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  • 1
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    Effective components of nurse-coordinated care to prevent recurrent coronary events: a systematic review and meta-analysis
    BMJ ; 2016
    In:  Heart Vol. 102, No. 1 ( 2016-01-01), p. 50-56
    Details
    In: Heart, BMJ, Vol. 102, No. 1 ( 2016-01-01), p. 50-56
    Type of Medium: Online Resource
    ISSN: 1355-6037 , 1468-201X
    URL: Article
    DOI: 10.1136/heartjnl-2015-308050
    Language: English
    Publisher: BMJ
    Publication Date: 2016
    detail.hit.zdb_id: 2378689-9
    detail.hit.zdb_id: 1475501-4
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  • 2
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    Older patients’ perspectives toward lifestyle-related secondary cardiovascular prevention after a hospital admission—a qualitative study
    Oxford University Press (OUP) ; 2021
    In:  Age and Ageing Vol. 50, No. 3 ( 2021-05-05), p. 936-943
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 50, No. 3 ( 2021-05-05), p. 936-943
    Abstract: lifestyle-related secondary prevention reduces cardiac events and is recommended irrespective of age. However, motivation may be influenced by age and disease progression. Objective to explore older cardiac patients’ perspectives toward lifestyle-related secondary prevention after a hospital admission. Methods a generic qualitative design was used. Semi-structured interviews were performed with cardiac patients ≥ 70 years within 3 months after a hospital admission. The interview guide was based on the Attitudes, Social influence and self-Efficacy (ASE) model. All interviews were analysed using thematic analysis. Results eight themes emerged which were linked to the determinants of the ASE-model. The three themes (i) Perspectives are determined by general health and habits, (ii) feeling the threat as a motivator and (iii) balancing between health benefits and quality of life (QoL), were linked to attitude. Regarding social influence, the themes (iv) feeling both encouraged and hindered by family members, and (v) the healthcare professional says so, were identified. For the self-efficacy determinant, (vi) experiences from previous lifestyle changes, (vii) integrating advice in daily life and (viii) feeling limited by functional impairments, emerged as themes. Conclusion most older cardiac patients made no lifestyle modifications after the last hospital admission and balanced possible benefits against their QoL. Functional impairments frequently limit implementation, in particular of physical activity. Patients’ preferences and patient-centred outcomes focusing on QoL and functional independence may be the starting point when healthcare professionals discuss lifestyle modification in older patients. The involvement of family members may help patients to integrate lifestyle-related secondary prevention in daily life.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afaa283
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2065766-3
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  • 3
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    Effects of a transitional care programme on medication adherence in an older cardiac population: A randomized clinical trial
    Wiley ; 2022
    In:  British Journal of Clinical Pharmacology Vol. 88, No. 3 ( 2022-03), p. 965-982
    Details
    In: British Journal of Clinical Pharmacology, Wiley, Vol. 88, No. 3 ( 2022-03), p. 965-982
    Abstract: Medication non‐adherence post‐discharge is common among patients, especially those suffering from chronic medical conditions, and contributes to hospital admissions and mortality. This study aimed to evaluate the effect of the Cardiac Care Bridge (CCB) intervention on medication adherence post‐discharge. Methods We performed a secondary analysis of the CCB randomized single‐blind trial, a study in patients ≥70 years, at high risk of functional loss and admitted to cardiology departments in six hospitals. In this multi‐component intervention study, community nurses performed medication reconciliation and observed medication‐related problems (MRPs) during post‐discharge home visits, and pharmacists provided recommendations to resolve MRPs. Adherence to high‐risk medications was measured using the proportion of days covered (PDC), using pharmacy refill data. Furthermore, MRPs were assessed in the intervention group. Results For 198 (64.7%) of 306 CCB patients, data were available on adherence (mean age: 82 years; 58.9% of patients used a multidose drug dispensing [MDD] system). The mean PDC before admission was 92.3% in the intervention group ( n  = 99) and 88.5% in the control group ( n  = 99), decreasing to 85.2% and 84.1% post‐discharge, respectively (unadjusted difference: −2.6% (95% CI −9.8 to 4.6, P  = .473); adjusted difference −3.3 (95% CI −10.3 to 3.7, P  = .353)). Post‐hoc analysis indicated that a modest beneficial intervention effect may be restricted to MDD non‐users ( P interaction  = .085). In total, 77.0% of the patients had at least one MRP post‐discharge. Conclusions Our findings indicate that a multi‐component intervention, including several components targeting medication adherence in older cardiac patients discharged from hospital back home, did not benefit their medication adherence levels. A modest positive effect on adherence may potentially exist in those patients not using an MDD system. This finding needs replication.
