Britt Borregaard

Patient-reported outcomes at hospital discharge from Heart Centres, a national cross-sectional survey with a register-based follow-up: the DenHeart study protocol

Introduction Patient reported health status, which includes symptom burden, functional status and quality of life, is an important measure of health. Differences in health status between diagnostic groups within cardiology have only been sparsely investigated. These outcomes may predict morbidity, mortality, labour market affiliation and healthcare utilisation in various diagnostic groups. A national survey aiming to include all cardiac diagnostic groups from a total Heart Centre population has been designed as the DenHeart survey. Methods and analysis DenHeart is designed as a cross-sectional survey with a register-based follow-up. All diagnostic groups at the five national Heart Centres are included during 1 year (15 April 2013 to 15 April 2014) and asked to fill out a questionnaire at hospital discharge. The total eligible population, both responders and non-responders, will be followed in national registers. The following instruments are used: SF-12, Hospital Anxiety and Depression Scale, EQ-5D, Brief Illness Perception Questionnaire (B-IPQ), HeartQoL and Edmonton Symptom Assessment Scale. The following variables are collected from national registers: action diagnosis, procedures, comorbidity, length of hospital stay, type of hospitalisation, visits to general practitioners and other agents in primary healthcare, dispensed prescription medication, vital status and cause of death. Labour market affiliation, sick leave, early retirement pension, educational degree and income will be collected from registers. Frequency distributions and multiple logistic regression analyses will be used to describe and assess differences in patient reported outcomes at hospital discharge between diagnostic groups and in-hospital predicting factors. Cox proportional hazards regression models with age as the time scale will be used to investigate associations between patient reported outcomes at baseline and morbidity/mortality, labour market affiliation and healthcare utilisation after 1 year. Ethics and dissemination The study complies with the Declaration of Helsinki. The study has been approved by the Danish Data Protection Agency: 2007-58-0015/30-0937 and registered at ClinicalTrials.gov (NCT01926145). Study findings will be disseminated widely through peer reviewed publications and conference presentations.

Patient-reported outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses: Findings from the national DenHeart survey

Aims Patient-reported quality of life and anxiety/depression scores provide important prognostic information independently of traditional clinical data. The aims of this study were to describe: (a) mortality and cardiac events one year after hospital discharge across cardiac diagnoses; (b) patient-reported outcomes at hospital discharge as a predictor of mortality and cardiac events. Design A cross-sectional survey with register follow-up. Methods Participants: All patients discharged from April 2013 to April 2014 from five national heart centres in Denmark. Main outcomes Patient-reported outcomes: anxiety and depression (Hospital Anxiety and Depression Scale); perceived health (Short Form-12); quality of life (HeartQoL and EQ-5D); symptom burden (Edmonton Symptom Assessment Scale). Register data: mortality and cardiac events within one year following discharge. Results There were 471 deaths among the 16,689 respondents in the first year after discharge. Across diagnostic groups, patients reporting symptoms of anxiety had a two-fold greater mortality risk when adjusted for age, sex, marital status, educational level, comorbidity, smoking, body mass index and alcohol intake (hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.52–2.42). Similar increased mortality risks were found for patients reporting symptoms of depression (HR 2.29, 95% CI 1.81–2.90), poor quality of life (HR 0.46, 95% CI 0.39–0.54) and severe symptom distress (HR 2.47, 95% CI 1.92–3.19). Cardiac events were predicted by poor quality of life (HR 0.71, 95% CI 0.65–0.77) and severe symptom distress (HR 1.58, 95% CI 1.35–1.85). Conclusions Patient-reported mental and physical health outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses.

Mental health is a risk factor for poor outcomes in cardiac patients: Findings from the national DenHeart survey

