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Competing Interests: Conflict of interest: none declared.

Background: Patient education is a cardiac rehabilitation core component and is associated with improvements in self-management of patients with coronary heart disease (CHD). However, the efficacy of such interventions on psychosocial outcomes and relative impact of duration is less clear., Objectives: This study aimed to assess the efficacy of patient education for secondary prevention related to behaviour change and risk factor modification on psychological outcomes in CHD patients., Design: A systematic review and meta-analysis., Data Sources: PsycINFO, CINAHL, Embase, EmCare, MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials were searched from inception to February 2021., Eligibility Criteria for Study Selection: Randomized controlled trials (RCTs) evaluating patient education in CHD patients, or following myocardial infarction, or revascularization compared with usual care were identified. Outcomes included depression and anxiety at <6 and 6-12 months of follow-up., Results: A total of 39 RCTs and 8748 participants were included. Patient education significantly improved participants' depressive symptoms at <6 (SMD -0.82) and 6-12 months (SMD -0.38) of follow-up and anxiety level at <6 (SMD -0.90), and 6-12 months (SMD -0.32) of follow-up. Patient education also reduced the risk for having clinical depression by 35% and anxiety by 60%. Longer patient education of ≥3 months, resulted in more improvement in depressive symptoms at 6-12 months (coefficient -0.210) compared to shorter duration., Conclusions: Patient education for secondary prevention reduces anxiety and depressive symptoms in CHD patients. Regardless of intensity, longer patient education improves depression more than short duration. More information is needed on the relative impact of other intervention components., Data Registration: PROSPERO (CRD42020200504)., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Objective: This systematic review and meta-analysis aimed to summarize and synthesize the available evidence in adult Chinese cardiac patients to determine the effect of education interventions on health behaviours, disease-related knowledge, self-efficacy, depressive symptoms, anxiety symptoms, health-related quality of life, morbidity, and mortality., Methods: Seven databases were searched from database inception until January 2020 for randomized controlled trials. Characteristics of education interventions were described and random-effects meta-analysis was performed where feasible., Results: Overall, 18 randomized controlled trials were included in this systematic review and suggested that education interventions are effective in improving patients' physical activity, dietary habits, medication behaviour, disease-related knowledge, and health-related quality of life. Meta-analysis of two studies demonstrated benefit on physical activity (standardized mean difference [SMD] 1.27, 95% confidence interval [CI] 1.06-1.48; participants = 422; I 2 = 0%), dietary habits (SMD 0.76, 95%CI 0.44-1.08; participants = 422; I 2 = 61%), and medication behaviour (mean difference [MD] 0.31, 95%CI 0.17-0.46; participants = 422; I 2 = 28%)., Conclusion: This study supports the benefits of education interventions for adult Chinese cardiac patients on health behaviours, disease-related knowledge, and health-related quality of life. Future studies should characterize their education interventions in detail to facilitate reproducibility and comparison., Practice Implications: This study identified the need for studies on the outcome of alcohol consumption and in Chinese immigrant populations., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background and Objectives: This mixed-methods study aimed to assess health-related quality of life in young adults with CHD following surgery in a low middle-income country, Pakistan. Despite the knowledge that geographic, cultural and socio-economic factors may shape the way health and illness is experienced and managed and consequently determine a person's health-related quality of life, few health-related quality of life studies are conducted in low middle-income countries. This deficit is pronounced in CHD, so there is little guidance for patient care., Methods: The study utilised concurrent, mixed methods. Adults with CHD (n = 59) completed health-related quality of life surveys (PedsQLTM 4.0 Generic Core Scale, PedsQLTM Cognitive Functioning Scale and PedsQLTM 3.0 Cardiac Module). Semi-structured interview data were collected from a nested sub-sample of 17 participants and analysed using qualitative content analysis, guided by the revised Wilson-Cleary model of health-related quality of life., Results: The lowest health-related quality of life domain was emotional with the mean score (71.61 ± 20.6), followed by physical (78.81 ± 21.18) and heart problem (79.41 ± 18.05). There was no statistical difference in general or cardiac-specific health-related quality of life between mild, moderate or complex CHD. Qualitative findings suggested low health-related quality of life arose from a reduced capacity to contribute to family life including family income and gender. A sense of reduced marriageability and fear of dependency were important socio-cultural considerations., Conclusions: CHD surgical patients in this low-income country experience poor health-related quality of life, and contributing factors differ to those reported for high-income countries. Socio-cultural understandings should underpin assessment, management and care-partnering with young adults with CHD following surgical correction.

