Late gadolinium enhancement following covid-19 infection does not predict outcome: a single-centre study

182 Figure 1Cardiovascular events in COVID-19 Survivors by LGE Status[Figure omitted. See PDF] 182 Figure 2All-cause mortality in COVID-19 Survivors by LGE Status[Figure omitted. See PDF]Conflict of InterestNone

Aspirin is associated with lower risks of severe covid-19 disease: a population-based study

IntroductionThe use of aspirin has been hypothesized to improve severe clinical outcomes in COVID-19 infection. The present study aims to evaluate the effect of both antecedent and inpatient aspirin use, individually and concomitant with other medications, on severe disease outcomes in COVID-19 positive patients treated with steroids/antiviral therapy.MethodsConsecutive patients who attended Hong Kong's public hospitals or outpatient clinics between 1st January and 8th December 2020 for COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) and received steroids/antiviral therapy were included. Propensity score matching (1:1) between aspirin users and non-users was performed. The primary endpoint was the composite outcome of the need for intubation and 30-day all-cause mortality.ResultsA total of 2664 RT-PCR positive and hospitalized COVID-19 patients receiving steroids/antiviral therapy were included (male= 50.7%, baseline age= 52.3 [35.2-64.6] years old). Over follow-up, 2.96% suffered from 30-day all-cause mortality. Univariable logistic regression showed that aspirin use was associated with lower odds of severe COVID-19 in the propensity score-matched cohort (odds ratio [OR]: 0.33, 95% confidence interval [CI]: [0.18, 0.6];P=0.0003). This association remained significant following adjustment for significant confounders (OR= 0.33, 95% CI= [0.18, 0.59], P= 0002).ConclusionAspirin use was associated with lower odds of severe outcomes in COVID-19.Conflict of InterestNone

Does intensive follow-up increase days alive and well out of hospital in heart failure?

151 Figure 1Day after discharge from hospitalDid you feel well today?Please write yes or no.Weight, kg123456789101112131415161718192021222324252627282930 151 Table 1Baseline characteristicsBaseline characteristicsStandard Follow-UpN=9Intensive Follow-UpN=17Age (years)78 [69,81]74 [65,82]Gender [number of females (%)] 2 (22%)7 (41%)Rockwood Frailty Score (2 weeks pre admission) 3 [3,5]5 [3,5]Left Ventricular Systolic Function (%)Preserved 34%Mildly impaired 11%Moderately impaired 33%Severely impaired 22%Preserved 35%Mildly impaired 12%Moderately impaired 18%Severely impaired 35%NTproBNP ng/L4772 [2883,4859]9 88 [4333,14876]eGFR on discharge, ml/min/1.73m246 [35,63]51 [30,82]Comorbidity Number (in addition to HF)3 [2,4]5 [3,6]SBP, mmHg108 [106,111]110 [103,120]Number of people known COVID positive (%)0%6%Descriptive statistics are expressed as Median [IQR] or N (%).Abbreviations: eGFR: Estimated Glomerular Filtration Rate, HF: Heart failure, IQR: Inter-Quartile Range, NTproBNP: N-terminal prohormone of brain natriuretic peptide, SBP: Systolic Blood Pressure. 151 Table 2Effectiveness of intensive follow-upStandard Follow-UpIntensive Follow-UpDays alive and well out of hospital12 [8,25]22 [15,28]Days with weight recorded27 [14,30]27 [7,30]ACEi, ARB, or entresto (%)6 (67%)14 (82%)Beta-Blocker (%)8 (89%)16 (94%)% max. dose of Beta-Blocker 44 [25,53]50 [34,100]MRA%5 (56%)9 (53%)Dose of MRA, mg25 [25,25]25 [25, 25]SGLT2 inhibitor (on Dapaglifozin or empaglifozin) (%)5 (56%)14 (82%)Total number of Disease Modifying Agents (max 4)3 [2,4]3 [3,4]Descriptive statistics are expressed as Median [IQR] or N (%).Abbreviations: ACEi: Angiotensin Converting Enzyme Inhibitor, ARB: Angiotensin Receptor Blocker, IQR: Inter-Quartile Range, MRA: Mineralocorticoid receptor antagonist, SGLT2 inhibitors: Sodium-glucose cotransporter-2 inhibitors.Conflict of InterestNone

