Patient-Centered Adult Cardiovascular Care: A Scientific Statement From the American Heart Association.

Patient-centered care is gaining widespread acceptance by the medical and lay communities and is increasingly recognized as a goal of high-quality health care delivery. Patient-centered care is based on ethical principles and aims at establishing a partnership between the health care team and patient, family member, or both in the care planning and decision-making process. Patient-centered care involves providing respectful care by tailoring management decisions to patients' beliefs, preferences, and values. A collaborative care approach can enhance patient engagement, foster shared decision-making that aligns with patient values and goals, promote more personalized and effective cardiovascular care, and potentially improve patient outcomes. The objective of this scientific statement is to inform health care professionals and stakeholders about the role and impact of patient-centered care in adult cardiovascular medicine. This scientific statement describes the background and rationale for patient-centered care in cardiovascular medicine, provides insight into patient-oriented medication management and patient-reported outcome measures, highlights opportunities and strategies to overcome challenges in patient-centered care, and outlines knowledge gaps and future directions.

Patients' perceptions on the facilitators and barriers using injectable therapies in dyslipidaemia: An empirical qualitative descriptive international study.

BACKGROUND: Injectable medicines are increasingly used to manage abnormal levels of lipids, which is a major risk factor for cardiovascular events. Enhancing our understanding of patients' perceptions of these injectables, can inform practice with the aim of increasing uptake and medication adherence. AIM: To explore patient's experiences of using injectables and to identify potential facilitators and barriers to using injectable therapies in dyslipidaemia. DESIGN: A qualitative descriptive study using semi-structured interviews was conducted with patients who were using injectables to manage their cardiovascular conditions. METHODS: A total of 56 patients, 30 from the United Kingdom and 26 from Italy, were interviewed online from November 2020 to June 2021. Interviews were transcribed and schematic content analysis performed. RESULTS: Four distinct themes emerged from interviews with patients and caregivers: (i) Their behaviours and personal beliefs; (ii) Knowledge and education about injectable medication; (iii) Clinical skills and previous experiences and (iv) Organizational and governance. Participants expressed initial fears such as needle phobia, and their concerns about commencing therapy were compounded by a lack of accessible information. However, patients' pre-existing knowledge of lipid lowering medication, previous experience with statins and history of adverse side effects informed their decision-making regarding using injectables. Organization and governance-related issues were primarily around the distribution and management of medication supply within primary care, and the lack of a standardized clinical support monitoring system. CONCLUSION: Changes are needed in clinical practice to better educate and support patients to improve the uptake of injectables and optimize their use of these medications in the management of dyslipidaemia. IMPACT: This study suggests that injectable therapies were acceptable to people with cardiovascular disease. However, healthcare professionals need to play a key role in improving education and providing support to aid patients' decision-making regarding commencing and adhering to injectable therapies. REPORTING METHOD: The study adhered to the Consolidated Criteria for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution.

Needs and problems related to sociodemographic factors of informal caregiving of people with heart failure: A mixed methods study in three European countries.

AIMS: To explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics. DESIGN: A qualitative focused mixed methods design was used. METHODS: In total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven-phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed. RESULTS: Three clusters of caregivers were identified: spouses, adult children and non-family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health. CONCLUSIONS: Informal caregiving emerged as a complex process influenced by various sociodemographic factors. Gender, relationship type and economic status are the important factors to be considered planning to develop approaches to address the needs of caregivers serving people with heart failure. IMPACT: A comprehensive understanding of the nature of informal caregiving of individuals with heart failure, the complexity of the real-world sociodemographic and cultural factors is warranted. The use of the EMDA method gave us the possibility of processing large masses of qualitative data through rapid, complex calculations. In detail, AATD allowed us to study in deep the significant fuzziness of what caregivers expressed and to analyse the content of the entire interviews and to produce global knowledge by using multi-dimensional statistical methods to grasp the fundamental sense of the interviews, beyond the simple words. Three clusters were identified in the samples, including spouses, adult children and non-family members. This study demonstrated that some sociodemographic characteristics could lead to everyday needs. Therefore, these demographic characteristics should be considered in developing targeted interventions. The research was conducted in Europe, but the technique shown can be replicated everywhere. The findings not only impact nursing but can be extended to all those stakeholders who concur with a public health educational mission. PATIENT OR PUBLIC CONTRIBUTION: Carers were involved in this study after the discharge of their loved ones or at the time of the outpatient visit. They were involved after they had been observed in their dynamics of involvement in caring of the familiars or friends with heart failure.

Informal caregivers of people with heart failure and resilience: A convergent mixed methods study.