OBJECTIVE To explore (i) the prevalence of cardiac risk factors (obesity, smoking, excessive alcohol consumption and medication non-adherence) among cardiac patients with depression and anxiety, (ii) associations between depression and anxiety scores and cardiac risk factors and (iii) the association of depression and anxiety and cardiac risk factors with mortality, and their population attributable risk. METHODS A national cross-sectional study using patient-reported outcomes at discharge and national register data. For one year (April 15th 2013 to April 15th 2014) all patients discharged or transferred from the five Danish Heart Centres were included in the study. A total of 14,239 patients answered the HADS questionnaire, response rate 51%. RESULTS Mean age was 64.8 years and 69% were male. Patients with depression or anxiety (HADS-D or HADS-A score ≥ 8) had 30% and 45%, respectively, higher odds of being current smokers; 19% and 37% higher odds of being obese and 31% and 24% higher odds of excessive alcohol consumption. Depressive patients had 34% higher odds of being non-adherent to their medication. At one-year follow-up, patients with depression (HADS-D score ≥ 11) had the highest attributable risk associated with mortality followed by: smoking, ischemic heart disease, anxiety, diabetes, hypertension chronic obstructive pulmonary disease and excessive alcohol consumption. CONCLUSION Depression and anxiety in patients with cardiac disease is associated with cardiac risk behaviour such as smoking, obesity, excessive alcohol consumption and medication non-adherence. Depression and anxiety have an attributable risk associated with mortality that is comparable to other well-known risk factors such as smoking.

Exchanging narratives – a qualitative study of peer support among surgical lung cancer patients

AIM AND OBJECTIVE The aim of this study was to examine how hospitalised, surgical lung cancer patients experience talking to a former patient, and how the former patient experiences the role as supportive. BACKGROUND During hospitalisation, patients often create a community in which they can engage with fellow patients. The exchange of experiences with others in a similar situation might increase opportunities for support and complement nursing care, but there is a need for more evidence and understanding on the topic. DESIGN The methodological framework is based on the French philosopher Paul Ricoeurs text interpretation theory. Qualitative interviews were conducted with nine patients, including a peer informant, using a narrative structure. The analysis was conducted on three levels: (i) naïve reading, (ii) structural analysis and (iii) critical interpretation . RESULTS Four themes were developed from the analysis of the interviews: Exchanging emotional thoughts is easier with a peer; Talking to a peer reduces loneliness; Being ambiguous about a relationship with fellow patients; and Being the main person in the conversation with a peer. Sharing stories about having similar symptoms and undergoing similar journeys predominated, and the key feature of the contact between patients was the commonality of their stories. CRITICAL INTERPRETATION AND CONCLUSION Telling ones story to a former patient, and thereby creating a joint, common story, is the essence of this study. The support received in this process can be empowering because knowledge of the illness experience is shared and increased. This can help create new coping strategies. The contact with a former patient offered a way to confirm ones thoughts and to find a way out of the illness perspective, by seeing how the former patient had recovered. RELEVANCE TO CLINICAL PRACTICE The nursing field faces challenges in the relational aspect of caring because of ever greater efficient and shortened hospital stays; therefore, the peer support concept is becoming increasingly relevant. Patient peers offer each other their own perspectives, and it is important to raise awareness of the value of this and incorporate it into patient stays in hospital.

Both mental and physical health predicts one year mortality and readmissions in patients with implantable cardioverter defibrillators: findings from the national DenHeart study

Background: Although highly effective in preventing arrhythmic death, there is a high prevalence of anxiety, depression and reduced quality of life among patients who have received an implantable cardioverter defibrillator (ICD). Whether mortality, ICD shock and readmission are predicted by patient-reported outcomes is unknown. Aim: The aim of this study was to describe patient-reported outcomes among patients with ICDs compared by: ICD indication and generator type (ICD or cardiac resynchronisation therapy ICD), and to determine whether patient-reported outcomes at discharge predict mortality, ICD therapy and readmission. Methods: A national cross-sectional survey at hospital discharge (n=998) with register follow-up. Patient-reported outcomes included the Hospital Anxiety and Depression Scale, Short Form-12, HeartQoL, EQ-5D and Edmonton Symptom Assessment Scale. Register data: ICD therapy, readmissions and mortality within one year following discharge. Results: Patients with primary prevention ICDs had significantly worse patient-reported outcomes at discharge than patients with secondary prevention ICDs. Likewise, patients with cardiac resynchronisation therapy ICDs had significantly worse patient-reported outcomes at discharge than patients without cardiac resynchronisation therapy. One-year mortality was predicted by patient-reported outcomes, with the highest hazard ratio (HR) being anxiety (HR 2.02; 1.06–3.86), but was not predicted by indication or cardiac resynchronisation therapy. ICD therapy and ventricular tachycardia/ventricular fibrillation were not predicted by patient-reported outcomes, indication or cardiac resynchronisation therapy. Overall, patient-reported outcomes predicted readmissions, e.g. symptoms of anxiety and depression predicted all readmissions within 3 months (HR 1.50; 1.13–1.98) and 1.47 (1.07–2.03), respectively). Conclusion: Patients with primary indication ICDs and cardiac resynchronisation therapy ICDs report worse patient-reported outcomes than patients with secondary indication and no cardiac resynchronisation therapy. Patient-reported outcomes such as mental health, quality of life and symptom burden predict one-year mortality and acute and planned hospital readmissions.

