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.

At the Heart of Resilience: Empowering Women's Agency in Navigating Cardiovascular Disease.

Cardiovascular disease (CVD) is the leading cause of death among women globally, emphasizing the need for a healthcare approach that empowers women through agency. This review focuses on the critical role of women's agency in navigating CVD, integrating insights from various fields, including medicine, education, psychology, and sociology. The review highlights the shift toward patient-centred care, a framework in which women are recognized as key decision-makers, a crucial change given the historical underemphasis on women's health issues in medical practice. The diagnosis of CVD in women often involves emotional and psychological challenges. Unexpected diagnoses significantly disrupt perceived well-being, and prolonged diagnostic processes lead to professional skepticism and neglect of symptoms, resulting in delayed or inaccurate diagnoses and strained healthcare relationships. Effective management of CVD necessitates continuous self-management and a holistic approach to care, particularly for those with trauma who are at increased risk of cardiac incidents. Empowerment for women with CVD involves promoting self-confidence, autonomy, and active patient participation in healthcare. Implementing comprehensive care models is crucial for improving chronic CVD management, highlighting the need for healthcare systems that prioritize patient agency and empowerment. From the perspective of a woman with lived experience, this article examines the impact of CVD on women's agency throughout the diagnostic journey. By highlighting women's agency rather than particular behavioural changes, this review offers a comprehensive analysis that can shape policy, stimulate new research, and foster a more equitable, efficient, and empathetic healthcare system for women with CVD.

Les maladies cardiovasculaires (MCV) sont la principale cause de décès chez les femmes dans le monde, ce qui souligne la nécessité d'une approche de soins de santé qui responsabilise les femmes et favorise leur agentivité. Le présent article de synthèse porte sur le rôle crucial de l'agentivité des femmes dans leur parcours avec les MCV, et il intègre des renseignements provenant de diverses disciplines dont la médecin, l'éducation, la psychologie et la sociologie. Nous soulignons le passage vers un modèle de soins centrés sur la personne dans lequel les femmes sont perçues comme des preneuses de décisions clés. Cette approche marque un changement important, dans un contexte où une faible importance a historiquement été accordée aux problèmes de santé des femmes dans la pratique médicale. Le processus diagnostique des MCV chez les femmes comporte souvent des défis émotionnels et psychologiques. Les diagnostics inattendus perturbent considérablement la perception de bien-être, et les processus de diagnostic longs donnent lieu au scepticisme professionnel et à la négligence des symptômes, ce qui peut causer des retards ou des erreurs de diagnostic et des relations tendues avec les professionnels de la santé. La prise en charge efficace des MCV fait appel à une autogestion continue et à une approche holistique des soins de santé, en particulier pour les personnes ayant vécu des traumatismes et qui sont exposées à un risque accru de manifestations cardiaques. La responsabilisation des femmes atteintes de MCV passe par la promotion de la confiance en soi, l'autonomie et la participation active des patientes dans leurs soins de santé. La mise en œuvre de soins complets est déterminante pour améliorer la prise en charge des MCV chronique, et les systèmes de soins de santé doivent donc placer l'agentivité et l'autonomisation des patients au premier plan. Du point de vue d'une femme ayant une expérience personnelle de la réalité des MCV, le présent article examine ses répercussions sur l'agentivité des femmes tout au long du processus diagnostique. En soulignant l'agentivité des femmes plutôt que certains changements comportementaux, notre article de synthèse offre une analyse globale susceptible d'influencer les politiques, de stimuler la recherche et de favoriser des systèmes de santé plus équitables, efficaces et empreints d'empathie envers les femmes atteintes de MCV.

Qualitative Analysis of Patient Decisional Needs for Medications to Treat Heart Failure.

