26 research outputs found
Patient perspectives of participating in the cardiac CopenHeartRFA rehabilitation program for patients treated with ablation for atrial fibrillation
No full textSigne S Risom,1,2 Johanne Lind,2 Pamela J McCabe,3 Selina Kikkenborg Berg1,4,5 1The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 2Department of Nursing, Metropolitan University College, Copenhagen, Denmark; 3Mayo Clinic, Rochester, MN, USA; 4Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 5National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark Purpose: The CopenHeartRFA trial was designed and conducted to explore the effects of rehabilitation on patients treated with ablation for atrial fibrillation (AF). It included a cardiac rehabilitation program consisting of physical exercise and psychoeducational consultations over 6 months. As part of the evaluation of the CopenHeartRFA trial, both quantitative and qualitative data were collected. The intervention was delivered by a multidisciplinary team. Aim: This study aimed to understand the experience of patients treated for AF with ablation who participated in the CopenHeartRFA cardiac rehabilitation program. Methods: A qualitative descriptive design was used. A purposive sample of 10 patients who had completed the intervention consented to participate. The interviews were conducted face-to-face and were audio-recorded and transcribed. Qualitative content analyses were used to analyze the data. The interviews were analyzed individually by two researchers and themes were constructed and discussed. Results: The sample included 10 participants, mean age 54.6 years. Four categories were identified and labeled: 1) strengthening belief in one’s own physical capacity and survival; 2) still struggling with fear of AF symptoms; 3) a need for support to move on; and 4) regaining confidence in one’s own mental strength with support from professionals. Conclusion: The four themes describe a positive experience from participating in the rehabilitation program. The rehabilitation program promoted self-efficacy for engaging in physical activity and the benefit of a safe environment for processing the emotional responses and the value of the therapeutic relationship between the patient and the rehabilitation provider. Keywords: atrial fibrillation, rehabilitation, qualitative researc
Patient perspectives of participating in the cardiac CopenHeartRFA rehabilitation program for patients treated with ablation for atrial fibrillation
No full textPurpose: The CopenHeartRFA trial was designed and conducted to explore the effects of rehabilitation on patients treated with ablation for atrial fibrillation (AF). It included a cardiac rehabilitation program consisting of physical exercise and psychoeducational consultations over 6 months. As part of the evaluation of the CopenHeartRFA trial, both quantitative and qualitative data were collected. The intervention was delivered by a multidisciplinary team.Aim: This study aimed to understand the experience of patients treated for AF with ablation who participated in the CopenHeartRFA cardiac rehabilitation program.Methods: A qualitative descriptive design was used. A purposive sample of 10 patients who had completed the intervention consented to participate. The interviews were conducted face-to-face and were audio-recorded and transcribed. Qualitative content analyses were used to analyze the data. The interviews were analyzed individually by two researchers and themes were constructed and discussed.Results: The sample included 10 participants, mean age 54.6 years. Four categories were identified and labeled: 1) strengthening belief in one's own physical capacity and survival; 2) still struggling with fear of AF symptoms; 3) a need for support to move on; and 4) regaining confidence in one's own mental strength with support from professionals.Conclusion: The four themes describe a positive experience from participating in the rehabilitation program. The rehabilitation program promoted self-efficacy for engaging in physical activity and the benefit of a safe environment for processing the emotional responses and the value of the therapeutic relationship between the patient and the rehabilitation provider.</p
Quality of life and symptom experience measurement tools in adults with atrial fibrillation:a scoping review protocol
No full textOBJECTIVE: The objective of this scoping review is to identify and map measurement tools for evaluating disease-specific quality of life and symptoms in adults with atrial fibrillation. The review will also identify key concepts that differentiate quality of life from symptom experience.INTRODUCTION: Quality of life is a broad concept influenced by physical health, psychological state, degree of independence, and social/functional status. Symptoms of a chronic disease may influence quality of life through their effect on an individual's perception of physical health. Symptom experience is distinct from quality of life; however, the distinction is ill-defined, resulting in conceptual overlap in the measurement tools used to assess these concepts in patients with atrial fibrillation.INCLUSION CRITERIA: Included manuscripts will describe a scale, index, questionnaire, checklist, or other form of measurement tool designed to assess quality of life or symptom experience in adults with atrial fibrillation or supraventricular arrhythmia. Peer-reviewed research manuscripts and systematic reviews, gray literature, and conceptual/theoretical papers will be included.METHODS: The review will follow the JBI methodology for scoping reviews. MEDLINE, CINAHL, PsycINFO, the Cochrane Database of Systematic Reviews, and Embase will be searched, as well as Google Scholar, MedNar, and OpenGrey. Articles will be considered if they are published in English, Danish, Swedish, or Norwegian, with no date limitation. The title and abstract of each article will be independently screened by two authors, followed by full-text review of remaining articles, according to the inclusion criteria. Data will be independently extracted by two authors using a data extraction tool.</p
