Lifestyle support preferences of patients with cardiovascular diseases: What lifestyle support might work best for whom?

Background

Lifestyle support is essential in preventing and treating cardiovascular diseases (CVD), and eHealth may be an easy and affordable solution to provide this support. However, CVD patients vary in their ability and interest to use eHealth. This study investigates demographic characteristics determining CVD patients' online and offline lifestyle support preferences.

Methods

We used a cross-sectional study design. 659 CVD patients (Harteraad panel) completed our questionnaire. We assessed demographic characteristics and preferred lifestyle support type (coach, eHealth, family/friends, self-supportive).

Results

Respondents mostly preferred being self-supportive (n = 179, 27.2%), and a coach in a group or individually (n = 145, 22.0%; n = 139, 21.1%). An app/internet to work independently (n = 89, 13.5%) or being in touch with other CVD patients (n = 44, 6.7%) was least preferred. Men were more likely to prefer being supported by family/friends (p = .016) or self-supportive (p < .001), while women preferred a coach individually or via an app/internet (p < .001). Older patients mostly preferred self-support (p = .001). Patients with low social support were more likely to prefer being coached individually (p < .001), but not support from family/friends (p = .002).

Conclusion

Men and older patients are more interested in being self-supportive, and patients with lower levels of social support could need extra support outside their social network. eHealth could provide a solution, but attention should be paid to spike interest for digital interventions among certain groups.

Impact of admission hours on each stage of care and total reperfusion delays in patients with ST elevation myocardial infarction

BACKGROUND

ST segment elevation myocardial infarction (STEMI) is preferably treated by prompt primary percutaneous coronary intervention (pPCI). Delays in initial stages of care of STEMI patients admitted off versus routine hours are controversial. The aim of this study was to evaluate time periods in each stage of care of STEMI patients submitted to pPCI in a private tertiary hospital during on- vs. off-hours, and the adherence to current guidelines recommended times.

METHODS

consecutive STEMI patients admitted 2013-2019 who underwent pPCI were enrolled in this cohort study. Time periods were prospectively registered and other variables retrieved from electronic medical records. Primary outcomes were the time periods of each stage of care, since patient arrival in the emergency room (ER) until reperfusion of the culprit artery, performed during on-hours (weekdays, from 08:00 AM to 07:59 PM) or off-hours (all other days and time periods, or holidays).

RESULTS

218 patients were included, 131 (60%) presented off-hours, with longer time periods between calling the catheterization laboratory staff until reperfusion, [55 min × 72 min; P < 0.001] and ER door-to-reperfusion [73 min × 98 min; P < 0.001]. Exploratory analysis by year suggested a decreasing reperfusion delay during on-hours admissions. In most years, total time for reperfusion exceeded the sixty minutes frame recommended in current North American guidelines, for both on- and off-hours admissions. Considering the ninety minutes recommendation of the European guideline, only on-hour admissions were in accordance during most years.

CONCLUSIONS

STEMI patients, particularly when admitted off-hours, have lags in some stages of care, culminating in delayed myocardial reperfusion greater than recommended in current guidelines.

ECG Images dataset of Cardiac and COVID-19 Patients

The study contains the dataset of ECG images of Cardiac and COVID-19 patients. This rare dataset contains 1937 distinct patient records, data is collected using ECG Device 'EDAN SERIES-3' installed in Cardiac Care and Isolation Units of different health care institutes across Pakistan. The collected ECG images data were manually reviewed by medical professors using Telehealth ECG diagnostic system, under the supervision of senior medical professionals with experience in ECG interpretation. The manual reviewing process of ECG images took several months to review the five distinct categories (COVID-19, Abnormal Heartbeat, Myocardial Infarction (MI), Previous History of MI, and Normal Person). The collected data contains 12 leads-based ECG images dataset can be used by Data Scientist, IT Professional and Medical Research Institutes to design, compare, fine-tune classical techniques and Deep learning methods in studies focused on COVID-19, Arrhythmia, and other cardiovascular conditions. The dataset contains rare categories of patients that may be used for the development of automatic diagnosis tool for healthcare institutes.

ECG Images dataset of Cardiac and COVID-19 Patients

The study contains the dataset of ECG images of Cardiac and COVID-19 patients. This rare dataset contains 1937 distinct patient records, data is collected using ECG Device 'EDAN SERIES-3' installed in Cardiac Care and Isolation Units of different health care institutes across Pakistan. The collected ECG images data were manually reviewed by medical professors using Telehealth ECG diagnostic system, under the supervision of senior medical professionals with experience in ECG interpretation. The manual reviewing process of ECG images took several months to review the five distinct categories (COVID-19, Abnormal Heartbeat, Myocardial Infarction (MI), Previous History of MI, and Normal Person). The collected data contains 12 leads-based ECG images dataset can be used by Data Scientist, IT Professional and Medical Research Institutes to design, compare, fine-tune classical techniques and Deep learning methods in studies focused on COVID-19, Arrhythmia, and other cardiovascular conditions. The dataset contains rare categories of patients that may be used for the development of automatic diagnosis tool for healthcare institutes.

