Factors affecting patient and physician engagement in remote healthcare for heart failure: a systematic review (Preprint)

BACKGROUND Adult chronic heart failure mainly affects an elderly population with multiple co-morbidities that often require frequent medical visits to prevent poor health outcomes. However the heart failure disease process reduces their independence by reducing mobility, exercise tolerance and cognitive decline. Remote care technologies can bridge the gap in care for these patients by allowing them to be followed up within the comfort of their home and encourage their self-care. However, patients, carers and healthcare professionals need to engage with the technology for it to be useful. OBJECTIVE This systematic review explored qualitative primary studies of remote care technologies used in heart failure, to determine the factors that affect user engagement with the technology. This is explored from the perspective of patients, carers, and healthcare professionals. METHODS Relevant studies published between 1/1/1990 – 19/9/2020 were identified from EMBASE, Ovid MEDLINE, Pubmed, Cochrane library and Scopus. These studies were then synthesized using thematic analysis. Relevant user experiences with remote care were extracted using line-by-line coding. These codes were summarised into secondary codes and core concepts, which were further merged into overarching themes that encapsulate user experience with remote care. RESULTS The review included 47 studies, which led to the generation of 5 overarching themes which affect engagement: (a) ‘Convenience’ relates to time saved by the intervention; (b) ‘Clinical Care’ relates to perceived quality of care and health outcomes; (c) ‘Communication’ involves feedback and interaction between patients, staff and carers; (d) ‘Education’ concerns the tailored information provided; and (e) ‘Ease of Use’ relates to accessibility and technical barriers to engagement. Each theme was applied to each user base of patient, carer and healthcare professional in a different manner. CONCLUSIONS The 5 themes identified highlight aspects of remote care that facilitate engagement, and should be considered in both future design and trials evaluating these technologies.

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Barriers and facilitators to implementing clinical imaging guidelines by healthcare professionals using theoretical domains framework: a mixed-methods systematic review protocol

BJR|Open ◽

10.1259/bjro.20210004 ◽

2021 ◽

Vol 3 (1) ◽

pp. 20210004

Author(s):

Harriet Nalubega Kisembo ◽

Ritah Nassanga ◽

Faith Ameda Ameda ◽

Moses Ocan ◽

Alison A Kinengyere ◽

...

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Systematic Reviews ◽

Financial Incentives ◽

Healthcare Professionals ◽

Information Source ◽

Theoretical Domains Framework ◽

Barriers And Facilitators ◽

Cochrane Library ◽

Clinical Imaging

Objectives: To identify, categorize, and develop an aggregated synthesis of evidence using the theoretical domains framework (TDF) on barriers and facilitators that influence implementation of clinical imaging guidelines (CIGs) by healthcare professionals (HCPs) in diagnostic imaging Methods: The protocol will be guided by the Joanna Briggs Institute Reviewers’ Manual 2014. Methodology for JBI Mixed Methods Systematic Reviews and will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P). Information source will include databases (MEDLINE, EMBASE and The Cochrane Library), internet search (https://www.google.com/scholar), experts’ opinion, professional societies/organizations websites and government bodies strategies/recommendations, and reference lists of included studies. Articles of any study design published in English from 1990 to date, having investigated factors operating as barriers and/or facilitators to the implementation CIGs by HCPs will be eligible. Selecting, appraising, and extracting data from the included studies will be independently performed by at least two reviewers using validated tools and Rayyan – Systematic Review web application. Disagreements will be resolved by consensus and a third reviewer as a tie breaker. The aggregated studies will be synthesized using thematic analysis guided by TDF. Results: Identified barriers will be defined a priori and mapped into 7 TDF domains including knowledge, awareness, effectiveness, time, litigationand financial incentives Conclusion: The results will provide an insight into a theory-based approach to predict behavior-related determinants for implementing CIGs and develop strategies/interventions to target the elicited behaviors. Recommendations will be made if the level of evidence is sufficient Advances in knowledge: Resource-constrained settings that are in the process of adopting CIGs may opt for this strategy to predict in advance likely impediments to achieving the goal of CIG implementation and develop tailored interventions during the planning phase. Systematic review Registration: PROSPERO ID = CRD42020136372 (https://www.crd.york.ac.uk/PROSPERO).