    Type of Medium: Online Resource
    ISSN: 0306-5251 , 1365-2125
    URL: Issue
    URL: Article
    DOI: 10.1111/bcp.v88.3
    DOI: 10.1111/bcp.15044
    RVK:
    XA 33650
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 1498142-7
    SSG: 15,3
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  • 4
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    The course of readmission in frail older cardiac patients
    Wiley ; 2021
    In:  Journal of Advanced Nursing Vol. 77, No. 6 ( 2021-06), p. 2807-2818
    Details
    In: Journal of Advanced Nursing, Wiley, Vol. 77, No. 6 ( 2021-06), p. 2807-2818
    Abstract: The aim of this study is to explore patients’ and (in)formal caregivers’ perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. Design This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. Methods Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi‐structured interviews were held with patients ( n  = 4), informal caregivers ( n  = 5), physical therapists ( n  = 4), and community nurses ( n  = 5) between April and June 2019. Patients’ medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six‐step analysis of Strauss & Corbin have been used. Results Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients’ health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers’ perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). Conclusion Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients’ care needs and expectations should be prioritized to stimulate participation. Impact (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients’ care needs and expectations.
    Type of Medium: Online Resource
    ISSN: 0309-2402 , 1365-2648
    URL: Issue
    URL: Article
    DOI: 10.1111/jan.v77.6
    DOI: 10.1111/jan.14828
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2009963-0
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  • 5
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    The performance of the Dutch Safety Management System frailty tool to predict the risk of readmission or mortality in older hospitalised cardiac patients
    Springer Science and Business Media LLC ; 2021
    In:  BMC Geriatrics Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Geriatrics, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Early identification of older cardiac patients at high risk of readmission or mortality facilitates targeted deployment of preventive interventions. In the Netherlands, the frailty tool of the Dutch Safety Management System (DSMS-tool) consists of (the risk of) delirium, falling, functional impairment, and malnutrition and is currently used in all older hospitalised patients. However, its predictive performance in older cardiac patients is unknown. Aim To estimate the performance of the DSMS-tool alone and combined with other predictors in predicting hospital readmission or mortality within 6 months in acutely hospitalised older cardiac patients. Methods An individual patient data meta-analysis was performed on 529 acutely hospitalised cardiac patients ≥70 years from four prospective cohorts. Missing values for predictor and outcome variables were multiply imputed. We explored discrimination and calibration of: (1) the DSMS-tool alone; (2) the four components of the DSMS-tool and adding easily obtainable clinical predictors; (3) the four components of the DSMS-tool and more difficult to obtain predictors. Predictors in model 2 and 3 were selected using backward selection using a threshold of p  = 0.157. We used shrunk c-statistics, calibration plots, regression slopes and Hosmer-Lemeshow p -values (P HL ) to describe predictive performance in terms of discrimination and calibration. Results The population mean age was 82 years, 52% were males and 51% were admitted for heart failure. DSMS-tool was positive in 45% for delirium, 41% for falling, 37% for functional impairments and 29% for malnutrition. The incidence of hospital readmission or mortality gradually increased from 37 to 60% with increasing DSMS scores. Overall, the DSMS-tool discriminated limited (c-statistic 0.61, 95% 0.56–0.66). The final model included the DSMS-tool, diagnosis at admission and Charlson Comorbidity Index and had a c-statistic of 0.69 (95% 0.63–0.73; P HL was 0.658). Discussion The DSMS-tool alone has limited capacity to accurately estimate the risk of readmission or mortality in hospitalised older cardiac patients. Adding disease-specific risk factor information to the DSMS-tool resulted in a moderately performing model. To optimise the early identification of older hospitalised cardiac patients at high risk, the combination of geriatric and disease-specific predictors should be further explored.
