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2. Using an Electronic App to Promote Home-Based Self-Care in Older Patients With Heart Failure: Qualitative Study on Patient and Informal Caregiver Challenges

Author

Wali, Sahr, Keshavjee, Karim, Nguyen, Linda, Mbuagbaw, Lawrence, and Demers, Catherine

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundHeart failure (HF) affects many older individuals in North America, with recurrent hospitalizations despite postdischarge strategies to prevent readmission. Proper HF self-care can potentially lead to better clinical outcomes, yet many older patients find self-care challenging. Mobile health (mHealth) apps can provide support to patients with respect to HF self-care. However, many mHealth apps are not designed to consider potential patient barriers, such as literacy, numeracy, and cognitive impairment, leading to challenges for older patients. We previously demonstrated that a paper-based standardized diuretic decision support tool (SDDST) with daily weights and adjustment of diuretic dose led to improved self-care. ObjectiveThe aim of this study is to better understand the self-care challenges that older patients with HF and their informal care providers (CPs) face on a daily basis, leading to the conversion of the SDDST into a user-centered mHealth app. MethodsWe recruited 14 patients (male: 8/14, 57%) with a confirmed diagnosis of HF, aged ≥60 years, and 7 CPs from the HF clinic and the cardiology ward at the Hamilton General Hospital. Patients were categorized into 3 groups based on the self-care heart failure index: patients with adequate self-care, patients with inadequate self-care without a CP, or patients with inadequate self-care with a CP. We conducted semistructured interviews with patients and their CPs using persona-scenarios. Interviews were transcribed verbatim and analyzed for emerging themes using an inductive approach. ResultsSix themes were identified: usability of technology, communication, app customization, complexity of self-care, usefulness of HF-related information, and long-term use and cost. Many of the challenges patients and CPs reported involved their unfamiliarity with technology and the lack of incentive for its use. However, participants were supportive and more likely to actively use the HF app when informed of the intervention’s inclusion of volunteer and nurse assistance. ConclusionsPatients with varying self-care adequacy levels were willing to use an mHealth app if it was simple in its functionality and user interface. To promote the adoption and usability of these tools, patients confirmed the need for researchers to engage with end users before developing an app. Findings from this study can be used to help inform the design of an mHealth app to ensure that it is adapted for the needs of older individuals with HF.

Published
2020
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3. Evaluation of Heart Failure Apps to Promote Self-Care: Systematic App Search

Author

Wali, Sahr, Demers, Catherine, Shah, Hiba, Wali, Huda, Lim, Delphine, Naik, Nirav, Ghany, Ahmad, Vispute, Ayushi, Wali, Maya, and Keshavjee, Karim

Subjects
Information technology, T58.5-58.64, Public aspects of medicine, RA1-1270
Abstract

BackgroundHeart failure (HF) is a chronic disease that affects over 1% of Canadians and at least 26 million people worldwide. With the continued rise in disease prevalence and an aging population, HF-related costs are expected to create a significant economic burden. Many mobile health (mHealth) apps have been developed to help support patients’ self-care in the home setting, but it is unclear if they are suited to the needs or capabilities of older adults. ObjectiveThis study aimed to identify HF apps and evaluate whether they met the criteria for optimal HF self-care. MethodsWe conducted a systematic search of all apps available exclusively for HF self-care across Google Play and the App Store. We then evaluated the apps according to a list of 25 major functions pivotal to promoting HF self-care for older adults. ResultsA total of 74 apps for HF self-care were identified, but only 21 apps were listed as being both HF and self-care specific. None of the apps had all 25 of the listed features for an adequate HF self-care app, and only 41% (31/74) apps had the key weight management feature present. HF Storylines received the highest functionality score (18/25, 72%). ConclusionsOur findings suggest that currently available apps are not adequate for use by older adults with HF. This highlights the need for mHealth apps to refine their development process so that user needs and capabilities are identified during the design stage to ensure the usability of the app.

