European Journal of Cardiovascular Nursing

Govind, Natalie; Ferguson, Caleb; Phillips, Jane L; Hickman, Louise

doi: 10.1093/eurjcn/zvac112pmid: 36443841

AimsInternationally, there is an urgent need to implement guidelines supporting integration of palliative care into stroke clinical practice. Despite considerable advances in acute stroke management, ∼20% of all acute stroke patients die within the first 30 days. Palliative care is well established in diseases such as cancer or advanced heart failure, but evidence-based interventions of high quality are limited in stroke populations. This systematic review aims to identify and evaluate quantitative studies that describe palliative care interventions and end-of-life care as reported by patient’s post-stroke and their families.Methods and resultsA systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted in Cumulative Index to Nursing and Allied Health Literature, PubMed, Cochrane, Embase, Ovid, Proquest, and Scopus from 1990 to April 2021. The National Heart, Lung and Blood Institute standardized quality rating tools for quality assessment were used. Seven studies were identified, and all used descriptive quantitative designs. There were no interventional studies. The results were synthesized narratively according to the elements of palliative care interventions and end-of-life care: symptom burden and satisfaction, loss of autonomy at the end of life, and acknowledging uncertainty.ConclusionThis review highlights the limited empirical evidence that describes palliative care interventions and end-of-life care as reported by patient’s post-stroke and their families. Most of the current evidence focuses on the provision of care during the final days and hours of life, or end-of-life care, with little evidence to guide the integration of palliative care into post-stroke clinical care, especially for patients with an uncertain prognosis. Acute stroke is sudden, unexpected, and life-changing, and patients and families would benefit from well-designed targeted interventions to determine strategies that address the diverse palliative needs of this patient population.RegistrationPROSPERO CRD42021254536.

Busca, Erica; Airoldi, Chiara; Bertoncini, Fabio; Buratti, Giulia; Casarotto, Roberta; Gaboardi, Samanta; Faggiano, Fabrizio; Barisone, Michela; White, Ian R; Allara, Elias; Dal Molin, Alberto

doi: 10.1093/eurjcn/zvac098pmid: 36256701

AimsTo assess the effects of bed rest duration on short-term complications following transfemoral catheterization.Methods and resultsA systematic search was carried out in MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, Scopus, SciELO and in five registries of grey literature. Randomized controlled trials and quasi-experimental studies comparing different durations of bed rest after transfemoral catheterization were included. Primary outcomes were haematoma and bleeding near the access site. Secondary outcomes were arteriovenous fistula, pseudoaneurysm, back pain, general patient discomfort and urinary discomfort. Study findings were summarized using a network meta-analysis (NMA). Twenty-eight studies and 9217 participants were included (mean age 60.4 years). In NMA, bed rest duration was not consistently associated with either primary outcome, and this was confirmed in sensitivity analyses. There was no evidence of associations with secondary outcomes, except for two effects related to back pain. A bed rest duration of 2–2.9 h was associated with lower risk of back pain [risk ratio (RR) 0.33, 95% confidence interval (CI) 0.17–0.62] and a duration over 12 h with greater risk of back pain (RR 1.94, 95% CI 1.16–3.24), when compared with the 4–5.9 h interval. Post hoc analysis revealed an increased risk of back pain per hour of bed rest (RR 1.08, 95% CI 1.04–1.11).ConclusionA short bed rest was not associated with complications in patients undergoing transfemoral catheterization; the greater the duration of bed rest, the more likely the patients were to experience back pain. Ambulation as early as 2 h after transfemoral catheterization can be safely implemented.RegistrationPROSPERO: CRD42014014222.

