Takotsubo Syndrome or Peripartum Cardiomyopathy? Depends on Who You Are Talking to.

Takotsubo syndrome (otherwise known as broken-heart syndrome or left ventricular apical ballooning) is a rare cause of reversible heart failure that predominantly affects postmenopausal women. It was first described by Japanese researchers in the 1990s and has become established as a differential for heart failure following a physically or psychologically stressful event. This was popularised by a spike in cases following natural disasters in Japan. As the recognition of takotsubo syndrome in the differential diagnosis for sudden, onset heart failure in a previously healthy individual has grown, so has the discussion concerning takotsubo in the peripartum period. Peripartum cardiomyopathy is a rare cause of reversible heart failure in the latter weeks of pregnancy and the postpartum period. Morbidity and mortality for both cardiomyopathies can be highly variable, ranging from complete recovery of cardiac function to life threatening arrhythmias and even death. This rapid review highlights the similarities between both cardiomyopathies and challenges the hitherto assumption that both takotsubo and peripartum cardiomyopathies are distinct entities that can easily be distinguished from one another. The implications of this are significant within the context of the behavioural aspects of diagnosis, treatment, and outcome.

Clinical and demographic moderators of self-care and hospitalizations in pre-coronary artery bypass grafting patients: A cross-sectional study.

AIM: To examine the influence of clinical and demographic factors on self-care behaviour and hospitalization rates among patients with coronary heart disease awaiting coronary artery bypass grafting. BACKGROUND: Appropriate self-care behaviour can improve the management of patients with coronary heart disease and reduce hospitalization rates among those awaiting coronary artery bypass graft surgery. However, little is known about the influence of clinical and demographic factors on self-care or hospitalizations in this population. DESIGN: A cross-sectional study. METHODS: A convenience sample of 99 participants diagnosed with coronary heart disease awaiting coronary artery bypass grafting surgery were recruited from an outpatient clinic of a public tertiary hospital in southern Thailand. Data were collected on clinical (left ventricular ejection fraction, symptom severity and comorbid disease) and demographic (age, education level and marital status) factors, self-care behaviour and hospitalization rates. Path analysis using LISREL was performed to examine the influence of self-care on hospitalizations, with clinical and demographic factors as moderators. RESULTS: Path analysis showed that clinical and demographic factors accounted for nearly half of the variance (46%) in self-care, and that self-care accounted for nearly half of the variance (48%) in hospitalization rates. CONCLUSION: Our findings demonstrate that clinical and demographic factors play an important role in self-care behaviour, and in turn hospitalization rates of pre-coronary artery bypass graft surgery patients. It is suggested that the period pre-surgery is an ideal time to introduce programmes designed to bolster self-care and minimize uncertainty among this patient population and that nurses are well-positioned to do so. REPORTING METHOD: Study methods and results reported in adherence to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: Patients contributed their consent, time and data to the study.

Determining the Key Education Priorities Related to Heart Failure Care in Nursing Homes: A Modified Delphi Approach.

There is currently a limited understanding of what nurses in nursing homes view as the key education priorities to support their ability to provide the appropriate care for residents with heart failure (HF). A modified Delphi technique was utilized to gain a consensus on the key education priorities for nurses working in nursing homes in Northern Ireland. An initial list of items (n = 58), across 19 domains, was generated using the findings of a scoping review and stakeholder interviews, and a review of available clinical guidelines. Two rounds of surveys were undertaken. Items were presented using a 5-point Likert scale, with an additional exercise in the second round to rank the domains in order of importance. Fifty-four participants completed the first-round survey and 34 (63%) returned to complete the second. The findings highlight the importance of providing nurses in nursing home settings with general HF education and the delivery of person-centered care. Participants perceived education around technology for the management of HF and quality improvement or research methodologies associated with HF in nursing homes as lower priorities. This study illuminates key priorities from nursing home nurses regarding HF education that are applicable to this care setting.

Exploring perceptions of what increased gender diversity might bring to the nursing profession.

