Effect of an Internet-based Intervention on Motor Behavior in Patients after Percutaneous Coronary Intervention

Background During the containment of COVID-19，the traditional face-to-face interventions conducted at the rehabilitation center were plagued by many limitations，while internet-based interventions can overcome the limitations of geographic location，working hours and transportation，with less medical costs. Objective To examine the effects of internet-based interventions on knowledge，attitude/belief and practice（KAP） toward rehabilitation exercises，physical activity（PA）level，and exercise compliance inpatients after PCI. Methods The subjects were 76 patients who received their first PCI in Department of Cardiology，Tangshan Gongren Hospital from November 2021 to June 2022. They were randomly and equally divided into two groups to receive either internet-based intervention with routine nursing（experimental group） or routine nursing （control group）. Before and three months after the intervention，the Rehabilitation Exercise Knowledge-Belief-Practice Scale for Patients with Coronary Heart Disease（REKBPCHD），the International Physical Activity Questionnaire-Short Form （IPAQ-SF），and Patients' Exercise Log were used to assess the KAP level，PA level，and exercise adherence，respectively. The impact of network intervention on exercise adherence in patients after PCI by univariate Logistic regression analysis. Results After 3 months of intervention，a significant increase was found in the average total score of REKBPCHD，and the average scores of the knowledge dimension，attitude dimension and practice dimension of the scale in the experimental group（P<0.05），and the increase was more notable than that in the control group（P<0.05）. Moreover，both post-intervention low PA level and total PA level in the experimental group were higher than those in the control group（P<0.05）. Both post-intervention low PA level and total PA level were higher than the baseline levels in the experimental group（P<0.05）. The post-intervention exercise compliance of experimental group were higher than that in the control group（P=0.003）. Univariate Logistic regression analysis showed that the risk of non-adherence to exercise in the experimental group was relatively lower than that in the control group 〔OR=0.143，95%CI（0.034，0.594），P=0.007〕. Conclusion Theinternet-based intervention can effectively improve the KAP level toward rehabilitation，PA level，and exercise adherence in patients after PCI. © 2023 Chinese General Practice. All rights reserved.

Developing and delivering a hybrid Cardiac Rehabilitation Phase II exercise program during the COVID-19 pandemic: a quality improvement program.

The COVID-19 pandemic resulted in the cessation of approximately 75% of cardiac rehabilitation (CR) programmes worldwide. In March 2020, CR phase II (CRP2) services were stopped in Qatar. Multiple studies had shown safety, effectiveness, reduced cost of delivery and improved participation with hybrid CR. A multidisciplinary team reviewed various alternative models for delivery and decided to implement a hybrid CRP2 exercise programme (HCRP2-EP) to ensure continuation of our patient care. Our aim was to enrol in the HCRP2-EP 70% of all eligible patients by 30 September 2020. Institute for Health Care Improvement's collaborative model was adopted. Multiple plan-do-study-act cycles were used to test change ideas. The outcomes of the project were analysed using standard run chart rules to detect the changes in outcomes over time. This project was implemented from March 2020, and the male patients enrolled between August 2020 and April 2021, with sustained monthly median enrolment above target of 70% throughout. As for our secondary outcome, 75.8% of the male patients who completed HCRP2-EP showed a meaningful change in peak exercise capacity of ≥10% (mean change 17%±6%). There were no major adverse events reported, and the median Patient Satisfaction Score was 96% well above the institutional target of 90%. This shows a well-designed quality improvement programme is an appropriate strategy for implementing HCRP2-EP in a clinical setting, and HCRP2-EP is a feasible, effective and safe intervention in eligible male patients with cardiovascular disease.

A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities.

Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.

The Challenge of High Coronary Thrombotic Events in Patients with ST-Segment Elevation Myocardial Infarction and COVID-19.

The aim of this observational study was to describe the characteristics and outcomes of coronavirus disease 2019 (COVID-19)-positive patients with ST-segment elevation myocardial infarction (STEMI), with a special focus on factors associated with a high risk of coronary thrombosis and in-hospital mortality. Comparing the two groups of patients with STEMI separated according to the presence of SARS-CoV-2 infections, it was observed that COVID-19 patients were more likely to present with dyspnea (82.43% vs. 61.41%, p = 0.048) and cardiogenic shock (10.52% vs. 5.40%, p = 0.012). A longer total ischemia time was observed in COVID-19 patients, and they were twice as likely to undergo coronary angiography more than 12 hours after the onset of symptoms (19.29% vs. 10.13%, p = 0.024). In 10 of 57 COVID-19-positive patients, a primary PCI was not necessary, and only thromboaspiration was performed (17.54% vs. 2.70%, p < 0.001). Platelet level was inversely correlated (r = -0.512, p = 0.025) with a higher risk of coronary thrombosis without an atherosclerotic lesion. Using a cut-off value of 740 ng/ml, D-dimers predicted a higher risk of coronary thrombosis, with a sensitivity of 80% and a specificity of 66% (ROC area under the curve: 0.826, 95% CI: 0.716-0.935, p = 0.001). These are novel findings that raise the question of whether more aggressive antithrombotic therapy is necessary for selected COVID-19 and STEMI patients.

