Phenotyping patient-reported health profiles in octogenarians with coronary artery disease – a latent profile analysis

Background

Percutaneous coronary intervention (PCI) has demonstrated to be an effective treatment strategy also in octogenarian patients (≥80 years). However, limited studies describe patient-reported outcomes in older adults two months after the PCI procedure.

Purpose

To identify latent health profiles concerning fatigue, generic and disease-specific physical and mental health, anxiety and depression, insecurity, dependency and angina frequency. Further, to investigate if these profiles were associated with sex or cohabitation status.

Method

A prospective cohort multicenter study including 3417 patients was conducted. The following patient-reported outcome measures were used: Level of fatigue was assessed using de novo created questions. Generic physical and mental health was assessed using RAND-12. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Disease-specific physical and mental health status, insecurity and dependency were assessed with Myocardial Infarction Dimensional Assessment Scale, and disease-specific physical limitation, quality of life and angina frequency was assessed with Seattle Angina Questionnaire (SAQ-7). All scales were converted to a 0–100 scale (worst to best). Latent profile analysis was used for phenotyping health profiles and multinomial logistic regression analysis for investigating the association of sex and cohabitation status across health profiles.

Result

A total of 318 octogenarians were included. The mean age was 83.6 years, and 69% were males. Three health profiles differing in the level of fatigue, health status, insecurity and dependency and angina frequency were identified (Figure 1). Health profile 1 (26.1%) represents “Low-level of life satisfaction, high level of insecurity and dependency and monthly frequency of angina”. Health profile 2 (38.1%) represents “Medium-level of life satisfaction, medium-level of insecurity and dependency and monthly frequency of angina”. Health profile 3 (35.8%) represents “High-level of life satisfaction, low level of insecurity and dependency and angina free”. Importantly, female sex was strongly associated with being classified into Health profile 1 compared to Health profile 3 [OR 3.6, 95% CI 1.3–7.9]. Living alone however, did not predict a likelihood of being classified into any particular health profile.

Conclusion

We identified three unique health profiles of octogenarians with coronary artery disease. A quarter of the participants were classified into the “Low-level of life satisfaction” profile. In addition, female sex was strongly associated with being identified into the “Low-level of life satisfaction” profile. These result suggest a need for a more tailored and patient-centered aftercare in octogenarians undergoing PCI.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): MTG Holding AS

eHealth technology use and eHealth literacy after percutaneous coronary intervention

AIMS

Electronic health (eHealth) sources have great potential to improve patients' access to health information for self-management of secondary prevention after percutaneous coronary intervention (PCI). It remains unclear, however, whether patients are health-related digitally active and whether they have sufficient eHealth literacy. This study aimed to determine the extent to which patients after PCI are health-related digitally active at baseline, two and six months after PCI, and to determine the association between patients' eHealth literacy and their health-related digital activity.

METHODS AND RESULTS

This multicentre cohort study included patients at three large referral PCI centres in Norway (n = 1970). Data was collected from medical records, national registries, and patients' self-reports. The eHealth Literacy Scale (eHEALS) assessed patients' eHealth literacy. At baseline, 67% had used the internet to find health information. The mean eHEALS score was 25.71 (SD 6.22), illustrating a lower level of eHealth literacy. There were substantial associations between eHealth literacy and use of the internet to find health information (Coef. 10.90, 95% CI 8.05-14.57). At the two-month follow-up, there were substantial associations between baseline eHealth literacy and use of the internet to find information about health, prevention, illness, or treatment (OR 1.19, 95% CI 1.14-1.24) and use of health applications (OR 1.15, 95% CI 1.08-1.22).

CONCLUSION

This study provides evidence that patients' level of eHealth literacy after PCI is associated to how patients use, and can make use of, eHealth technology for health information.

REGISTRATION

ClinicalTrials.gov (NCT03810612).

Health literacy and physical and mental health status in octogenarian patients with coronary artery disease - a prospective cohort multicentre study

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): MTG Holding AS

Introduction

The number of octogenarians (≥80 years of age) receiving percutaneous coronary intervention (PCI) is rising. Evidence supports that PCI improves quality of life and functional status in this group. Optimal health-promoting behaviour is strongly influenced by health literacy. However, there is limited knowledge about the association between health literacy, physical and mental health status in octogenarians.

Purpose

To determine if octogenarians health literacy is associated with generic and disease-specific physical and mental health status after PCI.

Methods

A prospective cohort study recruited 3417 participants from seven Danish and Norwegian PCI centres, and was conducted from June 2017 until May 2019. Multiple linear regression analysis was used. Health literacy was assessed by four of the nine scales from the Health Literacy Questionnaire (HLQ) (were higher score are better); "Social support for health" (scale range 1-4) "Appraisal of health information", (scale range 1-4) "Ability to find good health information" (scale range 1-5) and "Understand health information well enough to know what to do" (scale range 1-5). Generic physical and mental health status was assessed with RAND-12 at baseline (scale range 0-100, were higher score are better). After two months, disease-specific physical and mental health status was assessed with Myocardial Infarction Dimensional Assessment Scale (scale range 0-100, were lower score are better). Socio-demographic (age, gender, cohabitation status, education) and clinical variables (number of comorbidities) were included as covariates.

