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Aim: To explore experiences of cardiac arrest in‐hospital and the impact on life for the patient who suffered the arrest and the family member who witnessed the resuscitation. Background: Guidelines advocate that the family should be offered the option to be present during resuscitation, but little is known about family‐witnessed cardiopulmonary resuscitation in hospital and the impact on the patient and their family. Design: A qualitative design consisting of joint in‐depth interviews with patients and family members. Methods: Family interviews were conducted with seven patients and their eight corresponding family members (aged 19–85 years) 4–10 months after a family‐witnessed in‐hospital cardiac arrest. Data were analysed using interpretative phenomenological analysis. The study followed the guidelines outlined in the consolidated criteria for reporting qualitative research (COREQ) checklist. Results: The participants felt insignificant and abandoned following the in‐hospital cardiac arrest. Surviving patients and their close family members felt excluded, alone and abandoned throughout the care process; relationships, emotions and daily life were affected and gave rise to existential distress. Three themes and eight subordinate themes were identified: (1) the intrusion of death—powerless in the face of the fragility of life, highlights what it is like to suffer a cardiac arrest and to cope with an immediate threat to life; (2) being totally exposed—feeling vulnerable in the care relationship, describes how a lack of care from healthcare staff damaged trust; (3) learning to live again—making sense of an existential threat, pertaining to the family's reactions to a difficult event that impacts relationships but also leads to a greater appreciation of life and a positive view of the future. Conclusion: Surviving and witnessing a cardiac arrest in‐hospital is a critical event for everyone involved. Patients and family members are vulnerable in this situation and need to be seen and heard, both in the hospital and after hospital discharge. Consequently, healthcare staff need to show compassion and attend to the needs of the family, which involves continually assessing how family members are coping during the process, and providing support and information during and after resuscitation. Relevance to clinical practice: It is important to provide support to family members who witness the resuscitation of a loved one in‐hospital. Structured follow‐up care is crucial for cardiac arrest survivors and their families. To promote person‐centred care, nurses need interprofessional training on how to support family members during resuscitation, and follow‐up care focusing on providing resources for multiple challenges faced by survivors (emotional, cognitive, physical) and families (emotional) is needed. Patient or public contribution: In‐hospital cardiac arrest patients and family members were involved when designing the study. [ABSTRACT FROM AUTHOR]

An editorial is presented on the evolution and challenges of Open Access publishing, and it discusses the establishment of coalition S and its Plan S initiative to transform research accessibility. It reports that major European funding agencies and the White House Office of Science and Technology Policy (OSTP) and the perspectives of journals, funders, and universities on the benefits and challenges of this publishing model.

Introduction. Awareness of epidemiological and clinical consequences of atrial fibrillation (AF) has increased, as have disease-related costs. Less attention has been paid to patient-related issues, such as understanding how symptoms, different therapies, and lifestyle adjustments affect daily life. We aimed to describe patients' experiences of living with AF. Methods. The study design used a parallel convergent mixed methods approach. Patients with AF were included in the SMURF study and referred for catheter ablation. Patients completed questionnaires on symptoms, health-related quality of life, depression, anxiety, and perceived control and were interviewed. The datasets were analysed separately using inductive content analysis and descriptive statistics. Data were merged to obtain a final interpretation. Results. Nineteen patients were interviewed and 18 completed questionnaires. Twelve of the patients were male, mean age 60 years (45–75 years). Inductive qualitative analysis revealed three categories: (i) symptoms and concerns limiting life, (ii) dimensions of worries, and (iii) strategies for management. The most common symptoms were tiredness, weakness/fatigue, and breathlessness during activities, and the most pronounced negative impacts on health-related quality of life (HRQOL) were physically related, shown in the ASTA questionnaire. The most negative SF-36 scores were found in role limitations due to physical health problems and vitality. HADS revealed five patients with some degree of anxiety and four with some degree of depression. Patients had lower scores on perceived control than perceived helplessness in CAS. Patients' perceived control was higher than their families', and families experienced more helplessness. Conclusions. The mixed methods design deepens our understanding of challenges faced by patients. Patients experienced a limited ability to perform activities of daily living due to AF which created different kinds of worries that encouraged the use of various strategies to manage their lives. Healthcare providers need to be aware that relationships between patients and their relatives can change, and therefore they need to be supported and integrated into the care system. [ABSTRACT FROM AUTHOR]

Introduction: Physical activity and appetite are important components for maintaining health. Yet, the association between physical activity and appetite in heart failure (HF) populations is not completely understood. The aim of the present study was to investigate the relationship between physical activity, functional capacity, and appetite in patients with HF. Methods: This was a prospective observational study. In total, 186 patients diagnosed with HF, New York Heart Association (NYHA) class II–IV (mean age 70.7, 30% female), were included. Physical activity was measured using a multi-sensor actigraph for seven days and with a self-reported numeric rating scale. Physical capacity was measured by the six-minute walk test. Appetite was measured using the Council on Nutrition Appetite Questionnaire. Data were collected at inclusion and after 18 months. A series of linear regression analyses, adjusted for age, NYHA class, and B-type natriuretic peptide were conducted. Results: At baseline, higher levels of physical activity and functional capacity were significantly associated with a higher level of appetite in the unadjusted models. In the adjusted models, number of steps (p = 0.019) and the six-minute walk test (p = 0.007) remained significant. At the 18-month follow-up, all physical activity variables and functional capacity were significantly associated with appetite in the unadjusted regression models. In the adjusted models, number of steps (p = 0.001) and metabolic equivalent daily averages (p = 0.040) remained significant. Conclusion: A higher level of physical activity measured by number of steps/day was associated with better self-reported appetite, both at baseline and the 18-month follow-up. Further research is needed to establish causality and explore the intertwined relationship between activity and appetite in patients with HF. [ABSTRACT FROM AUTHOR]

Aim: According to clinical guidelines, it is recommended that patients with heart failure (HF) receive structured multidisciplinary care at nurse-led HF clinics in order to optimise treatment and avoid preventable readmissions. Today, there are HF clinics with specialist-trained nurses at almost all Swedish hospitals, but HF clinics remain scarce in primary care (PC). The aim of this study was two-fold: firstly, to evaluate the effects of systematically implementing nurse-led HF clinics in PC settings with regard to hospital healthcare utilisation and evidence-based HF treatment, and secondly to explore patients' experiences of HF clinics in PC.Methods and Results: The study had a pre-post design. Annual measurement were done between 2010-2017 regarding in-hospital healthcare consumption and medical treatment. Data from 2011-2017 after the implementation of HF clinics in PC in one county council Sweden were compared with baseline data collected before the implementation in 2010. The implementation of HF clinics in PC significantly reduced the number of HF-related hospital admissions by 27% (P < 0.001), HF hospital days by 27.3% (P < 0.001) and HF emergency room visits by 24% (P < 0.001). Further, patients were to a higher extent medically treated according to guidelines and satisfied with the care they received at the PC HF clinic.Conclusion: Nurse-led HF clinics in PC seem to be effective in reducing the need for in-hospital care and provide high quality person-centred care. [ABSTRACT FROM AUTHOR]