Published
2019
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4. Abstract 4143270: PREDICTIVE MODELS AID PHYSICIAN PROGNOSTICATION: A SECONDARY ANALYSIS EVALUATING INTEGRATED MODEL AND PHYSICIAN PROGNOSTIC ESTIMATES IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION

Author

Alba, Ana, Buchan, Tayler, Mueller, Brigitte, Fan, Steve, Poon, Stephanie, Mak, Susanna, Toma, Mustafa, Zieroth, Shelley, Anderson, Kim, Porepa, Liane, Demers, Catherine, Chih, Sharon, Giannetti, Nadia, Rac, Valeria, Ross, Heather, and Guyatt, Gordon

Published
2024
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11. Exercise-Induced Left Atrial Hypertension in Heart Failure With Preserved Ejection Fraction

Author

Litwin, Sheldon E., Komtebedde, Jan, Hu, Mo, Burkhoff, Daniel, Hasenfuß, Gerd, Borlaug, Barry A., Solomon, Scott D., Zile, Michael R., Mohan, Rajeev C., Khawash, Rami, Sverdlov, Aaron L., Fail, Peter, Chung, Eugene S., Kaye, David M., Blair, John, Eicher, Jean-Christophe, Hummel, Scott L., Zirlik, Andreas, Westenfeld, Ralf, Hayward, Christopher, Gorter, Thomas M., Demers, Catherine, Shetty, Ranjith, Lewis, Gregory, Starling, Randall C., Patel, Sanjay, Gupta, Deepak K., Morsli, Hakim, Penicka, Martin, Cikes, Maja, Gustafsson, Finn, Silvestry, Frank E., Rowin, Ethan J., Cutlip, Donald E., Leon, Martin B., Kitzman, Dalane W., Kleber, Franz X., and Shah, Sanjiv J.

Published
2023
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19. Incidence and short-term outcomes of Kawasaki disease

Author

Robinson, Cal, Chanchlani, Rahul, Gayowsky, Anastasia, Brar, Sandeep, Darling, Elizabeth, Demers, Catherine, Klowak, Jennifer, Knight, Braden, Kuenzig, Ellen, Mondal, Tapas, Parekh, Rulan, Seow, Hsien, Jimenez-Rivera, Carolina, Webster, Richard, Fung, Stephen, Benchimol, Eric I., and Batthish, Michelle

Published
2021
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21. Prenatal Maternal Sleep Quality Predicts Neonatal Uncinate Fasciculus White Matter Development and Infant Negative Emotionality

Author

Nevarez-Brewster, Melissa, primary, Demers, Catherine H., additional, Deer, LillyBelle, additional, Aran, Özlü, additional, Hoeflich Haase, Mercedes, additional, Al-Ali, Khalid, additional, Bagonis, Maria, additional, Gilmore, John H., additional, Hoffman, M. Camille, additional, Styner, Martin A., additional, Hankin, Benjamin L., additional, and Davis, Elysia Poggi, additional

Published
2024
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25. Predicting 1-Year Mortality in Outpatients With Heart Failure With Reduced Left Ventricular Ejection Fraction: Do Empiric Models Outperform Physician Intuitive Estimates? A Multicenter Cohort Study

Author

Alba, Ana C., primary, Buchan, Tayler A., additional, Saha, Sudipta, additional, Fan, Steve, additional, Demers, Catherine, additional, Poon, Stephanie, additional, Mak, Susanna, additional, Al-Hesayen, Abdul, additional, Toma, Mustafa, additional, Zieroth, Shelley, additional, Anderson, Kim, additional, Porepa, Liane, additional, Chih, Sharon, additional, Giannetti, Nadia, additional, Rac, Valeria, additional, Levy, Wayne C., additional, Ross, Heather J., additional, and Guyatt, Gordon H., additional

Published
2023
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26. Barriers to Goals of Care Discussions With Patients Who Have Advanced Heart Failure: Results of a Multicenter Survey of Hospital-Based Cardiology Clinicians

Author

You, John J., Aleksova, Natasha, Ducharme, Anique, MacIver, Jane, Mielniczuk, Lisa, Fowler, Robert A., Demers, Catherine, Clarke, Brian, Parent, Marie-Claude, Toma, Mustafa, Strachan, Patricia H., Farand, Paul, Isaac, Debra, Zieroth, Shelley, Swinton, Marilyn, Jiang, Xuran, Day, Andrew G., Heyland, Daren K., and Ross, Heather J.

Published
2017
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30. Obesity in heart failure with preserved ejection fraction: Insights from the REDUCE LAP‐HF II trial.