ECG Images dataset of Cardiac and COVID-19 Patients

The study contains the dataset of ECG images of Cardiac and COVID-19 patients. This rare dataset contains 1937 distinct patient records, data is collected using ECG Device 'EDAN SERIES-3' installed in Cardiac Care and Isolation Units of different health care institutes across Pakistan. The collected ECG images data were manually reviewed by medical professors using Telehealth ECG diagnostic system, under the supervision of senior medical professionals with experience in ECG interpretation. The manual reviewing process of ECG images took several months to review the five distinct categories (COVID-19, Abnormal Heartbeat, Myocardial Infarction (MI), Previous History of MI, and Normal Person). The collected data contains 12 leads-based ECG images dataset can be used by Data Scientist, IT Professional and Medical Research Institutes to design, compare, fine-tune classical techniques and Deep learning methods in studies focused on COVID-19, Arrhythmia, and other cardiovascular conditions. The dataset contains rare categories of patients that may be used for the development of automatic diagnosis tool for healthcare institutes.

Designing a commercial bundle for cardiac procedures: The Percutaneous Coronary Intervention Episode Payment Model

BACKGROUND

Cardiac interventions account for a significant share of overall healthcare spending and have been the focus of several large-scale interventions to develop effective bundled payments. To date, however, none have proven successful in commercially insured populations. In 2018, we worked with Hawaii Medical Service Association (HMSA), the Blue Cross Blue Shield of Hawaii, to design a novel commercial bundled payment for percutaneous coronary interventions, the Percutaneous Coronary Intervention Episode Payment Model (PCI EPM).

METHODS

Descriptive analysis of HMSA's PCI EPM, including its inclusion criteria, contents of the bundle, target prices, shared savings model, and incentivized quality metrics. We also compare HMSA's PCI EPM to Medicare's Bundled Payment for Care Improvement programs and the cancelled Cardiac Care Model.

RESULTS

HMSA's PCI EPM was designed through an iterative process with cardiologists and is the first commercial bundle to specifically target a cardiac procedure. PCI EPM incorporates site neutrality and incentivizes providers to shift care to the outpatient setting when medically permissible. Compared to existing non-commercial models, PCI EPM incorporate first-dollar shared savings and incentivized fewer quality metrics.

CONCLUSIONS

Reviewing features of the Percutaneous Coronary Intervention Episode Payment Model in comparison to existing Medicare programs is intended to help guide health plan and health policymakers when designing programs and policies related to cardiac interventions.

IMPLICATIONS

Bundled commercial payments for interventional cardiology procedures are promising and should continue to be further explored.

LEVEL OF EVIDENCE

VI.

Improving clinical outcomes and patient satisfaction among patients with coronary artery disease: an example of enhancing regional integration between a cardiac centre and a referring hospital

BACKGROUND

Value-based healthcare (VBHC) is a promising strategy to increase patient value. For a successful implementation of VBHC, intensive collaborations between organizations and integrated care delivery systems are key conditions. Our aim was to evaluate the effects of a pilot study regarding enhancing regional integration between a cardiac centre and a referring hospital on patient-relevant clinical outcomes and patient satisfaction.

METHODS

The study population consisted of a sample of patients treated for coronary artery disease by use of a coronary artery bypass graft (CABG) or a percutaneous coronary intervention between 2011 and 2016. Since 2013, the two hospitals have implemented different interventions to improve clinical outcomes and the degree of patient satisfaction, e.g. improvement of communication, increased consultant capacity, introduction of outpatient clinic for complex patients, and improved guideline adherence. To identify intervention effects, logistic regression analyses were conducted. Patients' initial conditions, like demographics and health status, were included in the model as predictors. Clinical data extracted from the electronic health records and the hospitals' cardiac databases as well as survey-based data were used.

RESULTS

Our findings indicate a non-significant increase of event-free survival of patients treated for coronary artery disease between 2014 and 2016 compared to patients treated between 2011 and 2013 (97.4% vs. 96.7% respectively). This non-significant improvement over time has led to significant better outcomes for patients referred from the study referring hospital compared to patients referred from other hospitals. The level of patient satisfaction (response rate 32.2%; 216 out of 669) was improved and reached statistically significant higher scores regarding patient information and education (p = .013), quality of care (p = .007), hospital admission and stay (p = .032), personal contact with the physician (p = .024), and total impression (p = .007).

CONCLUSIONS

This study shows a promising effect of regional integration. An intensified collaboration in the care chain, organized in a structured manner between a cardiac centre and a referring hospital and aiming at high quality, resulted in successful improvement of clinical outcomes and degree of patient satisfaction. The applied method may be used as a starting point of regional integration with other referring hospitals. We encourage others to organize the whole care chain to continuously improve patient-relevant outcomes and patient satisfaction.

TRIAL REGISTRATION

ISRCTN11311830. Registered 01 October 2018 (retrospectively registered).