BACKGROUND: The development of tools to support shared decision-making should be informed by patients' decisional needs and treatment preferences, which are largely unknown for heart failure (HF) with reduced ejection fraction (HFrEF) pharmacotherapy decisions. We aimed to identify patients' decisional needs when considering HFrEF medication options. METHODS: This was a qualitative study using semi-structured interviews. We recruited patients with HFrEF from 2 Canadian ambulatory HF clinics and clinicians from Canadian HF guideline panels, HF clinics, and Canadian HF Society membership. We identified themes through inductive thematic analysis. RESULTS: Participants included 15 patients and 12 clinicians. Six themes and associated subthemes emerged related to HFrEF pharmacotherapy decision-making: (1) patient decisional needs included lack of awareness of a choice or options, difficult decision timing and stage, information overload, and inadequate motivation, support and resources; (2) patients' decisional conflict varied substantially, driven by unclear trade-offs; (3) treatment attribute preferences-patients focused on both benefits and downsides of treatment, whereas clinicians centered discussion on benefits; (4) quality of life-patients' definition of quality of life depended on pre-HF activity, though most patients demonstrated adaptability in adjusting their daily activities to manage HF; (5) shared decision-making process-clinicians' described a process more akin to informed consent; (6) decision support-multimedia decision aids, virtual appointments, and primary-care comanagement emerged as potential enablers of shared decision-making. CONCLUSIONS: Patients with HFrEF have several decisional needs, which are consistent with those that may respond to decision aids. These findings can inform the development of HFrEF pharmacotherapy decision aids to address these decisional needs and facilitate shared decision-making.

Patients and caregivers perspectives of the connection between home and the transplant journey.

BACKGROUND: For many heart failure patients, a heart transplant is required. Few hospitals in Canada perform heart transplants; thus, patients and caregivers must relocate to access transplant care. OBJECTIVE: This study explores Canadian patients' and caregivers' experiences of to access transplant care and how patients and caregivers define home. The study's goal is to gain insights from the patient and caregiver experience and identify opportunities to improve the experience for those who relocate to access heart transplants. The research question was: How is the concept of home connected to the heart transplant journey? METHODS: We conducted 18 interviews with advanced heart failure patients and caregivers, to explore patient and caregiver experiences of relocating to access transplant care. Patients and caregivers ranged in ages from 20's to 60's and had left their home of origin to move to a new location where medical care was available. 7 patients were male, 3 were female. All caregivers were female. RESULTS: Patients and caregivers identified three supports during relocation: other patients and caregivers, medical team and family. Patients and caregivers defined home as friends, family, community, warmth, safety, belonging and comfort. CONCLUSION: During relocation, patients and caregivers were supported by: other patients and caregivers, their medical team and family, and how these people made them feel: safe, warm, comfortable and that they belonged is how they defined home. The supports and definitions of home are connected; thus, a sense of home is inextricably linked to the transplant journey for patients and caregivers.

Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post-hospital discharge period.

BACKGROUND: People living with heart failure (HF) are particularly vulnerable after hospital discharge. An alliance between patient authors, clinicians, industry, and co-developers of HF programs can represent an effective way to address the unique concerns and obstacles people living with HF face during this period. The aim of this narrative review article is to discuss challenges and opportunities of this approach, with the goal of improving participation and clinical outcomes of people living with HF. METHODS: This article was co-authored by people living with HF, heart transplant recipients, patient advocacy representatives, cardiologists with expertise in HF care, and industry representatives specializing in patient engagement and cardiovascular medicine, and reviews opportunities and challenges for people living with HF in the post-hospital discharge period to be more integrally involved in their care. A literature search was conducted, and the authors collaborated through two virtual roundtables and via email to develop the content for this review article. RESULTS: Numerous transitional-care programs exist to ease the transition from the hospital to the home and to provide needed education and support for people living with HF, to avoid rehospitalizations and other adverse outcomes. However, many programs have limitations and do not integrally involve patients in the design and co-development of the intervention. There are thus opportunities for improvement. This can enable patients to better care for themselves with less of the worry and fear that typically accompany the transition from the hospital. We discuss the importance of including people living with HF in the development of such programs and offer suggestions for strategies that can help achieve these goals. An underlying theme of the literature reviewed is that education and engagement of people living with HF after hospitalization are critical. However, while clinical trial evidence on existing approaches to transitions in HF care indicates numerous benefits, such approaches also have limitations. CONCLUSION: Numerous challenges continue to affect people living with HF in the post-hospital discharge period. Strategies that involve patients are needed, and should be encouraged, to optimally address these challenges.