Background: As treatment has improved, patients with heart failure live longer, and the care mostly takes place at home with partners providing the main assistance. Perceived control over heart failure is important in managing self-care activities to maintain health in patients and their family. Depressive symptoms are associated with impaired health status in patients with heart failure and their family. However, there is limited knowledge about how depressive symptoms affect the relationship between health status and perceived control over heart failure in patients with heart failure and their cohabiting partners. Aim: The aim of this study was to examine whether the relationship between perceived control and health status (i.e. mental and physical) was mediated by depressive symptoms in patients with heart failure and their partners. Methods: In this secondary data analysis, we included 132 heart failure patients and 132 partners who completed measures of depressive symptoms (the Beck depression inventory II), perceived control (the control attitude scale), and physical and mental health status (the short form-36) instruments. The mediation effect of depression was examined using a series of multiple regression in patients and their family caregivers separately. Results: We found a mediator effect of depressive symptoms in the relationship between perceived control and mental health status in both patients and partners. The relationship between perceived control and physical health status was mediated by depressive symptoms in the patients, not in the partners. Conclusion: Efforts to improve self-care management and maintenance by targeting perceived control may be more effective if depressive symptoms are also effectively managed. [ABSTRACT FROM AUTHOR]

Aims and objectives: To gain in-depth knowledge of patients’ experiences of the consultation processes at a multidisciplinary atrial fibrillation outpatient clinic in a university hospital in Denmark. Background: Atrial fibrillation is the most common cardiac arrhythmia associated with morbidity and mortality if not diagnosed and treated as recommended. Patients with newly diagnosed atrial fibrillation preferably should be managed in an outpatient setting which includes medical examination, patient education and decision-making on medical therapy. Design: This is a qualitative study of 14 patients newly diagnosed with atrial fibrillation, ranging from asymptomatic patients, to those with mild to severe symptoms; they were all referred from general practitioners. Methods: Data were generated in 2013-2015 using participant observation during each consultation, followed by individual interviews postconsultation. Results: Patients were referred with limited information on AF and knowledge about the management consultation procedures. The consultations were performed in a professional way by the cardiologist as well as by the nurses with an emphasis on the medical aspects of atrial fibrillation. The understanding that atrial fibrillation is not a fatal disease in itself was very important for patients. At the same time, visiting the clinic was overwhelming, information was difficult to understand, and patients found it difficult to be involved in decision-making. Conclusions: This study indicates that patients were uncertain on what AF was before as well as after their consultation. The communication was concentrated on the medical aspects of atrial fibrillation and visiting the clinic was an overwhelming experience for the patients. They had difficulty understanding what atrial fibrillation was, why they were treated with anticoagulation, and that anticoagulating was a lifelong treatment. Relevance for clinical practice: This study demonstrates some lack of patient centred care and an absence of tailored patient AF-related education. Furthermore, the study highlights the need for and importance of active patient involvement. [ABSTRACT FROM AUTHOR]

The article discusses how nursing students in the middle of their education perceived a clinical examination focusing on caring needs in cardiac patients.

Evaluation of cervical evoked myogenic potentials (c-VEMP) is commonly applied in clinical investigations of patients with suspected neurotological symptoms. Short intense acoustic stimulation of peak levels close to 130 dB SPL is required to elicit the responses. A recent publication on bilateral significant sensorineural hearing loss related to extensive VEMP stimulation motivates evaluations of immediate effects on hearing acuity related to the intense acoustic stimulation required to elicit c-VEMP responses. The aim of the current study was to investigate changes in DPOAE-levels and hearing thresholds in relation to c-VEMP testing in humans. More specifically, the current focus is on immediate changes in hearing thresholds and changes in DPOAE-levels at frequencies 0.5 octaves above the acoustic stimulation when applying shorter tone bursts than previously used. Hearing acuity before and immediately after exposure to c-VEMP stimulation was examined in 24 patients with normal hearing referred for neurotologic testing. The stimulation consisted of 192 tonebursts of 6 ms and was presented at 500 Hz and 130 dB peSPL. Békésy thresholds at 0.125–8 kHz and DPOAE I/O growth functions with stimulation at 0.75 and 3 kHz were used to assess c-VEMP related changes in hearing status. No significant deterioration in Békésy thresholds was detected. Significant reduction in DPOAE levels at 0.75 (0.5–1.35 dB) and 3 kHz (1.6–2.1 dB) was observed after c-VEMP stimulation without concomitant changes in cochlear compression. The results indicated that there was no immediate audiometric loss related to c-VEMP stimulation in the current group of patients. The significant reduction of DPOAE levels at a wider frequency range than previously described after the c-VEMP test could be related to the stimulation with shorter tone bursts. The results show that c-VEMP stimulation causes reduction in DPOAE-levels at several frequencies that corresponds to half the reductions in DPOAE levels reported after exposure to the maximally allowed occupational noise for an 8 h working day. Consequently, extended stimuli intensity or stimulation repetition with c-VEMP testing should be avoided to reduce the risk for noise-induced cochlear injury. [ABSTRACT FROM AUTHOR]

