1
|
Sanders KH, Carver K, Eggleton E, Pugh PJ, Walker L, Azzawi M. Perceived benefits of patient support groups and their format for people with an implantable cardioverter defibrillator. Heart Lung 2024; 67:152-157. [PMID: 38762963 DOI: 10.1016/j.hrtlng.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/17/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Support groups for people with Implantable Cardioverter Defibrillators (ICDs) are widely used, however, it is not clear what people with ICDs gain from a support group or what format they should take. OBJECTIVES The aim of the present study is to define the perceived benefit of ICD support groups and develop practical recommendations for group format. METHODS 14 individuals with ICDs were interviewed using a semi-structured interview guide. Reflexive thematic analysis methods were utilised to code and analyse the transcripts before generating themes. RESULTS Four themes were defined: confronting mortality, coping through sharing, coping through learning, and providing space. Making connections with other people with ICDs, reassurance, access to information, and advice from health care professionals were important perceived benefits of the support group. CONCLUSION People with ICDs may have to confront their own mortality and adapt to considerable life changes after implant. The findings from the present study have improved understanding of how support groups are perceived and how ICD indication and group format influence the experience. A blended format of in-person community meetings, online forums, HCP-led education and space for person-person interaction is recommended. Importantly, provision of support should not be time-limited to allow people to access it when it most likely to be of benefit to them.
Collapse
Affiliation(s)
- Katie H Sanders
- Department of Life Sciences, Manchester Metropolitan University, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, England.
| | - Kathryn Carver
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| | | | - Peter J Pugh
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| | - Lucy Walker
- Department of Psychology, Manchester Metropolitan University, UK
| | - May Azzawi
- Department of Life Sciences, Manchester Metropolitan University, UK
| |
Collapse
|
2
|
Nevarez-Flores AG, Chappell KJ, Morgan VA, Neil AL. Health-Related Quality of Life Scores and Values as Predictors of Mortality: A Scoping Review. J Gen Intern Med 2023; 38:3389-3405. [PMID: 37653208 PMCID: PMC10682357 DOI: 10.1007/s11606-023-08380-4] [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: 11/14/2022] [Accepted: 08/15/2023] [Indexed: 09/02/2023]
Abstract
Health-related quality of life (HRQoL) can be assessed through measures that can be generic or disease specific, encompass several independent scales, or employ holistic assessment (i.e., the derivation of composite scores). HRQoL measures may identify patients with differential risk profiles. However, the usefulness of generic and holistic HRQoL measures in identifying patients at higher risk of death is unclear. The aim of the present study was to undertake a scoping review of generic, holistic assessments of HRQoL as predictors of mortality in general non-patient populations and clinical sub-populations with specified conditions or risk factors in persons 18 years or older. Five databases were searched from 18 June to 29 June 2020 to identify peer-reviewed published articles. The searches were updated in August 2022. Reference lists of included and cited articles were also searched. Of 2552 articles screened, 110 met criteria for inclusion. Over one-third of studies were from North America. Most studies pertained to sub-populations with specified conditions and/or risk factors, almost a quarter for people with cardiovascular diseases. There were no studies pertaining to people with mental health conditions. Nearly three-quarters of the studies used a RAND Corporation QoL instrument, predominantly the SF-36, and nearly a quarter, a utility instrument, predominantly the EQ-5D. HRQoL was associated with mortality in 67 of 72 univariate analyses (92%) and 100 of 109 multivariate analyses (92%). HRQoL was found to be associated with mortality in the general population and clinical sub-populations with physical health conditions. Whether this relationship holds in people with mental health conditions is not known. HRQoL assessment may be useful for screening and/or monitoring purposes to understand how people perceive their health and well-being and as an indicator of mortality risk, encouraging better-quality and timely patient care to support and maximize what may be a patient's only modifiable outcome.
Collapse
Affiliation(s)
| | - Katherine J Chappell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Vera A Morgan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
| |
Collapse
|
3
|
Risom SS, Thygesen LC, Rasmussen TB, Borregaard B, Nørgaard MW, Mols R, Christensen AV, Thorup CB, Thrysoee L, Juel K, Ekholm O, Berg SK. Association Between Risk Factors and Readmission for Patients With Atrial Fibrillation Treated With Catheter Ablation: Results From the Nationwide DenHeart Study. J Cardiovasc Nurs 2023; 38:E31-E39. [PMID: 35275884 DOI: 10.1097/jcn.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Because of high readmission rates for patients treated with ablation for atrial fibrillation (AF), there is great value in nurses knowing which risk factors make the largest contribution to readmission. OBJECTIVE The aims of this study were to (1) describe potential risk factors at discharge and (2) describe the associations of risk factors with readmission from 60 days to 1 year after discharge. METHODS Data from a national cross-sectional survey exploring patient-reported outcomes were used in conjunction with data from national health registers. This study included patients who had an ablation for AF during a single calendar year. The Hospital Anxiety and Depression Scale and questions on risk factors were included. Sociodemographic and clinical data were collected through registers, and readmissions were examined at 1 year. RESULTS In total, 929 of 1320 (response rate, 70%) eligible patients treated with ablation for AF completed the survey. One year after ablation, there were 333 (36%) acute readmissions for AF and 401 (43%) planned readmissions for AF. Readmissions were associated with ischemic heart disease, anxiety, and depression. CONCLUSION High observed readmission rates were associated with risk factors that included anxiety and depression. Postablation care should address these risk factors.