Outcomes among patients admitted with cardiogenic shock during the first year of the covid-19 pandemic in the united states

BackgroundOutcomes of patients hospitalized for cardiogenic shock during the midst of the COVID-19 pandemic in the United States have yet to be well described. This study aimed to examine if the COVID-19 pandemic led to gender differences in in-hospital outcomes, length of stay, and total hospital charges.MethodsData was extracted from the National Inpatient Sample database for the calendar year 2020. Patients who were admitted with a principal diagnosis of cardiogenic shock (R57.0) were identified using relevant International Classification of Disease, and Clinical Modification codes. The key outcomes of mortality, use of mechanical ventilation, use of mechanical circulatory support, hemodialysis, vasopressors use, length of stay, and total hospital charges were then accessed.ResultsThere were 2,670 hospitalizations for a principal diagnosis of cardiogenic shock in 2020, of which 955 were females. After adjusting for age, race, hospital bed size, hospital location, hospital teaching status, insurance status, income level, and Elixhauser comorbidities;we found that females admitted with cardiogenic shock were more likely to require mechanical ventilation (aOR 1.54, 95% CI 1.02- 2.34), but had no difference in mortality, vasopressor use, mechanical circulatory support use, hemodialysis initiation, length of hospital stay and total hospital charges relative males.ConclusionOur study found that females admitted for cardiogenic shock during the first year of the pandemic had significantly higher rates of mechanical ventilation but no difference in other outcomes. Further studies are needed to investigate the effect of COVID-19 on the outcomes of female patients admitted for cardiogenic shock.Conflict of InterestNone

Mechanisms underlying atrial dysfunction in heart failure: role of the mitochondrial permeability transition pore

IntroductionHeart Failure (HF) carries significant mortality and morbidity, especially due to comorbidities such as Atrial Fibrillation (AF). Previous work illustrates that mitochondrial dysfunction underpins the pathophysiology of both HF and AF, including decreased Adenosine TriPhosphate (ATP) production, Ca2+ mishandling, oxidative stress and elevated apoptosis. In addition to these problems, recent work suggests the Mitochondrial Permeability Transition Pore (MPTP) in ventricular cardiomyocytes may become sensitised to Ca2+ during HF, leading to increased apoptosis. Nevertheless, the role of mitochondrial dysfunction has not been investigated in the atria. In this study, we investigated the role of Ca2+ sensitivity of the MPTP and mitochondrial aerobic capacity in atrial muscle of the failing heart.MethodsRight atrial appendage and right ventricular free wall were dissected from 15 sheep representing an ovine model of tachycardia-induced HF. The tissue was subsequently homogenized and differentially centrifuged, yielding isolated mitochondria. Respiratory function was measured using a respirometer, with the electron transport system (ETS) selectively probed through addition of various substrates stimulating differing ETS complexes. A Calcium Retention Capacity (CRC) assay determined MPTP Ca2+ sensitivity, which involved Ca2+ titrations onto isolated mitochondria containing a Ca2+-sensitive fluorescent dye. An increase in fluorescence marked MPTP opening.ResultsAerobic capacity was not affected by HF, but an increase in ventricular leak respiration was statistically significant (p=0.0140). HF reduced atrial mitochondrial efficiency by 68% (p=0.0063) but did not affect maximal mitochondrial respiration. There was no significant effect of HF or tissue-type on MPTP Ca2+ sensitivity and mitochondrial Ca2+ buffering capacity.ConclusionOur data suggests HF affects atrial and ventricular mitochondrial respiratory function asymmetrically, with HF affecting atrial mitochondrial efficiency and ventricular leak respiration. The COVID-19 pandemic hindered this research project;however, it provides rationale on the unequal effect of HF on mitochondrial function across the atria and ventricle. Future research should therefore consider incorporating atrial samples when assessing potential HF therapies.Conflict of InterestNil

A trial emulation comparing thromboprophylaxis versus no thromboprophylaxis among ward-based patients with covid-19

209 Figure 1Kaplan-Meier curves displaying cumulative all-cause mortality[Figure omitted. See PDF]Conflict of InterestNo conflicts of interest

