthcare and Health Literacy in Croatia: Empirical Investigation. Healthcare (Basel) 2023; 11:1955. [PMID: 37444789 DOI: 10.3390/healthcare11131955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Health literacy is related to different health-related outcomes. However, the nature of the relationship between health literacy and health outcomes is not well understood. One pathway may lead from health literacy to health outcomes by means of access to healthcare. The goal of the current study is to explore the association between health literacy and the particular measure of access to healthcare-unmet medical need-for the first time in Croatia and, to the best of our knowledge, for the first time in the EU context. We use data obtained from face-to-face interviews in a large nationally representative sample of the Croatian population (n = 1000) to estimate the level of health literacy and self-reported access to care and investigate the association between health literacy and self-perceived barriers to access. Our study showed that limited and problematic health literacy is prevalent and associated with higher rates of unmet medical need. Unmet need is largely caused by long waiting lists. It is therefore essential to design health services fitting the needs of those who have limited and/or problematic health literacy as well as enhance health education with the potential of improving the access to care and health outcomes as well as design policies that reduce waiting times.
Collapse
Affiliation(s)
- Ana Bobinac
- Center for Health Economics and Pharmacoeconomics (CHEP), Faculty of Economics and Business, University of Rijeka, 51 000 Rijeka, Croatia
| |
Collapse
|
7
|
Lalor JP, Wu H, Mazor KM, Yu H. Evaluating the efficacy of NoteAid on EHR note comprehension among US Veterans through Amazon Mechanical Turk. Int J Med Inform 2023; 172:105006. [PMID: 36780789 PMCID: PMC9992155 DOI: 10.1016/j.ijmedinf.2023.105006] [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: 11/01/2022] [Revised: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Low health literacy is a concern among US Veterans. In this study, we evaluated NoteAid, a system that provides lay definitions to medical jargon terms in EHR notes to help Veterans comprehend EHR notes. We expected that low initial scores for Veterans would be improved by using NoteAid. MATERIALS AND METHODS We recruited Veterans from the Amazon Mechanical Turk crowd work platform (MTurk). We also recruited non-Veterans from MTurk as a control group for comparison. We randomly split recruited MTurk Veteran participants into control and intervention groups. We recruited non-Veteran participants into mutually exclusive control or intervention tasks on the MTurk platform. We showed participants de-identified EHR notes and asked them to answer comprehension questions related to the notes. We provided participants in the intervention group with EHR note content processed with NoteAid, while NoteAid was not available for participants in the control group. RESULTS We recruited 94 Veterans and 181 non-Veterans. NoteAid leads to a significant improvement for non-Veterans but not for Veterans. Comparing Veterans recruited via MTurk with non-Veterans recruited via MTurk, we found that without NoteAid, Veterans have significantly higher raw scores than non-Veterans. This difference is not significant with NoteAid. DISCUSSION That Veterans outperform a comparable population of non-Veterans is a surprising outcome. Without NoteAid, scores on the test are already high for Veterans, therefore, minimizing the ability of an intervention such as NoteAid to improve performance. With regards to Veterans, understanding the health literacy of Veterans has been an open question. We show here that Veterans score higher than a comparable, non-Veteran population. CONCLUSION Veterans on MTurk do not see improved scores when using NoteAid, but they already score high on the test, significantly higher than non-Veterans. When evaluating NoteAid, population specifics need to be considered, as performance may vary across groups. Future work investigating the effectiveness of NoteAid on improving comprehension with local Veterans and developing a more difficult test to assess groups with higher health literacy is needed.
Collapse
Affiliation(s)
- John P Lalor
- Department of Information Technology, Analytics, and Operations, Mendoza College of Business, University of Notre Dame, Notre Dame, IN, US
| | - Hao Wu
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, TN, US
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, US; Meyers Primary Care Institute, University of Massachusetts Medical School/Reliant Medical Group/Fallon Health, Worcester, MA, US
| | - Hong Yu
- Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, US; College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, US; Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center, Bedford, MA, US.
| |
Collapse
|
8
|
Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1269] [Impact Index Per Article: 1269.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
9
|
Hu H, Wang L, Li H, Li H, Chen X, Peng W, Wang J, Zhao Y, Liu M, Li D. Long-term amelioration of an early-onset familial atrial fibrillation model with AAV-mediated in vivo gene therapy. FUNDAMENTAL RESEARCH 2022; 2:829-835. [PMID: 38933375 PMCID: PMC11197581 DOI: 10.1016/j.fmre.2022.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/05/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022] Open
Abstract
Atrial fibrillation (AF) is a common cardiac disease with high prevalence in the general population. Despite a mild manifestation at the onset stage, it causes serious consequences, including sudden death, when the disease progresses to the late stage. Most available treatments of AF focus on symptom management or alleviation, due to a lack of fundamental knowledge and the fact that considerable variations of AF exist. With the popularisation of the next-generation sequencing technology, several causal genetic factors, including MYL4, have been discovered to contribute to AF, giving hope to developing its gene therapies. In this study, we attempted to treat a previously established rat AF model, which carried Myl4E11K/E11K loss of function mutation, via overexpression of exogenous wild-type Myl4 by AAV9 vectors. Our results showed that delivery of Myl4 expressing AAV9 to postnatal rat models rescued the symptoms of AF, indicating the therapeutic potential that early gene therapy intervention can achieve long-term effects in treating cardiac arrhythmias caused by gene mutations.
Collapse
Affiliation(s)
- Handan Hu
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
| | - Liren Wang
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
| | - Huiying Li
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
- Southern Medical University Affiliated Fengxian Hospital, Shanghai 201499, China
| | - Hailing Li
- The Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Xi Chen
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
| | - Wenhui Peng
- The Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Jun Wang
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Yongxiang Zhao
- National Center for International Biotargeting Theranostics, Guangxi Key Laboratory of Biotargeting Theranostics, Collaborative Innovation Center for Targeting Tumor Theranostics, Guangxi Medical University, Guangxi 530021, China
| | - Mingyao Liu
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
| | - Dali Li
- Shanghai Frontiers Science Center of Genome Editing and Cell Therapy, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai 200241, China
| |
Collapse
|
10
|
Isakadze N, Molello N, MacFarlane Z, Gao Y, Spaulding EM, Commodore Mensah Y, Marvel FA, Khoury S, Marine JE, Michos ED, Spragg D, Berger RD, Calkins H, Cooper LA, Martin SS. The Virtual Inclusive Digital Health Intervention Design to Promote Health Equity (iDesign) Framework for Atrial Fibrillation: Co-design and Development Study. JMIR Hum Factors 2022; 9:e38048. [DOI: 10.2196/38048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/28/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022] Open
Abstract
Background
Smartphone ownership and mobile app use are steadily increasing in individuals of diverse racial and ethnic backgrounds living in the United States. Growing adoption of technology creates a perfect opportunity for digital health interventions to increase access to health care. To successfully implement digital health interventions and engage users, intervention development should be guided by user input, which is best achieved by the process of co-design. Digital health interventions co-designed with the active engagement of users have the potential to increase the uptake of guideline recommendations, which can reduce morbidity and mortality and advance health equity.
Objective
We aimed to co-design a digital health intervention for patients with atrial fibrillation, the most common cardiac arrhythmia, with patient, caregiver, and clinician feedback and to describe our approach to human-centered design for building digital health interventions.
Methods
We conducted virtual meetings with patients with atrial fibrillation (n=8), their caregivers, and clinicians (n=8). We used the following 7 steps in our co-design process: step 1, a virtual meeting focused on defining challenges and empathizing with problems that are faced in daily life by individuals with atrial fibrillation and clinicians; step 2, a virtual meeting focused on ideation and brainstorming the top challenges identified during the first meeting; step 3, individualized onboarding of patients with an existing minimally viable version of the atrial fibrillation app; step 4, virtual prototyping of the top 3 ideas generated during ideation; step 5, further ranking by the study investigators and engineers of the ideas that were generated during ideation but were not chosen as top-3 solutions to be prototyped in step 4; step 6, ongoing engineering work to incorporate top-priority features in the app; and step 7, obtaining further feedback from patients and testing the atrial fibrillation digital health intervention in a pilot clinical study.
Results
The top challenges identified by patients and caregivers included addressing risk factor modification, medication adherence, and guidance during atrial fibrillation episodes. Challenges identified by clinicians were complementary and included patient education, addressing modifiable atrial fibrillation risk factors, and remote atrial fibrillation episode management. Patients brainstormed more than 30 ideas to address the top challenges, and the clinicians generated more than 20 ideas. Ranking of the ideas informed several novel or modified features aligned with the Theory of Health Behavior Change, features that were geared toward risk factor modification; patient education; rhythm, symptom, and trigger correlation for remote atrial fibrillation management; and social support.
Conclusions
We co-designed an atrial fibrillation digital health intervention in partnership with patients, caregivers, and clinicians by virtually engaging in collaborative creation through the design process. We summarize our experience and describe a flexible approach to human-centered design for digital health intervention development that can guide innovative clinical investigators.
