Background: Heart failure (HF) is a common and deadly disease, precipitated by physical inactivity and sedentary behavior. Although the 1-year survival rate after the first diagnosis is high, physical inactivity and sedentary behavior are associated with increased mortality and negatively impact the health-related quality of life (HR-QoL).

Objective: We tested the recruitment frequency, implementation fidelity, and feasibility of outcomes of the Activity Coach app that was developed using an existing mobile health (mHealth) tool, Optilogg, to support older adults with HF to be more physically active and less sedentary.

Methods: In this pilot clinical randomized controlled trial (RCT), patients with HF who were already using Optilogg to enhance self-care behavior were recruited from 5 primary care health centers in Sweden. Participants were randomized to either have their mHealth tool updated with the Activity Coach app (intervention group) or a sham version (control group). The intervention duration was 12 weeks, and in weeks 1 and 12, the participants wore an accelerometer daily to objectively measure their physical activity. The HR-QoL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), and subjective goal attainment was assessed using goal attainment scaling. Baseline data were collected from the participants’electronic health records (EHRs).

Results: We found 67 eligible people using the mHealth tool, of which 30 (45%) initially agreed to participate, with 20 (30%) successfully enrolled and randomized to the control and intervention groups in a ratio of 1:1. The participants’ daily adherence to registering physical activity in the Activity Coach app was 69% (range 24%-97%), and their weekly adherence was 88% (range 58%-100%). The mean goal attainment score was –1.0 (SD 1.1) for the control group versus 0.6 (SD 0.6) for the intervention group (P=.001). The mean change in the overall HR-QoL summary score was –9 (SD 10) for the control group versus 3 (SD 13) in the intervention group (P=.027). There was a significant difference in the physical limitation scores between the control (mean 45, SD 27) and intervention (mean 71, SD 20) groups (P=.04). The average length of sedentary bouts increased by 27 minutes to 458 (SD 84) in the control group minutes and decreased by 0.70 minutes to 391 (SD 117) in the intervention group (P=.22). There was a nonsignificant increase in the mean light physical activity (LPA): 146 (SD 46) versus 207 (SD 80) minutes in the control and intervention groups, respectively (P=.07).

Conclusions: The recruitment rate was lower than anticipated. An active recruitment process is advised if a future efficacy study is to be conducted. Adherence to the Activity Coach app was high, and it may be able to support older adults with HF in being physically active.

Trial Registration: ClinicalTrials.gov NCT05235763; https://clinicaltrials.gov/study/NCT05235763

AimThis paper describes the trajectory during 1 year of four patient-reported outcomes (PROs), namely, sleep, depressive symptoms, health-related quality of life (HrQoL), and well-being, in patients with heart failure (HF), their relationship and the patient characteristics associated with changes in these PROs.Methods and resultsData analyses of PROs from 603 patients (mean age 67 years; 29% female, 60% NYHA II) enrolled in the HF-Wii study. On short term, between baseline and 3 months, 16% of the patients experienced continuing poor sleep, 11% had sustained depressive symptoms, 13% had consistent poor HrQoL, and 13% consistent poor well-being. Across the entire 1-year period only 21% of the patients had good PRO scores at all timepoints (baseline, 3, 6, and 12 months). All others had at least one low score in any of the PROs at some timepoint during the study. Over the 12 months, 17% had consistently poor sleep, 17% had sustained symptoms of depression, 15% consistently rated a poor HrQoL, and 13% poor well-being. Different patient characteristics per PRO were associated with a poor outcomes across the 12 months. Age, education, New York Heart Association, and length of disease were related to two PRO domains and submaximal exercise capacity (6 min test), co-morbidity, and poor physical activity to one.ConclusionIn total, 79% of the patients with HF encountered problems related to sleep, depressive symptoms, HrQoL, and well-being at least once during a 1-year period. This underscores the need for continuous monitoring and follow-up of patients with HF and the need for dynamic adjustments in treatment and care regularly throughout the HF trajectory.

AimsTo describe assistant nurses experiences of thirst and ethical challenges in relation to thirst in terminally ill patients in specialized palliative care (PC) units.DesignA qualitative, reflexive thematic design with an inductive analysis was used.MethodsData were collected during November 2021-January 2023. Twelve qualitative interviews with assistant nurses working in five different specialized PC units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. The study was guided by the Standards for Reporting Qualitative Research (SRQR).ResultsTwo main themes were found in this study. (1) A world of practice for thirst relief where assistant nurses present a task-oriented world where the knowledge of thirst is an experience-based unspoken knowledge where mainly routines rule. (2) Ethical challenges presents different ethical problems that they meet in their practice, such as when patients express thirst towards the end of their life but are too severely ill to drink or when they watch lack of knowledge in the area among other health professionals.ConclusionThirst in dying patients is a neglected area that assistant nurses work with, without communicating it. Their knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patients record. There is a need for nurses to take the lead in changing nursing practice regarding thirst.Patient or Public ContributionNo patient or public contribution.ImpactIn palliative care, previous studies have shown that dying patients might be thirsty. Assistant nurses recognize thirst in dying patients, but thirst is not discussed in the team. Nurses must consider the patients fundamental care needs and address thirst, for example in the nursing process to ensure patients quality of life in the last days of life.Reporting MethodThe study was guided by the SRQR.What does this Article Contribute to the Wider Global Clinical Community?Thirst is a distressing symptom for all humans. However, when a patient is dying, he or she loses several functions and can no longer drink independently. The knowledge from this article contributes to our understanding of current practice and shows an area that requires immediate attention for the improvement of fundamental palliative care delivery.

