Search

Aortic stenosis is the most common valvular disease, and its prevalence is increasing due to the ageing population. Transcatheter aortic valve replacement (TAVR) is the recommended method when treating frail, older patients. Knowledge of what motivates older patients to undergo TAVR is important, in order to meet patients' expectations.The study aimed to explore the meaning of older patients' motivation to undergo TAVR.The design was a qualitative study, analysed using a phenomenological hermeneutic approach. In-depth, semi-structured interviews with open-ended questions were conducted. Participants were selected from a specialist cardiology clinic in Sweden. Eighteen patients, six women and twelve men, aged 66-92, were recruited.The analysis showed that patients who had agreed to undergo TAVR were deeply affected by their body's failure. Before the TAVR procedure, the participants were limited in their daily activities and experienced that their life was on hold. They experienced that they were barely existing. They were aware of their life-threatening condition and were forced to confront death. Yet despite an advanced age, they still had considerable zest for life. It was very important to them to remain independent in everyday life, and fear of becoming dependent had a strong impact on their motivations for undergoing TAVR.Older patients' motivations to undergo TAVR are strongly influenced by their fear of being dependent on others and their zest for life. Health care professionals need to support these patients in setting realistic and personalised goals.Person-centered care actions could facilitate patients' involvement in the decision about TAVR and strenghten patients' beliefs in their own capabilities, before and after TAVR.

Background/Aims Atrial fibrillation is the most common heart rhythm disorder, which increases the risk for stroke and heart failure, and commonly impairs quality of life. Increasing evidence has shown the causative role of several risk factors and suggested that aggressive lifestyle interventions might reduce atrial fibrillation incidence and effects. The size of the problem and how to provide optimal multidisciplinary management is less well known. This study aimed screened patients with atrial fibrillation for potentially modifiable risk factors and describe patients' symptom burden, wellbeing and treatment expectations. Methods The atrial fibrillation risk profile, symptom burden, wellbeing and expectations of future treatment were studied in 352 patients. Various questionnaires and instruments were used, in addition to medical history assessment. Results In total, 69% of patients had 1–5 possibly modifiable risk factors for atrial fibrillation: 50% were overweight/obese, 39% had a blood pressure of >140/90 mmHg, 28% had symptoms of obstructive sleep apnoea and 25% reported no physical exercise. Most patients had high expectations for their upcoming atrial fibrillation treatment, but men expected full recovery more often than women. Worries about future health and reduced survival were present in approximately 28% of patients. Conclusions Most patients with paroxysmal/persistent atrial fibrillation had potentially modifiable risk factors for atrial fibrillation and other cardiovascular events suitable for lifestyle interventions. Several patients experienced limitations in daily life, anxiety related to atrial fibrillation, and worry about their future health and survival. The results of this study might help identify relevant components for risk management and plan an individualised programme for atrial fibrillation patients.

Background Clinical decision-making is often based on evidence of outcome after a specific treatment. Healthcare providers and patients may, however, have different perceptions and expectations of what to achieve from a certain healthcare measure. Aims To evaluate patients’ expectations, perceptions and health related quality of life (HRQoL) before a care process including coronary angiography for suspected coronary artery disease and to evaluate the fulfilment of these expectations in relation to established patient reported outcome measures (PROMs) 6 months later. Furthermore, an aim was to try to define meaningful patient reported experience measures (PREMs) in this population. Methods 544 patients planned for coronary angiography completed a newly developed questionnaire to assess expectations and perceptions of treatment, the expectation questionnaire (ExpQ) and two established HRQoL questionnaires together with the established generic Short-Form 36 (SF36) and the disease specific Seattle Angina Questionnaire (SAQ). Results Patients had before the intervention, in general, high expectations of improvement after investigation and treatment and there was a positive attitude towards life style changes, medication and participation in decision-making regarding their own treatment. Only, 56.4% of the patients, however, reported fulfilment of treatment expectations. Fulfilment of treatment expectations correlated strongly with improvement in HRQoL after the care process. Conclusions To measure patients expectations and fulfilments of these may offer simple and meaningful outcomes to evaluate a healthcare process from a patient s perspective. To approach patients’ expectations may also strengthen patient involvement in the care process with the possibilities of both higher patient satisfaction and medical results of the treatment.

