| 11. |
- Khatib, Rani, et al.
(author)
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Evaluating the Extent of Patient-Centred Care in a Selection of ESC Guidelines
- 2020
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In: European Heart Journal - Quality of Care and Clinical Outcomes. - : Oxford University Press. - 2058-5225 .- 2058-1742. ; 6:1, s. 55-61
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Patient-centred care (PCC) is the cornerstone for healthcare professionals (HCP) to promote high quality care for patients with cardiovascular conditions. It is defined as 'Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions'. PCC can improve patient outcomes and allow patients and HCP to manage care collaboratively using best available evidence. However, there is no clear understanding how extensively these guidelines incorporate PCC recommendations. The aim of the study was to evaluate the incorporation of PCC into a selection of guidelines published by the European Society of Cardiology (ESC).METHODS: Using a narrative literature review and expert consensus, the Science Committee within the Cardiovascular Nursing and Allied Professions (ACNAP) developed a checklist to determine PCC incorporation in clinical guidelines. Nine ESC guidelines were reviewed evaluated with committee members independently evaluating five PCC aspects: patient voice & involvement, multidisciplinary involvement, holistic care recommendations, flexibility to meet patients' needs, and provision of patient tools. The level of congruence in item ratings by experts was then compared.RESULTS: The incorporation of PCC using these respective five categories, ranged from 4% (patient tools) to 53% in the 'multidisciplinary involvement' category.CONCLUSIONS: Overall, the inclusion of PCC was low, indicating that patient perspectives and needs were less likely to be taken into account when developing, endorsing or formulating recommendations. Future development of guidelines should ensure better incorporation of patients' perspective, in particular, and other PCC aspects highlighted in this study.
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| 12. |
- Mourad, Ghassan, 1974-, et al.
(author)
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Hälsorelaterad livskvalitet och psykisk ohälsa hos patienter med icke-kardiell bröstsmärta
- 2020
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In: BestPractice Nordic, Primärvård. ; :2
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Journal article (pop. science, debate, etc.)abstract
- Återkommande icke-kardiell bröstsmärta har negativ inverkan på psykiskt välmående och hälsorelaterad livskvalitet (HRQoL). Detta gäller i synnerhet patienter med tidigare hjärtsjukdom vilka visar signifikant lägre HRQoL än patienter med icke-kardiell bröstsmärta utan tidigare hjärtsjukdom.Många patienter som söker akut på grund av bröstsmärta blir utskrivna utan någon förklaring, annat än att akut hjärtsjukdom uteslutits, så kallad icke-kardiell bröstsmärta.1,2 Återkommande bröstsmärta kan påverka patienternas psykiska välbefinnande och hälsorelaterade livskvalitet (HRQoL) negativt.3-6 En stor andel av dessa patienter kan ha haft hjärtsjukdom sedan tidigare.7 Det råder i dag brist på studier som undersökt HRQoL bland patienter med icke-kardiell bröstsmärta samt hur tidigare erfarenhet av hjärtsjukdom påverkar sambandet mellan psykiskt välbefinnande och HRQoL hos dessa patienter. Syftet med denna studie var därför att beskriva HRQoL bland patienter med icke-kardiell bröstsmärta, med eller utan tidigare hjärtsjukdom. Vidare var syftet att undersöka sambandet mellan HRQoL och psykisk ohälsa, vilket i denna studie omfattade hjärtrelaterad ångest, depressiva symtom, rädsla för kroppsliga sensationer och somatisering. Metod Sammanlagt 552 patienter som vårdats för bröstsmärta och skrivits ut från fyra sjukhus i sydöstra Sverige med icke-kardiell bröstsmärta som diagnos (ICD 10–diagnoskoder: R07.2, R07.3, R07.4 och Z03.4) deltog i studien. Patienterna var 64 ± 17 år gamla, huvudsakligen gifta/sambo och jämnt fördelade avseende kön. Patienter med tidigare hjärtsjukdom var äldre än de utan (71 år respektive 60 år) och bestod av fler män än kvinnor (60 procent respektive 44 procent). HRQoL undersöktes med frågeformuläret EuroQol-5D-5L (EQ-5D),8 hjärtrelaterad ångest med Cardiac Anxiety Questionnaire (CAQ),9 depressiva symtom med Patient Health Questionnaire-9 (PHQ-9),10 rädsla för kroppsliga sensationer med Body Sensations Questionnaire (BSQ)11 och somatisering med Patient Health Questionnaire-15 (PHQ-15).12 Resultat Omkring hälften av patienterna rapporterade minst måttliga problem avseende smärtor/besvär och en av fyra rapporterade minst måttliga problem i HRQoL–dimensionerna rörlighet, vanliga aktiviteter och oro/nedstämdhet. Avseende personlig vård var det åtta procent som rapporterade problem. EQ-5D VAS och EQ-5D index var 0,7 ± 0,2 respektive 0,7 ± 0,3 för den totala studiepopulationen. Patienter med icke-kardiell bröstsmärta och tidigare hjärtsjukdom rapporterade signifikant lägre HRQoL (p ≤0,05) jämfört med patienter med icke-kardiell bröstsmärta utan tidigare hjärtsjukdom. Hjärtrelaterad ångest, depressiva symtom och somatisering hade i den totala studiepopulationen svaga