1
|
Mascheroni J, Stockburger M, Patwala A, Mont L, Rao A, Retzlaff H, Garweg C, Verbelen T, Gallagher AG. Effect of Metrics-Based Simulation Training to Proficiency on Procedure Quality and Errors Among Novice Cardiac Device Implanters: The IMPROF Randomized Trial. JAMA Netw Open 2023; 6:e2322750. [PMID: 37651144 PMCID: PMC10472192 DOI: 10.1001/jamanetworkopen.2023.22750] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 09/01/2023] Open
Abstract
Importance In cardiac device implant training, there is no common system to objectively assess trainees' ability to perform tasks at predetermined performance levels before in vivo practice; therefore, patients are potentially exposed to risks related to operators' early learning curve. Objective To assess the effect on implant performance quality of novel metrics-based simulation training to proficiency (proficiency-based progression [PBP]) vs traditional simulation-based training (SBT). Design, Setting, and Participants In this prospective randomized trial, conducted between March 8, 2022 and November 24, 2022, novice implanters were randomized (blinded) 1:1 to participate in an SBT curriculum (procedural knowledge e-learning and in-person simulation training) at an international skills training center, with proficiency demonstration requirements at each training stage for advancing (PBP approach) or without the requirements. Ultimately, trainees performed a cardiac resynchronization therapy (CRT) implant using virtual reality simulation. The procedure was video-recorded and subsequently scored using previously validated metrics by 2 independent assessors blinded to group. Physicians who had already implanted more than 20 pacemakers or defibrillators and fewer than 200 CRT systems as the first operator were eligible. Thirty-two implanters from 10 countries voluntarily enrolled in the training program and were randomized; 30 (15 per group) started and completed training. Data analysis was performed from November 27 to December 22, 2022. Intervention Training with PBP vs SBT. Main Outcome and Measures The primary outcome comprised 4 objectively assessed performance metrics derived from the video-recordings: number of procedural steps completed, errors, critical errors, and all errors combined. Results Baseline experience of the 30 participants (19 [63%] male; mean [SD] number of years in implant practice, 2.0 [1.8]; median [IQR] number of implanted pacemakers or defibrillators, 47.5 [30.0-115.0]; median [IQR] number of implanted CRT systems, 3.0 [1.25-10.0]) was similar between study groups. Compared with the SBT group, the PBP group completed 27% more procedural steps (median [IQR], 31 [30-32] vs 24 [22-27]; P < .001) and made 73% fewer errors (median [IQR], 2 [1-3] vs 7 [5-8]; P < .001), 84% fewer critical errors (median [IQR], 1 [0-1] vs 3 [3-5]; P < .001), and 77% fewer all errors combined (errors plus critical errors) (median [IQR], 3 [1-3] vs 11 [8-12]; P < .001); 14 of the 15 PBP trainees (93%) demonstrated the predefined target performance level vs 0 of the 15 SBT trainees. Conclusions and Relevance In this randomized trial, the PBP approach to novice implanter training generated superior objectively assessed performance vs SBT. If implemented broadly and systematically, PBP training may ensure safe and effective performance standards before trainees proceed to (supervised) in vivo practice. Future studies are needed to verify implications on procedure-related patient complications. Trial Registration ClinicalTrials.gov Identifier: NCT05952908.
Collapse
Affiliation(s)
- Jorio Mascheroni
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Rhythm Management Training and Education, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Martin Stockburger
- Department of Cardiology and Internal Medicine, Havelland Kliniken, Nauen, Germany
- Department of Cardiology and Angiology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Ashish Patwala
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Lluís Mont
- Department of Cardiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Madrid, Spain
| | - Archana Rao
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Christophe Garweg
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, UZ Leuven, Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| | - Anthony G. Gallagher
- Orsi Academy, Melle, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- School of Medicine, Faculty of Life and Health Sciences, Ulster University, Londonderry, United Kingdom
| |
Collapse
|
2
|
Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Thomas Lumbers R, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, van Thiel G, van Bochove K, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best practice framework for the use of structured electronic healthcare records in clinical research. Eur Heart J 2022; 43:3578-3588. [PMID: 36208161 PMCID: PMC9452067 DOI: 10.1093/eurheartj/ehac426] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Big data is central to new developments in global clinical science aiming to improve the lives of patients. Technological advances have led to the routine use of structured electronic healthcare records with the potential to address key gaps in clinical evidence. The covid-19 pandemic has demonstrated the potential of big data and related analytics, but also important pitfalls. Verification, validation, and data privacy, as well as the social mandate to undertake research are key challenges. The European Society of Cardiology and the BigData@Heart consortium have brought together a range of international stakeholders, including patient representatives, clinicians, scientists, regulators, journal editors and industry. We propose the CODE-EHR Minimum Standards Framework as a means to improve the design of studies, enhance transparency and develop a roadmap towards more robust and effective utilisation of healthcare data for research purposes.
