European journal of cardiovascular nursing最新文献

Aims: Productivity Adjusted Life Year (PALY) metric is a novel measure for exploring the societal impact of health conditions on work productivity. Given that stroke is a major cause of disability-adjusted life years and the crucial role of caregivers in post-stroke care, our study aims to quantify the PALY and the quality-adjusted life years (QALYs) loss associated with stroke caregivers.

Methods and results: The model compared the Australian stroke informal carer group and a hypothetical cohort of non-carers over 30 years of follow-up (2023-2052 using the working-age population, aged 15-65 years). A life table model was constructed using Microsoft Excel® (Microsoft Corporation, Redmond, WA, USA). Key data were obtained from literature and publicly available data. Labour force participation rates were applied to population estimates to arrive at the approximate number of full-time equivalents, which was then multiplied by the productivity index and years of life lived (YLL) to estimate PALYs and the utility values were multiplied by YLL to estimate QALYs. All costs are presented as 2022 Australian dollars (AUD).Over a 30 year period, 27 551 QALYs, 67 488 PALYs and 14.7 billion AUD were lost due to the health and productivity burden among informal care of stroke patients. On average, the annual informal carer losses were 918 QALYs and 2250 PALYs and 490 million AUD.

Conclusion: Our analyses demonstrate the health and economic consequences among informal caregivers of stroke patients over the forthcoming decades and highlight the need for interventions to reduce the burden of stroke and its impact.

Aims: The Modified Caregiver Strain Index (M-CSI) is a 13-item instrument that measures caregiver strain among various populations. A Danish version is lacking, and the psychometric properties among relatives of out-of-hospital cardiac arrest (OHCA) survivors are unknown. This study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of the Danish version of the M-CSI in relatives of OHCA survivors.

Methods and results: The study used data from the national cross-sectional DANCAS (DANish Cardiac Arrest Survivorship) survey, where relatives of OHCA survivors completed the Danish versions of M-CSI, the Hospital Anxiety and Depression Scale (HADS), and the World Health Organisation's Five Well-being Index (WHO-5). The M-CSI was forward- and back-translated, pre-tested, and culturally adapted. Structural validity was examined with exploratory factor analysis (EFA) and construct validity was investigated using a priori hypothesis testing (known-groups validity) and correlations with the other instruments (convergent validity/overlapping constructs). The internal consistency reliability was assessed using Cronbach's α. In total, 561 relatives responded (response rate 45%), of which 88% were women, the median age was 64, and 24% reported caregiver strain (M-CSI ≥7). The EFA supported a one-factor structure. Based on the a priori hypotheses, it was confirmed that younger caregivers (<55 years) described more caregiver strain (effect size δ = 0.13; small). Correlations between M-CSI, HADS-A, HADS-D, and WHO-5 were moderate. Internal consistency was α = 0.90.

Conclusion: The Danish version of the M-CSI demonstrated good structural validity, good internal consistency reliability, and good construct validity in relatives of OHCA survivors.

Aim: To describe trajectories of insomnia symptoms over 12 months in patients with heart failure (HF) and to identify characteristics associated with persistent, fluctuating, or low/no insomnia.

Methods and results: This secondary analysis used data from the HF-Wii randomized trial, including 400 patients from 10 centers in six countries (Sweden, Italy, Israel, the Netherlands, Germany, USA). Insomnia was assessed at baseline, 3, 6, and 12 months using the Minimal Insomnia Symptom Scale. Patients were grouped into insomnia trajectories (persistent, fluctuating, low/no insomnia). Depression and anxiety were measured with the Hospital Anxiety and Depression Scale, well-being with Cantril's Ladder, quality of life with the Minnesota Living with Heart Failure Questionnaire, comorbidity burden with the Charlson Comorbidity Index, and functional capacity with the 6-minute walk test. Group differences were examined with ANOVA and chi-square tests; variables with p ≤ 0.05 were entered into multivariate logistic regression. Associations were examined with ANOVA, chi-square, and multivariable logistic regression.At baseline, 126 patients (32%) reported insomnia: 51 (40%) had persistent, 48 (38%) fluctuating, and 27 (21%) recovered. Among 274 without baseline insomnia, 25 (9%) developed insomnia at 2-3 follow-ups and 36 (13%) at one time point. Persistent insomnia was independently associated with higher anxiety (OR = 2.73; p < 0.001) and lower functional capacity (OR = 0.50; p < 0.005).

Conclusion: A substantial proportion of HF patients experience persistent or fluctuating insomnia. Routine assessment-particularly in those with anxiety or low functional capacity-may aid early detection and guide targeted interventions.

Aim: To describe how telemedicine in cardiac rehabilitation can be optimized through the development of a co-produced, family-focused Cardiac TeleRehabilitation model.

Methods and results: A co-production approach was used to collaboratively develop a cardiac telerehabilitation model with eight cardiac patients, three family members, and eight healthcare professionals through three workshops. Data were analysed iteratively after each workshop using an inductive, semantic-level approach inspired by Braun and Clarke's thematic analysis, identifying themes from explicit data content. We first identified the needs, barriers, and facilitators associated with video consultations and home monitoring in cardiac rehabilitation. We gained a deeper understanding of the participants' expectations, preferences, and challenges in adopting video consultations and home monitoring. Six themes emerged from the workshops: (1) Trust and relationship building initiated by the first in-person consultation; (2) Communication and presence in a digital setting; (3) Inclusion of family members; (4) Digital competencies and technical readiness; (5) Informed decision-making and patient autonomy; (6) Practicality, flexibility, and organizational readiness. These themes shaped a cardiac telerehabilitation model, comprising video consultations, home monitoring, manuals, a nurse support tool and a patient decision tool.

Conclusion: Through co-productive workshops with patients, family members, and healthcare professionals, a cardiac telerehabilitation model was developed to support the use of video consultations and home monitoring. The model is intended to support the delivery of flexible, accessible rehabilitation tailored to each patient's individual needs. The model requires further evaluation in more diverse settings before broader implementation.

Registration: Part of ClinicalTrials.gov (NCT06320652).

Aims: To study whether chronic physiological stress may play a role in the onset of Takotsubo Syndrome (TS) and whether it is associated with worse psychological distress in patients recovering from a recent TS episode.

Methods and results: We compared hair cortisol concentration (HCC), a validated biomarker of chronic stress, between a group of patients recently admitted with a new diagnosis of TS (Mayo criteria) and a cohort of clinically stable historical controls. HCC, demographics, perceived stress, depression, anxiety, PTSD symptoms, and trigger history were assessed approximately 4 weeks after discharge. Descriptive statistics and linear regression models were used to assess associations. Participants (n=59) had a mean age of 64.5 years and were mostly non-Hispanic White (94.9%) and female (96.6%). A large proportion of participants had a history of psychiatric disorders (62.7%), including anxiety disorders (40.7%) and mood disorders (39.0%). The HCC in the TS sample was twice as high as that of clinically stable controls (geometric mean: 7.3 pg/mg (SD 2.9) vs. 3.5 pg/mg (SD 3.7), p < .01). We found that patients with higher HCC did not report a history of triggers prior to TS onset or greater psychological distress post-discharge.

Conclusions: Patients with a recent TS episode had significantly higher HCC compared to clinically stable controls, suggesting that chronic physiological stress may play a role in the onset of TS. These preliminary findings support further investigation into the effects of stress-reduction approaches for the prevention of recurrent TS and related morbidity.

Registration: ClinicalTrials.gov NCT04325321.