Patients and healthcare professionals views on injectables for cardiovascular disease

Introduction: Injectable medicines are increasingly used to manage risk factors for cardiovascular (CV) events, such as PCSK-9 inhibitors in dyslipidaemia and GLP-1 agonists in diabetes. However, there is a paucity of data around the administrative and clinical practicalities when using these injectables, and limited information on patient and healthcare professionals' perceptions. Purpose(s): To identify the facilitators and barriers on the use of injectable therapies with CV benefits by undertaking interviews with patients, caregivers and healthcare professionals (HCPs). Method(s): Interviews were conducted via telephone and using MS Teams due to Covid-19 restrictions in the United Kingdom (London and Leeds) and Italy (Rome and Milan) in 2021. Coding was undertaken using NVivo and thematic analysis performed. Result(s): A total of 56 patients were interviewed: 30 in the U.K. (mean age 66 yrs, 60% male) and 26 patients in Italy (mean age 63 yrs, 80% male) and 11 caregivers (mean age 59 yrs, 73% female). A total of 38 HCPs were interviewed, 19 in each country and composed of physicians (n=18), pharmacists (n=10), nurses (n=9) and pharmacy technician (n=1). Three distinct themes were identified: (i) Organisational and governance issues - relating to prescribing restrictions and availability of the drugs locally (PCSK9i are initiated and supplied from hospitals) and lack of communication between hospital and primary care setting;(ii) Clinical issues around HCPs' skills and experience - including: Lack of experience with these injectables, lack of time to provide education to patients and caregivers, therapeutic inertia (HCPs not adopting a change in practice despite the evidence or due to bureaucratic restrictions) as well as lack of knowledge on long-term effects, and finally (iii) Patient-related issues - relating to behaviours and beliefs such as reluctance about using injectable therapies, and lack of education about these injectables in terms of indications/clinical benefits for use. Despite some differences in the prescribing of these injectables in the two countries, the analysis captured similar facilitators and barriers. Facilitators included prior use of injectables (e.g. insulin), and the ability to reach a clinical target of lower cholesterol by having just a one shot . HCPs stated that access to rapid pathology tests would aid uptake of injectables with CV benefit as well as having educational tools on these injectables in practice. Conclusion(s): This qualitative study identified barriers to initiation, continuation, and adherence with injectable therapies with CV benefits but also highlighted areas where changes can be made especially around education and support for patients and HCPs.

Determinants of Post-Traumatic Stress Disorders in Italian university students during the Covid-19 outbreak: the leading role of sex, health concerns, and health engagement.

Background: The unprecedented changes in daily-life caused by Covid-19 restrictions had many psycho-logical and adverse effects, not only in sufferers but also in the general population, including university students. To date, little is known about Post-Traumatic Stress Disorder symptoms experienced by university students during the peak of Covid-19 in Italy. Thus, the study describes Post-Traumatic Stress Disorders related to the Covid-19 outbreak among Italian university students and identifies the psychological distress risk and protective factors. Study design: A multicentre observational cross-sectional study. Methods: Data collection was involved in a self-reported web questionnaire, using the on-line platform Qualtrics®, in March and April 2020, involving convenience and consecutive sampling of Italians university students in different Italy regions. Results: A sample of 720 Italian university students was enrolled. Data analysis highlighted the leading role of sex, health concerns, and health engagement as negative or positive determinants of Post-Traumatic Stress Disorders in Italian university students during the Covid-19 outbreak. In particular, it is very insightful having discovered that health engagement is a protective factor of students' mental health. Conclusions: This is the first study identifying sex, health issues and health commitment as positive or negative determinants of Post-Traumatic Stress Disorders symptoms in Italian university students during the Covid-19 epidemic. Accordingly, this new achievement could be the starting point for the development of awareness campaigns for the psychological health of Italian university students.

Technology-delivered motivational interviewing interventions for patients with cardiovascular diseases-a systematic review

Introduction: Cardiovascular diseases (CVD) are a major source of burden worldwide. COVID-19 pandemic has renewed the importance of remote psychoeducational interventions to improve outcomes in these patients. Technology-delivered motivational interviewing (TD-MI) has proven to be effective in chronic disease populations, yet there has been no attempt to summarize TD-MI characteristics and effectiveness in CVD populations. Methods: We searched PubMed, CINHAL, PsychInfo and Web of Science (from inception to May 1, 2021) for randomized controlled trials that enrolled adults with CVD. Record screening, data extraction and risk of bias assessment were performed in duplicate. This review is registered in PROSPERO, CRD42021241516. Results: Of the 2,742 records identified, 7 studies were eligible for qualitative synthesis. Participants (n=12,053, mean age = 62.25, 37.5% females) enrolled from community settings and prevalently affected by coronary artery disease (n. studies=5), hypertension (n=3) and heart failure (n=3), received an average of 11 phone (n=6) or video calls (n=1) over an average of 7 months. Interventionists were mostly nurses (n=4), followed by psychologists (n=2) and a social worker (n=1). Treatment fidelity was assessed in 5 trials;2 trials reported the intervention to be based on a theoretical framework, and 2 studies specified if the interventionist underwent some training before TD-MI administration. Caregivers were never involved. Most targeted outcomes were medication adherence (n=5), quality of life (n=4), disease-related parameters (n=4), and depression (n=3). Risk of bias varied markedly, with the largest source resulting from lack of blinding of participants and assessors (performance bias). The only feasible meta-analysis showed no significant effects of TDMI on depression (n=3;Z=1.18, p=0.24;I2=42%). Conclusions: The number of trials involving TD-MI interventions across CVD populations is scarce and their effectiveness is inconclusive. There was lack of reporting of interventionists' training, description of treatment fidelity, and blinding procedures. More trials with stronger designs and better reporting are needed in the CVD field to inform clinical decision making and research.