AIM: To develop a comprehensive understanding of resilience and its associated factors among informal caregivers of people with heart failure. DESIGN: Transnational multicentre convergent mixed methods approach. METHODS: This study was conducted in three European countries: Italy, Spain and the Netherlands; during February 2017 and December 2018. In total, 195 caregivers completed the Connor-Davidson Resilience Scale, Caregiver Burden Inventory and Hospital Anxiety and Depression Scale. From a nested sample 50 caregivers participated in semi-structured face-to-face interviews. Data were analysed using qualitative content analysis, multiple regression and joint displays. RESULTS: The caregivers' mean age was over 60 years. The quantitative results showed that caregivers experienced anxiety and depression regardless of a good score of resilience and moderate level of burden. Regression analysis showed that the resilience was associated with caregiver depression. From qualitative findings three resilience inhibiting (psychological outlook, physical weariness and affective state) and two promoting factors (community interconnectedness and self-comforting activities) were generated. Mixed analysis confirmed that depression decreased caregivers' resilience. CONCLUSIONS: Caregivers of people with heart failure experience continuous stress and anxiety resulting in reduced resilience. Collaborative efforts are needed to build multifaceted interventions and programs to enhance caregivers' resilience by targeting the factors identified in this study. IMPACT: The quality of informal caregiving is affected by the resilience of caregivers. No research has explored the resilience levels and its factors in this population. Depression, psychological outlook, physical weariness and affective state are negative factors of caregivers' resilience. Personal strategies combined with social and community support and belongingness enhance caregivers' resilience. Community care organizations and hospitals could establish alliances to develop programs for enhancing caregivers' resilience.

Nurses' Roles in Caring for Older People in Domiciliary Settings: A Scoping Review Protocol.

Due to global shifts in demographics and advances in chronic illness management over the past few decades, domiciliary care has become the primary setting for caring for older people. In this regard, nurses play a crucial role, promoting quality care and minimizing hospital admissions and the need for institutionalization. However, historical and geographic variation in nursing titles and the multitude of labels for different roles have been obstacles to the creation of a clear map outlining specific nursing roles in home care for older people. The aim of this scoping review is to map the evidence on the different nurses' roles in caring for older people in domiciliary settings. This review will include primary, secondary, and gray literature on nurses' roles in domiciliary settings for older people, sourced through comprehensive searches of various databases (MEDLINE, Embase, CINAHL) and reference scanning. No language restrictions will be applied. Two independent reviewers will conduct screening and data extraction. The tabulated results will be informed by descriptive frequencies and content analysis, presenting comprehensive findings. The review protocol was retrospectively registered within OSF database on the 23 November 2023.

Psychological Health Among Older Adults During and After Quarantine: A Multi-Method Study.

OBJECTIVE: Depression among older adults is a growing problem. With aging being a risk factor for COVID-19 infection, depression in this population may have been exacerbated. This study aimed to describe experiences and changes in depressive symptoms and well-being of older adults during and after the COVID-19 first wave in Spain. METHODS: The study used a multi-method design. Participants self-reported depressive symptoms (Geriatric Depression Scale) and well-being (Cantril Ladder of Life). Participants were asked about changes in depressive symptoms or well-being during quarantine. If a change was perceived, they were asked to describe the change. In addition, the Patient Global Impression of Change scale was used. Both quantitative and qualitative analyses were performed on the data. RESULTS: 111 participants (mean age: 71±5 years; 76% women) completed the study. Sixty-three percent reported mild and 2% reported major depressive symptoms. Nearly half (47.7%) reported changes in depressive symptoms during the lockdown. While 37% reported feeling better during the lockdown, about 11% reported depressive symptoms were worse now compared with during the lockdown. 60% reported worsening well-being during the quarantining period. The qualitative analysis revealed 2 main themes: (1) psychological discomfort (mood deflection, fear/worries, and boredom/inactivity) and (2) social issues (inability to go out, missing family members and others). CONCLUSIONS: Worsening depressive symptoms and lowering of well-being were noticed in this sample of older adults during and post-COVID lockdowns. Evaluation of mental health in the primary care setting and providing referrals for mental health services is essential for older adults who experienced COVID-19-related lockdowns.

Media Exposure of Suicidal Behaviour: An Umbrella Review.

AIM: To analyse recommended interventions for the safe and responsible dissemination of suicidal behaviour in the media for preventive purposes. BACKGROUND: Suicide is a serious public health problem that leads to more than 700,000 deaths per year, which translates into one death every forty seconds. The media play a significant role in shaping public perceptions and reflecting societal issues. Because of its active role in the construction of reality, the way in which the media report and expose suicidal behaviour has the capacity to influence the population in either a preventive or harmful way. DESIGN: An umbrella review was carried out and a report was written according to the Preferred Reporting Items for Overviews of Reviews. METHODS: We systematically searched for reviews published from inception to February 2023 in MEDLINE (PubMed), CINAHL and PsycInfo (via EBSCOhost), Web of Science, Embase, Cochrane Library of Systematic Reviews, Scopus, and Google Scholar. A narrative synthesis of the results was conducted. RESULTS: Six systematic reviews with a moderate to high quality level were selected. Among the recommended interventions were the inclusion of positive messages of hope, resilience, or of overcoming the event, narratives with information on available resources or the promotion of support-seeking attitudes as an effective prevention mechanism, as well as the avoidance of repetitive reporting of the same suicide. The appropriate and responsible dissemination of information on suicidal behaviour in the media with complete and up-to-date information on available centres, organisations, institutions, and resources has proven to be effective, especially in vulnerable populations. CONCLUSION: Educating and training the media in an appropriate approach to disseminating suicidal behaviour helps to reduce the number of suicidal behaviours. Knowing what information is advisable to include in the news item as well as what information to avoid is a strong point. Guidelines to promote responsible media reporting are a key component of suicide prevention strategies. This study was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 23 April 2022 with the registration number CRD42022320393.