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Risk Prediction Models for Patients With Acute Heart Failure: A Protocol for Systematic Review, Critical Appraisal, and Meta-Analysis

10.21203/rs.3.rs-948336/v1 ◽

2021 ◽

Author(s):

Xuecheng Zhang ◽

Kehua Zhou ◽

Jingjing Zhang ◽

Ying Chen ◽

Hengheng Dai ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Prediction Model ◽

Acute Heart Failure ◽

Risk Prediction ◽

Methodological Quality ◽

Critical Appraisal ◽

Prediction Models ◽

Cochrane Library ◽

Risk Prediction Models

Abstract Background Nearly a third of patients with acute heart failure (AHF) die or are readmitted within three months after discharge, accounting for the majority of costs associated with heart failure-related care. A considerable number of risk prediction models, which predict outcomes for mortality and readmission rates, have been developed and validated for patients with AHF. These models could help clinicians stratify patients by risk level and improve decision making, and provide specialist care and resources directed to high-risk patients. However, clinicians sometimes reluctant to utilize these models, possibly due to their poor reliability, the variety of models, and/or the complexity of statistical methodologies. Here, we describe a protocol to systematically review extant risk prediction models. We will describe characteristics, compare performance, and critically appraise the reporting transparency and methodological quality of risk prediction models for AHF patients. Method Embase, Pubmed, Web of Science, and the Cochrane Library will be searched from their inception onwards. A back word will be searched on derivation studies to find relevant external validation studies. Multivariable prognostic models used for AHF and mortality and/or readmission rate will be eligible for review. Two reviewers will conduct title and abstract screening, full-text review, and data extraction independently. Included models will be summarized qualitatively and quantitatively. We will also provide an overview of critical appraisal of the methodological quality and reporting transparency of included studies using the Prediction model Risk of Bias Assessment Tool(PROBAST tool) and the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis(TRIPOD statement). Discussion The result of the systematic review could help clinicians better understand and use the prediction models for AHF patients, as well as make standardized decisions about more precise, risk-adjusted management. Systematic review registration : PROSPERO registration number CRD42021256416.

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Humanistic burden and economic impact of heart failure – a systematic review of the literature

F1000Research ◽

10.12688/f1000research.19365.1 ◽

2019 ◽

Vol 8 ◽

pp. 859 ◽

Cited By ~ 1

Author(s):

Lucia Giles ◽

Caroline Freeman ◽

Polly Field ◽

Elisabeth Sörstadius ◽

Bernt Kartman

Keyword(s):

Heart Failure ◽

Systematic Review ◽

General Population ◽

Economic Impact ◽

Chronic Diseases ◽

Resource Use ◽

Kansas City ◽

Short Form ◽

Cochrane Library ◽

Humanistic Burden

Background: Heart failure (HF) is increasing in prevalence worldwide. This systematic review was conducted to inform understanding of its humanistic and economic burden. Methods: Electronic databases (Embase, MEDLINE®, and Cochrane Library) were searched in May 2017. Data were extracted from studies reporting health-related quality of life (HRQoL) in 200 patients or more (published 2007–2017), or costs and resource use in 100 patients or more (published 2012–2017). Relevant HRQoL studies were those that used the 12- or 36-item Short-Form Health Surveys, EuroQol Group 5-dimensions measure of health status, Minnesota Living with Heart Failure Questionnaire or Kansas City Cardiomyopathy Questionnaire. Results: In total, 124 studies were identified: 54 for HRQoL and 71 for costs and resource use (Europe: 25/15; North America: 24/50; rest of world/multinational: 5/6). Overall, individuals with HF reported worse HRQoL than the general population and patients with other chronic diseases. Some evidence identified supports a correlation between increasing disease severity and worse HRQoL. Patients with HF incurred higher costs and resource use than the general population and patients with other chronic conditions. Inpatient care and hospitalizations were identified as major cost drivers in HF. Conclusions: Our findings indicate that patients with HF experience worse HRQoL and incur higher costs than individuals without HF or patients with other chronic diseases. Early treatment of HF and careful disease management to slow progression and to limit the requirement for hospital admission are likely to reduce both the humanistic burden and economic impact of HF.