ANALYSIS OF PUBLIC OPINION ON THE NEED TO USE DIGITAL HEALTH SOLUTIONS BY RISK PATIENTS FOR CARDIOVASCULAR DISEASES.

Cardiovascular disease is the leading cause of death. Of these types of diseases, stroke was the leading cause of death in Bulgaria in 2018, accounting for almost 20% of all deaths. Mortality from coronary heart disease is the next leading cause, accounting for 11% of all deaths, despite a sharp decline since 2000. The importance of digital health solutions is growing and the role of the cardiology community is to support their rapid and effective implementation. This is becoming increasingly important in the context of pandemic crises with COVID-19 .Digital health solutions have the potential to identify at-risk patients, which allows for more aggressive intervention at an earlier stage of disease development - primary and secondary prevention.This could save time and financial resources for patients as well as for medical professionals and healthcare institutions. Nowadays, the possibilities of new technologies in cardiology are numerous - from telemedicine, through artificial intelligence in imaging to the processing and analysis of large data sets. Patients' remote monitoring devices are designed to increase home care. Hospitals could use these solutions to significantly reduce the costs and risks associated with hospitalization. [ FROM AUTHOR] Copyright of Management & Education / Upravlenie i Obrazovanie is the property of Prof. Dr. Assen Zlatarov University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Associations of pre-existing cardiovascular morbidity with severity and the fatality rate in COVID-19 patients: a systematic review and meta-analysis.

Objectives: The aim of this study was to evaluate the association of pre-existing cardiovascular comorbidities, including hypertension and coronary heart disease, with coronavirus disease 2019 (COVID-19) severity and mortality. METHODS: PubMed, ScienceDirect, and Scopus were searched between January 1, 2020, and July 18, 2020, to identify eligible studies. Random-effect models were used to estimate the pooled event rates of pre-existing cardiovascular disease comorbidities and odds ratio (OR) with 95% confidence intervals (95% CIs) of disease severity and mortality associated with the exposures of interest. RESULTS: A total of 34 studies involving 19,156 patients with COVID-19 infection met the inclusion criteria. The prevalence of pre-existing cardiovascular disease in the included studies was 14.0%. Pre-existing cardiovascular disease in COVID-19 patients was associated with severe outcomes (OR, 4.1; 95% CI, 2.9 to 5.7) and mortality (OR, 6.1; 95% CI, 2.9 to 12.7). Hypertension and coronary heart disease increased the risk of severe outcomes by 2.6 times (OR, 2.6; 95% CI, 1.9 to 3.6) and 2.5 times (OR, 2.5; 95% CI, 1.7 to 3.8), respectively. No significant publication bias was indicated. Conclusion: COVID-19 patients with pre-existing cardiovascular comorbidities have a higher risk of severe outcomes and mortality. Awareness of pre-existing cardiovascular comorbidity is important for the early management of COVID-19.

Mortality Sensitivity of Cardiovascular, Cerebrovascular, and Respiratory Diseases to Warm Season Climate in Japanese Cities

We investigated decadal (2010–2019) cardiovascular, cerebrovascular, and respiratory mortality sensitivity to annual warm temperatures in major Japanese cities: Sapporo, Tokyo (23 wards), and Osaka. The summer mortalities (June–August) increased with the monthly mean temperature for acute myocardial infarction, other acute ischemic heart diseases, cerebral infarction, and pneumonia in the three cities. Monthly mean temperatures were an indicator of these disease mortalities in Japan. However, similar responses were not found for cardiac arrhythmia and heart failure (excluding Sapporo), subarachnoid hemorrhage, and intracerebral hemorrhage. The decadal sensitivities and risk ratios between the maximum and minimum monthly mean temperatures were calculated using a linear regression model. In Sapporo, Tokyo, and Osaka, for example, the analyses of acute myocardial infarction showed summer positive responses of 0.19–0.25, 0.13–0.18, and 0.12–0.30, respectively, as the mortality rate (per 100,000 population) per 1 °C of monthly mean temperature, which estimated increased risks (between the coolest and hottest months) of 37–65% in Sapporo, 31–42% in Tokyo, and 35–39% in Osaka. [ FROM AUTHOR] Copyright of Atmosphere is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Pediatric COVID-19 infection in Sulaimaniyah Governorate, Iraq.