Exercise-based cardiac rehabilitation for adults after heart valve surgery
No full textExercise-based cardiac rehabilitation may benefit heart valve surgery patients. We conducted a systematic review to assess the evidence for the use of exercise-based intervention programmes following heart valve surgery.To assess the benefits and harms of exercise-based cardiac rehabilitation compared with no exercise training intervention, or treatment as usual, in adults following heart valve surgery. We considered programmes including exercise training with or without another intervention (such as a psycho-educational component).We searched: the Cochrane Central Register of Controlled Trials (CENTRAL); the Database of Abstracts of Reviews of Effects (DARE); MEDLINE (Ovid); EMBASE (Ovid); CINAHL (EBSCO); PsycINFO (Ovid); LILACS (Bireme); and Conference Proceedings Citation Index-S (CPCI-S) on Web of Science (Thomson Reuters) on 23 March 2015. We handsearched Web of Science, bibliographies of systematic reviews and trial registers (ClinicalTrials.gov, Controlled-trials.com, and The World Health Organization International Clinical Trials Registry Platform).We included randomised clinical trials that investigated exercise-based interventions compared with no exercise intervention control. The trial participants comprised adults aged 18 years or older who had undergone heart valve surgery for heart valve disease (from any cause) and received either heart valve replacement, or heart valve repair.Two authors independently extracted data. We assessed the risk of systematic errors ('bias') by evaluation of bias risk domains. Clinical and statistical heterogeneity were assessed. Meta-analyses were undertaken using both fixed-effect and random-effects models. We used the GRADE approach to assess the quality of evidence. We sought to assess the risk of random errors with trial sequential analysis.We included two trials from 1987 and 2004 with a total 148 participants who have had heart valve surgery. Both trials had a high risk of bias.There was insufficient evidence at 3 to 6 months follow-up to judge the effect of exercise-based cardiac rehabilitation compared to no exercise on mortality (RR 4.46 (95% confidence interval (CI) 0.22 to 90.78); participants = 104; studies = 1; quality of evidence: very low) and on serious adverse events (RR 1.15 (95% CI 0.37 to 3.62); participants = 148; studies = 2; quality of evidence: very low). Included trials did not report on health-related quality of life (HRQoL), and the secondary outcomes of New York Heart Association class, left ventricular ejection fraction and cost. We did find that, compared with control (no exercise), exercise-based rehabilitation may increase exercise capacity (SMD -0.47, 95% CI -0.81 to -0.13; participants = 140; studies = 2, quality of evidence: moderate). There was insufficient evidence at 12 months follow-up for the return to work outcome (RR 0.55 (95% CI 0.19 to 1.56); participants = 44; studies = 1; quality of evidence: low). Due to limited information, trial sequential analysis could not be performed as planned.Our findings suggest that exercise-based rehabilitation for adults after heart valve surgery, compared with no exercise, may improve exercise capacity. Due to a lack of evidence, we cannot evaluate the impact on other outcomes. Further high-quality randomised clinical trials are needed in order to assess the impact of exercise-based rehabilitation on patient-relevant outcomes, including mortality and quality of life
Dancing with atrial fibrillation how arrhythmia affects everyday life of family members:A qualitative study
No full textBackground Atrial fibrillation (AF) is the most common cardiac arrhythmia. Patients with AF often experience debilitating symptoms, stress and reduced health-related quality of life. Previous qualitative research on AF has primarily focused on the patient. AF, however, can also be burdensome for the patient s family. Aim The aim of this study was to explore how family members experience life when a close member in the family has AF. Method Transcribed focus group interviews were analysed using content analysis approach inspired by Graneheim and Lundman. Results Two focus group interviews were conducted with 11 family members. The overall theme was Dancing with AF. The theme emerged from three categories: 1) Handling AF as a living condition, 2) Influencing the roles of family members, 3) Fear of AF attack. AF had a very significant impact on the patients family members, forcing them to reconstruct their daily lives. Conclusions AF has multiple consequences for family members and can give rise to conflicts concerning family roles. Family members have a lack of knowledge of AF and fear of how AF can cause changes in the family members everyday lives. This study demonstrates that there is a need for further research of ways to support the family members of patients with AF. </p
Identifying rehabilitation needs as part of secondary prevention in individuals with atrial fibrillation-a Delphi consensus study