Background Treatment with glycoprotein (GP) IIb/IIIa inhibitors during percutaneous coronary intervention (PCI) reduce ischemic complications and improve outcome. Of the GPIIb/IIIa inhibitors abciximab is better documented than eptifibatide, but the former is more expensive. The aim of this study was to monitor a switch from abciximab to eptifibatide with respect to clinical outcome up to six months after PCI. Methods All consecutive patients that six months before and six months after a switch from abciximab to eptifibatide received GPIIb/IIIa inhibitors during and after de novo PCIs were followed for six months with respect to clinical outcome. Results 310 patients received abciximab and 350 eptifibatide. Baseline characteristics were similar in the two groups. 55% of the patients underwent PCI for acute ST-elevation myocardial infarction and 41% for unstable coronary artery disease. There were trends for lower mortality among abciximab-treated than among the eptifibatide-treated patients during in-hospital stay (0.6% vs 2.0%:NS) as well as during the six month follow up (2.3% vs 3.7%:NS). The combined endpoint of death, myocardial infarction, stroke, repeated revascularisation and serious bleeding occurred in 14.9% in the abciximab group vs 16.8% in the eptifibatide group (NS). Conclusion The study could not demonstrate any significant deterioration of clinical results after a switch from abciximab to eptifibatide as routine GPIIb/IIIa inhibition during PCI. With respect to the limited number of patients a clinical significant difference between the two GPIIb/IIIa inhibitors cannot, however, be excluded.

The outcome after percutaneous coronary intervention (PCI) of all patients treated for stable and unstable angina pectoris from July 1992 to June 1993 (group A [n = 590], of whom 3.7% received stents) was compared with the outcome in patients treated from July 1996 to June 1997 (group B [n = 768], of whom 64.7% received stents). All patients were followed up for at least 1 year. PCI was performed due to unstable angina in 34.1% and 33.5% of patients in groups A and B, respectively. More patients in group B than in group A had systemic hypertension, previous coronary artery bypass grafting, and PCI. Within 1 year, 42.2% of patients in group A versus 27.2% in group B (p

Background: Balloon dilatation with related techniques (PCI) is well established for treatment of angina pectoris. New techniques, that may increase costs, have been developed with the aim of reducing the risk of recurrent stenosis and symptoms, restenosis. It has, however, not been defined what a restenosis means to the patient or what expectations patients in general have prior to investigation and treatment of coronary artery disease. Aims: To evaluate the effects increased usage of stents in association with PCI, what it means to the patient to have a restenosis and to collect patients´ expectations, perceptions and attitudes in connection to investigation for suspect coronary artery disease. Results: Increased use of stents in association with PCI resulted in fewer new revascularizations without influencing subsequent mortality or risk for acute myocardial infarction. The initial in-hospital costs increased but were unchanged in the long term, as were sick leaves. The patients´ perception of restenosis was dominated by the experience of “living with uncertainty”. With a newly developed questionnaire patients´ expectations, perceptions and attitudes prior to and after a planned coronary angiography were collected and compared with quality of life measured with established instruments. The majority of patients had high expectations before the health care process and a positive attitude to treatment, life style changes and to be involved in the health care process. The expectations were, however, six months later fulfilled to a lower degree. Those who had their expectations fulfilled had higher quality of life and improvement in quality of life than those who did not have their expectations fulfilled.

Background: The general usage of stents during percutaneous coronary intervention (PCI) reduces the need for subsequent repeated revascularizations when compared with balloon dilatation. The aim was to evaluate the impact of stenting on short- and long-term in-hospital care costs after PCI. Method and Results: Patients who underwent PCI from July 1992 to June 1993 (group A, n = 166; 4.2% stents) and from July 1996 to June 1997 (group B, n = 233; 61.4% stents) were included. The clinical outcome and all in-hospital care costs during 2.5 years following the procedures were analyzed. During the study period the number of deaths and acute myocardial infarctions was similar in the groups, but repeated revascularization occurred more often in group A than in group B (53.6 vs. 39.5%; p = 0.007). The initial procedural cost per patient was higher in group B than in group A (EUR 7,653 ± 5,071 vs. EUR 6,048 ± 3,242; p = 0.002), but after 2.5 years the costs were similar in the 2 groups (not significant). Conclusion: General usage of stents increases immediate health care cost compared with balloon dilatation, but despite reduction in subsequent revascularization, there is no reduction in long-term in-hospital costs.

PCI has been established as an effective treatment for coronary artery disease. Restenosis is a recurrence of a significant narrowing in the treated vessel. Although a part of the investigative and research funding is invested in the prevention and resolving the restenosis problem, little is known about its clinical significance apart from further revascularisation.The intention of this study was to clarify the patients perspective of what it means to suffer from documented restenosis after PCI.Patients interviewed had undergone PCI. Data collection and analysis was done simultaneously according to Grounded Theory methodology and continued until new interviews provided no additional information."Living with uncertainty" was identified as the core category, and the central focus in the data explains what it means to patients' to suffer from restenosis. The core category was further illuminated in four additional categories labelled "fighting for access to care", "moderating health threats", "trying to understand" and "controlling relatives anxiety".Patients' perceptions of illness and illness-related events, such as symptoms, diagnosis, treatment and prognosis, are considerably affected by uncertainty. This infiltrates their struggle to acquire the care needed, their endeavour to comprehend and moderate health threats, and caring for their family.