Purpose: To review the literature on health-related quality of life (HRQoL) outcomes for exercise-based cardiac rehabilitation (EBCR) in contemporary acute coronary syndrome (ACS) patients., Methods: Electronic databases (CENTRAL, MEDLINE, Embase, and CINAHL) were searched from January 2000 to March 2019 for randomised controlled trials (RCTs) comparing EBCR to a no-exercise control in ACS patients recruited after year 2000, follow-up of at least 6 months, and HRQoL as outcome. Potential papers were independently screened by two reviewers. Risks of bias were assessed using the Cochrane Tool. Data analyses were performed using RevMan v5.3, random effects model., Results: Fourteen RCTs (1739 participants) were included, with eight studies suitable for meta-analyses. EBCR resulted in statistically significant and clinically important improvements in physical performance (mean difference [MD] 7.09, 95% CI 0.08, 14.11) and general health (MD 5.08, 95% CI 1.03, 9.13) (SF-36) at 6 months, and in physical functioning (MD 9.82, 95% CI 1.46, 18.19) at 12 months. Statistically significant and sustained improvements were also found in social and physical functioning. Meta-analysis of two studies using the MacNew Heart Disease HRQoL instrument did not show any significant benefits. Of the six studies unsuitable for meta-analyses, five reported significant changes in overall HRQoL, general physical activity levels and functional capacity, or quality-adjusted life-years (QALYs)., Conclusions: In an era where adherence to clinical practice guidelines has improved survival, EBCR still achieves clinically meaningful improvements in physical performance, general health, and physical functioning in the short and long term in contemporary ACS patients.

Objective: Inconsistencies 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 Measures: General and cardiac-related HRQOL, associated predictors., Methods: This 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., Results: The 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., Conclusions: HRQOL 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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: As 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., Objective: To conduct a systematic review and meta-analyses of general and cardiac-related HRQOL in CHD surgical children and young adults., Method: Medline, 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 Measures: General and cardiac-related HRQOL., Results: Studies (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%., Conclusions: CHD 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., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: transcatheter aortic valve replacement (TAVR) provides prognostic benefit for high surgical-risk patients with severe aortic stenosis (AS), yet the impact to patient outcomes is far less understood., Method: we performed a systematic review and meta-analysis to evaluate functional capacity and health-related quality of life (HRQoL) outcomes for patients up to 12 months post TAVR. A total of 20 eligible publications, comprising randomised-controlled trials, observational studies and a registry study were identified from electronic databases, including MEDLINE, EMBASE, Cochrane Library and others (inception to February 2017)., Results: the total sample was 2,775 with a mean age of 81.8 ± 2.1 years, more than half (52%) were female and high surgical risk 9.6 ± 4.3% mean STS (Society of Thoracic Surgeons risk model). Post TAVR, patients had significant improvement in functional capacity of >40 m in the 6-minute walk test (6MWT) (95% confidence interval (CI) 9.69-73.28) and a clinically meaningful increase in ability to perform daily physical-based tasks (Duke Activity Status Index (DASI), mean difference (MD) increase 5.42 points, 95% CI 3.16-7.68). HRQoL improved consistently following TAVR regardless of measure used. Significant increases occurred in the physical component summary scores (PCS) of the short form (SF) health surveys (MD increase 10.45 (SF36) and 10.14 (SF12) points)., Conclusion: functional capacity and HRQoL improved substantially following TAVR, despite evolving patient selection criteria, thus TAVR continues to provide a directly beneficial option for severe AS patients.