Collapse
|
4
|
Forman J, Murtagh E, Cheung J, Chakrabarti S, Macleod S, MacEwing C, Owens S, Alley H, Bangma K, Villeneuve M, Lauck S. Development of a patient and clinician co-led education program to promote living well with an implantable cardioverter defibrillator: Insights from a pilot project. PEC INNOVATION 2022; 1:100104. [PMID: 37213750 PMCID: PMC10194333 DOI: 10.1016/j.pecinn.2022.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 05/23/2023]
Abstract
Objective To evaluate a pilot education program designed to improve patients' experience of living well with an implantable cardioverter-defibrillator (ICD). Methods Patient Partners with previously implanted ICD and clinicians collaboratively performed monthly education sessions for potential and recent ICD recipients. Curriculum development was informed by current evidence of ICD patients' unique educational needs; delivery format transitioned to a virtual platform following the onset of COVID-19. Participants' experience was evaluated using a tailored questionnaire to explore preliminary insights. Results 126 participants (median age: 62 years; women: 30%) attended 24 sessions. In-person participants (n = 62, 49.2%) reported sessions as helpful (n = 56, 94%) with regards to format and Patient Partner interactions. Virtual participants 64 (50.8%) completed an electronic survey (n = 27, 45%); reporting sufficient information for most topics with the exception of potential psychological effects of ICD implantation. Patient Partners as collaborative session leaders was perceived to be very helpful (n = 22, 82%) or somewhat helpful (n = 5, 18%). Conclusion This novel educational partnership met the learning needs of patients at the vulnerable time of new cardiac device implantation of both in-person and virtual formats. Innovation The inclusion of Patient Partners in co-led cardiac education informs novel approach to care that may improve patients' experiences of living well with complex technology.
Collapse
Affiliation(s)
| | | | | | - Santabhanu Chakrabarti
- St. Paul’s Hospital, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | | | | | | | | | - Sandra Lauck
- St. Paul’s Hospital, Vancouver, Canada
- University of British Columbia School of Nursing, Vancouver, Canada
| |
Collapse
|
5
|
Sanders KH, Chousou PA, Carver K, Pugh PJ, Degens H, Azzawi M. Benefits of support groups for patients living with implantable cardioverter defibrillators: a mixed-methods systematic review and meta-analysis. Open Heart 2022; 9:openhrt-2022-002021. [PMID: 36252993 PMCID: PMC9577922 DOI: 10.1136/openhrt-2022-002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients with implantable cardioverter defibrillators (ICD) experience anxiety, depression and reduced quality of life (QoL). OBJECTIVES This mixed-methods systematic review evaluates whether ICD support groups have a beneficial effect on mental well-being. METHODS Literature searches were carried out in MEDLINE, Embase, CINAHL, PsycINFO and Web of Science. Eligible studies investigated patient-led support groups for ICD patients aged 18 years or older, using any quantitative or qualitative design. The Mixed-Methods Assessment Tool was used to assess quality. Meta-analysis of measures of mental well-being was conducted. Thematic synthesis was used to generate analytic themes from the qualitative data. The data were integrated and presented using the Pillar Integration Process. RESULTS Ten studies were included in this review. All studies bar one were non-randomised or had a qualitative design and patients had self-selected to attend a support group. Five contributed to the quantitative data synthesis and seven to the qualitative synthesis. Meta-analysis of anxiety and QoL measures showed no significant impact of support groups on mental well-being, but qualitative data showed that patients perceived benefit from attendance through sharing experiences and acceptance of life with an ICD. DISCUSSION ICD support group attendance improved the patients' perceived well-being. Attendees value the opportunity to share their experiences which helps to accept their new life with an ICD. Future research could consider outcomes such as patient acceptance and the role of healthcare professionals at support groups.
Collapse
Affiliation(s)
- Katie H Sanders
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Panagiota Anna Chousou
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kathryn Carver
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter J Pugh
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hans Degens
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK,Lithuanian Sports University, Kaunas, Lithuania
| | - May Azzawi
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
6
|
Lindekilde N, Skov O, Skovbakke SJ, Johansen JB, Nielsen JC, Pedersen SS. Anxiety and depression as risk factors for ICD shocks and mortality in patients with an implantable cardioverter defibrillator - A systematic review. Gen Hosp Psychiatry 2022; 78:96-107. [PMID: 35933929 DOI: 10.1016/j.genhosppsych.2022.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine associations between baseline anxiety and depression and occurrence of ICD shocks and risk of mortality in patients with an implantable cardioverter defibrillator (ICD). METHOD We systematically searched EMBASE, PubMed, PsycINFO, and CINAHL for eligible studies fulfilling the predefined criteria. RESULTS We included 37 studies based on 25 different cohorts following 35,003 participants for up to seven years. We observed no association between baseline anxiety nor depression and the occurrence of ICD shocks. More than half of the identified studies (respectively 56% and 60%) indicated a significant association between baseline anxiety or depression and increased risk of mortality (anxiety: n = 5, ranging from Hazard ratios (HR):1.02 [Confidence intervals (CI) 95% 1.00-1.03] to HR:3.45 [CI 95% 1.57-7.60]; depression: n = 6, ranging from HR:1.03 [CI 95% 1.00-1.06] to HR:2.10 [CI 95% 1.44-3.05]). We found a significant association between high methodological quality of the primary study and the detection of a significant association (p < 0.01). CONCLUSIONS Baseline anxiety and depression are associated with increased risk of mortality in patients with an ICD, but not with occurrence of ICD shocks. Inclusion of baseline anxiety and depression in risk stratification of mortality may be warranted.