Collapse
|
11
|
Abdel-Qadir H, Akioyamen LE, Fang J, Pang A, Ha AC, Jackevicius CA, Alter DA, Austin PC, Atzema CL, Bhatia RS, Booth GL, Johnston S, Dhalla I, Kapral MK, Krumholz HM, McNaughton CD, Roifman I, Tu K, Udell JA, Wijeysundera HC, Ko DT, Schull MJ, Lee DS. Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study. Circulation 2022; 146:159-171. [PMID: 35678171 PMCID: PMC9287095 DOI: 10.1161/circulationaha.122.058949] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND There are limited data on the association of material deprivation with clinical care and outcomes after atrial fibrillation (AF) diagnosis in jurisdictions with universal health care. METHODS This was a population-based cohort study of individuals ≥66 years of age with first diagnosis of AF between April 1, 2007, and March 31, 2019, in the Canadian province of Ontario, which provides public funding and prohibits private payment for medically necessary physician and hospital services. Prescription medications are subsidized for residents >65 years of age. The primary exposure was neighborhood material deprivation, a metric derived from Canadian census data to estimate inability to attain basic material needs. Neighborhoods were categorized by quintile from Q1 (least deprived) to Q5 (most deprived). Cause-specific hazards regression was used to study the association of material deprivation quintile with time to AF-related adverse events (death or hospitalization for stroke, heart failure, or bleeding), clinical services (physician visits, cardiac diagnostics), and interventions (anticoagulation, cardioversion, ablation) while adjusting for individual characteristics and regional cardiologist supply. RESULTS Among 347 632 individuals with AF (median age 79 years, 48.9% female), individuals in the most deprived neighborhoods (Q5) had higher prevalence of cardiovascular disease, risk factors, and noncardiovascular comorbidity relative to residents of the least deprived neighborhoods (Q1). After adjustment, Q5 residents had higher hazards of death (hazard ratio [HR], 1.16 [95% CI, 1.13-1.20]) and hospitalization for stroke (HR, 1.16 [95% CI, 1.07-1.27]), heart failure (HR, 1.14 [95% CI, 1.11-1.18]), or bleeding (HR, 1.16 [95% CI, 1.07-1.25]) relative to Q1. There were small differences across quintiles in primary care physician visits (HR, Q5 versus Q1, 0.91 [95% CI, 0.89-0.92]), echocardiography (HR, Q5 versus Q1, 0.97 [95% CI, 0.96-0.99]), and dispensation of anticoagulation (HR, Q5 versus Q1, 0.97 [95% CI, 0.95-0.98]). There were more prominent disparities for Q5 versus Q1 in cardiologist visits (HR, 0.84 [95% CI, 0.82-0.86]), cardioversion (HR, 0.80 [95% CI, 0.76-0.84]), and ablation (HR, 0.45 [95% CI, 0.30-0.67]). CONCLUSIONS Despite universal health care and prescription medication coverage, residents of more deprived neighborhoods were less likely to visit cardiologists or receive rhythm control interventions after AF diagnosis, even though they exhibited higher cardiovascular disease burden and higher risk of adverse outcomes.
Collapse
Affiliation(s)
- Husam Abdel-Qadir
- Women’s College Hospital, Toronto, Canada (H.A.-Q., J.A.U.)
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Leo E. Akioyamen
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Jiming Fang
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
| | - Andrea Pang
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
| | - Andrew C.T. Ha
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Cynthia A. Jackevicius
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Western University of Health Sciences, Pomona, CA (C.A.J.)
| | - David A. Alter
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Peter C. Austin
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Clare L. Atzema
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - R. Sacha Bhatia
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Gillian L. Booth
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Canada (G.L.B., I.D.)
| | - Sharon Johnston
- Departments of Family Medicine, University of Ottawa, Ottawa, Canada (S.J.)
- Institu du Savoir, Hôpital Montfort‚ Ottawa, Canada (S.J.)
| | - Irfan Dhalla
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Canada (G.L.B., I.D.)
| | - Moira K. Kapral
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.)
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.)
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Candace D. McNaughton
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - Idan Roifman
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - Karen Tu
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Family and Community Medicine (K.T.), University of Toronto, Toronto‚ Canada
- North York General Hospital, Toronto, Canada (K.T.)
| | - Jacob A. Udell
- Women’s College Hospital, Toronto, Canada (H.A.-Q., J.A.U.)
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Harindra C. Wijeysundera
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - Dennis T. Ko
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - Michael J. Schull
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - Douglas S. Lee
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| |
Collapse
|
12
|
Sandhu RK, Seiler A, Johnson CJ, Bunch TJ, Deering TF, Deneke T, Kirchhof P, Natale A, Piccini JP, Russo AM, Hills MT, Varosy PD, Araia A, Smith AM, Freeman J. Heart Rhythm Society Atrial Fibrillation Centers of Excellence Study: A survey analysis of stakeholder practices, needs, and barriers. Heart Rhythm 2022; 19:1039-1048. [PMID: 35428582 DOI: 10.1016/j.hrthm.2022.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/31/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND An integrated, coordinated, and patient-centered approach to atrial fibrillation (AF) care delivery may improve outcomes and reduce cost. OBJECTIVE The purpose of this study was to gain a better understanding from key stakeholder groups on current practices, needs, and potential barriers to implementing optimal integrated AF care. METHODS A series of comprehensive questionnaires were designed by the Heart Rhythm Society Atrial Fibrillation Centers of Excellence (CoE) Task Force to conduct surveys with physicians, advanced practice professionals, patients, and hospital administrators. Data collected focused on the following areas: access to care, stroke prevention, education, AF quality improvement, and AF CoE needs and barriers. Survey responses were collated and analyzed by the Task Force. RESULTS The surveys identified 5 major unmet needs: (1) Standardized protocols, order sets, or care pathways in the emergency department or inpatient setting were uncommon (36%-42%). (2) All stakeholders agreed stroke prevention was a top priority; however, prior bleeding or risk of bleeding was the most frequent barrier for initiation. (3) Patients indicated that education on modifiable causes, AF-related complications, and lowering stroke risk is most important. (4) Less than half (43%) of the health care systems track patients with AF or treatment status. Patients reported that stroke and heart failure prevention and access to procedures were priority areas for an AF CoE. The most common barriers to implementing AF CoE identified by clinicians were administrative support (69%) and cost (52%); administrators reported physical space (43%). CONCLUSION On the basis of the findings of this study, the Task Force identified high priority areas to develop initiatives to aid the implementation of AF CoE.
Collapse
Affiliation(s)
- Roopinder K Sandhu
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | | | - Colleen J Johnson
- Southeast Louisiana Veterans Healthcare System, Tulane University, New Orleans, Louisiana
| | - T Jared Bunch
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | | | - Paulus Kirchhof
- University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
| | | | | | - Andrea M Russo
- Cooper Medical School at Rowan University, Camden, New Jersey
| | | | - Paul D Varosy
- VA Eastern Colorado Health Care Systems, Aurora, Colorado; University of Colorado, Aurora, Colorado
| | - Almaz Araia
- Heart Rhythm Society, Washington, District of Columbia
| | | | - James Freeman
- Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
13
|
Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2475] [Impact Index Per Article: 1237.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
14
|
Burton S, Hayes JA, Morrell-Scott N, Sanders J, Walthall H, Wright DJ, Jones ID. Should I stay or should I go? An exploration of the decision-making behavior of acute cardiac patients during the COVID-19 pandemic. Heart Lung 2021; 52:16-21. [PMID: 34823051 PMCID: PMC8606948 DOI: 10.1016/j.hrtlng.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/10/2022]
Abstract
Background During the SARS-COV-2 (COVID-19) pandemic efforts to reduce virus transmission resulted in non-emergency patients being deterred from seeking help. The number of patients presenting with acute cardiac conditions reduced, significantly Objectives To explore the decision-making process, and influential factors in that process, of patients and their family during an acute cardiac event. Methods A qualitative research design was employed using purposive sampling of patients who experienced an acute cardiac event during the social containment mandates. Semi-structured interviews were conducted, with thematic analysis of interview transcripts. Results Twenty-five participants were recruited from three UK hospitals. Themes identified were reliance on informal support network, lack of awareness of cardiac symptoms leading to delayed help-seeking, and an indirect COVID-19 effect (e.g. avoiding treatment). Conclusions These results highlight the need for informed public health messages, targeting patients and their support networks, that allow those in need of treatment to access care.
Collapse
Affiliation(s)
- S Burton
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Tithebarn Building, Liverpool L2 2ER, United Kingdom
| | - J A Hayes
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Tithebarn Building, Liverpool L2 2ER, United Kingdom
| | - N Morrell-Scott
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Tithebarn Building, Liverpool L2 2ER, United Kingdom; Liverpool Centre for Cardiovascular Science, United Kingdom
| | - J Sanders
- Barts Health NHS Trust William Harvey Research Institute, St Bartholomew's Hospital, Queen Mary University of London, United Kingdom
| | - H Walthall
- Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - D J Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, United Kingdom
| | - I D Jones
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Tithebarn Building, Liverpool L2 2ER, United Kingdom; Liverpool Centre for Cardiovascular Science, United Kingdom.
| |
Collapse
|
15
|
Essien UR, Kornej J, Johnson AE, Schulson LB, Benjamin EJ, Magnani JW. Social determinants of atrial fibrillation. Nat Rev Cardiol 2021; 18:763-773. [PMID: 34079095 PMCID: PMC8516747 DOI: 10.1038/s41569-021-00561-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 02/05/2023]
Abstract
Atrial fibrillation affects almost 60 million adults worldwide. Atrial fibrillation is associated with a high risk of cardiovascular morbidity and death as well as with social, psychological and economic burdens on patients and their families. Social determinants - such as race and ethnicity, financial resources, social support, access to health care, rurality and residential environment, local language proficiency and health literacy - have prominent roles in the evaluation, treatment and management of atrial fibrillation. Addressing the social determinants of health provides a crucial opportunity to reduce the substantial clinical and non-clinical complications associated with atrial fibrillation. In this Review, we summarize the contributions of social determinants to the patient experience and outcomes associated with this common condition. We emphasize the relevance of social determinants and their important intersection with atrial fibrillation treatment and outcomes. In closing, we identify gaps in the literature and propose future directions for the investigation of social determinants and atrial fibrillation.
Collapse
Affiliation(s)
- Utibe R. Essien
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,
| | - Jelena Kornej
- Sections of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Amber E. Johnson
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lucy B. Schulson
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Emelia J. Benjamin
- Sections of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jared W. Magnani
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
16
|
Kyoon-Achan G, Schroth RJ, Sanguins J, Campbell R, Demaré D, Sturym M, Edwards J, Bertone M, Dufour L, Hai Santiago K, Chartrand F, Dhaliwal T, Patterson B, Levesque J, Moffatt M. Early childhood oral health promotion for First Nations and Métis communities and caregivers in Manitoba. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2021; 41:14-24. [PMID: 33438942 DOI: 10.24095/hpcdp.41.1.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Early childhood caries is a public health concern, and the considerable burden exhibited by Indigenous children highlights the oral health inequities across populations in Canada. Barriers include lack of access to oral health care and lack of culturally appropriate oral health promotion. The purpose of this study was to determine where and how First Nations and Métis parents, caregivers and community members learn about caring for young children's oral health, and what ideas and suggestions they have on how to disseminate information and promote early childhood oral health (ECOH) in Indigenous communities. METHODS Sharing circles and focus groups engaged eight groups of purposively sampled participants (n = 59) in four communities in Manitoba. A grounded theory approach guided thematic analysis of audiorecorded and transcribed data. RESULTS Participants said that they learned about oral health from parents, caregivers and friends, primary care providers, prenatal programs, schools and online. Some used traditional medicines. Participants recommended sharing culturally appropriate information through community and prenatal programs and workshops; schools and day care centres; posters, mailed pamphlets and phone communication (calls and text messages) to parents and caregivers, and via social media. Distributing enticing and interactive oral hygiene products that appeal to children was recommended as a way to encourage good oral hygiene. CONCLUSION Evidence-based oral health information and resources tailored to First Nations and Métis communities could, if strategically provided, reach more families and shift the current trajectory for ECOH.