Collapse
Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Division of Guy’s St Thomas’ NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine Sciences, King’s College London, London, UK
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland and Ava AG, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
- British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Wim Goettsch
- National Health Care Institute (ZIN), Diemen, Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Harry Hemingway
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Barts Health NHS Trust and University College London Hospitals NHS Trust
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Research, Education & Development, Royal Brompton and Harefield Hospitals, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Central Michigan University College of Medicine, Midlands, MI, USA
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Carl Steinbeisser
- Bayer AG, Leverkusen, Germany
- Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science AI, Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | | | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Diederick E Grobbee
- Department of Epidemiology, University Medical Centre Utrecht, Division Julius Centrum, Utrecht, Netherlands
| |
Collapse
|
3
|
Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Lumbers RT, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, Thiel GV, Bochove KV, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best-practice framework for the use of structured electronic health-care records in clinical research. Lancet Digit Health 2022; 4:e757-e764. [PMID: 36050271 DOI: 10.1016/s2589-7500(22)00151-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Abstract
Big data is important to new developments in global clinical science that aim to improve the lives of patients. Technological advances have led to the regular use of structured electronic health-care records with the potential to address key deficits in clinical evidence that could improve patient care. The COVID-19 pandemic has shown this potential in big data and related analytics but has also revealed important limitations. Data verification, data validation, data privacy, and a mandate from the public to conduct research are important challenges to effective use of routine health-care data. The European Society of Cardiology and the BigData@Heart consortium have brought together a range of international stakeholders, including representation from patients, clinicians, scientists, regulators, journal editors, and industry members. In this Review, we propose the CODE-EHR minimum standards framework to be used by researchers and clinicians to improve the design of studies and enhance transparency of study methods. The CODE-EHR framework aims to develop robust and effective utilisation of health-care data for research purposes.
Collapse
Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Department of Cardiology, Division of Heart and Lungs, University of Utrecht, Utrecht, Netherlands.
| | - Folkert W Asselbergs
- Health Data Research UK London, London, UK; Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research, Charité Universitätsmedizin, Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Colin Baigent
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK London, London, UK; University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Cardiovascular Medicine Sciences, King's College London, London, UK
| | - Filippo Crea
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland; Ava, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK London, London, UK; Alan Turing Institute, London, UK; British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism, Biopharmaceuticals, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wim Goettsch
- University Medical Centre Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands; National Health Care Institute, Diemen, Netherlands
| | | | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK London, London, UK; Institute of Health Informatics, Barts Health NHS Trust and University College London Hospitals NHS Trust, London, UK
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland; Research, Education and Development, Royal Brompton and Harefield Hospitals, London, UK; Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA; College of Medicine, Central Michigan University, Midlands MI, USA
| | | | - Carl Steinbeisser
- Bayer, Leverkusen, Germany; Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science and Artificial Intelligence, Biopharmaceuticals, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Center for Health Sciences and Primary Care, University of Utrecht, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece; European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | - Wim Weber
- The British Medical Journal, London, UK
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | |
Collapse
|
4
|
Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Lumbers RT, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, van Thiel G, van Bochove K, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best practice framework for the use of structured electronic healthcare records in clinical research. BMJ 2022; 378:e069048. [PMID: 36562446 PMCID: PMC9403753 DOI: 10.1136/bmj-2021-069048] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Birmingham, UK
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Division of Guy's St Thomas' NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine Sciences, King's College London, London, UK
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland and Ava AG, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
- British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Wim Goettsch
- National Health Care Institute (ZIN), Diemen, Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Harry Hemingway
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Barts Health NHS Trust and University College London Hospitals NHS Trust
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Central Michigan University College of Medicine, Midlands, MI, USA
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Carl Steinbeisser
- Bayer AG, Leverkusen, Germany
- Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science AI, Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | | | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Diederick E Grobbee
- Department of Epidemiology, University Medical Centre Utrecht, Division Julius Centrum, Utrecht, Netherlands
| |
Collapse
|
5
|