Collapse
Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Ole Skov
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Søren J Skovbakke
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej, 8200 Aarhus, Denmark & Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| |
Collapse
|
7
|
Sandhu U, Nguyen AT, Dornblaser J, Gray A, Paladino K, Henrikson CA, Kovacs AH, Nazer B. Patient-Reported Outcomes in a Multidisciplinary Electrophysiology-Psychology Ventricular Arrhythmia Clinic. J Am Heart Assoc 2022; 11:e025301. [PMID: 35904213 PMCID: PMC9375498 DOI: 10.1161/jaha.122.025301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Ventricular arrhythmias (VAs) and their treatment have been associated with psychological distress and diminished quality of life (QOL). We administered a battery of patient-reported outcome measures (PROMs) to patients seeing an electrophysiologist and psychologist in a multidisciplinary VA clinic for patients referred for consideration of catheter ablation for sustained VAs or implantable cardioverter-defibrillator therapies. Methods and Results In this retrospective study of the initial VA clinic visit, we analyzed PROMs of: anxiety and depression symptoms, visual analog scales for physical health status and quality of life, cardiac anxiety, implantable cardioverter-defibrillator acceptance, and implantable cardioverter-defibrillator shock anxiety. We quantitated baseline PROM score means and performed correlation analysis with clinical makers of cardiac and VA disease severity. We also performed an item-level analysis of each PROM question to quantify most frequent patient concerns. A total of 66 patients (56±15 years; 77% men) were included; 70% had prior implantable cardioverter-defibrillator shock, and 44% with prior VA ablation. Elevated symptoms of anxiety (53%) and depression (20%) were common. Younger patients had greater symptom burden of general health anxiety, cardiac anxiety, and shock anxiety, and lower device acceptance, but indices of VA burden such as number of ICD shocks and time since last ICD shock did not predict anxiety or depression. Item-level review of cardiac-specific PROMs revealed that >40% of patients expressed concern regarding resumption of physical activity, sex and employment. Conclusions Clinicians can expect elevated symptoms of depression, and cardiac and device-related anxiety among patients with VAs. Routine use of PROMs may elicit these symptoms, which were otherwise not predicted by arrhythmia burden. Review of individual PROM items can facilitate targeting specific patient concerns, which commonly involved physical activity.
Collapse
Affiliation(s)
- Uday Sandhu
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Andrew T Nguyen
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - John Dornblaser
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Andrew Gray
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Karen Paladino
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Charles A Henrikson
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Babak Nazer
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| |
Collapse
|
8
|
Association of patient-reported psychosocial healthcare and risk of readmissions and mortality in patients with ischemic heart disease: A population-based cohort study. J Psychosom Res 2022; 156:110776. [PMID: 35276588 DOI: 10.1016/j.jpsychores.2022.110776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Psychosocial risk factors are common in patients with ischemic heart disease (IHD) and linked to poor prognosis. Psychosocial healthcare is recommended in international guidelines and has demonstrated positive effects, primarily on psychosocial symptoms. We examined the association between patient-reported psychosocial healthcare and hospital readmissions and mortality in patients with IHD. METHODS A population-based cohort study with register-based follow-up. Patient-reported psychosocial healthcare was measured by seven items in a survey sent to a random sample of patients with incident IHD in Denmark in 2014. We used multivariable Cox proportional hazards models and Poisson regression to examine the association between psychosocial healthcare and readmissions and all-cause mortality. RESULTS In total, 1083 (57%) patients were followed up to 4½ years. Low psychosocial support was reported by 53.4%, medium by 26.2% and high by 20.4% patients. The hazard of acute cardiac readmission for patients reporting low psychosocial healthcare was 2.08 higher than for patients reporting high psychosocial healthcare (95%CI:1.01-4.30). No association was found with time to first all-cause readmission. The acute cardiac readmission rate was 3.24 (95%CI:1.66-6.29) and 4.23 (95%CI:2.15-8.33) times higher among patients reporting low and medium psychosocial healthcare compared to high, and the all-cause readmission rate was 1.30 (95%CI:1.16-1.46) and 1.32 (95%CI:1.17-1.49) times higher. The hazard of death was 2.86 (95%CI:1.23-6.69) and 2.88 (95%CI:1.18-7.04) times higher among patients reporting low and medium psychosocial healthcare compared to high. CONCLUSION In patients with IHD, a high level of patient-reported psychosocial healthcare was significantly associated with reduced hospital readmissions and all-cause mortality.
Collapse
|
9
|
Li Z, Liu Y, Wang J, Zhang C, Liu Y. Effectiveness of cognitive behavioral therapy on mood symptoms in patients with implantable cardioverter defibrillator: A systematic review and meta-analysis. Complement Ther Clin Pract 2022; 47:101570. [DOI: 10.1016/j.ctcp.2022.101570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 02/26/2022] [Accepted: 02/26/2022] [Indexed: 11/25/2022]
|
10
|
Kahle AK, Jungen C, Alken FA, Scherschel K, Willems S, Pürerfellner H, Chen S, Eckardt L, Meyer C. Management of ventricular tachycardia in patients with ischaemic cardiomyopathy: contemporary armamentarium. Europace 2021; 24:538-551. [PMID: 34967892 DOI: 10.1093/europace/euab274] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Indexed: 01/10/2023] Open
Abstract
Worldwide, ∼4 million people die from sudden cardiac death every year caused in more than half of the cases by ischaemic cardiomyopathy (ICM). Prevention of sudden cardiac death after myocardial infarction by implantation of a cardioverter-defibrillator (ICD) is the most common, even though not curative, therapy to date. Optimized ICD programming should be strived for in order to decrease the incidence of ICD interventions. Catheter ablation reduces the recurrence of ventricular tachycardias (VTs) and is an important adjunct to sole ICD-based treatment or pharmacological antiarrhythmic therapy in patients with ICM, as conclusively demonstrated by seven randomized controlled trials (RCTs) in the last two decades. However, none of the conducted trials was powered to reveal a survival benefit for ablated patients as compared to controls. Whereas thorough consideration of an early approach is necessary following two recent RCTs (PAUSE-SCD, BERLIN VT), catheter ablation is particularly recommended in patients with recurrent VT after ICD therapy. In this context, novel, pathophysiologically driven ablation strategies referring to deep morphological and functional substrate phenotyping based on high-resolution mapping and three-dimensional visualization of scars appear promising. Emerging concepts like sympathetic cardiac denervation as well as radioablation might expand the therapeutical armamentarium especially in patients with therapy-refractory VT. Randomized controlled trials are warranted and on the way to investigate how these translate into improved patient outcome. This review summarizes therapeutic strategies currently available for the prevention of VT recurrences, the optimal timing of applicability, and highlights future perspectives after a PAUSE in BERLIN.