Background: Patients with recurrent episodes of non-cardiac chest pain may experience cardiac anxiety and avoidance behavior, leading to increased healthcare utilization. These patients might benefit from help and support to evaluate the perception and management of their chest pain. The purpose of this study was to test the feasibility of a short guided Internet-delivered cognitive behavioural therapy (CBT) program and explore the effects on cardiac anxiety, fear of body sensations, depressive symptoms, and chest pain in patients with non-cardiac chest pain, compared with usual care.Methods: A pilot randomized controlled study was conducted. Fifteen patients with non-cardiac chest pain with cardiac anxiety or fear of body sensations, aged 22-76 years, were randomized to intervention (n = 7) or control (n = 8) groups. The four-session CBT program contained psychoeducation, physical activity, and relaxation. The control group received usual care. Data were collected before and after intervention.Results: Five of seven patients in the intervention group completed the program, which was perceived as user-friendly with comprehensible language, adequate and varied content, and manageable homework assignments. Being guided and supported, patients were empowered and motivated to be active and complete the program. Patients in both intervention and control groups improved with regard to cardiac anxiety, fear of body sensations, and depressive symptoms, but no significant differences were found between the groups.Conclusions: The Internet-delivered CBT program seems feasible for patients with non-cardiac chest pain, but needs to be evaluated in larger groups and with a longer follow-up period.Trial Registration: Clinicaltrials.gov NCT02336880 . Registered on 8 January 2015. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the prevalence of decreased appetite and factors associated with appetite among patients with stable heart failure. Background Decreased appetite is an important factor for the development of undernutrition among patients with heart failure, but there are knowledge gaps about prevalence and the factors related to appetite in this patient group. Design Observational, cross-sectional study. Methods A total of 186 patients with mild to severe heart failure were consecutively recruited from three heart failure outpatient clinics. Data were obtained from medical records (heart failure diagnosis, comorbidity and medical treatment) and self-rated questionnaires (demographics, appetite, self-perceived health, symptoms of depression and sleep). Blood samples were taken to determine myocardial stress and nutrition status. Heart failure symptoms and cognitive function were assessed by clinical examinations. The Council on Nutrition Appetite Questionnaire was used to assess self-reported appetite. Bivariate correlations and multivariate linear regression analyses were conducted to explore factors associated with appetite. Results Seventy-one patients (38%) experienced a loss of appetite with a significant risk of developing weight loss. The final multiple regression model showed that age, symptoms of depression, insomnia, cognitive function and pharmacological treatment were associated with appetite, explaining 27% of the total variance. Conclusion In this cross-sectional study, a large share of patients with heart failure was affected by decreased appetite, associated with demographic, psychosocial and medical factors. Relevance to clinical practice Loss of appetite is a prevalent problem among patients with heart failure that may lead to undernutrition. Health care professionals should routinely assess appetite and discuss patients' experiences of appetite, nutrition intake and body weight and give appropriate nutritional advice with respect to individual needs. [ABSTRACT FROM AUTHOR]

Monocytes/macrophages (MOs/MΦs) are suggested to be crucial for skeletal muscle repair and remodeling. This has been attributed to their proangiogenic potential, secretion of growth factors, and clearance of tissue debris. Skeletal muscle injury increases the number of MΦs in the tissue, and their importance for muscle regeneration has been supported by studies demonstrating that depletion of MOs/MΦs greatly impairs repair after muscle injury. Whether noninjurious exercise leads to induced expression of chemoattractants for MOs/ MΦs is poorly investigated. To this end, we analyzed the expression of CX3CL1 (fractalkine), CCL2 (MCP-1), and CCL22 (MDC) in human skeletal muscle after a bout of exercise, all of which are established MO/MΦ chemotactic factors that are expressed by human myoblasts. Muscle biopsies from the musculus vastus lateralis were obtained up to 24 h after 1 h of cycle exercise in healthy individuals and in age-matched nonexercised controls. CX3CL1 increased at both the mRNA and protein level in human skeletal muscle after one bout of exercise. It was not possible to distinguish changes in CCL2 or CCL22 mRNA levels between biopsy vs. exercise effects, and the expression of CCL22 was very low. CX3CL1 mainly localized to the skeletal muscle endothelium, and it increased in human umbilical vein endothelial cells stimulated with tissue fluid from exercised muscle. CX3CL1 increased the expression of proinflammatory and proangiogenic factors in THP-1 monocytes (a human acute monocytic leukemia cell line) and in human primary myoblasts and myotubes. Altogether, this suggests that CX3CL1 participates in cross-talk mechanisms between endothelium and other muscle tissue cells and may promote a shift in the microenvironment toward a more regenerative milieu. [ABSTRACT FROM AUTHOR]

The study aimed to develop and evaluate whether a computer-based program for patients with heart failure was user-friendly, could be operated by elderly patients and gave sufficient information about heart failure. The program was developed by a multidisciplinary group and designed with large, clear illustrations and buttons. A total of 42 patients aged 51–92 years tested the program and completed afterwards a questionnaire. Three heart failure nurses evaluated how the patients used the program and their attitudes towards the computer. All patients could use the program, despite the fact that only six had used a computer before. The patients were satisfied with the computer-based information and appreciated that the program was interactive, flexible and contained a self-test. They thought it was a better way of receiving information than reading a booklet or watching a video about heart failure. The nurses reported that the patients were positive towards the computer and seemed to understand the information and that the patient education was less time-consuming, when the patients could seek knowledge on their own. [Copyright &y& Elsevier]

Background: The current international expert consensus statements recommend that clinicians should discuss elective implantable cardioverter defibrillator (ICD) deactivation before implantation of the device, and then consistently during the illness trajectory. However, no previous studies have investigated predictors of ICD patients' knowledge about end-of-life issues or whether knowledge influences patients' attitudes about deactivation. Methods: This nationwide survey study (n = 3,067) had a cross-sectional correlational design of self-reported data. Participants were recruited from the Swedish ICD and Pacemaker Registry and asked to complete a questionnaire about knowledge in relation to the ICD and end-of-life. Results: Only 79 respondents (3%) scored correctly on all 11 questions. The mean sample score was 6.6 ± 2.7 out of a maximum score of 11. A total of 835 participants (29%) had an insufficient knowledge when using the 25th percentile as a cutoff. Younger ICD recipients, those cohabiting, male participants, and those who had received shocks, had a generator replacement, or who had discussed illness trajectory with their physician were more likely to have sufficient knowledge on the end-of-life issues. Insufficient knowledge was associated with indecisiveness to make decisions about ICD deactivation in the end-of-life situations, and with favorable attitudes about replacing the ICD even if seriously ill or have reached an advanced age, and keeping the shock therapy of the ICD even in a terminal phase of life when dying from cancer or other serious chronic illnesses. Conclusion: Insufficient knowledge is common among ICD recipients and is associated with attitudes and decisions that may result in a stressful and potentially painful end-of-life situation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents. Methods: Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale. Results: In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries. Conclusion: Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide. Practice implications: Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior. [Copyright &y& Elsevier]