Aim: To examine the quality of life of nurses and midwives in New South Wales, Australia and compare values with those of the Australian general population; to determine the influence of workforce, health and work life characteristics on quality of life and its effect on workforce intention to leave., Background: Few studies have examined nurses' and midwives' quality of life and little is known of its effects on workforce longevity., Design: This was a cross-sectional survey conducted in 2014-2015., Method: The "Fit for the Future" electronic survey, delivered to nurses and midwives, examined demographic, work and health-related factors, which were compared with Australian general population normative values for physical and mental components of quality of life (the Short Form-12). Univariate and multivariate logistic regression models assessed associations with workforce intention to leave., Result: Physical and mental component scores, calculated for 4,592 nurses and midwives, revealed significantly higher physical but lower mental component scores than the general population. Physical component scores decreased with increasing age; higher scores were seen in nurses with better health indices and behaviours. Mental well-being scores increased with increasing age; in nurses who reported job satisfaction, no work injury, sleep problems or frequent pain and non-smokers. The odds of intention to leave decreased with increasing mental well-being., Conclusion: Managers and decision-makers should heed study recommendations to implement health promotion strategies for nurses and midwives, aiming to improve mental health, specifically to promote workforce retention., (© 2017 John Wiley & Sons Ltd.)

Introduction: Reduced health-related quality of life (HRQOL) has been reported in postoperative patients with congenital heart disease (CHD). However, there is a paucity of data from low-income and middle-income countries (LMIC). Differences in sociodemographics and sociocultural contexts may influence HRQOL. This protocol paper describes a study exploring HRQOL in surgical patients with CHD from a tertiary hospital in Pakistan. The study findings will assist development of strategies to improve HRQOL in a resource-constrained context., Methods and Analysis: This prospective, concurrent triangulation, mixed-methods study aims to compare HRQOL of postsurgery patients with CHD with age-matched healthy siblings and to identify HRQOL predictors. A qualitative component aims to further understand HRQOL data by exploring the experiences related to CHD surgery for patients and parents. Participants include patients with CHD (a minimum of n~95) with at least 1-year postsurgery follow-up and no chromosomal abnormality, their parents and age-matched, healthy siblings. PedsQL 4.0 Generic Core Scales, PedsQL Cognitive Functioning Scale and PedsQL 3.0 Cardiac Module will measure HRQOL. Clinical/surgical data will be retrieved from patients' medical files. Student's t-test will be used to compare the difference in the means of HRQOL between CHD and siblings. Multiple regression will identify HRQOL predictors. A subsample of enrolled patients (n~20) and parents (n~20) from the quantitative arm will be engaged in semistructured qualitative interviews, which will be analysed using directed content analysis. Anticipated challenges include patient recruitment due to irregular follow-up compliance. Translation of data collection tools to the Urdu language and back-translation of interviews increases the study complexity., Ethics and Dissemination: Ethics approval has been obtained from The Aga Khan University, Pakistan (3737-Ped-ERC-15). Study findings will be published in peer-reviewed journals and presented at national and international conferences., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objectives: The study aimed to determine perceived motivations and benefits of photoshoot participation for young adults who have heart disease., Background: Feeling isolated and different can have lifelong affects on quality of life in heart disease survivors. Photoshoots, where people create a photographic image of themselves, promote positive interpretation of their cardiac illness experience, but participant experiences remain under-investigated., Methods: Young adult heart disease support group members completing a photoshoot were interviewed and data were thematically analyzed., Results: Seven females and one male aged 20-47 years participated. The main theme, People Like Me, emphasized feelings of being different, isolated and uncertain due to the heart disease. Other themes related to support gained from people who were not like them, gaining and providing support to their peers. The photoshoot enabled a highly valued collective feeling., Conclusions: For young adult heart disease survivors, the photoshoot provides a fun, social opportunity to reduce isolation and share experiences., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aims and Objectives: To investigate whether using the 'think aloud' technique during standard quality of life surveys provides useful additional information about patients' experiences of living with atrial fibrillation (AF) and health related quality of life (HRQoL)., Background: Atrial fibrillation is the most common cardiac arrhythmia and has serious health consequences, particularly ischaemic stroke, high rates of morbidity and mortality and poor HRQoL. Standard quality-of-life questionnaires are often used but may not provide sufficient detail of patients' experiences living with AF., Design: A qualitative interpretative study based on semi-structured interviews., Methods: Patients with AF (n=12) were recruited from the Choice of Health Options in Prevention of Cardiovascular Events-in Atrial Fibrillation (CHOICE-AF), a risk factor management program. Participants were interviewed using a 'think aloud' technique with questions guided by the AF Effects on Quality Of Life Questionnaire (AFEQT) and the Short Form-12 (SF-12). Interviews were audio-recorded, transcribed and analysed thematically., Results: Participants had a median age of 71 years (interquartile range 52 to 77 years), and included four women and eight men. Four themes were identified related to experiences of living with AF and HRQoL including: (1) the adverse impact of atrial fibrillation symptoms, treatments, and related knowledge; (2) loss of function or independence; (3) the influence of age; and (4) approach to life., Conclusions: Atrial fibrillation, especially in older adults, creates an additional layer of requirements for self-management onto existing self-care needs. Even for patients with relatively high HRQoL, the 'think aloud' technique together with standard HRQoL questionnaires can help identify additional issues that can be addressed by health professionals to improve the HRQoL of these patients., (Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Aims: This study compared health-related quality of life (HRQOL) between patients aged ≥ 70 and <70 years at 4 weeks and 6 months after primary percutaneous coronary intervention (PPCI) and examined predictors of HRQOL., Background: HRQOL is an important patient outcome following PPCI for ST elevation myocardial infarction (STEMI) including pre-hospital field triage., Methods: A comparative cohort design was conducted on STEMI patients undergoing PPCI. HRQOL was measured using the Medical Outcomes Short Form-12 (SF-12) and the Seattle Angina Questionnaire (SAQ) at 4 weeks and 6 months post-PPCI., Results: HRQOL improved significantly from 4 weeks to 6 months in all aspects measured except anginal frequency and mental health. Patients aged ≥ 70 years had poorer physical HRQOL (SF-12) and physical limitations (SAQ), but better mental HRQOL (SF-12), angina frequency and QOL (SAQ) at both time points. Age, length of hospital stay, gender, partnership status and number of stents deployed are independent predictors of HRQOL improvement over time., Conclusion: People ≥ 70 years reported better cardiac-specific quality of life, primarily from angina relief and improved mental function, despite worse physical limitations. HRQOL assessment is an important gauge of health status after PPCI for STEMI., (Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.)