Obesity and smoking is widespread in patients with ischemia and heart failure, but not in congenital heart disease and heart transplant patients: results from the national DenHeart survey The study is funded by the heart centres and the Novo Nordisk Foundation

no: 166 Flowchart Abstracts S33 ! 2016 European Journal of Preventive Cardiology Framingham Risk Score and the PRECARD Scale. Statistical analysis involved uniand multivariate linear regression and logistic regression. Results: The CREP program enrolled 139 patients participation (45%). Included 56.8% men and 43.2% women. Smoking was associated with lower chance to participate compared to non-smokers (OR = 0.42, 95%CI = 0.16 0.88). There was small but signification difference between men and women in change in risk assessment according to the Framingham Risk Score (0.69%). Participation in supervised physical exercise program increased the effectiveness of the program assessment by SPE (0.22 points per each session). There was a strong correlation between the effectiveness of the program after 1 year and the result of evaluation directly after CREP completion. The better was the direct effect of the program the lower risk after 1 year. Conclusions: Cigarette smoking was associated with twofold lower participation in the CREP. Participation in supervised physical exercise program was associated with significantly greater effectiveness of the program. Additionally, male sex and older age had a negative effect on risk change according to the Framingham Risk Score. Significant correlation between the effectiveness of CREP after its completion and its distant consequences were reported. 168 Impact of cardiac rehabilitation on dietary habits and aerobic exercise after an acute coronary syndrome E Elio Venturini, C Sansoni, V Venturini, L Lo Conte, M Siragusa, N Bosio, R Testa Department of Cardiology Civic Hospital , Cecina (LI), Italy, University of Pisa, Department of Veterinary Sciences, Pisa, Italy Topic: Cardiac rehabilitation Purpose: aerobic exercise and the dietary habits, if maintained overtime, can be useful tools not only to attenuate the progression of coronary artery disease but also to induce a regression of the plaque. We evaluated the effect of a cardiology rehabilitation outpatient program (CR OP) on diet and physical activity in patients after acute coronary syndrome (ACS). Methods: we studied 50 P (67% men, mean age 67.3 10 y) enrolled in a CR OP duration 2 months, 24 sessions) after an ACS. The Mediterranean Diet (MD) was assessed with a translated version of the Med Diet Score which provides 0-8 points (the larger the value, the better adherence to diet). The International Physical Activity Questionnaire, in the short version, was used to assess the level of physical activity (PA): less than 700 METs /week subject inactive, 700-2519 sufficiently active, more than 2520 very active. Both questionnaires were administered before and after 1 year of the end of the program. It was provided a motivational telephone call, operated by nurses, at 3 and 6 months after the end of the CR OP. Results: the results are reported in the table below. The level of physical activity, too low at the beginning of the OP, was increased by CR; but above all, the good results persisted even a year later. Regarding the MD was observed a not significant improvement of the score going, however, by a category of sufficient adherence to MD (4-5: A good start, but you can do better), to the next still better (6-7: You’re doing well) Conclusions: a healthy lifestyle is a cornerstone for reducing cardiovascular mortality and morbidity. A comprehensive CR OP, when the training sessions are associated with educational intervention, can improve, permanently, the level of PA after ACS. Since the atherosclerosis is a process that develops over the years improvements in lifestyle can have a positive impact only if sustained. The minor impact on dietary habits could be explained by the already good adherence to the MD at the beginning of the OP, and for the absence, in the CR team, of the dietitian. A program of CR with a limited follow-up is an effective and low cost tool to promote a healthy lifestyle after an ACS.

Health related quality of life, anxiety and depression differs significantly between cardiac diagnostic groups at hospital discharge: results from denheart, a large scale national survey

Background: Heart failure is a common chronic condition that affects patients’ life situation and puts high demands on self-care and patient participation. Patients often need advanced care due to ...

DenHeart - A national cardiac health survey with register based follow-up

Associations between fatigue, symptom experiences and sleep quality after myocardial infarction