signifikanta negativa samband (beta = 0,187–0,284, p <0,001) med HRQoL. Hos patienter med tidigare hjärtsjukdom var sambandet mellan depressiva symtom och HRQoL måttligt (beta = -0,339, p <0,001), jämfört med svagt samband hos patienter utan tidigare hjärtsjukdom (beta = -0,193, p <0,001). Å andra sidan var sambandet mellan hjärtrelaterad ångest och HRQoL svagt hos både patienter med tidigare hjärtsjukdom (beta = -0,156, p = 0,05) och patienter utan tidigare hjärtsjukdom (beta = -0,229, p <0,001). Slutsatser Patienter med icke-kardiell bröstsmärta, särskilt de med tidigare hjärtsjukdom, rapporterade låga nivåer av HRQoL och en stor andel uppvisade problem med smärtor/besvär och oro/nedstämdhet. Hjärtrelaterad ångest, depressiva symtom och somatisering hade negativ inverkan på HRQoL, men skiljde sig en del mellan dem som haft eller inte haft hjärtsjukdom sedan tidigare. Detta bör beaktas vid utveckling av psykologiska interventioner som syftar till att förbättra HRQoL hos patienter med icke-kardiell bröstsmärta.Referenser 1. spalding L, Reay E, Kelly C. Cause and outcome of atypical chest pain in patients admitted to hospital. Journal of the Royal Society of Medicine. 2003;96(3):122-125. 2. Leise MD, Locke GR, 3rd, Dierkhising RA, et al. Patients dismissed from the hospital with a diagnosis of noncardiac chest pain: cardiac outcomes and health care utilization. Mayo Clinic proceedings. Mayo Clinic. 2010;85(4): 323-330. 3. Eslick GD. Health care seeking behaviors, psychological factors, and quality of life of noncardiac chest pain. Disease-a-month : DM. 2008;54(9): 604-612. 4. Mol KA, Smoczynska A, Rahel BM, et al. Non-cardiac chest pain: prognosis and secondary healthcare utilisation. Open Heart. 2018;5(2): e000859. 5. Mourad G, Stromberg A, Johansson P, et al. Depressive Symptoms, Cardiac Anxiety, and Fear of Body Sensations in Patients with Non-Cardiac Chest Pain, and Their Relation to Healthcare-Seeking Behavior: A Cross-Sectional Study. The Patient. 2016;9(1): 69-77.6. Fagring AJ, Gaston-Johansson F, Kjellgren KI, et al. Unexplained chest pain in relation to psychosocial factors and health-related quality of life in men and women. European journal of cardiovascular nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. 2007;6(4): 329-336. 7. Mourad G, Jaarsma T, Stromberg A, et al. The associations between psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter? BMC Psychiatry. 2018;18(1): 172. 8. EuroQolGroup. EQ-5D 2017. Available from: www.euroqolgroup.org, accessed 2017-11-06. 9. Eifert GH, Thompson RN, Zvolensky MJ, et al. The cardiac anxiety questionnaire: development and preliminary validity. Behaviour Research and Therapy. 2000;38(10): 1039-1053. 10. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9): 606-613.11. Chambless DL, Caputo GC, Bright P, et al. Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology. 1984;52(6): 1090-1097. 12. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine. 2002;64(2): 258-266.
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| 13. |
- Mourad, Ghassan, 1974-, et al.
(author)
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Somatization in women and men with non-cardiac chest pain compared to the general Swedish population
- 2022
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In: Psychiatry Research Communications. - : Elsevier. - 2772-5987. ; 2:2
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Journal article (peer-reviewed)abstract
- We compare the prevalence of somatization in women and men with NCCP in relation to the general Swedish population, analyze the overlap between somatization, cardiac anxiety, and depressive symptoms, and explore variables associated with somatization. A cross sectional design is implemented with data collected between late October 2013 and early January 2014 from 552 patients with NCCP (mean age of 64 ± 17 years, 51% women) from four hospitals in southeast Sweden. Somatization was measured with the Patient Health Questionnaire-15, cardiac anxiety with the Cardiac Anxiety Questionnaire, and depressive symptoms with the Patient Health Questionnaire-9. Data were self-reported. The general population consists of 1898 females and 1508 males. Compared to the general population, somatization was significantly (p < .001) more common in both women and men with NCCP. Women with NCCP had significantly (p = .003) higher prevalence of somatization than men with NCCP. In patients with NCCP, 12% had only somatization, whereas 39% also reported cardiac anxiety and depressive symptoms. Younger age in women tended to be associated with somatization (OR = 0.98, p < .073), but also being non-worker (OR = 0.40, p = .024). In men, somatization tended to be associated with increased healthcare contacts (OR = 1.82, p = .051). Furthermore, in both women and men, number of co-morbidities (OR = 9.69 p < .001 and OR = 3.45, p = .002), cardiac anxiety (OR = 2.93 and OR = 2.09, p < .001), and depressive symptoms (OR = 8.71 and OR = 4.44, p < .001) were significantly associated with somatization. Our study demonstrates that somatization is very common among patients with NCCP, especially in women. Patients with NCCP have higher somatization and greater overlap with psychological distress compared to the general population.