Improving health-related quality of life (HRQL) is an important goal for heart failure (HF) patients, and understanding the factors that influence HRQL is essential to this process. We investigated the influence of social support and cognitive impairment on HRQL in community dwelling HF patients (n = 104) without diagnosed dementia. Patients were aged mean 80.93 years (SD 11.01) and were classified as New York Heart Association Class 1/II (45%) or III/IV (53%). Age, social support and cognition had important independent effects. Younger people had the most negative effects of HF in all areas of HRQL: emotional (B = -0.32), physical (B = -0.44) and overall (B = -1). Well-supported patients (general social support) had the least negative effect from HF on HRQL: emotional domain (B = -4.62) and overall (B = -11.72). Patients with normal cognition had more negative impact of HF on HRQL: physical domain (B = 5.51) and overall HRQL (B = 10.42). A clearer understanding of the relationships between age, social support and cognition and the effect on the impact of HF on HRQL is needed before interventions can be appropriately developed., (© 2015 John Wiley & Sons Australia, Ltd.)

Objective: To examine clinical and health-related quality of life (HRQOL) outcomes and predictors of HRQOL for uncomplicated field triage ST-elevation myocardial infarction (STEMI) patients aged ≥70 years and <70 years after primary percutaneous coronary intervention (PPCI)., Background: Pre-hospital field triage for PPCI is associated with lower mortality but the impact of age and other factors on HRQOL remains unknown., Methods: 77 field triage STEMI patients were assessed for HRQOL using the Short Form-12 (SF-12) and the Seattle Angina Questionnaire (SAQ) at 4 weeks and 6 months after PPCI., Results: Regression analysis showed improvements in SF-12 domains and angina stability for older people. Age predicted lower physical function (p = 0.001) and better SAQ QOL at 6 months (p = 0.003)., Conclusion: Age, length of hospitalization, recurrent angina and hypertension were important predictors of HRQOL with PPCI. Assessment of HRQOL combined with increased support for physical and emotional recovery is needed to improve clinical care for field triage PPCI patients., (Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.)