Collapse
Affiliation(s)
- Grace Kyoon-Achan
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Ongomiizwin Research - Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert J Schroth
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julianne Sanguins
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Metis Federation, Winnipeg, Manitoba, Canada
| | - Rhonda Campbell
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Daniella Demaré
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Melina Sturym
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Mary Bertone
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,School of Dental Hygiene, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Tiffany Dhaliwal
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Brayden Patterson
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Joshua Levesque
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Moffatt
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | |
Collapse
|
17
|
Cabellos-García AC, Martínez-Sabater A, Díaz-Herrera MÁ, Gea-Caballero V, Castro-Sánchez E. Health literacy of patients on oral anticoagulation treatment- individual and social determinants and effect on health and treatment outcomes. BMC Public Health 2021; 21:1363. [PMID: 34243749 PMCID: PMC8272331 DOI: 10.1186/s12889-021-11259-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 06/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background Assessment health literacy in people with cardiovascular health problems would facilitate the development of appropriate health strategies for the care and reduction of complications associated with oral anticoagulation therapy. Aim: To evaluate the relationship between health literacy and health and treatment outcomes (concordance with oral anticoagulants, Normalized Ratio control and occurrence of complications) in patients with cardiovascular pathology. Methods Observational, analytic and cross-sectional study carried out on 252 patients with cardiovascular pathology (atrial fibrillation, flutter or valve prosthesis), aged 50–85 years, accessing primary care services in Valencia (Spain) in 2018–2019. Variables referring to anticoagulant treatment with vitamin K antagonists (years of treatment, adequate control, polypharmacy and occurrence of complications, among others) and health literacy (Health Literacy Questionnaire) were analysed. Results All dimensions of health literacy were significantly related to the level of education (p < 0.02), social class (p < 0.02), an adequate control of acenocoumarol (p < 0.001), frequentation of health services (p < 0.001), information by patients to health professionals about anticoagulant treatment (p < 0.03), emergency care visits (p < 0.001) and unscheduled hospital admissions (p < 0.001). Conclusion Health literacy has a relevant influence on the adequate self-management of anticoagulation treatment and the frequency of complications. The different dimensions that comprise health literacy play an important role, but the “social health support” dimension seems to be essential for such optimal self-management. Trial registration ACC-ACE-2016-01. Registration date: December 2015.
Collapse
Affiliation(s)
- Ana Cristina Cabellos-García
- Hospital Universitario y politécnico La Fe, Valencia, Spain.,Health Research Institut La Fe, Research Group GREIACC, Valencia, Spain
| | - Antonio Martínez-Sabater
- Nursing Department, Universitat de València, Valencia, Spain. .,Facultat d'Infermeria i Podologia. Nursing Care and Education Research Group. (GRIECE). Grupo Investigación en Cuidados (INCLIVA), Hospital Clínico Universitario, Valencia, Spain.
| | - Miguel Ángel Díaz-Herrera
- Direcció d'Atenció Primaria Costa Ponent, Institut Català de la Salut, Avinguda de la Gran via de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Unitat de Suport a la Recerca Costa de Ponent, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08940, Cornellà de Llobregat, Spain
| | - Vicente Gea-Caballero
- Health Research Institut La Fe, Research Group GREIACC, Valencia, Spain.,Escuela de Enfermería La Fe, centre affiliated to Universitat de Valencia, Valencia, Spain
| | - Enrique Castro-Sánchez
- School of Health Sciences, University of London, London, UK.,National Institute for Health Research Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
| |
Collapse
|
18
|
Ali-Ahmed F, Pieper K, North R, Allen LA, Chan PS, Ezekowitz MD, Fonarow GC, Freeman JV, Go AS, Gersh BJ, Kowey PR, Mahaffey KW, Naccarelli GV, Pokorney SD, Reiffel JA, Singer DE, Steinberg BA, Peterson ED, Piccini JP, O'Brien EC. Shared decision-making in atrial fibrillation: patient-reported involvement in treatment decisions. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 6:263-272. [PMID: 32392287 DOI: 10.1093/ehjqcco/qcaa040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/26/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
AIMS To determine the extent of shared decision-making (SDM), during selection of oral anticoagulant (OAC) and rhythm control treatments, in patients with newly diagnosed atrial fibrillation (AF). METHODS AND RESULTS We evaluated survey data from 1006 patients with new-onset AF enrolled at 56 US sites participating in the SATELLITE substudy of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT II). Patients completed surveys at enrolment and at 6-month follow-up. Patients were asked about who made their AF treatment decisions. Shared decision-making was classified as one that the patient felt was an autonomous decision or a shared decision with their healthcare provider (HCP). Approximately half of patients reported that their OAC treatment decisions were made entirely by their HCP. Compared with those reporting no SDM, patients reporting SDM for OAC were more often female (47.2% vs. 38.4%), while patients reporting SDM for rhythm control were more often male (62.2% vs. 57.6%). The most important factors cited by patients during decision-making for OAC were reducing stroke and bleeding risk, and their HCP's recommendations. After adjustment, patients with self-reported understanding of OAC, and rhythm control options, had higher odds of having participated in SDM [odds ratio (OR) 2.54, confidence interval (CI): 1.75-3.68 and OR 2.36, CI: 1.50-3.71, both P ≤ 0.001, respectively]. CONCLUSION Shared decision-making is not widely implemented in contemporary AF practice. Patient understanding about available therapeutic options is associated with a more than a two-fold higher likelihood of SDM, and may be a potential target for future interventions.
Collapse
Affiliation(s)
- Fatima Ali-Ahmed
- Department of Cardiology, Duke Clinical Research Institute, Durham, NC 27701, USA
| | - Karen Pieper
- Department of Cardiology, Duke Clinical Research Institute, Durham, NC 27701, USA
| | - Rebecca North
- Department of Statistics, North Carolina State University, Raleigh, NC 27695, USA
| | - Larry A Allen
- Department of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Paul S Chan
- Department of Cardiovascular Research, St. Luke's Mid America Heart Institute, Kansas City, MO 64111, USA
| | - Michael D Ezekowitz
- Department of Cardiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Gregg C Fonarow
- Department of Medicine, University of California, Los Angeles, CA 90095, USA
| | - James V Freeman
- Division of Research, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - Bernard J Gersh
- Department of Cardiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
| | - Peter R Kowey
- Department of Cardiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA.,Department of Cardiology, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Kenneth W Mahaffey
- Department of Medicine, Stanford Center for Clinical Research, Stanford School of Medicine, Stanford, CA 94305, USA
| | | | - Sean D Pokorney
- Department of Cardiology, Duke Clinical Research Institute, Durham, NC 27701, USA
| | - James A Reiffel
- Department of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Daniel E Singer
- Department of Cardiology, Harvard Medical School, and Massachusetts General Hospital, Boston, MA 02114, USA
| | - Benjamin A Steinberg
- Department of Cardiology, University of Utah Health Sciences Center, Salt Lake City, UT 84112, USA
| | - Eric D Peterson
- Department of Cardiology, Duke Clinical Research Institute, Durham, NC 27701, USA
| | - Jonathan P Piccini
- Department of Cardiology, Duke Clinical Research Institute, Durham, NC 27701, USA
| | - Emily C O'Brien
- Department of Cardiology, Duke Clinical Research Institute, Durham, NC 27701, USA
| |
Collapse
|
19
|
Lalor JP, Hu W, Tran M, Wu H, Mazor KM, Yu H. Evaluating the Effectiveness of NoteAid in a Community Hospital Setting: Randomized Trial of Electronic Health Record Note Comprehension Interventions With Patients. J Med Internet Res 2021; 23:e26354. [PMID: 33983124 PMCID: PMC8160802 DOI: 10.2196/26354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/07/2021] [Accepted: 04/06/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Interventions to define medical jargon have been shown to improve electronic health record (EHR) note comprehension among crowdsourced participants on Amazon Mechanical Turk (AMT). However, AMT participants may not be representative of the general population or patients who are most at-risk for low health literacy. OBJECTIVE In this work, we assessed the efficacy of an intervention (NoteAid) for EHR note comprehension among participants in a community hospital setting. METHODS Participants were recruited from Lowell General Hospital (LGH), a community hospital in Massachusetts, to take the ComprehENotes test, a web-based test of EHR note comprehension. Participants were randomly assigned to control (n=85) or intervention (n=89) groups to take the test without or with NoteAid, respectively. For comparison, we used a sample of 200 participants recruited from AMT to take the ComprehENotes test (100 in the control group and 100 in the intervention group). RESULTS A total of 174 participants were recruited from LGH, and 200 participants were recruited from AMT. Participants in both intervention groups (community hospital and AMT) scored significantly higher than participants in the control groups (P<.001). The average score for the community hospital participants was significantly lower than the average score for the AMT participants (P<.001), consistent with the lower education levels in the community hospital sample. Education level had a significant effect on scores for the community hospital participants (P<.001). CONCLUSIONS Use of NoteAid was associated with significantly improved EHR note comprehension in both community hospital and AMT samples. Our results demonstrate the generalizability of ComprehENotes as a test of EHR note comprehension and the effectiveness of NoteAid for improving EHR note comprehension.
Collapse
Affiliation(s)
- John P Lalor
- Department of Information Technology, Analytics, and Operations, Mendoza College of Business, University of Notre Dame, Notre Dame, IN, United States
| | - Wen Hu
- Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, United States
| | - Matthew Tran
- Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, United States
| | - Hao Wu
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, TN, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School/Reliant Medical Group/Fallon Health, Worcester, MA, United States
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Hong Yu
- Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, United States
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States
- Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center, Bedford, MA, United States
| |
Collapse
|
20
|
Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3093] [Impact Index Per Article: 1031.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
21
|
Naurita M, Wibowo YI, Setiadi AP, Setiawan E, Halim SV, Sunderland B. Information on antibiotics in an Indonesian hospital outpatient setting: What is provided by pharmacy staff and recalled by patients? Pharm Pract (Granada) 2021; 19:2167. [PMID: 33520037 PMCID: PMC7819704 DOI: 10.18549/pharmpract.2021.1.2167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/10/2021] [Indexed: 11/14/2022] Open
Abstract
Background:
The provision of information by pharmacy staff is a key factor to ensure
patients’ understanding and quality use of medications, including
antibiotics. However, little is known regarding the transmission of
information between pharmacy staff and patients in Indonesia.