Adhami, Nassim; Rozor, Mihaela; Percy, Celeste; Achtem, Leslie; Johnston, Sylvia; Nathoo, Naureen; Pak, Melissa; Polderman, Jopie; Lauck, Sandra B

doi: 10.1093/eurjcn/zvac066pmid: 35895525

AimsMitral valve transcatheter edge-to-edge repair (TEER) is a minimally invasive treatment option for patients with severe symptomatic mitral regurgitation who are at increased risk for cardiac surgery and are receiving optimal medical therapy. Little is known about patients’ perspectives on their journey of care, including their experiences leading up to treatment and their early recovery period. The aim of this study was to explore patients’ experiences of their journey to TEER and their perspectives on early recovery.Methods and resultsWe conducted a qualitative study using interpretive description. A purposive sample of 12 patients from a purposive sample, 3–6 monthspost-TEER procedure, were recruited from a tertiary hospital. The median age of the patients was 79 years, with seven males and five females. Data collection included semi-structured interviews over the phone. Data analysis followed an iterative process and utilized thematic analysis. There were four central themes highlighting the experiences of the patients leading up to their procedure: (i) escalating challenges with everyday life; (ii) plummeting losses; (iii) choosing and readiness to proceed with TEER; and (iv) the long and uncertain waiting time. The theme-improved health status highlights the experiences of patients in their early recovery.ConclusionPatients’ experiences of waiting for TEER are complex and involve multifaceted challenges related to their worsening cardiac symptoms and navigating the healthcare system. Therefore, care pathways must be put in place to provide continuity of care and support.

Ramstad, K J; Brørs, G; Pettersen, T R; Deaton, C; Palm, P; Rotevatn, S; Wentzel-Larsen, T; Norekvål, T M

doi: 10.1093/eurjcn/zvac087pmid: 36190843

AimsElectronic health (eHealth) sources have great potential to improve patients’ access to health information for self-management of secondary prevention after percutaneous coronary intervention (PCI). It remains unclear, however, whether patients are health-related digitally active and whether they have sufficient eHealth literacy. This study aimed to determine the extent to which patients after PCI are health-related digitally active at baseline, 2 and 6 months after PCI, and to determine the association between patients’ eHealth literacy and their health-related digital activity.Methods and resultsThis multicentre cohort study included patients at three large referral PCI centres in Norway (n = 1970). Data were collected from medical records, national registries, and patients’ self-reports. The eHealth Literacy Scale (eHEALS) assessed patients’ eHealth literacy. At baseline, 67% had used the internet to find health information. The mean eHEALS score was 25.71 (standard deviation 6.22), illustrating a lower level of eHealth literacy. There were substantial associations between eHealth literacy and use of the internet to find health information [coefficient 10.90, 95% confidence interval (CI) 8.05–14.57]. At the 2-month follow-up, there were substantial associations between baseline eHealth literacy and use of the internet to find information about health, prevention, illness, or treatment [odds ratio (OR) 1.19, 95% CI 1.14–1.24] and use of health applications (OR 1.15, 95% CI 1.08–1.22).ConclusionThis study provides evidence that patients’ level of eHealth literacy after PCI is associated to how patients use, and can make use of, eHealth technology for health information.RegistrationClinicalTrials.gov (NCT03810612).

Laastad Sørensen, Marianne; Oterhals, Kjersti; Pönitz, Volker; Morken, Ingvild M

doi: 10.1093/eurjcn/zvac089pmid: 36149811

AimsHaving nurses to perform point-of-care ultrasound (POCUS) when physically examining patients to assess for early signs of decompensation and fluid overload has been proven to be feasible, provide extra information, and improve quality of care. To date, few studies have analyzed whether it is feasible for intensive care nurses to perform POCUS on critically ill patients. This study aimed to evaluate whether the findings of briefly trained intensive care nurses’ ultrasound examinations agreed with conventional examinations performed by physicians.Methods and resultsThis comparative cross-sectional inter-rater agreement study comprised 50 patients admitted to a cardiac intensive care unit (CICU), with signs and symptoms of acute dyspnoea and suspected cardiac disease. After a brief training session, the study nurses performed standardized examinations of each patient’s inferior vena cava (IVC) and the pleural and pericardial cavities using a handheld ultrasound device. A blinded physician repeated the same examinations using conventional ultrasound. Analysis using Gwet’s agreement coefficient with quadratic weights showed moderate agreement for the IVC respiration variation [0.60; 95% confidence interval (CI): 0.38–0.82], and substantial agreement for the IVC diameter (0.70; 95% CI: 0.50–0.90) and right-sided pleural effusion (0.70; 95% CI: 0.52–0.88). For left-sided pleural effusion (0.85; 95% CI: 0.75–0.95) and pericardial effusion (0.95; 95% CI: 0.90–1.01), the agreement was almost perfect.ConclusionsBriefly trained intensive care nurses in a CICU can perform POCUS examinations of the IVC and pleural and pericardial cavities with moderate to almost perfect agreement with identical examinations performed by physicians.

