What are the needs and experiences of caregivers of people with heart failure? A qualitative study.

BACKGROUND: The global burden of heart failure is estimated to be around 64 million people, with many needing care and support for daily living activities. These needs are usually filled by close relatives, often a spouse, and therefore someone of a similar age to the person for whom they care. OBJECTIVES: The aim of this study was to explore the needs and experiences of caregivers caring for a person with heart failure through a qualitative interview approach. METHODS: A qualitative study was conducted in a large region in South England. 17 caregivers were interviewed using a semi-structured approach and the data analysed using thematic analysis. RESULTS: Four themes were identified from the data: a) Taking on the role of caregiver with the sub-themes of: acceptance and life changes; b) Getting to grips with being a caregiver with sub-themes: carrying out the care and coping with the care; c) Impact on own health and wellbeing: sub-themes of physical health and mental and emotional health and finally: d) Need for information and Support with sub-themes: trying to get knowledge and making sense. CONCLUSIONS: This study has shown that heart failure caregiving can have a negative impact on caregivers' own health and wellbeing and involves complex care delivery for which they receive little support. Caregivers of people with heart failure report having significant information needs in order to understand the reasons for the care they provide yet feel marginalised by health care professionals.

Should I stay or should I go? An exploration of the decision-making behavior of acute cardiac patients during the COVID-19 pandemic.

BACKGROUND: During the SARS-COV-2 (COVID-19) pandemic efforts to reduce virus transmission resulted in non-emergency patients being deterred from seeking help. The number of patients presenting with acute cardiac conditions reduced, significantly OBJECTIVES: To explore the decision-making process, and influential factors in that process, of patients and their family during an acute cardiac event. METHODS: A qualitative research design was employed using purposive sampling of patients who experienced an acute cardiac event during the social containment mandates. Semi-structured interviews were conducted, with thematic analysis of interview transcripts. RESULTS: Twenty-five participants were recruited from three UK hospitals. Themes identified were reliance on informal support network, lack of awareness of cardiac symptoms leading to delayed help-seeking, and an indirect COVID-19 effect (e.g. avoiding treatment). CONCLUSIONS: These results highlight the need for informed public health messages, targeting patients and their support networks, that allow those in need of treatment to access care.

Recording of vital signs in a district general hospital emergency department.

AIM: To examine and explore factors that may influence the recording of vital signs in adult patients within the initial 15 min and again within 60 min of arrival in the "resuscitation" and "major" areas of the emergency department (ED). METHODS: A retrospective analysis of recording of vital signs was performed on 400 consecutive sets of notes from adult patients presenting to the "major" or "resuscitation" areas of a district general hospital ED. The effect of staffing levels, triage category and attendances on the recording of vital signs was examined using logistic regression. The main outcome measures were the proportion of patients with all vital signs recorded within 15 min of arrival, the proportion of patients with all vital signs repeated within 60 min of arrival and the outcomes of logistic regression analysis. RESULTS: Only 223/387 patients (58%) had all vital signs recorded within 15 min of arrival and only 29/387 (7%) had all vital signs repeated at 60 min. There was a significant relationship between the failure to record vital signs and lower triage categories. There was no evidence that staffing levels or number of attendances predicted the recording of vital signs within 15 min of arrival. CONCLUSION: Recording of vital signs was poor and unrelated to staffing levels or numbers of patients attending the ED. Failure to record patients' vital signs undermines strategies to detect and manage ill patients.

Do any preoperative variables affect extubation time after coronary artery bypass graft surgery?

OBJECTIVE: The purpose of this study was to determine whether any preoperative variable had a significant effect on extubation time after coronary artery bypass graft surgery. DESIGN: The study design was retrospective. SETTING: The study was conducted in a cardiac center in the United Kingdom where 1700 cardiac surgical operations are performed per year. SUBJECTS: The study sample was composed of 89 patients who had coronary artery bypass graft surgery performed by the designated consultant cardiac surgeon in the first 6 months of 1998. OUTCOME MEASURES: The measures included preoperative variables (age, gender, body mass index, cardiac status, pulmonary status) and extubation time. RESULTS: Mean extubation time was found to be 4.97 hours. Left ventricular function was found to be statistically significant (P =.05) to extubation time. CONCLUSIONS: We found that cardiac status had an effect on extubation time and that this warranted further investigation. No other preoperative variable had a significant effect on extubation time, raising questions concerning the need for strict preoperative exclusion criteria.

Does extubation result in haemodynamic instability in patients following coronary artery bypass grafts?

