180 research outputs found
Naar meer geïntegreerde zorg voor patiënten met voorkamerfibrillatie.
No full textAtrial fibrillation (AF) is the most common heart arrhythmia and is associated with increased morbidity and mortality. It places an enormous burden on the current society and healthcare system and it is expected that the worldwide prevalence will at least double over the next 50 years. Optimization of AF management will need to be a prime public health focus over the next decades. There is a high need for more efficient care models and a structured approach for the treatment and follow-up of AF patients. A proposed approach to better structure this complex AF management is the establishment of an “interdisciplinary nurse-led AF clinic”. Recent studies have shown that nurse-led integrated care is an efficient and cost-effective manner to improve the care of AF patients. However, hospitals and cardiology practices do not have any predefined and structured guidance how this nurse-led integrated care can be implemented in daily practice. Moreover, from the studies that have shown a positive outcome, it is unclear which aspects of the integrated care had most impact on the improved outcomes.
The aim of this thesis was to study the contribution of specific interventions to the effectiveness of an interdisciplinary AF expert program with a focus on four different aspects: (i) screening for AF; (ii) education for patients with AF; (iii) adherence to non-vitamin K antagonist oral anticoagulants (NOACs); (iv) risk factor management.
We have shown that the usability and accuracy of handheld electrocardiogram devices to detect AF are not optimal when they are applied in a hospital setting. Nevertheless, making use of a well-planned screening strategy, these devices may provide an effective and cost-effective screening approach (Chapter 1).
The Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) was developed and validated within the scope of this PhD thesis. It is a brief but complete questionnaire that can be used to assess patients’ insight into their condition (Chapter 2). The JAKQ revealed major knowledge gaps in the general AF population. Notwithstanding, it is an ideal tool to efficiently guide and target personalized education. A first targeted educational session based on the JAKQ will significantly improve patients’ knowledge level. Additional educational sessions will maintain and even strengthen this effect (Chapter 3). Furthermore, we showed that tailored education via an online platform is also an effective strategy to improve the knowledge level of AF patients about their arrhythmia and the associated treatment (Chapter 4).
Although electronic monitoring already revealed an unexpectedly high adherence to NOAC therapy, it was shown that telemonitoring-based rapid and personalized feedback could further optimize adherence. This intervention could be cost-effective when higher risk, poorly adherent patients are targeted and when the used technology would become cheaper (Chapter 5). The Health Buddies app was developed as a tool to improve adherence to NOACs in an elderly AF population by providing a virtual contract with their grandchildren. In a pilot study, it was however shown that only a small proportion of the current AF population was eligible for this innovative app in its current form. Still the app was positively rated by its users on most aspects (Chapter 6).
Together with a team of experts in the field we summarized the literature about obstructive sleep apnea testing and management in patients with AF and we came up with a proposal for an integrated care pathway to tackle this cardiovascular risk factor in daily care (Chapter 7). Similar pathways can be developed to provide guidance on how to deal with different modifiable risk factors in AF patients.
These results provide further insights and guidance into the practical aspects, workload, feasibility and impact of different aspects of a patient-centered integrated AF care approach. This can be instrumental for future studies with the aim to improve the overall care of AF patients
Naar meer geïntegreerde zorg voor patiënten met voorkamerfibrillatie.
No full textAtrial fibrillation (AF) is the most common heart arrhythmia and is associated with increased morbidity and mortality. It places an enormous burden on the current society and healthcare system and it is expected that the worldwide prevalence will at least double over the next 50 years. Optimization of AF management will need to be a prime public health focus over the next decades. There is a high need for more efficient care models and a structured approach for the treatment and follow-up of AF patients. A proposed approach to better structure this complex AF management is the establishment of an “interdisciplinary nurse-led AF clinic”. Recent studies have shown that nurse-led integrated care is an efficient and cost-effective manner to improve the care of AF patients. However, hospitals and cardiology practices do not have any predefined and structured guidance how this nurse-led integrated care can be implemented in daily practice. Moreover, from the studies that have shown a positive outcome, it is unclear which aspects of the integrated care had most impact on the improved outcomes.
The aim of this thesis was to study the contribution of specific interventions to the effectiveness of an interdisciplinary AF expert program with a focus on four different aspects: (i) screening for AF; (ii) education for patients with AF; (iii) adherence to non-vitamin K antagonist oral anticoagulants (NOACs); (iv) risk factor management.
We have shown that the usability and accuracy of handheld electrocardiogram devices to detect AF are not optimal when they are applied in a hospital setting. Nevertheless, making use of a well-planned screening strategy, these devices may provide an effective and cost-effective screening approach (Chapter 1).
The Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) was developed and validated within the scope of this PhD thesis. It is a brief but complete questionnaire that can be used to assess patients’ insight into their condition (Chapter 2). The JAKQ revealed major knowledge gaps in the general AF population. Notwithstanding, it is an ideal tool to efficiently guide and target personalized education. A first targeted educational session based on the JAKQ will significantly improve patients’ knowledge level. Additional educational sessions will maintain and even strengthen this effect (Chapter 3). Furthermore, we showed that tailored education via an online platform is also an effective strategy to improve the knowledge level of AF patients about their arrhythmia and the associated treatment (Chapter 4).
Although electronic monitoring already revealed an unexpectedly high adherence to NOAC therapy, it was shown that telemonitoring-based rapid and personalized feedback could further optimize adherence. This intervention could be cost-effective when higher risk, poorly adherent patients are targeted and when the used technology would become cheaper (Chapter 5). The Health Buddies app was developed as a tool to improve adherence to NOACs in an elderly AF population by providing a virtual contract with their grandchildren. In a pilot study, it was however shown that only a small proportion of the current AF population was eligible for this innovative app in its current form. Still the app was positively rated by its users on most aspects (Chapter 6).
Together with a team of experts in the field we summarized the literature about obstructive sleep apnea testing and management in patients with AF and we came up with a proposal for an integrated care pathway to tackle this cardiovascular risk factor in daily care (Chapter 7). Similar pathways can be developed to provide guidance on how to deal with different modifiable risk factors in AF patients.
These results provide further insights and guidance into the practical aspects, workload, feasibility and impact of different aspects of a patient-centered integrated AF care approach. This can be instrumental for future studies with the aim to improve the overall care of AF patients
Patient-reported outcomes in atrial fibrillation:is it worthwhile systematically evaluating?
No full textAssessment of comorbidity awareness in patients with atrial fibrillation: The ACAPAF study
No full textBackground and aim: Systematic and integrated comorbidity management in patients with atrial fibrillation (AF) requires patient involvement, starting with comorbidity awareness. This study evaluates comorbidity awareness in patients with AF before and after a first nurse-led AF clinic visit and after six months. We also measured the time needed for full comorbidity mapping using the EHRA-PATHS software. Methods: This prospective two-centre study included patients diagnosed with AF attending the AF clinic for the first time. The software systematically assessed 23 comorbidities. Patients completed a comorbidity awareness questionnaire, focusing on nine AF-related comorbidities two weeks before their first visit, less than a week after, and six months later. Patients also had a telephone consultation with the AF nurse to discuss their comorbidities 1-3 months post-visit. Results: The study included 76 patients (mean age 68.3 +/- 10.3 y). Baseline awareness of comorbidity relevance for AF ranged between 11.1-100.0 %. Awareness about own alcohol consumption was the most 'underestimated' comorbidity before first contact (50.0 %), while smoking was most 'overestimated' (55.6 %; i.e. admitted in private but not during formal evaluation by nurses). The impact of an AF clinic visit on awareness of personal comorbidities was limited (p = 0.456), and also after an additional phone consultation, awareness was suboptimal after six months (p = 0.099). AF nurses needed 18.4 +/- 8.7 min to complete the software. Conclusions: Patients' comorbidity awareness is moderate, and more educational efforts are needed to improve their awareness. A systematic and complete comorbidity evaluation at the AF clinic using EHRA-PATHS software can be done within a reasonable time frame.The EHRA-PATHS project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 945260
sj-docx-1-dhj-10.1177_20552076231176941 - Supplemental material for Assessment of functionalities and attitude toward telemedicine for patients with cardiovascular disease
No full textSupplemental material, sj-docx-1-dhj-10.1177_20552076231176941 for Assessment of functionalities and attitude toward telemedicine for patients with cardiovascular disease by Lieselotte Knaepen, Maarten Falter, Martijn Scherrenberg, Paul Dendale, Lien Desteghe and Hein Heidbuchel in DIGITAL HEALTH</p
Development of systematic care pathways to tackle multimorbidity in elderly patients with atrial fibrillation: results of a Delphi process among the Horizon 2020 EHRA-PATHS investigators
No full textOn behalf of The Horizon 2020 EHRA-PATHS investigators Funding Acknowledgements: Type of funding sources: Public grant(s)-EU funding. Main funding source(s): This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 945260 Background: Atrial fibrillation (AF) is the result of underlying diseases and many underlying comorbidities impact clinical outcomes. Elderly AF patients (≥65 years) have on average five comorbidities. Comorbidity management requires a systematic approach and interdisciplinary care pathways, which are lacking in most care settings. The EHRA-PATHS H2020 project No. 945260, coordinated by EHRA and ESC, aims to tackle this problem.Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 94526