Collapse
Affiliation(s)
- Ann-Kathrin Kahle
- Division of Cardiology, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.,Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Universitätsstrasse 1, 40225 Düsseldorf, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
| | - Christiane Jungen
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany.,Clinic for Cardiology, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Fares-Alexander Alken
- Division of Cardiology, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.,Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Universitätsstrasse 1, 40225 Düsseldorf, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
| | - Katharina Scherschel
- Division of Cardiology, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.,Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Universitätsstrasse 1, 40225 Düsseldorf, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
| | - Stephan Willems
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany.,Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmühlenstrasse 5, 20099 Hamburg, Germany
| | - Helmut Pürerfellner
- Department of Electrophysiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, 4020 Linz, Austria
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Straße 4, 60431 Frankfurt am Main, Germany
| | - Lars Eckardt
- Department for Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Christian Meyer
- Division of Cardiology, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.,Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Universitätsstrasse 1, 40225 Düsseldorf, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
| |
Collapse
|
11
|
Thorup CB, Berg SK, Mols RE, Fonager K, Ekholm O, Thrysoee L, Rasmussen TB, Christensen AV, Borregaard B. Are patient-reported outcomes at discharge associated with employment status after cardiac hospitalization? Results from the national DenHeart study. Eur J Cardiovasc Nurs 2021; 21:453-463. [PMID: 34570213 DOI: 10.1093/eurjcn/zvab088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/20/2021] [Accepted: 09/12/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In patients hospitalized for cardiac disease, a more comprehensive understanding of the potential predictors of returning to the workforce or detachment from employment is lacking. AIM The aims were (i) to explore the patterns of employment status within 1 year following hospital discharge and (ii) to investigate the association between self-reported physical health, mental health, and symptom burden at discharge and employment status at 13, 26, and 52 weeks, respectively, following discharge. METHODS AND RESULTS Patients discharged from Danish heart centres from April 2013 to April 2014 who were a part of the workforce prior to hospitalization and aged 18-63 were included. Questionnaires were used to measure physical and mental health and symptom burden. Information on comorbidity and return to the workforce was obtained from registers. Multiple logistic regression models were used to estimate the associations between self-reported health status and returning to the workforce. Of the 5365 patients, 14.1% had not returned to the workforce 52 weeks after discharge. Patients admitted due to 'observation for a cardiac disease' had the highest proportion (89.4%) and patients with heart failure had the lowest proportion (72.6%) of returning to the workforce. Poor self-reported physical and mental health and high symptom burden were associated with detachment from the workforce. CONCLUSION Self-reported health status measured at discharge may be beneficial for identifying patients at increased risk of detachment from the workforce. Occupational initiatives may be implemented in the initial period after discharge, remembering that not all patients will benefit from returning to the workforce.
Collapse
Affiliation(s)
- Charlotte Brun Thorup
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J. B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | | | | | - Britt Borregaard
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.,Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B Winsløvs Vej 4, 5000 Odense C, Denmark
| |
Collapse
|
12
|
Pettersson H, Alexanderson H, Poole JL, Varga J, Regardt M, Russell AM, Salam Y, Jensen K, Mansour J, Frech T, Feghali-Bostwick C, Varjú C, Baldwin N, Heenan M, Fligelstone K, Holmner M, Lammi MR, Scholand MB, Shapiro L, Volkmann ER, Saketkoo LA. Exercise as a multi-modal disease-modifying medicine in systemic sclerosis: An introduction by The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis (G-FoRSS). Best Pract Res Clin Rheumatol 2021; 35:101695. [PMID: 34217607 PMCID: PMC8478716 DOI: 10.1016/j.berh.2021.101695] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Systemic sclerosis (SSc) is a heterogeneous multisystem autoimmune disease whereby its main pathological drivers of disability and damage are vascular injury, inflammatory cell infiltration, and fibrosis. These mechanisms result in diffuse and diverse impairments arising from ischemic circulatory dysfunction leading to painful skin ulceration and calcinosis, neurovascular aberrations hindering gastrointestinal (GI) motility, progressive painful, incapacitating or immobilizing effects of inflammatory and fibrotic effects on the lungs, skin, articular and periarticular structures, and muscle. SSc-related impairments impede routine activities of daily living (ADLs) and disrupt three critical life areas: work, family, social/leisure, and also impact on psychological well-being. Physical activity and exercise are globally recommended; however, for connective tissue diseases, this guidance carries greater impact on inflammatory disease manifestations, recovery, and cardiovascular health. Exercise, through myogenic and vascular phenomena, naturally targets key pathogenic drivers by downregulating multiple inflammatory and fibrotic pathways in serum and tissue, while increasing circulation and vascular repair. G-FoRSS, The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis recognizes the scientific basis of and advocates for education and research of exercise as a systemic and targeted SSc disease-modifying treatment. An overview of biophysiological mechanisms of physical activity and exercise are herein imparted for patients, clinicians, and researchers, and applied to SSc disease mechanisms, manifestations, and impairment. A preliminary guidance on exercise in SSc, a research agenda, and the current state of research and outcome measures are set forth.