    Type of Medium: Online Resource
    ISSN: 1471-2318
    URL: Article
    DOI: 10.1186/s12877-021-02243-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2059865-8
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  • 6
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    Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention - a qualitative study
    Springer Science and Business Media LLC ; 2021
    In:  BMC Health Services Research Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients’ participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients. Methods A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed. Results Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants’ recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention. Conclusion Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients’ needs, considering their frailty, self-management skills and existing formal and informal caregiver networks.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-021-06719-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2050434-2
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  • 7
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    Prediction models for hospital readmissions in patients with heart disease: a systematic review and meta-analysis
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 8 ( 2021-08), p. e047576-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 8 ( 2021-08), p. e047576-
    Abstract: To describe the discrimination and calibration of clinical prediction models, identify characteristics that contribute to better predictions and investigate predictors that are associated with unplanned hospital readmissions. Design Systematic review and meta-analysis. Data source Medline, EMBASE, ICTPR (for study protocols) and Web of Science (for conference proceedings) were searched up to 25 August 2020. Eligibility criteria for selecting studies Studies were eligible if they reported on (1) hospitalised adult patients with acute heart disease; (2) a clinical presentation of prediction models with c-statistic; (3) unplanned hospital readmission within 6 months. Primary and secondary outcome measures Model discrimination for unplanned hospital readmission within 6 months measured using concordance (c) statistics and model calibration. Meta-regression and subgroup analyses were performed to investigate predefined sources of heterogeneity. Outcome measures from models reported in multiple independent cohorts and similarly defined risk predictors were pooled. Results Sixty studies describing 81 models were included: 43 models were newly developed, and 38 were externally validated. Included populations were mainly patients with heart failure (HF) (n=29). The average age ranged between 56.5 and 84 years. The incidence of readmission ranged from 3% to 43%. Risk of bias (RoB) was high in almost all studies. The c-statistic was 〈 0.7 in 72 models, between 0.7 and 0.8 in 16 models and 〉 0.8 in 5 models. The study population, data source and number of predictors were significant moderators for the discrimination. Calibration was reported for 27 models. Only the GRACE (Global Registration of Acute Coronary Events) score had adequate discrimination in independent cohorts (0.78, 95% CI 0.63 to 0.86). Eighteen predictors were pooled. Conclusion Some promising models require updating and validation before use in clinical practice. The lack of independent validation studies, high RoB and low consistency in measured predictors limit their applicability. PROSPERO registration number CRD42020159839.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-047576
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 8
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    Not feeling ready to go home: a qualitative analysis of chronically ill patients’ perceptions on care transitions
    Oxford University Press (OUP) ; 2019
    In:  International Journal for Quality in Health Care Vol. 31, No. 2 ( 2019-03-01), p. 125-132
    Details
    In: International Journal for Quality in Health Care, Oxford University Press (OUP), Vol. 31, No. 2 ( 2019-03-01), p. 125-132
    Type of Medium: Online Resource
    ISSN: 1353-4505 , 1464-3677
    URL: Article
    DOI: 10.1093/intqhc/mzy139
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2002180-X
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  • 9
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    Lifestyle modification in older versus younger patients with coronary artery disease
    BMJ ; 2020
    In:  Heart Vol. 106, No. 14 ( 2020-07), p. 1066-1072
    Details
    In: Heart, BMJ, Vol. 106, No. 14 ( 2020-07), p. 1066-1072
    Abstract: To compare the treatment effect on lifestyle-related risk factors (LRFs) in older (≥65 years) versus younger ( 〈 65 years) patients with coronary artery disease (CAD) in The Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 (RESPONSE-2) trial. Methods The RESPONSE-2 trial was a community-based lifestyle intervention trial (n=824) comparing nurse-coordinated referral with a comprehensive set of three lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to usual care. In the current analysis, our primary outcome was the proportion of patients with improvement at 12 months follow-up (n=711) in ≥1 LRF stratified by age. Results At baseline, older patients (n=245, mean age 69.2±3.9 years) had more adverse cardiovascular risk profiles and comorbidities than younger patients (n=579, mean age 53.7±6.6 years). There was no significant variation on the treatment effect according to age (p value treatment by age=0.45, OR 1.67, 95% CI 1.22 to 2.31). However, older patients were more likely to achieve ≥5% weight loss (OR old 5.58, 95% CI 2.77 to 11.26 vs OR young 1.57, 95% CI 0.98 to 2.49, p=0.003) and younger patients were more likely to show non-improved LRFs (OR old 0.38, 95% CI 0.22 to 0.67 vs OR young 0.88, 95% CI 0.61 to 1.26, p=0.01). Conclusion Despite more adverse cardiovascular risk profiles and comorbidities among older patients, nurse-coordinated referral to a community-based lifestyle intervention was at least as successful in improving LRFs in older as in younger patients. Higher age alone should not be a reason to withhold lifestyle interventions in patients with CAD.
    Type of Medium: Online Resource
    ISSN: 1355-6037 , 1468-201X
    URL: Article
    DOI: 10.1136/heartjnl-2019-316056
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2378689-9
    detail.hit.zdb_id: 1475501-4
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  • 10
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    The Cardiac Care Bridge randomized trial in high‐risk older cardiac patients: A mixed‐methods process evaluation
    Wiley ; 2021
    In:  Journal of Advanced Nursing Vol. 77, No. 5 ( 2021-05), p. 2498-2510
    Details
    In: Journal of Advanced Nursing, Wiley, Vol. 77, No. 5 ( 2021-05), p. 2498-2510
    Abstract: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse‐coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design A mixed‐methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi‐structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data‐analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in‐hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non‐significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
    Type of Medium: Online Resource
    ISSN: 0309-2402 , 1365-2648
    URL: Issue
    URL: Article
    DOI: 10.1111/jan.v77.5
    DOI: 10.1111/jan.14786
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2009963-0
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