AIMS: To explore university nursing students and academic staff's perceptions of what increased gender diversity might bring to the nursing profession. DESIGN: An exploratory study with students and academic staff from two university nursing schools. METHODS: Students and staff in two university nursing schools were invited to participate in an anonymous online survey (October-November 2022). The survey focused on gender diversity within nursing and patient care, asking respondents about existing barriers to gender diversity and inviting ideas on increasing gender diversity within nursing. The survey findings helped inform questions, which were used to further explore views and thoughts of gender diversity within nursing through semi-structured one-to-one interviews (January-February 2023). RESULTS: Nearly, two-thirds (64%, n = 69) of survey respondents strongly agreed/agreed that the lack of gender diversity in nursing negatively impacted delivering care to a gender-diverse society. Most (84%, n = 90) strongly agreed/agreed that increased gender diversity within the nursing workforce would positively contribute to nursing. Three-quarters (75%, n = 74) strongly agreed/agreed that working with a more gender-diverse nursing workforce would enrich their experience as a nurse. Three themes emerged from the interview data: shared stereotypes; improved care through knowledge, better relations and the presence of a gender-diverse workforce; a culture of welcome: suggested changes for the future. CONCLUSION: Most of those who participated in the study believe there are benefits to be gained from greater gender diversity within nursing. This study provides insight into the lack of gender diversity in the nursing environment, highlights how this might impact patient care and suggests actions to make nursing a more inclusive profession. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Practical solutions were suggested, including the greater visibility of trans and non-binary persons in advertisement and recruitment campaigns to ensure nursing is viewed as a career choice for "all". Including a space for considered pronouns on university application forms, hospital documentation and name badges. Gender-neutral titles and uniforms should be considered for all nursing staff, and more gender-neutral toilets should be made available for staff and patients in university and hospital settings. IMPACT: This study addressed the lack of gender diversity in nursing and explored what an increase in gender diversity might bring to the nursing profession. The main findings were: (i) Less than a tenth (9%, n = 12) of respondents described their team of colleagues as being "extremely gender diverse". (ii) Most (84%, n = 90) strongly agreed/agreed that increased gender diversity within the nursing workforce would be a positive attribute to nursing. (iii) Three-quarters 75% (n = 74) strongly agreed/agreed that working with a more gender-diverse nursing workforce would enrich their experience as a nurse. (iv) Many stereotypes still exist in nursing and tackling them is important to make the profession more inclusive. (v) A nurse's gender can impact the care they provide. (vi) A more gender-diverse workforce would better reflect the population it serves. (vii) This research will have an impact on the nursing profession globally. REPORTING METHOD: The consolidated criteria for reporting qualitative studies (COREQ) was used as a guide throughout data collection and analysis. PATIENT OR PUBLIC CONTRIBUTION: Every step of the study, including the survey and interview schedule, was co-constructed using an iterative approach with service users, students and staff who had personal experience of gender diversity and were a core part of the study team.

Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation: Cochrane systematic review and meta-analysis.

AIM: Depression and anxiety occur frequently in individuals with cardiovascular disease and are associated with poor prognosis. This Cochrane systematic review and meta-analysis assessed the effectiveness of psychological interventions on psychological and clinical outcomes in adults with coronary heart disease (CHD), heart failure (HF) or atrial fibrillation (AF). METHODS AND RESULT: CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases were searched from January 2009 to July 2022 for randomised controlled trials of psychological interventions versus controls in adults with CHD, HF or AF. Twenty-one studies (n = 2591) were assessed using random-effects models. We found psychological interventions reduced depression (standardised mean difference [SMD] -0.36; 95% confidence interval [CI] -0.65 to -0.06; P = 0.02), anxiety (SMD -0.57; 95% CI -0.96 to -0.18; P = 0.004), and improved mental health-related quality of life (HRQoL) (SMD 0.63, 95% CI 0.01 to 1.26; P = 0.05) (follow-up 6-12 months), but not physical health-related quality of life, all-cause mortality or major adverse cardiovascular events compared with controls. High heterogeneity was present across meta-analyses. Meta-regression analysis showed that psychological interventions designed to target anxiety, were more effective than non-targeted interventions. CONCLUSION: This review found that psychological interventions improved depression, anxiety and mental HRQoL, with those targeting anxiety to show most benefit. Given the statistical heterogeneity, the precise magnitude of effects remains uncertain. Increasing use of multifactorial psychological interventions shows promise for incorporating patient needs and preferences. Investigation of those at high risk of poor outcomes, comparison of intervention components and those with AF is warranted.

What do patients want from a digital device that supports heart failure self-management?

