Leonie Sadler

A pre-test post-test study of a brief educational intervention demonstrates improved knowledge of potential acute myocardial infarction symptoms and appropriate responses in cardiac rehabilitation patients

BACKGROUND Patient delay in recognizing and responding to potential acute myocardial infarction (AMI) symptoms is an international issue. Cardiac rehabilitation provides an ideal opportunity to deliver an intervention. AIMS This study examines an individual educational intervention on knowledge of heart attack warning signs and specific chest pain action plans for people with coronary heart disease. METHODS Cardiac rehabilitation participants at five hospitals were assessed at program entry and tailored education was provided using the Heart Foundation of Australias Heart Attack Warning Signs campaign educational tool. Participants (n=137) were reassessed at program conclusion (six to eight weeks). RESULTS Study participants had a mean age of 64.48 years (SD 12.22), were predominantly male (78%) and most commonly presented with a current referral diagnosis of a percutaneous coronary intervention (PCI) (80%) and/or AMI (60%). There were statistically significant improvements in the reporting of 11 of the 14 warning signs of heart attack, with patients reporting 2.56 more warning signs on average at outcome (p<.0001). Patients reported more heart attack warning signs if they had completed high school education (β=1.14) or had better knowledge before the intervention (β=.57). There were statistically significant improvements in reporting of all appropriate actions in response to potential AMI symptoms, with patients reporting an average of 1.3 more actions at outcome (p<.001), with no change in the median time they would tolerate symptoms (p=.16). CONCLUSIONS A brief education session using a single standardised tool and adapted to a patient assessment is effective in improving knowledge of potential AMI symptoms and appropriate responses in cardiac rehabilitation up to two months following.

Sublingual nitroglycerin practices in patients with coronary artery disease in Australia.

Background and Research Objective:Sublingual nitroglycerin (SLNTG) medications are a recommended treatment for people with coronary artery disease (CAD); however, prescription and knowledge may be suboptimal. This study set out to determine how often SLNTG is prescribed and the knowledge and factors associated in patients with CAD. Subjects and Methods:Patients (n = 142) were recruited from cardiac rehabilitation and surveyed regarding SLNTG prescription and key knowledge areas related to SLNTG in those prescribed (n = 89). Multiple regression analysis was used to determine independent predictors of knowledge. Results and Conclusions:Despite having CAD, 37% were not prescribed SLNTG, and of those prescribed, only 43% received related instruction. Knowledge of SLNTG was low at a mean 7.11 (SD, 2.05) points of a possible 14. Most participants (96%) knew to use SLNTG to treat chest pain/discomfort, and no participant described inappropriate symptoms for treatment. Although most patients (80%) knew to have the SLNTG available at all times, only 46% did so in reality. One in 5 participants reported that they would not call an ambulance if chest pain was unrelieved by SLNTG. Participants had more SLNTG knowledge if they were married, were male, and had been instructed about SLNTG and had less knowledge if their hospital discharge diagnosis included angina. The reporting of calling an ambulance for unrelieved symptoms was increased by having more knowledge of SLNTG, but decreased if participants had prior use of SLNTG, were married, or had more comorbidities. Consideration of prescription for SLNTG and related instruction, particularly for their chest-pain action plan, needs to be provided more systematically for patients with CAD.

Who Gets Stroke Prevention? Stroke Prevention in Atrial Fibrillation Patients in the Inpatient Setting

BACKGROUND Current guidelines strongly recommend antithrombotic therapy, particularly warfarin, for stroke prevention in atrial fibrillation (AF) patients at high risk of stroke. Despite this, use of these medications is far from optimal. The aim of this study was to describe the use of stroke prevention medication in inpatients and identify factors associated with prescription in one local health district in Sydney, Australia. METHODS A prospective audit of medical records for patients admitted with an AF diagnosis to five hospitals in the health district and excluding cardiac surgery patients was undertaken. Patients were classified as high or low for stroke risk as well as for risk of bleeding and predictors were identified by logistic regression. RESULTS A total of 204 patients were enrolled from July 2012 to April 2013, with a mean age of 75 years (SD 13) and half (50%) were male. Valve disease was present in 17% and 15% received a procedure for their AF (cardioversion/ablation/pulmonary vein isolation). Patients were least likely to be prescribed warfarin/novel oral anticoagulant (NOAC) if they were non-valvular and did not undergo cardioversion/ablation (p=.03), and least likely to be prescribed aspirin if they had no AF procedure (p=.01). In non-valvular patients who did not have cardioversion/ablation the odds of being prescribed warfarin/NOAC were increased by being classified at high risk of stroke (OR 3.1, 95% CI 1.0 -9.5) and decreased if there was a prescription for aspirin (OR .3. 95% CI .1 -.6). CONCLUSIONS Overall use of stroke prevention medication indicates that gaps remain in translation of evidence into clinical practice.