Results

In all, 318 octogenarians with mean age 83.4 years (range 80-96) participated, of which 69% were males. Three aspects of health literacy, "Social support for health", "Ability to find good health information" and "Understand health information well enough to know what to do", were significantly associated with health status. Specifically, for a unit increase of "Social support for health", the generic mental health status increased by 3 units (B: 3.0 [0.2 to 5.8] P=0.034). Further, a unit increase of "Ability to find good health information" was associated with a significant 4.2 higher disease-specific physical health and significant 5.3 higher disease-specific mental health (B:-4.2 [-8.0 to -0.4] P=0.029, B:-5.3 [-9.0 to -1.6] P=0.005, respectively). Finally, for a unit increase of "Understand health information well enough to know what to do" the disease-specific physical health improved by 5.1 units (B:-5.1 [-9.7 to -0.5] P=0.029) and disease-specific mental health improved by 5.2 units (B:-5.2 [-9.7 to -0.7] P=0.025).

Conclusion

In this study, we found that elements of health literacy were associated with both physical and mental health status in octogenerians. These findings highlight the importance of adequate health literacy and the need to support those with lower health literacy following PCI.

Had percutaneous coronary intervention, now what? Searching the internet for health information

Background/Introduction

Health information and secondary prevention strategies after percutaneous coronary intervention (PCI) are pivotal to reduce the risk of new cardiac events and achieve good quality of life. However, whether patients are digitally active and have sufficient electronic health literacy (eHL) skills to access, understand and use internet-based health information remain unclear.

Purpose

To determine the extent to which patients after PCI are digitally active, and determine associations of health related internet use and socio-demographic factors with eHealth literacy.

Methods

This study is a sub-study of the prospective, multicenter CONCARDPCI study including >3000 patients after PCI. A total of 1956 patients were included from three Norwegian university hospitals between June 2017 and May 2019. Clinical data were collected through Norwegian Registry of Invasive Cardiology and patient medical records. Sociodemographics were obtained by self-report during index hospitalization. The eHealth Literacy Scale (eHEALS) assessed patient's eHL at baseline, measured on an 8–40 scale. De novo created questions assessed patient's health-related internet use, and use of the national health portal for information was measured at baseline and 2- and 6-month follow-up. Linear regression analysis determined the association between eHEALS, use of the internet, and sociodemographic factors.

Results

Most participants were men (78%), mean age 66 years (range; 20–96 years, SD 10.9). A total of 94% of the participants reported to have access to the internet, 67% had used the internet to find health information, and 54% had used the national health portal. After 6 months, patients increased their use of the national health portal (54% to 66%). Use of health applications on mobile phones or tablets increased from 10% to 40% from 2- to 6-month follow-up (P<0.001). At baseline 45% found the internet useful or very useful to make health decisions, and 57% found access to health resources on the internet to be important or very important. However, 50% were uncertain about how to use the information to make decisions about their own health. The eHEALS mean score was low; 25,66 (SD 6,24). Adjusted for sociodemographic factors there was an significant association between eHEALS and use of the internet to find health information at baseline (coefficient 11.41, 95% CI 8.05–14.57, P=0.001). At 2-month follow-up there was an significant association between eHEALS and use of the internet to find information about health, prevention, illness or treatment (coefficient 9.027, 95% CI 6.78–11.06, P=0.001), and the use of health applications (coefficient 3.197, 95% CI 0.24–6.30, P=0.046).

Conclusions

This study provided evidence that higher eHL predicts use of the internet to find health information and indicates that eHL and sociodemographic factors have an impact on how patients use, and can make use of, eHealth technology.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): The Western Norway Health Authority

Keeping the plates spinning: a qualitative study of the multifaceted role of caregiving in HFpEF

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health Research School for Primary Care Research

OnBehalf

Optimise HFpEF

Background

Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of all heart failure cases yet remains poorly understood, diagnosed and managed, which can add complexity to the caregiver role. No study to date has explicitly investigated the experiences of informal caregivers of people with HFpEF.

Objective

The aim of this study was to explore and understand the role and experiences of informal caregivers of people with HFpEF.

Methods and design

A qualitative study using semi-structured interviews involving caregivers alone, patients alone or caregiver/patient dyads. The interviews were performed as part of a larger programme of research in HFpEF. Participants were recruited from three regions of England. Interviews were transcribed verbatim and analysed thematically.

Results

22 interviews were conducted with a total of 38 participants, 17 of which were informal caregivers. Three inter-related themes were identified: (1) ‘spinning plates’ - the multifaceted nature of informal caregiving: household manager, health manager and motivator; (2) ‘the spinning falters’- the barriers to caregiving: lack of HFpEF awareness, information and support, the burden of multimorbidity, caregiver stress and the caregiver’s health status; (3) ‘keeping the plates spinning’- the facilitators of caregiving: being informed, being appreciated, having a champion (a health care professional that is key to managing the patient’s HFpEF), and engaging a wider support network.