No full textAims This study aimed to establish general consensus on a systematic needs assessment model to determine eligibility for cardiac rehabilitation (CR) as part of secondary prevention in individuals with atrial fibrillation (AF). Specific objectives included identifying relevant needs assessment criteria and establishing consensus on referral criteria.Methods and results A Delphi study was conducted following the ACCORD guidelines (ACcurate COnsensus Reporting Document) with participation of an international, multi-disciplinary expert panel including physicians, nurses, and other healthcare professionals, across primary and secondary care as well as academic research. The panel also included six people who had AF themselves. The Delphi process involved three iterative rounds of surveys and a video meeting to determine needs assessment criteria and facilitate consensus. Data collection included qualitative feedback and quantitative voting on proposed criteria. Sixty-nine experts participated. There was high agreement on the importance of the study, which identified 12 needs assessment criteria related to AF symptom burden, health-related quality of life, anxiety, medicine adherence, and various risk factors. Whilst there was agreement on the needs assessment model, experts noted that referral criteria should be flexible and tailored to local healthcare settings, emphasizing that each individual's situation is unique.Conclusion This Delphi study established a needs assessment model that can be adapted to local contexts for individuals with AF. More research is needed to refine referral criteria and ensure effective implementation of individually tailored CR strategies. This study aimed to create a model that helps healthcare providers assess the needs of individuals with atrial fibrillation to determine their eligibility for cardiac rehabilitation as part of secondary prevention. The key findings were:An expert panel identified 12 important criteria for assessing the needs of individuals with atrial fibrillation, including factors such as symptom burden, quality of life, anxiety, medicine adherence, and various risk factors.Whilst there was high agreement on the needs assessment model, experts noted that referral criteria should be flexible and tailored to local healthcare settings, emphasizing that each individual's situation is unique.Funding
This project is part of a PhD study, which is partially funded by a PhD faculty scholarship from the University of Southern Denmark (no Grant number), a PhD scholarship from the Region of Southern Denmark (grant number: J.no.: 21/58092), and the fund to support independent, strategic clinical research in the Region of Southern Denmark (grant number: J.no.: 2024-0022).
Acknowledgements
We would like to thank Anton Pottegaard (Denmark) for inspiring us with the idea to conduct an international Delphi process. Moreover, we would like to thank all experts who participated in the study, with special appreciation to those who consistently responded to the surveys. A special thanks to Hein Heidbuchel (Belgium) and additional Danish participants: Andi Albertsen, Anja Skov, Anne-Marie Hedegaard, Claus Tveskov, Dagmar Lybak Sieg, Jesper Eilsø, Jonas Bjerring Olesen, Kirsten Gerholt, Louise Huang Juul, Margit Brinck, Robert Bedsted, and Ulla Dam-Schmidt for their valuable inputs during the development of the assessment model
Nurses experience and perceptions towards video consultations and how affects the relation to the patients
No full textBackgroundThe integration of telehealth services, particularly video consultations, has rapidly expanded in healthcare settings, presenting a paradigm shift in patient care.The study aimed to contribute to a deeper understanding of how ambulatory nurses experience using video consultations. Further, we aimed to explore how video consultations are established and how video consultations affect ambulatory nursing care from the nurse’s perspective.MethodA hermenutic qualitative focus group approach was employed with nurses from two Danish cardiological outpatient clinics.FindingsTwo focus group interviews provided qualitative insights into the nuanced perspectives of nurses. Findings are presented by three themes 1) ‘Nursing care is a relational practice and must remain so’, 2) ‘Video consultations have both pros and cons and must be used at the right time’ and 3) ‘Missing initiatives that will enable the nurses to use video consultation’. The findings provided an in-depth understanding of factors that can affect the motivation, opportunities, and enablers, which, in their absence, can be used to explain the limited scope of videConclusionThe study highlights the importance of organizational support and infrastructure in shaping nurses' attitudes towards video consultations. Strategies for successful implementation include targeted training programs, user-friendly technology, and clear implementation strategy. Additionally, understanding the contextual factors influencing nurses' attitudes is crucial for tailoring interventions and optimizing the integration of video consultations into routine clinical practice
Exercise-based cardiac rehabilitation improves exercise capacity and health-related quality of life in people with atrial fibrillation: a systematic review and meta-analysis of randomised and non-randomised trials
No full textObjective: The aim of this study was to undertake a contemporary review of the impact of exercise-based cardiac rehabilitation (CR) targeted at patients with atrial fibrillation (AF).