Risk of infection with ferric derisomaltose compared to standard of care in patients with heart failure and iron deficiency in the uk: a prespecified analysis of the ironman trial

IntroductionRecent results from the IRONMAN trial add to previous data and demonstrate that correction of iron deficiency in patients with heart failure, with high dose IV iron can improve quality of life, and reduce the risk of heart failure hospitalisation (by around 25% in meta-analysis). Yet there are theoretical risks that IV iron administration may increase the risk from bacterial infection. A meta-analysis in 2021 (across many clinical indications) suggested an excess risk of infections with IV iron but noted most trials did not pre-specify infection as an end point, with risk of reporting bias. To answer this important question hospitalisation for infection or death due to infection were pre-specified safety endpoints in IRONMAN.MethodsIRONMAN was a prospective, randomised open-label, blinded endpoint (PROBE) event-driven trial of IV ferric derisomaltose (FDI) and usual care versus usual care alone in patients with heart failure (LVEF ≤45% ) and iron deficiency (ferritin <100 µg/L and/or TSAT <20%, provided ferritin ≤400 µg/L). Patients were enrolled if they had a current or recent hospitalisation for heart failure or elevated natriuretic peptide plasma concentration. Every four months, IV iron was administered if either ferritin was <100 µg/L or TSAT was <25% (provided ferritin ≤400 µg/L). All hospitalisations and deaths were adjudicated blindly. Given that a large part of the trial was conducted during the COVID-19 pandemic, we also evaluated COVID-19 related SAEs.Results1137 patients (26.4% women) with median (IQR) age 73 (63 to 79) years were recruited by the Ironman Study Group between Aug 2016 and Oct 2021 across 70 UK sites. Median (IQR) follow-up was 2·7 (1·8 to 3·6) years. 97% of patients consented to record linkage to national databases of deaths and hospital discharge summaries, thereby ensuring investigators were aware of all potential events. There were a similar number of hospitalisations due to infection for those assigned to ferric derisomaltose (175) and usual care (213) (p = 0.16) and infection related death (34 and 28, respectively, p = 0.43). When considering first events of hospitalisation for infection or infection death there were 120 (21.1%) events for those randomised to IV FDI and 146 (25.7%) for the usual care arm (figure). There were fewer patients with COVID related SAEs in those randomised to IV FDI (12) as compared with usual care (30), HR (95% CI) 0.40 (0.20, 0.78). p=0.007. For deaths attributed to COVID-19, 4 were seen in the IV FDI arm and 8 in the usual care arm: HR 0.51 (0.15, 1.68) p=0.27.ConclusionsThere was no excess risk of infection related hospitalisation or death in patients receiving IV ferric derisomaltose. Fewer COVID-19 related SAEs were seen in patients receiving IV FDI. Given that iron plays an important role in the T and B cell response to vaccination, further analysis needs to be done in this area.Conflict of InterestHonorarium for education from Pharmocosmos

The impact of covid-19 on amiodarone use in nottingham university hospitals dc cardioversion service, 1 year follow up

106 Table 13 MonthsRhythmAmiodarone (n=159)No Amiodarone (n=223)SR126141AF3382 106 Table 212 MonthsRhythmAmiodarone (n=113)No Amiodarone (n=125)SR5934AF5491Conflict of InterestNil

Exploring the relationship between physical activity and covid-19 infection in a young, non-hospitalized cohort in the united kingdom