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| 14. |
- Säfström, Emma, 1980-, et al.
(author)
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Associations between continuity of care, perceived control and self-care and their impact on health-related quality of life and hospital readmission - A structural equation model
- 2023
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In: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 79:6, s. 2305-2315
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Journal article (peer-reviewed)abstract
- AimThe aim of this study is to examine whether a conceptual model including the associations between continuity of care, perceived control and self-care could explain variations in health-related quality of life and hospital readmissions in people with chronic cardiac conditions after hospital discharge. DesignCorrelational design based on cross-sectional data from a multicentre survey study. MethodsPeople hospitalized due to angina, atrial fibrillation, heart failure or myocardial infarction were included at four hospitals using consecutive sampling procedures during 2017-2019. Eligible people received questionnaires by regular mail 4-6 weeks after discharge. A tentative conceptual model describing the relationship between continuity of care, self-care, perceived control, health-related quality of life and readmission was developed and evaluated using structural equation modelling. ResultsIn total, 542 people (mean age 75 years, 37% females) were included in the analyses. According to the structural equation model, continuity of care predicted self-care, which in turn predicted health-related quality of life and hospital readmission. The association between continuity of care and self-care was partly mediated by perceived control. The model had an excellent model fit: RMSEA = 0.06, 90% CI, 0.05-0.06; CFI = 0.90; TLI = 0.90. ConclusionInterventions aiming to improve health-related quality of life and reduce hospital readmission rates should focus on enhancing continuity of care, perceived control and self-care. ImpactThis study reduces the knowledge gap on how central factors after hospitalization, such as continuity of care, self-care and perceived control, are associated with improved health-related quality of life and hospital readmission in people with cardiac conditions. The results suggest that these factors together predicted the quality of life and readmissions in this sample. This knowledge is relevant to researchers when designing interventions or predicting health-related quality of life and hospital readmission. For clinicians, it emphasizes that enhancing continuity of care, perceived control and self-care positively impacts clinical outcomes. Patient or Public ContributionPeople and healthcare personnel evaluated content validity and were included in selecting items for the short version.
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| 15. |
- Säfström, Emma, 1980-, et al.
(author)
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Development and psychometric properties of a short version of the Patient Continuity of Care Questionnaire
- 2023
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In: Health Expectations. - : John Wiley & Sons. - 1369-6513 .- 1369-7625. ; 26:3, s. 1137-1148
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Journal article (peer-reviewed)abstract
- IntroductionHospitalization due to cardiac conditions is increasing worldwide, and follow-up after hospitalization usually occurs in a different healthcare setting than the one providing treatment during hospitalization. This leads to a risk of fragmented care and increases the need for coordination and continuity of care after hospitalization. Furthermore, international reports highlight the importance of improving continuity of care and state that it is an essential indicator of the quality of care. Patients' perceptions of continuity of care can be evaluated using the Patient Continuity of Care Questionnaire (PCCQ). However, the original version is extensive and may prove burdensome to complete; therefore, we aimed to develop and evaluate a short version of the PCCQ. MethodsThis was a psychometric validation study. Content validity was evaluated among user groups, including patients (n = 7), healthcare personnel (n = 15), and researchers (n = 7). Based on the results of the content validity and conceptual discussions among the authors, 12 items were included in the short version. Data from patients were collected using a consecutive sampling procedure involving patients 6 weeks after hospitalization due to cardiac conditions. Rasch analysis was used to evaluate the psychometric properties of the short version of the PCCQ. ResultsA total of 1000 patients were included [mean age 72 (SD = 10), 66% males]. The PCCQ-12 presented a satisfactory overall model fit and a person separation index of 0.79 (Cronbach's alpha: .91, ordinal alpha: .94). However, three items presented individual item misfits. No evidence of multidimensionality was found, meaning that a total score can be calculated. A total of four items presented evidence of response dependence but, according to the analysis, this did not seem to affect the measurement properties or reliability of the PCCQ-12. We found that the first two response options were disordered in all items. However, the reliability remained the same when these response options were amended. In future research, the benefits of the four response options could be evaluated. ConclusionThe PCCQ-12 has sound psychometric properties and is ready to be used in clinical and research settings to measure patients' perceptions of continuity of care after hospitalization. Patient or Public ContributionPatients, healthcare personnel and researchers were involved in the study because they were invited to select items relevant to the short version of the questionnaire.
