1,721,065 research outputs found
EXAMINATION OF TREADMILL STRESS TEST EXPOSURE THERAPY FOR PEDIATRIC CARDIAC DEVICE PATIENTS (TreadExpo)
No full textPediatric patients with cardiac devices report fear and anxiety associated with exertion and activity resulting in high avoidance of activities, things, or places post-device implant. Extant pediatric cardiac literature is minimal, establishing the need for improved description of the sample. The field is in need of a better understanding of the role of anxiety in physical activity and self-limiting behaviors of the pediatric arrhythmia population. Examining the strength of relationship between patient estimations for duration of exercise capacity and general anxiety, as well as cardiac specific anxiety, may provide clinicians with information to guide intervention for re-engaging this population in exertive behavior. The primary aims of the current project were: 1) to examine feasibility of using treadmill stress tests as a clinical intervention, 2) determine the effects of a treadmill test on anxiety, and 3) examine the strength of relationship between patient-predicted treadmill stress test duration and activity, psychosocial distress, and cardiac specific distress. Participants were recruited from an outpatient electrophysiology (EP) clinic at Texas Children's Hospital in Houston, Texas, presenting for a standard of care (SOC) exercise treadmill test (ETT). Child report of general anxiety and device specific anxiety was collected, as well as predicted and total ETT time for six cardiac device patients aged 12-17. Analyses included descriptives, paired t-tests, and correlations. Results indicated moderate feasibility for the current study design, after multiple logistical adjustments to the recruiting process, the protocol, and the personnel necessary to complete the procedures. The use of ETT as an anxiety intervention was not statistically efficacious in this sample. Statistical results indicated strong relationships between predicted ETT duration and general anxiety (r = 0.85, p = 0.033), post-ETT state anxiety and device acceptance (r = -0.82, p = 0.048), general anxiety and report of normal daily functioning (r = -0.84, p = 0.036), body image and Total ETT duration (r = 0.85, n = 6, p = 0.032), and post-ETT state anxiety and report of device distress (r = -0.84, p = 0.036). In conclusion, future projects could be feasible with increased research personnel, increased engagement of clinic EPs, expanded eligibility criteria, and funding to compensate families for parking or traveling expenses. Participants and families saw inherent value in researchers' improved understanding of fears of exertion via ETT. Future research should determine the impact of number of exposure sessions necessary to impact anxiety in patients who report marked anxiety or activity avoidance
EXAMINATION OF ACTIVITY RATES IN ADULT PATIENTS, POST-MYOCARDIAL INFACTION WITH WEARABLE CARDIOVERTER DEFIBRILLATORS
No full textBackground: Wearable cardioverter defibrillators (WCD) are external devices capable of providing monitoring and immediate intervention from sudden cardiac death (SCD). WCDs contain accelerometers, providing data on patient activity levels. The literature indicates a positive relationship among patient activity levels, survival, and quality of life outcomes in cardiac populations (Kramer et al., 2015; Sears, Whited, Koehler, & Gunderson, 2015). However, there is no research to date on post-myocardial infarction patient activity levels while wearing the WCD. Methods: This study derived data from patients prescribed a WCD post myocardial infarction with a suppressed left ventricular ejection fraction (LVEF). Patient wear-time and activity data, captured by the device accelerometer, was used to describe the relationship between wear-time and physical activity, as well as examine influence of different demographic variables, including sex and age, on wear-time and activity levels. Changes in activity over the duration of days of WCD were also examined. Results: A total of 480 patients (70% male), were included in the study. Descriptive analyses indicated a median age of 64 years (range 31-90) and an overall median wear-time of 23.8 hours per day; median activity per day was 5,727.5 steps. Results indicated a negative relationship between patient wear-time and patient activity over the course of 90 days. Patient age significantly predicted activity over the course of 90 days, as well as patient wear-time. Results also indicated significant differences in median steps over 90 days, based on sex. Significant differences in activity over time were detected, with the median number of steps increasing from 3,681.5 during the first week of wear to 6,327.5 during the last week of wear. Conclusion: Physical activity in adults with a WCD is generally modest and improves over the course of the 90-day typical prescription. Improved health status likely accounts for this change. Younger patients and men were more active, but older adults tended to wear the device more each day. These results provide evidence that the accelerometer may allow clinicians to more closely attend to activity level in overall patient management and in specific populations of patients
Examining the Base Rates of Atrial Fibrillation in Eastern North Carolina: Community Screening, Associated Risk Factors, and Psychological Correlates of Disease
No full textBackground: Eastern North Carolina has historically high prevalence rates of cardiovascular disease. Novel solutions such as mobile screening technology may aid in reaching this region’s vulnerable health population to prevent further disease progression. Additionally, symptoms of psychological distress are commonly comorbid with cardiovascular disease but often overlooked as formal predictors or modifiers of increased disease burden. Behavioral medicine providers recognize the importance of screening for psychological stress as it relates to cardiovascular disease as a way to reduce disease burden and advancement. Therefore, mobile-ECG screening for atrial fibrillation and exploration of adding psychological variables to a well-established cardiovascular stroke risk calculator (CHA₂DS₂-VASc) are discussed.