201 Table 1Demographics of cohortVariableCategory/SummaryNegativePositiveOverallORP-value95%CI low95%CI high3043(79.7%)777(20.3%)3820AgeMean/SD21.19/6.7920.93/6.0721.12/6.640.9800.2580.9451.015Median (Q1-Q3)18(15, 27)19(16, 25)18(15, 27)Min-Max14-3614-3614-36BMIMean/SD23.34/4.8924.12/4.9023.48/4.831.068<.0011.0351.103Median (Q1-Q3)22.44(19.9, 25.9)23.39(20.5, 26.8)22.60(20.06, 26.03)Min-Max13.36-55.2514.40-45.9013.36-55.25SexWomen1107(36.3%)250(32.4%)1357 (35.5%)1Men1935 (63.5%)521(67.6%)2456 (64.3%)1.2020.0321.0161.421EthnicityWhite2789(91.65%)707(90.99%)3496(91.5%)Asian89(2.92%)23(2.96%)112 (2.93%)Black53(1.74%)11(1.42%)64 (1.68%)Other112(3.68%)36(4.63%)148 (3.87%)BAME vs. White1.0870.5550.8241.434Group Sedentary495(16.24%)112(14.53%)607 (15.89%)1typeRecreational1331(43.67%)302(39.17%)1633 (42.76%)0.7720.0030.6500.916Elite1222(40.09%)357(46.30%)1579 (41.35%)0.7620.0240.6020.965MET A (0 METs)440 (14.44%)105(13.62%)545(14.27%)1CategoryB (<500 MET-min/week)91(2.99%)12(1.56%)103 (2.70%)0.5540.0700.2921 049C (500-999 MET-min/week)128(4.20%)25(3.24%)153 (4.01%)0.8200.4170.5081.324D (1000-1499 MET-min/week)149(4.89%)37(4.80%)186 (4.87%)1.0780.7220.7121.633E (>1500MET-min/week)2240(73.49%)592(76.78%)2832 (74.16%)1.1220.3300.8901.414 201 Table 2The effects of demographics, physical activity, and symptoms on disease durationORp-value95%CI low95%CI highMen vs. Women0.561<0.0010.4180.753MET categoriesCATEGORY B vs. A1.4360.5490.4414.679CATEGORY C vs. A0.8650.7430.3642.056CATEGORY D vs. A0.5440.0890.2691.098CATEGORY E vs. A0.5320.0020.3560.795Recreational vs. Elite athlete1.698<0.0011.2602.288Sedentary vs. Elite athlete2.255<0.0011.4913.411Sedentary vs. recreational1.3280.185.8732.019Shortness of breath (YES vs. NO)3.558<0.0012.6144.842Chest pain (YES vs. NO)2.341<0.0011.5093.630Chest tightness (YES vs. NO)2.733<0.0011.9143.902Palpitations (YES vs. NO)3.1370.0011.5616.305 201 Figure 1The effect of the available variables on the duration of the disease in COVID-19 positive participants[Figure omitted. See PDF]Conflict of InterestNone

Effect of covid-19 infection and preventive public health measures on haemodynamics, activity and quality of life in patients with pulmonary arterial hypertension

155 Figure 1 155 Figure 2Conflict of InterestNone

Anca negative egpa myocarditis/ heart failure

163 Figure 1 163 Figure 2Conflict of InterestNONE

Level of knowledge about prevention of arterial hypertension in patients without this disease

Introducción: La hipertensión arterial es un problema creciente en el Perú y una de las principales causas de morbilidad y mortalidad. Sin embargo, muchas personas no tienen concienciación sobre la prevención de esta enfermedad. El objetivo de este estudio es identificar el nivel de los conocimientos sobre la prevención de la hipertensión arterial en los pacientes que no tienen está enfermedad en una clínica de Lima Norte-Perú, 2021. Métodos: El estudio fue transversal descriptivo. La muestra estuvo conformada por 235 pacientes de ambos sexos que se atendieron en un consultorio externo. Se empleó un cuestionario para medir nivel de conocimientos, datos sociodemográficos y clínicos del paciente. Asimismo, el . Solo para medir glucosa, presión arterial media e índice de masa corporal se empleó la historia clínica actual del paciente. Resultados: Se evidencia que el nivel de conocimiento sobre la prevención de la HTA fue medio (46.81%). Con respecto a sus dimensiones, el nivel de conocimiento sobre las generalidades de la prevención fue medio (39.15%) y el nivel de conocimiento sobre los factores de riesgo de esta enfermedad fue bajo (42.55%). Por otro lado, la mayoría no recibió charla sobre la HTA (94.89%). El índice de masa corporal promedio fue de 27 (sobrepeso). Conclusiones: El nivel de conocimiento de los pacientes sobre la prevención de la hipertensión arterial es regular. Además, la mayoría tiene sobrepeso. Es necesario promover la concienciación sobre un estilo de vida saludable a los pacientes.Alternate :Introduction: Arterial hypertension is a growing problem in Peru and one of the main causes of morbidity and mortality. However, many people are not aware of the prevention of this disease. The objective of this study is to identify the level of knowledge about the prevention of arterial hypertension in patients who do not have this disease in a clinic in Lima Norte-Peru, 202'. Methods: The study was cross-sectional descriptive. The sample consisted of 235 patients of both sexes who attended an outpatient clinic. A questionnaire was used to measure the level of knowledge, sociodemographic and clinical data of the patient. Only the patient's current clinical history was used to measure glucose, mean arterial pressure and body mass index. Results: It is evident that the level of knowledge about the prevention of hypertension was medium (46.81%). Regarding its dimensions, the level of knowledge about the generalities of prevention was medium (39.15%) and the level of knowledge about the risk factors of this disease was low (42.55%). On the other hand, the majority did not receive any talk about hypertension (94.89%). The average body mass index was 27 (overweight). Conclusions: The level of knowledge of patients about the prevention of arterial hypertension is regular. Also, most of them are overweight. It is necessary to promote awareness of a healthy lifestyle to patients.