Wijtvliet EPJP, Tieleman RG, van Gelder IC, Pluymaekers NAHA, Rienstra M, Folkeringa RJ, Bronzwaer P, Elvan A, Elders J, Tukkie R, Luermans JGLM, Van Asselt ADIT, Van Kuijk SMJ, Tijssen JG, Crijns HJGM. Nurse-led vs. usual-care for atrial fibrillation. Eur Heart J 2021; 41:634-641. [PMID: 31544925 DOI: 10.1093/eurheartj/ehz666] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/15/2019] [Accepted: 08/29/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nurse-led integrated care is expected to improve outcome of patients with atrial fibrillation compared with usual-care provided by a medical specialist. METHODS AND RESULTS We randomized 1375 patients with atrial fibrillation (64 ± 10 years, 44% women, 57% had CHA2DS2-VASc ≥ 2) to receive nurse-led care or usual-care. Nurse-led care was provided by specialized nurses using a decision-support tool, in consultation with the cardiologist. The primary endpoint was a composite of cardiovascular death and cardiovascular hospital admissions. Of 671 nurse-led care patients, 543 (81%) received anticoagulation in full accordance with the guidelines against 559 of 683 (82%) usual-care patients. The cumulative adherence to guidelines-based recommendations was 61% under nurse-led care and 26% under usual-care. Over 37 months of follow-up, the primary endpoint occurred in 164 of 671 patients (9.7% per year) under nurse-led care and in 192 of 683 patients (11.6% per year) under usual-care [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.69 to 1.04, P = 0.12]. There were 124 vs. 161 hospitalizations for arrhythmia events (7.0% and 9.4% per year), and 14 vs. 22 for heart failure (0.7% and 1.1% per year), respectively. Results were not consistent in a pre-specified subgroup analysis by centre experience, with a HR of 0.52 (95% CI 0.37-to 0.71) in four experienced centres and of 1.24 (95% CI 0.94-1.63) in four less experienced centres (P for interaction <0.001). CONCLUSION Our trial failed to show that nurse-led care was superior to usual-care. The data suggest that nurse-led care by an experienced team could be clinically beneficial (ClinicalTrials.gov NCT01740037). TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT01740037).
Collapse
Affiliation(s)
- E P J Petra Wijtvliet
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Department of Cardiology, Martini Hospital, Van Swietenplein 1, 9728 NT Groningen, The Netherlands
| | - Robert G Tieleman
- Department of Cardiology, Martini Hospital, Van Swietenplein 1, 9728 NT Groningen, The Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Nikki A H A Pluymaekers
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Richard J Folkeringa
- Department of Cardiology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | - Patrick Bronzwaer
- Department of Cardiology, Zaans Medical Centre, Kon. Julianaplein 58, 1502 DV Zaandam, The Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Jan Elders
- Department of Cardiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Raymond Tukkie
- Department of Cardiology, Spaarne Hospital, Haarlem, The Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - A D I Thea Van Asselt
- Department of Epidemiology, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Sander M J Van Kuijk
- Department of Clinical Epidemiology, Medical Technology Assessment, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Jan G Tijssen
- Amsterdam University Medical Centre, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | | |
Collapse
|
6
|
Mascheroni J, Mont L, Stockburger M, Patwala A, Retzlaff H, Gallagher AG. The imperative of consistency and proficiency in cardiac devices implant skills training. Open Heart 2021; 8:e001629. [PMID: 33972405 PMCID: PMC8112444 DOI: 10.1136/openhrt-2021-001629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jorio Mascheroni
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Lluís Mont
- Department of Cardiology, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Martin Stockburger
- Department of Cardiology and Internal Medicine, Havelland Kliniken, Nauen, Germany
- Department of Cardiology and Angiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Ashish Patwala
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, UK
| | | | - Anthony G Gallagher
- Orsi Academy, Melle, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- School of Medicine, Faculty of Life and Health Sciences, Ulster University, Londonderry, UK
| |
Collapse
|
7
|
Baldewijns K, Brunner-La Rocca HP, de Maesschalck L, Devillé A, Boyne J. Unravelling heart failure nurses' education: Content comparison of heart failure nurses' education in three European Society of Cardiology states and the Heart Failure Association heart failure curriculum. Eur J Cardiovasc Nurs 2019; 18:711-719. [PMID: 31322435 DOI: 10.1177/1474515119863179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The European Society of Cardiology (ESC) guidelines state that heart failure nurse specialists (heart-failure nurses) with specific competences are essential for a successful heart-failure-management programme. Thus, the Heart Failure Association (HFA) of the ESC developed the heart failure nurse curriculum (HFA curriculum). Several ESC member states developed cardiovascular education programmes to enable nurses to deliver high specialist care, but little is known of whether these curricula are in line with the HFA curriculum. Therefore, this paper describes the extent to which cardiovascular education programmes in Belgium, The Netherlands and Germany correspond to the HFA curriculum. METHODS AND RESULTS A case study approach was adopted to obtain an in-depth understanding of the programme contents in relation to the HFA curriculum. For this purpose, representatives of the educational programmes and/or delegates of the national cardiovascular nursing organization shared their educational curricula. All of the studied cardiovascular education programmes aim to provide heart failure and/or cardiovascular nurses with essential competences for implementation of evidence based and guideline derived care. However, every cardiovascular education programme has a different focus/area of attention. Cardiovascular education in Belgium discusses aspects of all core-learning objectives of the HFA curriculum and emphasizes mostly knowledge aspects of these. Learning objectives in cardiovascular education in The Netherlands focus on chronic diseases in general and on learning objectives concerning patient education, support in self-care and management of device and pharmacological therapy. Cardiovascular education in Germany discusses most learning objectives; however, not all learning objectives receive equal attention. CONCLUSIONS Although local cardiovascular education programmes adopt certain aspects of the HF curriculum, the curriculum as a whole is not adopted.