Objective:
This study aimed to identify information on antibiotics provided by pharmacy
staff and recalled by patients in an Indonesian outpatient setting.
Methods:
The study was conducted in a hospital outpatient clinic in Malang, Indonesia,
in 2019. A checklist was used to obtain the data on information provided by
pharmacy staff, while interviews were conducted to determine information
recalled by patients (only presenting patients were included); a total of 15
information items – i.e. 14 essential and one secondary – were
observed. Descriptive analysis was used to summarise data on the checklists
(‘given’ versus ‘not given’) as well as
responses from the interviews (‘recalled’ versus
‘missed’).
Results:
Eleven pharmacy staff (two pharmacists and nine pharmacy technicians) were
involved in providing information for patients obtaining oral antibiotics
during the study period. Of 14 essential information items, only about half
was given by pharmacy staff, with pharmacists significantly providing on
average more information items than pharmacy technicians (7.96 versus 7.67
respectively; p<0.001). The most frequently information items
provided (>90%) included “antibiotic
identification”, “indication”, administration
directions (i.e. “dosage”, “frequency”,
“hour of administration”, “administration before/after
meal”, “route of administration”), and “duration
of use”. A total of 230 patients consented to the study, giving
79.9% response rate. The average number of information items recalled
by patients was 7.09 (SD 1.45). Almost all patients could recall information
on administration directions [i.e. “route of administration”
(97.0%), “frequency” (95.2%),
“dosage” (92.6%), “hour of
administration” (85.7%), “administration before/after
meal” (89.1%)] and “duration of use”
(90.9%). Fewer patients were able to recall “antibiotic
identification” (76.5%) and “indication”
(77.0%).
Conclusions:
Pharmacy staff provided antibiotic information in a limited fashion, while
patients showed adequate ability to recall the information given to them.
Further study is needed to better understand the effective process of
information transmission between pharmacy staff and patients, especially if
more information was provided, to better optimise the use of antibiotics in
outpatient settings in Indonesia.
Collapse
Affiliation(s)
- Melani Naurita
- BSc. Pharm. Master Student, Faculty of Pharmacy, University of Surabaya . Surabaya ( Indonesia ).
| | - Yosi I Wibowo
- PhD. Senior Lecturer. Centre for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya . Surabaya ( Indonesia ).
| | - Adji P Setiadi
- Dr. Associate Professor. Centre for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya . Surabaya ( Indonesia ).
| | - Eko Setiawan
- M.Sc. in Clin. Pharm. Lecturer. Centre for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya . Surabaya ( Indonesia ).
| | - Steven V Halim
- MPharm. Lecturer. Centre for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya . Surabaya ( Indonesia ).
| | - Bruce Sunderland
- PhD. Professor. School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University . Perth, WA ( Australia ).
| |
Collapse
|
22
|
Du X, Guo L, Xia S, Du J, Anderson C, Arima H, Huffman M, Yuan Y, Zheng Y, Wu S, Guang X, Zhou X, Lin H, Cheng X, Dong J, Ma C. Atrial fibrillation prevalence, awareness and management in a nationwide survey of adults in China. Heart 2021; 107:heartjnl-2020-317915. [PMID: 33509976 PMCID: PMC7958113 DOI: 10.1136/heartjnl-2020-317915] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/14/2020] [Accepted: 11/22/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine AF prevalence and gaps in atrial fibrillation (AF) awareness and management in China. METHODS We conducted a community-based survey of 47 841 adults (age ≥45 years) in seven geographic regions of China between 2014 and 2016. Participants underwent a structured questionnaire, a standard 12-lead ECG, physical examination and blood sampling. AF prevalence, defined by either ECG detection or self-report, was estimated according to sampling weights, non-response and age and sex distribution of the population. We used multivariable logistic regression to estimate associations among sociodemographic, clinical and geographic factors with the AF prevalence, awareness and treatment. RESULTS The weighted AF prevalence was 1.8% (95% CI 1.7% to 1.9%), but varied from 0.9% to 2.4% across geographical regions and equates to being present in an estimated 7.9 (95% CI 7.4 to 8.4) million people in China. Among men and women, the AF prevalence increased from 0.8% and 0.6% in the age group 45-54 years to 5.4% and 4.9% in the age group ≥75 years, respectively. Proportions of people who were aware of having AF decreased overall from 65.3% in 45-54 year-olds to 53.9% in ≥75 year-olds and varied between sex (men 58.5%, women 68.8%) and residency status (urban 78.3%, rural 35.3%). Only 6.0% of patients with high-risk AF received anticoagulation therapy. CONCLUSIONS AF prevalence is higher than previously reported in China, with low awareness and large treatment gaps. Large-scale efforts are urgently needed to reduce AF adverse consequences.
Collapse
Affiliation(s)
- Xin Du
- Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Heart Health Research Centre, Beijing, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lizhu Guo
- Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Shijun Xia
- Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jing Du
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Craig Anderson
- Heart Health Research Centre, Beijing, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The George Institute China at Peking University Health Science Centre, Beijing, China
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Mark Huffman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yiqiang Yuan
- The Seventh People's Hospital of Zhengzhou, Zhengzhou, China
| | - Yang Zheng
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuefeng Guang
- Department of Cardiology, Yanan Hospital of Kunming, Kunming, China
| | - Xianhui Zhou
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumchi, China
| | - Hongbo Lin
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Xiaoshu Cheng
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianzeng Dong
- Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Zhengzhou, China
| | - Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| |
Collapse
|
23
|
Sedney C, Abu HO, Trymbulak K, Mehawej J, Wang Z, Waring ME, Saczynski J, McManus DD. Sociodemographic, behavioral, and clinical factors associated with low atrial fibrillation knowledge among older adults with atrial fibrillation: The SAGE-AF study. PATIENT EDUCATION AND COUNSELING 2021; 104:194-200. [PMID: 32690396 PMCID: PMC7749812 DOI: 10.1016/j.pec.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Management of AF requires patient engagement in disease management which requires adequate knowledge about AF. OBJECTIVE To identify the patient characteristics associated with low AF knowledge among older adults with AF. METHODS The SAGE-AF cohort enrolled adults aged ≥65 diagnosed with AF in 2016-2018. Patient characteristics associated with low AF knowledge (<6/8 JAKQ items correct) were examined using multivariable adjusted logistic regression models. RESULTS Participants (N = 950) were on average 74 years old (SD: 6.7), 50 % female, and 87 % non-Hispanic white. The average JAKQ score was 68.7 (SD: 17.1), and 78 % had low AF knowledge. Participants aged ≥ 75 (OR: 1.55, 95 % CI: 1.03, 2.33), without a college degree (OR: 0.46, 95 % CI: 0.32, 0.65), cognitively impaired (OR: 1.72, 95 % CI: 1.15, 2.58), with a history of anxiety (OR: 1.76, 95 % CI: 1.09, 2.83), myocardial infarction (OR: 1.82, 95 % CI: 1.08, 3.07), and heart failure (OR: 1.84, 95 % CI: 1.16, 2.91) were more likely to have low AF knowledge. PRACTICE IMPLICATIONS Characteristics available in the electronic medical record may identify patients at risk for low AF knowledge. Formal assessment of AF knowledge may identify areas of weakness and allow for targeted education.
Collapse
Affiliation(s)
- Colleen Sedney
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA, United States.
| | - Hawa O Abu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA, United States
| | - Katherine Trymbulak
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA, United States
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA, United States
| | - Ziyue Wang
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA, United States
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs CT, United States
| | - Jane Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston MA, United States
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA, United States
| |
Collapse
|
24
|
Ware KB, Faile M, Lynch C. An Analysis of Perceived and Actual Anticoagulant Knowledge among Independent Pharmacy Patients. Innov Pharm 2020; 11. [PMID: 34007661 PMCID: PMC8127123 DOI: 10.24926/iip.v11i4.3421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Deficits in knowledge of parameters surrounding anticoagulant therapy administration carry substantial risks for patient harm. Patients prescribed anticoagulants may overestimate their knowledge of anticoagulant use principles. The purpose of this study was to analyze independent pharmacy patients’ perceived versus actual knowledge of their anticoagulation therapies. Methods: A 15-item survey across a dual-site pharmacy location evaluated patients’ confidence in their understanding of anticoagulant prescribing parameters and their awareness of measures to take to safeguard anticoagulant therapy routines. A pharmacist reviewed patient responses to survey items referencing actual understanding of anticoagulant therapies at the conclusion of the survey. Data analyses occurred by gender, age, ethnicity, location, living situation, self-management of anticoagulants, patient perception of anticoagulant safety, and reported receipt of anticoagulant education. Linear regressions were used for statistical analyses, with significance set at p<.05. Results: During the span of three months, 45 patients, 20 females and 25 males, completed the survey. Perceived anticoagulant knowledge did not differ significantly by demographics. Actual anticoagulant knowledge declined by over 20% between age groups 60-69 and 80-89 years old. African Americans displayed 10% lower actual anticoagulant knowledge than Caucasian Americans. Conclusions: This study revealed gaps in knowledge of anticoagulants among patients at an independent pharmacy. An appeal remains for more strategies to assist with knowledge of anticoagulant regimens. Healthcare institutions should continue to incorporate programs geared towards ongoing anticoagulant education, such as question and answer sessions, along with peer support mediums that foster optimal outcomes.