An updated cochrane systematic review and meta-analysis of exercise-based cardiac rehabilitation in adults with heart failure: a subgroup analysis of delivery mode

BackgroundParticipation in exercise-based cardiac rehabilitation (ExCR) is consistently a class I recommendation by national and international guidelines for the management of adults with heart failure (HF). However, global access and uptake of ExCR remains poor, a situation that has worsened with the COVID-19 pandemic. The availability of evidence-based alternative modes of ExCR delivery is urgently needed to improve future access.AimTo update the Cochrane review of ExCR in adults with HF and to examine how the impact of ExCR on mortality, hospitalisation, and health-related health quality of life (HRQoL) may vary across modes of ExCR delivery.MethodsLiterature searches were run up to December 2021 with no language restriction. Meta-analyses were stratified according to three modes of ExCR delivery i.e. (1) centre-based programmes, (2), home-based programmes, and (3) hybrid (both centre and home) programmes.ResultsA total of 8,728 HF patients were included from 60 randomised controlled trials. At 12-months follow up, compared with no-exercise control, ExCR reduced the risk of all-cause and HF hospitalisation (relative risk [RR]:0.60;95% Confidence Interval [CI] 0.56 to 0.86;RR: 0.80;CI: 0.60 to 1.06) and improved disease-specific HRQoL (Minnesota Living with HF questionnaire total score mean difference: -7.39;CI -10.30 to -4.47). ExCR had no impact on the risk of mortality (RR:0.93;CI: 0.71 to 1.21). There was no significant difference in the impact of ExCR across outcomes when comparing trials undertaken in a centre, home, or hybrid setting.ConclusionThis latest Cochrane systematic review and meta-analysis update of controlled trials confirms the benefits of ExCR in terms of improved patient HRQoL and reduced risk of hospitalisation. To drive future improvements in access to rehabilitation for HF, our results support the need for health services to provide evidence-based home and hybrid models of ExCR alongside the more traditional centre-based programmes.

Relationship Between Vaccines Against Coronavirus Disease 2019 (Covid-19) and Myocarditis

Due to 2019 coronavirus disease (COVID-19) pandemic, it was necessary to develop a vaccine able to reduce the severity of the disease, decreasing hospitalization and death. The approval of the emergency use of these immunizers brought concerns about monitoring possible adverse effects, including myocarditis. This study aimed to analyse the incidence of myocarditis after immunization against COVID-19. A systematic review was conducted using the PRISMA method, searching the bibliographic databases PubMed, Cochrane and Scielo, April 2022, with the following descriptors: [covid-19 vaccine] AND [myocarditis] AND [adverse effect]. Inclusion criteria were articles published in the last 5 years approaching review, systematic review and meta-analysis type that addressed the association of immunization against COVID-19 with the development of myocarditis, in English. A total of 162 articles were found and 24 were eligible.Vaccines can induce an immune response including antibodies production against pathogens. On account of COVID-19, vaccines were developed with different technologies such as messenger RNA and, as their side effect, myocarditis has been observed, mostly in young adults and male teenagers, days after immunization and usually after the second dose. Studies suggest that a possible cause for the male incidence of post-vaccine myocarditis would be the difference in sexual hormones in the immune response. More research should be carried out to understand better the risk-benefit ratio of COVID-19 vaccines, even though there are already reports where the benefits and effectiveness of vaccines against COVID-19 have been shown outweighing the risk of myocarditis.