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Effect of dose administration aids on adherence to self-administered medications: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2019-030536 ◽

2019 ◽

Vol 9 (10) ◽

pp. e030536

Author(s):

Kanika Chaudhri ◽

Madeleine Kearney ◽

Richard O Day ◽

Anthony Rodgers ◽

Emily Atkins

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Meta Analysis ◽

Study Participant ◽

Risk Of Bias ◽

Cochrane Library ◽

Secondary Outcome ◽

Dose Administration ◽

Common Solution ◽

The Impact

IntroductionForgetting to take a medication is the most common reason for non-adherence to self-administered medication. Dose administration aids (DAAs) are a simple and common solution to improve unintentional non-adherence for oral tablets. DAAs can be in the form of compartmentalised pill boxes, automated medication dispensing devices, blister packs and sachets packets. This protocol aims to outline the methods that will be used in a systematic review of the current literature to assess the impact of DAAs on adherence to medications and health outcomes.Methods and analysisRandomised controlled trials will be identified through electronic searches in databases including EMBASE, MEDLINE, CINAHL and the Cochrane Library, from the beginning of each database until January 2020. Two reviewers will independently screen studies and extract data using the standardised forms. Data extracted will include general study information, characteristics of the study, participant characteristics, intervention characteristics and outcomes. Primary outcome is to assess the effects of DAAs on medication adherence. Secondary outcome is to evaluate the changes in health outcomes. The risk of bias will be ascertained by two reviewers in parallel using The Cochrane Risk of Bias Tool. A meta-analysis will be performed if data are homogenous.Ethics and disseminationEthics approval will not be required for this study. The results of the review described within this protocol will be disseminated through publication in a peer-reviewed journal and relevant conference presentations.PROSPERO registration numberCRD42018096087

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Emergency department ultrasound for the detection of B-lines in the early diagnosis of acute decompensated heart failure: a systematic review and meta-analysis

CJEM ◽

10.1017/cem.2018.27 ◽

2018 ◽

Vol 20 (3) ◽

pp. 343-352 ◽

Cited By ~ 11

Author(s):

Kyle McGivery ◽

Paul Atkinson ◽

David Lewis ◽

Luke Taylor ◽

Tim Harris ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Emergency Department ◽

Lung Ultrasound ◽

Acute Decompensated Heart Failure ◽

Meta Analysis ◽

Decompensated Heart Failure ◽

Diagnostic Methods ◽

Cochrane Library ◽

B Lines

AbstractObjectivesDyspnea is a common presenting problem that creates a diagnostic challenge for physicians in the emergency department (ED). While the differential diagnosis is broad, acute decompensated heart failure (ADHF) is a frequent cause that can be challenging to differentiate from other etiologies. Recent studies have suggested a potential diagnostic role for emergency lung ultrasound (US). The objective of this systematic review was to assess the accuracy of early bedside lung US in patients presenting to the ED with dyspnea.MethodsA systematic search of EMBASE, PubMed, and the Cochrane Library was performed in addition to a grey literature search. We selected prospective studies that reported on the sensitivity and specificity of B-lines from early lung ultrasound in dyspneic patients presenting to the ED. Selected studies underwent quality assessment using the Critical Appraisal and Skills Program (CASP) questionnaire.Data Extraction and SynthesisThe search yielded 3674 articles; seven studies met inclusion criteria and fulfilled CASP requirements for a total of 1861 patients. Summary statistics from the meta-analysis showed that as a diagnostic test for ADHF, bedside lung US had a pooled sensitivity of 82.5% (95% confidence interval [CI]=66.4% to 91.8%) and a pooled specificity of 83.6% (95% CI=72.4% to 90.8%).ConclusionsOur results suggest that in patients presenting to the ED with undifferentiated dyspnea, B-lines from early bedside lung US may be reliably used as an adjunct to current diagnostic methods. The incorporation of lung US may lead to more appropriate and timely diagnosis of patients with undifferentiated ADHF.

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Recovery rate and determinants of severe acute malnutrition children treatment in Ethiopia: a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-019-1249-4 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Kassahun Gebeyehu Yazew ◽