Development of systematic care pathways to tackle multimorbidity in elderly patients with atrial fibrillation: results of a Delphi process among the Horizon 2020 EHRA-PATHS investigators
No full textOn behalf of The Horizon 2020 EHRA-PATHS investigators Funding Acknowledgements: Type of funding sources: Public grant(s)-EU funding. Main funding source(s): This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 945260 Background: Atrial fibrillation (AF) is the result of underlying diseases and many underlying comorbidities impact clinical outcomes. Elderly AF patients (≥65 years) have on average five comorbidities. Comorbidity management requires a systematic approach and interdisciplinary care pathways, which are lacking in most care settings. The EHRA-PATHS H2020 project No. 945260, coordinated by EHRA and ESC, aims to tackle this problem.Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 94526
Knowledge gaps in patients with venous thromboembolism : usefulness of a new questionnaire
No full textAbstract: INTRODUCTION The current awareness of venous thromboembolism (VTE) and knowledge of thromboprophylaxis among patients receiving oral anticoagulation therapy (OAC) are insufficient. OBJECTIVES We sought to develop and evaluate the usefulness of the Jessa AF Knowledge Questionnaire (JAKQ), modified for VTE patients. PATIENTS AND METHODS Consecutive patients at least 1 month since the VTE event (n = 273, mean [SD] age, 51 [17] years; 52.7%, women; 55.9%, unprovoked event) were enrolled to the study. RESULTS The median percentage of correct responses was 64.2% (interquartile range, 53%-73%; minimum, 12%; maximum, 100%). Younger patients had better knowledge about VTE in general, including a higher proportion of correct responses to the question about the definition of PE (71.4% vs 57.7%, P = 0.03), about the possible consequence of DVT, including PE (81.1% vs 62%, P = 0.001) and VTE risk related to long travels (78.1% vs 59.2%, P = 0.002). There was no difference in overall scoring between patients taking new oral anticoagulants and those taking vitamin K antagonists (mean [SD], 64.1% [16.3%] vs 63.9% [13.8%], respectively, P = 0.7). Regardless of the type of anticoagulants, 39.3% of patients knew that VTE is not always symptomatic, 33.6% knew what to do when they missed an OAC dose, and 50% did not know which painkillers are the safest in combination with anticoagulants. Education applied in 27 patients resulted in an increase in the median percentage of correct responses from 60% to 80% (P = 0.0001). CONCLUSIONS Knowledge on VTE and anticoagulation is suboptimal among patients on VKA and NOACs. Education of VTE patients should be improved especially in older individuals on NOACs
Pacemaker guided screening for severe sleep apnea, a possible option for patients with atrial fibrillation: A systematic review and meta‐analysis
No full textIntroduction Obstructive sleep apnea is often underdiagnosed in atrial fibrillation (AF) patients although it is an important risk factor. A systematic review and meta-analysis was performed to assess which techniques cardiac implantable electronic devices (CIED) and Holter monitors use to screen for sleep apnea (SA), and to evaluate if these are suitable for AF patients from a diagnostic accuracy perspective.Methods The search was conducted in accordance with the PRISMA-guidelines. PICO was defined as (P) patients with AF, (I) Holter monitors or CIED suitable for screening for SA, (C) overnight polysomnography (PSG), (O) positive screening with subsequent positive polysomnographic diagnosis of SA. Optimal index test cut-off points corresponding to reference test cut-off for severe SA (PSG-AHI >= 30) were compared. Meta-analysis was conducted for the diagnostic odds ratio (DOR), with forest plot and ROC-curve for summary DOR.Results A total of five prospective cohort studies (n = 192) were included in the systematic review of which four studies (n = 132) were included in the meta-analysis. All included studies use transthoracic impedance measurement as a screening parameter. No studies evaluating Holter monitors were included. The population consisted of patients indicated for pacemaker implantation. The summary DOR was 27.14 (8.83; 83.37), AUC was 0.8689 (0.6872; 0.9456) and Q* was 0.8390 (0.7482; 0.9013).Conclusion At optimal pacemaker-cut-off, pacemaker-guided screening for severe SA in patients with AF can be an effective triage tool for clinical practice. Further studies with larger sample sizes are needed to strengthen the evidence for this conclusion.This study is part of Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital
sj-docx-1-dhj-10.1177_20552076211067105 - Supplemental material for A new smartphone application for integrated transmural care of atrial fibrillation, AF-EduApp: Usability and validation study
No full textSupplemental material, sj-docx-1-dhj-10.1177_20552076211067105 for A new smartphone application for integrated transmural care of atrial fibrillation, AF-EduApp: Usability and validation study by Lieselotte Knaepen, Michiel Delesie, Rik Theunis, Johan Vijgen, Paul Dendale, Lien Desteghe and Hein Heidbuchel in Digital Health</p
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