Methods: Participants (N = 250) were approached at pharmacies in Eastern North Carolina. Participants completed demographic and medical history questionnaires, the DASS-21, and were administered a single-lead mobile-ECG (mECG). All mECG readings were interpreted by the mECG device in addition to adjudication by three electrophysiologists. Medical referrals were provided when indicated. Chi-squared statistics were utilized to investigate regional rates of atrial fibrillation and associated risk factors. Binary logistic regression modeling measured the capability of the CHA₂DS₂-VASc stroke risk calculator to predict abnormal mECG readings both with and without the addition of DASS-21 symptom scores.
Results: Rates of previously undiagnosed atrial fibrillation were much higher than rates found in studies of similar scope and design. Participants’ average CHA₂DS₂-VASc scores (2.68 ± 1.35) signify an alarming rate of untreated ischemic stroke risk in a community sample. Additionally, the prevalence rates of six, known independent stroke risk factors were also significantly higher in the study sample than reported national US averages. Significant correlations were not found between psychological endpoints and abnormal mECG readings or elevated CHA₂DS₂-VASc scores, but binary logistic regression modeling revealed that a longstanding stroke risk calculator could be potentially strengthened with the addition of one (anxiety) or three (depression, anxiety, and stress) psychological endpoints.
Discussion: The results of the current study further the knowledge of the utility of using mobile-health techniques to capture previously undiagnosed atrial fibrillation and associated risk factors. Prevalence of chronic disease and other health metrics in the Eastern North Carolina region are substantially worse than the general US population. Additionally, the results presented begin a compelling argument for the addition of psychological symptom scores to a long-standing stroke risk calculator
Fear of Recurrence in Atrial Fibrillation Patients: Development of the ECU Fear of Recurrence Scale
No full textAtrial fibrillation (AF) is characterized by a rapid and irregular heartbeat that results from abnormal impulse generation from the upper chambers of the heart, the atria. A disorganized heartbeat obstructs the ability of the heart to adequately pump blood through the heart and to other vital organs. Because of this, individuals with AF are at increased risk of adverse health effects including stroke, premature death, and heart failure. Advances in medicine have allowed for treatment developments that target arrhythmic substrate dysfunction and decrease the risk of adverse events. While some AF patients respond effectively to anti-arrhythmic medications, others may require additional interventions to decrease the burden of AF.
Given the increased burden among patients who present with sustained AF recurrence rate following intervention, it is plausible that many patients experience significant fear or anxiety related to AF recurrence. The phenomenon of fear of recurrence (FOR) is well-researched in cancer survivors and is often associated with significant psychological and behavioral consequences. The role of FOR among AF patients, however, has not yet been studied despite notable psychological concerns in this population.
The present study aimed to determine the overall prevalence and impact of FOR among AF patients through the development of a valid, reliable measure to assess this construct. At the East Carolina Heart Institute (ECHI), 51 patients were recruited to complete the ECU Fear of Recurrence Scale, the Cardiac Anxiety Questionnaire, the ECU Behavioral and Lifestyle Assessment for Atrial Fibrillation, the Fear about Exercise Questionnaire, and the Generalized Anxiety Disorder and Patient Health Questionnaire screeners. Descriptive analyses revealed that the mean age of the sample was 69.71 (SD = 10.12) with 49% identifying as women and the majority identifying their racial/ethnic background as non-Hispanic White (80.4%). Medical and psychological co-morbid conditions were common across the study sample, and health care utilization was high. Major findings of the present study included a) an acceptable degree of reliability ([alpha] = .92) and construct validity for the new measure b) notable prevalence of recurrence fears across the sample c) moderate-high relationships between FOR, cardiac-specific anxiety, and fears about experience and d) evidence of a predictive relationship between AF-specific fears and exercise-related fears. The findings in the present study provide promising evidence for conceptualization and existence of FOR among AF populations and offer a foundation for continuing to address nuance in the patient experience. This measure can likely help to continue to identify patients struggling with adjustment to this condition and aid in future development of targeted interventions to address AF-specific fears
Development of the Peripartum Cardiomyopathy Quality Of Life Registry
No full textPeripartum cardiomyopathy (PPCM) is a relatively rare form of heart failure that develops in young women in the third trimester of pregnancy or during the postpartum period. Despite its potentially devastating impact on new mothers and their families, no prior studies have evaluated the extent to which PPCM and its treatment negatively affect survivors' long-term physical health and emotional recovery. The current study sought to develop a prospective online research registry to examine clinically relevant behavioral and psychosocial outcomes in women with PPCM. A conceptual model was also developed and used to evaluate predictors of depression. Seventy-five PPCM patients (mean age of 35.0 years, SD = 5.8 years) enrolled in the registry. Among PPCM patients in this sample, 35% endorsed symptoms of clinical depression which was associated with worse adherence to scheduled medical appointments. More than half the women in this cohort (52%) endorsed clinical levels of generalized anxiety. High levels of cardiac anxiety, good maternal social support, poor adherence to heart failure self-care behaviors and reproductive risk behaviors were also found. Finally, multivariate analyses revealed that physical health significantly predicted depression (p = 0.004). The addition of generalized anxiety and disease-specific distress to the regression model significantly increased R2 (p [less than] 0.001) and explained an additional 38.1% of the variation in depression. Demographic factors and disease severity were not significantly associated with depression. In sum, data from this study support the prevalence and persistence of adverse behavioral and psychosocial outcomes in women with PPCM. Further research, assessment and intervention is warranted to facilitate patient education and improve patient care