Evaluation of a brief educational intervention to improve knowledge of sublingual nitroglycerin in cardiac rehabilitation patients.

Objective: This study aimed to evaluate the impact of a brief educational intervention delivered in cardiac rehabilitation (CR) on patients’ knowledge of sublingual nitroglycerin (SLN). Methods: Patients (n=86) commencing CR were provided with a brief educational intervention tailored to deficits identified in an assessment of SLN knowledge using the Sublingual Nitroglycerin Questionnaire, with reassessment at the end of program completion (6–8 weeks). Results: The mean age of patients was 64.95 years (standard deviation (SD) 10.87); 74% were male, 78% were married and 60% had not completed high school. Most (70%) had no prior coronary heart disease (CHD) history and 80% had been referred to CR following percutaneous coronary intervention. SLN knowledge scores increased from baseline to outcome. Patients were significantly more likely to know: the name of their SLN medication (11% increase, p=0.001), the recommended timing between doses (29% increase, p=0.02), the maximum number of doses (27% increase, p=0.005), to have SLN on their person at the time of the interview (25% increase, p<0.001) and to know the interaction between SLN and sildenafil (36% increase, p=0.001). The independent predictors of SLN knowledge included having better knowledge at baseline (β=0.28) and having consulted a general practitioner post discharge and before commencing CR (β=1.48). Conclusion: A brief standardised knowledge intervention, individually tailored to identified deficits in a knowledge screen and delivered during CR, shows promise for improving patient knowledge of SLNs. The role of general practitioners in delivering medication education needs further investigation.

Cardiac Patients’ Experiences and Perceptions of Social Media: Mixed-Methods Study

Background Traditional in-person cardiac rehabilitation has substantial benefits for cardiac patients, which are offset by poor attendance. The rapid increase in social media use in older adults provides an opportunity to reach patients who are eligible for cardiac rehabilitation but unable to attend traditional face-to-face groups. However, there is a paucity of research on cardiac patients’ experiences and perspectives on using social media to support their health. Objective The aim of this study was to describe cardiac rehabilitation patients’ experiences in using social media in general and their perspective on using social media, particularly Facebook, to support their cardiac health and secondary prevention efforts. Methods A mixed-methods study was undertaken among cardiac rehabilitation patients in both urban and rural areas. First, this study included a survey (n=284) on social media use and capability. Second, six focus group interviews were conducted with current Facebook users (n=18) to elucidate Facebook experience and perspectives. Results Social media use was low (28.0%, 79/282) but more common in participants who were under 70 years of age, employed, and had completed high school. Social media users accessed Web-based information on general health issues (65%, 51/79), medications (56%, 44/79), and heart health (43%, 34/79). Participants were motivated to invest time in using Facebook for “keeping in touch” with family and friends and to be informed by expert cardiac health professionals and fellow cardiac participants if given the opportunity. It appeared that participants who had a higher level of Facebook capability (understanding of features and the consequences of their use and efficiency in use) spent more time on Facebook and reported higher levels of “liking,” commenting, or sharing posts. Furthermore, higher Facebook capability appeared to increase a participants’ willingness to participate in a cardiac Facebook support group. More capable users were more receptive to the use of Facebook for cardiac rehabilitation and more likely to express interest in providing peer support. Recommended features for a cardiac rehabilitation Facebook group included a closed group, expert cardiac professional involvement, provision of cardiac health information, and ensuring trustworthiness of the group. Conclusions Cardiac health professionals have an opportunity to capitalize on cardiac patients’ motivations and social media, mostly Facebook, as well as the capability for supporting cardiac rehabilitation and secondary prevention. Participants’ favored purposeful time spent on Facebook and their cardiac health provides such a purpose for a Facebook intervention. The study results will inform the development of a Facebook intervention for secondary prevention of cardiovascular disease.

Profile of atrial fibrillation inpatients: Cardiovascular risk factors and cardiac rehabilitation programme delivery and referral patterns.

Atrial fibrillation (AF) is increasingly common; however, the cardiovascular risk factor profile and the patterns of delivery and referral to cardiac rehabilitation (CR) in this population are poorly described. We conducted an audit of medical records (n = 145) of patients admitted with AF in one local health district in Sydney, Australia. Patients were aged a mean 72 years, and 51% were male. Lack of risk factor documentation was common. Despite this, 65% had two or more modifiable cardiovascular risk factors, including hypertension (63%) and hypercholesterolaemia (52%). Referral to Phase II CR occurred for 25% and was decreased with permanent AF diagnosis and increased with more risk factors. AF patients admitted to hospital have multiple cardiovascular risk factors but limited risk factor screening and/or referral to outpatient CR programmes.