Background: During the past decade, several animal studies have demonstrated that in addition to local cells, cells from the bone marrow (BM) possess the ability to contribute to regeneration of injured skeletal muscle tissue. In addition, in mice, regular physical activity has been displayed to be a sufficient stimulus for BM-derived cell contribution to the muscle, indicating that this is part of the ongoing physiological remodeling of skeletal muscle. However, whether BM-derived cells participate in human skeletal muscle remodeling is not known. To this end, we analyzed the incorporation of BM-derived cells in healthy human skeletal muscle in women transplanted with male BM. Methods: Skeletal muscle biopsies were obtained from the m. vastus lateralis of women transplanted with male donor hematopoietic stem cells 6 to 12 years earlier. Healthy women served as controls. Immunohistochemical staining for skeletal muscle fibers, satellite cells (SCs) or endothelial cells (ECs) combined with fluorescent in situ hybridization (FISH) of X and Y chromosomes was used to identify cells of BM origin within the biopsies. Three dimensional confocal imaging was performed to demonstrate colocalization of Y chromosome and DAPI within muscle fibers. To further investigate whether BM-derived cells incorporate into the SC niche, myoblasts were extracted from the biopsies from the transplanted women, cultured, and analyzed using XY FISH and immunocytochemistry. Results: Three dimensional confocal imaging indisputably demonstrated colocalization of Y chromosome and DAPI within muscle fibers. Some Y chromosomes were found within centrally located nuclei. No Y chromosomes were detected in CD56+ SCs in the tissue sections nor in the myoblasts cultured from the extracted SCs. Y chromosome+ ECs were found in all sections from the transplanted subjects. No Y chromosomes were found in the skeletal muscle biopsies obtained from healthy control women. Conclusions: We demonstrate that BM-derived cells contribute to skeletal muscle fibers and ECs. Our results support that BM contribution to skeletal muscle occurs via direct fusion to muscle fibers, and that the contributing cells derive from the hematopoietic lineage. Thus, the present findings encourage further studies of the importance of this process for the physiological adaptation occurring throughout life. [ABSTRACT FROM AUTHOR]

Aims Chronic heart failure (CHF) and sleep-disordered breathing (SDB) are often co-existing problems among the elderly. Apnoeic events may cause cognitive impairment. The aim of the study was to compare sleep and wake patterns, insomnia, daytime sleepiness, and cognitive function in community-dwelling CHF patients, with and without SDB, and to investigate the association between sleep-related factors and cognitive dysfunction. Methods and results In this cross-sectional observational study, SDB was measured with an ApneaLink device and defined as an apnoea–hypopnoea index (AHI) ≥15/h of sleep. Sleep and wake patterns were measured with actigraphy for 1 week. Insomnia was measured with the Minimal Insomnia Symptom Scale, daytime sleepiness with the Epworth Sleepiness Scale, and cognitive function with a neuropsychological test battery. A total of 137 patients (68% male, median age 72 years, 58% NYHA functional class II) were consecutively included. Forty-four per cent had SDB (AHI ≥15). The SDB group had significantly higher saturation time below 90%, more difficulties maintaining sleep, and lower levels of daytime sleepiness compared with the non-SDB group. Cognitive function and sleep and wake patterns did not differ between the SDB and the non-SDB group. Insomnia was associated with decreased global cognition. Conclusion The prevalence of cognitive dysfunction was low in this population with predominantly mild to moderate CHF. This might have influenced the lack of associations between cognitive function and SDB. Insomnia was the only sleep-related factor significantly influencing cognition. [ABSTRACT FROM PUBLISHER]

Conclusion. Noise levels sufficient to cause sensorineural hearing loss can be measured when electrical drills and suction are used during otological surgery, particularly if a running burr touches the endosteal membrane of the otic capsule. Our noise measurements confirm the theory that 'soft surgery' should be employed during otological surgery, with focus on reduction of noise exposure. Objective: To investigate noise levels generated by otological electrical drills and suction. Methods: Airborne noise levels generated by different drills and suction tips of different diameters were evaluated in 12 fresh isolated human temporal bones by means of an ER7C probe microphone system. Results: Noise levels ranged from 120 to 122 dB SPL during drilling in cortical bone and from 117 to 121 dB SPL during drilling in the mastoid cavity. There was no statistically significant difference between cutting and diamond burrs ( p > 0.05). Noise levels during cochleostomy ranged from 116 to 131 dB SPL. Noise levels recorded in the round window exceeded 130 dB SPL when the endosteal membrane was touched by the burr. Noise levels generated by various types of suctions ranged from 100 to 129 dB SPL and a positive significant relation was found between noise and increased luminal diameter of the suction tip up to a diameter of 2 mm. [ABSTRACT FROM AUTHOR]

Conclusion: The use of a silicone tube and a microphone enables peroperative noise recordings in cadavers and should be safe to apply in vivo. Our preliminary data indicate that noise levels during inner ear surgery reach levels that can cause noise-induced hearing loss. Our method is easily performed and enables future uncomplicated and safe noise recordings and we suggest future application in vivo to expand knowledge regarding peroperative noise levels. Objectives: To evaluate the safety and utility of a silicone tube connected to a microphone probe in noise recordings during middle ear surgery and to achieve preliminary results regarding drill-related noise levels. Methods: Peroperative noise recordings were obtained during mastoidectomy and at the round window during cochleostomy in a cadaver model by means of a silicone tube connected to a microphone and a Matlab® computer program. Results: Our method enabled recordings of radiated noise levels close to the drill ranging from 84 to 125 dB SPL during drilling in cortical bone and from 85 to 117 dB during drilling in the mastoid cavity. During cochleostomy noise levels ranged from 114 to 128 dB SPL when recordings were made close to the round window. Maximal noise levels were underestimated due to microphone overload above 80 Pa. [ABSTRACT FROM AUTHOR]

