Effect of a Home-Based Mobile Health App Intervention on Physical Activity Levels in Patients With Heart Failure: A Randomized Controlled Trial.

BACKGROUND: The use of mobile health applications (apps) is an effective strategy in supporting patients' self-management of heart failure (HF) in home settings, but it remains unclear whether they can be used to reduce sedentary behaviors and increase overall physical activity levels. AIM: The aims of this study were to determine the effect of an 8-week home-based mobile health app intervention on physical activity levels and to assess its effects on symptom burden and health-related quality of life. METHOD: In this study, we collected repeated-measures data from 132 participants with HF (60.8 ± 10.47 years) randomized into a usual care group (n = 67) or an 8-week home-based mobile health app intervention group (n = 65). The intervention was tailored to decrease the time spent in sedentary behavior and to increase the time spent in physical activities performed at light or greater intensity levels. Physical activity levels were monitored for 2 weeks before the intervention and during the 8-week intervention using the Samsung mobile health app. Heart failure symptom burden and health-related quality of life were assessed at baseline, 2 weeks from baseline assessment, and immediately post intervention. RESULTS: At week 8, all participants in the intervention group demonstrated an increase in the average daily step counts above the preintervention counts (range of increase: 2351-7925 steps/d). Only 29 participants (45%) achieved an average daily step count of 10 000 or higher by week 6 and maintained their achievement to week 8 of the intervention. Repeated-measures analysis of variance showed a significant group-by-time interaction, indicating that the intervention group had a greater improvement in physical activity levels, symptom burden, and health-related quality of life than the usual care group. CONCLUSION: Home-based mobile health app-based interventions can increase physical activity levels and can play an important role in promoting better HF outcomes.

Sex Differences in the Association Between Inflammation and Event-Free Survival in Patients With Heart Failure.

BACKGROUND: Heart failure (HF) is associated with chronic inflammation, which is adversely associated with survival. Although sex-related differences in inflammation have been described in patients with HF, whether sex-related differences in inflammation are associated with event-free survival has not been examined. AIM: The aim of this study was to determine whether the association between inflammation as indicated by tumor necrosis factor-α and event-free survival differs between men and women with HF after controlling for demographic and clinical variables. METHOD: This was a secondary analysis of data from 301 male (age, 61.0 ± 11.4 years) and 137 female (age, 60.3 ± 12.1 years) patients with HF. Serum levels of soluble tumor necrosis factor receptor 1 were used to indicate inflammatory status. Patients were grouped according to median split of soluble tumor necrosis factor receptor 1 level and sex into male with low inflammation (≤1820 pg/mL) (n = 158) or high inflammation (>1820 pg/mL) (n = 143), and female with low inflammation (n = 63) or high inflammation (n = 74). Cox regression models were run separately for men and women to determine whether inflammation contributed to differences in event-free survival between sexes with HF. RESULTS: There were 84 male (27.9%) and 27 female (19.7%) patients who had an event. Event-free survival in women did not differ by the severity of inflammation in the Cox regression analysis. In contrast, men with high inflammation had 1.85 times higher risk for an event compared with men with low inflammation. CONCLUSION: These data provide evidence that inflammation contributed to differences in event-free survival in men but not women with HF. Clinicians should be aware that men who have higher inflammation may be at a greater risk of HF or cardiac-related events than others with HF.

High-fidelity simulation effects on CPR knowledge, skills, acquisition, and retention in nursing students.

BACKGROUND: There is a gap in the literature regarding learning outcomes linked to the use of high-fidelity simulators compared to that of traditional teaching methods. AIM: To examine the effect of using high-fidelity simulators on knowledge and skills acquisition and retention with university students. METHODS: A randomized two-arm trial using two different educational approaches on 90 nursing students assigned randomly to two groups was used at two points of time. FINDINGS: The results showed significant differences in favor of the participants in the high-fidelity simulator group on both the acquisition and retention of knowledge and skills over time. However, a significant loss of cardiopulmonary resuscitation knowledge and skills occurred at 3 months after training in both groups. CONCLUSIONS: The findings of this study may assist educators in integrating high-fidelity simulators in education and training. In addition, the findings may help nursing educators to arrange additional cardiopulmonary resuscitation training sessions in order to improve cardiac arrested patients' outcomes. LINKING EVIDENCE TO ACTION: High-fidelity simulation (HFS) provides students with interactive learning experiences in a safe controlled environment. HFS enables teachers to implement critical clinical scenarios, such as cardiac arrest, without risk to patients. Integrating the simulation training into nursing curricula will help to overcome the challenges that face many courses, specifically the shortage of clinical areas for training and the increase in numbers of nursing students.