Collapse
Affiliation(s)
| | - Marty Faile
- Sarasota Memorial Healthcare System, Sarasota, FL
| | | |
Collapse
|
25
|
Liu J, Wang Y, Guo W, Cheng Y, Zhang S, Wu B, Liu M. Temporal trends of atrial fibrillation and/or rheumatic heart disease-related ischemic stroke, and anticoagulant use in Chinese population: An 8-year study. Int J Cardiol 2020; 322:258-264. [PMID: 32814110 DOI: 10.1016/j.ijcard.2020.08.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE Underuse of anticoagulants in ischemic stroke patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD) is a global concern, especially in China. However, the extent to which anticoagulants are underused in AF and/or RHD-related ischemic stroke in China has not been well characterized. We aimed to explore the temporal trends of AF and/or RHD-related ischemic stroke patients, anticoagulation use and factors related to suboptimal use of anticoagulants in a Chinese population. METHODS Acute ischemic stroke patients admitted to department of neurology, West China hospital, Sichuan university were included from January 1st 2010 to December 31st 2017. Temporal trends of AF and RHD related ischemic strokes were compared over 2 year epochs (2010-2011, 2012-2013, 2014-2015 and 2016-2017). Multivariable logistic regression models were performed to evaluate the variables associated with non-anticoagulants at discharge. RESULTS Of 4357 acute ischemic stroke patients (≤7 days after onset) included between 2010 and 2017, 823(18.9%) were AF and/or RHD-related. Over the 8 years, the proportion of RHD-ischemic stroke decreased significantly from 7.8% in 2010-2011 to 4.5% in 2016-2017, whereas no reduction in AF-ischemic stroke was observed. There was an increase in the proportion of AF and/or RHD patients who were prescribed anticoagulants at discharge (from 26.4% to 45.1%, P for trend<0.001), while the proportion given antiplatelet therapy decreased with time (from 56.0% to 30.0%, P for trend<0.001). The use of non-vitamin K antagonist oral anticoagulants (NOAC) use at discharge remained low during the study period (2.1%).Older age (per 5 years increase, OR 1.91, 95% CI 1.28-2.86), higher NIHSS score on admission(OR 1.08, 95% CI 1.05-1.11), the presence of non-symptomatic hemorrhagic transformation(OR 2.54, 95% CI 1.67-3.94) and symptomatic hemorrhagic transformation(OR 3.04, 95% CI 1.14-9.73) were independently associated with non-anticoagulant use at discharge. However, patients with a prior diagnosis of AF/RHD and anticoagulation before admission were more likely to receive anticoagulants at discharge. CONCLUSIONS In an ischemic stroke population in China we found an increasing but still low use of anticoagulation. Further research is required on how to improve anticoagulation use at discharge in ischemic stroke patients, including access to NOAC's.
Collapse
Affiliation(s)
- Junfeng Liu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yanan Wang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Wen Guo
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yajun Cheng
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Shihong Zhang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Bo Wu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Ming Liu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China.
| |
Collapse
|
26
|
Son YJ, Baek KH, Won MH, Hong HC. Development and psychometric testing of the self-care scale for patients with chronic atrial fibrillation (AF-SCS-10). Eur J Cardiovasc Nurs 2020; 19:619-628. [PMID: 32340477 DOI: 10.1177/1474515120920472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) require continuous self-care due to possible complications and side effects from treatment. However, existing tools do not capture all of the critical factors of AF self-care and have limited evidence of reliability and validity. AIMS The aim of this study was to develop and evaluate a new Atrial Fibrillation Self-Care Scale-10 (AF-SCS-10) that assesses disease-specific, multidimensional, person-centered self-care for AF patients in South Korea. METHODS For this cross-sectional research design, 290 individuals over 20 years of age with a diagnosis of AF for at least three months were recruited. A literature review and in-depth interviews were utilized to identify the scale items. An expert panel evaluated the validity and reliability of a preliminary scale. Exploratory factor analysis and parallel analysis was performed to extract factors; confirmatory factor analysis (CFA) was performed to evaluate fit on the factor structures. Criterion validity was supported by the correlation between AF-SCS-10 and AF quality of life. RESULTS The internal consistency reliability coefficient was 0.87. Three factors, "self-care knowledge," "self-care behavior," and "self-care resources" were extracted from the exploratory factory analysis, explaining 79.30% of the total variance in the data. The three-factor model was also confirmed by parallel analysis; CFA met the fitness criteria. CONCLUSION There is preliminary evidence for internal consistency reliability, as well as content and construct validity, for the AF-SCS-10. Future research is needed to confirm the study results using a larger, more culturally diverse sample.
Collapse
Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Dongjak-gu, Seoul, South Korea
| | - Kyoung Hwa Baek
- Department of Nursing, Gyeongbuk College of Health, Kimcheon-Si, Gyeongsangbuk-Do, South Korea
| | - Mi Hwa Won
- Department of Nursing, Wonkwang University, Iksan, Jeonbuk, South Korea
| | - Hye Chong Hong
- Red Cross College of Nursing, Chung-Ang University, Dongjak-gu, Seoul, South Korea
| |
Collapse
|
27
|
Magon A, Arrigoni C, Moia M, Mancini M, Dellafiore F, Manara DF, Caruso R. Determinants of health-related quality of life: a cross-sectional investigation in physician-managed anticoagulated patients using vitamin K antagonists. Health Qual Life Outcomes 2020; 18:73. [PMID: 32178684 PMCID: PMC7077005 DOI: 10.1186/s12955-020-01326-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Literature has paid little attention in describing the specific contribution of each modifiable and non-modifiable characteristics on health-related quality of life (HRQoL) in physician-managed anticoagulated patients using vitamin K antagonists (VKAs). To describe how patients' treatment-specific knowledge, health literacy, treatment beliefs, clinical, and socio-demographic characteristics influence HRQoL in Italian physician-managed anticoagulated patients using VKAs. METHODS Cross-sectional multicentre study with a consecutive sampling strategy, enrolling 164 long-term anticoagulated patients. Clinical and socio-demographic characteristics were collected from electronic medical records. Valid and reliable questionnaires were used to collect patients' treatment-specific knowledge, health literacy, beliefs about VKAs, physical and health perceptions. RESULTS Obtaining and understanding health information (i.e., communicative health literacy) positively predicts both adequate mental (ORadjusted = 10.9; 95%CI = 1.99-19.10) and physical (ORadjusted = 11.54; 95%CI = 1.99-34.45) health perceptions. Conversely, the ability to perform proper health decision making (i.e., critical health literacy) was associated with lower rates of adequate mental health perception (ORadjusted = 0.13; 95%CI = 0.03-0.63). Further, age negatively predicted physical health perception (ORadjusted = 0.87; 95%CI = 0.81-0.93). CONCLUSIONS Health literacy plays an interesting role in predicting HRQoL. The relationship between critical health literacy and mental health perception could be influenced by some psychological variables, such as distress and frustration, which could be present in patients with higher levels of critical health literacy, as they could be more inclined for self-monitoring. For this reason, future research are needed to identify the most suitable patients' profile for each OAC-management model, by longitudinally describing the predictive performance of each modifiable and non-modifiable determinant of HRQoL.
Collapse
Affiliation(s)
- Arianna Magon
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, Italy.
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Marco Moia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Michela Mancini
- Nursing Office, ASST Melegnano e della Martesana, Melzo, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Duilio F Manara
- School of Nursing, Vita-Salute San Raffaele University, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| |
Collapse
|
28
|
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4842] [Impact Index Per Article: 1210.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
29
|
Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial. BMC Health Serv Res 2020; 20:60. [PMID: 31973765 PMCID: PMC6979365 DOI: 10.1186/s12913-020-4901-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background Improving the training of physicians about communication skills and patient health literacy (HL) is a major priority that remains an open question. We aimed to examine the effectiveness of communication skills training for physicians on the hypertension outcomes and the health literacy skills, self-efficacy and medication adherence in patients with uncontrolled blood pressure (BP). Methods A randomized, controlled trial method was conducted on 240 hypertensive patients and 35 physicians presenting to healthcare clinics in the Mashhad, Iran, from 2013 to 2014. Using stratified blocking with block sizes of 4 and 6, eligible patients with uncontrolled blood pressure were randomly allocated to the intervention and control groups. Physicians in the intervention group received educational training over 3 sessions of Focus –Group Discussion and 2 workshops. The control group received the routine care. The primary outcome was a reduction in systolic and diastolic BP from baseline to 6 months. The secondary outcome was promoting HL skills in hypertensive patients. Data were analyzed using the regression model and bivariate tests. Results After the physician communication training, there was a significant improvement in physicians-patient communication skills, hypertension outcomes, medication adherence, and self-efficacy among the patients being managed by the physicians receiving training, compared to the control group. Conclusion The educational intervention leads to better BP control; it may have been sufficient training of physicians change to impact counseling, HL and self-efficacy and adherence. The quality of physician-patient communication is an important modifiable element of medical communication that may influences health outcomes in hypertensive Iranian patients. Trial registration Iranian Registry of Clinical Trials (IRCT), IRCT20160710028863N24. Registered April 4, 2018 [retrospectively registered].
Collapse
|
30
|
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5324] [Impact Index Per Article: 1064.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
31
|
Lindahl B, Norberg M, Johansson H, Lindvall K, Ng N, Nordin M, Nordin S, Näslund U, Persson A, Vanoli D, Schulz PJ. Health literacy is independently and inversely associated with carotid artery plaques and cardiovascular risk. Eur J Prev Cardiol 2019; 27:209-215. [DOI: 10.1177/2047487319882821] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims Health literacy, the degree to which individuals understand and act upon health information, may have a pivotal role in the prevention of cardiovascular disease (CVD), with low health literacy potentially explaining poorer adherence to prevention guidelines. We investigated the associations between health literacy, ultrasound-detected carotid atherosclerosis and cardiovascular risk factors. Methods Baseline data (cross-sectional analysis) from a randomized controlled trial, integrated within the Västerbotten Intervention Program, Northern Sweden, was used. We included 3459 individuals, aged 40 or 50 years with ≥1 conventional risk factor or aged 60 years old. The participants underwent clinical examination, blood sampling, carotid ultrasound assessment of intima-media wall thickness (CIMT) and plaque formation, and answered a questionnaire on health literacy – the Brief Health Literacy Screen. The European Systematic Coronary Risk Evaluation and Framingham Risk Score were calculated. Results About 20% of the participants had low health literacy. Low health literacy was independently associated with the presence of ultrasound-detected carotid artery plaques after adjustment for age and education, odds ratio (95% confidence interval) 1.54 (1.28–1.85), demonstrating a similar level of risk as for smoking. Health literacy was associated with CIMT in men. Low health literacy was associated with higher CVD risk scores. Sensitivity analyses with low health literacy set to 9% or 30% of the study sample, respectively, yielded essentially the same results. Conclusions Low health literacy was independently associated with carotid artery plaques and a high level of CVD risk scores. Presenting health information in a fashion that is understood by all patients may improve preventive efforts.