Background: Living with paroxysmal supraventricular tachycardia affects a patient's whole life situation, but few studies have addressed health-related quality of life (HRQOL) aspects in these patients. The aim was therefore to describe HRQOL in patients with atrioventricular nodal re-entry tachycardia (AVNRT) or Wolff-Parkinson-White (WPW) syndrome, referred for radiofrequency ablation (RF-ablation), compared to age- and gender-matched Swedish reference groups. Methods: HRQOL was assessed with SF-36 and EuroQol (EQ-5D and EQ-VAS) and the patients were asked disease-specific questions. Results: The 97 patients with AVNRT [53 ± 16 years of age/65 women] and 79 patients with WPW [42 ± 15 years of age/26 women] exhibited significantly lower HRQOL scores in SF-36 in the same seven of the eight scales: Physical functioning (PF), role-physical (RP), social functioning (SF), role-emotional (RE), general health (GH), vitality (VT), and mental health (MH) while there was no difference in bodily pain (BP) compared to their respective age- and gender matched Swedish reference group. HRQOL scores were lower for patients with AVNRT compared to WPW in the areas of PF (P < 0.001), BP (P < 0.05), and GH (P < 0.01) in SF-36, and the same was found in EQ-VAS (64.8 vs. 71.2, P < 0.05). Occurrence of episodes of tachycardia more often than once a month compared to less frequently than once a month was associated with significantly lower HRQOL in all eight scales in SF-36 (GH, RE, MH: P < 0.01 and PF, RP, BP, VT, SF: P < 0.001) and EQ-5D index (P < 0.001) and EQ-VAS (P < 0.05) Arrhythmia duration longer than one hour compared to patients with shorter duration of the tachycardia-affected GH in SF-36 negatively (P < 0.05). Patients who experienced symptoms not only during activity but also at rest scored lower in SF-36 GH (P < 0.01) and SF (P < 0.05). Conclusion: Measuring HRQOL in patients with WPW or AVNRT is an important way to evaluate and describe these patients’ life situation. These conditions were found to have a pronounced negative impact on HRQOL. The frequency of arrhythmia occurrence is one important factor to consider when setting priorities for treatment with RF-ablation. [ABSTRACT FROM AUTHOR]

Objective: To compare perceptions among continuous positive airway pressure (CPAP) treated patients with obstructive sleep apnoea syndrome (OSAS) and healthcare personnel with regard to informational needs, side-effects and their consequences on adherence. Methods: A cross-sectional descriptive design was used including 350 CPAP treated OSAS patients from three Swedish hospitals and 105 healthcare personnel from 26 Swedish hospitals. Data collection was performed using two questionnaires covering informational needs, side-effects and adherence to CPAP. Results: Both groups perceived all surveyed informational areas as very important. Patients perceived the possibilities to learn as significantly greater in all areas (p <0.001) compared to healthcare personnel, and scored significantly higher regarding positive effects on adherence of information about pathophysiology (p <0.05), self-care (p <0.001) and troubleshooting (p <0.01). A total of 11 out of 15 surveyed side-effects were perceived to be more frequent by healthcare personnel (p <0.01–p <0.001). They also scored all side-effects to cause greater problems and decrease the CPAP use to a greater extent (p <0.001). Conclusion: Knowledge about these differences between patients and healthcare personnel regarding educational needs, side-effects and their effects on adherence can be important when designing educational programmes to increase CPAP adherence. Practice implications: Measurement of these parameters before, during and after educational programs are suggested. [Copyright &y& Elsevier]

Objective. To compare the effects of a restrictive versus a liberal fluid prescription, on quality of life, physical capacity, thirst and hospital admissions, in patients who had improved from NYHA class (III-)IV CHF to a stable condition without clinical signs of significant fluid overload. Design. The present study is a randomised cross-over study. Seventy-four patients (mean age 70±10 years, 16% women) -- with mild-moderate CHF -- were randomised 1:1 to either of two 16-week interventions. Intervention 1 prescribed a maximum fluid intake of 1.5 L/day. Intervention 2 prescribed a maximum fluid intake of 30-35 ml/kg body weight/day. Sixty-five patients completed the study. Results. There were no significant between-intervention differences in end-of-intervention quality of life, physical capacity or hospitalisation. However, there was a significant favourable effect on thirst and less difficulties to adhere to the fluid prescription during the liberal fluid prescription intervention. Conclusion. The results from this study indicate that it may be beneficial and safe to recommend a liberal fluid prescription, based on body weight, in stabilised CHF patients. These results warrant further investigation of the effects of fluid advice in CHF. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To explore thoughts about death and perceived health status in elderly patients with heart failure during a 6 month period after a deterioration needing hospitalisation. Methods: A descriptive, mixed methods design was used. Health was measured with EuroQol-5D, thoughts about death with multiple choice and open questions. A total of 145 patients with New York Heart Association class II–IV heart failure, mean age 70 years, 70% males, were included. Results: During deterioration, 16% of the patients were afraid of dying and 4% had this fear very often. Fear of death did not change significantly during the 6 months after deterioration. Both during deterioration (r =0.26, P <0.01) and 6 months later (r =0.40, P <0.001), fear of death and anxiety/depression were correlated. Content analysis of the open question produced 5 categories: (1) Death as a natural part of life; (2) Death as a relief from symptoms and disability (3) Death as fearful (4) Arrangements for time after death (5) A wish for an extended life. Conclusion: Elderly patients with heart failure had a lot of thoughts about death. Higher levels of anxiety/depression were correlated to fear of death. Many expressed death as a natural relief from suffering, others were afraid of pain, loss of independence and dignity. [Copyright &y& Elsevier]

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side effects are common and long-term adherence low. The Type D (distressed) personality is defined as a combination of negative affectivity and social inhibition. The association of Type D personality with adherence has not been studied in CPAP-treated patients with OSAS. This study aimed to describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. A cross-sectional descriptive design was used. A total of 247 OSAS patients with a mean use of CPAP treatment for 55 months (6–182 months) were included. Data collection was achieved by two questionnaires; the Type D scale 14 (DS14) (Type D personality), SECI (side effects of CPAP), as well as from medical records (clinical variables and objective adherence to CPAP treatment). Type D personality occurred in 30% of the patients with OSAS and significantly ( P < 0.05–0.001) increased the perceived frequency and severity of a broad range of side effects. The objective adherence was significantly lower ( P < 0.001) for OSAS patients with Type D compared to OSAS patients without Type D, both with regard to a mean use of 4 h per night and 85% of the self-rated sleep time per night. The additional effect of a Type D personality on perceived side effects and adherence to CPAP treatment found in this study could be used by healthcare personnel when evaluating patients waiting for treatment. [ABSTRACT FROM AUTHOR]

The article presents an introduction in which the editor discusses articles in the issue on topics including introduction to dyad research, research methods in Cardiovascular care and the promotion of evidence-based clinical practice.