OBJECTIVE: To assess patients' needs and the factors determining their acceptance of an e-Health intervention. METHODS: Purposive sample of patients with heart failure, attending an outpatient consultation were invited to complete a questionnaire designed to assess their needs and acceptance of an e-Health intervention. Data analysis was performed using Chi-square tests with post-hoc corrections. RESULTS: Response rate was 61 % (n = 101), with most patients (>70 %) indicating they could see themselves using an e-Health intervention to manage their heart failure. Participants with a healthy lifestyle (i.e., non-smoker and consumed alcohol < once/week) were more likely to have a positive attitude towards technology (p adj.=0.013). Those willing to use an e-Health intervention were convinced of its advantages by other patients with heart failure (p adj.=0.013). Advanced age, education level, employment or marital status did not influence patient attitudes toward health technology. CONCLUSIONS & PRACTICE IMPLICATIONS: Results indicate patients have a positive attitude towards the use of e-Health interventions to enable their self-management of heart failure. These findings will inform further development and delivery strategies of e-Health interventions.

Prevention and Rehabilitation After Heart Transplantation: A Clinical Consensus Statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a Section of ESOT.

Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus statement focuses on the importance and the characteristics of prevention and rehabilitation designed for HTx recipients.

Prevention and rehabilitation after heart transplantation: A clinical consensus statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a section of ESOT.

Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus statement focuses on the importance and the characteristics of prevention and rehabilitation designed for HTx recipients.

International guideline comparison of lifestyle management for acute coronary syndrome and type 2 diabetes mellitus: A rapid review.

Acute coronary syndrome (ACS) is a life-threatening condition, with ACS-associated morbidity and mortality causing substantial human and economic challenges to the individual and health services. Due to shared disease determinants, those with ACS have a high risk of comorbid Type 2 diabetes mellitus (T2DM). Despite this, the two conditions are managed separately, duplicating workload for staff and increasing the number of appointments and complexity of patient management plans. This rapid review compared current ACS and T2DM guidelines across Australia, Canada, Europe, Ireland, New Zealand, the UK, and the USA. Results highlighted service overlap, repetition, and opportunities for integrated practice for ACS-T2DM lifestyle management across diet and nutrition, physical activity, weight management, clinical and psychological health. Recommendations are made for potential integration of ACS-T2DM service provision to streamline care and reduce siloed care in the context of the health services for ACS-T2DM and similar comorbid conditions.

Prevention and rehabilitation after heart transplantation: A clinical consensus statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a section of ESOT.

Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus.

Heart failure in nursing homes: A scoping review of educational interventions for optimising care provision.

Background: Heart failure has an estimated global prevalence of 64.3 million cases, with an average age of a person living with heart failure at 75.2 years. Approximately 20% of residents living in nursing homes (a long-term residential care environment for some individuals) report living with heart failure. Residents living with heart failure in nursing home environments are often frail, have reduced quality of life, higher rates of rehospitalisation and mortality, and greater complications in heart failure management. Further, nursing home staff often lack the knowledge and skills required to provide the necessary care for those living with heart failure. Interventions for improving heart failure management in nursing homes have proven effective, yet there is a lack of understanding regarding interventions for optimising care provision. The aim of this review was to synthesise the current evidence on educational interventions to optimise care provided to people with heart failure in nursing homes. Methods: A scoping review with four databases searched: Medline, CINAHL, Web of Science, and EMBASE. Relevant reference lists were searched manually for additional records. Studies of nursing home staff or resident outcomes associated with changes in care provision (i.e., resident quality of life, staff knowledge of heart failure) were included. Results from the charting data process were collated into themes: intervention outcomes, changes to practice, and implementation and process evaluation. Results: Seven papers were deemed eligible for inclusion. Most studies (n=6) were comprised of nursing home staff only, with one comprised only of residents. Study aims were to improve heart failure knowledge, interprofessional communication, heart failure assessment and management. Positive changes in staff outcomes were observed, with improvements in knowledge, self-efficacy, and confidence in providing care reported. No difference was reported concerning nursing home resident outcomes. Interprofessional communication and staff ability to conduct heart failure assessments improved post-intervention. Changes to practice were mixed, with issues around sustainability reported. Nursing home staff highlighted their appreciation towards receiving education, recommending that videos, images, and humour could improve the intervention content. Conclusions: There is a paucity of evidence around educational interventions to support residents living with heart failure in nursing homes. However, available evidence suggests that educational interventions in nursing homes may improve care through improving staff self-efficacy and confidence in providing care, heart failure knowledge and interprofessional communication. The complexity of implementing educational interventions in the nursing home setting must be considered during the development process to improve implementation, effectiveness, and sustainability.

Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation.

BACKGROUND: Depression and anxiety occur frequently (with reported prevalence rates of around 40%) in individuals with coronary heart disease (CHD), heart failure (HF) or atrial fibrillation (AF) and are associated with a poor prognosis, such as decreased health-related quality of life (HRQoL), and increased morbidity and mortality. Psychological interventions are developed and delivered by psychologists or specifically trained healthcare workers and commonly include cognitive behavioural therapies and mindfulness-based stress reduction. They have been shown to reduce depression and anxiety in the general population, though the exact mechanism of action is not well understood. Further, their effects on psychological and clinical outcomes in patients with CHD, HF or AF are unclear. OBJECTIVES: To assess the effects of psychological interventions (alone, or with cardiac rehabilitation or pharmacotherapy, or both) in adults who have a diagnosis of CHD, HF or AF, compared to no psychological intervention, on psychological and clinical outcomes. SEARCH METHODS: We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2009 to July 2022. We also searched three clinical trials registers in September 2020, and checked the reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing psychological interventions with no psychological intervention for a minimum of six months follow-up in adults aged over 18 years with a clinical diagnosis of CHD, HF or AF, with or without depression or anxiety. Studies had to report on either depression or anxiety or both. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were depression and anxiety, and our secondary outcomes of interest were HRQoL mental and physical components, all-cause mortality and major adverse cardiovascular events (MACE). We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: Twenty-one studies (2591 participants) met our inclusion criteria. Sixteen studies included people with CHD, five with HF and none with AF. Study sample sizes ranged from 29 to 430. Twenty and 17 studies reported the primary outcomes of depression and anxiety, respectively. Despite the high heterogeneity and variation, we decided to pool the studies using a random-effects model, recognising that the model does not eliminate heterogeneity and findings should be interpreted cautiously. We found that psychological interventions probably have a moderate effect on reducing depression (standardised mean difference (SMD) -0.36, 95% confidence interval (CI) -0.65 to -0.06; 20 studies, 2531 participants; moderate-certainty evidence) and anxiety (SMD -0.57, 95% CI -0.96 to -0.18; 17 studies, 2235 participants; moderate-certainty evidence), compared to no psychological intervention. Psychological interventions may have little to no effect on HRQoL physical component summary scores (PCS) (SMD 0.48, 95% CI -0.02 to 0.98; 12 studies, 1454 participants; low-certainty evidence), but may have a moderate effect on improving HRQoL mental component summary scores (MCS) (SMD 0.63, 95% CI 0.01 to 1.26; 12 studies, 1454 participants; low-certainty evidence), compared to no psychological intervention. Psychological interventions probably have little to no effect on all-cause mortality (risk ratio (RR) 0.81, 95% CI 0.39 to 1.69; 3 studies, 615 participants; moderate-certainty evidence) and may have little to no effect on MACE (RR 1.22, 95% CI 0.77 to 1.92; 4 studies, 450 participants; low-certainty evidence), compared to no psychological intervention. AUTHORS' CONCLUSIONS: Current evidence suggests that psychological interventions for depression and anxiety probably result in a moderate reduction in depression and anxiety and may result in a moderate improvement in HRQoL MCS, compared to no intervention. However, they may have little to no effect on HRQoL PCS and MACE, and probably do not reduce mortality (all-cause) in adults who have a diagnosis of CHD or HF, compared with no psychological intervention. There was moderate to substantial heterogeneity identified across studies. Thus, evidence of treatment effects on these outcomes warrants careful interpretation. As there were no studies of psychological interventions for patients with AF included in our review, this is a gap that needs to be addressed in future studies, particularly in view of the rapid growth of research on management of AF. Studies investigating cost-effectiveness, return to work and cardiovascular morbidity (revascularisation) are also needed to better understand the benefits of psychological interventions in populations with heart disease.

World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update.

