This study investigates the interplay between biomedical practices and sociocultural constructs of gender and masculinity in shaping healthcare professionals' (HCPs) understandings of myocardial infarction (MI) and MI patients. Theoretically, the study departed from the ongoing reframing of healthcare in Sweden and internationally, whereby the medical gaze is transformed into biomedicalization. The findings show that the dominance of biomedical perspectives serves to create certain norms regarding how bodies and illness are to be treated, bringing a strong focus to person-centered care, and to patients' own moral responsibility to adhere to medical advice. The expansion of individualized perspectives - the construction of "biological citizens" - however, also entails a risk of creating a false sense of universality, whereby social and cultural aspects of illness are made invisible. Even though some HCPs describe MI as a "male disease," patients are largely constructed as gender-neutral. The dominance of biomedicalization serves to obscure opportunities to think through the connections between risk factors, gender/masculinity, and MI. Accordingly, the healthcare system and HCPs working in MI care may fail to account for how diverse gender scripts and cultural dynamics might contribute to form patients' experiences, care seeking behavior and adherence with medical advice in rehabilitation.

Remote dielectric sensing (ReDS) technology noninvasively assesses lung congestion, but its value in primary care remains unknown. This study aimed to evaluate the feasibility of a ReDS-guided heart failure (HF) management programme in primary care.The 1-month programme, including ReDS measurements, a decision-support algorithm for diuretic adjustments, follow-up, and support for patient symptom monitoring, was provided to 18 patients with HF (mean age 81 years, mean ReDS values 33.6 ± 6.0 indicating optimal volume status) in one rural primary care centre. The feasibility areas of acceptability, demand, implementation, practicality, and limited efficacy were evaluated in a mixed-methods study. Data were collected from 18 patients with HF and two healthcare professionals (HCPs) at baseline and 1-month follow-up. Acceptability: Patients found the programme satisfactory, while HCPs expressed uncertainty about using the algorithm for patients with deviating ReDS values but no worsening symptoms. Demand: Patients recognized the potential to prevent hospitalizations. Healthcare professionals perceived higher demand in rural settings. Practicality: The ReDS technology was found practical and easy to use. Implementation: Fidelity was partial, with algorithm-recommended clinical actions not always implemented. Limited efficacy: Self-care improved with a medium effect size and N-terminal pro-B-type natriuretic peptide (NT-proBNP), with a small effect size. No adverse events were reported.Our study demonstrates the feasibility of a ReDS-guided HF management programme, which may enable early detection of subclinical congestion and improve outcomes for patients with HF in primary care settings. Further effort is necessary to refine the algorithm and improve its fidelity.

Background:  Physical activity plays a central role in the course and progression of chronic conditions in older adults. However, individuals within this population tend to have an inactive lifestyle. Exergaming, which is defined as the integration of physical activity with game-based elements, offers a promising approach to promote physical activity in individuals with chronic conditions. Despite its potential, limited evidence exists on how specific game elements influence behavioral and psychological outcomes in this population.

Objective:  The aim of this study is to explore the behavioral and psychological change techniques experienced by individuals with chronic conditions using a walking-based mobile exergame, called Heart Farming.

Methods:  A cross-sectional qualitative design was used based on a gamification framework, using data from semistructured interviews with 14 participants aged 67 to 92 years who used the Heart Farming exergame for 3 months. Participants with chronic conditions, including heart failure, Parkinson disease, type 2 diabetes, stroke, or rheumatic disease, were recruited from 2 ongoing studies. Data were analyzed using deductive content analysis and presented based on the gamification framework.

Results:  The data analysis revealed increased motivation to walk, which was facilitated by game elements such as goals, rewards, feedback, and planning. Participants valued not only the sense of progression and achievement within the game but also the real-world benefits, such as spending time in nature or feeling a sense of community with others. Exergaming was integrated into daily routines by supporting the planning and structuring of daily activities. It was also perceived as enjoyable, especially due to its farming theme and visual design. Behavioral change techniques such as goal setting, feedback, and social support were commonly experienced, whereas focus on past success (as described in the gamification framework) was not used as a technique by the exergame. Psychological techniques, including self-monitoring and stress management, were mentioned. A feeling of discomfort due to playing in public was reported, and participants varied in terms of the levels of digital literacy. Social interaction features were not adequately used, even though some participants created informal support groups to exergame.