Collapse
Affiliation(s)
- Bernt Lindahl
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Margareta Norberg
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Helene Johansson
- Department of Epidemiology and Global Health, Umeå University, Sweden
| | - Kristina Lindvall
- Department of Epidemiology and Global Health, Umeå University, Sweden
| | - Nawi Ng
- Department of Epidemiology and Global Health, Umeå University, Sweden
| | - Maria Nordin
- Department of Psychology, Umeå University, Sweden
| | | | - Ulf Näslund
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Amanda Persson
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Davide Vanoli
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Peter J Schulz
- Institute of Communication and Health, University of Lugano, Switzerland
| |
Collapse
|
32
|
Cognitive Impairment Is Independently Associated with Non-Adherence to Antithrombotic Therapy in Older Patients with Atrial Fibrillation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152698. [PMID: 31362337 PMCID: PMC6696263 DOI: 10.3390/ijerph16152698] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 12/17/2022]
Abstract
Atrial Fibrillation (AF) patients could reduce their risk of stroke by using oral antithrombotic therapy. However, many older people with AF experience cognitive impairment and have limited health literacy, which can lead to non-adherence to antithrombotic treatment. This study aimed to investigate the influence of cognitive impairment and health literacy on non-adherence to antithrombotic therapy. The study performed a secondary analysis of baseline data from a cross-sectional survey of AF patients’ self-care behaviors at a tertiary university hospital in 2018. Data were collected from a total of 277 AF patients aged 65 years and older, through self-reported questionnaires administered by face-to-face interviews. Approximately 50.2% of patients were non-adherent to antithrombotic therapy. Multiple logistic regression analysis revealed that cognitive impairment independently increased the risk of non-adherence to antithrombotic therapy (odds ratio = 2.628, 95% confidence interval = 1.424–4.848) after adjustment for confounding factors. However, health literacy was not associated with non-adherence to antithrombotic therapy. Cognitive impairment is a significant risk factor for poor adherence to antithrombotic therapy. Thus, health professionals should periodically assess both cognitive function after AF diagnosis and adherence to medication in older patients. Further studies are needed to identify the factors that affect cognitive decline and non-adherence among AF patients.
Collapse
|
33
|
Briggs R, Drumm B, Dwyer R, O'Neill D, Kennelly SP, Coughlan T, Collins R. Awareness of atrial fibrillation-effectiveness of a pilot national awareness campaign. Ir J Med Sci 2019; 189:149-153. [PMID: 31256311 DOI: 10.1007/s11845-019-02049-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/20/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although atrial fibrillation (AF) causes one-third of strokes in Ireland, studies have shown that public awareness and knowledge of AF are poor. The Irish Heart Foundation conducted a national AF awareness campaign in 2013. AIMS The aim of this study was to assess the effectiveness of the campaign in promoting awareness of AF in the general Irish population, by analyzing knowledge of AF at a population level pre- and post-campaign. METHODS Two thousand people were surveyed before the campaign to establish baseline knowledge, and the survey was then repeated in a sample of 1000 people in 2 months after the end of the campaign. RESULTS Awareness of AF was low, with 28% (560/2000) of those surveyed reporting they had heard of AF prior to the campaign and 30% (297/1002) after (p 0.347). Of those that had heard of the condition, 58% (174/300) in the pre-campaign group correctly identified AF as an irregular heartbeat compared with 35% (105/297) of the post-campaign group (p < 0.01). CONCLUSIONS Our study shows that overall public knowledge of AF in Ireland is generally poor. While this pilot national awareness campaign had no positive impact on awareness levels, there are several possible reasons for this including the limited funding allocation to the campaign. A further AF awareness campaign is planned for next year.
Collapse
Affiliation(s)
- Robert Briggs
- Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland.
| | - Breffni Drumm
- Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
| | - Ruth Dwyer
- Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
| | - Des O'Neill
- Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
| | - Tara Coughlan
- Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
| | - Ronan Collins
- Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
| |
Collapse
|
34
|
Borges FM, Silva ARVD, Lima LHDO, Almeida PCD, Vieira NFC, Machado ALG. Health literacy of adults with and without arterial hypertension. Rev Bras Enferm 2019; 72:646-653. [PMID: 31269128 DOI: 10.1590/0034-7167-2018-0366] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 02/13/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Assess the level of health literacy of adults, with and without hypertension, treated in three basic health units (UBS) in Picos, Piauí. METHODS Cross-sectional study conducted with 357 adults. Data were collected using a questionnaire with sociodemographic variables, and literacy was assessed by the Test of Functional Literacy in Adults. Descriptive analysis was performed followed by the association between literacy and exposure variables with Pearson's chi-squared (X2) test and Mann-Whitney U test. RESULTS Inadequate or marginal health literacy was found in three units investigated (71.5%; 77.8% and 85.2%);. Age and the years of schooling were factors associated with inadequate literacy in adults with hypertension (p<0.0001). CONCLUSION Inadequate literacy was found in more than 70% of the hypertensive patients investigated. This finding reinforces the need to improve the self-care skills of hypertensive patients, especially the older ones and those with few years of schooling.
Collapse
|
35
|
LaRosa AR, Pusateri AM, Althouse AD, Mathier AS, Essien UR, Magnani JW. Mind the gap: Deficits in fundamental disease-specific knowledge in atrial fibrillation. Int J Cardiol 2019; 292:272-276. [PMID: 31256997 DOI: 10.1016/j.ijcard.2019.06.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/14/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient success with atrial fibrillation (AF) requires adequate health literacy to understand the disease and rationale for treatment. We hypothesized that individuals receiving treatment for AF would have increased knowledge about AF and that such knowledge would be modified by education and income. METHODS We enrolled adults with AF receiving anticoagulation at ambulatory clinic sites. Participants responded to survey items encompassing the definitions of AF and stroke, the rationale for anticoagulation, and an estimation of their annual stroke risk. We examined responses in relation to household income and education in multivariable-adjusted models. RESULTS We enrolled 339 individuals (age 72.0 ± 10.1; 43% women) with predominantly lower annual income ($20-49,999, n = 99, 29.2%) and a range of educational attainment (high school or vocational, n = 117, 34.5%). Participants demonstrated moderate AF knowledge (1.7 ± 0.6; range 0-2) but limited knowledge about anticoagulation (1.3 ± 0.7; range 0-3) or stroke (1.5 ± 0.8; range 0-3). Income was not associated with improvement in AF (P = 0.32 for trend), anticoagulation (P = 0.27) or stroke knowledge (P = 0.26). Individuals with bachelor or graduate degree had greater AF (1.8 ± 0.5) and stroke (1.6 ± 0.8) knowledge relative to those with high school or vocational training (1.4 ± 0.7 and 1.2 ± 0.9; P ≪ 0.01, both estimates). Education was not associated with understanding the rationale for anticoagulation. Most participants (230, 68%) estimated their annual stroke risk as ≥15%. CONCLUSIONS We identified consistent, fundamental gaps in disease-specific knowledge in a cohort of adults receiving treatment for non-valvular AF. Improved patient understanding of this complex and chronic disease may enhance shared decision making, patient engagement, anticoagulation adherence, and clinical outcomes in AF.
Collapse
Affiliation(s)
- Anna R LaRosa
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Alexandra M Pusateri
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Andrew D Althouse
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Abigail S Mathier
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
| | - Utibe R Essien
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States of America.
| |
Collapse
|
36
|
Ayyaswami V, Padmanabhan D, Patel M, Prabhu AV, Hansberry DR, Agarwal N, Magnani JW. A Readability Analysis of Online Cardiovascular Disease-Related Health Education Materials. Health Lit Res Pract 2019; 3:e74-e80. [PMID: 31049489 PMCID: PMC6489118 DOI: 10.3928/24748307-20190306-03] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Online cardiovascular health materials are easily accessible with an Internet connection, but the readability of its content may limit practical use by patients. Objective: The goal of our study was to assess the readability of the most commonly searched Internet health education materials for cardiovascular diseases accessed via Google. Methods: We selected 20 commonly searched cardiovascular disease terms: aneurysm, angina, atherosclerosis, cardiomyopathy, congenital heart disease, coronary artery disease, deep vein thrombosis, heart attack, heart failure, high blood pressure, pericardial disease, peripheral arterial disease, rheumatic heart disease, stroke, sudden death, valvular heart disease, mini-stroke, lower extremity edema, pulmonary embolism, and exertional dyspnea. Terms were selected on Google and selected up to 10 results in order of presentation in the search results by reviewing a maximum of 15 pages of Google search results specifically providing education toward patients to yield 196 total patient education articles. Key Results: All readability measures assessing grade level measures found the 196 articles were written at a mean 10.9 (SD = 1.8) grade reading level. Moreover, 99.5% of the articles were written beyond the 5th- to 6th-grade level recommended by the American Medical Association. Conclusions: Given the prominent use of online patient education material, we consider readability as a quality metric that should be evaluated prior to online publication of any health education materials. Further study of how to improve the readability of online materials may enhance patient education, engagement, and health outcomes. [HLRP: Health Literacy Research and Practice. 2019;3(2):e74–e80.] Plain Language Summary: Patients often use Google as a tool for understanding their medical conditions. This study examined the readability of articles accessed via Google for commonly searched cardiovascular diseases and found all articles were written above reading grade levels appropriate for patients. We hope this study will promote the importance of ensuring that online patient education articles are written at appropriate reading levels.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jared W Magnani
- University of Pittsburgh Medical Center Heart and Vascular Institute
| |
Collapse
|
37
|
Chan RWY, Kisa A. A Scoping Review of Health Literacy Measurement Tools in the Context of Cardiovascular Health. HEALTH EDUCATION & BEHAVIOR 2019; 46:677-688. [PMID: 30829066 DOI: 10.1177/1090198119831754] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Despite the strong link between health literacy and cardiovascular health outcomes, health literacy measurements remain flawed and fragmented. There exists a gap in the knowledge when formulating a valid measurement to capture the broad concept of health literacy. The existence of various tools for health literacy measurement also hampers the availability of health literacy data. Additionally, little research is available on a valid measurement tool for cardiovascular health literacy. Objective. This study aims to provide an overview of the health literacy measurement tools used in the context of cardiovascular health. Method. A scoping review was conducted. Two electronic databases, Medline and Embase, were searched to identify studies that described a tool for the measurement of health literacy in the context of cardiovascular health. Results. After reviewing the available studies, 53 studies met the inclusion criteria. A total of 26 health literacy measurement tools were identified in the studies. Among the 26 tools, 16 used an objective measurement approach, 9 adopted a subjective approach, and 1 employed a mixed approach. Additionally, 28 studies used tools to measure print literacy, 15 studies measured print literacy and numeracy, and 5 studies measured print literacy, oral literacy, and numeracy. Conclusions. STOFHLA, TOFHLA, and REALM were the mostly commonly used tools in the selected studies. The majority of tools were based heavily on reading skills and word recognition. Researchers should focus on the development of more comprehensive and reliable health literacy measurement tool(s) specific to cardiovascular health to assist health care providers to more efficiently and accurately identify people with cardiovascular problems who have inadequate health literacy.