AIM: The aim of this study is to examine whether a conceptual model including the associations between continuity of care, perceived control and self-care could explain variations in health-related quality of life and hospital readmissions in people with chronic cardiac conditions after hospital discharge.

DESIGN: Correlational design based on cross-sectional data from a multicentre survey study.

METHODS: People hospitalized due to angina, atrial fibrillation, heart failure or myocardial infarction were included at four hospitals using consecutive sampling procedures during 2017-2019. Eligible people received questionnaires by regular mail 4-6 weeks after discharge. A tentative conceptual model describing the relationship between continuity of care, self-care, perceived control, health-related quality of life and readmission was developed and evaluated using structural equation modelling.

RESULTS: In total, 542 people (mean age 75 years, 37% females) were included in the analyses. According to the structural equation model, continuity of care predicted self-care, which in turn predicted health-related quality of life and hospital readmission. The association between continuity of care and self-care was partly mediated by perceived control. The model had an excellent model fit: RMSEA = 0.06, 90% CI, 0.05-0.06; CFI = 0.90; TLI = 0.90.

CONCLUSION: Interventions aiming to improve health-related quality of life and reduce hospital readmission rates should focus on enhancing continuity of care, perceived control and self-care.

IMPACT: This study reduces the knowledge gap on how central factors after hospitalization, such as continuity of care, self-care and perceived control, are associated with improved health-related quality of life and hospital readmission in people with cardiac conditions. The results suggest that these factors together predicted the quality of life and readmissions in this sample. This knowledge is relevant to researchers when designing interventions or predicting health-related quality of life and hospital readmission. For clinicians, it emphasizes that enhancing continuity of care, perceived control and self-care positively impacts clinical outcomes.

PATIENT OR PUBLIC CONTRIBUTION: People and healthcare personnel evaluated content validity and were included in selecting items for the short version.

Aims Management of comorbidities represents a critical step in optimal treatment of heart failure (HF) patients. However, minimal attention has been paid whether comorbidity burden and their prognostic value changes over time. Therefore, we examined the association between comorbidities and clinical outcomes in HF patients between 2002 and 2017. Methods and results The 2002-HF cohort consisted of patients from The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) trial (n = 1,032). The 2017-HF cohort were outpatient HF patients enrolled after hospitalization for HF in a tertiary referral academic hospital (n = 382). Kaplan meier and cox regression analyses were used to assess the association of comorbidities with HF hospitalization and all-cause mortality. Patients from the 2017-cohort were more likely to be classified as HF with preserved ejection fraction (24 vs 15%, p < 0.001), compared to patients from the 2002-cohort. Comorbidity burden was comparable between both cohorts (mean of 3.9 comorbidities per patient) and substantially increased with age. Higher comorbidity burden was significantly associated with a comparable increased risk for HF hospitalization and all-cause mortality (HR 1.12 [1.02-1.22] and HR 1.18 [1.05-1.32]), in the 2002- and 2017-cohort respectively. When assessing individual comorbidities, obesity yielded a statistically higher prognostic effect on outcome in the 2017-cohort compared to the 2002-HF cohort (p for interaction 0.026). Conclusion Despite major advances in HF treatment over the past decades, comorbidity burden remains high in HF and influences outcome to a large extent. Obesity emerges as a prominent comorbidity, and efforts should be made for prevention and treatment. [GRAPHICS] .

To improve the practical application of measuring exercise capacity, the purpose of this study was to compare the 6 min walk distance (6MWD) obtained at a 30 m track with the guidance of healthcare professionals vs. the 6MWD obtained by participants themselves using an app. In total, 37 participants performed both tests. The mean of the differences between the 6MWD on the tests was -4 +/- 45 m (95% limits of agreement: 84 to -99 m). The overall agreement between the two 6MWD measures was 97% with an intraclass correlation coefficient of 0.96 (95% confidence interval: 0.91-0.98, P < 0.001). The use of an app is feasible, reliable, and valid to assess the 6MWD.