Conclusions:  This study contributes to the exergaming literature by examining behavioral and psychological change techniques from the perspective of individuals with chronic conditions. Exergaming incorporates a variety of behavioral and psychological change techniques, which were experienced by the participants in various ways. Individuals' previous knowledge of exergaming, interests, and illness progression were mentioned as factors that can influence their experiences of exergaming. By increasing the understanding of how game elements are experienced and how they influence health-related behavior, the findings of this study may inform the development of exergames that are better tailored to users' needs. Further research is needed to refine behavioral change techniques and assess condition-specific adaptations to maximize engagement and health outcomes.

Aim Self-reported cognitive function has been described as an important complement to performance-based measurements but has seldom been investigated in cardiac arrest (CA) survivors. Therefore, the aim was to describe self-reported cognitive function and its association with health status, psychological distress, and life satisfaction. Methods This study utilised data from the Swedish Register of Cardiopulmonary Resuscitation (2018–2021), registered 3–6 months post-CA. Cognitive function was assessed by a single question: “How do you experience your memory, concentration, and/or planning abilities today compared to before the cardiac arrest?”. Health status was measured using the EQ VAS, psychological distress with the Hospital Anxiety and Depression Scale, and overall life satisfaction with the Life Satisfaction checklist. Data were analysed using binary logistic regression. Results Among 4026 identified survivors, 1254 fulfilled the inclusion criteria. The mean age was 65.9 years (SD = 13.4) and 31.7% were female. Self-reported cognitive function among survivors was reported as: ‘Much worse’ by 3.1%, ‘Worse’ by 23.8%, ‘Unchanged’ by 68.3%, ‘Better’ by 3.3%, and ‘Much better’ by 1.5%. Declined cognitive function was associated with lower health status (OR = 2.76, 95% CI = 2.09–3.64), symptoms of anxiety (OR = 3.84, 95% CI = 2.80–5.24) and depression (OR = 4.52, 95% CI = 3.22–6.32), and being dissatisfied with overall life (OR = 2.74, 95% CI = 2.11–3.54). These associations remained significant after age, sex, place of CA, aetiology, initial rhythm, initial witnessed status, and cerebral performance were controlled. Conclusions Survivors experiencing declined cognitive function post-CA are at a higher risk of poorer health status, increased psychological distress, and reduced life satisfaction, and these risks should be acknowledged by healthcare professionals.

Thorough consideration of user experiences and the weighing of advantages and disadvantages are essential when implementing new technology in clinical practice. This article describes a primary care nurse's experience using two technologies to monitor lung congestion in six patient cases: a remote dielectric sensing device for non-invasive lung fluid measurement and a portable handheld ultrasound device. Both can support decision-making when assessing lung congestion in heart failure patients. However, technical difficulties and interpretational complexities are inherent in their use. Balancing these advantages and disadvantages and finding effective strategies to address challenges is crucial for successful clinical implementation.

Aims This study aimed to explore effects of exergaming and medical yoga on exercise capacity, fatigue, shortness of breath, health-related quality of life, depression, and anxiety in patients with heart failure.Methods and results A randomized sub-study with a 3-month intervention and outcomes measures at baseline, 3, 6, and 12 months. Participants were recruited from heart failure clinics in Sweden. Treatment effects in change of outcomes were tested in an analysis of mixed-effects models with repeated measures. Change in outcomes was the dependent variable. The independent fixed-effect parameters were treatment group, time, and the interaction between treatment group and time. In total, 104 patients (37% women, mean age 71 +/- 12, 48% in New York Heart Association Class II and 42% in III) were randomized to exergaming (n = 35), medical yoga (n = 33), or an active control group (n = 36). No statistically significant differences were found between these three groups on any of the outcome measures. Exergaming significantly improved exercise capacity, fatigue, shortness of breath, and physical health-related quality of life and medical yoga improved symptoms of fatigue and emotional health-related quality of life. The control group did not change on the exercise capacity, symptoms, health-related quality of life, or depressive or anxiety symptoms. The well-being score in patients in the control group significantly decreased at 3 months.Methods and results A randomized sub-study with a 3-month intervention and outcomes measures at baseline, 3, 6, and 12 months. Participants were recruited from heart failure clinics in Sweden. Treatment effects in change of outcomes were tested in an analysis of mixed-effects models with repeated measures. Change in outcomes was the dependent variable. The independent fixed-effect parameters were treatment group, time, and the interaction between treatment group and time. In total, 104 patients (37% women, mean age 71 +/- 12, 48% in New York Heart Association Class II and 42% in III) were randomized to exergaming (n = 35), medical yoga (n = 33), or an active control group (n = 36). No statistically significant differences were found between these three groups on any of the outcome measures. Exergaming significantly improved exercise capacity, fatigue, shortness of breath, and physical health-related quality of life and medical yoga improved symptoms of fatigue and emotional health-related quality of life. The control group did not change on the exercise capacity, symptoms, health-related quality of life, or depressive or anxiety symptoms. The well-being score in patients in the control group significantly decreased at 3 months.Conclusion Both exergaming and medical yoga demonstrated positive impacts on outcomes when compared with a control group. Exergaming, characterized by its elevated physical intensity, exerted effects primarily on physical health, while medical yoga, as a mind-body intervention, exhibited influences on emotional well-being.Registration ClinicalTrial.gov: NCT01785121