Hill, Loreena; Meyer, Timothy; McKane, Scott; Lainscak, Mitja; Ahmed, Qanta A

doi: 10.1093/eurjcn/zvac086pmid: 36125322

AimsSleep disorder breathing is an important non-cardiovascular comorbidity in patients with heart failure (HF). However, central sleep apnoea (CSA) remains poorly diagnosed and treated. This post hoc analysis examined symptoms and quality of life in patients with CSA and HF following 12 months of transvenous phrenic nerve stimulation (TPNS) therapy.Methods and resultsPatients enrolled in the remedē System Pivotal trial were invited to complete self-reported questionnaires. Symptoms and responses to three validated questionnaires were examined. Percentage of patients noting an impairment was calculated at baseline. At 12 months, % of patients experiencing improvement, no change, or worsening was calculated. Shifts from symptom presence at baseline to absence at 12 months were assessed for those symptoms experienced by ≥50% of patients at baseline. Seventy-five patients were included. Most frequently reported symptoms were fatigue and daytime sleepiness. Following 12 months of TPNS, a variety of subjective improvements were observed; 45% of patients indicating cessation of daytime sleepiness, 44% cessation of fatigue/weakness, and 52% no longer having difficulty falling/staying asleep. Specific questions related to tiredness/fatigue, motivation, and chance of dozing provided an insight into potential areas of improvement. Furthermore, at least 60% of patients reported resolution of insomnia/fragmented sleep and snoring on therapy.ConclusionAdult patients with CSA and HF experience distressing symptoms and limitations. Transvenous phrenic nerve stimulation was found to improve many of these. Awareness of key symptoms or limitations patients experience can be used to inform the development of a CSA-specific patient questionnaire to identify CSA sooner and aid treatment decisions.

Verhaert, Dominique V M; Linz, Dominik; Wassink, Geert F; Weijs, Bob; Philippens, Suzanne; Luermans, Justin G L M; Westra, Sjoerd W; Schotten, Ulrich; Vernooy, Kevin; den Uijl, Dennis W

doi: 10.1093/eurjcn/zvac095pmid: 36218087

AimsIn this quality improvement project, a care pathway for patients considered for atrial fibrillation (AF) ablation was optimized with the goals to improve the patient journey and simultaneously integrate prospective data collection into the clinical process.Methods and resultsThe Lean Six Sigma approach was used to map the pre-existing process, identify constraints, and formulate countermeasures. The percentage of patients going through the full pre-ablation preparation that eventually underwent AF ablation, number of hospital visits and consultations, pathway compliance, and completeness of scientific data were measured before and after pathway optimization. Constraints in the process were (i) lack of standardized processes, (ii) inefficient use of resources, (iii) lack of multidisciplinary integration, (iv) lack of research integration, and (v) suboptimal communication. The impact of the corresponding countermeasures (defining a uniform process, incorporating ‘go/no-go’ moment, introducing a ‘one-stop-shop’, integrating prospective data collection, and improving communication) was studied for 33 patients before and 26 patients after pathway optimization. After optimization, the percentage of patients receiving a full pre-ablation preparation that eventually underwent AF ablation increased from 59% to 94% (P < 0.01). Fewer hospital visits (3.2 ± 1.2 vs. 2.3 ± 0.8, P = 0.01) and electrophysiologist consultations (1.8 ± 0.7 vs. 1.0 ± 0.3, P < 0.01) were required after pathway optimization. Pathway compliance and complete collection of scientific data increased significantly (3% vs. 73%, P < 0.01 and 15% vs. 73%, P < 0.01, respectively).ConclusionThe optimization project resulted in a more efficient evaluation of patients considered for AF ablation. The new more efficient process includes prospective data collection and facilitates easy conduct of research studies focused on improvements of patient outcomes.