Objectives: Exergaming is promising for patients with heart failure who are less inclined to start or maintain exercise programs involving traditional modes of physical activity. Although no effect on exercise capacity was found for an off-the-shelf exergame, it is important to gain insights into aspects related to costs to develop such interventions further.Materials and Methods: In a randomized controlled trial, the Heart Failure Wii study (HF-Wii study), the intervention group (exergame group) received an introduction to the exergame, the exergame was installed at home and help was offered when needed for 3 months. Patients received telephone follow-ups at 2, 4, 8, and 12 weeks after the installation. The control group (motivational support group) received activity advice and telephone follow-ups at 2, 4, 8, and 12 weeks. We collected data on hospital use and costs, costs of the exergame intervention, patient time-related costs, and willingness to pay.Results: No significant differences were found between the exergame group (n = 300) versus the motivational support group (n = 305) in hospital use or costs (1-year number of hospitalizations: P = 0.60, costs: P = 0.73). The cost of the intervention was 190 Euros, and the patient time-related costs were 98 Euros. Of the total estimated costs for the intervention, 287 Euros, patients were willing to pay, on average, 58%.Conclusion: This study shows that the costs of an intervention using an off-the-shelve exergame are relatively low and that the patients were willing to pay for more than half of the intervention costs. The trial is registered in ClinicalTrials.gov (NCT01785121).

INTRODUCTION: Hospitalization due to cardiac conditions is increasing worldwide, and follow-up after hospitalization usually occurs in a different healthcare setting than the one providing treatment during hospitalization. This leads to a risk of fragmented care and increases the need for coordination and continuity of care after hospitalization. Furthermore, international reports highlight the importance of improving continuity of care and state that it is an essential indicator of the quality of care. Patients' perceptions of continuity of care can be evaluated using the Patient Continuity of Care Questionnaire (PCCQ). However, the original version is extensive and may prove burdensome to complete; therefore, we aimed to develop and evaluate a short version of the PCCQ.

METHODS: This was a psychometric validation study. Content validity was evaluated among user groups, including patients (n = 7), healthcare personnel (n = 15), and researchers (n = 7). Based on the results of the content validity and conceptual discussions among the authors, 12 items were included in the short version. Data from patients were collected using a consecutive sampling procedure involving patients 6 weeks after hospitalization due to cardiac conditions. Rasch analysis was used to evaluate the psychometric properties of the short version of the PCCQ.

RESULTS: A total of 1000 patients were included [mean age 72 (SD = 10), 66% males]. The PCCQ-12 presented a satisfactory overall model fit and a person separation index of 0.79 (Cronbach's α: .91, ordinal α: .94). However, three items presented individual item misfits. No evidence of multidimensionality was found, meaning that a total score can be calculated. A total of four items presented evidence of response dependence but, according to the analysis, this did not seem to affect the measurement properties or reliability of the PCCQ-12. We found that the first two response options were disordered in all items. However, the reliability remained the same when these response options were amended. In future research, the benefits of the four response options could be evaluated.

CONCLUSION: The PCCQ-12 has sound psychometric properties and is ready to be used in clinical and research settings to measure patients' perceptions of continuity of care after hospitalization.

PATIENT OR PUBLIC CONTRIBUTION: Patients, healthcare personnel and researchers were involved in the study because they were invited to select items relevant to the short version of the questionnaire.

Exercise-based cardiac rehabilitation programmes can reduce mortality but their effects on readmission rates are unclear. The primary aim was to evaluate the efficacy of a supervised exercise-based cardiac rehabilitation programme on cardiac readmissions in patients with acute coronary syndrome at five years.

Background: Research on the use of home telemonitoring data and adherence to it can provide new insights into telemonitoring for the daily management of patients with heart failure (HF). Objective: We described the use of a telemonitoring platform—including remote patient monitoring of blood pressure, pulse, and weight—and the use of the electronic personal health record. Patient characteristics were assessed in both adherent and nonadherent patients to weight transmissions. Methods: We used the data of the e-Vita HF study, a 3-arm parallel randomized trial performed in stable patients with HF managed in outpatient clinics in the Netherlands. In this study, data were analyzed from the participants in the intervention arm (ie, e-Vita HF platform). Adherence to weight transmissions was defined as transmitting weight ≥3 times per week for at least 42 weeks during a year. Results: Data from 150 patients (mean age 67, SD 11 years; n=37, 25% female; n=123, 82% self-assessed New York Heart Association class I-II) were analyzed. One-year adherence to weight transmissions was 74% (n=111). Patients adherent to weight transmissions were less often hospitalized for HF in the 6 months before enrollment in the study compared to those who were nonadherent (n=9, 8% vs n=9, 23%; P=.02). The percentage of patients visiting the personal health record dropped steadily over time (n=140, 93% vs n=59, 39% at one year). With univariable analyses, there was no significant correlation between patient characteristics and adherence to weight transmissions. Conclusions: Adherence to remote patient monitoring was high among stable patients with HF and best for weighing; however, adherence decreased over time. Clinical and demographic variables seem not related to adherence to transmitting weight.

Trial Registration: ClinicalTrials.gov NCT01755988; https://clinicaltrials.gov/ct2/show/NCT01755988