Abstract: Objective: To evaluate the effects of a single-session, interactive computer-based educational program on knowledge, compliance and quality of life in heart failure patients with special emphasis on gender differences. Methods: One hundred and fifty-four patients, mean age 70 years, from five heart failure clinics were randomised to either receiving only standard education (n =72) or standard education and additional computer-based education (n =82). Results: Knowledge was increased in both groups after 1 month with a trend towards higher knowledge (P =0.07) in the computer-based group. The increase in knowledge was significantly higher in the computer-based group after 6 months (P =0.03). No differences were found between the groups with regard to compliance with treatment and self-care or quality of life. The women had significantly lower quality of life and did not improve after 6 months as the men did (P =0.0001). Conclusion: Computer-based education gave increased knowledge about heart failure. Practice implications: Computers can be a useful tool in heart failure education, but to improve compliance a single-session educational intervention is not sufficient. Gender differences in learning and quality of life should be further evaluated. [Copyright &y& Elsevier]

Abstract: Background: Deterioration of heart failure causes and complicates many hospital admissions in people aged over 65 years. Frequent readmissions cause an immense burden on the individual, the family and the health care system. Heart failure management programmes, in which patient education is an important component, have been shown to be effective in improving self-care and reducing readmissions. Aim: This paper reviews the literature on the education of patients with heart failure. The paper addresses the level of knowledge in patients with heart failure, barriers to learning, learning needs, educational methods, goals and how the effects of patient education can be evaluated. Conclusion: Many patients had low levels of knowledge and lacked a clear understanding of heart failure and self-care. Educational interventions need to be designed specifically for elderly patients and need to target barriers to learning such as functional and cognitive limitations, misconceptions, low motivation and self-esteem. Health care professionals need to be skilled in assessing the requirements and level of education given to the individual. New technologies such as computer-based education and telemonitoring can be used as tools to improve the education. Patient education is an important component of heart failure care and should be provided through effective and well-evaluated strategies. [Copyright &y& Elsevier]

Thirst is a common and troublesome symptom for patients with moderate to severe heart failure. The pharmacological and non-pharmacological treatment as well as the nature of the disease itself causes increased thirst. There is no evidence in the literature about the usefulness of fluid restriction for heart failure patients. Formerly, when very little pharmacological treatment was available, fluid restriction was one of the few interventional options but nowadays when the pharmacological treatment has improved, its importance may be questioned. This article describes the design of an ongoing study with the aim to determine if an individualised and less restrictive fluid prescription can improve the quality of life, cardiac function and exercise capacity, and decrease in hospital admissions and thirst. This study will be performed as a two-group, 1:1 randomised cross-over study. In group 1, the patients are instructed to comply with a maximum fluid intake of 1.5 l. This is a standard treatment today. In group 2, the patients are recommended to intake a fluid, based on the physiological need of 30 ml/kg body weight/24 h, and are allowed to increase the fluid intake to a maximum of 35 ml/kg body weight/24 h. After 16 weeks, the patients will cross over to the other intervention strategy and continue for another 16 weeks. [Copyright &y& Elsevier]

Aim: The aim of this literature review was to review and discuss the differences between men and women with heart failure with regard to epidemiology, aetiology, diagnostics, prognosis, pharmacological and non-pharmacological treatment, and the impact of heart failure on psychosocial factors and healthcare utilisation. Method: Two primary health care resources, medline and cinahl, were selected to review the current literature. In medline, 234 abstracts dealing with heart failure and gender/sex were found and in cinahl, 20 abstracts. Conclusion: Men have a higher incidence of heart failure, but the overall prevalence rate is similar in both sexes, since women survive longer after the onset of heart failure. Women tend to be older when diagnosed with heart failure and more often have diastolic dysfunction than men. The extent of sex differences in treatment, hospital cost and quality of care can partly be explained by age differences. The life situations for men and women with heart failure are different. Physical and social restrictions affecting daily life activities are experienced as most bothersome for men, whereas restrictions affecting the possibility to support family and friends are most difficult to accept for women. Women with heart failure ascribe more positive meanings to their illness. Despite this, women seem to experience a lower overall quality of life than men. The known gender differences in patients with heart failure need to be highlighted in guidelines as well as implemented in standard care. [Copyright &y& Elsevier]

Patient education is an important component in the management of patients with heart failure and nurses are increasingly involved in this area. This paper reviews the literature on education to patients with heart failure and the education and training for heart failure nurses. Patients with heart failure need education in order to adapt to their chronic syndrome and perform self-care. The education process often starts during the hospital admission, but must continue in the outpatient setting. Nurses need to be skilled in assessing the requirements and level of the education given to the individual. Computer-based education has been found to be a preferred and effective compliment to the education provided by health care professionals. The effect of new materials and methods needs to be evaluated in order to improve the overall effectiveness of the education provided. The patient with heart failure should have an active role in this development and evaluation. The heart failure nurse needs to be experienced in cardiac care, have an ability to work independently in order to be delegated responsibilities such as drug titration and patient assessment. This requires optimal experience, training and education for advanced practice. In order to develop and evaluate the education of patients with heart failure and the overall effectiveness of heart failure nurses in this regard, national and international collaborations are needed. [Copyright &y& Elsevier]

Objective: The aim of this study was to describe the nurse-led heart failure care in Sweden.Methods: A postal questionnaire was sent to all 86 hospitals in Sweden treating heart failure patients. All hospitals completed the questionnaire, which contained 20 questions about heart failure nurses, patient education, heart failure clinics, co-operation with primary healthcare and care programmes.Results: Sixty-nine percent of all hospitals (n=86) had nurses specialised in taking care of heart failure patients, in total 148 heart failure nurses. The nurses were involved in patient education and follow-up. There were nurse-led heart failure clinics in 66% of the hospitals. The clinics provided follow-up after hospitalisation, telephone counselling and drug titration. The majority of the heart failure nurses had been delegated the responsibility for making protocol-led changes in medications. Most clinics registered the number of annual visits to the clinic, and the largest clinic had up to 1000 visits. Approximately half of the hospitals had a special care plan for patients with heart failure and an organised co-operation with primary healthcare.Conclusion: The first nurse-led heart failure clinic started in Sweden in 1990 and since then the model has been spread to two-thirds of the Swedish hospitals. [ABSTRACT FROM AUTHOR]