Collapse
Affiliation(s)
- Henrik Pettersson
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Division of Rheumatology, Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helene Alexanderson
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Division of Rheumatology, Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Janet L Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA
| | - Janos Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Malin Regardt
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Anne-Marie Russell
- University of Exeter, College of Medicine and Health, Exeter, UK; National Institute of Health Research, Senior Nurse Research Leader, London, UK
| | - Yasser Salam
- Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kelly Jensen
- Oregon Health and Science University, Portland, OR, USA; New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA
| | - Jennifer Mansour
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA
| | - Tracy Frech
- Vanderbilt University, Division of Rheumatology, Nashville, TN, USA
| | | | - Cecília Varjú
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | | | - Matty Heenan
- Scleroderma Foundation/Pulmonary Hypertension Association, Tucson, AZ, USA
| | - Kim Fligelstone
- Scleroderma & Raynaud Society UK (SRUK), London, UK; Royal Free Hospital, London, UK
| | - Monica Holmner
- The Swedish Rheumatism Association National Association for Systemic Sclerosis, Sweden
| | - Matthew R Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA
| | - Mary Beth Scholand
- University of Utah, Division of Pulmonary Medicine, Pulmonary Fibrosis Center, Salt Lake City, UT, USA
| | - Lee Shapiro
- Division of Rheumatology, Albany Medical Center, Albany, NY, USA; Steffens Scleroderma Foundation, Albany, NY, USA
| | - Elizabeth R Volkmann
- University of California, David Geffen School of Medicine, UCLA Scleroderma Program and UCLA CTD-ILD Program, Division of Rheumatology, Department of Medicine, Los Angeles, CA, USA
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA.
| |
Collapse
|
13
|
Saketkoo LA, Russell AM, Jensen K, Mandizha J, Tavee J, Newton J, Rivera F, Howie M, Reese R, Goodman M, Hart P, Strookappe B, De Vries J, Rosenbach M, Scholand MB, Lammi MR, Elfferich M, Lower E, Baughman RP, Sweiss N, Judson MA, Drent M. Health-Related Quality of Life (HRQoL) in Sarcoidosis: Diagnosis, Management, and Health Outcomes. Diagnostics (Basel) 2021; 11:1089. [PMID: 34203584 PMCID: PMC8232334 DOI: 10.3390/diagnostics11061089] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Health-related quality of life (HRQoL), though rarely considered as a primary endpoint in clinical trials, may be the single outcome reflective of patient priorities when living with a health condition. HRQoL is a multi-dimensional concept that reflects the degree to which a health condition interferes with participation in and fulfillment of important life areas. HRQoL is intended to capture the composite degree of physical, physiologic, psychological, and social impairment resulting from symptom burden, patient-perceived disease severity, and treatment side effects. Diminished HRQoL expectedly correlates to worsening disability and death; but interventions addressing HRQoL are linked to increased survival. Sarcoidosis, being a multi-organ system disease, is associated with a diffuse array of manifestations resulting in multiple symptoms, complications, and medication-related side effects that are linked to reduced HRQoL. Diminished HRQoL in sarcoidosis is related to decreased physical function, pain, significant loss of income, absence from work, and strain on personal relationships. Symptom distress can result clearly from a sarcoidosis manifestation (e.g., ocular pain, breathlessness, cough) but may also be non-specific, such as pain or fatigue. More complex, a single non-specific symptom, e.g., fatigue may be directly sarcoidosis-derived (e.g., inflammatory state, neurologic, hormonal, cardiopulmonary), medication-related (e.g., anemia, sleeplessness, weight gain, sub-clinical infection), or an indirect complication (e.g., sleep apnea, physical deconditioning, depression). Identifying and distinguishing underlying causes of impaired HRQoL provides opportunity for treatment strategies that can greatly impact a patient's function, well-being, and disease outcomes. Herein, we present a reference manual that describes the current state of knowledge in sarcoidosis-related HRQoL and distinguish between diverse causes of symptom distress and other influences on sarcoidosis-related HRQoL. We provide tools to assess, investigate, and diagnose compromised HRQoL and its influencers. Strategies to address modifiable HRQoL factors through palliation of symptoms and methods to improve the sarcoidosis health profile are outlined; as well as a proposed research agenda in sarcoidosis-related HRQoL.
Collapse
Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, LA 70112, USA
- Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA 70112, USA
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, Devon EX1 2LU, UK
- Imperial College Healthcare NHS Foundation Trust, London W2 1NY, UK
| | - Kelly Jensen
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jessica Mandizha
- Respiratory Medicine, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter EX2 5DW, UK;
| | - Jinny Tavee
- Department of Neurology, National Jewish Health, Denver, CO 80206, USA;
| | - Jacqui Newton
- Sarcoidosis UK, China Works, Black Prince Road, London SE1 7SJ, UK; (J.N.); (M.H.)
| | - Frank Rivera
- Foundation for Sarcoidosis Research, Chicago, IL 60614, USA; (F.R.); (R.R.)
- National Sarcoidosis Support Group, Stronger than Sarcoidosis, New York, NY 11727, USA
| | - Mike Howie
- Sarcoidosis UK, China Works, Black Prince Road, London SE1 7SJ, UK; (J.N.); (M.H.)