Atrial fibrillation is the most common sustained cardiac arrhythmia affecting 1-2% of the population; the prevalence of atrial fibrillation increases with ageing. The condition is associated with high morbidity and mortality, as well as reduced health-related quality of life, particularly in older people. A PubMed, CINAHL, EMBASE and CENTRAL search (January 2003 to April 2013) was conducted using the search terms atrial fibrillation, quality of life, health-related quality of life, older, aged, and over 65 years. In total, 572 papers were identified of which 15 were eligible, including three observational studies, five descriptive comparative studies and seven randomized control trials. Older atrial fibrillation patients (≥65 years) were significantly impaired in their health-related quality of life in both physical and mental domains compared to the general population or patients with sinus rhythm. Increasing age, being female or having severe symptoms resulted in poorer health-related quality of life particularly in the physical domain. The review also found that the current treatment of AF including rate and rhythm control strategies improved some aspects of health-related quality of life in atrial fibrillation patients but no specific strategy had a superior effect., (© The European Society of Cardiology 2014.)

Background: Heart valve replacement surgery is undertaken to improve cardiac function and health-related quality of life (HRQoL). Mechanical valves are typically used for younger people (aged <65 years). Implantation of these valves comes with life-long health self-management requirements which potentially impact on HRQoL., Aims: The purpose of this study was to identify the short and long-term impact on HRQoL after mechanical valve replacement surgery., Methods: Multiple electronic databases were searched for peer-reviewed studies published between 2000-2013, which focused on patients who had mechanical valve replacement, aged <65 years, and used a valid measure of HRQoL., Results: Eight papers were included, all of which used the Short-Form 36 Health Survey (SF-36). Preoperatively, HRQoL was impaired, particularly in the SF-36 health domains of role-physical, physical-functioning, vitality and role-emotional. Postoperatively, most people had positive and sustained HRQoL improvement. In the early postoperative period all data showed significant improvement in at least four of eight health domains (physical function, role-physical, vitality, social function). Two-thirds of people also had significant improvement in an additional two health domains (general and mental-health). Whilst most people sustained HRQoL over time, one-third of younger adults (age <24 years) showed impairment in three domains (physical-function, mental-health and general-health)., Conclusions: Mechanical valve replacement surgery results in important and sustained improvements in HRQoL. Future research should include investigation of HRQoL outcomes after mechanical valve replacement for specific groups such as younger adults and people in developing countries, and include evaluations of the potential impact of valve-specific factors and health self-management requirements., (© The European Society of Cardiology 2014.)

People aged over 60 years represent an increasingly high proportion of the population undergoing percutaneous coronary intervention. While risks are greater for older people in terms of major adverse cardiovascular events and higher mortality for this treatment, it is unclear if the benefits of health-related quality of life outcomes may outweigh risks. A search of the PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica, and Cochrane databases was conducted for the period from January 1999 to June 2012 using key words "percutaneous coronary intervention"/"angioplasty," "older," "elderly," and "quality of life"/"health-related quality of life." Using a systematic review approach, data from 18 studies were extracted for description and synthesis. Findings revealed that everyone regardless of age reported better health-related quality of life, primarily from the relief of angina and improved physical and mental function. Age itself did not have an independent predictive effect when other factors such as comorbid conditions were taken into account. Assessment of older peoples' health status following percutaneous coronary intervention by nurses and other health professionals is therefore important for the provision of quality care., (© 2014 Wiley Publishing Asia Pty Ltd.)