Aims A short time span from symptom onset to reperfusion is imperative in ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine factors associated with patient decision time for seeking care in STEMI, particularly how symptoms were experienced and affected patient response. Methods and results A multicentre cross-sectional self-report survey study was completed at five Swedish hospitals representing geographic diversity. The 521 patients were divided into three groups based on their time to respond to symptoms: early (<20 min), intermediate (20–90 min), and late responders (>90 min). Only one out of five patients both responded early and called an ambulance within 20 min. Believing symptoms were cardiac in origin [odds ratio (OR) 2.60], male sex (OR 2.40), left anterior descending artery as culprit artery (OR 1.77), and bystanders calling an ambulance (OR 4.32) were factors associated with early response and correct action. Associated symptoms such as dyspnoea (OR 1.67) and weakness (OR 1.65) were associated with an early action (<20 min), while chest pain was not independently associated with response time. Cold sweat (OR 0.61) prevented late care-seeking behaviour as did a high symptom burden (OR 0.86). Conclusion Misinterpretation of symptoms delays correct care-seeking behaviour because patient expectations may not be aligned with the experience when stricken by Myocardial infarction. Therefore, it is imperative to continuously enhance public awareness in correct symptom recognition and appropriate care-seeking behaviour and to make efforts to educate individuals at risk for STEMI as well as their next of kin. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity and a sedentary lifestyle are common among people with heart failure (HF), which may lead to worse prognosis. On an already existing mHealth platform, we developed a novel tool called the Activity coach, aimed at increasing physical activity. The aim of this study was to evaluate the usability of the Activity coach and assess feasibility of outcome measures for a future efficacy trial. Methods: A mixed-methods design was used to collect data. People with a HF diagnosis were recruited to use the Activity coach for four weeks. The Activity coach educates the user about physical activity, provides means of registering daily physical activity and helps the user to set goals for the next week. The usability was assessed by analysing system user logs for adherence, reported technical issues and by interviews about user experiences. Outcome measures assessed for feasibility were objective physical activity as measured by an accelerometer, and subjective goal attainment. Progression criteria for the usability assessment and for the proposed outcomes, were described prospectively. Results: Ten people with HF were recruited, aged 56 to 78 with median age 72. Data from nine of the ten study participants were included in the analyses. Usability: The Activity coach was used 61% of the time and during the first week two study participants called to seek technical support. The Activity coach was found to be intuitive and easy to use by all study participants. An increased motivation to be more physically active was reported by six of the nine study participants. However, in spite of feeling motivated, four reported that their habits or behaviours had not been affected by the Activity coach. Feasibility: Data was successfully stored in the deployed hardware as intended and the accelerometers were used enough, for the data to be analysable. One finding was that the subjective outcome goal attainment, was challenging to collect. A proposed mitigator for this is to use pre-defined goals in future studies, as opposed to having the study participants be completely free to formulate the goals themselves. Conclusions: It was confirmed that the Activity coach was easy to use. Furthermore, it might stimulate increased physical activity in a population of people with HF, who are physically inactive. The outcomes investigated seem feasible to include in a future efficacy trial. Trial registration: ClinicalTrials.gov identifier: NCT05235763. Date of first registration: 11/02/2022. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Impact Patient or Public Contribution To explore adolescents' experiences of having a parent with heart disease.This qualitative study was performed with semi‐structured individual interviews.Interviews were conducted with 33 adolescents between 13 and 19 years old, who either had a mother or father with one of these diagnoses: ischemic heart disease, arrhythmia, heart failure, cardiac arrest or heart valve disease. The parent had been ill for at least 6 months and up to 5 years. The study was carried out in Denmark, Norway and Sweden between 2019 and 2022. The analysis was inspired by Reflexive Methodology.Three central themes emerged: Response to parental heart disease; Growing up ahead of time; and Strategies in a changed life situation. For the adolescents, heart disease was experienced as an acute and lethal disease that put their parents' lives in danger. New routines and roles not only changed everyday life within the family but they also enhanced maturity and appreciation of life. To maintain a balance in life, the adolescents pursued normality and sought a safe space to have a normal youthful life.In a period known to be significant for development, life with parental heart disease appeared as a biographical disruption because adolescents renegotiated their identity to manage their new life situation.It is important to help younger family members adapt to parental heart disease by informing them about possible reactions and supporting them in how to adapt to their new life by seeking breaks and normality.No patient or public involvement. [ABSTRACT FROM AUTHOR]

Purpose: To examine profiles in patients with heart failure (HF) regarding their exercise motivation and self-efficacy. Patients & Methods: The baseline data of patients with HF participating in the HF-Wii study were analysed. In total, 517 patients were divided into four groups based on their exercise motivation (exercise motivation index) and self-efficacy (exercise self-efficacy scale). To describe the differences in demographic and clinical variables between the groups, chi-square cross-tabulations and ANOVAs were conducted. Results: The four groups were labelled as insecure avoiders (25%), laid-back strugglers (10%), conscientious self-doubters (42%) and determined achievers (22%). Patients' profiles differ according to their motivations and self-efficacy towards exercise. Most patients were conscientious self-doubters (high motivation and low self-efficacy), and these patients had more comorbidities and lower exercise capacity compared to the other groups, which could decrease their confidence in exercising. However, only half of the patients who were determined achievers (high motivation and high self-efficacy) reached the recommended amount of physical activity per week. This indicates that motivation and self-efficacy are crucial determinants, but more factors are important for becoming more physically active. Conclusion: Understanding patients' motivations and self-efficacy are necessary in order to provide meaningful physical activity counselling and promotion. [ABSTRACT FROM AUTHOR]

Background: Patients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care. Methods: A randomised controlled trial with an embedded evaluation of intervention engagement and cost-effectiveness will be conducted to investigate the effect of eHealth intervention after hospital discharge on the self-efficacy of self-care. Eligible patients with HF or CRC will be recruited before discharge from two Norwegian university hospitals. The intervention group will use a nurse-assisted intervention—eHealth@Hospital-2-Home—for six weeks. The intervention includes remote monitoring of vital signs; patients' self-reports of symptoms, health and well-being; secure messaging between patients and hospital-based nurse navigators; and access to specific HF and CRC health-related information. The control group will receive routine care. Data collection will take place before the intervention (baseline), at the end of the intervention (Post-1), and at six months (Post-2). The primary outcome will be self-efficacy in self-care. The secondary outcomes will include measures of burden of treatment, health-related quality of life and 30- and 90-day readmissions. Sub-study analyses are planned in the HF patient population with primary outcomes of self-care behaviour and secondary outcomes of medication adherence, and readmission at 30 days, 90 days and 6 months. Patients' and nurse navigators' engagement and experiences with the eHealth intervention and cost-effectiveness will be investigated. Data will be analysed according to intention-to-treat principles. Qualitative data will be analysed using thematic analysis. Discussion: This protocol will examine the effects of the eHealth@ Hospital-2-Home intervention on self-care in two prevalent patient groups, HF and CRC. It will allow the exploration of a generic framework for an eHealth intervention after hospital discharge, which could be adapted to other patient groups, upscaled, and implemented into clinical practice. Trial registration: Clinical trials.gov (ID 301472). [ABSTRACT FROM AUTHOR]

The author reflects on the use of pocket-sized ultrasound by heart-failure nurses in daily clinical practice. Topics discussed include professional guidelines for heart-failure management programmes, common method used by nurses and physicians in heart-failure clinics which is the lung-auscultation, and feasibility and reliability of the tool.