Collapse
Affiliation(s)
- Karolien Baldewijns
- Mobilab&Care@thomasmore, Geel, Belgium.,Maastricht University Medical Centre, Cardiology Department, Maastricht, the Netherlands
| | | | | | | | - Josiane Boyne
- Maastricht University Medical Centre, Cardiology Department, Maastricht, the Netherlands
| |
Collapse
|
8
|
De Caterina R, Kelly P, Monteiro P, Deharo JC, de Asmundis C, López-de-Sá E, Weiss TW, Waltenberger J, Steffel J, de Groot JR, Levy P, Bakhai A, Zierhut W, Laeis P, Kerschnitzki M, Reimitz PE, Kirchhof P. Characteristics of patients initiated on edoxaban in Europe: baseline data from edoxaban treatment in routine clinical practice for patients with atrial fibrillation (AF) in Europe (ETNA-AF-Europe). BMC Cardiovasc Disord 2019; 19:165. [PMID: 31299906 PMCID: PMC6625115 DOI: 10.1186/s12872-019-1144-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/27/2019] [Indexed: 01/26/2023] Open
Abstract
Background Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have substantially improved anticoagulation therapy for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF). The available routine care data have demonstrated the safety of different NOACs; however, such data for edoxaban are scarce. Here, we report baseline characteristics of 13,638 edoxaban-treated patients with AF enrolled between November 2016 and February 2018. Methods ETNA-AF-Europe is a multinational, multi-centre, post-authorisation, observational study conducted in 825 sites in 10 European countries. Patients will be followed up for four years. Results Overall, 13,980 patients were enrolled of which 342 patients were excluded from the analysis. Mean patient age was 73.6 years with an average creatinine clearance of 69.4 mL/min. 56.6% were male. The calculated CHA2DS2-VASc and HAS-BLED mean scores were 3.1 and 2.6, respectively. Overall, 3.3, 14.6 and 82.0% of patients had low (CHA2DS2-VASc = 0), intermediate (CHA2DS2-VASc = 1) and high (CHA2DS2-VASc≥2) risks of stroke, respectively. High-risk patients (those with prior stroke, prior major bleeding, prior intracranial bleed or CHA2DS2-VASc ≥4) comprised 38.4% of the overall population. For 75.1% of patients edoxaban was their first anticoagulant prescription, whilst 16.9% switched from a VKA and 8.0% from another NOAC. A total of 23.4% of patients in ETNA-AF-Europe received the reduced dose of edoxaban 30 mg. Overall, 83.8% of patients received an edoxaban dose in line with the criteria outlined in the label. Conclusion Edoxaban was predominantly initiated in older, often anticoagulation-naïve, unselected European patients with AF, with a good overall adherence to the approved label. Trial registration NCT02944019; Date of registration: October 24, 2016.
Collapse
Affiliation(s)
| | - Peter Kelly
- HRB Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland
| | - Pedro Monteiro
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | | | | | - Thomas W Weiss
- Karl Landsteiner Institute for Cardiometabolics and SFU, Vienna, Austria
| | | | - Jan Steffel
- University Hospital of Zurich, Zürich, Switzerland
| | - Joris R de Groot
- Amsterdam University Medical Centers/University of Amsterdam, Amsterdam, The Netherlands
| | - Pierre Levy
- Université Paris-Dauphine, PSL Research University, Paris, France
| | - Ameet Bakhai
- Royal Free London NHS Foundation Trust, Chase Farm Hospital, London, UK
| | | | | | | | | | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, SWBH and UHB NHS Trusts, IBR 136, Wolfson Drive, Birmingham, B15 2TT, UK. .,The Atrial Fibrillation NETwork (AFNET), Münster, Germany.
| | | |
Collapse
|