Collapse
Affiliation(s)
| | - Adnan Kisa
- University of Oslo, Oslo, Norway
- Kristiania University College, Oslo, Norway
| |
Collapse
|
38
|
Reading SR, Black MH, Singer DE, Go AS, Fang MC, Udaltsova N, Harrison TN, Wei RX, Liu ILA, Reynolds K. Risk factors for medication non-adherence among atrial fibrillation patients. BMC Cardiovasc Disord 2019; 19:38. [PMID: 30744554 PMCID: PMC6371431 DOI: 10.1186/s12872-019-1019-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/04/2019] [Indexed: 12/16/2022] Open
Abstract
Background Atrial fibrillation (AF) patients are routinely prescribed medications to prevent and treat complications, including those from common co-occurring comorbidities. However, adherence to such medications may be suboptimal. Therefore, we sought to identify risk factors for general medication non-adherence in a population of patients with atrial fibrillation. Methods Data were collected from a large, ethnically-diverse cohort of Kaiser Permanente Northern and Southern California adult members with incident diagnosed AF between January 1, 2006 and June 30, 2009. Self-reported questionnaires were completed between May 1, 2010 and September 30, 2010, assessing patient socio-demographics, health behaviors, health status, medical history and medication adherence. Medication adherence was assessed using a previously validated 3-item questionnaire. Medication non-adherence was defined as either taking medication(s) as the doctor prescribed 75% of the time or less, or forgetting or choosing to skip one or more medication(s) once per week or more. Electronic health records were used to obtain additional data on medical history. Multivariable logistic regression analyses examined the associations between patient characteristics and self-reported general medication adherence among patients with complete questionnaire data. Results Among 12,159 patients with complete questionnaire data, 6.3% (n = 771) reported medication non-adherence. Minority race/ethnicity versus non-Hispanic white, not married/with partner versus married/with partner, physical inactivity versus physically active, alcohol use versus no alcohol use, any days of self-reported poor physical health, mental health and/or sleep quality in the past 30 days versus 0 days, memory decline versus no memory decline, inadequate versus adequate health literacy, low-dose aspirin use versus no low-dose aspirin use, and diabetes mellitus were associated with higher adjusted odds of non-adherence, whereas, ages 65–84 years versus < 65 years of age, a Charlson Comorbidity Index score ≥ 3 versus 0, and hypertension were associated with lower adjusted odds of non-adherence. Conclusions Several potentially preventable and/or modifiable risk factors related to medication non-adherence and a few non-modifiable risk factors were identified. These risk factors should be considered when assessing medication adherence among patients diagnosed with AF.
Collapse
Affiliation(s)
- Stephanie R Reading
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA
| | - Mary Helen Black
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA
| | - Daniel E Singer
- Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Departments of Epidemiology, Biostatistics and Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Margaret C Fang
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Natalia Udaltsova
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Teresa N Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA
| | - Rong X Wei
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA
| | - In-Lu Amy Liu
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA.
| | | |
Collapse
|
39
|
Lalor JP, Woolf B, Yu H. Improving Electronic Health Record Note Comprehension With NoteAid: Randomized Trial of Electronic Health Record Note Comprehension Interventions With Crowdsourced Workers. J Med Internet Res 2019; 21:e10793. [PMID: 30664453 PMCID: PMC6351990 DOI: 10.2196/10793] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/28/2018] [Accepted: 10/26/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Patient portals are becoming more common, and with them, the ability of patients to access their personal electronic health records (EHRs). EHRs, in particular the free-text EHR notes, often contain medical jargon and terms that are difficult for laypersons to understand. There are many Web-based resources for learning more about particular diseases or conditions, including systems that directly link to lay definitions or educational materials for medical concepts. OBJECTIVE Our goal is to determine whether use of one such tool, NoteAid, leads to higher EHR note comprehension ability. We use a new EHR note comprehension assessment tool instead of patient self-reported scores. METHODS In this work, we compare a passive, self-service educational resource (MedlinePlus) with an active resource (NoteAid) where definitions are provided to the user for medical concepts that the system identifies. We use Amazon Mechanical Turk (AMT) to recruit individuals to complete ComprehENotes, a new test of EHR note comprehension. RESULTS Mean scores for individuals with access to NoteAid are significantly higher than the mean baseline scores, both for raw scores (P=.008) and estimated ability (P=.02). CONCLUSIONS In our experiments, we show that the active intervention leads to significantly higher scores on the comprehension test as compared with a baseline group with no resources provided. In contrast, there is no significant difference between the group that was provided with the passive intervention and the baseline group. Finally, we analyze the demographics of the individuals who participated in our AMT task and show differences between groups that align with the current understanding of health literacy between populations. This is the first work to show improvements in comprehension using tools such as NoteAid as measured by an EHR note comprehension assessment tool as opposed to patient self-reported scores.
Collapse
Affiliation(s)
- John P Lalor
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States
| | - Beverly Woolf
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States
| | - Hong Yu
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States.,Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.,Bedford Veterans Affairs Medical Center, Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
| |
Collapse
|
40
|
Elbashir M, Awaisu A, El Hajj MS, Rainkie DC. Measurement of health literacy in patients with cardiovascular diseases: A systematic review. Res Social Adm Pharm 2019; 15:1395-1405. [PMID: 30709731 DOI: 10.1016/j.sapharm.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND While many instruments have been developed, validated, and used to assess health literacy skills, their use and appropriateness among patients with cardiovascular diseases (CVDs) are not widely studied. OBJECTIVE To identify, appraise, and synthesize available health literacy assessment instruments used in patients with CVDs. METHODS Electronic databases were searched for studies that used validated measures to assess health literacy in patients with CVDs. Included studies were assessed for risk of bias and the identified instruments were evaluated based on their psychometric properties. Data were synthesized using a narrative approach. RESULTS Forty-three studies were included in the review, of which 20 were cross-sectional studies and 12 were randomized controlled trials. Eleven health literacy assessment instruments were identified, of which only one was disease-specific. The Abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) (n = 19) and the Rapid Estimate of Adult Literacy in Medicine (REALM) (n = 13) were found to be the most commonly used instruments to assess health literacy in CVDs. CONCLUSIONS The S-TOFHLA and the REALM are the most widely used instruments to evaluate health literacy in CVD population. More CVD-specific health literacy screening instruments are warranted. Assessment of health literacy should be a standard of care in patients with CVDs and effective interventions should be developed to improve the impact of limited health literacy on health outcomes in this population.
Collapse
Affiliation(s)
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar.
| | | | | |
Collapse
|
41
|
Guo J, Guan T, Fan S, Chao B, Wang L, Liu Y. Underuse of Oral Anticoagulants in Patients With Ischemic Stroke and Atrial Fibrillation in China. Am J Cardiol 2018; 122:2055-2061. [PMID: 30292336 DOI: 10.1016/j.amjcard.2018.08.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 01/27/2023]
Abstract
Anticoagulant therapy is an effective stroke prevention measurement for subjects with atrial fibrillation (AF) who are at high risk of ischemic stroke. However, it is reported that oral anticoagulants (OACs) are generally underused in clinical practice. A better awareness of current usage of anticoagulant therapy would enable prevention of stroke secondary to AF. Therefore, we determined the nationwide prevalence of AF and the frequency of OACs use among patients with ischemic stroke in China. Based on the China National Stroke Screening Survey, a representative nationwide sample of 1,252,703 adults over 40 years old during 2013 and 2014 was involved. Information on demographic data, diagnosis of stroke, behavioral risk factors, family history of stroke, related diseases, and medications was collected. The community-based survey data showed that 5,588 patients (12.0%) with ischemic stroke had previous, or newly diagnosed, AF. Therefore, more than 2.15 million ischemic stroke patients had AF in China. Among ischemic stroke patients with AF, the strongest risk factor was coronary heart disease (odds ratio = 2.53), whereas dyslipidemia accounted for the largest contribution (population-attributable risk proportion = 17.33%). Of ischemic stroke patients with AF, only 2.2% had taken OACs; of them, 98.2% had taken warfarin. In conclusion, a large number of ischemic stroke patients with AF are significantly undertreated with OACs in China. This highlights the need for improvement of prevention of ischemic stroke secondary to AF.
Collapse
|
42
|
Diederichs C, Jordan S, Domanska O, Neuhauser H. Health literacy in men and women with cardiovascular diseases and its association with the use of health care services - Results from the population-based GEDA2014/2015-EHIS survey in Germany. PLoS One 2018; 13:e0208303. [PMID: 30521588 PMCID: PMC6283547 DOI: 10.1371/journal.pone.0208303] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Health literacy (HL), defined as the ability to access, understand, appraise and apply health information, offers a promising approach to reduce the development of cardiovascular diseases (CVD) and to improve the management of CVD in populations. DESIGN We used data from nationwide cross-sectional German Health Update (GEDA2014/2015-EHIS) survey. 13,577 adults ≥ 40 years completed a comprehensive standardized paper or online questionnaire including the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). METHODS We compared participants with and without CVD with regard to their HL. We also analyzed the association between HL level and health care outcomes among individuals with CVD, i.e. frequency of general practitioner or specialist consultations, hospitalization and treatment delay. RESULTS The percentage of "problematic" or "inadequate" HL, defined as "not sufficient" HL, was significantly higher in individuals with CVD compared to without CVD (men 41.8% vs. 33.6%, women 46.7% vs. 33.4%). Having CVD was independently associated with "not sufficient" HL after adjusting for age, education, income, health consciousness and social support (adjusted OR: men 1.36, women 1.64). Among participants with CVD, individuals with "inadequate" HL were more likely to have more than 6 general practitioner consultations (49.3% vs. 28.7%), hospitalization (46.6% vs. 36.0%) in the last 12 months and to experience delay in getting health care because of long waiting lists for an appointment (30.7% vs. 18.5%) compared to participants with "sufficient" HL. CONCLUSION "Problematic" or "inadequate" HL is independently associated with CVD and health care use. This is a challenge and an opportunity for both CVD prevention and treatment.