Aim: To describe the co‐designing process of an online support programme with and for informal carers of people with heart failure. Design: A co‐design process built on core concepts and ideas embedded in co‐design methodology. Data sources: Our co‐design process included three phases involving 32 informal caregivers and 25 content creators; (1) Identification of topics and content through literature searches, focus group interviews and user group sessions; (2) Development of the online support programme and; (3) Refinement and finalization which included testing a paper prototype followed by testing the online version and testing and approval of the final version of the support programme. Outcomes: The co‐design process resulted in a support programme consisting of 15 different modules relevant to informal carers, delivered on a National Health Portal. Conclusion: Co‐design is an explorative process where researchers need to balance a range of potentially conflicting factors and to ensure that the end users are genuinely included in the process. Relevance to clinical practice: Emphasizing equal involvement of end users (e.g. carers or patients) in the design and development of healthcare interventions aligns with contemporary ideas of person‐centred care and provides a valuable learning opportunity for those involved. Furthermore, a co‐designed online support programme has the capacity to be both accessible and meet end users' information and support needs, thereby optimizing their self‐care abilities. Additionally, an online support programme provides the opportunity to address current challenges regarding scarce resources and the lack of healthcare personnel. Reporting methods: Consolidated criteria for reporting qualitative research (COREQ). Patient or public contribution: Both informal carers and content creators were involved in developing the support programme. [ABSTRACT FROM AUTHOR]

The delivery of effective healthcare entails the configuration and resourcing of health economies to address the burden of disease, including acute and chronic heart failure, that affects local populations. Increasing migration is leading to more multicultural and ethnically diverse societies worldwide, with migration research suggesting that minority populations are often subject to discrimination, socio‐economic disadvantage, and inequity of access to optimal clinical support. Within these contexts, the provision of person‐centred care requires medical and nursing staff to be aware of and become adept in navigating the nuances of cultural diversity, and how that can impact some individuals and families entrusted to their care. This paper will examine current evidence, provide practical guidance, and signpost professionals on developing cultural competence within the setting of patients with advanced heart failure who may benefit from palliative care. [ABSTRACT FROM AUTHOR]

The article presents an overview of the peer manuscript review process which is used for all manuscripts which are submitted for publication to the "European Journal of Cardiovascular Nursing". In the article the authors offer their opinions on what constitutes a good peer review and on the evaluation of scientific quality which takes place during a peer review.

An editorial is presented on population with behaviors, circumstances, and needs distinct from children and young adults. Topics include broad field of cardiovascular nursing including chronic and acute care, pediatric cardiology, adult congenital heart disease, cardiac rehabilitation, primary and secondary prevention, heart failure; and evaluation of the care of cardiac patients and building the scientific knowledge.

Aim: To explore factors associated with health-related quality of life (HRQoL) among cardiac arrest (CA) survivors treated with an implantable cardioverter-defibrillator (ICD) in relation to gender, and to compare their HRQoL with a general population.Methods: This cross-sectional study included 990 adults treated with an ICD after suffering CA. All participants received a questionnaire including demographics, comorbidities and instruments to measure HRQoL (EQ-5D-3L and HADS), ICD-related concerns (ICDC), perceived control (CAS), and type D personality (DS-14). HRQoL (EQ-5D-3L) was compared to a general Swedish population, matched for age and gender. Linear regression analyses were used to explore factors associated with HRQoL.Results: The CA survivors reported better HRQoL in EQ index and less pain/discomfort compared to the general population (p < 0.001). In contrast, they reported more problems in mobility and usual activities (p < 0.01). Problems with anxiety and depression were reported by 15.5% and 7.4% respectively. The following factors were independently associated with all aspects of worse HRQoL: being unemployed, suffering more comorbidity, perceiving less control, and having a type D personality. Further, being female and suffering ICD-related concerns were independently associated with worse HRQoL in three of the four final regression models.Conclusions: This extensive population-based study showed that most CA survivors living with an ICD rate their HRQoL as acceptable. In addition, their HRQoL is similar to a general population. Women reported worse HRQoL compared to men. Several factors associated with HRQoL were identified, and might be used when screening patients for health problems and when developing health promoting interventions. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a progressive disease associated with a high burden of symptoms, high morbidity and mortality, and low quality of life (QoL). This study aimed to evaluate the feasibility and potential outcomes of a novel multicomponent complex intervention, to inform a future full-scale randomized controlled trial (RCT) in Switzerland. Methods: We conducted a pilot RCT at a secondary care hospital for people with HF hospitalized due to decompensated HF or with a history of HF decompensation over the past 6 months. We randomized 1:1; usual care for the control (CG) and intervention group (IG) who received the intervention as well as usual care. Feasibility measures included patient recruitment rate, study nurse time, study attrition, the number and duration of consultations, intervention acceptability and intervention fidelity. Patient-reported outcomes included HF-specific self-care and HF-related health status (KCCQ-12) at 3 months follow-up. Clinical outcomes were all-cause mortality, hospitalization and days spent in hospital. Results: We recruited 60 persons with HF (age mean = 75.7 years, ± 8.9) over a 62-week period, requiring 1011 h of study nurse time. Recruitment rate was 46.15%; study attrition rate was 31.7%. Follow-up included 2.14 (mean, ± 0.97) visits per patient lasting a total of 166.96 min (mean, ± 72.55), and 3.1 (mean, ± 1.7) additional telephone contacts. Intervention acceptability was high. Mean intervention fidelity was 0.71. We found a 20-point difference in mean self-care management change from baseline to 3 months in favour of the IG (Cohens' d = 0.59). Small effect sizes for KCCQ-12 variables; less IG participants worsened in health status compared to CG participants. Five deaths occurred (IG = 3, CG = 2). There were 13 (IG) and 18 (CG) all-cause hospital admissions; participants spent 8.90 (median, IQR = 9.70, IG) and 15.38 (median, IQR = 18.41, CG) days in hospital. A subsequent full-scale effectiveness trial would require 304 (for a mono-centric trial) and 751 participants (for a ten-centre trial) for HF-related QoL (effect size = 0.3; power = 0.80, alpha = 0.05). Conclusion: We found the intervention, research methods and outcomes were feasible and acceptable. We propose increasing intervention fidelity strategies for a full-scale trial. Trial registration: ISRCTN10151805, retrospectively registered 04/10/2019. [ABSTRACT FROM AUTHOR]