- CGI UK, Space Defense & Intelligence (Cyber Security Operations), London EC3M 3BY, UK
| | - Rodney Reese
- Foundation for Sarcoidosis Research, Chicago, IL 60614, USA; (F.R.); (R.R.)
- National Sarcoidosis Support Group, Stronger than Sarcoidosis, New York, NY 11727, USA
- Sarcoidosis Awareness Foundation of Louisiana, Baton Rouge, LA 70812, USA
| | - Melanie Goodman
- New Orleans Sarcoidosis Support Group, New Orleans, LA 70112, USA;
| | - Patricia Hart
- iHart Wellness Holistic Approach to Sarcoidosis Certified Health & Wellness Coach, International Association of Professionals, New York, NY 11727, USA;
| | - Bert Strookappe
- Department of Physiotherapy, Gelderse Vallei Hospital, 10, 6716 RP Ede, The Netherlands; (B.S.); (M.E.)
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
| | - Jolanda De Vries
- Admiraal de Ruyter Hospital (Adrz), 114, 4462 RA Goes, The Netherlands;
- Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Misha Rosenbach
- Cutaneous Sarcoidosis Clinic, Department of Dermatology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Mary Beth Scholand
- Division of Pulmonary Medicine, Interstitial Lung Disease Center, University of Utah, Salt Lake City, UT 84132, USA;
| | - Mathew R. Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, LA 70112, USA
- Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA 70112, USA
| | - Marjon Elfferich
- Department of Physiotherapy, Gelderse Vallei Hospital, 10, 6716 RP Ede, The Netherlands; (B.S.); (M.E.)
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
| | - Elyse Lower
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA; (E.L.); (R.P.B.)
| | - Robert P. Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA; (E.L.); (R.P.B.)
| | - Nadera Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Marc A. Judson
- Division of Pulmonary Medicine and Critical Care, Albany Medical College, Albany, NY 12208, USA;
| | - Marjolein Drent
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
- Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
- Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, 40, 6229 ER Maastricht, The Netherlands
| |
Collapse
|
14
|
Pan CW, Liu RJ, Yang XJ, Ma QH, Xu Y, Luo N, Wang P. Could the EQ-5D-3L predict all-cause mortality in older Chinese? Evidence from a 5-year longitudinal study in eastern China. Qual Life Res 2021; 30:2887-2894. [PMID: 34028640 DOI: 10.1007/s11136-021-02883-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the ability of the 3-level EQ-5D (i.e., EQ-5D-3L) in predicting all-cause mortality in older Chinese adults. METHODS The data were from a 5-year longitudinal study, Weitang Geriatric Diseases Study, including 4579 community-dwelling older people in eastern China, with the mean age of 72.5 years at baseline and female being 52.0%. Three multivariable logistic regression models were adopted to assess the associations of the baseline EQ-5D data [i.e., the EQ-5D problems, EQ-5D-3L index score, and EQ-5D visual analog scale (VAS) score] with the 5-year all-cause mortality, adjusting for socio-demographic characteristics, and subsequently, health conditions and lifestyle habits. RESULTS A total of 183 participants died over the 5-year study period. A larger proportion of the dead reported problems in physical dimensions (i.e., including three dimensions: mobility, self-care, and usual activities, p < 0.05 for all). The mean EQ-5D index score (0.928) and EQ-VAS score (79.7) of the living were higher than those of the dead (0.915 and 73.2, p < 0.05 for both). In multivariable logistic analyses, the EQ-5D health problems in the physical-related dimensions [odds ratio (OR) 2.16, p < 0.05] and the EQ-VAS score (OR: 0.97, p < 0.001) were associated with the 5-year all-cause mortality when adjusting for socio-demographic characteristics, health conditions, and lifestyle habits. CONCLUSIONS It appears that the EQ-5D-3L could predict mortality in general older Chinese, which could be used to detect high-risk older individuals in China.
Collapse
Affiliation(s)
- Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Rui-Jie Liu
- School of Public Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China
| | - Xue-Jiao Yang
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Qing-Hua Ma
- The 3rd People's Hospital of Xiangcheng District, Suzhou, China
| | - Yong Xu
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pei Wang
- School of Public Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China. .,Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, China.
| |
Collapse
|
15
|
Device Adjustment and Recovery in Patients With Heart Failure Undergoing a Cardiac Resynchronization Therapy Implantation: A Longitudinal Study. J Cardiovasc Nurs 2021; 37:221-230. [PMID: 33657066 DOI: 10.1097/jcn.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about risk factors for poor adjustment to the device after cardiac resynchronization therapy (CRT) implantation in patients with heart failure. PURPOSE The aim of this study was to explore device adjustment and the postoperative recovery of patients with heart failure undergoing elective CRT device implantation. METHODS In this prospective multicenter longitudinal study, data were collected before implantation and after 2 weeks, 6 months, and 1 year, using validated self-reported instruments and investigator-designed, CRT-specific questions. RESULTS A total of 133 patients, 79% male, with a mean age of 70 ± 10 years, were included. Patients adjusted to the device over time (P < .001), but 20% of patients had difficulties after 2 weeks, and 11% had difficulties at the 1-year follow-up. Fatigue was the most common health problem before surgery (87%), which was reduced to 65% after 1 year, P < .001. Patients' recovery improved over time (P < .001). Device-specific problems with hiccups (7% vs 14%), pulsation around the device (29% vs 24%), tachycardia (28% vs 29%), appearance of the scar (21% vs 17%), and the device bulging out (65% vs 61%) remained unchanged over time, whereas stiffness in the shoulder (64% vs 28%, P < .001) and wound healing (9% vs 2%, P < .05) improved. CONCLUSIONS Most patients with heart failure recover and adjust early after their CRT implantation and improve even more during follow-up. However, recovery and adjustment are problematic for some patients, and many experience bodily discomforts because of the device. Early screening for poor adjustment and psychological distress can lead to appropriate interventions and timely referrals. This is important in the era of remote monitoring with less face-to-face contact.