BACKGROUND: COVID-19 is a severe acute respiratory syndrome caused by SARS-CoV-2. OBJECTIVE: To study the demographic and clinical presentations of COVID-19 with their types including MIS-C and Kawasaki among children who were admitted to Doctor Jamal Ahmad Rashid Pediatric Teaching Hospital (DJARPTH) at Sulaimaniyah city, Iraq. PATIENTS AND METHODS: A prospective cohort study was conducted from June to December 2020 in which 50 cases suspected of COVID-19 were enrolled in the study that was admitted at the first visit to the emergency department of DJARPTH and their age ranged between 3 months to 14 years. Then, the collected data were divided into 3 groups: COVID-19, Kawasaki disease (KD), and MIS-C. RESULTS: The fever was the most common presented symptom in all cases with COVID-19 regardless of the severity. COVID-19 may be presented as KD as well as MIS-C. There is an increase in the number of Kawasaki cases since 2019 by 6.7 fold due to the increased number of COVID-19 cases in children. Death was more related to MIS-C and primary COVID-19 diseases. Most COVID-19 cases presented with pericardial effusion; although coronary involvement and LV dysfunction mostly seen with MIS-C cases. CONCLUSION: COVID-19 is not uncommon in pediatric patients and it presents as either primary, MIS-C, and KD. Most of the deaths and ICU outcomes were related to MIS-C presentations.

Surgical treatment of pleural empyema in Coronavirus disease 19 patients: the Southern Switzerland experience.

We report the first surgical series of patients developing pleural empyema after severe bilateral interstitial lung disease in confirmed severe acute respiratory syndrome coronavirus 2 infection. The empyema results in a complex medical challenge that requires combination of medical therapies, mechanical ventilation and surgery. The chest drainage approach was not successful to relieve the symptomatology and to drain the excess fluid. After multidisciplinary discussion, a surgical approach was recommended. Even though decortication and pleurectomy are high-risk procedures, they must be considered as an option for pleural effusion in Coronavirus disease-positive patients. This is a life-treating condition, which can worsen the coronavirus disease manifestation and should be treated immediately to improve patient's status and chance of recovery.

An Exploration of the help-seeking experiences of patients in an allied professions-led rapid access chest pain pathway: a qualitative study.

OBJECTIVE: A number of studies have explored delayed help-seeking practices for acute coronary syndrome (ACS) and have indentified multiple intersecting factors which may play a role, for example, attributing symptoms, age, gender, ethnicity and contextual influences. However, the pathway to diagnosis for suspected coronary heart disease (CHD) symptoms in a rapid access chest pain clinic (RACPC) context is underexplored. The objective of this study was to examine patients' help-seeking experiences of accessing RACPC services, from the point at which they notice and interpret symptoms, to their decision to seek help from their general practitioner. DESIGN: Qualitative study. SETTING: Interviews were conducted in the RACPC at Queen Mary's Roehampton Hospital, London, UK. PARTICIPANTS: Maximum variation sampling was used to recruit 30 participants (15 men and 15 women) referred to a RACPC, using sampling dimensions of age, ethnicity and occupation. METHODS: Semi-structured interviews focussed on the patient experience of their pathway to the RACPC. Thematic analysis was used to analyse the interview data. RESULTS: Participant interpretation of symptoms was shaped by multiple influences; reluctance to seek help contributed to delay; various factors acted as drivers as well as barriers to help-seeking; and GP referrals to RACPC were based on symptoms as well as patients' need for reassurance. CONCLUSION: We found complex issues shaped the patient's decision-making when accessing the RACPC, including making sense of symptoms and help-seeking practices. These findings can be used to develop health promotion literature to encourage early help-seeking and improve RACPC services.

Gamut of cardiac manifestations and complications of COVID-19: a contemporary review.

COVID-19 has posed an extraordinary burden on health and the economy worldwide. Patients with cardiovascular diseases are more likely to have severe illness due to COVID-19 and are at increased risk for complications and mortality. We performed a narrative literature review to assess the burden of COVID-19 and cardiovascular morbidity and mortality. Myocardial injury has been reported in 20%-30% of patients hospitalized due to COVID-19 and is associated with a worse prognosis and high mortality (~50%-60%). Proposed mechanisms of myocardial injury include inflammation within the myocardium (due to direct viral infection or cytokine storm), endotheliitis, coronary vasculitis, myocarditis, demand ischemia, plaque destabilization and right ventricular failure. The right ventricle is particularly vulnerable to injury and failure in COVID-19-infected patients, given the hypoxic pulmonary vasoconstriction, pulmonary microthrombi or pulmonary embolism. Echocardiography is an effective and accessible tool to evaluate left and right ventricular functions and risk stratify patients with COVID-19 infection. Cardiac MRI has detected and characterized myocardial injury, with changes compatible with other inflammatory cardiomyopathies. The long-term consequences of these inflammatory changes are unknown, but accumulating data will provide insight regarding the longitudinal impact of COVID-19 infection on cardiovascular morbidity and mortality.