Adaptation and psychometric properties of the Norwegian version of the heart continuity of care questionnaire (HCCQ)

Background

Continuity of cardiac care after hospital discharge is a priority, especially as healthcare systems become increasingly complex and fragmented. There are few available instruments to measure continuity of cardiac care, especially from the patient perspective. The aim of this study was (1) to translate and adapt the Heart Continuity of Care Questionnaire (HCCQ) to conditions in Norway, and (2) to determine its psychometric properties in self-report format administered to patients after percutaneous coronary intervention (PCI).

Methods

The HCCQ was first translated into Norwegian from the original English version, following a widely used cross-cultural adaptation process. Data were collected before hospital discharge and in a follow-up after 2 months. To assess psychometric properties, a confirmatory factor analysis (CFA) was performed and three aspects of construct validity were evaluated: structural validity, hypotheses testing and cross-cultural validation. Internal consistency of the HCCQ subscales was calculated using Cronbach’s alpha, while intra-class correlation (ICC) was used to assess test-retest reliability. Additionally, socio-demographic and patient-reported data were collected to correlate with HCCQ scores.

Results

Of those included at baseline, 436 (76%) completed the questionnaires after 2 months. CFA suggested that the fit of the HCCQ data to a 3-factor model was modest (RMSEA = 0.11, CFI = 0.90, TLI = 0.90). However, convergent validity was satisfactory, based on existing research. Internal consistency was good, as indicated by its Cronbach’s alphas: total continuity of care (0.95); informational (0.93), relational (0.87), and management (0.89) continuity. The ICC for the total HCCQ score was 0.80 (95% CI [0.71, 0.87] p < 0.001). As indicated by negative care experiences (rated as 1 or 2 on the five-point scale), patients seemed to have limited knowledge about medical treatment, lifestyle modification and follow-up after PCI. Participation in cardiac rehabilitation and longer consultations with the general practitioner after hospital discharge were positively correlated with better continuity of care.

Conclusions

Implementation of the HCCQ will likely support healthcare providers and researchers in identifying problem areas of continuity of cardiac care and in evaluating interventions aimed at improving continuity of care.

Government health insurance and spatial peer effects: New evidence from India

What is the role of spatial peers in diffusion of information about health care? We use the implementation of a health insurance program in Karnataka, India that provided free tertiary care to poor households to explore this issue. We use administrative data on location of patient, condition for which the patient was hospitalized and date of hospitalization (10,507 observations) from this program starting November 2009 to June 2011 for 19 months to analyze spatial and temporal clustering of tertiary care. We find that the use of healthcare today is associated with an increase in healthcare use in the same local area (group of villages) in future time periods and this association persists even after we control for (1) local area fixed effects to account for time invariant factors related to disease prevalence and (2) local area specific time fixed effects to control for differential trends in health and insurance related outreach activities. In particular, we find that 1 new hospitalization today results in 0.35 additional future hospitalizations for the same condition in the same local area. We also document that these effects are stronger in densely populated areas and become pronounced as the insurance program becomes more mature suggesting that word of mouth diffusion of information might be an explanation for our findings. We conclude by discussing implications of our results for healthcare policy in developing economies.

Efficiency and safety of coronary CT angiography compared to standard care in the evaluation of patients with acute chest pain: a Canadian study

The optimal assessment of patients with chest pain and possible acute coronary syndrome (ACS) remains a diagnostic dilemma for emergency physicians. Cardiac computed tomographic angiography (CCTA) may identify patients who can be safely discharged home from the emergency department (ED). The objective of the study was to compare the efficiency and safety of CCTA to standard care in patients presenting to the ED with low- to intermediate-risk chest pain. This was a single-center before-after study enrolling ED patients with chest pain and low to intermediate risk of ACS, before and after implementing a cardiac CT-based management protocol. The primary outcome was efficiency (time to diagnosis). Secondary outcomes included safety (30-day incidence of major adverse cardiovascular events (MACE)) and length of stay in the ED. We enrolled 258 patients: 130 in the standard care group and 128 in the cardiac CT-based management group. The cardiac CT group had a shorter time to diagnosis of 7.1 h (IQR 5.8-14.0) compared to 532.9 h (IQR 312.8-960.5) for the standard care group (p < 0.0001) but had a longer length of stay in the ED of 7.9 h (IQR 6.5-10.8) versus 5.5 h (IQR 3.9-7.7) (p < 0.0001). The MACE rate was 1.6 % in the standard care group and 0 % in the cardiac CT group. In conclusion, a cardiac CT-based management strategy to rule out ACS in ED patients with low- to intermediate-risk chest pain was safe and led to a shorter time to diagnosis but increased length of stay in the ED.

The impact of telemedicine in cardiac critical care

Telemedicine was recognized in the 1970s as a legitimate entity for applying the use of modern information and communications technologies to the delivery of health services. Telecardiology is one of the fastest growing fields in telemedicine. The advancement of technologies and Web-based applications has allowed better transmission of health care delivery. This article discusses current advancements, the scope of telemedicine in cardiology, and its application to the critically ill. The impact of telecardiology consultation continues to evolve and includes many promising applications with potential positive implications for admission rates, morbidity, and mortality.