Understanding Wearable Cardioverter Defibrillator Use and Activity Level in Pediatric Populations
No full textResearch suggests that most patients utilize WCDs appropriately. However, very little is known about pediatric cardiac patients prescribed a wearable cardioverter defibrillator (WCD). In other pediatric cardiac populations, patients are typically achieving recommended levels of physical activity, which is influenced by sex, age, and disease severity; however, no information on the physical activity of patients with a WCD exists. The current study aimed to provide information on the usage of WCDs and physical activity in pediatric populations and influencing factors. Findings suggest that patients wear their device for an average of 33 days with daily wear time averaging 20 hours. Additionally, these patients were active for approximately 80 minutes per day, with an average step count of 7,493. Results indicated that these patients significantly increase their steps over the first three weeks of wear. Taken together, these findings indicated that patients are relatively compliant to WCD and physical activity recommendations. Additionally, changes in physical activity suggest that as patients adjust to wearing the device they become more active. Future research in needed to further assess psychosocial factors related to WCD usage
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Psychological Responses and Behaviors During the Initial Stages of COVID-19 Among General US Population
No full textBackground: The novel coronavirus, COVID-19, has posed a major public health risk across the world. The threat of the virus and the resulting quarantine or "stay-home-orders," likely impacted physical and mental health across the US population. The purpose of this study was to examine the psychological responses and behaviors during the initial stages of the COVID-19 epidemic in a US sample, applying the Common-Sense Model of illness to encourage a more comprehensive conceptualization of psychological and behavioral response to COVID-19. Methods: This study used Amazon Mechanical Turk (MTurk), a widely used data-sourcing tool, to assess the psychological impact of COVID-19 and quarantine for a large sample (N = 584) of US citizens, applying the Common-Sense Model of Illness as a way of predicting cognitive and emotional representations of the virus, engagement in precautionary and self-care behaviors, and appraisals of control. Conclusions: These results suggested that US citizens felt knowledgeable about COVID-19 and confident in precautionary behaviors to control the spread of COVID-19. However, while most US citizens reported normative levels of emotional distress in response to COVID-19, about 19-30% reported scores that indicated moderate to severe distress. Greater distress predicted decreased engagement in self-care behaviors and certain precautionary behaviors. People who engaged in both precautionary and self-care behaviors felt that they were helpful. While the results of this study are preliminary and further study is needed, these results suggest that Leventhal's Common-Sense Model of Illness may be applicable to understanding the US citizen experience of COVID-19
Cardiac Monitoring with Smartphones: MobileECG Usage in ICD Patients
No full textBackground: Addressing behavioral risk factors and having access to high quality medical care with increased information, biometrics, and treatment planning could reduce global cardiovascular mortality. There has been a surge of medical technologies that can help prevent, manage, and even forecast medically distressing cardiovascular events. As a new wave of medical technologies are developed, patients will increasingly be considered “key personnel” in the process of using novel techniques to improve self-care, engagement and overall quality of life. The purpose of this study was to examine the perceived added value of smartphone-ECG technology to an ICD patient user experience.
Methods: Fifty-one participants were recruited from an existing ICD patient population at the East Carolina Heart Institute in Greenville, North Carolina. Participants were given smartphone-ECG devices and asked to take a thirty-second reading at least once per day. In addition to overall technology satisfaction, three major constructs were examined in this population including cardiac and device-specific anxiety, quality of life, and self-management. Time points of data collection were at baseline, thirty-day, and ninety-day.
Results: The current study findings indicate that smartphone-ECG technology is widely accepted and positively appraised by this user base. Positive technology appraisal did not correlate to significant within-group changes in domains of quality of life and self-management after using the technology for thirty days. ICD shock anxiety was significantly increased during the period of technology usage, which may have been maintained by the task of using a device that required them to focus on their disease state at least once per day. Conversely, overall ICD device acceptance increased significantly indicating that the external technology use of the mECG device may have led to positive appraisals of their implantable devices.
Discussion: The results of the current study further the knowledge of the mobile-health field by asking a series of simple, yet important, questions related to device acceptance and technology satisfaction. Medical technology development will most likely continue to outpace the speed at which clinicians and researchers are able to critically evaluate and integrate novel technology into their patient care centers. QoL, shock-related anxiety, and more general cardiac anxiety remain important treatment targets among ICD patient populations
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