Coronary heart disease and its management continue to be at the centre of Government health policy. The present political climate demands clinical effectiveness and best practice should be established, while maintaining the philosophy of cost-effectiveness and resource management. These directives have led practitioners to question the care of patients following coronary artery bypass surgery, in particular the role of mechanical ventilation and the subsequent act of extubation. A retrospective study of 89 patients who had coronary artery bypass grafts (emergency and elective) was undertaken, to establish if extubation had a significant effect on the haemodynamic status of patients with variable degrees of left ventricular function (19% with poor left ventricular function). The study found that extubation was achieved within a mean time of 4.97 hours following return from surgery. Extubation resulted in a significant increase in heart rate (P = 0.001), as well as a respiratory acidosis (pCO2: P = 0.000; pH: P = 0.000). However, the stability of the patient was not compromised, with neither mean arterial blood pressure (P = 0.825) nor oxygenation levels (P = 0.267) being significantly altered by extubation. On multivariate analysis, the act of extubation had no significant effect on any of the dependent variables. These results suggest that it is not extubation alone that has an impact on the haemodynamic stability of patients following coronary artery bypass grafts, but that this is indeed multifactorial. Therefore extubation is 'safe' practice for patients with varying degrees of left ventricular function following coronary artery bypass grafts. Limitations of the study are acknowledged.

Regulation of fatty acid oxidation by acetyl-CoA generated from glucose utilization in isolated myocytes.

The regulation of fatty acid oxidation in isolated myocytes was examined by manipulating mitochondrial acetyl-CoA levels produced by carbohydrate and fatty acid oxidation. L-carnitine had no effect on the oxidation of [U-14C]glucose, but stimulated oxidation of [1-14C]palmitate in a concentration-dependent manner. L-carnitine (5 mM) increased palmitate oxidation by 37%. The phosphodiesterase inhibitor, enoximone (250 microM), also increased palmitate oxidation by 51%. Addition of L-carnitine to enoximone resulted in a two-fold increase of palmitate oxidation. Whereas, dichloroacetate (DCA, 1 mM), which stimulates PDH activity, decreased palmitate oxidation by 25%. Furthermore, the addition of DCA to myocytes preincubated with either L-carnitine or enoximone, had no effect on the carnitine-induced stimulation of palmitate, and reduced that of enoximone by 50%. Varied concentrations of DCA decreased the oxidation of palmitate and octanoate; but increased glucose oxidation in myocytes. The rate of efflux of acetylcarnitine was highest when pyruvate was present in the medium compared to efflux rates in presence of palmitate or palmitate plus glucose. Although the addition of L-carnitine plus enoximone resulted in a two-fold increase in palmitate oxidation, acetylcarnitine efflux was minimal under these conditions. Acetylcarnitine efflux was highest when pyruvate was present in the medium. These rates were dramatically decreased when myocytes were preincubated with enoximone, despite the stimulation of palmitate oxidation by this compound. These data suggest that: (1) fatty acid oxidation is influenced by acetyl-CoA produced from pyruvate metabolism; (2) L-carnitine may be specific for mitochondrial acetyl-CoA derived from pyruvate oxidation; and (3) it is probable that acetyl-CoA from beta-oxidation of fatty acids is directly channeled into the citric acid cycle.

Myocardial tolerance to mechanical actuation is affected by biomaterial characteristics.

Direct mechanical ventricular actuation (DMVA) uses a pressure regulated heart cup, fabricated from silicone rubber (SR) for mechanical massage of the heart. Because DMVA has demonstrated potential for long-term circulatory support, investigations are currently exploring the use of more durable materials for fabricating DMVA heart cups. This study assessed the acute effects of heart cups fabricated from SR versus polyurethane (PU) on the myocardium. Dogs (n - 18) received DMVA for 4 hr of ventricular fibrillation (VF) using either SR (n = 10) or PU (n = 8) cups. Microspheres were used to determine perfusion during sinus rhythm (control) and at 2 and 4 hr of support. After support, myocardial biopsies were assayed for high energy phosphate content. Results demonstrated that PU cups required relatively frequent adjustments in drive line parameters that were likely due to material softening during PU cup support. Both PU and SR cups achieved similar hemodynamics during 4 hr of support. Myocardial perfusion, however, demonstrated a marked hyperemia at 4 hr of PU versus SR cup support. Regional high energy phosphate content was significantly decreased in hearts supported by PU versus SR cups. These results suggest that the relatively compliant characteristics of SR materials are important for achieving effective DMVA support without injuring the myocardium.