Author

Litwin, Sheldon E., Komtebedde, Jan, Seidler, Tim, Borlaug, Barry A., Winkler, Sebastian, Solomon, Scott D., Eicher, Jean‐Christophe, Mazimba, Sula, Khawash, Rami, Sverdlov, Aaron L., Hummel, Scott L., Bugger, Heiko, Boenner, Florian, Hoendermis, Elke, Cikes, Maja, Demers, Catherine, Silva, Guillherme, van Empel, Vanessa, Starling, Randall C., and Penicka, Martin

Subjects
VENTRICULAR ejection fraction, HEART failure, OBESITY, VASCULAR resistance, CARDIAC output, BODY mass index
Abstract

Aims: Obesity is causally related to the development of heart failure with preserved ejection fraction (HFpEF) but complicates the diagnosis and treatment of this disorder. We aimed to determine the relationship between severity of obesity and clinical, echocardiographic and haemodynamic parameters in a large cohort of patients with documented HFpEF. Methods and results: The REDUCE LAP‐HF II trial randomized 626 patients with ejection fraction ≥40% and exercise pulmonary capillary wedge pressure (PCWP) ≥25 mmHg to atrial shunt or sham procedure. We tested for associations between body mass index (BMI), clinical characteristics, cardiac structural and functional abnormalities, physical limitations, quality of life and outcomes with atrial shunt therapy. Overall, 60.9% of patients had BMI ≥30 kg/m2. As the severity of obesity increased, symptoms (Kansas City Cardiomyopathy Questionnaire score) and 6‐min walk distance worsened. More severe obesity was associated with lower natriuretic peptide levels despite more cardiac remodelling, higher cardiac filling pressures, and higher cardiac output. Lower cut points for E/e′ were needed to identify elevated PCWP in more obese patients. Strain measurements in all four chambers were maintained as BMI increased. Pulmonary vascular resistance at rest and exercise decreased with higher BMI. Obesity was associated with more first and recurrent heart failure events. However, there was no significant interaction between obesity and treatment effects of the atrial shunt. Conclusions: Increasing severity of obesity was associated with greater cardiac remodelling, higher right and left ventricular filling pressures, higher cardiac output and increased subsequent heart failure events. Despite significant obesity, many HFpEF patients have preserved right heart and pulmonary vascular function and thus, may be appropriate candidates for atrial shunt therapy. [ABSTRACT FROM AUTHOR]

Published
2024
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39. Maternal adverse childhood experiences and infant subcortical brain volume

Author

Demers, Catherine H., primary, Hankin, Benjamin L., additional, Hennessey, Ella-Marie P., additional, Haase, Mercedes Hoeflich, additional, Bagonis, Maria M., additional, Kim, Sun Hyung, additional, Gilmore, John H., additional, Hoffman, M. Camille, additional, Styner, Martin A., additional, and Davis, Elysia Poggi, additional

Published
2022
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43. Needs, Barriers and Facilitators of Adolescents Participating in a Lifestyle Promotion Program in Oncology: Stakeholders, Adolescents and Parents’ Perspective

Author

Kerba, Johanne, primary, Demers, Catherine, additional, Bélanger, Véronique, additional, Napartuk, Mélanie, additional, Bouchard, Isabelle, additional, Meloche, Caroline, additional, Morel, Sophia, additional, Prud’homme, Nicolas, additional, Gélinas, Isabelle, additional, Higgins, Johanne, additional, Curnier, Daniel, additional, Sultan, Serge, additional, Laverdière, Caroline, additional, Sinnett, Daniel, additional, and Marcil, Valérie, additional

Published
2022
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45. The State of Heart Failure Care in Canada: Minimal Improvement in Readmissions Over Time Despite an Increased Number of Evidence-Based Therapies

Author

Poon, Stephanie, primary, Leis, Benjamin, additional, Lambert, Laurie, additional, MacFarlane, Kendra, additional, Anderson, Kim, additional, Blais, Claudia, additional, Demers, Catherine, additional, Ezekowitz, Justin A., additional, Hawkins, Nathaniel M., additional, Lee, Douglas S., additional, Moe, Gordon, additional, Sandhu, Roopinder K., additional, Virani, Sean A., additional, Wilton, Stephen, additional, Zieroth, Shelley, additional, and McKelvie, Robert, additional

Published
2022
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49. High-Dose Thiamine Supplementation in Older Patients With Heart Failure: A Pilot Randomized Controlled Crossover Trial (THIAMINE-HF)

Author

Wong, Eric K.C., primary, Lee, Justin Y., additional, Chow, Justin, additional, Power, Patricia, additional, Jin, Laura, additional, Leong, Darryl P., additional, Mbuagbaw, Lawrence, additional, Keen, Sabina, additional, Yousuf, Haroon, additional, Patterson, Christopher, additional, Straus, Sharon, additional, and Demers, Catherine, additional

Published
2022
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