Collapse
|
16
|
Kikkenborg Berg S. The heart and mind connection. Int J Cardiol 2020; 310:92-93. [DOI: 10.1016/j.ijcard.2020.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022]
|
17
|
Kim J, Choi J, Shin MS, Park JK, An M, Kim SH, Choi N, Lee MO, Heo S. Effect of physical and psychocognitive function and perceived health status on 12-month adverse cardiac events among implantable cardioverter-defibrillator recipients. Heart Lung 2020; 49:530-536. [PMID: 32434703 DOI: 10.1016/j.hrtlng.2020.04.010] [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: 01/28/2020] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Post-implant recovery in patients with implantable cardioverter-defibrillators (ICDs) is often compromised because of reduced physical and psycho-cognitive function and poor health perception, leading to short event-free survival. OBJECTIVES To examine the effects of psychocognitive function, health perception, and ICD-related factors on 12-month cardiac events among ICD patients. METHODS Using a prospective study design, ICD patients underwent baseline assessment and were followed for 12 months to assess cardiac events. RESULTS Cardiac events occurred in 14 patients (18.9%) (N = 74: age, 58 years; primary ICDs, 45.9%). Time after ICD implant (odds ratio [OR] = 1.002; p = .028) and executive function (OR = 1.021; p = .027) were significant predictors of 12-month cardiac events, while other physical and psychological indices were not. CONCLUSIONS Reduced executive function and longer time after implant predicted the events. Healthcare professionals need to assess executive function and provide treatment and support to improve executive function.
Collapse
Affiliation(s)
- JinShil Kim
- Gachon University, College of Nursing, Incheon, South Korea
| | - Jiin Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, College of Medicine, Incheon, South Korea
| | - Jin-Kyu Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, South Korea
| | - Minjeong An
- Chonnam National University, College of Nursing, Gwangju, South Korea
| | - Sun Hwa Kim
- Department of Nursing, Hanyang University Medical Center, Seoul, South Korea.
| | - Nayeon Choi
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Mee Ok Lee
- Gachon University Gil Medical Center, Incheon, South Korea
| | - Seongkum Heo
- Mercer University, Georgia Baptist College of Nursing, Atlanta, USA
| |
Collapse
|
18
|
Sears SF, Ford J. Seeking innovation in the delivery of psychosocial care for ICD patients. Eur Heart J 2020; 41:1212-1214. [PMID: 30957866 DOI: 10.1093/eurheartj/ehz167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Samuel F Sears
- Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Jessica Ford
- Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| |
Collapse
|
19
|
Moons P. Quality-of-life research in the European Journal of Cardiovascular Nursing: A call for more conceptual scrutiny. Eur J Cardiovasc Nurs 2020; 19:373-375. [PMID: 32114797 DOI: 10.1177/1474515120910868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, South Africa
| |
Collapse
|
20
|
Piepoli MF. Editor’s Presentation. Secondary prevention: First of all, address the basics. Eur J Prev Cardiol 2020; 27:227-230. [DOI: 10.1177/2047487320904919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, G da Saliceto Hospital, Italy
- Institute of Life Sciences, Sant’Anna School of Advanced Studies, Italy
| |
Collapse
|
21
|
Höfer S. Cognitive behavioural therapy in patients with an implanted cardioverter defibrillator. Eur J Prev Cardiol 2020; 27:256-257. [DOI: 10.1177/2047487319884375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Stefan Höfer
- Department of Medical Psychology, Medical University Innsbruck, Austria
| |
Collapse
|
22
|
Christensen AV, Bjorner JB, Ekholm O, Juel K, Thrysoee L, Borregaard B, Rasmussen TB, Mols RE, Thorup CB, Berg SK. Increased risk of mortality and readmission associated with lower SF-12 scores in cardiac patients: Results from the national DenHeart study. Eur J Cardiovasc Nurs 2019; 19:330-338. [PMID: 31696734 DOI: 10.1177/1474515119885480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The SF-12v2 health survey (SF-12) is widely used as a generic measure of health-related quality of life. However, interpretation of score differences can be difficult. AIM To estimate benchmarks for interpretation of score differences on the SF-12 for readmission and all-cause mortality in cardiac patients. METHODS Data from the DenHeart study, a national cross-sectional survey including one year follow-up register data, were used. Patients with ischaemic heart disease, arrhythmia, heart failure and heart valve disease answered the survey at hospital discharge. Cox proportional hazards models were used to regress readmission and all-cause mortality. RESULTS A total of 10,813 cardiac patients completed the SF-12. For patients with ischaemic heart disease and arrhythmia, a one point lower physical component summary score was associated with a 2% increase in risk in readmission (hazard ratio (HR) 1.022 (95% confidence interval 1.017;1.027) and HR 1.024 (1.018; 1.029), respectively) and a 3% increase in risk for patients with heart failure (HR 1.027 (1.015; 1.038)). A one point lower mental component summary score was associated with a 2% increase in the risk of readmission (HR 1.017 (1.013; 1.022)) across diagnoses. For both the physical and mental component summary score, a one point lower score meant a 5% increase in the risk of all-cause mortality (HR 1.046 (1.031; 1.060) and HR 1.046 (1.029; 1.065), respectively) across diagnoses. CONCLUSION In a large group of cardiac patients, a one point lower physical or mental component summary score was associated with an up to 3% increased risk of readmission and a 5% increased risk of mortality in the first year after discharge.