Conclusions

Informal caregivers play an important role in supporting people with HFpEF. The experience of caregiving to people with HFpEF is similar to HFrEF, but complicated by challenges of poor HFpEF information and support, and the burden of multimorbidity. Healthcare providers should assess the needs of informal caregivers as part of patient care in HFpEF. Caregivers and patients would both benefit from improved information and management of HFpEF and associated multi-morbidities. Helping caregivers ‘keep the plates spinning’ will require innovative approaches and coordination across the care continuum.

Characteristics and health status of patients with and without confirmed HFpEF

Aims

Patients with heart failure with preserved ejection fraction (HFpEF) are usually older and multi-morbid and diagnosis can be challenging. The aims of this cohort study were to confirm diagnosis of HFpEF in patients with possible HFpEF recruited from primary care, to compare characteristics and health status between those with and without HFpEF, and to determine factors associated with health status in patients with HFpEF.

Methods

Patients with presumed HFpEF were recruited from primary care practices and underwent clinical assessment and diagnostic evaluation as part of a longitudinal cohort study. Health status was measured by Montreal Cognitive Assessment (MOCA), 6-minute walk test, symptoms, and the Kansas City Cardiomyopathy Questionnaire (KCCQ), and quality of life (QoL) by EQ-5D-5L visual analogue scale (VAS).

Results

151 patients (mean age 78.5±8.6 years, 40% women, mean EF 56% + 9.4) were recruited and 93 (61.6%) were confirmed HFpEF (those without HFpEF had other HF and cardiac diagnoses). Patients with and without HFpEF did not differ by age, MOCA, blood pressure, heart rate, NYHA class, proportion with atrial fibrillation, Charlson Comorbidity Index, or NT-ProBNP levels. Patients with HFpEF were more likely to be women, overweight or obese, frail, and to be more functionally impaired by 6 minute walk distance and gait speed than those without. Although not statistically significant, patients with HFpEF had clinically significant differences (>5 points) on the physical limitations, symptom burden and clinical summary subscales of the KCCQ, but did not differ by other subscales or by EQ-5D-5L VAS (70±17 vs 73±19, p=0.385). More patients with HFpEF reported daytime dyspnoea (63% vs 46%, p=0.035) and fatigue (81% vs 61%, p=0.008), but not other symptoms compared to those without HFpEF. For both groups BMI was moderately negatively correlated with KCCQ subscale scores, and 6 minute walk distance was positively correlated with KCCQ subscales.

Conclusions

Nearly 40% were not confirmed as HFpEF indicating the challenges of diagnosis. Patients with confirmed HFpEF differed by sex, overweight/obesity, frailty, functional impairment, and symptoms but not by age or comorbidities from those without HFpEF. These differences were reflected in some subscale scores of the KCCQ, but not how patients reported their quality of life on the KCCQ QoL subscale and EQ-5D-5L VAS. Older patients with HFpEF reported relatively high QoL despite poor health status by functional impairment, frailty and symptoms.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research School of Primary Care Research

71 Changes in Muscle Strength in Older Patients During Hospitalisation: A Prospective Repeated Measures Cohort Study

Introduction

Hospital associated deconditioning is a well-established phenomenon. Whilst mechanisms are not well understood, one is thought to be skeletal muscle wasting and/or loss of muscle strength. The primary aim of this study was to investigate changes in knee-extension muscle strength in older patients during and after an acute-hospital admission. We also aimed to explore the potential contributions of frailty, acute-illness severity and sedentary activity, with changes in knee-extension strength.

Methods

This was a prospective repeated-measures cohort study. Measurements of muscle strength and functional mobility were taken at recruitment, on day 7 of admission (or at discharge if earlier) and again 4-6 weeks post-hospitalisation. During the first 7 days of admission, daily measurements of muscle strength were taken.

Results

We recruited 70 participants, of which 65 had at least one repeated measure in hospital. Median age was 84 years, and participants participated in the study for a median of 6 days whilst in hospital, on average participants were ‘active’ for less than 4% of the day. Knee-extension strength significantly reduced by approximately 11% during hospitalisation, but no significant changes occurred post-hospitalisation. A repeated-measures mixed model included 292 observations from 62 participants and showed a significant decrease in the reduction in muscle strength as patients' sedentary time decreased on days 2 to 7 of the study. Additionally, the model showed that a higher frailty score, higher baseline knee-extension strength, lower baseline c-reactive protein levels were associated with greater loss in knee-extension strength during hospitalisation. Association between change in functional mobility after hospitalisation and change in knee-extension strength during hospitalisation was non-significant.

Conclusion

Our findings provide an important link in understanding the mechanisms and relative contributions of risk factors to hospital associated deconditioning. Further research is needed to confirm these findings and examine the impact of reducing sedentary time on muscle strength during and post-hospitalisation.