Dalsgaard, Jane Lange; Hansen, Michael Skov; Thrysoee, Lars; Ekholm, Ola; Thorup, Charlotte Brun; Mols, Rikke Elmose; Rasmussen, Trine Bernholdt; Christensen, Anne Vinggaard; Berg, Selina Kikkenborg; Pedersen, Andreas Kristian; Jensen, Lisette Okkels; Mogensen, Christian Backer;

Sanders, Julie; Bueser, Teofila; Beaumont, Emma; Dodd, Matthew; Murray, Sarah E; Owens, Gareth; Berry, Alan; Hyde, Edward; Clayton, Tim; Oo, Aung Ye

doi: 10.1093/eurjcn/zvac083pmid: 36099505

AimsThe outbreak of COVID-19 was potentially stressful for everyone and possibly heightened in those having surgery. We sought to explore the impact of the pandemic on recovery from cardiac surgery.Methods and resultsA prospective observational study of 196 patients who were ≥18years old undergoing cardiac surgery between March 23 and July 4, 2020 (UK lockdown) was conducted. Those too unwell or unable to give consent/complete the questionnaires were excluded. Participants completed (on paper or electronically) the impact of event [Impact of Events Scale-revised (IES-R)] (distress related to COVID-19), depression [Centre for Epidemiological Studies Depression Scale (CES-D)], and EQ-5D-5L [(quality of life, health-related quality of life (HRQoL)] questionnaires at baseline, 1 week after hospital discharge, and 6 weeks, 6 months and 1 year post-surgery. Questionnaire completion was >75.0% at all timepoints, except at 1 week (67.3%). Most participants were male [147 (75.0%)], white British [156 (79.6%)] with an average age 63.4years. No patients had COVID-19. IES-R sand CES-D were above average at baseline (indicating higher levels of anxiety and depression) decreasing over time. HRQoL pre-surgery was high, reducing at 1 week but increasing to almost pre-operative levels at 6 weeks and exceeding pre-operative levels at 6 months and 1 year. IES-R and CES-D scores were consistently higher in women and younger patients with women also having poorer HRQoL up to 1-year after surgery.ConclusionsHigh levels of distress were observed in patients undergoing cardiac surgery during the COVID-19 pandemic with women and younger participants particularly affected. Psychological support pre- and post-operatively in further crises or traumatic times should be considered to aid recovery.RegistrationClinicaltrials.gov ID:NCT04366167.

Forsyth, Faye; Blakeman, Thomas; Burt, Jenni; Chew-Graham, Carolyn A; Hossain, Muhammad; Mant, Jonathan; Sharpley, John; Sowden, Emma; Deaton, Christi

doi: 10.1093/eurjcn/zvac081pmid: 36073202

AimsTo investigate how heart failure with preserved ejection fraction (HFpEF), within the context of limited clinical services, impacts patients’ lives.Methods and resultsSecondary thematic analysis informed by the cumulative complexity model (CCM), of interview transcripts from 77 people diagnosed with HFpEF and their carers. Four themes corresponding to the core concepts of workload, capacity, access, and outcome described in the CCM were generated. Theme 1: Shouldering a heavy workload described the many tasks expected of people living with HFpEF. Theme 2: The multiple threats to capacity described how patients and carers strived to engage with this work, but were often faced with multiple threats such as symptoms and mobility limitations. Deficient illness identity (Theme 3) reflects how HFpEF either was not recognized or was perceived as a more benign form of HF and therefore afforded less importance or priority. These themes contributed to a range of negative physical, social, and psychological outcomes and the perception of loss of control described in Theme 4: Spiraling complexity.ConclusionsThe constellation of HFpEF, multi-morbidity, and ageing creates many demands that people with HFpEF are expected to manage. Concurrently, the same syndromes threaten their ability to physically enact this work. Patients’ recollections of their interactions with health professionals suggest that there is a widespread misunderstanding of HFpEF, which can prohibit access to care that could potentially reduce or prevent deterioration.