Methods: We conducted searches of PubMED, EMBASE and the Cochrane Library of Controlled Trials (up until 30 November 2017) using key terms related to exercise-based CR and AF. Randomised and non-randomised controlled trials were included if they compared the effects of an exercise-based CR intervention to a no exercise or usual care control group. Meta-analyses of outcomes were conducted where appropriate.
Results: The nine randomised trials included 959 (483 exercise-based CR vs 476 controls) patients with various types of AF. Compared with control, pooled analysis showed no difference in all-cause mortality (risk ratio (RR) 1.08, 95% CI 0.77 to 1.53, p=0.64) following exercise-based CR. However, there were improvements in health-related quality of life (mean SF-36 mental component score (MCS): 4.00, 95% CI 0.26 to 7.74; p=0.04 and mean SF-36 physical component score: 1.82, 95% CI 0.06 to 3.59; p=0.04) and exercise capacity (mean peak VO2: 1.59 ml/kg/min, 95% CI 0.11 to 3.08; p=0.04; mean 6 min walk test: 46.9 m, 95% CI 26.4 to 67.4; p<0.001) with exercise-based CR. Improvements were also seen in AF symptom burden and markers of cardiac function.
Conclusions: Exercise capacity, cardiac function, symptom burden and health-related quality of life were improved with exercise-based CR in the short term (up to 6 months) targeted at patients with AF. However, high-quality multicentre randomised trials are needed to clarify the impact of exercise-based CR on key patient and health system outcomes (including health-related quality of life, mortality, hospitalisation and costs) and how these effects may vary across AF subtypes
ICU-recovery in Scandinavia : a comparative study of intensive care follow-up in Denmark, Norway and Sweden
No full textOBJECTIVES: The aim of our study was to describe and compare models of intensive care follow-up in Denmark, Norway and Sweden to help inform clinicians regarding the establishment and continuation of ICU aftercare programmes.METHODS: Our study had a multi-centre comparative qualitative design with triangulation of sources, methods and investigators. We combined prospective data from semi-structured key-informant telephone interviews and unreported data from a precursory investigation.RESULTS: Four basic models of follow-up were identified representing nurse-led or multidisciplinary programmes with or without the provision of patient diaries. A conceptual model was constructed including a catalogue of interventions related to the illness trajectory. We identified three temporal areas for follow-up directed towards the past, present or future.CONCLUSIONS: ICU follow-up programmes in the Scandinavian countries have evolved as bottom-up initiatives conducted on a semi-voluntary basis. We suggest reframing follow-up as an integral part of patient therapy. The Scandinavian programmes focus on the human experience of critical illness, with more attention to understanding the past than looking towards the future. We recommend harmonization of programmes with clear goals enabling programme assessment, while moving towards a paradigm of empowerment, enabling patient and family to take an active role in their recovery and wellbeing
Atrial Fibrillation Specific Exercise Rehabilitation: Are We There Yet?
No full textRegular physical activity and exercise training are integral for the secondary prevention of cardiovascular disease. Despite recent advances in more holistic care pathways for people with atrial fibrillation (AF), exercise rehabilitation is not provided as part of routine care. The most recent European Society of Cardiology report for AF management states that patients should be encouraged to undertake moderate-intensity exercise and remain physically active to prevent AF incidence or recurrence. The aim of this review was to collate data from primary trials identified in three systematic reviews and recent real-world cohort studies to propose an AF-specific exercise rehabilitation guideline. Collating data from 21 studies, we propose that 360–720 metabolic equivalent (MET)-minutes/week, corresponding to ~60–120 min of exercise per week at moderate-to-vigorous intensity, could be an evidence-based recommendation for patients with AF to improve AF-specific outcomes, quality of life, and possibly prevent long-term major adverse cardiovascular events. Furthermore, non-traditional, low-moderate intensity exercise, such as Yoga, seems to have promising benefits on patient quality of life and possibly physical capacity and should, therefore, be considered in a personalised rehabilitation programme. Finally, we discuss the interesting concepts of short-term exercise-induced cardioprotection and ‘none-response’ to exercise training with reference to AF rehabilitation