Chanyalew Worku Kassahun ◽

Amare Wondim Ewnetie ◽

Habtamu Kerebih Mekonen ◽

Endalamaw Salilew Abagez

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Congestive Heart Failure ◽

Health Care Providers ◽

Recovery Rate ◽

Severe Acute Malnutrition ◽

Meta Analysis ◽

Acute Malnutrition ◽

Cochrane Library ◽

Care Providers

Abstract Background Severe acute malnutrition affects more than 20 million children. Africa is pointed out as a region where the problem is highly prevalent. There were individual studies on the recovery rate and its determinants among children with severe acute malnutrition in Ethiopia. But, there is no national pooled estimate. Therefore, this systematic review and meta-analysis aimed to estimate the recovery rate and determinants among children with severe acute malnutrition admitted to the therapeutic feeding unit in Ethiopia. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed in this study. Studies were accessed through electronic web-based search from PubMed, Cochrane Library, Google Scholar, and EMBASE. The statistical analysis was conducted using STATA version-11 software. The pooled prevalence was estimated with 95% confidence intervals using a random-effects model. Result A total of 12 studies were included with 2658 participants in the analysis. The overall pooled estimated recovery rate among children with severe acute malnutrition admitted to the inpatient therapeutic feeding unit in Ethiopia was 72.02 % (CI, 64.83, 79.22%). In the subgroup analysis, the highest estimate (80.29%) was observed in studies conducted in Oromia regional state, while 68.63% was observed in studies Southern Nation Nationality of people region 68.63%. Children who had no congestive heart failure were 4.88 times (OR, 4.88; 95% CI, 2.246, 10.586) more likely to recover than their counterparts. Conclusion The recovery rate among severe acute malnourished children on the therapeutic feeding unit in Ethiopia lied within the international minimum sphere. Hence, health care providers shall strengthen the management of severe acute malnutrition and management other co-morbidities like congestive heart failure. Systematic review registration PROSPERO CRD42019119124

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Systematic Review of the Impact of Cancer Survivorship Care Plans on Health Outcomes and Health Care Delivery

Journal of Clinical Oncology ◽

10.1200/jco.2018.77.7482 ◽

2018 ◽

Vol 36 (20) ◽

pp. 2088-2100 ◽

Cited By ~ 65

Author(s):

Paul B. Jacobsen ◽

Antonio P. DeRosa ◽

Tara O. Henderson ◽

Deborah K. Mayer ◽

Chaya S. Moskowitz ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Health Outcomes ◽

Health Care Delivery ◽

Care Delivery ◽

Cochrane Library ◽

Survivorship Care Plan ◽

Satisfaction With Care ◽

Survivorship Care ◽

Care Plans

Purpose Numerous organizations recommend that patients with cancer receive a survivorship care plan (SCP) comprising a treatment summary and follow-up care plans. Among current barriers to implementation are providers’ concerns about the strength of evidence that SCPs improve outcomes. This systematic review evaluates whether delivery of SCPs has a positive impact on health outcomes and health care delivery for cancer survivors. Methods Randomized and nonrandomized studies evaluating patient-reported outcomes, health care use, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Data extracted by independent raters were summarized on the basis of qualitative synthesis. Results Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer types, SCP delivery timing and method, SCP recipients and content, SCP-related counseling, and outcomes assessed. Nonrandomized study findings yielded descriptive information on satisfaction with care and reactions to SCPs. Randomized study findings were generally negative for the most commonly assessed outcomes (ie, physical, functional, and psychological well-being); findings were positive in single studies for other outcomes, including amount of information received, satisfaction with care, and physician implementation of recommended care. Conclusion Existing research provides little evidence that SCPs improve health outcomes and health care delivery. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal outcomes. Findings are limited but more positive for proximal outcomes (eg, information received) and for care delivery, particularly when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. Recommendations for future research include focusing to a greater extent on evaluating ways to ensure SCP recommendations are subsequently acted on as part of ongoing care.

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Tools to help healthcare professionals recognize palliative care needs in patients with advanced heart failure: A systematic review

Palliative Medicine ◽

10.1177/0269216320963941 ◽

2020 ◽

pp. 026921632096394 ◽

Cited By ~ 1

Author(s):

Stephanie MC Ament ◽

Inge ME Couwenberg ◽

Josiane JJ Boyne ◽

Jos Kleijnen ◽

Henri EJH Stoffers ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Palliative Care ◽

Chronic Heart Failure ◽

Health Care Professionals ◽

Healthcare Professionals ◽

Care Process ◽

Care Needs ◽

Process Guidance ◽

Palliative Care Needs

Background: The delivery of palliative care interventions is not widely integrated in chronic heart failure care as the recognition of palliative care needs is perceived as difficult. Tools may facilitate healthcare professionals to identify patients with palliative care needs in advanced chronic heart failure. Aim: To identify tools to help healthcare professionals recognize palliative care needs in patients with advanced chronic heart failure. Design: This systematic review was registered in the PROSPERO database (CRD42019131896). Evidence of tools’ development, evaluation, feasibility, and implementation was sought and described. Data sources: Electronic searches to identify references of tools published until June 2019 were conducted in MEDLINE, CINAHL, and EMBASE. Hand-searching of references and citations was undertaken. Based on the identified tools, a second electronic search until September 2019 was performed to check whether all evidence about these tools in the context of chronic heart failure was included. Results: Nineteen studies described a total of seven tools. The tools varied in purpose, intended user and properties. The tools have been validated to a limited extent in the context of chronic heart failure and palliative care. Different health care professionals applied the tools in various settings at different moments of the care process. Guidance and instruction about how to apply the tool revealed to be relevant but may be not enough for uptake. Spiritual care needs were perceived as difficult to assess. Conclusion: Seven tools were identified which showed different and limited levels of validity in the context of palliative care and chronic heart failure.