Objective: Women who live alone are becoming an increasing proportion of our population, yet few studies have examined the experiences that these women have during recovery from an acute cardiac event. This study aims to describe women's experiences of recovering alone from acute coronary syndrome., Methods: Women attending cardiac rehabilitation were interviewed 3 to 9 months after acute coronary syndrome using a life history approach to address their personal/social background, professional life, and work-related processes, and to acquire an in-depth narrative of their recovery from illness in relation to this background. The sample included 11 women aged from 44 to 82 years who lived alone., Results: "Being on my own" was the pervasive theme, with independence being both required and valued. One subtheme included the complexity of social support arrangements women needed for their recovery. This was particularly important because women felt vulnerable when they were alone, particularly if they had experienced a sudden cardiac event or recurrent symptoms. Recurrent cardiac symptoms were an important subtheme because of the pervasive influence on women's lives, including their ability to work and plan ahead. Finally, the work and financial issues subtheme was a central concern for women, first because work was an important source of income and enjoyment, and second because loss of work meant loss of income. For some women, this meant selling their home or moving to another house., Conclusion: Women who live alone are an increasing proportion of patients with cardiac disease. Although they share many similar issues with other women and men who live alone, they seem to have unique concerns related to vulnerability, recurrent cardiac symptoms, social support, work, and finances.

Implantable cardioverter defibrillators (ICDs) have become a well-established therapy for people experiencing potentially lethal dysrhythmias. Australian recipients' quality of life and adjustment to the device over time, device-related complications, shock and associated sensations, and potential sequelae have not been widely explored. This paper reports a longitudinal prospective study of Australian ICD recipients (n = 74) to determine their responses to the device, health-related quality of life over time and shock experiences. A questionnaire designed for the study and the Medical Outcomes Trust Quality of Life Instrument, the SF36, were completed by recipients prior to and at 3 and 12 months post insertion. Results show that quality of life decreased for general health and social function between 3 and 12 months. Nearly half (49%) of the recipients received shocks within 12 months and the majority (92%) of these experienced sequelae that could make driving hazardous. Half of the population (49%) were driving at 3 months and 69% by 12 months, including 67% of those who had been shocked. Twenty-seven percent were hospitalized with device-related complications. Driving, the shock experience and rehospitalization, the shock experience and driving behaviour are significant issues for those with the implanted device. While it is a limitation of the study that partners and carers were not included, these findings will also be of interest to them.

Aims Enforced suspension and reduction of in-person cardiac rehabilitation (CR) services during the coronavirus disease-19 (COVID-19) pandemic restrictions required rapid implementation of remote delivery methods, thus enabling a cohort comparison of in-person vs. remote-delivered CR participants. This study aimed to examine the health-related quality of life (HRQL) outcomes and patient experiences comparing these delivery modes. Methods and results Participants across four metropolitan CR sites receiving in-person (December 2019 to March 2020) or remote-delivered (April to October 2020) programmes were assessed for HRQL (Short Form-12) at CR entry and completion. A General Linear Model was used to adjust for baseline group differences and qualitative interviews to explore patient experiences. Participants (n = 194) had a mean age of 65.94 (SD 10.45) years, 80.9% males. Diagnoses included elective percutaneous coronary intervention (40.2%), myocardial infarction (33.5%), and coronary artery bypass grafting (26.3%). Remote-delivered CR wait times were shorter than in-person [median 14 (interquartile range, IQR 10–21) vs. 25 (IQR 16–38) days, P < 0.001], but participation by ethnic minorities was lower (13.6% vs. 35.2%, P < 0.001). Remote-delivered CR participants had equivalent benefits to in-person in all HRQL domains but more improvements than in-person in Mental Health, both domain [mean difference (MD) 3.56, 95% confidence interval (CI) 1.28, 5.82] and composite (MD 2.37, 95% CI 0.15, 4.58). From qualitative interviews (n = 16), patients valued in-person CR for direct exercise supervision and group interactions, and remote-delivered for convenience and flexibility (negotiable contact times). Conclusion Remote-delivered CR implemented during COVID-19 had equivalent, sometimes better, HRQL outcomes than in-person, and shorter wait times. Participation by minority groups in remote-delivered modes are lower. Further research is needed to evaluate other patient outcomes. [ABSTRACT FROM AUTHOR]