Coronary Embolism After Infection with Covid-19 in Non-Diabetic Non-Hypertensive Patient. A Case Report

A 72-year-old female patient presented to the emergency department with one week history of dry cough, sore throat, and dyspnea grade 3, and 9 hours history of retrosternal chest pain. The patient had normal pulse, temperature and blood pressure. She had bilateral decreased air entry, S1 and S2 heard normally and had no lower limb edema. The patient had free past medical and surgical history. Laboratory investigations and ECG were done. Laboratory investigations showed that the patient was infected with SARS-CoV-2, and also showed positive cardiac enzymes, low hemoglobin (10.4 g/dl), high WBCs (14.9) 10

Comorbidity Burden in Patients with Covid-19 Treated with Molnupiravir in the United States

Individuals with certain medical conditions, e.g., diabetes, heart, and/or lung disease, are at higher risk of severe COVID-19. Molnupiravir, an oral antiviral drug for treatment of mild-to-moderate COVID-19 in certain adults, was granted US FDA emergency use authorization. Retrospective analyses of US patient-level medical and pharmacy claims, and hospital chargemaster data, aggregated by HealthVerity, was conducted. Adults (≥18 years) were indexed to their first outpatient pharmacy fill for molnupiravir between Dec-24-2021 and May-02-2022. Comorbidities were identified using ICD-10 diagnosis, CPT, and/or HCPCS codes during pre-index period (back to Dec-01-2018) and comedications by generic name (from NDCs) ≤90 days before index. Demographic, comorbidity, and comedication characteristics were reported using descriptive statistics. The analyses included 26,191 patients: mean age 58.7 (SD 16.3) years, 59.0% female and 75.9% resided in the South. Presence of ≥1 comorbidity associated with severe COVID-19 was observed in 87.0%: hypertension (52.5%), overweight/obesity (37.4%), mood disorder (30.7%) and cardiovascular disease (18.9%). Diabetes mellitus was observed in 6,944 (26.5%) patients: mean age 62.5 (SD 14.3) years and 54.4% female. Polypharmacy (≥5 comedications) within the last 90 days was also prevalent in both the overall (49.7%) and patients with diabetes (66.1%). Concomitant use of comedications contraindicated with ritonavir-based COVID-19 treatment was noted in 33.7% of all patients and 45.8% of patients with diabetes. Majority of COVID-19 patients treated with molnupiravir in clinical practice were at high risk of severe COVID-19. Future research needs to assess impact of molnupiravir on clinical outcomes in real-world practice, including in patients with comorbid conditions.

Potential Cyp3a4-Mediated Drug-Drug Interactions with Ritonavir-Containing Medications in U.S. Patients with Diabetes or Cardiovascular Diseases: An Analysis of Nhanes Data

This cross-sectional study examined the 2015-2019 National Health and Nutrition Examination Surveys (NHANES), which has been used in previous COVID-19 research, to estimate the proportion of adults with diabetes and serious heart conditions (SHCs) at risk of potential drug-drug interactions (pDDIs) arising from concomitant use of ritonavir and medications used to treat their comorbid conditions. Medications metabolized through the CYP3A4 pathway were identified as having pDDI with ritonavir, and were categorized as contraindicated, major, moderate, or minor pDDI severity using data sources from University of Liverpool, Lexicomp® and the FDA. Age-stratified prevalence of pDDIs were estimated using U.S. population weights (Table 1). 6.3% and 11.0% of survey participants reported a diagnosis of SHC and diabetes, respectively. pDDIs of any severity were identified in 44.5% of all adults;with 28.4% at risk of major or contraindicated pDDIs. Major or contraindicated pDDIs were observed in 58.1% of adults 60+. Among individuals with diabetes and SHCs, respectively, pDDIs were identified in 83.5% and 90.9% of all adults and in 92.1% and 95.5% of adults 60+. Major or contraindicated pDDIs were identified in 69.5% and 80.2% of adults with diabetes and SHC, respectively;and in 81.4% and 86.0% of individuals with diabetes and SHC aged 60+. This study suggests that majority of U.S. adults with diabetes or SHC are at risk of a major or contraindicated pDDI if treated with ritonavir-containing therapies. Findings highlight the importance of pDDI assessments in determining appropriate COVID-19 therapies, especially for multimorbid and elderly patients.