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| 16. |
- Vellone, Ercole, et al.
(author)
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Cognitive impairment in patients with heart failure : an international study
- 2020
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In: ESC Heart Failure. - : John Wiley & Sons. - 2055-5822. ; 7:1, s. 47-54
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Journal article (peer-reviewed)abstract
- Aims: Cognitive impairment (CI) in heart failure (HF) patients has mostly been studied in single countries in specific health care settings. Sociodemographic and clinical predictors of the global CI and CI dimensions are still unclear. We described CI in a diverse HF population recruited in several countries and in different health care settings and investigated sociodemographic and clinical factors associated with the global and specific CI dimensions in HF patients.Methods and results: A secondary analysis from the baseline data of the Wii-HF trial. Patients (n = 605) were enrolled in Sweden, Italy, Israel, The Netherlands, Germany, and the United States. We used the Montreal Cognitive Assessment to evaluate CI and the 6 minute walk test (6MWT) to measure exercise capacity. Patients were on average 67 years old (SD, 12), and 86% were in New York Heart Association Class II and III. The mean Montreal Cognitive Assessment score was 24 (SD, 4), and 67% of patients had at least a mild CI. The item evaluating short-term memory had a considerable proportion of low scoring patients (28.1%). Worse CI was associated with patients' older age, lower education, and lower 6MWT scores (R2 = 0.27). CI dimension scores were differently associated with specific clinical and demographic variables, but the 6MWT scores were associated with five out of seven CI dimension scores.Conclusions: CI is an important problem in HF patients, with specific challenges in regard to memory. Exercise capacity is a modifiable factor that could be improved in HF patients with the potential to improve cognition and other outcomes in this population.
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| 17. |
- Verheijden Klompstra, Leonie, 1982-, et al.
(author)
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Comparison of the 6-minute walk distance measured on a 30 m track with guidance of a healthcare professional and those measured with a mobile application outdoors by participants themselves : a validation study
- 2023
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In: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 22:5, s. 544-546
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Journal article (peer-reviewed)abstract
- To improve the practical application of measuring exercise capacity, the purpose of this study was to compare the 6 min walk distance (6MWD) obtained at a 30 m track with the guidance of healthcare professionals vs. the 6MWD obtained by participants themselves using an app. In total, 37 participants performed both tests. The mean of the differences between the 6MWD on the tests was -4 +/- 45 m (95% limits of agreement: 84 to -99 m). The overall agreement between the two 6MWD measures was 97% with an intraclass correlation coefficient of 0.96 (95% confidence interval: 0.91-0.98, P < 0.001). The use of an app is feasible, reliable, and valid to assess the 6MWD.
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| 18. |
- Verheijden Klompstra, Leonie, 1982-, et al.
(author)
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Costs of an Off-the-Shelve Exergame Intervention in Patients with Heart Failure
- 2023
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In: Games for Health Journal. - : MARY ANN LIEBERT, INC. - 2161-783X .- 2161-7856. ; 12:3, s. 242-248
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Journal article (peer-reviewed)abstract
- Objectives: Exergaming is promising for patients with heart failure who are less inclined to start or maintain exercise programs involving traditional modes of physical activity. Although no effect on exercise capacity was found for an off-the-shelf exergame, it is important to gain insights into aspects related to costs to develop such interventions further.Materials and Methods: In a randomized controlled trial, the Heart Failure Wii study (HF-Wii study), the intervention group (exergame group) received an introduction to the exergame, the exergame was installed at home and help was offered when needed for 3 months. Patients received telephone follow-ups at 2, 4, 8, and 12 weeks after the installation. The control group (motivational support group) received activity advice and telephone follow-ups at 2, 4, 8, and 12 weeks. We collected data on hospital use and costs, costs of the exergame intervention, patient time-related costs, and willingness to pay.Results: No significant differences were found between the exergame group (n = 300) versus the motivational support group (n = 305) in hospital use or costs (1-year number of hospitalizations: P = 0.60, costs: P = 0.73). The cost of the intervention was 190 Euros, and the patient time-related costs were 98 Euros. Of the total estimated costs for the intervention, 287 Euros, patients were willing to pay, on average, 58%.Conclusion: This study shows that the costs of an intervention using an off-the-shelve exergame are relatively low and that the patients were willing to pay for more than half of the intervention costs. The trial is registered in ClinicalTrials.gov (NCT01785121).
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