Collapse
Affiliation(s)
| | - Jakob Bue Bjorner
- Optum Patient Insights, USA.,Section of Social Medicine, University of Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Denmark
| | - Britt Borregaard
- Cardiothoracic and Vascular Department, Odense University Hospital, Denmark
| | | | | | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,National Institute of Public Health, University of Southern Denmark, Denmark
| |
Collapse
|
23
|
Berg SK, Rasmussen TB, Herning M, Svendsen JH, Christensen AV, Thygesen LC. Cognitive behavioural therapy significantly reduces anxiety in patients with implanted cardioverter defibrillator compared with usual care: Findings from the Screen-ICD randomised controlled trial. Eur J Prev Cardiol 2019; 27:258-268. [PMID: 31575299 DOI: 10.1177/2047487319874147] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to investigate the effect of a cognitive behavioural therapy intervention provided by trained cardiac nurses plus usual care compared with usual care alone in patients with an implanted cardioverter defibrillator who, prior to randomization, had presented with symptoms of anxiety measured by the Hospital Anxiety and Depression Scale. BACKGROUND Around 20-25% of all patients with an implanted cardioverter defibrillator experience anxiety. Among these patients anxiety is associated with mortality, presumably explained by risk behaviour and activation of the autonomic nervous system. We hypothesised that cognitive behavioural therapy provided by cardiac nurses in an out-patient setting would be an effective treatment of anxiety. METHODS This was an investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive behavioural therapy plus usual care or to usual care. The primary outcome was Hospital Anxiety and Depression Scale-Anxiety mean score at 16 weeks. Secondary outcomes included Hospital Anxiety and Depression Scale-Depression, Becks Anxiety Inventory, HeartQoL and Hamilton Anxiety Scale. Primary outcome analysis was based on the intention-to-treat principle. RESULTS A total of 88 participants were included, 66% men, mean age 64.3 years and 61% had primary indication implantable cardioverter defibrillator. A significant difference after 16 weeks was found between groups: intervention group (Hospital Anxiety and Depression Scale-A mean (standard deviation) 4.95 points (3.30) versus usual care group 8.98 points (4.03) (p < 0.0001)). Cohen's d was -0.86, indicating a strong clinical effect. The effect was supported by secondary outcomes. CONCLUSION Cognitive behavioural therapy provided by cardiac nurses to patients with a positive screening for anxiety had a statistically and clinically significant effect on anxiety compared with patients not receiving cognitive behavioural therapy.
Collapse
Affiliation(s)
- Selina K Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Denmark.,National Institute of Public Health, University of Southern Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | | | | | - Jesper H Svendsen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Anne V Christensen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| |
Collapse
|
24
|
|
25
|
Palese A, Cracina A, Purino M, Urli N, Fabris S, Danielis M. The experiences of patients electrically shocked by an implantable cardioverter defibrillator: Findings from a descriptive qualitative study. Nurs Crit Care 2019; 25:229-237. [DOI: 10.1111/nicc.12424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Alvisa Palese
- Department of Medical SciencesUdine University Udine Italy
| | | | - Michela Purino
- Neonatal Intensive Care UnitAzienda Sanitaria Universitaria Integrata di Udine Udine Italy
| | - Nadia Urli
- Pediatric UnitAzienda per l'Assistenza Sanitaria Udine Italy
| | - Stefano Fabris
- Department of Medical SciencesUdine University Udine Italy
| | | |
Collapse
|
26
|
Patient-Reported Quality of Life as a Predictor of Mortality and Ventricular Tachyarrhythmia's During 7 Years' Follow-Up in Patients With an Implantable Cardioverter Defibrillator (from the MIDAS Study). Am J Cardiol 2019; 123:605-610. [PMID: 30553508 DOI: 10.1016/j.amjcard.2018.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/28/2018] [Accepted: 11/01/2018] [Indexed: 11/22/2022]
Abstract
Preliminary evidence suggests that poor patient-reported quality of life (QoL) predicts mortality on the short term in patients with an implantable cardioverter defibrillator (ICD). It is unclear if this association persists on the long term. We evaluated whether patient-reported QoL at the time of implantation predicts mortality and ventricular tachyarrhythmias (VTa's) during 7 years' follow-up in patients with an ICD. A consecutive cohort of patients (80% men; mean [SD] age = 58 [12]) implanted with an ICD completed the Short Form Health Survey (SF-36). The 8 SF-36 subscales and the 2 component summary scores were used as predictors of VTa's and mortality at 7 years' follow-up. At 7 years' follow-up, 34% (132/392) of patients had died. Baseline physical functioning (hazard ratio [HR]: 1.59; 95% confidence interval [CI]: 1.11 to 2.29), role physical functioning (HR: 1.59; 95% CI: 1.09 to 2.31), vitality (HR: 1.53; 95% CI: 1.05 to 2.22), and general health (HR: 1.57; 95% CI: 1.09 to 2.27) were associated with 7-year mortality in adjusted analyses. There was a trend for low mental health being associated with an increased risk of mortality (HR: 1.38; 95% CI: 0.98 to 1.96). The other SF-36 dimensions were not significantly associated with mortality. Only baseline social functioning was associated with risk of VTa's during follow-up. In conclusion, patients with lower levels of physical functioning, role physical functioning, vitality, or general health had a greater risk of mortality, whereas only poor social functioning was associated with VTa's during 7 years' follow-up. Patient-reported QoL at the time of implant could be used to identify patients at risk for long-term mortality.
Collapse
|