Background: Secondary prevention lifestyle and pharmacological treatment of atherosclerotic cardiovascular disease (ASCVD) reduce a high proportion of recurrent events and mortality. However, significant gaps exist between guideline recommendations and usual clinical practice. Objectives: Describe the state of the art, the roadblocks, and successful strategies to overcome them in ASCVD secondary prevention management. Methods: A writing group reviewed guidelines and research papers and received inputs from an international committee composed of cardiovascular prevention and health systems experts about the article's structure, content, and draft. Finally, an external expert group reviewed the paper. Results: Smoking cessation, physical activity, diet and weight management, antiplatelets, statins, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and cardiac rehabilitation reduce events and mortality. Potential roadblocks may occur at the individual, healthcare provider, and health system levels and include lack of access to healthcare and medicines, clinical inertia, lack of primary care infrastructure or built environments that support preventive cardiovascular health behaviours. Possible solutions include improving health literacy, self-management strategies, national policies to improve lifestyle and access to secondary prevention medication (including fix-dose combination therapy), implementing rehabilitation programs, and incorporating digital health interventions. Digital tools are being examined in a range of settings from enhancing self-management, risk factor control, and cardiac rehab. Conclusions: Effective strategies for secondary prevention management exist, but there are barriers to their implementation. WHF roadmaps can facilitate the development of a strategic plan to identify and implement local and national level approaches for improving secondary prevention.

Patient experiences of the Long COVID-Optimal Health Programme: a qualitative interview study in community settings.

BACKGROUND: Long COVID (LC) symptoms persist 12 weeks or more beyond the acute infection. To date, no standardised diagnostic or treatment pathways exist. However, a holistic approach has been recommended. This study explored participants' experiences of a Long COVID-Optimal Health Programme (LC-OHP); a psychoeducational self-efficacy programme. AIM: To explore perceptions and experiences of people with LC regarding the LC-OHP and identify suggestions to further improve the programme. DESIGN & SETTING: Qualitative study with patients with LC recruited through community settings. METHOD: This study is part of a wider randomised controlled trial. Eligible participants were aged ≥18 years, have LC, and attended a minimum of five LC-OHP sessions plus a booster session. We interviewed those randomised to the intervention group. Interviews were conducted by an independent researcher and thematically analysed to identify common, emerging themes. RESULTS: Eleven participants were interviewed, mostly women from a White British ethnic group (n = 10). Four main themes were identified, reflecting programme benefits and suggestions for improvement. The programme demonstrated potential for assisting patients in managing their LC, including physical health and mental wellbeing. Participants found the programme to be flexible and provided suggestions to adapting it for future users. CONCLUSION: Findings support the acceptability of the LC-OHP to people living with LC. The programme has shown several benefits in supporting physical health and mental wellbeing. Suggestions made to further adapt the programme and improve its delivery will be considered for future trials.

Apathy mediates the association between age and cognition after stroke.

PURPOSE: To examine if the association between age and post-stroke cognition is mediated by apathy. METHODS: A cross-sectional investigation was carried out with 389 stroke survivors and informants. Data were collected through the Apathy Evaluation Scale (AES-C) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Bivariate analyses were conducted between the IQCODE total score and each of the demographic and clinical characteristics as well as apathy, while Baron and Kenny's 4-step approach was used to examine the mediating effect of apathy on the association between age and post-stroke cognition. RESULTS: Participants were aged 64.3 years on average, with a mean IQCODE score of 97.6 (SD: 14.8) and a mean AES-C score of 41.3 (SD: 8.0). IQCODE scores were positively correlated with age (r = 0.32, p < 0.001) and apathy (r = 0.54, p < 0.001). Apathy contributed to 24% of the total effect of age on post-stroke cognition, exerting a significant mediating effect on the relationship between age and post-stroke cognition. CONCLUSIONS: Apathy may have a significant impact on the cognitive health of stroke survivors. Therefore, the early identification of apathy symptoms could facilitate consideration of potential interventions, such as multisensory and cognitive stimulation, designed to improve cognitive outcomes in this population.

Cognitive impairment after stroke is common and has negative impacts on survivors' rehabilitation and quality of life.Ageing survivors are prone to mood disorders which may be associated with poorer cognitive outcomes.Apathy was found to significantly mediate the relationship between age and post-stroke cognition.Psychological assessments should be carried out regularly to improve cognitive outcomes through the timely recognition and management of apathy.