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Clinician barriers and facilitators to heart failure advance care plans: a systematic literature review and qualitative evidence synthesis

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001747 ◽

2019 ◽

pp. bmjspcare-2018-001747 ◽

Cited By ~ 2

Author(s):

Markus Schichtel ◽

Bee Wee ◽

John I MacArtney ◽

Sarah Collins

Keyword(s):

Heart Failure ◽

Healthcare Professionals ◽

Evidence Synthesis ◽

Barriers And Facilitators ◽

Cochrane Library ◽

Emotional Impact ◽

Qualitative Evidence Synthesis ◽

Care Plans ◽

Advance Care ◽

Disease Specific

BackgroundClinicians hesitate to engage with advance care planning (ACP) in heart failure. We aimed to identify the disease-specific barriers and facilitators for clinicians to engage with ACP.MethodsWe searched Medline, Embase, CINAHL, PubMed, Scopus, the British Nursing Index, the Cochrane Library, the EPOC register, ERIC, PsycINFO, the Science Citation Index and the Grey Literature from inception to July 2018. We conducted the review according to Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two reviewers independently assessed original and empirical studies according to Critical Appraisal Skills Programme criteria. The SURE framework and thematic analysis were used to identify barriers and facilitators.ResultsOf 2308 articles screened, we reviewed the full text of 42 studies. Seventeen studies were included. The main barriers were lack of disease-specific knowledge about palliative care in heart failure, high emotional impact on clinicians when undertaking ACP and lack of multidisciplinary collaboration between healthcare professionals to reach consensus on when ACP is indicated. The main facilitators were being competent to provide holistic care when using ACP in heart failure, a patient taking the initiative of having an ACP conversation, and having the resources to deliver ACP at a time and place appropriate for the patient.ConclusionsTraining healthcare professionals in the delivery of ACP in heart failure might be as important as enabling patients to start an ACP conversation. This twofold approach may mitigate against the high emotional impact of ACP. Complex interventions are needed to support clinicians as well as patients to engage with ACP.

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Efficacy and Safety of PARACHUTE® Device: systematic review

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.09.853 ◽

2018 ◽

Vol 64 (9) ◽

pp. 853-860 ◽

Cited By ~ 1

Author(s):

Roberta da Silva Teixeira ◽

Bruna Medeiros Gonçalves de Veras ◽

Kátia Marie Simões e Senna ◽

Rosângela Caetano

Keyword(s):

Quality Of Life ◽

Myocardial Infarction ◽

Heart Failure ◽

Systematic Review ◽

Left Ventricular ◽

Cochrane Library ◽

Efficacy And Safety ◽

Frequent Event

SUMMARY INTRODUCTION Heart failure due to an acute myocardial infarction is a very frequent event, with a tendency to increase according to improvements in the treatment of acute conditions which have led to larger numbers of infarction survivors. OBJECTIVE The aim of this study is to synthesize the evidence, through a systematic review, on efficacy and safety of the device in patients with this basic condition. METHODS Studies published between January 2002 and October 2016 were analysed, having as reference databases Embase, Medline, Cochrane Library, Lilacs, Web of Science and Scopus. The selection of studies, data extraction and methodological quality assessment of studies were examined by two independent reviewers, with disagreements resolved by consensus. RESULTS Only prospective studies without control group were identified. Six studies were included, with averages of 34 participants and follow-up of 13 months. Clinical, functional, hemodynamic and quality of life outcomes were evaluated. The highest mortality rate was 8.4% with 12-month follow-up for unspecified cardiovascular reasons, and heart failure rehospitalization was 29.4% with 36-month follow-up. Statistically significant improvements were found only in some of the studies which evaluating changes in left ventricular volume indices, the distance measured by the six-minute walk test, New York Heart Association functional classification, and quality of life, in pre and post-procedure analysis. CONCLUSIONS The present review indicates that no available quality evidence can assert efficacy and safety of PARACHUTE® in the treatment of heart failure after apical or anterior wall myocardial infarction.

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