Background: Physical activity is beneficial and recommended to improve outcomes for patients with heart failure (HF). Exergaming combines gaming technology with physical activity. Therefore, we developed a mobile exergame in a co-design process, the exergame would engage participants in physical activity anywhere and anytime. This study aims to assess the feasibility of a newly developed mobile exergame, heart farming, for patients with HF.Methods: A total of 14 participants with HF used the exergame on their smartphones for one month (9 Swedish and 5 Spanish participants; 9 males, mean 72 years, range 61-82 years). Participants were provided an introduction to the exergame, and follow-up was carried out regularly by telephone. Participants were advised to increase the daily walking duration by 10 minutes a day, based on the number of meters walked in the 6-minute walk test (6MWT). Areas of feasibility identified were acceptability, demand, implementation, and practicality, which were examined during telephone follow-ups and interviews, and data downloaded from the exergame.Results: Participants found the farming theme appealing, and coaching encouraged them to perform the exergame on a regular basis (acceptability). Based on the 6MWT, the personal goal for daily walking was set (mean of 704 meters, range 250-900 meters). Participants reported that daily goals and tasks were manageable. The exergame was perceived as appropriate to decrease sedentary time, and participants reported improved physical health (demand). The exergame was perceived as easy to learn and use, and adjustable to individual needs (implementation). Exergaming while walking and conversing with others was described as less convenient (practicality).Conclusion: Participants with HF valued personalized support and the exergame's farming theme was appealing. The goal to increase walking by 10 minutes a day was seen as a realistic way to reduce sedentary behavior. When introducing the exergame, it is essential to emphasize the importance of proper lighting, so meters walked are accurately recorded.

Aims Due to insufficient evidence and a lack of cohesive guidelines, the management and use of fluid restriction in patients with heart failure (HF) may vary among healthcare professionals. However, the extent of this variation is unknown. The aim of this study was to describe physicians' and registered nurses' (RN) clinical practice regarding fluid intake and fluid restriction in adult patients with HF. Methods and results Physicians and RNs treating patients with HF at 75 hospitals across all healthcare regions in Sweden were invited to answer a web-based survey regarding management on fluid intake and fluid restriction. Data were analysed with descriptive statistics and chi-square test. A total of 646 physicians and RNs across 45 hospitals in Sweden completed the survey. Significant differences in recommendations and management were found in relation to professional role, care setting and work experience. Overall, 93.8% recommend fluid restriction for all or some patients with HF. RNs recommend fluid restriction for all patients with HF to a significantly higher extent compared with physicians (34.5% vs. 14.9%; P < 0.001). Additionally, 49.2% believe that fluid restriction is an effective treatment strategy to prevent congestion, and 29.3% recommend fluid restriction routinely. One-third lacked knowledge of existing local guidelines regarding fluid restriction. Conclusions This study shows that there are differences in clinical practice regarding healthcare professionals' recommendations on fluid intake and fluid restriction. These differences may result in patients with HF receiving varied and inconsistent care. Recommendations were primarily based on each healthcare professional's individual opinion rather than on evidence and guidelines.