Heart failure (HF) is a common, serious condition that causes debilitating symptoms. HF results in an enormous burden on individuals and society. For many people living with HF, the transition to the home after hospital discharge is filled with uncertainty, fear, miscommunication, feelings of vulnerability, loss of control, high rates of being hospitalized again, and the need for education about HF self-care. People living with HF need reliable support, personalized education, and encouragement to minimize disruption to their lives and to enable them to participate in and take ownership of their health. Interventions after hospitalization focused on self-care and education have been shown to improve confidence, medication adherence rates, quality of life, and self-care, and to reduce the risk of death or being hospitalized again. However, not all studies have found benefits. Many interventions do not include patients in their co-design and co-development, and/or co-authorship of the study publications. In this review article, we discuss challenges and opportunities for better involving people living with HF in self-care HF programs, both as co-creators and as participants. A literature search was conducted and the authors collaborated through email and two remote discussions to develop the article's content. We discuss the burden of HF and existing approaches to care after hospitalization. We also provide an overview of some of the challenges and opportunities in involving people living with HF more closely in their care. We conclude that patient-focused solutions aligned with behavioral approaches and education related to self-care may help overcome these challenges.

A Disorienting Dilemma: Teaching and Learning in Technology Education During a Time of Crisis.

The way individuals interpret and reinterpret their experience is central to meaning-making and impacts teaching and learning. Grounded in Mezirow's transformative learning theory, this research explores whether pandemic-related emergency remote teaching manifested as a "disorienting dilemma" for technology educators. Teachers negotiated curricular outcomes between physical aspects of making and doing, as well as creative problem solving through design, resulting in a pandemic transformed pedagogy. Thematic analysis revealed that making and doing was severely challenged due to decreased communication, student motivation, and engagement. However, most concerning to educators was the heightened disparity in equity and access in their most vulnerable and at-risk students. In conditions of fear and trauma, little is known about the impact a chaotic way of being has on learners and educators. While we cannot predict what the "new normal" will look like for schools, and what the long-term effects of emergency remote teaching will be, our research demonstrates that the disorienting dilemma COVID-19 presents will continue to shape the pandemic transformed pedagogy of technology educators.

La manière dont les individus interprètent et renouvellent le sens de leur expérience est fondamentale au processus de recherche de significations et cela a des incidences sur l'enseignement et l'apprentissage. Ancrée dans la théorie de l'apprentissage transformationnel de Mezirow, cette étude vise à déterminer si l'enseignement à distance en tant que mesure d'urgence liée à la pandémie a causé un « dilemme déstabilisant¼ pour les formateurs en technologie. Les enseignants ont négocié des résultats d'apprentissage situés entre certains aspects physiques du « faire et mettre en pratique¼ et ont adopté une approche créative dans la résolution de problèmes par réflexion conceptuelle, ce qui a donné lieu à une pédagogie transformée par la pandémie. L'analyse thématique a démontré que le « faire et mettre en pratique¼ a été grandement éprouvé par la diminution dans les communications, la baisse de motivation des étudiants ainsi que de leur engagement. Toutefois, le plus inquiétant pour les enseignants, c'est la disparité grandissante en ce qui a trait aux questions d'équité et d'accès qui touchent leurs étudiants les plus vulnérables et les plus à risque. L'on connait bien peu de choses sur les conséquences d'une façon d'être qui est chaotique sur les apprenants et les enseignants évoluant dans des conditions qui favorisent la peur et le traumatisme. Bien que nous ne puissions pas prédire en quoi consistera la « nouvelle normalité¼ dans les écoles ni quels seront les effets à long terme de l'enseignement à distance comme mesure d'urgence, notre étude montre que le dilemme déstabilisant que la COVID-19 nous apporte continuera de façonner la pédagogie transformée par la pandémie pour les formateurs en technologie.