Patient and clinician experiences of remote cardiac rehabilitation during the COVID-19 pandemic: a qualitative study

BackgroundThe covid-19 pandemic heavily impacted the delivery of phase three cardiac rehabilitation (CR) in the UK. Most face-to-face exercise programmes were forced to close, and centres shifted to home-based and remote delivery models. As a result, the use of technology for CR has increased.AimThe aim of this study was to explore patient and clinician experiences of remote exercise-based CR during the covid-19 pandemic.MethodsNine patients and six clinicians from a single General Hospital in South West England were recruited for semi-structured telephone or video interviews. Interviews included open-ended questions about the acceptability of home-based exercise guidance for CR and clinician support, and any difficulties faced. Interviews were audio recorded, transcribed verbatim and analysed thematically.ResultsPatients wanted more guidance and feedback around physical activity post cardiac event and felt anxious about exercising without having reassurance and supervision from a clinician. Some patients felt that the remote exercise programme was not suited to their needs and would value a more individualised approach, as well as the opportunity to interact with other patients. For these reasons, many patients stated that they would attend face-to-face exercise sessions if available. Clinicians favoured face-to-face sessions for observing patients and building rapport and reinforced that remote CR does not currently facilitate patient interaction. Clinicians also highlighted the need for objective methods of measuring patient compliance to remote CR but stated that remote delivery had increased access and uptake.ConclusionsThe shift to remote programmes as a result of the covid-19 pandemic has evoked mixed feelings among patients and clinicians. More guidance, support and options for physical activity and exercise-based CR are needed to ensure that remote approaches are acceptable to patients and clinicians. Technology-enabled interventions could be explored to bridge the gap between centre-based and remote CR and to support their adoption.

Factors affecting implementation of home-based cardiac rehabilitation programme for patients with heart failure in four NHS sites

BackgroundThere is a global underutilisation of cardiac rehabilitation in heart failure. Offering alternative modes of delivery, such as home-based programmes, can lead to an increase in uptake. However, adopting this new mode of delivery may be challenging for service providers who predominantly offer centre-based programmes.AimThe study aimed to evaluate the process of implementation in real-world clinical practice by using data generated at four NHS Beacon Sites from England and Northern Ireland which were setup to offer a novel home-based programme – the REACH-HF programme – to 200 patients.MethodsWe used in-depth semi-structured interviews and an online survey. Interviews were conducted with the Beacon Site staff – these were identified using opportunity and snowball sampling. The online survey was subsequently presented to NHS staff who took part in online REACH-HF training during the COVID-19 pandemic. Normalisation Process Theory was used as a framework to guide data collection and analysis.ResultsWe interviewed 17 healthcare professionals working at the Beacon Sites and 17 survey responses were received (20% response rate). We identified a large number of general barriers and enablers to implementation and a smaller number of site-specific factors. The identified barriers and enablers included a lack of resources, a lack of commissioning, having interest in heart failure and working closely with the heart failure team. Different implementation contexts (urban/rural) and factors outside the healthcare team/system (quality of the REACH-HF training, the COVID-19 pandemic) were observed to negatively or positively impact the implementation process.ConclusionThe identified factors were translated into practical solutions. Following consultation with the Beacon Sites we created the REACH-HF Service Delivery Guide, which is now published on the NICE Shared Learning website. The guide is a useful tool that can be used by cardiac rehabilitation services wishing to introduce the REACH-HF programme into routine NHS practice.

Screening for anxiety and depression in cardiac rehabilitation prior to and during COVID-19 – an observational study

10 Figure 1Flowchart of the study population[Figure omitted. See PDF]ConclusionWe found a substantial drop in screening for anxiety and depression in CR during the first year of the COVID-19 pandemic. Screening practice seems to be improving in the following year but is still far from pre-COVID-19.Please submit this entire document via email to education@bacpr.comThe document should be saved as the surname and initial of the lead author followed by the submission data in the following format:SURNAME INITIAL DAY MONTH YEARFor exampleSmith T 01 05 2022(Deadline: midday, Date: Monday 11th July, 2022)