Aims: This study compared health-related quality of life (HRQOL) between patients aged ≥70 and <70 years at 4 weeks and 6 months after primary percutaneous coronary intervention (PPCI) and examined predictors of HRQOL. Background: HRQOL is an important patient outcome following PPCI for ST elevation myocardial infarction (STEM1) including pre-hospital field triage. Methods: A comparative cohort design was conducted on STEMI patients undergoing PPCI. HRQOL was measured using the Medical Outcomes Short Form-12 (SF-12) and the Seattle Angina Questionnaire (SAQ) at 4 weeks and 6 months post-PPCI. Results: HRQOL improved significantly from 4 weeks to 6 months in all aspects measured except anginal frequency and mental health. Patients aged >70 years had poorer physical HRQOL (SF-12) and physical limitations (SAQ), but better mental HRQOL (SF-12), angina frequency and QOL (SAQ) at both time points. Age, length of hospital stay, gender, partnership status and number of stents deployed are independent predictors of HRQOL improvement over time. Conclusion: People ≥70 years reported better cardiac-specific quality of life, primarily from angina relief and improved mental function, despite worse physical limitations. HRQOL assessment is an important gauge of health status after PPCI for STEM. [ABSTRACT FROM AUTHOR]

Background Few studies have examined young adults with type 1 diabetes use of health services and the development of vascular complications. As part of the Youth Outreach for Diabetes (YOuR-Diabetes) project, this study identified health service usage, the prevalence and factors predictive of development of vascular complications (hypertension, retinopathy and nephropathy) in a cohort of young adults (aged 16-30 years) with type 1 diabetes in Hunter New England and the Lower Mid-North Coast area of New South Wales, Australia. Methods A cross-sectional retrospective documentation survey was undertaken of case notes of young adults with type 1 diabetes accessing Hunter New England Local Health District public health services in 2010 and 2011, identified through ambulatory care clinic records, hospital attendances and other clinical records. Details of service usage, complications screening and evidence of vascular complications were extracted. Independent predictors were modelled using linear and logistic regression analyses. Results A cohort of 707 patients were reviewed; mean (SD) age was 23.0 (3.7) years, with mean diabetes duration of 10.2 (5.8, range 0.2 - 28.3) years; 42.4% lived/ 23.1% accessed services in non-metropolitan areas. Routine preventative service usage was low and unplanned contacts high; both deteriorated with increasing age. Low levels of complications screening were found. Where documented, hypertension, particularly, was common, affecting 48.4% across the study period. Diabetes duration was a strong predictor of vascular complications along with glycaemic control; hypertension was linked with renal dysfunction. Conclusion Findings indicate a need to better understand young people's drivers and achievements when accessing services, and how services can be reconfigured or delivered differently to better meet their needs and achieve better outcomes. Regular screening is required using current best practice guidelines as this affords the greatest chance for early complication detection, treatment initiation and secondary prevention. [ABSTRACT FROM AUTHOR]

Background: Health related quality of life (HRQOL) is an important indicator of long-term well-being, influenced by environmental factors such as family, culture, societal norms and available resources. This study aimed to explore parental perspectives on the influence of socio-cultural factors and environmental resources on the HRQOL of children and adolescents after congenital heart disease (CHD) surgery. Methods: Using a descriptive, qualitative design, semi-structured interviews of children/adolescents who had CHD surgery in this low-middle income country (LMIC) were collected between July to December 2017. There were 20 families enrolled, which included 18 parent dyads (mother and father) and two single mothers, making a total of 38 participants. Initial inductive analysis was further refined using the Social Ecological Model as an analytic lens. Results: At the intrapersonal level, unrealistic expectations of surgery, residual CHD symptoms and difficulty maintaining educational progress were of great concern. There were low levels of health literacy and understanding about CHD among family and friends, however, strong kinship ties were an important resource at the interpersonal level. These families lived in poverty and mothers often carried the sole burden of care for their sick children. At the institutional level, there were unclear expectations of the child's needs at school, and parents had poor access to psychological, family-planning and genetic counselling, and poor access to CHD education resources. At a sociocultural level, religion and trust in God were important coping factors, however, CHD was a gendered experience with particular concerns around scarring and the marriageability of girls. Parents noted the deficit of antenatal and specialist CHD services and felt the consequence of a lack of a universal health care system at the public policy level. Conclusion: Socio-ecological factors have the potential to explain the issues and challenges that children living in LMIC experience with CHD after surgery. The study findings will help to inform future interventions to be implemented in countries like Pakistan. [ABSTRACT FROM AUTHOR]