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Confidence to exercise improves in cardiac rehabilitation (CR) programs, providing an important source of resilience to support sustained exercise efforts over time. Social disparities, including ethnic minority background and being single, are important factors to consider in developing intervention to improve exercise self-efficacy within current CR programs.

The PROMIS-29v2 health-related quality-of-life (HRQOL) questionnaire is valid, reliable, and responsive in patients with coronary heart disease attending remotely delivered cardiac rehabilitation, allowing baseline HRQOL assessment, comparisons between cardiac diagnostic groups, and evaluation of changes over time.

ObjectiveInconsistencies have been reported in health-related quality of life (HRQOL) in postoperative congenital heart disease (CHD). Despite the need for lifelong care due for residual symptoms, only a few studies have explored cardiac-related HRQOL but none in lower middle-income countries (LMIC). This study therefore addresses the gap by exploring HRQOL and its associated predictors in postoperative CHD in Pakistan.Outcome measuresGeneral and cardiac-related HRQOL, associated predictors.MethodsThis cross-sectional study recruited patients with CHD and age-matched healthy siblings as controls (n=129 each) at a single centre in Pakistan. Patients and their siblings completed HQROL surveys (PedsQL 4.0 Generic Core, PedsQL Cognitive Functioning). Patients only completed PedsQL 3.0 Cardiac module. Generalised linear models identified predictors.ResultsThe sample mean age was 8.84±3.87 years and 70% were below the poverty line for an LMIC. The majority (68%) had their first surgery after 1 year of age and were interviewed at a mean 4.08±1.91 years postoperatively.Patients with CHD had lower HRQOL in all domains compared with their age-matched siblings, with the biggest differences for total HRQOL (effect size, d=−1.35). Patients with complex CHD had lower HRQOL compared with simple to moderate CHDs in cardiac-related HRQOL. The lowest scores were for treatment problems (effect size, d=−0.91). HRQOL was worse for patients who were on cardiac medications, had complex CHD, longer cardiopulmonary bypass time, re-operations and were female.ConclusionsHRQOL issues persist in postoperative patients with CHD in LMIC, Pakistan. Solutions are needed to address poor HRQOL and lifelong concerns of patients and their parents.

BackgroundAs survival improves in the congenital heart disease (CHD) population, health-related quality of life (HRQOL) outcomes become increasingly important. While surgery improves survival, poor HRQOL occurs postoperatively and cardiac-related HRQOL outcomes are rarely reported.ObjectiveTo conduct a systematic review and meta-analyses of general and cardiac-related HRQOL in CHD surgical children and young adults.MethodMedline, CINAHL and EMBASE were searched. Quantitative designs with a minimum of 80% CHD surgical patients and mean age ≤18 years compared with healthy controls were included in the review. Data were analysed in RevMan V.5.3 using a random effects model.Outcome measuresGeneral and cardiac-related HRQOL.ResultsStudies (n=20) were conducted in high-income countries and included 3808 patients plus 2951 parental reports of patients. HRQOL was worse in postoperative patients with CHD versus healthy controls in all domains with the largest difference seen for physical function (standard mean difference (SMD) of −0.56, 95% CI −0.82 to −0.30). Cardiac-related HRQOL was worse in complex compared with simple CHD with the largest SMD (−0.60, 95% CI −0.80 to −0.40) for symptoms. Heterogeneity ranged from 0% to 90%.ConclusionsCHD surgical patients have substantially worse HRQOL compared with age-matched healthy controls. Strategies should focus on improving HRQOL in this subgroup. Results may not be applicable to low/middle-income countries given the dearth of relevant research.

Background People with unknown atrial fibrillation (AF), who are often asymptomatic, have a substantially increased risk of stroke. Although recommended in European guidelines, AF screening is not routinely performed. Screening at the time of influenza vaccination presents an ideal opportunity to detect AF in large numbers in a primary care medical setting, with an existing annual recall system for patients aged ≥65 years.Design Cross-sectional pilot study of handheld smartphone electrocardiogram (iECG) screening to identify unknown AF.Methods General practices in Sydney, Australia, were recruited during the influenza-vaccination period of April–June 2015. Practice nurses screened patients aged ≥65 years with a 30-second iECG, which has a validated algorithm for detecting AF in real time. In order to confirm the accuracy of the algorithm, two research cardiologists reviewed de-identified iECGs. In order to explore barriers and enablers, semi-structured interviews were conducted with selected nurses, practice managers and general practitioners.Results Five general practices were recruited, and 973/2476 (39%) patients attending influenza vaccination were screened. Screening took an average of 5 minutes (range 1.5–10 minutes); however, abnormal iECGs required additional time. Newly identified AF was found in 8/973 patients (0.8%). The sensitivity of the iECG automated algorithm was 95% (95% confidence interval: 83–99%) and the specificity was 99% (95% confidence interval: 98–100%). Screening by practice nurses was well accepted by practice staff. Key enablers were the confidence and competence of nurses and a ‘designated champion’ to lead screening at the practice. Barriers were practice specific, and mainly related to staff time and funding.Conclusions Screening with iECG during influenza vaccination by primary care nurses is feasible and well accepted by practice staff. Addressing barriers is likely to increase uptake.

Introduction:The Pediatrics Early Warning Scoring (PEWS) system is a quantitative instrument that measures the severity of the clinical situation of children aged 1 month to 18 years.Hypothesis:To assess the knowledge, attitude, and practices among nurses and doctors regarding the Pediatric Early Warning Signs (PEWS) system, in a pediatric ward at a tertiary care hospital in Karachi, Pakistan.Methods:A cross-sectional study design was used to address the study question. The universal sampling technique was used to recruit a total of 142 eligible nurses and doctors to explore the knowledge and attitude regarding the PEWS system. Medical records of patients who had a Pediatric Rapid Response Team (PRRT) request raised was reviewed for practice assessment of PEWS. The relationship between the study participants’ demographic characteristics and their knowledge and attitude regarding PEWS was assessed through Chi-square for categorical variables and one-way ANOVA for continuous variables.Results:The findings of the study revealed that out of 142 study participants, 50% participants had a low level of knowledge yet positive attitude towards the PEWS system. Professional qualification and age of participants were significantly associated with knowledge regarding the PEWS system. Profession, professional qualification, current position of the study participants and specialized training on PEWS had a significant association with attitude regarding the PEWS system.Medical records of 30 patients were eligible for practice assessment which revealed that 56.7% of the PEWS observations were documented in patient records which were either incomplete or inappropriate. About 50% showed a poor level of practice regarding PEWS.Conclusions:Our study revealed a knowledge and practice gap among the nurses and doctors while utilizing the PEWS system. Despite having a low level of knowledge, the participants had a positive attitude towards PEWS to enhance their PEWS knowledge and practices. PEWS should be incorporated in the Pediatric Advanced Life Support (PALS) certification course. Moreover, simulation-based teaching strategies should be planned to improve practice and knowledge regarding the system.