Collapse
Affiliation(s)
- Claudia Diederichs
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
| | - Susanne Jordan
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
| | - Olga Domanska
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
| |
Collapse
|
43
|
Lunde ED, Nielsen PB, Riahi S, Larsen TB, Lip GYH, Fonager K, Larsen ML, Joensen AM. Associations between socioeconomic status, atrial fibrillation, and outcomes: a systematic review. Expert Rev Cardiovasc Ther 2018; 16:857-873. [PMID: 30293472 DOI: 10.1080/14779072.2018.1533118] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a growing epidemic and evidence of a relationship to socioeconomic status (SES) is inconsistent. We aimed to summarize the literature about SES and AF and defined two objectives: (1) To examine the association between SES and the risk of AF; (2) To examine the association between SES and AF-related outcomes in an AF-population. METHODS We performed a separate search for each objective in Ovid-MEDLINE and Ovid-Embase. For objective 1, the population included was healthy participants and outcome of interest was AF. For objective 2, the population included were patients with AF and outcome of interest was mortality, treatment, ablation for AF, knowledge about AF, and morbidity. RESULTS For objective 1, 12 studies were included. No consistent pattern for an association between SES and the risk of AF was discovered. For objective 2, 39 studies comprising 42 outcomes were included. The majority of studies showed an association between low SES and increased mortality and morbidity. CONCLUSION Low SES was associated with poorer outcomes when AF was present. These findings may imply that health-care professionals and policy interventions should focus on the promotion of AF-education and management among patients with AF and low SES.
Collapse
Affiliation(s)
| | - Peter Brønnum Nielsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
| | - Sam Riahi
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
| | - Torben Bjerregaard Larsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
| | - Gregory Y H Lip
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
- e Institute of Cardiovascular Sciences , University of Birmingham , UK
| | - Kirsten Fonager
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- f Department of Social Medicine , Aalborg University Hospital , Aalborg , Denmark
| | - Mogens Lytken Larsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- g Danish Centre of Inequality in Health, Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
| | - Albert Marni Joensen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
| |
Collapse
|
44
|
Cabellos-García AC, Martínez-Sabater A, Castro-Sánchez E, Kangasniemi M, Juárez-Vela R, Gea-Caballero V. Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review. BMC Public Health 2018; 18:1157. [PMID: 30286744 PMCID: PMC6172776 DOI: 10.1186/s12889-018-6070-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/25/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Oral anticoagulants (OAC) are widely used in patients with cardiovascular diseases. However, for optimal OAC self-care patients must have skills, among which health literacy (HL) is highlighted. We aimed to describe the relation between HL and self-care in cardiovascular patients on OAC treatment. METHODS Electronic searches were carried out in the PubMed, Scopus, Embase, CINAHL, Web of Science, Cochrane Library, SciELO, IME-Biomedicina, CUIDEN Plus and LILACS databases, limited to Spanish and English language and between January 2000-December 2016. Papers reported on adults older than 18 years, taking OAC by themselves for at least three months. PRISMA guidelines were used for paper selection. RESULTS We identified 142 articles and finally included 10; almost all of them about warfarin. Our results suggest that in patients taking OAC treatments there is a positive relationship between HL and the level of knowledge. In addition, a small percentage of participants on the selected papers recognized the side effects and complications associated with OAC treatment. Lower HL level was associated with greater knowledge deficits and less adherence to treatment. CONCLUSION There is a paucity of research evaluating the effect of HL on diverse aspects of OAC treatments. There is a need to expand the evidence base regarding appropriate HL screening tools, determinants of adequate knowledge and optimal behaviours related to OAC self-management.
Collapse
Affiliation(s)
| | | | - Enrique Castro-Sánchez
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Du Cane Road, W12 0NN, London, UK
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Raul Juárez-Vela
- Universidad San Jorge de Zaragoza, Villanueva de Gállego, Zaragoza, Spain
| | - Vicente Gea-Caballero
- Escuela de Enfermería La Fe, centro adscrito Universidad de Valencia, Valencia, Spain
- Instituto de Investigación La Fe. Grupo de investigación GREIACC, Valencia, Spain
| |
Collapse
|
45
|
Magnani JW, Mujahid MS, Aronow HD, Cené CW, Dickson VV, Havranek E, Morgenstern LB, Paasche-Orlow MK, Pollak A, Willey JZ. Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e48-e74. [PMID: 29866648 PMCID: PMC6380187 DOI: 10.1161/cir.0000000000000579] [Citation(s) in RCA: 234] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.
Collapse
|
46
|
Lalor JP, Wu H, Chen L, Mazor KM, Yu H. ComprehENotes, an Instrument to Assess Patient Reading Comprehension of Electronic Health Record Notes: Development and Validation. J Med Internet Res 2018; 20:e139. [PMID: 29695372 PMCID: PMC5943623 DOI: 10.2196/jmir.9380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/06/2018] [Accepted: 02/20/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient portals are widely adopted in the United States and allow millions of patients access to their electronic health records (EHRs), including their EHR clinical notes. A patient's ability to understand the information in the EHR is dependent on their overall health literacy. Although many tests of health literacy exist, none specifically focuses on EHR note comprehension. OBJECTIVE The aim of this paper was to develop an instrument to assess patients' EHR note comprehension. METHODS We identified 6 common diseases or conditions (heart failure, diabetes, cancer, hypertension, chronic obstructive pulmonary disease, and liver failure) and selected 5 representative EHR notes for each disease or condition. One note that did not contain natural language text was removed. Questions were generated from these notes using Sentence Verification Technique and were analyzed using item response theory (IRT) to identify a set of questions that represent a good test of ability for EHR note comprehension. RESULTS Using Sentence Verification Technique, 154 questions were generated from the 29 EHR notes initially obtained. Of these, 83 were manually selected for inclusion in the Amazon Mechanical Turk crowdsourcing tasks and 55 were ultimately retained following IRT analysis. A follow-up validation with a second Amazon Mechanical Turk task and IRT analysis confirmed that the 55 questions test a latent ability dimension for EHR note comprehension. A short test of 14 items was created along with the 55-item test. CONCLUSIONS We developed ComprehENotes, an instrument for assessing EHR note comprehension from existing EHR notes, gathered responses using crowdsourcing, and used IRT to analyze those responses, thus resulting in a set of questions to measure EHR note comprehension. Crowdsourced responses from Amazon Mechanical Turk can be used to estimate item parameters and select a subset of items for inclusion in the test set using IRT. The final set of questions is the first test of EHR note comprehension.
Collapse
Affiliation(s)
- John P Lalor
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States
| | - Hao Wu
- Psychology Department, Boston College, Chestnut Hill, MA, United States
| | - Li Chen
- Psychology Department, Boston College, Chestnut Hill, MA, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School / Reliant Medical Group / Fallon Health, Worcester, MA, United States
| | - Hong Yu
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States.,Department of Computer Science, University of Massachusetts, Lowell, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.,Bedford Veterans Affairs Medical Center, Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
| |
Collapse
|
47
|
Tavakoly Sany SB, Peyman N, Behzhad F, Esmaeily H, Taghipoor A, Ferns G. Health providers' communication skills training affects hypertension outcomes. MEDICAL TEACHER 2018; 40:154-163. [PMID: 29183178 DOI: 10.1080/0142159x.2017.1395002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Hypertension is a common cardiovascular risk factor within the Iranian population, and this may be improved through changes in lifestyle. We aimed at improving hypertension outcomes and health literacy skills among hypertensive patients through communication skills training targeting health providers. METHODS A randomized controlled trial method was used to enroll 35 health providers and 240 hypertensive patients attending community-based healthcare practices in the Mashhad, Iran. We evaluated the effects of a communication skills intervention for primary care providers compared to usual care controls, on the hypertension outcomes, patient medication adherence, and self-efficacy, assessed at baseline and post-intervention. Bivariate analysis and the regression model were used to assess whether the health provider training improved outcomes. RESULTS Majority of participating patients were female (77.3%), less than high school education (80.3%), married (82.3%), and low income (82.3%), with mean age of 37 years. Following the educational intervention, there was a significant improvement (p < 0.05) in patient communication skills, self-efficacy, adherence to medication, and hypertension outcomes in the intervention compared to the control group. CONCLUSIONS The brief communication skills training for health care providers appear to be an efficient way to improve patient-provider communication skills and hypertension outcome among patients with uncontrolled BP.
Collapse
Affiliation(s)
- Seyedeh Belin Tavakoly Sany
- a Social Determinants of Health Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
- b Department of Health Education and Health Promotion, School of Health , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Nooshin Peyman
- a Social Determinants of Health Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
- b Department of Health Education and Health Promotion, School of Health , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Fatemeh Behzhad
- a Social Determinants of Health Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
- b Department of Health Education and Health Promotion, School of Health , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Habibollah Esmaeily
- a Social Determinants of Health Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
- c Department of Biostatistics and Epidemiology, School of Health , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Ali Taghipoor
- a Social Determinants of Health Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
- c Department of Biostatistics and Epidemiology, School of Health , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Gordon Ferns
- d Brighton and Sussex Medical School , Division of Medical education, Falmer , Brighton, Sussex , UK
| |
Collapse
|
48
|
Ozeke O, Aras D, Cay S, Ozcan F, Baser K, Hacili A, Topaloglu S. Perception paradox between the doctors and patients in the industrial-bureaucratic age of medicine: Defensive versus offensive medicine in anticoagulation and atrial fibrillation ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:979-980. [PMID: 28560730 DOI: 10.1111/pace.13124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 04/18/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Ozcan Ozeke
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Kazim Baser
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ayten Hacili
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| |
Collapse
|