Automated digital counselling with social network support as a novel intervention for patients with heart failure: protocol for randomised controlled trial.

INTRODUCTION: Heart failure (HF) symptoms improve through self-care, for which adherence remains low among patients despite the provision of education for these behaviours by clinical teams. Open Access Digital Community Promoting Self-Care, Peer Support and Health Literacy (ODYSSEE-vCHAT) combines automated digital counselling with social network support to improve mortality and morbidity, engagement with self-care materials, and health-related quality of life. METHODS AND ANALYSIS: Use of ODYSSEE-vCHAT via Internet-connected personal computer by 162 HF patients will be compared with a control condition over 22 months. The primary outcome is a composite index score of all-cause mortality, all-cause emergency department visits, and HF-related hospitalisation at trial completion. Secondary outcomes include individual components of the composite index, engagement with self-care materials, and patient-reported measures of physical and psychosocial well-being, disease management, health literacy, and substance use. Patients are recruited from tertiary care hospitals in Toronto, Canada and randomised on a 1:1 ratio to both arms of the trial. Online assessments occur at baseline (t=0), months 4, 8 and 12, and trial completion. Ordinal logistic regression analyses and generalised linear models will evaluate primary and secondary outcomes. ETHICS AND DISSEMINATION: The trial has been approved by the research ethics boards at the University Health Network (20-5960), Sunnybrook Hospital (5117), and Mount Sinai Hospital (21-022-E). Informed consent of eligible patients occurs in person or online. Findings will be shared with key stakeholders and the public. Results will allow for the preparation of a Canada-wide phase III trial to evaluate the efficacy of ODYSSEE-vCHAT in improving clinical outcomes and raising the standard of outpatient care. TRIAL REGISTRATION NUMBER: NCT04966104.

Social Media in Heart Failure: A Mixed-Methods Systematic Review.

BACKGROUND: Among social media (SoMe) platforms, Twitter and YouTube have gained popularity, facilitating communication between cardiovascular professionals and patients. OBJECTIVE: This mixed-methods systematic review aimed to assess the source profile and content of Twitter and YouTube posts about heart failure (HF). METHODS: We searched PubMed, Embase and Medline using the terms "cardiology," "social media," and "heart failure". We included full-text manuscripts published between January 1, 1999, and April 14, 2019. We searched Twitter and YouTube for posts using the hashtags "#heartfailure", "#HF", or "#CHF" on May 15, 2019 and July 6, 2019. We performed a descriptive analysis of the data. RESULTS: Three publications met inclusion criteria, providing 677 tweets for source profile analysis; institutions (54.8%), health professionals (26.6%), and patients (19.4%) were the most common source profiles. The publications provided 1,194 tweets for content analysis: 83.3% were on education for professionals; 33.7% were on patient empowerment; and 22.3% were on research promotion. Our search on Twitter and YouTube generated 2,252 tweets and > 400 videos, of which we analyzed 260 tweets and 260 videos. Sources included institutions (53.5% Twitter, 64.2% You- Tube), health professionals (42.3%, 28.5%), and patients (4.2%, 7.3%). Content included education for professionals (39.2% Twitter, 62.3% YouTube), patient empowerment (20.4%, 21.9%), research promotion (28.8%, 13.1%), professional advocacy (5.8%, 2.7%), and research collaboration (5.8%, 0%). CONCLUSION: Twitter and YouTube are platforms for knowledge translation in HF, with contributions from institutions, health professionals, and less commonly, from patients. Both focus largely on education for professionals and less commonly on patient empowerment. Twitter includes more research promotion, research collaboration, and professional advocacy than YouTube.

The Use of SMS Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2Prevent): Results From a Pilot Randomized Controlled Trial.

BACKGROUND: Acute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. SMS text messaging has the potential to provide support to patients during this postdischarge period. OBJECTIVE: This study pilot tested a 60-day SMS text messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and health care resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention. METHODS: This was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul's Hospital in Vancouver, Canada, and randomized them to 1 of 2 groups within 7 days of discharge. The Txt2Prevent program included automated 1-way SMS text messages about follow-up care, self-management, and healthy living. Data were collected during the index admission and at 60 days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ-5D-5L Visual Analog Scale, a modified Sullivan Cardiac Self-Efficacy Scale, and Morisky Medication Adherence Scale scores, and self-reported health care resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with 2 survey questions and semistructured interviews. RESULTS: There were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference [Txt2Prevent minus usual care] for each domain-Health-directed activity: -0.13, 95% CI -0.39 to 0.13, P=.31; Positive and active engagement in life: 0.03, 95% CI -0.19 to 0.25, P=.76; Emotional distress: 0.04, 95% CI -0.22 to 0.29, P=.77; Self-monitoring and insight: -0.14, 95% CI -0.33 to 0.05, P=.15; Constructive attitudes and approaches: -0.10, 95% CI -0.36 to 0.17, P=.47; Skill technique and acquisition: 0.05, 95% CI -0.18 to 0.27, P=.69; Social integration and support: -0.12, 95% CI -0.34 to 0.10, P=.27; and Health services navigation: -0.05, 95% CI -0.29 to 0.19, P=.69). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in 1 self-efficacy domain (Total plus), where the Txt2Prevent group had lower scores (mean difference -0.36, 95% CI -0.66 to -0.50, P=.03). The study protocol was feasible, but recruitment took longer than expected. Over 90% (29/31 [94%]) of participants reported they were satisfied with the program. CONCLUSIONS: The Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the 2 groups in adjusted analyses except for 1 self-efficacy domain. As the intervention appeared acceptable, there is potential in using SMS text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures. TRIAL REGISTRATION: ClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.6968.

The Use of Text Messaging to Improve the Hospital-to-Community Transition in Acute Coronary Syndrome Patients (Txt2Prevent): Intervention Development and Pilot Randomized Controlled Trial Protocol.

BACKGROUND: Acute coronary syndrome, including acute myocardial infarction (AMI), is one of the leading causes for hospitalization, with AMI 30-day readmission rates around 20%. Supporting patient information needs and increasing adherence to recommended self-management behaviors during transition from hospital to home has the potential to improve patient outcomes. Text messages have been effective in other interventions and may be suitable to provide support to patients during this transition period. OBJECTIVE: The goal of this study is to pilot test a text messaging intervention program (Txt2Prevent) that supports acute coronary syndrome patients for 60 days postdischarge. The primary objective is to compare self-management, as measured by the Health Education Impact Questionnaire, between patients receiving only usual care versus those who receive usual care plus the Txt2Prevent intervention. The secondary objectives are to compare medication adherence, health-related quality of life, self-efficacy, health care resource use (and associated costs), all-cause and cardiovascular disease (CVD) readmission, and all-cause and CVD mortality rates between the 2 groups. The third objective is to assess acceptability of the text messaging intervention and feasibility of the study protocol. METHODS: This is a randomized controlled trial with blinding of outcome assessors. The Txt2Prevent program includes automated text messages to patients about standard follow-up care, general self-management, and healthy living. The content of the text messages was informed by and developed based on interviews with patients, discharge materials, theoretical domains of behavior, and a clinical advisory group composed of patients, clinicians, and researchers. We will recruit 76 consecutive cardiac in-patients with acute coronary syndrome who are treated with either medical management or percutaneous coronary intervention from a hospital in Vancouver, Canada. RESULTS: Assessments at baseline will include measures for demographic information, self-management, health-related quality of life, and self-efficacy. Assessments at follow-up will include medication adherence, readmissions, health care resource use, and mortality in addition to the reassessment of baseline measures. Baseline assessments are done in-person while follow-up assessments are completed through a combination of mailed packages and phone calls. Semistructured interviews with participants will also be performed to better understand participant experiences managing their condition and with the text messages. CONCLUSIONS: This study will determine preliminary efficacy, feasibility, and acceptability of the Txt2Prevent program to support acute coronary syndrome patients in the transition to home following hospital discharge. The results of this study will be used to inform a larger trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919 (Archived by WebCite at http://www.webcitation.org/6qMjEqo6O).